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					Discharge Summary

Patient Name: Harold Prosser

Hospital No.: 11503

Admitted: 12/10/- - - -

Discharged: 12/16/- - - -

Consultations: Pulmonary and Thoracic Service

Procedures: Chest tube insertion x2, right thoracostomy.

Complications: Repeated pneumothoraces, air leak, subcutaneous emphysema,
bronchopleural fistula.

Admitting Diagnosis: Pneumothorax, right side.

SUMMARY HISTORY AND PHYSICAL: This is a 73-year-old white male patient with
a history of severe respiratory distress and COPD who presented to the emergency room
with acute shortness of breath. He had a long history of COPD and smoking, and he
continues to smoke in spite of his respiratory problems. He has been fairly noncompliant
with his care, showing subtherapeutic theophylline levels. He has been using home
oxygen and, after developing an acute onset of dyspnea, presented to the emergency
room and was found to have a collapsed lung on the right.

Physical exam on admission revealed blood pressure 128/80, pulse 120, respirations 20.
Temperature was normal. He appeared to be in moderate respiratory distress. Chest
revealed occasional wheezes with diminished breath sounds bilaterally. Heart sounds
were regular with tachycardia. Extremities revealed no edema. There was marked dryness
of the skin. Initial chest x-ray showed right pneumothorax.

HOSPITAL COURSE: The patient had two small chest tubes placed and was started on
IV corticosteroids and antibiotics empirically. Sputum culture showed evidence of
Pseudomonas and Streptococcus species. He had some initial electrolyte imbalance that
was readily corrected. His initial oxygen saturation was fairly low with low pH, and it
improved fairly dramatically once the

(Continued)
DISCHARGE SUMMARY
Patient Name: Harold Prosser
Hospital No.: 11503
Discharge Date: 12/16/- - - -
Page 2



chest tubes were inserted. He was initially started on IV Rocephin and later changed to
p.o. Cipro after culture reports were returned. He showed a gradual improvement with the
re-expansion of his lung and eventually had a decreased air leak. We attempted to clamp
the tubes one at a time, but he developed a sudden increase in dyspnea with resulting
partial collapse of the lung again with decrease in oxygen saturation. In spite of
reopening the tubes, the patient showed no dramatic improvement. An intraoperative
consultation was obtained with Dr. Graham, who reinserted a larger chest tube with
marked improvement of the patient’s symptoms again.

However, subsequent to that and during that time, he was developing increasing
subcutaneous emphysema, which has progressed over the last couple of days, becoming
acutely worse on the evening prior to transfer.

The patient was somewhat difficult to care for during this hospitalization due to the fact
that he continued to smoke and attempted to smoke while in his hospital bed with chest
tubes and oxygen in use. On the morning of his transfer he was noted to have a persistent
large air leak with increasing emphysema into the neck and face, causing some swelling
around the eyes.

At that point it was determined that it might be necessary for the patient to have further
aggressive treatment at Forrest General thoracic unit for closure of the apparent
bronchopleural fistula and relief of his morbid respiratory status.

Arrangements were coordinated through both Hillcrest and Forrest General admissions
departments for the patient to be transferred to the Forrest General thoracic unit under the
care of Dr. Graham for continued evaluation and treatment. The patient’s family was
advised of the seriousness of Mr. Chandler’s condition plus all the risks and benefits of
the planned aggressive treatment. They were in agreement with these plans and agreed to
the transfer to the thoracic unit.

DISCHARGE DIAGNOSES
   1. Spontaneous right pneumothorax.

   2. Subcutaneous emphysema.


(Continued)
DISCHARGE SUMMARY
Patient Name: Harold Prosser
Hospital No.: 11503
Discharge Date: 12/16/- - - -
Page 3



   3. Severe chronic obstructive pulmonary disease.


   4. Pneumonia (Pseudomonas aeruginosa and Streptococcus).


   5. Electrolyte imbalance.

CONDITION ON DISCHARGE: Critical but stable for ambulance transfer.

NOTE: Copy of the patient’s medical record to accompany him to Forrest General
thoracic unit.



_______________________
Lynne Andrew, MD

LA:xx
D:12/16/- - - -
T:12/16/- - - -
C: Robert Graham, MD

				
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posted:2/29/2012
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