Case for the AM: one level lami with the following:
76 yo female with multiple medical problems including paroxysmal afib, non-sustained VT (3 beat run on holter)-pt c/o palpitations at time of dysrhythmia, NIDDM, OA of entire body with recent MRI of spine showing L2-3 disc herniation. Pt c/o B leg numbness and weakness, R>L as well as pain throughout lower extemities.
Admitted 4 days ago s/p a fall at home, confused, CMP revealed Na+ of 120 mEq- holter X3 days showed progressive rate control (one 3 beat run of VT) off amiodarone, now on Toprol 100 mg/ day. With fluid restriction, today's Na at 126. Pt is lucid, cooperative, and excellent historian, ambulating for short distances with PT, no other subjective c/o. NSR at 90's with Toprol.
Cards consult not really helpful (d/c amio, repeat echo, control rate to avoid ischemia)- pt is s/p stent in 2004. No angina since.
Discussion with colleagues yielded different answers ranging from cancel to just go and everything inbetween. Any insight?
76 yo female with multiple medical problems including paroxysmal afib, non-sustained VT (3 beat run on holter)-pt c/o palpitations at time of dysrhythmia, NIDDM, OA of entire body with recent MRI of spine showing L2-3 disc herniation. Pt c/o B leg numbness and weakness, R>L as well as pain throughout lower extemities.
Admitted 4 days ago s/p a fall at home, confused, CMP revealed Na+ of 120 mEq- holter X3 days showed progressive rate control (one 3 beat run of VT) off amiodarone, now on Toprol 100 mg/ day. With fluid restriction, today's Na at 126. Pt is lucid, cooperative, and excellent historian, ambulating for short distances with PT, no other subjective c/o. NSR at 90's with Toprol.
Cards consult not really helpful (d/c amio, repeat echo, control rate to avoid ischemia)- pt is s/p stent in 2004. No angina since.
Discussion with colleagues yielded different answers ranging from cancel to just go and everything inbetween. Any insight?