71-year-old female with a past medical history significant for HTN, pulmonary sarcoidosis, multiple back surgeries and loss of bladder function requiring self-catheterization presented to ED complaining of palpitations and associated urinary frequency.
Day of presentation:
2350: ED Physician Evaluation. Initial BP 205/98.
0524: Observation order placed
0533: H&P assessment: Frequent urination. Poorly controlled BP. Elevated troponin. Plan Foley catheter, empiric ceftriaxone, usual BP meds with prn hydralazine, trend troponin, ECHO, cardiology consult.
1039: Hospitalist note: History prior troponin elevations, attributed to sarcoidosis. Trend, no evidence STEMI. Elevated BP treated IV labetalol.
1724: ECHO-Normal systolic function
2212: Troponin 0.135 (H)
0049: IV hydralazine 10 mg for BP 164/74
1201: Hospitalist note: Cardiology consult for elevated troponin. Continue ceftriaxone. BP stable.
1502: Cardiology consult-No EKG changes, symptoms of ischemia. Stress test negative 6 months previously. Medical management.
0138: IV hydralazine 10 mg for BP 165/76
0747: Discharge order placed
1224: Inpatient order placed (no authentication needed)
1357: Discharge to home