Patient Charts

[dwindsweptwayne]

This section is for patient records, for ongoing roleplay where individuals are being cared for, treated, or have medical issues to be resolved in AoTD. Any practitioner can use this section... please go ahead and label with either the practitioner or practice name, to help readers know who the treating practitioner was!

[dwindsweptwayne]

7/4

Rebekkah Johnson performed a prenatal ultrasound on Darlene.

Last Period (LMP): 2/18
Estimated Due Date (EDD): 11/24
Current gestational age (CGA): 19+ weeks
Mother's Weight: 138 lbs

Fundal Height (FH): 25cm

Ultrasound Results: During the ultrasound, three distinct fetal heartbeats, amnionic sacs, and fetuses were located.

Return To Clinic (RTC): no later than 7/11
[Note: RTC date was missed. Rescheduling]

7/18

Prenatal checkup.

Urine - negative for sugar, albumin
BP - 118/76

FHT: 30cm

CGA: 21 weeks, 4 days

Mother's Weight: 139.2 lbs

RTC: 8/5

**********
8/3

Prenatal checkup.

Urine - negative for sugar, +1 albumin
BP - 126/76

FHT: 36cm

CGA: 23 weeks, 2 days

Mother's Weight: 142.0 lbs

Mom is not gaining properly. Restrictions on activity (no more than 1/2 day active work in gardens/fields; NO standing at the hot stove canning. Feet elevated for at least 3 hrs per day.)

Mom has been directed to have smoothies, pureed foods, whatever it takes to make sure that she's getting a MINIMUM of 3600 calories per day, with 65% of those calories coming from fat (50% saturated or better), 30% from protein, and the remainder from complex carbohydrates.

8/20

[[Fundal height, 38.2"; vitals WNL; urine neg for sugar, trace of protein; FHT #1: 152 bpm, FHT#2: 148 bpm; FHT#3: 156 BPM]] ((FHT=Fetal Heart Tones))

10/13

Darlene was placed on complete bed rest, with contractions. L/S ratio is insufficient for successful survival of the infants, but will be repeated weekly until delivery.

Contractions are being managed using herbal concoction from Luc.

10/27

L/S shake test still showing low levels of surfactants. Heavy weather and dropping barometric pressure are aggravating contractions, however.

Tobey approached Rocky about adding terbutaline, but Darlene refused due to "black box" warnings indicating that terbutaline has severe risk to mother and baby.

Contractions are increasing, and daily L/S testing will be done to determine the status of lung surfactants.

10/28
L/S shake test improved. Viability is possible.

10/29

L/S shake test fair. Decent chance of viability, as long as all 3 babies have equivalent L/S ratios

10/30

L/S shake test good. High chance of viability. Continuing with herbal management, hoping birth holds off until the rest of this storm passes, but the extremely low pressure, combined with the tidal pressure from the full moon seems to be significantly aggravating contractions.

The birthing suite is prepped. It is likely that pre-term labor will progress into full labor, probably within 24 to 48 hrs.

[[NOTE from Writer: Weekend of nov 2,3,4 will be a Time-Warp of October 31st, encompassing the labor, birth, and immediate post-partum, as well as the Fete de Ghede -- particularly relevant as losses from the superstorm are tallied and burial rites for both humans and animals are taken up by Luc and, probably, Two Day]]

[dwindsweptwayne]

Multiple injuries
Sutures
Memory loss

Currently in Darlene's clinic. IV was placed when she was brought in. Darlene removed the IV on 7/4.

Released on 7/4

[dwindsweptwayne]

Sophie DuBois was seen in the clinic on 7/15, suffering from injuries acquired when the Watchtower in which she was an occupant collapsed secondary to an explosion from an incendiary device.

Sophie experienced a blow to the head, and inflammation of the aural canal and tympanic membrane. There is some substantial fluid collection behind the TM, resulting in reduced hearing.

When Sophie presented, she had about 70% hearing loss in both ears. She indicated this was a slight improvement over the 100% hearing loss at the time of the incident.

In addition, there was evidence of a mild concussion, and it was recommended that she stay quiet and rest, under supervision, for the next 12 hours, and maintain two to three days of quiet and rest after that.

In addition, there were multiple hematomas on body and extremeties. These should heal without incident, though icing was recommended for a shoulder and rib bruise that were grade 3 hematomas with substantial red surface mottling.

RTC: 7/19 and will release from observation at that time if there are no complications.

7/19
Sophie has fully recovered and is released.

7/28

Sophie was seen today with complications from sunburn and heat exhaustion. She was treated with fluids and rest.

7/29
Sophie has turned out to have developed the same set of symptoms as Luc. Fever, runny nose, sneezing, cough, and general malaise.

[dwindsweptwayne]

William Picket Smith
Age: 70
Gender: Male

Complaint: Patient was delivered to the clinic suffering from acute myocardial infarction with cardiac arrest. Patient collapsed at the annex, and fell from his horse. Patient was breathing at the time of initial collapse, but according to Tsuritsa and Milo, ceased breathing about 3 minutes away from the clinic.

When I arrived at ground level with the crash kit, Milo was performing solo CPR. I joined in, taking over compressions while Milo handled the Ambu bag with supplemental oxygen. After 15 compressions, compressions were halted while I attempted to find a pulse. No pulse was discernable at groin, carotid, or wrist, and patient was non-responsive and had no spontaneous respiration.

CPR was continued and the portable defibrillator was prepared. Patient was defibrillated at 18:57 hrs, with no conversion. CPR was recommenced. An IV was started with Ringer's Lactate. 1 ampule of Sodium Bicarbonate was given, along with 1 ampule of lidocaine cardiac infusion.

Compressions were stopped to check for pulse, with no response at any pulse-point and no spontaneous respiration. Defibrillator was re-charged to 400 j, and 2nd defibrillation was attempted with no conversion. CPR was resumed.

Milo was replaced on AMBU by security personnel, and took over compressions. 3rd attempt at defibrillation at 450j was met with no conversion.

1 ampule sodium bicarbonate and 1 ampule lidocaine were infused. Epinepherine was injected via cardiac needle. A 4th defibrillation was attempted, which resulted in conversion and palpable pulse.

Patient was transported to clinic level, and was started on intravenous heparin[ 80 units/kg IV x1, then 18 units/kg/h IV]; lasix [50ml over 30 min] and cardizem [initially 0.25 mg/kg over 2 min then 10 mg/hr], along with oxygen by mask at 10 lpm. on 12 lead EKG, which showed elevated ST segment, with late T inversions.

Wils regained consciousness, and has been communicative, though weak. EKG is showing progressive late T inversions, indicating significant heart muscle damage. Intermittent tachycardia, alternating with bounding bradycardia indicates significant damage to the cardiac pacing centers.

Prognosis: We are unable to provide an implantable or external pacing device, and damage to the heart muscle is progressing. It is unlikely that Wils will recover from the damage of this cardiac injury, and I am encouraging family and friends to visit often and share memories and joys, since I expect that Wils will not be with us for more than a couple of days.

7/22 9:35pm

William Smith passed this evening, in the company of his wife, Two-Day, his adopted grand-daughter, Tsuritsa, and his adopted daughter, Rebecca.

His heart failed, and by his choice, no attempt at resuscitation was made. We all grieve his passing, and I include below his last words, to be part of his permanent record, for posterity:

“I love you wanbli cikala. From the day I met you, you had my heart.” He took a shallow rasping breath that escaped in a series of coughs that rattled deep within him. And he began to speak, his words true, but slower and slower as he continued

Oh, Great Spirit
Whose voice I hear in the winds,
And whose breath gives life to all the world,
hear me, I am small and weak,
I need your strength and wisdom.

Let me walk in beauty
and make my eyes ever behold the red and purple sunset.
Make my hands respect the things yours have made
and my ears sharp to hear your voice.
Make me wise so that I may understand
the things you have taught my people.
Let me learn the lessons you have
hidden in every leaf and rock.

I seek strength, not to be greater than my brother,
but to fight my greatest enemy - myself.
Make me always ready to come to you
with clean hands and straight eyes.
So when life fades, as the fading sunset,
my Spirit may come to you without shame. “

William Picket Smith, known to those who cherish him as Wils, walked from our world to the Spirit World on 7/22. May his journey be gentle and his road smooth, until we meet again.

[dwindsweptwayne]

7/15

Tsuritsa Drobarjnac was admitted to the clinic after a fall from a horse. Preliminary evaluation shows a fracture of the left proximal tibia, without fibular involvement and with minimal displacement. Additionally, there is a distal fracture of the tibia at the ankle, as well as a radial fracture of the talus, and hairline fracture of the calcaneus, and sprain of both the anterior talofibular ligament, posterior tibiotalar ligament, and tibeonavicular ligament, consistent with a jarring-and-twisting injury.

An IV with D5W was started, and pain management was initiated with intravenous demerol at 5mg. There was no displacement of the tibia, and it was determined that traction would not improve the sprain injuries to the ankle. A soft splint was applied, to prevent secondary damage to the ankle due to swelling against a hard cast, and elevated support in the form of a sling was used to provide immobility and support of the injured leg. Once swelling has subsided, a hard cast will be applied.

Prognosis: I anticipate full recovery in approximately 8 weeks. There may be some residual discomfort and an increased risk of arthritis in the ankle due to the inability to confirm that no bone chips or tendon disconnections occurred, and that there was no displacement of ankle bones due to fracture. However, this should not affect quality of life.

In addition to the leg fracture, Tsuritsa suffered a blow to the head, resulting in a moderate concussion, and a 3" longitudinal laceration of the forehead and scalp. 20 3.0 chromic gut sutures were placed to close the wound. Because it was a head injury, and there were multiple abrasions and a couple of burns as well, oral penicillin at 250 mg T.I.D was prescribed.

Pain management is being handled via IV until Tsuritsa has a hard cast, at which point, she can be released from the hospital as long as there is someone who can help take care of her while she recovers.

Prognosis: I anticipate no problems with recovery. Sutures will be removed after 7 days. Concussion is treated with rest, and Tsuritsa should be fine to go home in 3-4 days.

7/21

Sutures were removed. Tissue is healing cleanly, and it looks like there will be minimal scarring.

7/28

Tsuritsa is healing well, and has been graduated to a walking cast with crutches.

[dwindsweptwayne]

Intake Visit - Josie Edwards.

LMP: ~April 7
EDD: ~ January 12

Josie is approximately 18 weeks pregnant. She is starting to 'show', but doesn't remember her exact LMP. She's estimating first week of March, which appears consistent with her appearance. I'll be able to get a better picture of things once I do a full prenatal exam, which will need to wait for our next visit. I sent her home with history forms to complete, and scheduled her an appointment in a week to do the pregnancy physical exam, prenatal, and labs.

11/21

Josie came into clinic today, bleeding and having contractions. Initial examination with ultrasound revealed a 10% central abruption of the placenta. Since she was already contracting, we were anticipating her going through labor and trying to deliver as peacefully as possible -- however, before we could implement treatment, the placenta separated to 70% separation and she began to hemorrhage. Lilly was in the clinic at the time, and an emergency c-section was done under local anesthesia, though Josie had fainted from blood loss before the surgery was started.

Both mother and baby survived the surgery.

Baby is a girl, 3 lbs 12 oz, and 15 inches long. Mother has not named the baby yet.

Baby may not survive the next few days, but if she does, she has a pretty good chance.

11/22

Baby did not survive RDS from prematurity.

11/23

Josie has developed a fever. Treating with 1 g/24 hrs Gentamycin and Clindamycin.

11/24

Temperature is still rising, 24 hrs after initiating antibiotic treatment. Current temp is 104.1. Indications of endometritis. Recommendation is for hysterectomy and change of antibiotic to vancomycin for 4 days.

11/25

Lilly performed a full hysterectomy without oophrectomy (in order to prevent premature menopause) to deal with massive uterine infection. Infective material cultured in clinic to reveal polybacterial infection (Gardnerella vaginalis, Peptococcus spp., Bacteroides spp., Staphylococcus epidermidis, group B Streptococcus, and Ureaplasma urealyticum). This is to be expected under the conditions which the c-section was done. Risk of infection was increased due to rupture of membranes prior to cesarean.

All infection control protocols were adequately met according to conditions, and post-hysterectomy treatment with cefoxitin, once cultures were available, completed course of treatment.

Josie will not go through surgical menopause, as ovaries are intact, however, she will be unable to bear children with the loss of both uterus and cervix. Counseling will be provided to assist her as best as possible in dealing with this loss.

[•Joy Naomi•]

7/19

Tsuritsa is ready to be released from care. Patient has been preped on what she can and can't do while wearing a cast. Patients vital signs were within the normal limit before release and she was shown how to use crutches. Instructed Tsuritsa to come back to be re-cheched to see how healing process is going.

[•Joy Naomi•]

Chart for Alesandra 7/20
Patient woke up from a coma. All vitals were stable. Patient is unable to form whole sentences but that can be expected after being out of it for so long. Will help patient work her muscles so they will be able to work again, for now they are stiff and unable to work. Started doing massage therapy and range of motion exercises on patient. Massage therapy and range of motion exercises will be done atleast twice a day for a few weeks and patient was instructed to let someone know when she felt comfortable enough to try to walk again

[dwindsweptwayne]

Great job, Josie! Good catch on the post-coma care!

[dwindsweptwayne]

7/27

Lucius is quarantined in the living area of the house/clinic.

Lucius presented with the following symptoms:

Fever (100-102)
Sore throat
Sneezing
Runny nose
Dry cough during day 1 of symptoms

Symptoms appeared 5-7 days after exposure during a trip to USAMRIID, where Lucius was exposed to unknown pathogens during an exploratory/information-liberating trip.

We don't yet know the contagious period for this, but we do know that Lucius has been in contact with a significant portion of the farming and food - prep group, as well as almost all the population of New Haven under 20 years of age.

For the moment, unless we discover that there are other individuals who exhibited symptoms prior to yesterday, we are considering Luc to be "Patient Zero", and will be observing the progress of this illness accordingly.

[dwindsweptwayne]

7/29

Anthony came to the clinic after a 'call' for those who were on the Maryland salvage mission. He arrived at the clinic sporting a snazzy 101 degree fever, chills, body aches, stuffy head, sneezing, runny nose, and a cough.

He has been added to the quarantine pool.

8/11

Anthony was treated for multiple contusions after participating in the search and eventual termination of Lawrence Keen et. al.

Anthony is suffering from serious bruising to ribs (both front and back), hips, shoulders, and damage to one shoulder from apparent recoil injury -- probably due to forced positioning during self-preservation-level fight.

In addition, Anthony was sent home with a 12 hour supply of chemical cold packs to deal with a moderate fabric-abrasion injury to the penis and scrotum. This was a direct result of violent yanking of the fabric over this sensitive tissue for a prolonged period of time, combined with the rubbing caused by running in that condition. Theer will be some swelling and mild to moderate pain for about 72 hrs, after which, there should be steady improvement.

[dwindsweptwayne]

7/28

Bobbie was seen in the clinic today with chest pains.

An examination and EKG were run, both resting and exercise-oriented.
Bobbie had several instances of chest pain during the EKG session.

Heart rate and signal was normal, and recovery from exercise was WNL. My recommendation is that Bobbie is suffering from angina, aggravated by the stress of panic attacks. I gave her nitroglycerine, 0.3 mg PRN for pain.

[dwindsweptwayne]

7/29

Kay arrived at the clinic today showing symptoms very much like those exhibited by Sophie and Luc:

Fever
Cough
Runny nose
Sneezing
General malaise

Because of the similarities and the timing, I have initiated quarantine protocol for all those individuals who were on the Maryland salvage project.

[Sophie]

Chart for Philip Mason 8/7

Phillip was carried into the clinic in serious condition post explosion within the chopper enclosure. According to reports, he was unconscious, unresponsive and not breathing immediatly after being thrown backwards by the explosion. Rescue breathing was initiated and respiration were restored after a few minutes.

He's been examined and the EKG showed a possible minor infarct.

Phillip has been settled into a room with an IV and telemetry.