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IP Encounter Report

Admission Information - Hospital Account/Patient Record

Arrival Date/Time: None Admit Date/Time: 08/20/2013 6:00 AM IP Adm. Date/Time: 08/20/2013 6:00 AM Admission Type: Elective Point of Origin: Clinic Or Physician Office Admit Category: None Means of Arrival: Walk In Primary Service: Cardiology Secondary Service: None Transfer Source: None Service Area: The Children's Hospital

(Sa) Unit: Cpcu

Admit Provider: Mitchell, Max B. Attending Provider: Truong, Uyen T. Referring Provider: None

Discharge Information - Hospital Account/Patient Record Discharge Date/Time Discharge Disposition Discharge Destination Discharge Provider Unit 08/26/2013 12:34 PM Dc To Home Or Self Care

(Routine Disch) Home Truong, Uyen T. Cpcu

ED Arrival Information

ED Disposition

None

Hospital Problems Reviewed: 6/28/2012 7:39 AM by Kaufholz, Charlotte D.

None

Non-Hospital Problems Reviewed: 6/28/2012 7:39 AM by Kaufholz, Charlotte D.

Codes Priority Class Noted - Resolved Single Ventricle 745.3 Unknown - Present

Entered by Dumond, Alison M.

severe pulmonary stenosis 746.9 1/20/2010 - Present Entered by Dumond, Alison M.

DOLV (Double Outlet Left Ventricle) 745.19 2/17/2010 - Present Entered by Bartakian, Sergio

Bilateral SVC's 747.49 3/3/2010 - Present Entered by Ivy, D. Dunbar

MAPCA (major aortopulmonary collaterals) without PA-VSD 747.39, 747.29

3/9/2013 - Present

Entered by Villavicencio, Karrie L.

RESOLVED: Double Outlet Right Ventricle/Mitral Atresia/Pulmonary Stenosis/Left SVC

745.11 - 2/17/2010

Entered by Mackie, Sara M. Resolved by Bartakian, Sergio

RESOLVED: Chylothorax 457.8 4/13/2010 - 2/21/2012 Entered and resolved by Dumond, Alison M.

Discharge Summaries - All Notes

Cardiology Inpatient Discharge Summary

Patient Name: Admit: 8/20/2013 Discharge: 8/26/2013 Attending: Uyen Truong, MD Primary Cardiologist:Karrie Villavicencio, MD CT Surgeon: Dr. Max Mitchell PCP: Jeremy D. Parker, M.D.

Diagnoses: Principal/Final Diagnosis: Single ventricle (left) with tricuspid valve atresia, L-malposed great vessels,

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Filed: 8/27/2013 11:38 AM Note Time: 8/26/2013 10:00 AM Related Notes: Original Note by Tiernan, Kendra D. filed at 8/26/2013 2:41 PM

Discharge Summaries signed by Truong, Uyen T. at 8/27/2013 11:38 AM Author: Truong, Uyen T. Service: Cardiology Author Type: Physician

Patient not seen in ED

First: Jerry Middle: Last: Lee DOB: 4/8/10

Address: 538 Happy Malls Drive Paramus, NJ 07653

Phone: 201-834-1313 MS:

MRN: 00-08-56-65-00 G: Male R: Asian SSN#: 234-55-6600 Adm:8/20/2013, D/C:8/26/2013

Site: Wilkes-Barre Hospital

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Summaries - All Notes (continued)

severe pulmonary valve stenosis, bilateral SVC.

History of Present Illness: is a 3 year old male with complex cyanotic congenital heart disease consisting of a single ventricle, L-

malposition of the arteries, severe pulmonary valve stenosis, and bilateral SVC's. had an atrial septostomy during the first week of life. He under went a Bilateral Bi-directional Glenn procedure with atrial septectomy, and ligation of the main pulmonary artery on 3/2/10 by Dr. Max Mitchell. His postoperative course was complicated by Chylothorax necessitating 6 weeks of Enfaport formula.

underwent cardiac cath on 5/31/13 in anticipation of Fontan surgery. The cath demonstrated stable hemodynamics. Glenn pressure was 12 mmHg with 1 mmHg between L-SVC and PA, LVED 9 mmHg, no gradient across the bulboventricular foramen, and fully saturated pulmonary veins. Angiography revealed Mild L-SVC and R-SVC anasotomosis stenosis. He underwent balloon angioplasty using 10 mm balloon with angiographic improvement. No significant collaterals were noted. He tolerated the procedure well and was discharged to home the next day. He has since been doing well, he has had no cyanosis, tachypnea or labored breathing. He has a good appetite although he remains small for age. He has not had any apparent arrhythmia or syncope. He is very active with no signs of fatigue. He has not had any recent fevers or intercurrent illness.

Problem List:

Patient Active Problem List Diagnosis •Single Ventricle •severe pulmonary stenosis •DOLV (Double Outlet Left Ventricle) •Bilateral SVC's •MAPCA (major aortopulmonary collaterals) without PA-VSD

Evaluation & Management: CV: was taken to the OR and underwent completion Fontan performed by Max Mitchell. cardiopulmonary bypass time was 129 min, cross-clamp 0 min, and circulatory arrest time was 2 min. tolerated the procedure well and was transferred to the CICU on the following infusions; Dopamine 5 mcg/kg/min Milrinone 0.5 mcg/kg/min. Inotropes were weaned to off on POD#1 and he had no hemodynamic issues throughout his post-operative cours. was started on Lasix IV Q6 for pulmonary edema and pleural effusions. Diuretics were weaned to Lasix PO BID at time of discharge. No cardiac medications at time of discharge. Will hae follow up on Thursday August 29th with Cardiac surgery for follow up visit. Pulm: was intubated for surgery and extubated on POD#1. Diuretics were started for pulmonary edema and were able to be weaned to Lasix PO Q6 at time of transfer. Mediastinal drain was removed on POD#1 and bilateral pleural drains remained. Fluid analysis of the left pleural fluid revealed a triglyceride level of 243 and cell count analysis with 4% lymphocytes. was placed on Low fat diet with plan to continue low fat diet for 6 weeks. Final pleural tube removed on 8/25/13. CXR today 8/26/13 without evidence of reaccumulation of pleural fluid (see film below). Discharged home on 1/2 lpm oxygen. FENGI: was NPO for surgery and was able to eat on POD#1. With evolution of potential chylous ascites form the left pleural chest tube analysis, was converted to a low-fat diet. was on ranitidine for stress prophylaxis, which was eventually discontinued. will continue on low fat 10g/day diet. Eating well and stooling at time of discharge. Diuretics were weaned to Lasix 13mg po bid at time of discharge. HEME: was transfused in the OR with 161 ml of packed red blood cells and 100 ml of fresh frozen

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Summaries - All Notes (continued)

plasma. HCT on 8/21 was 45. Home on Aspirin 81 mg Po q day ID: received peri-op antibiotics with no further infection concerns. Neuro: received IV pain control post operatively. He was weaned to Po pain control with Ibuprofen and tylenol at time of discharge.

Discharge Physical Exam: Exam: BP 86/67 | Pulse 85 | Temp 36.2 (Tympanic) | Resp 23 | Ht 97 cm | Wt 12.4 kg | SpO2 89% Temp Avg: 36.5 °C (97.7 °F) Min: 35.7 °C (96.3 °F) Max: 37 °C (98.6 °F) Pulse Avg: 84.8 Min: 66 Max: 105 Rhythm: Normal sinus rhythm Resp Avg: 24.3 Min: 21 Max: 28 Cuff BP: Systolic (24hrs), Avg:90 mmHg, Min:83 mmHg, Max:103 mmHg Diastolic (24hrs), Avg:60 mmHg, Min:50 mmHg, Max:70 mmHg BP Mean Avg: 65.6 Min: 56 Max: 75 SpO2 Avg: 89.3 % Min: 88 % Max: 94 % Oxygen:O2 Flow Rate - LPM: 0.5 LITERS/MIN

Weight: Admit/Med Weight: Weight: 12.4 kg Daily Weight: Wt. (Current): 12.4 kg Gen: awake, alert, and interactive and no acute distress HEENT: Normocephalic and atraumatic, pupils equal, round, and reactive to light, extraocular movements intact, OP clear with moist mucous membranes Neck: there is full active range of motion Cardiovascular: Precordium: quiet, Rhythm: RRR, Sounds: negative for: rub, gallop, murmur or systolic click, Pulses: +2 bilaterally throughout Resp: breath sounds clear to auscultation bilaterally Abdomen: liver span is 2 cm and abdomen is soft and non tender Extremities: warm, well-perfused without cyanosis, clubbing or edema Skin: incision clean, dry, and intact pink, warm, well perfused, no rashes Neurological: grossly nonfocal

General Discharge Information: Operative Procedures: Date of Surgery: 8/20/2013 Title of Procedure: Completion Fontan (16 mm GoreTex extracardiac Fontan with 4.0 mm fenestration) Preoperative Diagnosis: Single Ventricle s/p Bilateral Bi-directional Glenn Shunts Postoperative Diagnosis: Same Surgeon(s): Max Mitchell Assistant(s): Fisher and Handfland Anesthesia: GETA Findings: L-TGA -t ype great vessel relationship, Small left SVC, MPA stump very adherent to the heart Estimated Blood Loss: N/A Fluid Replacement: N/A Drains: blt 16F Chest tubes, 15F Blake pericardial drain Specimens: none Complications: None known CBP: 129 min XCI: none Condition: To CICU in critical condition

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Summaries - All Notes (continued)

CXR:

Post-Op Echo: 8/26/13 Technically study secondary to uncooperative, agitated and active patient. Fontan with laminar flow and a mean gradient of 6.8 mmHg through the fenestration. Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right and left Glenn shunts. The proximal branch pulmonary arteries are well visualized with low velocity, phasic flow from their respective Glenns. Collaterals are not visualized secondary to patient agitation on this study. Wide open atrial communication Unobstructed bulboventricular foramen. Trivial atrioventricular valve regurgitation. Trace insufficiency through the native pulmonary valve. Stump of native MPA seen No aortic valve stenosis, trace aortic insufficiency. Unobstructed aortic arch. Subjectively normal right-sided, morphologic left ventricular systolic function. No appreciable pericardial effusion or pleural effusions.

MRSA: Negative Cultures: none Pending Studies: None Condition on Discharge: Good Discharge Disposition: Discharged to: Home

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Summaries - All Notes (continued)

Discharge Medications and Treatment:

Current Discharge Medication List

START taking these medications Details

furosemide (LASIX) 10 MG/ML Solution

13 mg (1.3 mL) by mouth twice a day for 31 days

CONTINUE these medications which have CHANGED Details

aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab

81 mg (1 tab) by mouth every day

Follow Up/Information Provided to Family:

Home Oxygen Diagnosis (required) SV s/p fontan For renewal, please contact: Other (See Comments) cardiologist Room air saturation (include date and result)

85%

PCP Name Dr. Villavicencio PCP Phone Number 720.777.6820 Oxygen Flow Rate at Discharge (Lpm)

1/2L

Oxygen Usage CONTINUOUSLY Estimated length of need (maximum 6 months)

6 months

Discharge Follow-up Appointment

Follow-up appointment(s)

CV surgery post operative appointment Thursday August 29th: 1:00 chest xray and 1:45 with Faith Fisher NP

Follow-up appointment(s) Please f/u with primary cardiologist in 3-4 weeks. Please call to schedule appointment.

Discharge Activity Sternal precautions Discharge activity AS TOLERATED

Discharge Diet Low FAT diet Discharge diet REGULAR FOR AGE

Discharge Instructions Please call for concerns with fever greater than 100.4, increased work of breathing, cyanosis,

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Summaries - All Notes (continued)

chest pain, palpitations, fainting, redness or drainage from incision, nausea/vomiting, or with other concerns. 720.777.6820

Clean incision with warm soap and water. Do not rub. No submersion. Pat dry.

Discharge instructions including: follow-up appointments, return precautions, activity restrictions, and safe use of medications were discussed with parents and grandmother.

I have spent >30 minutes in planning discharge of patient including final exam, follow-up, reason to call, and homecare.

Kendra D. Tiernan, CPNP-PC 8/26/2013

.I saw and evaluated the patient. I discussed the case with the CPNP, Kendra Tiernan, and agree with the findings and plan as documented. is doing well. Echo shows unobstructed Fontan circuit with good SV systolic function. His wound looks c/d/i and he has good activity and appetite. Will plan for discharge with follow-up with CVS.

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Electronically signed by Tiernan, Kendra D. at 8/26/2013 2:41 PM Electronically signed by Truong, Uyen T. at 8/27/2013 11:38 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

H&P - All Notes

CARDIOLOGY PRE-OP HISTORY & PHYSICAL

PCP: Jeremy D. Parker, M.D. Cardiologist: Karrie Villavicencio, MD Surgeon: Dr. Max Mitchell

Diagnosis: Malposed great vessels great vessels,

HPI is a 3 year old male

Review of Systems: Constitutional: Negative HEENT: Negative Eyes: Negative Respiratory: Positive for desaturation related to single ventricle physiology, home sats 80% Cardiovascular: See history of present illness. Gastrointestinal: Negative Genitourinary: Negative Reproductive/Endocrine: Negative Musculoskeletal: Negative Hematology/Lymphatic: Negative Immune/Allergy/Rheumatologic: Negative Skin: Negative Neuro: Negative

Birth/Medical/Surgical/Family History: I have reviewed, verified and personally updated the past medical, surgical, birth, family and social history.

PAST MEDICAL HISTORY: Past Medical History Diagnosis Date •single ventricle

L TGA, Pulmonary stenosis, Bilateral SVCs •Chylothorax

PAST SURGICAL HISTORY: Past Surgical History Procedure Laterality Date •Atrial septostomy,xvenous,balloon 9/25/09 •Circumcision 9/28/09 •Shunt svc to pa, both lungs 3/2/10

Glenn, bidirectional (bilateral), Atrial septectomy, division of MPA

MEDICATIONS: 40.5 mg daily ASA IMMUNIZATIONS: up to date

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8/19/2013 11:41 AM

H&P signed by Fisher, Faith A. at 8/20/2013 5:34 AM Author: Fisher, Faith A. Service: Cardiology Author Type: Nurse Practitioner Filed: 8/20/2013 5:34 AM Note Time:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

H&P - All Notes (continued)

ALLERGIES: Review of patient's allergies indicates no known allergies. Family History Problem Relation Age of Onset •Negative Family History

History

Social History Narrative Parents live in Cheyanne on a military base

DIET: regular diet DEVELOPMENTAL HISTORY: appropriate for age FAMILY HISTORY: No Sudden Cardiac Death, No Congenital Heart Disease PSYCH/SOCIAL HISTORY: Patient has 1 siblings. Patient is in pre school grade in school.

RESULTS: LABS: CBC w/ diff Recent Labs

08/19/13 0946

WBC 5.1 RBC 6.20* HGB 17.1* HCT 50.2* MCV 81.1 MCH 27.6 MCHC 34.0 RDW 13.1 PLTCT 269 MPV 7.8 SEGS 52.9 LYMPHS 29.2 MONOS 10.3* EOS 6.8 BASOS 0.8

BMP plus (Chem 10) Recent Labs

08/19/13 0946

NA 139 K 3.8 CL 103 BIC 24 BUN 13 CRE 0.37 GLU 62 CA 9.4

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

H&P - All Notes (continued)

CHEST X-RAY: comparison is made with the most recent previous CXR dated June 1 FINDINGS: Stable appearance of sternotomy wires mediastinal clips and embolization coils. Stable lung volumes with stable interstitial prominence. There is no evidence of consolidation or pleural effusion. No bony abnormalities identified.

ECG: 79 bpm, sinus bradycardia ECHOCARDIOGRAM: Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right and left Glenn shunts. The branch pulmonary arteries are well visualized with low velocity, phasic flow from their respective Glenns. Multiple small aortopulmonary collaterals; most prominent one arises from descending aorta entering region of left pulmonary artery. Wide open atrial communication Unobstructed bulboventricular foramen. Trivial atrioventricular valve regurgitation. Trace infufficiency through the native pulmonary valve. Stump of native MPA seen No aortic valve stenosis, trace aortic insufficiency. Unobstructed aortic arch. Subjectively normal right-sided, morphologic left ventricular systolic function.

PHYSICAL EXAM: Weight: Weight: 12.4 kg (0.75%) Height: 94.00cm (12.12%) OFC: (Normalized head circumference data available only for age 0 to 36 months.) BMI: Body mass index is 13.26 kg/(m^2). 0.37% BP 88/53 | Pulse 112 | Temp 97.5 (Tympanic) | Ht 97 cm | Wt 12.4 kg Pulse oximetry on room air is 82% GENERAL: alert, no acute distress, acyanotic, well developed, well nourished HEAD: normocephalic, atraumatic EYES: PERRL, EOMI EARS: TM's clear bilaterally NOSE: septum midline, pink mucosa, no discharge MOUTH/THROAT: moist mucosa, no oral lesions TEETH: normal NECK: supple, full range of motion, no JVD, no lymphadenopathy CHEST: Sternum: medial sternotomy, healed LUNGS: clear to auscultation bilaterally and normal work of breathing without intercostal retractions, or accessory muscle use CARDIOVASCULAR: Precordium: quiet, Rhythm: RRR, Sounds: 1/6 systolic murmur LSB, Pulses: +2 bilaterally throughout ABDOMEN: soft, non-tender, non-distended, no organomegaly or masses EXTREMITIES: warm and well-perfused, without edema, moves extremities well and cyanosis SKIN: no rashes NEUROLOGIC: grossly intact, strength normal

ASSESSMENT 3 year old male with history of malposed great vessels and single ventricle with bilateral SVCs. He under went stage 1 and 2 palliation and is here for Fontan completion. He is well appearing today with no evidence of acute CV or Respiratory compromise. He remains afebrile with no s/s of systemic or localized infection. He is active and well to proceed to surgeryl. POC report no concerns.

PLAN Scheduled for Fontan Completion on 8/20/2013 with Dr. Max Mitchell.

Faith A. Fisher, CPNP-AC Time Spent:

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

H&P - All Notes (continued)

Outpt: I spent 30 minutes of a total visit of 30 minutes in counseling/ direct management/discussion/coordination of care. Please review the impression/plan/recommendations in my clinic note regarding what was discussed during this visit.

Cardiothoracic Surgery History and Physical Update

Date of Service: 8/20/2013 Cardiologist: Villavicencio PCP: Jeremy D. Parker, M.D.

H&P Review Statement: I have reviewed the previously documented H&P completed on 8/19/20132, assessed the patient, and confirmed the information and findings previously documented as current.

Assessment/Plan: is a 3 year old male with single ventricle who will undergo completion Fontan. The risks,

benefits, and alternatives for the procedure have been described to the parents/patient and have agreed to proceed and consent signed.

Max B. Mitchell, M.D.

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Author Type: Physician Filed: 8/20/2013 6:43 AM Note Time: 8/20/2013 6:42 AM

Electronically signed by Fisher, Faith A. at 8/20/2013 5:34 AM

Electronically signed by Mitchell, Max B. at 8/20/2013 6:43 AM

H&P signed by Mitchell, Max B. at 8/20/2013 6:43 AM Author: Mitchell, Max B. Service: Surgery-Cardio/Thoracic

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Consults - All Notes

Occupational Therapy and Speech Pathology Note:

Feeding and swallowing consult received. Chart reviewed and met with family. No identified concerns for dysphagia or progression of oral feeds at this time. No therapies are recommended at this time. Please re- consult if concerns or change in medical status occurs. Thank you.

Kaitlyn R. Goure, M.A. CCC-SLP Speech Language Pathologist Children's Hospital Colorado Desk: 720-777-6075 Monday-Friday

Jen Rodgers, OTR Occupational Therapist Childrens Hospital Colorado Aurora, CO 720-777-7442 PCD: 73851 Weds-Fri

8/21/2013

has been up and walking with parents and nursing by report. No Physical Therapy needs at this time. Please reconsult if needs arise.

Char S. Jacobs PT Physical Therapy Department Children's Hospital Colorado Voicemail (720) 777-7428 PCD X78505

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Electronically signed by Rodgers, Jennifer F. at 8/21/2013 2:13 PM

Rodgers, Jennifer F. Service: (none) Author Type: Occupational Therapist

Consults signed by Jacobs, Charle' S. at 8/21/2013 9:41 PM Author: Jacobs, Charle' S. Service: (none) Author Type: Physical Therapist Filed: 8/21/2013 9:41 PM Note Time: 8/21/2013 9:40 PM

Filed: 8/21/2013 2:13 PM Note Time:

Electronically signed by Jacobs, Charle' S. at 8/21/2013 9:41 PM

8/21/2013 2:12 PM

Consults signed by Rodgers, Jennifer F. at 8/21/2013 2:13 PM Author:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Procedures - All Notes

PROCEDURE NOTE

Title of Procedure: PICC Line Placement

Date Performed: 8/23/2013

Performed by: Wayne J. Blalock Assistants: Jason Justice RT (R) Supervised by: None

Indications: Difficult venous access, Extended period of IV therapy, Frequent blood sampling and Hyperosmolar drug, TPN, PPN, irritating drug, chemotherapy Consent: Written consent obtained from caregiver after procedure discussed

Procedure Technique: A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The left arm was prepped and draped in a sterile fashion. Using ultrasound for visualization, the brachial vein was identified and accessed with a 22G BD Insyte Autoguard needle x1 attempt(s). A single static image was captured and saved. A guidewire was placed into the vein and advanced 10 cm. Using the Modified Seldinger Technique, the catheter was advanced to the desired distance. The catheter was flushed with normal saline and attached to the skin with Tegaderm IV Advanced and Cavilon. A single image of the chest was obtained to document PICC position. Patient tolerated the procedure well with general anesthesia in Cardiac Pre/Post.

Size: 3 French Single Lumen

Catheter Type: BioFlo

Catheter Length: 14 cm

Tip Position: SVC

Complications: None

Follow up: Report given to Cardiology Service. Wayne Blalock MS, RN, VA-BC Interventional Radiology - PICC Service 720-777-9772

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Procedure Orders: 1. IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD [39610304] ordered by Blalock, Wayne J. at 08/23/13 1012

Author: Blalock, Wayne J. Service: Interventional Radiology Author Type:

Procedures 1. IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD [X10164]

Registered Nurse Filed: 8/23/2013 10:12 AM

Electronically signed by Blalock, Wayne J. at 8/23/2013 10:12 AM

Note Time: 8/23/2013 10:10 AM

Procedures signed by Blalock, Wayne J. at 8/23/2013 10:12 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes

CICU POST OP NOTE

Patient Name: MRN: DOB: Attending: Jon Kaufman, MD Primary Cardiologist: Karrie Villavicencio, MD

Date of Surgery: 8/20/2013 Title of Procedure: Completion Fontan (16 mm GoreTex extracardiac Fontan with 4.0 mm fenestration)

Diagnosis: Single left ventricle, malposed great arteries, TV atresia, B/L SVC Surgeon(s): Max Mitchell Procedure Details: Findings: L-TGA -type great vessel relationship, Small left SVC, MPA stump very adherent to the heart Bypass time: 129 min Cross clamp time: 0 min Circulatory arrest time: 2 min Infusions: Dopamine 5 mcg/kg/min Milrinone (mcg/kg/min): 0.5 Precedex 0.7 mcg/kg/hr Foreign bodies: Chest tube Mediastinal x1, Pleural Bilateral, ET Tube, Foley, NG Tube, Pacing Wires, PIV Central lines: Art line Lt Rad, CVP RIJ, RFV Estimated Blood Loss: N/A Fluid Replacement: PRBC, FFP, Cryo, PLTs

Temp Avg: 36.2 °C (97.2 °F) Min: 36 °C (96.8 °F) Max: 36.5 °C (97.7 °F) Pulse Avg: 96.7 Min: 91 Max: 104 Resp Avg: 16.3 Min: 0 Max: 47 Systolic (24hrs), Avg:85 mmHg, Min:85 mmHg, Max:85 mmHg

Diastolic (24hrs), Avg:42 mmHg, Min:42 mmHg, Max:42 mmHg CVP 14-18 SpO2 Avg: 88.7 % Min: 79 % Max: 100 % Resp/Oxygen: CONVENTIONAL VENT: Vent Mode: SIMV;Pressure Regulated Volume Control;Press Support Set Tidal Vol (ml): 110 ML Vent Rate: 20 Peak Pressure (measured): 19 CM/H2O PEEP/CPAP: 5 Pressure Support: 6

PE: General: No acute distress, Intubated, Sedated

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Physician Filed: 8/22/2013 12:59 PM Note Time: 8/20/2013 2:22 PM Related Notes: Original Note by Farina, Mark A. filed at 8/20/2013 5:39 PM

Progress Notes signed by Kaufman, Jonathan M. at 8/22/2013 12:59 PM Author: Kaufman, Jonathan M. Service: Cardiology Author Type:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

HEENT: Pupils 2 Neuro: Grossly non-focal CVS: Precordium: dynamic, Rhythm: RRR, Sounds: systolic ejection murmur grade 2/6 low pitched blowing murmur at the at LLSB, Pulses: radial 2+, femoral 2+ and pedal 2+ Resp: breath sounds clear to auscultation bilaterally GI: bowel sounds Absent, abdomen soft, nondistended, nontender, liver edge 1 cm below costal margin Ext: warm and cap refill 3 sec Skin: incision clean, dry, and intact and dressing in place over incision

Labs: CBC w/diff Recent Labs

08/20/13 1440

WBC 7.9 RBC 5.38* HGB 14.9* HCT 43.8* MCV 81.4 MCH 27.6 MCHC 33.9 RDW 13.3 PLTCT 128* MPV 7.0 SEGS 85.1* LYMPHS 6.6* MONOS 7.3 EOS 1.0 PLTEST DECREASED 50-130,000

BMP (Chem 10) Recent Labs

08/20/13 1440

NA 144* K 3.5 CL 109 BIC 21 BUN 12 CRE 0.33 GLU 117* CA 9.4 MG 2.6* PHOS 5.7

CARDS Recent Labs

08/20/13 1313

LACWB 1.86

COAGS: Recent Labs

08/20/13 1440

PT 17.2* INR 1.39 PTT 35

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued) FIB 208

ABG Recent Labs

08/20/13 1434

PHART 7.30* PCO2ART 45* PO2ART 74 HCO3ART 22 TCO2ART 23 BEART -5.0* O2SATART 94

Studies: CHEST X-RAY:

EKG: SR ECHO: TEE Post; CONCLUSIONS Fontan baffle is well seen with unobstructed flow. There is a fenestration with phasic forward flow (unable to calculate a mean gradient due to poor Doppler angle). Bilateral Glenn

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

anastomoses with unobstructed, phasic low velocity antegrade flow in right Glenn shunt. The left Glenn could not be optimally visualized. The branch pulmonary arteries are well visualized with low velocity, phasic flow. Unobstructed inferior vena cava. Multiple small aortopulmonary collaterals. Wide open atrial communication Trivial-to-mild atrioventricular valve regurgitation. Normal right-sided, morphologic left ventricular systolic function.

CATH: 5/31/2013; Hemodynamics: Glenn pressure 12 mmHg with 1 mmHg between L-SVC and PA. LVED 9 mmHg, no gradient across the bulboventricular foramen. Fully saturated pulmonary veins. Angiography: Mild L-SVC and R-SVC anastomosis stenosis, underwent balloon angioplasty using 10 mm balloon with angiographic improvement. No significant collaterals.

IMPRESSION: is a 3 year old male in critical condition s/p Fontan completion with a 16mm extracardiac, fenestrated conduit

PLAN: CV:

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

- continue inotropic support through extubation - moniotr HR and rhythm - no gradient between PAP and Fem line

Pulm: - wean to extubation - goal sats >80

FEN: - ADAT after extubation - replace electrolytes as needed - pt has h/o chylothorax. Needs to have established good PO intake prior to removing CT's

ID: - peri-op ancef

Heme: - monitor CT output and correct COAGs as needed - start ASA tonight if extubated - keep Hct >40

Neuro: - Precedex through extubation - toradol and PRN morphine, tylenol

GI: - stress prophylaxis with zantac

GU: Foley in place

Mark A. Farina, PA-C 8/20/2013

Cardiology CICU Attending Note For Children < 6 Years Old

Date of Service: 8/20/2013 At 1600, I examined who remains critically ill. I agree with the note by the the provider PA Farina, with the findings and recommendations as documented.

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Today, I saw and discussed with the CICU Team the following results: ECG ECHO CXR Ultrasound Cardiac Cath MRI Labs Other

Based upon the above results, I established a plan of care today which includes management of: Enteral and parenteral nutrition· Optimization of hemodynamics· Cardiac Rhythm· Invasive / Noninvasive Ventilation· Pain and sedation· Infectious disease / Risk for infectious disease· Endocrinological dysfunction· Neurologic dysfunction· Gastrointestinal dysfunction· ENT·

The time spent with the patient included personal communication with spoke with CT Surgery, spoke with referrring Cardiologist and counseled family 10 mins.

I examined the patient multiple times today. Time spent on any procedures is not included in today's billed critical care time.

Jonathan M. Kaufman, M.D.

Nutrition Inpatient Assessment:

Current Nutrition Order: Regular diet

Supplements: none

Provides: Current calorie intake varies and not quantified

Estimated Needs: (Using: RDA range; 12.20kg) 1-3yr: Energy: 75-100 kcal/kg (930-1240 kcal/d) Protein(post-op):2-2.5 g/kg (25-30 g/d) Fluid: per team.

Assessment: is a 3 year 10 month old male with Single left ventricle, malposed great arteries, TV atresia, B/L SVC s/p Completion Fontan. History chylothorax. Starting on a regular to diet see how

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 18

Progress Notes signed by Baltazar, Sarah H. at 8/21/2013 12:11 PM Author: Baltazar, Sarah H. Service: Nutrition Author Type: Dietitian Filed: 8/21/2013 12:11 PM Note Time: 8/21/2013 7:28 AM

Electronically signed by Farina, Mark A. at 8/20/2013 5:39 PM Electronically signed by Kaufman, Jonathan M. at 8/22/2013 12:59 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

he tolerates fat. POC not available at time of visit. Admits at 84% ideal body weight.

Nutrition Diagnosis Inadequate nutrient intake related to pre-op status, as evidenced by slowed weight growth since May.1. (Status: Active problem)

Nutrition Plan/Interventions Food/Nutrient Delivery:

Monitor tolerance of full fat diet.1. If intake is low consider instant breakfast with whole milk.2.

3. Food/Nutrient Delivery:If low fat diet is required

10 gm fat diet1. Can offer skim milk with chocolate instant breakfast (3 times per day) and/or Resource Breeze high2. calorie/high protein/no fat juice(2 per day). Both can be ordered from the kitchen.

Coordination of Nutrition Care: Weekly weights1.

Monitoring/Evaluating Oral intake and Weight. Goal: Wt to remain above 12.4kg. Progress: Newly established goals1.

Pt is high nutrition risk and dietitian will follow up within 7 days to assess progress in the hospital. Dietitian: Sarah Baltazar RD Clinical Pediatric Dietitian

Type: Inpatient Assessment Minutes: 30 __________________________________________________________________________________

General Assessment Information Subjective/Nutrition History: POC not available at time of visit. RN to page when they return. Previous note from Cardio Clinic RD in May notes that she gave samples of Boost Kid Essentials to supplement diet. MOC reported good intake but unknown if tried/liked the supplement.

Medical History: Pt has a past medical history of single ventricle and Chylothorax.

Anthropometrics: (Per CDC growth chart) Wt. (Current): 12.4 kg Wt Readings from Last 3 Encounters: 08/20/13 12.4 kg (1%*, Z = -2.44) 08/20/13 12.4 kg (1%*, Z = -2.44) 06/19/13 12.2 kg (1%*, Z = -2.40)

* Growth percentiles are based on CDC 2-20 Years data. Height: 94.00cm (12.04%) Body mass index is 13.26 kg/(m^2). (0.38%) BMI Category: Underweight (Peds less than 5% or Adults less than 18.5 kg/m2) IBW: 14.6 kg (84% IBW) for BMI @ the 50%ile. Growth trends: Slow weight gain. Physical Findings: covered in bed-not visualized

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Allergies: Review of patient's allergies indicates no known allergies.

Intake/Output:

Intake/Output Summary (Last 24 hours) at 08/21/13 0733 Last data filed at 08/21/13 0700

Gross per 24 hour Intake 1160.7 ml Output 905 ml Net 255.7 ml

Labs: Recent Labs

08/19/13 0946

08/20/13 1440

08/21/13 0530

NA 139 144* 139 K 3.8 3.5 3.6 CL 103 109 102 BIC 24 21 19* BUN 13 12 16 CRE 0.37 0.33 0.38 GLU 62 117* 81 CA 9.4 9.4 9.4 MG -- 2.6* 1.8 PHOS -- 5.7 6.1* HGB 17.1* 14.9* 15.3* HCT 50.2* 43.8* 45.5* MCV 81.1 81.4 82.1 ALB -- -- 3.9 BILT -- -- 0.9 ALK -- -- 90* AST -- -- 53 ALT -- -- 40

Medications: Current Facility-Administered Medications Medication Status •D5W-1/2NS (dextrose

5% in 0.45% sodium chloride) 500 mL

Active

•NS (sodium chloride 0.9%) 500mL with heparin 1,000 units

Active

•ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL

Active

•potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 3.72 mEq

Active

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 20

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

•potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 6.2 mEq

Active

•potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 12.4 mEq

Active

•calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL

Active

•calcium chloride 124 mg in NS (0.9% sodium chloride) 6.2 mL

Active

•calcium chloride 248 mg in NS (0.9% sodium chloride) 12.4 mL

Active

•magnesium sulfate (conc: 80 mg/mL) injectable 310 mg

Active

•DOPamine 128 mg in D5W (dextrose 5 %) 40 mL

Active

•milrinone 12 mg in D5W (dextrose 5 %) 60 mL

Active

•morphine (conc: 2mg/mL) injectable 0.62-1.24 mg

Active

•acetaminophen (conc: 160mg/5mL) oral suspension 160 mg

Active

•acetaminophen rectal suppository 120 mg

Active

•ketorolac (conc: 30mg/mL) injectable 6.2 mg

Active

•ondansetron (conc: 2mg/mL) injectable 1.9 mg

Active

•albumin 5% (conc: 5 g/100 mL) injectable 3-6 g

Active

•sodium bicarbonate 8.4 % (conc: 1 mEq/mL) injectable 12 mEq

Active

•furosemide (conc: 10mg/mL) injectable 12.4 mg

Active

•ondansetron oral disintegrating tablet 2 mg

Active

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 21

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Progress Notes - All Notes (continued)

CICU PROGRESS NOTE

Patient Name: Date of Service: 8/21/2013 Attending: Jon Kaufman, MD CT Surgeon: Max Mitchell Primary Cardiologist: Karrie Villavicencio, MD

Age: 3 year old

DIAGNOSIS: Single ventricle (left) with tricuspid valve atresia, L-malposed great vessels, severe pulmonary valve stenosis, bilateral SVC

S/P: Completion Fontan (16 mm GoreTex extracardiac Fontan with 4.0 mm fenestration) FINDINGS: L-TGA-type great vessel relationship, Small left SVC, MPA stump very adherent to the heart DOS: 8/20/2013 POD#: 1

PROBLEM LIST: Patient Active Problem List Diagnosis •Single Ventricle •severe pulmonary stenosis •DOLV (Double Outlet Left Ventricle) •Bilateral SVC's •MAPCA (major aortopulmonary collaterals) without PA-VSD

Significant 24 hour Events: - Operative and post-operative course was smooth. - Extubated without incident. - Hemodynamics stable with weans on vasoactive infusions, currently only on milrinone.

Weight: Admit/Med Weight: Weight: 12.4 kg

Vitals (past 24 hours): Temp Avg: 36.4 °C (97.6 °F) Min: 36 °C (96.8 °F) Max: 36.9 °C (98.4 °F) Pulse Avg: 93.1 Min: 66 Max: 124 Rhythm: Normal sinus rhythm Resp Avg: 16.7 Min: 3 Max: 37 Cuff BP: No data recorded. No data recorded. BP Mean Avg: 57.3 Min: 53 Max: 61 Art Line BP: ABP Mean Avg: 62.9 Min: 53 Max: 81

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 22

Electronically signed by Baltazar, Sarah H. at 8/21/2013 12:11 PM

Progress Notes signed by Kaufman, Jonathan M. at 8/26/2013 2:03 PM Author: Kaufman, Jonathan M. Service: Cardiology Author Type: Physician Filed: 8/26/2013 2:03 PM Note Time: 8/21/2013 7:40 AM Related Notes: Original Note by Kim, John S. filed at 8/22/2013 9:15 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

CVP Avg: 30.2 Min: -25 Max: 251 PAP Min: 3/1 Max: 247/230 SpO2 Avg: 88.9 % Min: 81 % Max: 100 % Resp/Oxygen: O2 Flow Rate - LPM: 2 LITERS/MIN; Pacer Settings: None

General: Pleasant, interactive, quiet, consolable, no acute distress HEENT: NCAT, PERRL, MMM Neuro: Face symmetric, grossly non-focal, moves all extremities, normal gait. CVS: Precordium quiet, RRR, single S2, no murmur, no rubs or gallop, pulses 2+, cap refill brisk Resp: Breath sounds clear to auscultation bilaterally, no increased work of breathing GI: Soft, nontender, nondistended, liver 1 cm below right costal margin Ext: Warm, well perfused Skin: incision clean, dry, and intact and dressing in place over incision

Foreign bodies: Chest tube Mediastinal blake, Pleural Bilateral, Foley, Pacing Wires Central lines: Art line left radial, CVP RIJ Fluids/Nutrition: PO, IVF I/O: Intake/Output Summary (Last 24 hours) at 08/21/13 0740 Last data filed at 08/21/13 0700

Gross per 24 hour Intake 1160.7 ml Output 905 ml Net 255.7 ml

UOP: 2.1 ml/kg/hr Stool: none Drains: - Mediastinal chest tube: 92 ml total (18 ml since midnight) - Left pleural chest tube: 45 ml total (13 ml since midnight) - Right pleural chest tube: 241 ml total (115 ml since midnight)

Data/Diagnostics Studies:

CBC w/diff Recent Labs

08/21/13 0530

WBC 14.0* RBC 5.54* HGB 15.3* HCT 45.5* MCV 82.1 MCH 27.7 MCHC 33.7 RDW 13.4 PLTCT 167 MPV 7.6 SEGS 84.3* LYMPHS 5.4* MONOS 10.3* PLTEST NORMAL 150-500,000

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 23

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

BMP (Chem 10) Recent Labs

08/21/13 0530

NA 139 K 3.6 CL 102 BIC 19* BUN 16 CRE 0.38 GLU 81 CA 9.4 MG 1.8 PHOS 6.1*

COAGS: Recent Labs

08/21/13 0530

PT 15.4* INR 1.20 PTT 28

ABG Recent Labs

08/20/13 1729

08/20/13 1833

08/21/13 0549

PHART 7.31* 7.36 7.36 PCO2ART 41* 43* 36 PO2ART 62* 60* 70 HCO3ART 20 24* 20 TCO2ART 21 25* 21 BEART -6.2* -2.1 -4.8* O2SATART 91* 91* 94

CXR 8/21/13: - Left lung well aerated with no effusion. - Right middle lobe atelectasis and small right pleural effusion. - Bilateral pleural and mediastinal chest tubes in place. - RIJ central line in the high SVC.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 24

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Last Echo 8/20/13: - Fontan baffle is well seen with unobstructed flow. There is a fenestration with phasic forward flow (unable to calculate a mean gradient due to poor Doppler angle). - Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right Glenn shunt. The left Glenn could not be optimally visualized. - The branch pulmonary arteries are well visualized with low velocity, phasic flow. - Unobstructed inferior vena cava. - Multiple small aortopulmonary collaterals. - Wide open atrial communication. - Trivial-to-mild atrioventricular valve regurgitation. - Normal right-sided, morphologic left ventricular systolic function.

Infusions: Milrinone (mcg/kg/min): 0.5

Medications:

Current Facility-Administered Medications: aspirin chewable tablet 40.5 mg Active 40.5 mg QDAY furosemide (conc: 10mg/mL) injectable 12.4 mg Active 1 mg/kg/dose Q8H spironolactone (conc: 2mg/mL) oral suspension 5 mg Active 5 mg BID D5W-1/2NS (dextrose 5% in 0.45% sodium chloride) 500 mL Active Continuous ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL Active 1 mg/kg/dose Q8H milrinone 12 mg in D5W (dextrose 5 %) 60 mL Active 0.3-1 mcg/kg/min CONTINUOUS morphine (conc: 2mg/mL) injectable 0.62-1.24 mg Active 0.05-0.1 mg/kg/dose Q2HPRN acetaminophen (conc: 160mg/5mL) oral suspension 160 mg Active 160 mg Q4HPRN ketorolac (conc: 30mg/mL) injectable 6.2 mg Active 0.5 mg/kg/dose Q6H ondansetron oral disintegrating tablet 2 mg Active 2 mg Q8HPRN

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 25

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Antibiotics: Perioperative Ancef

CICU IMPRESSION: is a 3 year old male with double-outlet left ventricle with malposed great vessels now status-post completion Fontan (history of bilateral bidirectional Glenn anastomoses). His post-operative course thus far has been unremarkable. He remains with bilateral pleural chest tubes and we are initiating oral feeds, we will watch for pleural effusion.

PLAN: CV: - Will wean off milrinone today. - Will follow clinical examination markers of perfusion. - Pull mediastinal chest tube. - Will follow for pleural effusion.

Pulm: - Wean nasal cannula as tolerated.

FENGI: - Start regular PO diet. - Will continue lasix IV Q8 today. - Will continue ranitidine for gastritis prophylaxis while on IV NSAID.

ID: - S/p perioperative cefazolin. - No acute concerns at this time.

Heme: - Hematocrit stable at 45. - Will restart antiplatelet therapy with aspirin daily.

Neuro: - Continue ketorolac for 48 hours total. - PRN oxycodone. - Acetaminophen around the clock.

Dispo: - Remains CICU status while initiation of oral intake.

John S. Kim, MD, MS Pediatric Cardiology Fellow Children's Hospital Colorado

8/21/2013

Communication: Patient seen and discussed with Dr. Kaufman.

Cardiology CICU Attending Note For Children < 6 Years Old

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 26

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Date of Service: 8/21/2013 At 0800 and throughout the day I examined who remains critically ill. I agree with the note by the fellow Dr Kim,, with the findings and recommendations as documented. POD from Fontan completion. Overall doing well, extubated quickly after return from CVOR, overnight has begun to po feed, Chest tubes in place for concern of development of chylous effusions. Exam is unremarkable but remains critically ill tapering off of milrinone

Today, I saw and discussed with the CICU Team the following results: ECG ECHO CXR Ultrasound Cardiac Cath MRI Labs Other

The time spent with the patient included personal communication with spoke with CT Surgery, spoke with referrring Cardiologist and counseled family 10 mins.

I examined the patient multiple times today. Time spent on any procedures is not included in today's billed critical care time.

Jonathan M. Kaufman, M.D.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 27

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Therapeutic Rec/Child Life Patient Compliance

Data: has been referred by RN to increase compliance with deep breathing.

Goal: will engage in deep breathing by utilizing marshmallow launcher and pinwheel.

Intervention: CCLS met with and GPOC to discuss expectations and response to compliance concerns for care providers , and discussed plan with patient and GPOC.

Response: was sitting in GMOC's lap and Grandfather was at the bedside. POC were not present at the time CCLS was present. GPOC acknowledged understanding of plan and parameters related to implementation, agreed to expectations, however refused to comply with plan at the time CCLS was present. GMOC encouraged participation and utilized the marshmallow launcher to demonstrate and attempt to entice to launch Marshmallows at GFOC. GMOC was speaking to about launching marshmallows at FOC once FOC returned to pt's room. appeared to be very tired.

Plan: CCLS will continue to follow to offer support and resources as necessary. If needs or concerns are identified please contact this CCLS at 76754

Debra L. Dutcher 8/21/2013 2:17 PM

CARDIOLOGY PROGRESS NOTE

Patient Name: Date of Service: 8/23/2013 Attending: Tony McCanta, MD CT Surgeon: Max Mitchell Primary Cardiologist: Karrie Villavicencio, MD

Age: 3 year old

CICU Transfer Date: 8/22/13

Diagnosis: Single ventricle (left) with tricuspid valve atresia, L-malposed great vessels, severe pulmonary valve stenosis, bilateral SVC S/P: Completion Fontan (16 mm GoreTex extracardiac Fontan with 4.0 mm fenestration) FINDINGS: L-TGA-type great vessel relationship, Small left SVC, MPA stump very adherent to the heart

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 28

Author: Dutcher, Debra L. Service: Medical-General (NOC Only) Author Type: TherRec/ChildLife Filed: 8/21/2013 2:24 PM Note Time: 8/21/2013 2:17 PM

Electronically signed by Kim, John S. at 8/21/2013 4:00 PM Electronically signed by Kim, John S. at 8/22/2013 9:15 AM

Electronically signed by Dutcher, Debra L. at 8/21/2013 2:24 PM

Electronically signed by Kaufman, Jonathan M. at 8/26/2013 2:03 PM

Progress Notes signed by Church, Jessica C. at 8/23/2013 2:55 PM Author: Church, Jessica C. Service: (none) Author Type: Nurse Practitioner Filed: 8/23/2013 2:55 PM Note Time: 8/23/2013 2:31 PM

Progress Notes signed by Dutcher, Debra L. at 8/21/2013 2:24 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

DOS: 8/20/2013 POD#: 3

Significant 24 hour Events: Transfer from CICU. Pleural fluid sent for analysis.

Weight: Admit/Med Weight: Weight: 12.4 kg

Vitals (past 24 hours): Stable Temp Avg: 36.6 °C (97.8 °F) Min: 36 °C (96.8 °F) Max: 37.5 °C (99.5 °F) Pulse Avg: 82 Min: 65 Max: 111 Rhythm: Normal sinus rhythm Resp Avg: 22.7 Min: 2 Max: 36 Cuff BP: Systolic (24hrs), Avg:90 mmHg, Min:73 mmHg, Max:104 mmHg Diastolic (24hrs), Avg:52 mmHg, Min:40 mmHg, Max:63 mmHg BP Mean Avg: 60.1 Min: 50.93 Max: 73 SpO2 Avg: 84.1 % Min: 82 % Max: 88 % Resp/Oxygen: O2 Flow Rate - LPM: 1 LITERS/MIN; Pacer Settings: None

Physical Exam: General: No acute distress HEENT: Anterior fontanelle closed Neuro: Grossly non-focal CVS: Precordium: quiet, Rhythm: RRR, Sounds: negative for: rub, gallop, murmur or systolic click, Pulses: +2 bilaterally throughout Resp: breath sounds clear to auscultation bilaterally, breath sounds decreased to both bases GI: bowel sounds Present, abdomen soft, nondistended, liver edge 2 cm below costal margin Ext: warm and cap refill 2 sec Skin: dressing in place over incision

Foreign bodies: Chest tube Pleural Left Central lines: PICC LAC Fluids/Nutrition: Feeds low fat diet ad lib 10g/d I/O: Intake/Output Summary (Last 24 hours) at 08/23/13 1431 Last data filed at 08/23/13 0500

Gross per 24 hour Intake 390 ml Output 378 ml Net 12 ml

UOP: 1.2 ml/kg/hr (MR # Printed by [103311] at 10/11/13 9:48 AM Page 29

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Stool: x1 Drains: Pleural Left

Labs (last 24 hrs): None Cultures: None MRSA: Negative

CXR: 8/23 Interval removal of the right chest tube. Decreased edema. Decreased bibasilar atelectasis. Last Echo: needs postop echo

Infusions: None

Medications:

Current Facility-Administered Medications: ibuprofen (conc: 100mg/5mL) oral suspension 120 mg

Active 120 mg Q8HPRN

acetaminophen (conc: 160mg/5mL) oral suspension 186 mg

Active 15 mg/kg/dos e

prn in PACU

oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg

Active 0.1 mg/kg/dos e

Q4HPRN

aspirin chewable tablet 81 mg Active 81 mg QDAY

furosemide (conc: 10mg/mL) oral solution 12.4 mg

Active 1 mg/kg/dos e

TID

spironolactone (conc: 2mg/mL) oral suspension 5 mg

Active 5 mg BID

acetaminophen (conc: 160mg/5mL) oral suspension 160 mg

Active 160 mg Q4HPRN

ondansetron oral disintegrating tablet 2 mg

Active 2 mg Q8HPRN

Antibiotics: None

Impression: is a 3 year old male with h/o double-outlet left ventricle (and tricuspid atresia) with malposed great vessels now status-post completion Fontan (history of bilateral bidirectional Glenn anastomoses). He is progressing well. His left chest tube continues to drain and has become chylous in nature.

Plan: CV: NSR. He will need postop echo when drain removed, sooner if clinically necessary. Pulm: Continue 1/2L O2 for pulm vasodilatory effects. - R chest tube removed today by CTS, L CT still draining. - Fluid analysis shows elevated TGs, low lymph count but clinically appears milky and has increased since eating more. - Cxray today with improved atelectasis. Continue to follow CT output, monitor cxray for reaccumulation of R effusion. - Cont lasix tid for further diuresis and can consider increasing to IV. FEN/GI: Changed to low fat diet 10g/day per Dr. Mitchell for chylous output. - BMP in am.

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

- Cont aldactone for K sparing effects. - Pt has stooled ID: Afebrile, no current concern. Heme: Last HCT 45. Cont daily ASA. Neuro: Alert, appropriate, pain seems controlled. Access: Left PICC placed today

Jessica C. Church, CPNP-AC 8/23/2013

I examined the patient and reviewed the history, examination, labs, imaging studies and information in the medical record. Total Accumulative time is 35 minutes. Time spent on any procedures is not included in today's billed care time.

Today I spoke with Tony McCanta, MD, spoke with CT Surgery and counseled family >15 mins.

Therapeutic Rec/Child Life Patient Compliance

Data: has been referred by RN to increase compliance with activities out of bed.

Goal: will increase ambulation.

Intervention/Response: CCLS met with Parents and GPOC to discuss concerns r/t pt being out of bed more to improve pulmonary toilet. POC report will get out of bed with encouragement and just wants to go to the playroom, however today the playroom has been closed which has been discouraging for

CCLS offered toys to pt's bedside to assist with pt being up out of bed playing when the playroom is not open. CCLS also opened the playroom and played with in the playroom after he walked to the playroom. did well getting up and down from the floor and moving around. was very engaging, rode on a riding toy and was very interested in engaging in lots of activities in the playroom. Family reported "this is just what he needed" and were very appreciative. even gave this CCLS a hug and said "thank you for playing with me". Family denied the need for an incentive chart or any additional needs or concerns at this time.

Plan: CCLS will continue to follow to offer support and resources. If needs or concerns are identified please contact this CCLS at 76754

Debra L. Dutcher 8/23/2013 4:37 PM

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 31

Author Type: TherRec/ChildLife Filed: 8/23/2013 4:45 PM Note Time: 8/23/2013 4:36 PM

Electronically signed by Church, Jessica C. at 8/23/2013 2:55 PM

Electronically signed by Dutcher, Debra L. at 8/23/2013 4:45 PM

Progress Notes signed by Diamond, Bethany A. at 8/24/2013 12:46 PM Author: Diamond, Bethany A. Service: Cardiology Author Type: Nurse Practitioner Filed: 8/24/2013 12:46 PM Note Time: 8/24/2013 12:21 PM

Progress Notes signed by Dutcher, Debra L. at 8/23/2013 4:45 PM Author: Dutcher, Debra L. Service: Medical-General (NOC Only)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

CARDIOLOGY PROGRESS NOTE

Patient Name: Date of Service: 8/24/2013 Attending: Tony McCanta, MD CT Surgeon: Max Mitchell Primary Cardiologist: Karrie Villavicencio, MD

Age: 3 year old

CICU Transfer Date: 8/22/13

Significant 24 hour Events: Pleural fluid drainage slowing, but unable to determine accurately the amount of drainage to due collection chamber being "knocked over" a few times. But it does appear that amount is decreasing and is less cloudy than previous day. Patient is OOB more and working on pulmonary toilet.

Weight: Admit/Med Weight: Weight: 12.4 kg

Vitals (past 24 hours): Stable Temp Avg: 36.9 °C (98.5 °F) Min: 36.4 °C (97.5 °F) Max: 37.5 °C (99.5 °F) Pulse Avg: 90.9 Min: 76 Max: 105 Rhythm: Normal sinus rhythm Resp Avg: 25.7 Min: 21 Max: 29 Cuff BP: Systolic (24hrs), Avg:92 mmHg, Min:78 mmHg, Max:105 mmHg Diastolic (24hrs), Avg:53 mmHg, Min:48 mmHg, Max:58 mmHg BP Mean Avg: 61 Min: 55 Max: 68 SpO2 Avg: 86.7 % Min: 78 % Max: 91 % Resp/Oxygen: O2 Flow Rate - LPM: 0.5 LITERS/MIN; Pacer Settings: None

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 32

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Resp: breath sounds clear to auscultation bilaterally, breath sounds decreased to both bases GI: bowel sounds Present, abdomen soft, nondistended, liver edge 2 cm below costal margin Ext: warm and cap refill 2 sec Skin: dressing in place over incision and CT sites

Foreign bodies: Chest tube Pleural Left Central lines: PICC LAC, PIV Fluids/Nutrition: Feeds low fat diet ad lib 10g/d I/O:

Intake/Output Summary (Last 24 hours) at 08/24/13 1221 Last data filed at 08/24/13 0800

Gross per 24 hour Intake 376 ml Output 874 ml Net -498 ml

UOP: 2.5 ml/kg/hr Stool: + Drains: Pleural Left , difficult to determine output but appears to be approx 20 ml over 12 hours

Labs (last 24 hrs): Component 8/24/2013

6:15 AM NA/Sodium 134 K/Potassium 5.7 (H) Chloride 93 (L) Bicarb/HCO3,S 34 (H) Glucose,S 89 BUN 24 (H) Creatinine,S 0.23 Calcium,S 9.4

Cultures: None MRSA: Negative

CXR: 8/24 final result pending

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Last Echo: postop TEE - Fontan baffle is well seen with unobstructed flow. There is a fenestration with phasic forward flow (unable to calculate a mean gradient due to poor Doppler angle). Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right Glenn shunt. The left Glenn could not be optimally visualized. The branch pulmonary arteries are well visualized with low velocity, phasic flow. Unobstructed inferior vena cava. Multiple small aortopulmonary collaterals. Wide open atrial communication Trivial-to-mild atrioventricular valve regurgitation. Normal right-sided, morphologic left ventricular systolic function.

Infusions: None

Medications:

Current Facility-Administered Medications: spironolactone (conc: 2mg/mL) oral suspension 5 mg

Active 5 mg QDAY

ibuprofen (conc: 100mg/5mL) oral suspension 120 mg

Active 120 mg Q8HPRN

oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg

Active 0.1 mg/kg/dose Q4HPRN

aspirin chewable tablet 81 mg Active 81 mg QDAY furosemide (conc: 10mg/mL) oral solution 12.4 mg

Active 1 mg/kg/dose TID

acetaminophen (conc: 160mg/5mL) oral suspension 160 mg

Active 160 mg Q4HPRN

ondansetron oral disintegrating Active 2 mg Q8HPRN

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

tablet 2 mg

Antibiotics: None

Plan: CV: - NSR. He will need postop echo when drain removed, sooner if clinically necessary. Pulm: - Continue 1/2L O2 for pulm vasodilatory effects. - Continue to follow CT output, monitor cxray for effusion. - Cont lasix tid for further diuresis. FEN/GI: - Changed to low fat diet 10g/day per Dr. Mitchell for chylous output. - BMP in am. - Cont aldactone for K sparing effects but decrease to daily due to elevated K+ (although may be partially due to hemolysis). Heme: - Cont daily ASA. Neuro: - Continue tylenol/Ibuprofen for pain control. Begin decreasing amount of oxy if possible. Access: - Since L PICC is in place, OK to remove PIV.

Bethany Diamond, DNP, MESS, CPNP Cardiology

8/24/2013

Today I spoke with Tony McCanta, MD, spoke with CT Surgery and counseled family >15 mins.

CARDIOLOGY PROGRESS NOTE

Patient Name: Date of Service: 8/25/2013 Attending: Tony McCanta, MD CT Surgeon: Max Mitchell Primary Cardiologist: Karrie Villavicencio, MD

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 35

Progress Notes signed by Diamond, Bethany A. at 8/25/2013 12:59 PM Author: Diamond, Bethany A. Service: Cardiology Author Type: Nurse Practitioner Filed: 8/25/2013 12:59 PM Note Time: 8/25/2013 12:42 PM

Electronically signed by Diamond, Bethany A. at 8/24/2013 12:46 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Age: 3 year old

CICU Transfer Date: 8/22/13

Significant 24 hour Events: Pleural fluid drainage significantly slowed. Dr. Jaggers removed CT this am in procedure room on CPCU.

Weight: Admit/Med Weight: Weight: 12.4 kg

Vitals (past 24 hours): Stable Temp Avg: 36.9 °C (98.4 °F) Min: 36.1 °C (97 °F) Max: 37.2 °C (99 °F) Pulse Avg: 91 Min: 75 Max: 105 Rhythm: Normal sinus rhythm Resp Avg: 25.6 Min: 22 Max: 30 Cuff BP: Systolic (24hrs), Avg:91 mmHg, Min:74 mmHg, Max:105 mmHg Diastolic (24hrs), Avg:61 mmHg, Min:50 mmHg, Max:76 mmHg BP Mean Avg: 67.6 Min: 57 Max: 83 SpO2 Avg: 88.6 % Min: 84 % Max: 94 % Resp/Oxygen: O2 Flow Rate - LPM: 0.5 LITERS/MIN; Pacer Settings: None

Physical Exam: General: No acute distress, alert and playing Neuro: Grossly non-focal CVS: Precordium: quiet, Rhythm: RRR, Sounds: negative for: rub, gallop, murmur or systolic click, Pulses: +2 bilaterally throughout Resp: breath sounds clear to auscultation bilaterally, breath sounds decreased to both bases GI: bowel sounds Present, abdomen soft, nondistended, liver edge 1 cm below costal margin Ext: warm and cap refill 2 sec Skin: dressing in place over incision and CT sites

Foreign bodies: none Central lines: PICC LAC Fluids/Nutrition: Feeds low fat diet ad lib 10g/d I/O:

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 36

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Intake/Output Summary (Last 24 hours) at 08/25/13 1242 Last data filed at 08/25/13 1200

Gross per 24 hour Intake 452 ml Output 909 ml Net -457 ml

UOP: 3.0 ml/kg/hr Stool: +

Labs (last 24 hrs): Component 8/25/2013

6:20 AM NA/Sodium 136 K/Potassium 5.7 (H) Chloride 95 (L) Bicarb/HCO3,S 31 Glucose,S 89 BUN 23 (H) Creatinine,S 0.30 Calcium,S 9.9 (H)

Cultures: None MRSA: Negative

CXR: 8/25 - The lungs remain hypoexpanded without focal consolidation, pleural effusion, or pneumothorax. Heart is normal in size.

Infusions: None

Medications:

Current Facility-Administered Medications: ibuprofen (conc: 100mg/5mL) oral suspension 120 mg

Active 120 mg Q8HPRN

oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg

Active 0.1 mg/kg/dos

Q4HPRN

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

e aspirin chewable tablet 81 mg Active 81 mg QDAY

furosemide (conc: 10mg/mL) oral solution 12.4 mg

Active 1 mg/kg/dos e

TID

acetaminophen (conc: 160mg/5mL) oral suspension 160 mg

Active 160 mg Q4HPRN

Antibiotics: None

Impression: is a 3 year old male with h/o double-outlet left ventricle (and tricuspid atresia) with malposed great vessels now status-post completion Fontan (history of bilateral bidirectional Glenn anastomoses). He is progressing well. Pt is much improved on low fat diet. CT was removed this am.

Plan: CV: - Continue on ASA for Fontan Physiology. - post op echo ordered for tomorrow Pulm: - Continue 1/2L O2 for pulm vasodilatory effects. Plan to d/c on O2. - CXR in am to evaluate for reaccumulation of effusion. - Cont lasix tid for further diuresis. - Continue IS type behaviors, ie...pinwheel and marshmallow blower FEN/GI: - Changed to low fat diet 10g/day per Dr. Mitchell for hx chylous output. - D/C aldactone as electrolytes are very stable with elevated K+ (although there is 1+ hemolysis). Neuro: - Continue tylenol/Ibuprofen for pain control. Begin decreasing amount of oxy if possible. Access: - Since L PICC is in place.

Bethany Diamond, DNP, MESS, CPNP Cardiology

8/25/2013

I examined the patient and reviewed the history, examination, labs, imaging studies and information in the medical record. Total Accumulative time is 25 minutes. Time spent on any procedures is not included in today's billed care time.

Today I spoke with Tony McCanta, MD, spoke with CT Surgery and counseled family >15 mins.

Nutrition Note: Diet Education for 10 gm fat diet

Met with POC and GPOC for teaching on the 10 gm fat diet for home today. likes fruits, veggies, grilled chicken, lunchmeat, hot dogs, mac and cheese, whole milk and cheese.

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Progress Notes signed by Baltazar, Sarah H. at 8/26/2013 11:50 AM Author: Baltazar, Sarah H. Service: Nutrition Author Type: Dietitian Filed: 8/26/2013 11:50 AM Note Time: 8/26/2013 11:45 AM

Electronically signed by Diamond, Bethany A. at 8/25/2013 12:59 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Progress Notes - All Notes (continued)

Recommended: 1. Skim milk with instant breakfast for added calories. 2. MOC verbalized understanding of diet teaching. 3. Provided handout.

Sarah Baltazar RD Clinical Pediatric Dietitian 15 min-Nutrition Review

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Electronically signed by Baltazar, Sarah H. at 8/26/2013 11:50 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

RN Progress - All Notes

Cardiothoracic Preop Note

Met with his parents and grandparents in the Cardiology clinic after his preop evaluation and echocardiogram. Reviewed the admission process for the AM. Toured through CICU only as they're familiar with the rest of our units. Visiting policy & family accommodations reviewed. Discussed plan of care for Fenestrated Fontan, including intraop & postop expectations, postop appearance, and potential risks & complications, i.e., arrhythmias, heart block, bleeding, ventricular dysfunction, infection, pulmonary problems especially pleural and/or chylous effusion, renal problems, nerve injury, ie.; phrenic and recurrent laryngeal and neuro problems. Explained our expectations for diet & activity progression, pain & sedation management, wound care, and discharge/follow-up care. Coordinated their preop visit with Dr. Max Mitchell. Consents obtained & placed in chart. Coordinated their preop visit with anesthesia fellow, Dr. Bjur. NPO & skin preparation instructions given. Informed the family that this RN would keep them updated during surgery.

POD #2 - Mediastinal incision dressing placed in the OR removed. Incision cleansed with sterile saline wipe. Indermil adhesive dressing intact. Incision well approximated. No erythema, drainage or swelling noted. Mepilex border lite 2x5in and 1.6x2in dressing applied to protect incision. Continue with daily incision care and dressing changes. POC present and updated with plan of care.

Pt DC'd home. MOC educated on all DC info.

MOC educated about when to call 911, followup appts, medication dosages and times, diet, activity.

Instructed to call MD in case of fever, s/s infection , redness, swelling, discharge from incision, nausea, vomiting, diarrhea, decrease in UOP. MOC educated on midsternal incision care and to remove old CT dressing 8/27 and PICC site dressing tomorrow. PICC line removed, tip intact and measured at 14cm and occlusive dressing applied

PNP Tiernan stated ok for pt to leave MSI open to air. Clean with soap and water daily.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 40

Service: Surgery-Cardio/Thoracic Author Type: Registered Nurse

RN Progress signed by Carpenter, Esther V. at 8/22/2013 8:53 AM Author: Carpenter, Esther V. Service: Surgery-Cardio/Thoracic Author Type: Registered Nurse Filed: 8/22/2013 8:53 AM Note Time: 8/22/2013 8:49 AM

Filed: 8/19/2013 3:30 PM Note Time:

Electronically signed by Carpenter, Esther V. at 8/22/2013 8:53 AM

8/19/2013 3:27 PM

RN Progress signed by Overholt, Julie A. at 8/26/2013 1:00 PM Author: Overholt, Julie A. Service: (none) Author Type: Registered Nurse Filed: 8/26/2013 1:00 PM Note Time: 8/26/2013 12:52 PM

RN Progress signed by Carpenter, Esther V. at 8/19/2013 3:30 PM

Electronically signed by Overholt, Julie A. at 8/26/2013 1:00 PM

Author:

Electronically signed by Carpenter, Esther V. at 8/19/2013 3:30 PM

Carpenter, Esther V.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

OP Note - All Notes

CARDIOTHORACIC SURGERY POST OP NOTE

Patient Name: MRN: DOB: Date of Surgery: 8/20/2013

Title of Procedure: Completion Fontan (16 mm GoreTex extracardiac Fontan with 4.0 mm fenestration) Preoperative Diagnosis: Single Ventricle s/p Bilateral Bi-directional Glenn Shunts Postoperative Diagnosis: Same Surgeon(s): Max Mitchell Assistant(s): Fisher and Handfland Anesthesia: GETA Findings: L-TGA -t ype great vessel relationship, Small left SVC, MPA stump very adherent to the heart Estimated Blood Loss: N/A Fluid Replacement: N/A Drains: blt 16F Chest tubes, 15F Blake pericardial drain Specimens: none Complications: None known CBP: 129 min XCI: none Condition: To CICU in critical condition

Patient Name: A ( DOB: Age: 3Y Sex: M

Date of Surgery: 08/20/2013

Primary Care Physician: Jeremy D Parker, M.D. Referring Physician(s): Karrie L Villavicencio, M.D.

PCP Operative Report

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 41

OP Note signed by Mitchell, Max B. at 8/20/2013 1:28 PM Author:

Electronically signed by Mitchell, Max B. at 8/20/2013 1:28 PM

Mitchell, Max B. Service: Surgery-Cardio/Thoracic Author Type: Physician

OP Note signed by Mitchell, Max B. at 8/27/2013 3:57 PM Author: Mitchell, Max B. Service: (none) Author Type: Physician Filed: 8/27/2013 3:57 PM Note Time: 8/20/2013 1:36 PM Trans ID: 26056851 Trans Status: Available Dictation Time: 8/20/2013 1:36 PM Trans Time: 8/20/2013 2:09 PM Trans Doc

Type: PCP Operative Report

Filed: 8/20/2013 1:28 PM Note Time: 8/20/2013 1:25 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

OP Note - All Notes (continued)

Surgeon: Max B Mitchell, M.D.

Assistant(s): Robert A Hanfland, M.D. Faith A Fisher, CPNP-AC

Preoperative Diagnosis: Single ventricle status post bilateral bidirectional Glenn shunt.

Postoperative Diagnoses: Single ventricle status post bilateral bidirectional Glenn shunt.

Procedures: Completion Fontan (16 mm Gore-Tex extracardiac conduit with 4.0 mm fenestration).

Faith Fisher was kind enough to assist me until the wound closure when Dr. Bob Hanfland was available and assisted with wound closure.

Anesthesia: General endotracheal.

Findings: The patient had L-TGA type great vessel relationship. There was a small left-sided superior vena cava. The main pulmonary artery stump, which had been reconstructed with a patch was densely adherent to the original pulmonary artery origination on the heart.

Indications: is a now, almost 4-year-old little boy with single ventricle anatomy and L- malposed great vessels. When he was an infant, he underwent a primary bidirectional bilateral Glenn procedure with ligation of a ductus arteriosus. He has had rather poor growth, and his Fontan and is now being completed per the request of his cardiologist, Dr. Karrie Villavicencio, as he is now 4 years of age, but just a little bit over 12 kg. Informed consent was obtained from his mother and father the day prior to surgery.

Description Of Procedure: Under general endotracheal anesthesia, adequate access was established. The chest was then prepped and draped sterilely. The chest was then opened through a repeat median sternotomy utilizing an oscillating saw. After dividing the sternum, we were easily able to get into both pleural spaces. We then dissected out the heart until the entire ascending aorta was mobilized off the branch pulmonary arteries. We gained control around the superior vena cava on both the right and left side and then dissected the inferior surface of the right branch pulmonary artery off of the dome of the atrium and its connections. The right atrium and inferior vena cava were then completely dissected free. I felt it quite risky to further the dissection to try to free the entire main pulmonary artery from the heart as it was densely adherent. So at this point, we systemically heparinized and cannulated the ascending aorta, the right atrial appendage, and went on bypass. An inferior vena cava cannula was then added followed by caval cannula in the right-sided superior vena cava. The left-sided superior vena cava was rather small, and I elected not to even cannulate it, although we did gain control around it.

At this point, we then initiated bypass. The patient was cooled. Originally, we were going to 32°, but as I dissected more I felt it would be very difficult to get the main pulmonary artery off of the heart without entering something, and I was concerned we would enter the cardiac side of it. Furthermore, with the left-sided superior vena cava difficult to control, I went ahead and cooled on down to about 25°. Once we were cool, we then opened the main pulmonary artery on the pulmonary arterial side of the previous patch reconstruction. This allowed me to then dissect it completely off the heart by just

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

OP Note - All Notes (continued)

simply sacrificing the stump reconstruction. At this point, I could easily see into both the left superior vena cava orifice as I temporarily occluded it and into the left pulmonary artery. The arteriotomy was then carried back out and down onto the inferior surface of the right-sided Glenn anastomosis. At this point, we then brought a 16 mm Gore-Tex graft to the field and sutured it to the pulmonary artery using a running continuous 5-0 Prolene suture with a beveled cut. This was at times due to blood return from the pulmonary artery. With the patient at 25°, we used a couple of 1- to 2-minute episodes of circulatory arrest to allow for the critical portions of the anastomosis at both corners. Then, once the back wall of the graft was completed, we simply put suckers up to the conduit and completed the front wall suturing. Once the pulmonary artery end of the conduit was completed, the graft was crossclamped with an angle crossclamp. We then trimmed it appropriately short. A clamp was placed on the right atrium and the snare was brought up around the inferior vena cava cannula and then the cava was transected from the heart, leaving a cuff of atrium adequate for the anastomosis to the graft. The atrial side was doubly oversewn with a running continuous 5-0 Prolene suture, leaving about a 5 mm gap unsewn. The other gap was closed with a pursestring suture for temporary closure for later use as a fenestration. At this point, we then connected the inferior vena cava to the graft after trimming the graft appropriately short. This was done with an end-to-end running continuous 5-0 Prolene suture. Next, a 4 mm hole was made in the graft about 7 or 8 mm above the inferior vena cava on the medial surface of the graft. The previously unsewn portion of the atriotomy was then exposed using a spoon clamp and then the anastomosis between the remaining open portion of the right atriotomy and the graft fenestration site was conducted, using bites that were full thickness on the muscle and taken outside the margin of the fenestration hole to assure a 4 mm precise fenestration. When this suture line was completed, we de-aired out this suture line prior to releasing the clamp on the left atrial side. We then released all of the clamps.

The patient's lungs were being expanded at this time. We rewarmed into normothermia, and when he was at normothermia, he came off bypass quite easily with a mild to moderate amount of inotropic support. Saturations settled out in the upper 80s due to the fenestration. An echocardiogram identified no issues. The patient's hemodynamics were pretty good with a Fontan pressure between 15 and 17. Bilateral 16 French drains were placed. A 15 French Blake was placed into the pericardium. Protamine was administered. All of the cannulas were removed and tied down. The patient was in sinus rhythm, but prophylactic pacing wires were placed. When hemostasis was adequate, the chest was closed. The sternum was reapproximated with #3 steel wire. The linea alba and presternal fascia were closed with absorbable suture, subcutaneous fat was closed with absorbable suture, and the skin was closed with running subcuticular closure. A sterile glue line was placed followed by a sterile dressing. The patient was then transported to the cardiac intensive care unit in critical condition.

Complications: There were no known intraoperative complications.

Total Pump Run: 129 minutes.

Crossclamp Time: There was no crossclamp time.

Specimens: There were no pathologic specimens sent.

Estimated Blood Loss: Cannot be estimated.

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

OP Note - All Notes (continued)

Max B Mitchell, M.D. Surgeon

Dictated by: Max B Mitchell, M.D.

MBM/kl D: 08/20/2013 13:36:00MDT / T: 08/20/2013 14:09:18MDT Job ID: 280680/31177734 Doc #: 26056851 Service: CTC 0

cc: Jeremy D Parker, M.D. Karrie L Villavicencio, M.D.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 44

Electronically signed by Mitchell, Max B. at 8/27/2013 3:57 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes

CICU TRANSFER SUMMARY

This Interim Summary Covers 8/20/13 to 8/22/13. Date of Service: 8/22/2013

Patient Name: Patient Age: 3 year old

Attending: Jon Kaufman, MD Primary Cardiologist: Karrie Villavicencio, MD CT Surgeon: Max Mitchell

DIAGNOSIS: Single ventricle (left) with tricuspid valve atresia, L-malposed great vessels, severe pulmonary valve stenosis, bilateral SVC

Hospital Course by Systems: CV: was taken to the OR and underwent completion Fontan performed by Max Mitchell. cardiopulmonary bypass time was 129 min, cross-clamp 0 min, and circulatory arrest time was 2 min. tolerated the procedure well and was transferred to the CICU on the following infusions; Dopamine 5 mcg/kg/min Milrinone 0.5 mcg/kg/min. Inotropes were weaned to off on POD#1 and he had no hemodynamic issues throughout his post-operative cours. was started on Lasix IV Q6 for pulmonary edema and pleural effusion.

Pulm: was intubated for surgery and extubated on POD#1. Diuretics were started for pulmonary edema and were able to be weaned to Lasix PO Q6 at time of transfer. Mediastinal drain was removed on POD#1 and bilateral pleural drains remain. Fluid analysis of the left pleural fluid revealed a triglyceride level of 243 and cell count analysis with 4% lymphocytes.

FENGI: was NPO for surgery and was able to eat on POD#1. With evolution of potential chylous ascites form the left pleural chest tube analysis, was converted to a low-fat diet. was on ranitidine for stress prophylaxis. At time of transfer he was maintained on Zantac while he continues on IV

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 45

Cardiology Author Type: Physician Filed: 8/26/2013 2:10 PM Note Time: 8/22/2013 8:22 AM Related Notes: Original Note by Kim, John S. filed at 8/22/2013 10:17 AM

Transfer Summary signed by Kaufman, Jonathan M. at 8/26/2013 2:10 PM Author: Kaufman, Jonathan M. Service:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes (continued)

NSAIDs. He is on lasix PO Q6 and aldactone PO BID.

HEME: was transfused in the OR with 161 ml of packed red blood cells and 100 ml of fresh frozen plasma.

ID: received peri-op antibiotics with no further infection concerns.

Neuro: pain has been controlled with IV ketorolac with PRN oxycodone and actaminophen.

Significant 24 hour Events: - Operative and post-operative course was smooth. - No acute events overnight. - Some complaint of dysuria, urinalysis normal. - Bilateral pleural chest tube drainage continues. - Left pleural fluid concerning for chyle.

Weight: Admit/Med Weight: Weight: 12.4 kg

Vitals (past 24 hours): Temp Avg: 37.2 °C (98.9 °F) Min: 36.5 °C (97.7 °F) Max: 37.8 °C (100 °F) Pulse Avg: 112.2 Min: 90 Max: 127 Rhythm: Normal sinus rhythm Resp Avg: 34.8 Min: 25 Max: 46 Cuff BP: Systolic (24hrs), Avg:96 mmHg, Min:81 mmHg, Max:114 mmHg Diastolic (24hrs), Avg:59 mmHg, Min:40 mmHg, Max:73 mmHg BP Mean Avg: 71.7 Min: 58 Max: 87 Art Line BP: No Data Recorded No Data Recorded No Data Recorded SpO2 Avg: 86.3 % Min: 80 % Max: 94 % Resp/Oxygen: O2 Flow Rate - LPM: 2 LITERS/MIN; Pacer Settings: None

General: Pleasant, interactive, quiet,no acute distress HEENT: NCAT, PERRL, MMM Neuro: Face symmetric, grossly non-focal, moves all extremities, normal gait. CVS: Precordium quiet, RRR, single S2, no murmur, no rubs or gallop, pulses 2+, cap refill brisk Resp: Breath sounds clear to auscultation bilaterally, no increased work of breathing GI: Soft, nontender, nondistended, liver at the right costal margin Ext: Warm, well perfused Skin: incision clean, dry, and intact and dressing in place over incision

Foreign bodies: Bilateral pleural chest tubes Central lines: none Fluids/Nutrition: low-fat diet I/O:

Intake/Output Summary (Last 24 hours) at 08/22/13 0822 Last data filed at 08/22/13 0800

Gross per 24 hour

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes (continued)

Intake 734.3 ml Output 996 ml Net -261.7 ml

UOP: 2.8 ml/kg/hr Stool: none Drains: - Left pleural chest tube: 156 ml total (54 ml since midnight) - Right pleural chest tube: 143 ml total (38 ml since midnight)

Data/Diagnostics Studies: BMP (Chem 10) Recent Labs

08/22/13 0810

NA 138 K 4.1 CL 98 BIC 29 BUN 16 CRE 0.30 GLU 99 CA 9.2 PHOS 3.5

CXR 8/22/13: - Upper lobe of left lung well aerated but with evolution of left pleural effusion. - Right middle lobe atelectasis improved. - Bilateral pleural chest tubes in place.

Infusions: none

Medications:

Current Facility-Administered Medications: oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg Active 0.1 mg/kg/dose Q4HPRN aspirin chewable tablet 40.5 mg Active 40.5 mg QDAY furosemide (conc: 10mg/mL) injectable 12.4 mg Active 1 mg/kg/dose Q8H spironolactone (conc: 2mg/mL) oral suspension 5 mg Active 5 mg BID acetaminophen (conc: 160mg/5mL) oral suspension 160 mg Active 160 mg Q4HPRN

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes (continued)

ketorolac (conc: 30mg/mL) injectable 6.2 mg Active 0.5 mg/kg/dose Q6H ondansetron oral disintegrating tablet 2 mg Active 2 mg Q8HPRN

Antibiotics: S/p perioperative cefazolin

CICU IMPRESSION: is a 3 year old male with double-outlet left ventricle (and tricuspid atresia) with malposed great vessels now status-post completion Fontan (history of bilateral bidirectional Glenn anastomoses). His post-operative course thus far has been unremarkable. He remains with bilateral pleural chest tubes and we are initiating oral feeds. left pleural fluid was analyzed but is revealing a mixed picture with high triglycerides but without lymphocyte predominance.

PLAN: CV: - Stable off milrinone. - Will follow clinical examination markers of perfusion. - Will follow for pleural effusion. - Will repeat pleural fluid analysis later today.

Pulm: - Wean nasal cannula as tolerated.

FENGI: - Will convert to low-fat diet today, pending further analysis. - Will wean lasix from IV to PO Q8. - Will continue ranitidine for gastritis prophylaxis while on IV NSAID.

ID: - S/p perioperative cefazolin. - No acute concerns at this time.

Heme: - Hematocrit stable at 45. - Continue aspirin.

Neuro: - Continue ketorolac for 48 hours total. - PRN oxycodone. - Acetaminophen around the clock.

Dispo: - Remains CICU status while initiation of oral intake.

John S. Kim, MD, MS Pediatric Cardiology Fellow Children's Hospital Colorado

8/22/2013

Communication: Patient seen and discussed with Dr. Kaufman.

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes (continued)

Discharge Order Set placed: No CARDIO Access updated: Yes

Cardiology CICU Attending Note For Children < 6 Years Old

Date of Service: 8/22/2103 At 0800, I examined who remains critically ill. I agree with the note by the the provider Dr Kim,, with the findings and recommendations as documented. No longer critically ill, taking po, equivocal chylous drainage with elevated TG but only 4% lymphocytes in pleural fluid that was tested. Plan to re- test, obtain a PICC placement and observe output. Transfer to the floor

Today, I saw and discussed with the CICU Team the following results: ECG ECHO CXR Ultrasound Cardiac Cath MRI Labs Other

The time spent with the patient included personal communication with spoke with CT Surgery, spoke with referrring Cardiologist and counseled family 10 mins.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 49

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Transfer Summary - All Notes (continued)

I examined the patient multiple times today. Time spent on any procedures is not included in today's billed critical care time.

Jonathan M. Kaufman, M.D.

Discharge Instructions

Instructions to Follow When You Get Home

Follow Up Care: You should call your primary care doctor as soon as you get home. He/She will be very· interested in seeing your child within 5-7 days after discharge. Incisional Wound Care: Keep the incision clean and dry.·

Infants and toddlers should wear bibs during meals and when teething.· Your child may need a sponge bath for a few days if he/she still has staples/ sutures in place.· Otherwise, your child may have a tub bath or shower depending on age and preference. If a tub bath is preferred, we ask that you fill the tub only waist deep when your child is sitting down. We don’t want the incision to soak in water while it is still healing. Typically the incision takes about 6-8 weeks to be fully healed. Clean the incision with soap and water and pat dry.· Wounds will take approximately 6-8 weeks to heal. Please have your child avoid situations where· falls or injuries might put undue tension on the wounds. For example, bike riding and swinging on bars should be avoided.

Activity Restrictions: Although your child is going home, the “work of recovery” is not done. Your child· will need to continue with the breathing treatments and walking as instructed by your doctor or nurse.

Avoid picking up your child from underneath the arms. With a sternal or breast bone incision,· nothing heavy (greater than 5 pounds) should be picked up by your child. With an incision on the side of the chest, help your child to exercise the arm to prevent a stiff shoulder by moving the arm up and down. (Ask your child’s nurse to demonstrate this). Your child will self-regulate his/her activities as he/she feels better.· Avoid situations of prolonged excessive group play with other children for the first few weeks,· especially if any of the children have any illnesses. You should check with your cardiologist about when your child can return to daycare or school.

When To Call: Please call your child’s surgeon and/or cardiologist for any concerns or questions,· especially if your child has:

Temperature greater than 101 degrees Fahrenheit (38.5 degrees Centigrade)· Prolonged nausea, vomiting, diarrhea· Decreased number of wet diapers or urine output· Redness, swelling, drainage, or tenderness of the incision· Signs or symptoms of respiratory distress: shortness of breath, blue skin color, pulling of chest· muscles when breathing, lung congestion, loose cough, etc.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 50

Electronically signed by Kaufman, Jonathan M. at 8/26/2013 2:10 PM Electronically signed by Kim, John S. at 8/22/2013 10:17 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Medications

Please be aware that pharmacies may use different concentrations of medications. Be sure to check with your pharmacist and the label on your prescription bottle for the appropriate amount of medication to give to your child.

It is important to keep a list of all the prescription medications, over-the –counter medications and herbal medications your child is taking. Have the medication information with you at all times in case of a medical emergency, and give the list to any medical provider that your child visits for care. It is important to update the medication list when any new medications are added, stopped or the dose of a medication is changed. Current Discharge Medication List

START taking these medications Details

furosemide (LASIX) 10 MG/ML Solution

13 mg (1.3 mL) by mouth twice a day for 31 days Next dose due: tonight @ 9pm

CONTINUE these medications which have CHANGED Details

aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab

81 mg (1 tab) by mouth every day Next dose due: 8/27 9am

Discharge Procedure Orders Home Oxygen Diagnosis (required) SV s/p fontan For renewal, please contact:

Other (See Comments) cardiologist

Room air saturation (include date and result)

85%

PCP Name Dr. Villavicencio PCP Phone Number 720.777.6820 Oxygen Flow Rate at Discharge (Lpm)

1/2L

Oxygen Usage CONTINUOUSLY Estimated length of need (maximum 6 months)

6 months

Discharge Follow-up Appointment

Follow-up appointment(s)

CV surgery post operative appointment Thursday August 29th: 1:00 chest xray and 1:45 with Faith Fisher NP

Follow-up appointment(s)

Please f/u with primary cardiologist in 3-4 weeks. Please call to schedule appointment.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 51

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Discharge Activity Sternal precautions Discharge activity AS TOLERATED

Discharge Diet Low FAT diet Discharge diet REGULAR FOR AGE

Discharge Instructions Please call for concerns with fever greater than 100.4, increased work of breathing, cyanosis, chest pain, palpitations, fainting, redness or drainage from incision, nausea/vomiting, or with other concerns. 720.777.6820

Clean incision with warm soap and water. Do not rub. No submersion. Pat dry.

Discharge Summary The patient is being discharged to home in stable condition. The discharge instructions have been reviewed with the adult assuming responsibility for care of the patient and a printed copy was given to them on 8/26/2013 . Their questions have been answered and they have stated that they will be able to provide the appropriate care.

Name of person receiving printed copy of discharge instructions: Rachel Richard

Relationship to patient: mom, dad

RN Giving Instructions: Julie A. Overholt8/26/2013

All Orders (08/26/13 - 08/19/13)

COMMUNICATION TO NURSING [39651511] Discontinued

Ordering user: Tiernan, Kendra D. 08/26/13 1130 Ordering provider: Tiernan, Kendra D. Authorized by: Tiernan, Kendra D. Frequency: Now 08/26/13 1130 - 1 Occurrences Electronically signed by:

Tiernan, Kendra D. 08/26/13 1130

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Comments:

D/c PICC line

aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab [39648301] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Tiernan, Kendra D. Frequency: QDAY 08/26/13 - Until Discontinued Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

furosemide (LASIX) 10 MG/ML Solution [39648302] Discontinued

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Tiernan, Kendra D. Frequency: BID 08/26/13 - 31 Days Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Discontinued by: Ferry, Susan C. 09/16/13 1243 [Dose adjustment]

INPATIENT DISCHARGE [39648303] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: ONCE 08/26/13 1030 - 1 Occurrences

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 52

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

INPATIENT DISCHARGE [39648303] (continued) Active Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Questions: Discharge when Other-add details in comments Comment - after diet education Disposition HOME Patient condition on discharge Good Discharge Summary To be completed in 24 hours by: TIERNAN, KENDRA D.

DISCHARGE F/U APPOINTMENT [39648304] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: 08/26/13 - Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Questions: Follow-up appointment(s) CV surgery post operative appointment Thursday August 29th: 1:00 chest xray and 1:45 with Faith Fisher NP Please f/u with primary cardiologist in 3-4 weeks. Please call to schedule appointment.

DISCHARGE ACTIVITY [39648305] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: 08/26/13 - Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Questions: Discharge activity AS TOLERATED Comments:

Sternal precautions

DISCHARGE DIET [39648306] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: 08/26/13 - Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Questions: Discharge diet REGULAR FOR AGE Comments:

Low FAT diet

DISCHARGE INSTRUCTIONS [39648307] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: 08/26/13 - Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Comments: Please call for concerns with fever greater than 100.4, increased work of breathing, cyanosis, chest pain, palpitations, fainting, redness or drainage from incision, nausea/vomiting, or with other concerns. 720.777.6820 Clean incision with warm soap and water. Do not rub. No submersion. Pat dry.

HOME OXYGEN [39648308] Active

Ordering user: Gerner, Bridget M. 08/26/13 1005 Ordering provider: Gerner, Bridget M. Authorized by: Gerner, Bridget M. Frequency: 08/26/13 - Electronically signed by:

Gerner, Bridget M. 08/26/13 1005

Diagnoses: Single ventricle [745.3] DOLV (double outlet left ventricle) [745.19] Other congenital anomalies of great veins [747.49] MAPCA (major aortopulmonary collaterals) without PA-VSD [747.39, 747.29]

Questions: Diagnosis (required) SV s/p fontan Room air saturation (include date and result) 85% PCP Name Dr. Villavicencio PCP Phone Number 720.777.6820 Oxygen Flow Rate at Discharge (Lpm) 1/2L Oxygen Usage CONTINUOUSLY Estimated length of need (maximum 6 months) 6 months For renewal, please contact: Other (See Comments) Comment - cardiologist

furosemide (conc: 10mg/mL) oral solution 12.4 mg [39648120] Discontinued

Ordering user: Tiernan, Kendra D. 08/26/13 0959 Ordering provider: Tiernan, Kendra D. Authorized by: Tiernan, Kendra D. Frequency: BID 08/26/13 2100 - 08/26/13 1334 Electronically signed by:

Tiernan, Kendra D. 08/26/13 0959

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Patient Discharged]

ECHO [39644587] Completed

Ordering user: Tiernan, Kendra D. 08/26/13 0747 Ordering provider: Tiernan, Kendra D.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 53

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ECHO [39644587] (continued) Completed

Authorized by: Tiernan, Kendra D. Frequency: ONCE 08/26/13 0800 - 1 Occurrences Electronically signed by:

Tiernan, Kendra D. 08/26/13 0747

Questions: Clinical indications? S/p Fontan Information desired from ECHO? post op study ECHO Type? Complete Echo Provider's name and phone/pager for questions/results: KT If you are not on the NICU, Hem/Onc or Cardiology service, please page 303-207-8815 for assistance. Please indicate who gave you authorization for this test: 74628

X-RAY CHEST 2 VIEW [39637753] Completed

Ordering user: Diamond, Bethany A. 08/25/13 1157 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: RAD ONE TIME 08/25/13 1156 - 1 Occurrences Electronically signed by:

Diamond, Bethany A. 08/25/13 1157

Questions: Select Date to be Performed: 8/26/2013 Enter IF needed within a Timeframe: AM

Comments: Clinical Indications for requested exam: s/p FONTAN, hx of effusions Information desired from requested exam: reaccumulation??

X-RAY CHEST 1 VIEW [39636519] Completed

Ordering user: Diamond, Bethany A. 08/25/13 0852 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: RAD ONE TIME 08/25/13 0825 - 1 Occurrences Electronically signed by:

Diamond, Bethany A. 08/25/13 0852

Questions: Select Date to be Performed: 8/25/2013 Comments:

Clinical Indications for requested exam: s/p chest tube removal Information desired from requested exam: pneumo??

midazolam (conc: 1mg/mL) injectable 0.5 mg [39636270] Discontinued

Ordering user: Mackie, Sara M. 08/25/13 0808 Ordering provider: Mackie, Sara M. Authorized by: Mackie, Sara M. Frequency: ONCE 08/25/13 0900 - 1 Occurrences Electronically signed by:

Mackie, Sara M. 08/25/13 0808

Discontinued by: Diamond, Bethany A. 08/25/13 1239

midazolam (conc: 1mg/mL) injectable 1 mg [39636264] Discontinued

Ordering user: Mackie, Sara M. 08/25/13 0807 Ordering provider: Mackie, Sara M. Authorized by: Mackie, Sara M. Frequency: ONCE 08/25/13 0900 - 1 Occurrences Electronically signed by:

Mackie, Sara M. 08/25/13 0807

Discontinued by: Mackie, Sara M. 08/25/13 0808

fentanyl (conc: 50mcg/mL) injectable 10 mcg [39636265] Completed

Ordering user: Mackie, Sara M. 08/25/13 0807 Ordering provider: Mackie, Sara M. Authorized by: Mackie, Sara M. Frequency: ONCE 08/25/13 0900 - 1 Occurrences Electronically signed by:

Mackie, Sara M. 08/25/13 0807

QCS=DRAINAGE CHEST INFAN [39630498] Completed

Ordering user: Romero, Kara R. 08/24/13 1301 Ordering provider: Romero, Kara R. Authorized by: Mackie, Sara M. Frequency: ONCE 08/24/13 1330 - 1 Occurrences Electronically signed by:

Romero, Kara R. 08/24/13 1301

Comments: Please send up ASAP

BASIC METABOLIC PANEL [39630219] Completed

Ordering user: Diamond, Bethany A. 08/24/13 1221 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: Now 08/25/13 0630 - 1 Occurrences Electronically signed by:

Diamond, Bethany A. 08/24/13 1221

X-RAY CHEST 2 VIEW [39630220] Discontinued

Ordering user: Diamond, Bethany A. 08/24/13 1221 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: RAD ONE TIME 08/24/13 1218 - 1 Occurrences Electronically signed by:

Diamond, Bethany A. 08/24/13 1221

Discontinued by: Ward, Matthew D. 08/25/13 0916 [RIS Other (Talked to

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 54

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

X-RAY CHEST 2 VIEW [39630220] (continued) Discontinued nurse. They pulled chest tube and just want a port 1 view. mdw)]

Questions: Select Date to be Performed: 8/25/2013 Enter IF needed within a Timeframe: AM

Comments: Clinical Indications for requested exam: s/p Fontan, hx of pleural effusions Information desired from requested exam: evidence of increasing effusion

spironolactone (conc: 2mg/mL) oral suspension 5 mg [39629662] Discontinued

Ordering user: Diamond, Bethany A. 08/24/13 1112 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: QDAY 08/25/13 0900 - 08/25/13 1239 Electronically signed by:

Diamond, Bethany A. 08/24/13 1112

Discontinued by: Diamond, Bethany A. 08/25/13 1239

WEIGHT, HEIGHT AND OFC [39628377] Discontinued

Ordering user: Diamond, Bethany A. 08/24/13 0903 Ordering provider: Diamond, Bethany A. Authorized by: Diamond, Bethany A. Frequency: As Specified 08/24/13 0930 - Until Specified Electronically signed by:

Diamond, Bethany A. 08/24/13 0903

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Weight DAILY

OXYGEN [39622136] Discontinued

Ordering user: Church, Jessica C. 08/23/13 1705 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: . 08/23/13 1730 - Until Specified Electronically signed by:

Church, Jessica C. 08/23/13 1705

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Titration Instructions: Do not titrate

Delivery Nasal Cannula O2 (enter specific LPM if certain flow desired) 1/2L Maintain SpO2 at: Other (enter in comments) Comment - >85

Comments: May change delivery to nasal cannula upon transport to nursing unit. Please notify the anesthesiologist if oxygen is required for more than 1 hour in the PACU.

X-RAY CHEST 2 VIEW [39618596] Completed

Ordering user: Church, Jessica C. 08/23/13 1456 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: RAD ONE TIME 08/23/13 1455 - 1 Occurrences Electronically signed by:

Church, Jessica C. 08/23/13 1456

Questions: Select Date to be Performed: 8/24/2013 Enter IF needed for a specific time: 8:00 AM Enter IF needed within a Timeframe: AM

Comments: Clinical Indications for requested exam: s/p fontan, chylothorax Information desired from requested exam: eval for effusion, interval change

DIET [39614756] Discontinued

Ordering user: Bernier, Benjamin 08/23/13 1238 Ordering provider: Bernier, Benjamin Authorized by: McCanta, Anthony C. Frequency: NOW 08/23/13 1300 - 1 Occurrences Electronically signed by:

Bernier, Benjamin 08/23/13 1238

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Type: Fat 10gm

appropriate for Junior 24-47mo Comments:

Low fat 10g/day

DIET [39614508] Discontinued

Ordering user: Tiernan, Kendra D. 08/23/13 1230 Ordering provider: Tiernan, Kendra D. Authorized by: Tiernan, Kendra D. Frequency: NOW 08/23/13 1230 - 1 Occurrences Electronically signed by:

Tiernan, Kendra D. 08/23/13 1230

Discontinued by: Bernier, Benjamin 08/23/13 1238 Questions: Type: Low Fat

appropriate for Junior 24-47mo Comments:

Low fat 10g/day

DIET [39614492] Discontinued

Ordering user: Tiernan, Kendra D. 08/23/13 1229 Ordering provider: Tiernan, Kendra D.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 55

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

DIET [39614492] (continued) Discontinued

Authorized by: Tiernan, Kendra D. Frequency: 0000 08/23/13 1230 - Until Specified Electronically signed by:

Tiernan, Kendra D. 08/23/13 1229

Discontinued by: Tiernan, Kendra D. 08/23/13 1230 Questions: Type: Low Fat

appropriate for Junior 24-47mo Comments:

Low fat 10g/day

CYTOPATHOLOGY REPORT [39645358] Completed

Ordering user: Interface, Results 08/23/13 1144 Ordering provider: McCanta, Anthony C. Authorized by: McCanta, Anthony C. Frequency: ONCE 08/23/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/23/13 1144

BASIC METABOLIC PANEL [39611034] Completed

Ordering user: Church, Jessica C. 08/23/13 1034 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: 0630 08/24/13 0630 - 1 Days Electronically signed by:

Church, Jessica C. 08/23/13 1034

X-RAY CHEST 2 VIEW [39610323] Completed

Ordering user: Church, Jessica C. 08/23/13 1014 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: RAD ONE TIME 08/23/13 1013 - 1 Occurrences Electronically signed by:

Church, Jessica C. 08/23/13 1014

Questions: Select Date to be Performed: 8/23/2013 Comments:

Clinical Indications for requested exam: s/p fontan, R CT removed Information desired from requested exam: eval for pneumo after CT removal, eval effusions

IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD [39610303] Completed

Ordering user: Blalock, Wayne J. 08/23/13 1012 Ordering provider: Blalock, Wayne J. Authorized by: Blalock, Wayne J. Frequency: 08/23/13 1012 - 1 Occurrences Electronically signed by:

Blalock, Wayne J. 08/23/13 1012

Comments: Unlinked Procedure Note Auto-Generation

DIET [39609932] Discontinued

Ordering user: Church, Jessica C. 08/23/13 1002 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: 0000 08/24/13 0002 - Until Specified Electronically signed by:

Church, Jessica C. 08/23/13 1002

Discontinued by: Tiernan, Kendra D. 08/23/13 1229 Questions: Type: Low Fat

appropriate for Junior 24-47mo Comments:

Low fat 10g/day

COMMUNICATION TO NURSING [39607168] Completed

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: ONCE 08/23/13 0830 - 1 Occurrences Electronically signed by:

Twite, Mark D. 08/23/13 0825

Comments: OK to start PCA ordered by procedural/surgical team

DISCONTINUE PACU ORDERS [39607169] Completed

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: ONCE 08/23/13 0830 - 1 Occurrences Electronically signed by:

Twite, Mark D. 08/23/13 0825

PACU DISCHARGE [39607170] Completed

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: ONCE 08/23/13 0830 - 1 Occurrences Electronically signed by:

Twite, Mark D. 08/23/13 0825

Questions: PACU Discharge Discharge patient from PACU per PACU Protocol

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 56

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

acetaminophen (conc: 160mg/5mL) oral suspension 186 mg [39607171] Expired

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: prn in PACU 08/23/13 0825 - 1 Occurrences PRN Comment: Pain Electronically signed by:

Twite, Mark D. 08/23/13 0825

Medication comments: Recommended dose: 15 mg/kg/dose (max dose: 650 mg/dose) x 1 dose

VITAL SIGNS [39607165] Discontinued

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: As Specified 08/23/13 0830 - Until Specified Electronically signed by:

Twite, Mark D. 08/23/13 0825

Discontinued by: Diamond, Bethany A. 08/24/13 1112 Comments:

Per "Peri-Operative Patient Care Guidelines for Nursing".

OXYGEN [39607166] Discontinued

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: . 08/23/13 0830 - Until Specified Electronically signed by:

Twite, Mark D. 08/23/13 0825

Discontinued by: Church, Jessica C. 08/23/13 1705 Questions: Titration Instructions: Titrate per clinical respiratory assessment and SpO2 (if applicable)

Delivery Blow By Maintain SpO2 at: Other (enter in comments) Comment - 92% or greater

Comments: May change delivery to nasal cannula upon transport to nursing unit. Please notify the anesthesiologist if oxygen is required for more than 1 hour in the PACU.

COMMUNICATION TO NURSING [39607167] Completed

Ordering user: Twite, Mark D. 08/23/13 0825 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: ONCE 08/23/13 0830 - 1 Occurrences Electronically signed by:

Twite, Mark D. 08/23/13 0825

Comments: OK to use oral analgesics ordered by procedural/surgical team

TRIGLYCERIDE, MISC FLUID [39606405] Completed

Ordering user: Church, Jessica C. 08/23/13 0748 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: Now 08/23/13 0800 - 1 Occurrences Electronically signed by:

Church, Jessica C. 08/23/13 0748

Comments: Enter Specimen Source: PLEURAL FLUID

PLEURAL FLD CC&DIFF(CYTOSPIN) [39606406] Completed

Ordering user: Church, Jessica C. 08/23/13 0748 Ordering provider: Church, Jessica C. Authorized by: Church, Jessica C. Frequency: Now 08/23/13 0800 - 1 Occurrences Electronically signed by:

Church, Jessica C. 08/23/13 0748

ibuprofen (conc: 100mg/5mL) oral suspension 120 mg [39605811] Discontinued

Ordering user: Burkett, Dale A. 08/23/13 0706 Ordering provider: Burkett, Dale A. Authorized by: Burkett, Dale A. Frequency: Q8HPRN 08/23/13 0706 - 08/26/13 1334 PRN Comment: pain Electronically signed by:

Burkett, Dale A. 08/23/13 0706

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Patient Discharged]

DIET. [39593102] Discontinued

Ordering user: Shirazi, Mona L. 08/22/13 1227 Ordering provider: Shirazi, Mona L. Authorized by: Kim, John S. Frequency: NOW 08/22/13 1230 - 1 Occurrences Electronically signed by:

Shirazi, Mona L. 08/22/13 1227

Discontinued by: Kim, John S. 08/23/13 0002 Questions: Type: Regular

Fats No Fat Restriction appropriate for Junior 24-47mo

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 57

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

TRANSFER PATIENT [39589063] Completed

Ordering user: Kim, John S. 08/22/13 1025 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: NOW 08/22/13 1030 - 1 Occurrences Electronically signed by:

Kim, John S. 08/22/13 1025

Questions: Attending MCCANTA, ANTHONY C. Service Cardiology

furosemide (conc: 10mg/mL) oral solution 12.4 mg [39587153] Discontinued

Ordering user: Kim, John S. 08/22/13 0924 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: TID 08/22/13 1500 - 08/26/13 0959 Electronically signed by:

Kim, John S. 08/22/13 0924

Discontinued by: Tiernan, Kendra D. 08/26/13 0959

aspirin chewable tablet 81 mg [39586959] Discontinued

Ordering user: Farina, Mark A. 08/22/13 0916 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: QDAY 08/22/13 1000 - 08/26/13 1334 Electronically signed by:

Farina, Mark A. 08/22/13 0916

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Patient Discharged]

CHEST TUBE [39586655] Discontinued

Ordering user: Kim, John S. 08/22/13 0907 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: . 08/22/13 0930 - Until Specified Electronically signed by:

Kim, John S. 08/22/13 0907

Discontinued by: Diamond, Bethany A. 08/25/13 1239 Questions: CHEST TUBE LOCATION 1 PLEURAL

CHEST TUBE LOCATION 2 PLEURAL Comments:

Please strip chest tubes every 4 hours

VITAL SIGNS [39586656] Discontinued

Ordering user: Kim, John S. 08/22/13 0907 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: Q4H 08/22/13 1200 - Until Specified Electronically signed by:

Kim, John S. 08/22/13 0907

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Comments:

**set arrhythmia mode on monitor**

CARDIAC PRE/POST PROCEDURE SCHEDULING [39586605] Active

Ordering user: Kim, John S. 08/22/13 0906 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: ONCE 08/22/13 0930 - 1 Occurrences Electronically signed by:

Kim, John S. 08/22/13 0906

Questions: This Admission? Yes Attending responsible for the patient: KAUFMAN, JONATHAN M. Preferred Date/Time to schedule procedure: 8/23/13 Complete Cardiac/Medical Diagnosis: s/p fontan with chylous effusion Procedure (1st): Other-see comment Comment - PICC line placement Procedure Length: 1 hr Pre-Procedure Patient Class/Status: Inpatient Post-Procedure Patient Class/Status: Inpatient Cardiac Anesthesia required? Yes Provider performing procedure: BLALOCK, WAYNE J.

WOUND CARE [39586400] Discontinued

Ordering user: Carpenter, Esther V. 08/22/13 0858 Ordering provider: Carpenter, Esther V. Authorized by: Mitchell, Max B. Frequency: As Specified 08/22/13 0900 - Until Specified Electronically signed by:

Kaufman, Jonathan M. 09/03/13 0927, for Ordering in Standing Order mode, Communicator - Carpenter, Esther V. Comment-as per CT surgery SSI prevention protocol

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Wound 1 Care: OTHER (IN COMMENTS) Comments:

Daily cleanse mediastinal incision with sterile saline wipe and change Mepilex border lite dressing until POD #7. Bedside RN may do daily incision care and change dressing. CT Surgery staff to assess and survey incision on M, W, F and prn. Please feel free to call CT Surgery re: any questions or concerns.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 58

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE [39586159] Completed

Ordering user: Carlson, Jeremy 08/22/13 0847 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: RAD ONE TIME 08/22/13 0847 - 1 Occurrences Electronically signed by:

Carlson, Jeremy 08/22/13 0847

Comments: Order Information: PICC LINE PROCEDURE SCHEDULING [S2070] (Order# 39585329) Ordered: 8/22/2013-0817 Priority: Inpt Surg Status: Sent Authorizing: John S. Kim, M.D. Ordering User: John S. Kim Order Class: inpatient Start Time: 08/22/13-0830 Freq: ONCE Duration: 1 Occurrence Scheduling Instructions: Use PICC Line Placement Order Set to place NPO and Medication orders Associated with PICC placement. *You MUST Contact the PICC Line at:720-777-9772 to SCHEDULE * Questions: Reason for PICC line EXTENDED PERIOD OF IV THERAPY Does the patient need general anesthesia or nurse sedation? Nurse Sedation Patient Class: Inpatient (Current Admission) Diagnosis: s/p fontan Attending Provider: KAUFMAN, JONATHAN M. [19466] Ordering Provider: KIM, JOHN S. [410047] Ordering Provider's contact number: 7-1960 Does patient require Interventional Radiologist for PICC Placement? No Single or dual lumen line? SINGLE Date Needed: 8/23/2013 Preferred location for PICC Procedure: CPPU

PICC LINE PROCEDURE SCHEDULING [39585326] Completed

Ordering user: Kim, John S. 08/22/13 0817 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: ONCE 08/22/13 0830 - 1 Occurrences Electronically signed by:

Kim, John S. 08/22/13 0817

Questions: Reason for PICC line EXTENDED PERIOD OF IV THERAPY Single or dual lumen line? DUAL Does the patient need general anesthesia or nurse sedation? Nurse Sedation Diagnosis: s/p fontan Patient Class: Inpatient (Current Admission) Ordering Provider: KIM, JOHN S. Ordering Provider's contact number: 7-1960 Does patient require Interventional Radiologist for PICC Placement? No Date Needed: 8/23/2013 Preferred location for PICC Procedure: CPPU Attending Provider: KAUFMAN, JONATHAN M.

DIET [39585327] Discontinued

Ordering user: Kim, John S. 08/22/13 0817 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: 0000 08/23/13 0002 - Until Specified Electronically signed by:

Kim, John S. 08/22/13 0817

Discontinued by: Church, Jessica C. 08/23/13 1002 Questions: Type: NPO

appropriate for Junior 24-47mo

DIET. [39584999] Discontinued

Ordering user: Shirazi, Mona L. 08/22/13 0759 Ordering provider: Shirazi, Mona L. Authorized by: Kim, John S. Frequency: NOW 08/22/13 0800 - 1 Occurrences Electronically signed by:

Shirazi, Mona L. 08/22/13 0759

Discontinued by: Shirazi, Mona L. 08/22/13 1227 Questions: Type: Low Fat

Fats Fat 10gm appropriate for Junior 24-47mo

RENAL FUNCTION PANEL [39584371] Completed

Ordering user: Farina, Mark A. 08/22/13 0709 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/22/13 0730 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/22/13 0709

CYTOPATHOLOGY REPORT [39585281] Completed

Ordering user: Interface, Results 08/22/13 0130 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/22/13 0130 - 1 Occurrences Electronically signed by:

Interface, Results 08/22/13 0130

TRIGLYCERIDE, MISC FLUID [39582821] Completed

Ordering user: Nicolarsen, Jeremy R. 08/22/13 0107 Ordering provider: Nicolarsen, Jeremy R. Authorized by: Nicolarsen, Jeremy R. Frequency: Now 08/22/13 0130 - 1 Occurrences Electronically signed by:

Nicolarsen, Jeremy R. 08/22/13 0107

Comments: Enter Specimen Source: PLEURAL FLUID

PLEURAL FLD CC&DIFF(CYTOSPIN) [39582822] Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 59

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

PLEURAL FLD CC&DIFF(CYTOSPIN) [39582822] (continued) Completed

Ordering user: Nicolarsen, Jeremy R. 08/22/13 0107 Ordering provider: Nicolarsen, Jeremy R. Authorized by: Nicolarsen, Jeremy R. Frequency: Now 08/22/13 0130 - 1 Occurrences Electronically signed by:

Nicolarsen, Jeremy R. 08/22/13 0107

oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg [39582816] Discontinued

Ordering user: Nicolarsen, Jeremy R. 08/22/13 0104 Ordering provider: Nicolarsen, Jeremy R. Authorized by: Nicolarsen, Jeremy R. Frequency: Q4HPRN 08/22/13 0104 - 08/26/13 1334 Electronically signed by:

Nicolarsen, Jeremy R. 08/22/13 0104

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Patient Discharged]

URINALYSIS WITH MICROSCOPIC [39581629] Completed

Ordering user: Nicolarsen, Jeremy R. 08/21/13 2152 Ordering provider: Nicolarsen, Jeremy R. Authorized by: Nicolarsen, Jeremy R. Frequency: ONCE 08/21/13 2200 - 1 Occurrences Electronically signed by:

Nicolarsen, Jeremy R. 08/21/13 2152

Questions: (Order Question) Source: Clean Catch/Bag Comments:

If timed, enter number of hours to be collected:

DIET. [39580886] Discontinued

Ordering user: Monaco, Anne 08/21/13 2029 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: NOW 08/21/13 2030 - 1 Occurrences Electronically signed by:

Monaco, Anne 08/21/13 2029

Discontinued by: Shirazi, Mona L. 08/22/13 0759 Questions: Type: Regular

appropriate for Junior 24-47mo

X-RAY CHEST 1 VIEW [39566384] Discontinued

Ordering user: Kim, John S. 08/21/13 1023 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: RADIOLOGY X 5 08/21/13 1023 - 99998 Occurrences Electronically signed by:

Kim, John S. 08/21/13 1023

Discontinued by: Kim, John S. 08/22/13 0907 Questions: Enter IF needed within a Timeframe: EARLY AM PORTABLES Comments:

Clinical Indications for requested exam: Post-op fontan with pleural chest tubes Information desired from requested exam: pleural effusion

CHEST TUBE [39566385] Discontinued

Ordering user: Kim, John S. 08/21/13 1023 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: . 08/21/13 1030 - Until Specified Electronically signed by:

Kim, John S. 08/21/13 1023

Discontinued by: Kim, John S. 08/22/13 0907 Questions: CHEST TUBE LOCATION 1 PLEURAL

CHEST TUBE LOCATION 2 PLEURAL

DIET. [39566355] Discontinued

Ordering user: Kim, John S. 08/21/13 1021 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: NOW 08/21/13 1030 - 1 Occurrences Electronically signed by:

Kim, John S. 08/21/13 1021

Discontinued by: Monaco, Anne 08/21/13 2029 Questions: Type: Regular

spironolactone (conc: 2mg/mL) oral suspension 5 mg [39566274] Discontinued

Ordering user: Kim, John S. 08/21/13 1019 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: BID 08/21/13 1100 - 08/24/13 1112 Electronically signed by:

Kim, John S. 08/21/13 1019

Discontinued by: Diamond, Bethany A. 08/24/13 1112

furosemide (conc: 10mg/mL) injectable 12.4 mg [39566235] Discontinued

Ordering user: Kim, John S. 08/21/13 1017 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: Q8H 08/21/13 1400 - 08/22/13 0924 Electronically signed Kim, John S. 08/21/13 1017

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 60

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

furosemide (conc: 10mg/mL) injectable 12.4 mg [39566235] (continued) Discontinued by: Discontinued by: Kim, John S. 08/22/13 0924

furosemide (conc: 10mg/mL) injectable 12.4 mg [39566099] Discontinued

Ordering user: Kim, John S. 08/21/13 1012 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: Q12H 08/21/13 1800 - 08/21/13 1017 Electronically signed by:

Kim, John S. 08/21/13 1012

Discontinued by: Kim, John S. 08/21/13 1017

aspirin chewable tablet 40.5 mg [39562213] Discontinued

Ordering user: Kim, John S. 08/21/13 0750 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: QDAY 08/21/13 0900 - 08/22/13 0916 Electronically signed by:

Kim, John S. 08/21/13 0750

Discontinued by: Farina, Mark A. 08/22/13 0916

midazolam (conc: 5mg/mL) injectable 1.24 mg [39562205] Discontinued

Ordering user: Kim, John S. 08/21/13 0748 Ordering provider: Kim, John S. Authorized by: Kim, John S. Frequency: Q1HPRN 08/21/13 0748 - 08/21/13 1024 PRN Comment: once Electronically signed by:

Kim, John S. 08/21/13 0748

Discontinued by: Kim, John S. 08/21/13 1024

BLOOD GASES, ART (RAPIDPOINT) [39561309] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

HCT (ISTAT) [39561311] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

SODIUM - WHOLE BLOOD [39561313] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

POTASSIUM - WHOLE BLOOD [39561315] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

GLUCOSE - WHOLE BLOOD [39561317] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

IONIZED CALCIUM - WHOLE BLOOD [39561319] Completed

Ordering user: Interface, Results 08/21/13 0549 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/21/13 0600 - 1 Occurrences Electronically signed by:

Interface, Results 08/21/13 0549

DIET. [39559036] Discontinued

Ordering user: Alvarez, Rita 08/20/13 2135 Ordering provider: Alvarez, Rita Authorized by: Alvarez, Rita Frequency: NOW 08/20/13 2200 - 1 Occurrences Electronically signed by:

Alvarez, Rita 08/20/13 2135

Discontinued by: Kim, John S. 08/21/13 1021

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 61

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All Orders (08/26/13 - 08/19/13) (continued)

DIET. [39559036] (continued) Discontinued Questions: Type: Clear Liquid

ondansetron oral disintegrating tablet 2 mg [39559023] Discontinued

Ordering user: Alvarez, Rita 08/20/13 2132 Ordering provider: Alvarez, Rita Authorized by: Alvarez, Rita Frequency: Q8HPRN 08/20/13 2132 - 08/25/13 1239 Electronically signed by:

Alvarez, Rita 08/20/13 2132

Discontinued by: Diamond, Bethany A. 08/25/13 1239

furosemide (conc: 10mg/mL) injectable 12.4 mg [39559005] Discontinued

Ordering user: Alvarez, Rita 08/20/13 2130 Ordering provider: Alvarez, Rita Authorized by: Alvarez, Rita Frequency: Q8H 08/20/13 2200 - 08/21/13 1012 Electronically signed by:

Alvarez, Rita 08/20/13 2130

Discontinued by: Kim, John S. 08/21/13 1012

BLOOD GASES, ART (RAPIDPOINT) [39557755] Completed

Ordering user: Interface, Results 08/20/13 1833 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1900 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1833

BLOOD GASES, ART (RAPIDPOINT) [39557026] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

HCT (ISTAT) [39557028] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

SODIUM - WHOLE BLOOD [39557030] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

POTASSIUM - WHOLE BLOOD [39557032] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

GLUCOSE - WHOLE BLOOD [39557034] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

IONIZED CALCIUM - WHOLE BLOOD [39557036] Completed

Ordering user: Interface, Results 08/20/13 1729 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1730 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1729

BLOOD GASES, ART (RAPIDPOINT) [39554188] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1534

HCT (ISTAT) [39554190] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 62

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

HCT (ISTAT) [39554190] (continued) Completed Electronically signed by:

Interface, Results 08/20/13 1534

SODIUM - WHOLE BLOOD [39554192] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1534

POTASSIUM - WHOLE BLOOD [39554194] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1534

GLUCOSE - WHOLE BLOOD [39554196] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1534

IONIZED CALCIUM - WHOLE BLOOD [39554198] Completed

Ordering user: Interface, Results 08/20/13 1534 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1600 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1534

BLOOD GASES, ART (RAPIDPOINT) [39552348] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

HCT (ISTAT) [39552350] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

SODIUM - WHOLE BLOOD [39552352] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

POTASSIUM - WHOLE BLOOD [39552354] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

GLUCOSE - WHOLE BLOOD [39552356] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

IONIZED CALCIUM - WHOLE BLOOD [39552358] Completed

Ordering user: Interface, Results 08/20/13 1434 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1500 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1434

BLOOD GASES, ARTERIAL [39550127] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed Interface, Results 08/20/13 1326

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

BLOOD GASES, ARTERIAL [39550127] (continued) Completed by:

HCT (ISTAT) [39550129] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1326

SODIUM - WHOLE BLOOD [39550131] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1326

POTASSIUM - WHOLE BLOOD [39550133] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1326

GLUCOSE - WHOLE BLOOD [39550135] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1326

IONIZED CALCIUM - WHOLE BLOOD [39550137] Completed

Ordering user: Interface, Results 08/20/13 1326 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1326

PLATELET COUNT [39550225] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

INR AND PROTHROMBIN TIME [39550227] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

PT 1:1 CORRECTION [39550229] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

FIBRINOGEN [39550231] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

D-DIMER [39550233] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

PLATELET FUNCT. ANAL. (EPI) [39550235] Completed

Ordering user: Interface, Results 08/20/13 1320 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1320

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 64

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

LACTATE, WHOLE BLOOD [39549744] Completed

Ordering user: Interface, Results 08/20/13 1313 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1313

ACTIVATED CLOTTING TIME [39549645] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

BLOOD GASES, ARTERIAL [39549731] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

HCT (ISTAT) [39549733] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

SODIUM - WHOLE BLOOD [39549735] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

POTASSIUM - WHOLE BLOOD [39549737] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

GLUCOSE - WHOLE BLOOD [39549739] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

IONIZED CALCIUM - WHOLE BLOOD [39549741] Completed

Ordering user: Interface, Results 08/20/13 1309 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1330 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1309

bacitracin injection [39549540] Discontinued

Ordering user: Stowers, Annamarie 08/20/13 1306 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: procedural 08/20/13 1258 - 08/20/13 1507 Electronically signed by:

Stowers, Annamarie 08/20/13 1306

Discontinued by: Farina, Mark A. 08/20/13 1507

BLOOD GASES, ARTERIAL [39548579] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

HCT (ISTAT) [39548581] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 65

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

SODIUM - WHOLE BLOOD [39548583] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

POTASSIUM - WHOLE BLOOD [39548585] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

GLUCOSE - WHOLE BLOOD [39548587] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

IONIZED CALCIUM - WHOLE BLOOD [39548589] Completed

Ordering user: Interface, Results 08/20/13 1225 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1225

ACTIVATED CLOTTING TIME [39548827] Completed

Ordering user: Interface, Results 08/20/13 1224 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1230 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1224

ACTIVATED CLOTTING TIME [39547912] Completed

Ordering user: Interface, Results 08/20/13 1158 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1158

BLOOD GASES, ARTERIAL [39547480] Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

HCT (ISTAT) [39547482] Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

SODIUM - WHOLE BLOOD [39547484] Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

POTASSIUM - WHOLE BLOOD [39547486] Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

GLUCOSE - WHOLE BLOOD [39547488] Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

IONIZED CALCIUM - WHOLE BLOOD [39547490] Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 66

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

IONIZED CALCIUM - WHOLE BLOOD [39547490] (continued) Completed

Ordering user: Interface, Results 08/20/13 1146 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1200 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1146

ACTIVATED CLOTTING TIME [39546889] Completed

Ordering user: Interface, Results 08/20/13 1120 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1130 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1120

BLOOD GASES, ARTERIAL [39545420] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

HCT (ISTAT) [39545422] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

SODIUM - WHOLE BLOOD [39545424] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

POTASSIUM - WHOLE BLOOD [39545426] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

GLUCOSE - WHOLE BLOOD [39545428] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

IONIZED CALCIUM - WHOLE BLOOD [39545430] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

ACTIVATED CLOTTING TIME [39545635] Completed

Ordering user: Interface, Results 08/20/13 1048 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1100 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1048

ACTIVATED CLOTTING TIME [39544898] Completed

Ordering user: Interface, Results 08/20/13 1027 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 1030 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 1027

LACTATE, WHOLE BLOOD [39540785] Completed

Ordering user: Interface, Results 08/20/13 0825 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0825

BLOOD GASES, ARTERIAL [39540788] Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 67

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

BLOOD GASES, ARTERIAL [39540788] (continued) Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

HCT (ISTAT) [39540790] Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

SODIUM - WHOLE BLOOD [39540792] Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

POTASSIUM - WHOLE BLOOD [39540794] Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

GLUCOSE - WHOLE BLOOD [39540796] Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

IONIZED CALCIUM - WHOLE BLOOD [39540798] Completed

Ordering user: Interface, Results 08/20/13 0821 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0821

ACTIVATED CLOTTING TIME [39540688] Completed

Ordering user: Interface, Results 08/20/13 0820 Ordering provider: Kaufman, Jonathan M. Authorized by: Kaufman, Jonathan M. Frequency: ONCE 08/20/13 0830 - 1 Occurrences Electronically signed by:

Interface, Results 08/20/13 0820

X-RAY 1 VIEW AP CHEST - VENTILATOR [39540107] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: RAD ONE TIME 08/20/13 0754 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: Clinical Indications for requested exam: Post-op cardiothoracic surgery Information desired from requested exam: Check lines and tubes Upon Arrival

X-RAY 1 VIEW AP CHEST - VENTILATOR [39540108] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: RADIOLOGY X 5 08/20/13 0754 - 5 Days Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Brett, Jean 08/21/13 0625 [RIS Clerical Error] Comments:

Clinical Indications for requested exam: Post-op cardiothoracic surgery Information desired from requested exam: check lines, tubes and lung fields

A WIRE [39540109] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: Clinical Indications for ECG: Information desired from ECG:

ECG [39540110] Discontinued

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 68

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ECG [39540110] (continued) Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/22/13 0907 Comments:

CICU

MIXED VENOUS OXYGEN SAT (SVO2) [39540111] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: CONTINUOUS 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2255 [No diagnostic need]

POSITIONING [39540112] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q2H 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Patient Positioning TURN AND POSITION

DOPamine 128 mg in D5W (dextrose 5 %) 40 mL [39540113] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: CONTINUOUS 08/20/13 0900 - 08/21/13 0750 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 0750 Medication comments:

Recommended dose: 3-15 mcg/kg/min

milrinone 12 mg in D5W (dextrose 5 %) 60 mL [39540114] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: CONTINUOUS 08/20/13 0900 - 08/22/13 0108 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Nicolarsen, Jeremy R. 08/22/13 0108 Medication comments:

Recommended dose: 0.3 - 1 mcg/kg/min

morphine (conc: 2mg/mL) injectable 0.62-1.24 mg [39540115] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q2HPRN 08/20/13 0800 - 08/22/13 0821 PRN Comment: pain Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/22/13 0821 Medication comments:

Recommended Dose Range: 0.05 - 0.1mg/kg/dose (max dose: 5 mg/dose) IV q1-2 hrs prn

acetaminophen (conc: 160mg/5mL) oral suspension 160 mg [39540116] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q4HPRN 08/20/13 0800 - 08/26/13 1334 PRN Comment: temp greater than 38.5C or pain Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Patient Discharged]

Medication comments: Recommended dose: 15 mg/kg/dose (max dose: 650mg/dose) every 4 hours prn

acetaminophen rectal suppository 120 mg [39540117] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q4HPRN 08/20/13 1200 - 08/21/13 1019 PRN Comment: temp greater than 38.5C or pain Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 69

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

acetaminophen rectal suppository 120 mg [39540117] (continued) Discontinued Recommended dose: 15 mg/kg/dose (max dose: 650 mg/dose) q4h PRN

ketorolac (conc: 30mg/mL) injectable 6.2 mg [39540118] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q6H 08/20/13 2000 - 48 Hours Electronically signed by:

Farina, Mark A. 08/20/13 0805

Medication comments: Recommended dose: 0.5 mg/kg/dose (max dose: 30mg/dose) q6h x 48 hours

ceFAZolin in dextrose (20 mg/mL) 372 mg [39540119] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q8H 08/20/13 1800 - 2 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Medication comments: Recommended dose for patients less than 7 days & wt greater than 2000g: 20 mg/kg/dose every 8 hours x 2 doses ** start first dose 8 hours after last administered dose **

ondansetron (conc: 2mg/mL) injectable 1.9 mg [39540120] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q6HPRN 08/20/13 0802 - 08/21/13 0750 PRN Comment: nausea & vomiting Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 0750 Medication comments:

Recommended dose: Standard dose (max dose: 4 mg/dose) q6h PRN

albumin 5% (conc: 5 g/100 mL) injectable 3-6 g [39540121] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: PRN 08/20/13 0802 - 08/21/13 1019 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose: 5 -10 mL/kg

sodium bicarbonate 8.4 % (conc: 1 mEq/mL) injectable 12 mEq [39540122] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: PRN 08/20/13 1200 - 08/21/13 1019 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019

X-RAY CHEST 1 VIEW [39561466] Discontinued

Ordering user: Brett, Jean 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: RADIOLOGY X 5 08/21/13 0754 - 99999 Occurrences Electronically signed by:

Brett, Jean 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Comments:

Clinical Indications for requested exam: Post-op cardiothoracic surgery Information desired from requested exam: check lines, tubes and lung fields

D5W-1/2NS (dextrose 5% in 0.45% sodium chloride) 500 mL [39540074] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Continuous 08/20/13 1200 - 08/22/13 0108 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Nicolarsen, Jeremy R. 08/22/13 0108

NS (sodium chloride 0.9%) 500mL with heparin 1,000 units [39540075] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Continuous 08/20/13 1200 - 08/21/13 1024 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1024

FEEDING & SWALLOWING CONSULTATION [39540076] Discontinued

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 70

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

FEEDING & SWALLOWING CONSULTATION [39540076] (continued) Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021

CONSULT INPT LACTATION NURSE [39540077] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

1. Farina, Mark A. 08/20/13 0805 2. Farina, Mark A. 08/20/13 1632, for Discontinuing in Standing Order mode, Communicator - Kascht, Catharine A.

Discontinued by: Kascht, Catharine A. 08/20/13 1223 [No diagnostic need] Questions: Reason for consult: Newborn infant in CICU

Specific question to be answered by consultant: Assist mother with breastfeeding/pumping to develop milk supply

CONSULT INPT PHYSICAL THERAPY [39540078] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Reason for consult: Evaluate and Treat

Precautions NONE

ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL [39540079] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q8H 08/20/13 1700 - 08/22/13 0108 Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Nicolarsen, Jeremy R. 08/22/13 0108 Medication comments:

Recommended dose: 1 mg/kg/dose (max dose: 50 mg/dose) IV q8h

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 3.72 mEq [39540080] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: PRN 08/20/13 1200 - 08/21/13 1019 PRN Comment: K+ less than 3.8 mmol/L Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose: 0.3 mEq/kg/dose (max dose: 10 mEq) prn for K+ less than 3.8 mmol/L; infuse over 2 hours

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 6.2 mEq [39540081] Discontinued

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose: 0.5 mEq/kg/dose (max dose: 20 mEq/dose) prn for K+ less than 3.4 mmol/L; Infuse over 2 hours

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 12.4 mEq [39540082] Discontinued

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose: 1 meq/kg/dose (max dose: 40 mEq/dose) prn if K+ less than 3 mmol/L; Infuse over 2 hours

calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL [39540083] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: PRN 08/20/13 1200 - 08/21/13 1019 PRN Comment: ionized calcium less than 1.4 mmol/L Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 71

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL [39540083] (continued) Discontinued Medication comments:

Recommended dose for ionized calcium less than 1.4 mmol/L: 5 mg/kg/dose (max dose: 500 mg/dose); Administer IV slowly

calcium chloride 124 mg in NS (0.9% sodium chloride) 6.2 mL [39540084] Discontinued

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose for ionized calcium less than 1.2 mmol/L: 10 mg/kg/dose (max dose: 500 mg/dose); Administer IV slowly

calcium chloride 248 mg in NS (0.9% sodium chloride) 12.4 mL [39540085] Discontinued

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose for ionized calcium less than or equal to 1 mmol/L: 20 mg/kg/dose (max dose: 1000 mg/dose); Administer IV slowly

magnesium sulfate (conc: 80 mg/mL) injectable 310 mg [39540086] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: PRN 08/20/13 1200 - 08/21/13 1019 PRN Comment: serum magnesium less than 1.7 mEq/L Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1019 Medication comments:

Recommended dose: 25 mg/kg/dose (max dose: 2000mg/dose) IV prn for serum magnesium less than 1.7 mEq/L ; infuse over 2 hours

POINT OF CARE CRIT CARE PROF [39540087] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

CBC WITH DIFF [39540088] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

BASIC METABOLIC PANEL [39540089] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

MAGNESIUM (SERUM) [39540090] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

PHOSPHORUS, SERUM [39540091] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

INR AND PROTHROMBIN TIME [39540092] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 72

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

PARTIAL THROMBOPLASTIN [39540093] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

FIBRINOGEN [39540094] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

LACTATE, WHOLE BLOOD [39540095] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Now 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

LACTATE, WHOLE BLOOD [39540096] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Per Comment 08/20/13 0754 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Comments:

12 Hours Post-op

COOXIMETRY STUDIES [39540097] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Per Comment 08/20/13 0754 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Questions: SPECIMEN TYPE: VENOUS Comments:

Every 12 Hours Post-op while monitoring, for catheter calibration

CBC WITH DIFF [39540098] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

BASIC METABOLIC PANEL [39540099] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

MAGNESIUM (SERUM) [39540100] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

PHOSPHORUS, SERUM [39540101] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 73

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

HEPATIC FUNCTION PANEL [39540102] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

LACTATE, WHOLE BLOOD [39540103] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 3 Days Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023

INR AND PROTHROMBIN TIME [39540104] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

PARTIAL THROMBOPLASTIN [39540105] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: 0630 08/21/13 0630 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Comments: First AM Post-Op, draw at 0400

POINT OF CARE CRIT CARE PROF [39540106] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Per Comment 08/20/13 0754 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Comments:

Per physician request

ADMISSION [39540051] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: NOW 08/20/13 0800 - 1 Occurrences Electronically signed by:

Farina, Mark A. 08/20/13 0805

Questions: Attending KAUFMAN, JONATHAN M. Admit to INPT STATUS Service Critical Care

VITAL SIGNS [39540052] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: As Specified 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/22/13 0907 Comments:

Every 15 minutes times 4, then every 30 minutes times 2, then every 1 hour. **set arrhythmia mode on monitor**

ARTERIAL LINE [39540053] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: CONTINUOUS 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Questions: Arterial line TRANSDUCE Comments:

Continuously monitor BP.

ACTIVITY [39540054] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 74

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ACTIVITY [39540054] (continued) Discontinued

Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Activity BEDREST

ELEVATE HEAD OF BED [39540055] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Indicate Degrees of Elevation 30

INTAKE AND OUTPUT [39540056] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Strict 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge]

CARDIORESPIRATORY MONITORING [39540057] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Frequency Continuous

Level of Activity while on Monitor: Patient needs to be on monitoring for procedures and transport Indication for CR Monitor: Arrhythmia (CPCU or Critical Care Only)

CATHETER [39540058] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Care: TO GRAVITY

Catheter: FOLEY

CHEST TUBE [39540059] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1023 Questions: CHEST TUBE LOCATION 1 PERICARDIAL

CHEST TUBE LOCATION 2 PLEURAL CHEST TUBE LOCATION 3 PLEURAL

FEEDING TUBE [39540060] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q4H 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2255 [No diagnostic need] Questions: Tube NASOGASTRIC

Action LOW INTERMITTENT SUCTION

COMMUNICATION TO NURSING [39540061] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Comments:

Check for blood return on all Central and Pressure lines once every shift with nursing discretion.

COMMUNICATION TO NURSING [39540062] Discontinued

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 75

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

COMMUNICATION TO NURSING [39540062] (continued) Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Comments:

First Post-Op Dressing Change to be done by Physician, Fellow or Nurse Practicioner.

WOUND CARE [39540063] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: As Specified 08/20/13 0800 - Until Specified Electronically signed by:

1. Farina, Mark A. 08/20/13 0805 2. Kaufman, Jonathan M. 09/03/13 0927, for Discontinuing in Standing Order mode, Communicator - Carpenter, Esther V. Comment-as per CT surgery SSI prevention protocol

Discontinued by: Carpenter, Esther V. 08/22/13 0858 Questions: Wound 1 Care: OTHER (IN COMMENTS) Comments:

Remove dressing 48 hours post-op or sooner if saturated.

IMPLEMENT MEDICAL/NON-VIOLENT RESTRAINT (WITH MED-EQUIP) [39540064] Completed

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Continuous x 24 Hours 08/20/13 0800 - 24 Hours Electronically signed by:

Farina, Mark A. 08/20/13 0805

PULSE OXIMETRY [39540065] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: CONTINUOUS 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge] Questions: Level of Activity While on Monitor (If Continuous) Patient needs to be on monitoring for procedures and transport

Indications for Continuous Pulse Ox: Unstable Respiratory Status Frequency Continuous - select an indication

VENTILATOR VOLUME MODE [39540066] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q3 Vent Check 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2135 [No diagnostic need] Questions: Rate (bpm) 16

PEEP / CPAP (cm H2O) 5 Tidal Volume (mL) 110 Operation Mode SIMV

ELEVATE HEAD OF BED [39540067] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: AS TOLERATED 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Farina, Mark A. 08/20/13 1507 Questions: Indicate Degrees of Elevation 30

ORAL CARE [39540068] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Q4H 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2255 [No diagnostic need]

COMMUNICATION TO NURSING [39540069] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Comments:

Check tube placement and taping q3-4 hours and upon return to unit (from radiology, OR, etc.)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 76

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

COMMUNICATION TO NURSING [39540070] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2255 [No diagnostic need] Comments:

Drain ventilator circuit PRN and before repositioning patient.

COMMUNICATION TO NURSING [39540071] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Alvarez, Rita 08/20/13 2135 [No diagnostic need] Comments:

Check Gastric pH q day if NPO Continue while pt. intubated, on Ranitidine/acid reducers and NG/OG in place

IMPLEMENT MEDICAL/NON-VIOLENT RESTRAINT (WITH MED-EQUIP) [39540072] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: Continuous x 24 Hours 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Farina, Mark A. 08/20/13 1507

TOTAL FLUIDS [39540073] Discontinued

Ordering user: Farina, Mark A. 08/20/13 0805 Ordering provider: Farina, Mark A. Authorized by: Farina, Mark A. Frequency: . 08/20/13 0800 - Until Specified Electronically signed by:

Farina, Mark A. 08/20/13 0805

Discontinued by: Kim, John S. 08/21/13 1021 Questions: Total fluid rate (volume/time period) 22 ml/hr Comments:

Open heart cases 1/2 maintenance (calculation per Nursing Procedure, "Intravenous Therapy"). Fat emulsion is NOT included in total fluids.

midazolam (conc: 2mg/mL) oral syrup 6 mg [39539106] Completed

Ordering user: Nichols, Christopher S. 08/20/13 0703 Ordering provider: Nichols, Christopher S. Authorized by: Nichols, Christopher S. Frequency: ONCE 08/20/13 0800 - 1 Occurrences Electronically signed by:

Nichols, Christopher S. 08/20/13 0703

Medication comments: Recommended dose: 0.25-0.3 mg/kg/dose (max dose: 20 mg)

mannitol 25% (conc: 0.25 g/mL) injectable 6.2 g [39539078] Discontinued

Ordering user: Bliss, Paula Sunshine 08/20/13 0700 Ordering provider: Twite, Mark D. Authorized by: Twite, Mark D. Frequency: Once in OR 08/20/13 0800 - 1 Occurrences Electronically signed by:

Twite, Mark D. 08/20/13 0850, for Ordering in Telephone with Readback mode, Communicator - Bliss, Paula Sunshine

Discontinued by: Farina, Mark A. 08/20/13 1507

dexmedetomidine 100 mcg in NS (0.9% sodium chloride) 25 mL [39538818] Expired

Ordering user: Bjur, Kara 08/20/13 0617 Ordering provider: Bjur, Kara Authorized by: Bjur, Kara Frequency: Once in CVOR 08/20/13 0700 - 1 Occurrences Electronically signed by:

Bjur, Kara 08/20/13 0617

nitroprusside sodium 15 mg in D5W (dextrose 5 %) 30 mL [39538819] Discontinued

Ordering user: Bjur, Kara 08/20/13 0617 Ordering provider: Bjur, Kara Authorized by: Bjur, Kara Frequency: Once in CVOR 08/20/13 0700 - 1 Occurrences Electronically signed by:

Bjur, Kara 08/20/13 0617

Discontinued by: Farina, Mark A. 08/20/13 1507

BLOOD TYPE (ABO/RH) [39520684] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 77

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ANTIBODY SCREEN [39520686] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

HOLD CLOT FOR TYPE AND SCREEN [39520717] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

CBC WITH DIFF [39521223] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

MRSA PCR QUAL [39521225] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

BASIC METABOLIC PANEL [39521227] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

PACKED CELL [39522397] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

FRESH FROZEN PLASMA [39539119] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

CRYOPRECIPITATE [39548228] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

APHERESED PLATELET [39548230] Completed

Ordering user: Interface, Results 08/19/13 0946 Ordering provider: Mitchell, Max B. Authorized by: Mitchell, Max B. Frequency: ONCE 08/19/13 1000 - 1 Occurrences Electronically signed by:

Interface, Results 08/19/13 0946

ADMISSION [39516782] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: NOW 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507 Questions: Attending MITCHELL, MAX B.

Admit to INPT STATUS Service Surgery-Cardio/Thoracic Condition Critical

WEIGHT, HEIGHT AND OFC [39516783] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: As Specified 08/19/13 0630 - Until Specified

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 78

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

WEIGHT, HEIGHT AND OFC [39516783] (continued) Discontinued Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Gerner, Bridget M. 08/22/13 1631 Questions: Height/Length ONCE

Weight ONCE

VITAL SIGNS [39516784] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Q4H 08/19/13 0800 - Until Specified Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507

DIET. [39516785] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: NOW 08/20/13 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Alvarez, Rita 08/20/13 2135 Questions: Type: NPO Comments:

For solids/formula/breast milk; may have clear liquids up to 0500

NS (sodium chloride 0.9%) 500mL with heparin 1,000 units [39516786] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Once in OR 08/20/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507

DOPamine 96 mg in D5W (dextrose 5 %) 30 mL [39516787] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Once in OR 08/20/13 0700 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507

milrinone 6 mg in D5W (dextrose 5 %) 30 mL [39516788] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Once in OR 08/20/13 0600 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507

CBC WITH DIFF [39516789] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Now 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

BASIC METABOLIC PANEL [39516790] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Now 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

ECHO [39516791] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Questions: Clinical indications? preop study Information desired from ECHO? complete non sedated ECHO Type? Complete Echo

ECHO [39516792] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 0630 - 1 Occurrences

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 79

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ECHO [39516792] (continued) Completed Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Questions: Clinical indications? preop tee Information desired from ECHO? Pre-op TEE ECHO Type? TEE Pre Echo

ECHO [39516793] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Questions: Clinical indications? post op complete Information desired from ECHO? Post-op TEE ECHO Type? TEE Post Echo

STANDARD PRECAUTIONS ONLY [39516794] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Auto Discontinue, At Discharge 08/26/13 1334 [Discharge]

chlorhexidine gluconate (HIBICLENS) 4% topical liquid [39516795] Expired

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: PREOP 08/19/13 1900 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

ceFAZolin in dextrose (20 mg/mL) 520 mg [39516796] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Once in OR 08/20/13 0600 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507 Medication comments:

Recommended dose: 40 mg/kg/dose (max dose: 2 grams/dose) x 1 dose for non-bypass patients; Order a second dose for bypass patients

ceFAZolin in dextrose (20 mg/mL) 520 mg [39516797] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Once in OR 08/20/13 0600 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507 Medication comments:

Recommended dose: 40 mg/kg/dose (max dose: 2 grams/dose); Order 2 doses for patients on bypass.

cardioplegia irrigation solution [39516798] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: PRN in OR 08/20/13 0600 - 08/20/13 1507 Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507

MRSA PCR QUAL [39516799] Discontinued

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Now 08/20/13 0600 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Discontinued by: Farina, Mark A. 08/20/13 1507 Questions: SOURCE: NASAL SWAB Comments:

Differentiating/Identifying Spec Info:

TYPE & SCREEN [39516800] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Now 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 80

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

CROSSMATCH RBC REQUEST [39516801] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: Send Order to BB Now 08/20/13 0600 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Questions: Has Signature been obtained for Informed Consent? No, TO BE OBTAINED on day of procedure and/or transfusion Transfusion History No Reaction History Is the Patient's current hemoglobin (Hb) greater than 7g/dL Yes, Other (describe in comments) Physician Pager # 303-916-8081 Product Special Requirements: (all units leukoreduced) None Enter # Units or # mL PRBC (recommend 10-15 mL/kg) 3 Units or mLs UNITS Infusion Rate or Duration: (Recommended Rate is 2-5 ml/kg/hr. Duration not to exceed 4 hours) During Procedure Place Needed: SURGERY Date/Time product needed: 0700 8/20/2013 Split Full Units into Halves? No Irradiation No

PLATELETS REQUEST [39516802] Completed

Fisher, Faith A. 08/19/13 0621

Questions: Has Signature been obtained for Informed Consent? No, TO BE OBTAINED on day of procedure and/or transfusion Is the Patient's current Platelet Count greater than 10,000/uL Yes, Other (describe in comments) Transfusion History No Reaction History Physician Pager # 303-916-8081 Product Special Requirements: (all units leukoreduced) None # Random Donor Equivalent Platelets Units: (Recommend 1 RDE/10 kg. 6 RDE Max) 3 Infusion Rate: DURING PROCEDURE Place Needed: SURGERY Date/Time product needed: 0700 8/20/2013 Irradiation No

FRESH FROZEN PLASMA REQUEST [39516803] Completed

Fisher, Faith A. 08/19/13 0621

Questions: Infusion Start Time: PRN FOR OR/PROCEDURE Has Signature been obtained for Informed Consent? No, TO BE OBTAINED on day of procedure and/or transfusion Indications: SURGERY/PROCEDURE Transfusion History No Reaction History Physician Pager # 303-916-8081 Units or mLs UNITS Infuse On (Date) 8/20/2013 # of Units or MLs of FFP: 3 ..or Infuse DURING PROCEDURE

CRYOPRECIPITATE REQUEST [39516804] Completed

Fisher, Faith A. 08/19/13 0621

Questions: Infusion Start Time: PRN FOR OR/PROCEDURE Has Signature been obtained for Informed Consent? No, TO BE OBTAINED on day of procedure and/or transfusion Transfusion History No Reaction History Physician Pager # 303-916-8081 Indications for Cryo: OTHER (SPECIFY) Infuse On (Date) 8/19/2013 Units Cryoprecipitate (recommend 1 unit/5kg) 3 ..or Infuse DURING PROCEDURE

X-RAY CHEST 2 VIEW [39516805] Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: RAD ONE TIME 08/19/13 0620 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Questions: Select Date to be Performed: 8/19/2013 Comments:

Clinical Indications for requested exam: preop study Information desired from requested exam: eval heart size and lung fields

ECG [39516806] Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 81

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Orders (08/26/13 - 08/19/13) (continued)

ECG [39516806] (continued) Completed

Ordering user: Fisher, Faith A. 08/19/13 0621 Ordering provider: Fisher, Faith A. Authorized by: Fisher, Faith A. Frequency: ONCE 08/19/13 0630 - 1 Occurrences Electronically signed by:

Fisher, Faith A. 08/19/13 0621

Comments: For CT Surg pre-op

Microbiology - Results

MRSA PCR QUAL [39521226] Resulted: 08/19/13 1154, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[2013:MM0015278R] RESPIRATORY; Nasal Swab 08/19/13 0946

Blood Bank - Results

PACKED CELL [39522398] Resulted: 08/19/13 0955, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

FRESH FROZEN PLASMA [39539120] Resulted: 08/19/13 0955, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 82

Result: Unit No Bld Type Product Sts Date W140513442295 ON PC TRANSFUSED 201308210652 W140513552321 ON PC NOT AVAILABLE W140513552349 ON PC NOT AVAILABLE

Component Value Ref Range Flag Comment Lab MRSA PCR QUAL - - TCH MAIN

LAB Result: NO METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS DNA DETECTED

Testing was performed by Xpert MRSA, a real-time qualitative PCR that detects a cassette inserted into the S. aureus genome which confers methicillin-resistance. Sensitivity is >86% and specificity is >93% compared to reference culture. In populations with a high prevalence of MRSA, assay PPV is >73% and NPV is >97%. Lower sensitivity can be caused by poor specimen collection or handling prior to testing. This test detects MRSA colonization and is indicated for making infection control decisions in the healthcare settings. It should not be used for diagnostic purposes or for making therapeutic decisions. The current version of the assay occasionally detects methicillin-sensitive strains of S. aureus.

Component Value Ref Range Flag Comment Lab Packed Cell - - TCH MAIN

LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Blood Bank - Results (continued)

FRESH FROZEN PLASMA [39539120] (continued) Resulted: 08/19/13 0955, Result Status: Edited Result - FINAL

ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

CRYOPRECIPITATE [39548229] Resulted: 08/19/13 0955, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

APHERESED PLATELET [39548231] Resulted: 08/19/13 0955, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

HOLD CLOT FOR TYPE AND SCREEN [39520718] Resulted: 08/19/13 0956, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00023R] Lab Specimen 08/19/13 0946

ANTIBODY SCREEN [39520687] Resulted: 08/19/13 1043, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

BLOOD TYPE (ABO/RH) [39520685] Resulted: 08/19/13 1109, Result Status: Edited Result - FINAL

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 83

- - TCH MAIN LAB

Component

Component Value Ref Range Flag Comment Lab Hold Clot 72HR. EXPIRATION - TCH MAIN

LAB

Value Ref Range Flag Comment Lab Cryoprecipitate - - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab Apheresed Platelet,LR - - TCH MAIN

LAB Result: Unit No Bld Type Product Sts Date

W036213787902A AN PLTA TRANSFUSED 201308210652

Component Value Ref Range Flag Comment Lab Antibody Screen NEG - TCH MAIN

LAB

Result: Unit No Bld Type Product Sts Date W140513551189 ON CRYO TRANSFUSED 201308210652 W140513551253 ON CRYO TRANSFUSED 201308210652 W140513441271 ON CRYO TRANSFUSED 201308210652

Result: Unit No Bld Type Product Sts Date W140513550830 ON FFP TRANSFUSED 201308210652

Component Value Ref Range Flag Comment Lab Fresh Frozen Plasma

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Blood Bank - Results (continued)

BLOOD TYPE (ABO/RH) [39520685] (continued) Resulted: 08/19/13 1109, Result Status: Edited Result - FINAL

Ordering provider: Mitchell, Max B. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:BB00024R] Lab Specimen 08/19/13 0946

Narrative: ENTER VOLUME ORDERED FOR WB or PC PRODUCT: 3 UNITS ENTER VOLUME ORDERED FOR CRYO: 3 ENTER VOLUME ORDERED FOR FFP: 200 ML ENTER VOLUME ORDERED FOR PLT: 3 RDE

Pathology - Results

CYTOPATHOLOGY REPORT [39585282] Resulted: 08/22/13 1520, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/22/13 0130 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[13:CY1722] Lab Specimen 08/22/13 0130

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 84

- TCH MAIN LAB

Component Value Ref Range Flag

Component Value Ref Range Flag Comment Lab Cytopathology Report - - TCH MAIN

LAB Result: Run: 08/22/13 1520 LIS Specimen Inquiry

Run User: INTERFACE --------------------------------------------------------------------- ---------- Name: Age/Sex: 3Y 10M/M Location: 9CPCU Acct#: 0204990349 Unit#: Status: ADM IN Room/Bed: 905-1 Reg: 08/20/13 Disch: Att Dr: MCCANTA,ANTHONY C --------------------------------------------------------------------- ---------- Spec #: 13:CY1722 Recd: 08/22/13-0812 Status: SOUT Req #: 05919066

SpType: CYTOPATH Sub Dr: KAUFMAN,JONATHAN M

CLINICAL DATA

3 year old male with pulmonary stenosis.

DIAGNOSIS

CEREBROSPINAL FLUID, CYTOSPIN PREPARATION: - ACUTE AND CHRONIC INFLAMMATION. - BLOOD CONTAMINATION AND/OR HEMORRHAGE.

LABORATORY DATA

CC-D PLEURAL TOT PLEU VOL 8.0 ML PLEU VOL 6.5 ML PLEU COLOR RED PLEU CHAR CLOUDY PLEU NUC CELLS 900 MM/3

No established pediatric reference range.

Comment Lab Blood Type O NEGATIVE

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Pathology - Results (continued)

CYTOPATHOLOGY REPORT [39585282] (continued) Resulted: 08/22/13 1520, Result Status: Final result

CYTOPATHOLOGY REPORT [39645359] Resulted: 08/26/13 1414, Result Status: Final result

Ordering provider: McCanta, Anthony C. 08/23/13 1144 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[13:CY1736] Lab Specimen 08/23/13 1144

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 85

Component Value Ref Range Flag Comment Lab Cytopathology Report - - TCH MAIN

LAB Result: Run: 08/26/13 1414 LIS Specimen Inquiry

Run User: INTERFACE --------------------------------------------------------------------- ---------- Name: Age/Sex: 3Y 11M/M Location: 9CPCU Acct#: 0204990349 Unit#: Status: DIS IN Room/Bed: 905-1 Reg: 08/20/13 Disch: 08/26/13 Att Dr: TRUONG,UYEN T

PLEU RBC 30000 MM/3 No established pediatric reference range.

DIFF, PLEURAL SEGS, PLEU 51 % LYMPHS, PLEU 4 % MONOS, PLEU 43 % MACRO, PLEU 1 % MESOTHCELL,PLEU 1 % C CNT ON PLEU 100

MICROSCOPIC DESCRIPTION

(1 Wright's): Specimen and slides are satisfactory for evaluation.

XL/vg 8/22/13 --------------------------------------------------------------------- ----------

Signed Xiayuan Liang, MD 08/22/13 1520

--------------------------------------------------------------------- ----------

** END OF REPORT **

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Pathology - Results (continued)

CYTOPATHOLOGY REPORT [39645359] (continued) Resulted: 08/26/13 1414, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 86

--------------------------------------------------------------------- ---------- Spec #: 13:CY1736 Recd: 08/26/13-0831 Status: SOUT Req #: 05923660

SpType: CYTOPATH Sub Dr: MCCANTA,ANTHONY C

CLINICAL DATA

3 year old with congenital heart and lung disorder.

DIAGNOSIS

PLEURAL FLUID, CYTOSPIN PREPARATION: - ACUTE AND CHRONIC INFLAMMATION. - BLOOD CONTAMINATION AND/OR HEMORRHAGE.

LABORATORY DATA

CC-D PLEURAL TOT PLEU VOL 1.5 ML PLEU VOL 1.5 ML PLEU COLOR AMBER PLEU CHAR CLOUDY PLEU NUC CELLS 807 MM/3

No established pediatric reference range. PLEU RBC 8050 MM/3

No established pediatric reference range. PLEU RBC MORPH NORMAL

DIFF, PLEURAL SEGS, PLEU 41 % EOS, PLEU 1 % LYMPHS, PLEU 26 % MONOS, PLEU 24 % MESOTHCELL,PLEU 8 % PLEU COMMENTS SEE PATH REPORT C CNT ON PLEU 100

MICROSCOPIC DESCRIPTION

(1 Wright's): Specimen and slides are satisfactory for evaluation.

XL/ac 08/26/2013 --------------------------------------------------------------------- ----------

Signed Xiayuan Liang, MD 08/26/13 1414

--------------------------------------------------------------------- ----------

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Pathology - Results (continued)

CYTOPATHOLOGY REPORT [39645359] (continued) Resulted: 08/26/13 1414, Result Status: Final result

EKG - Results

ECG [39516817] Resulted: 08/19/13 2148, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0621 Order Status: Completed Specimen: [ ]

08/19/13 1123

A WIRE [39540158] Resulted: 08/22/13 1221, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Specimen: [ ]

08/20/13 1544

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 87

55 QT Interval 388 - 55 QTc Interval 445 - 55 P Axis 49 - 55 I: 40 Axis 99 - 55 T: 40 Axis 124 - 55 QRS Axis 116 - 55 ST Axis 94 - 55 T Wave Axis 97 - 55 EKG Severity - ABNORMAL ECG - - 55 EKG Severity -------------------- PEDIATRIC ECG

INTERPRETATION -------------------- - 55

EKG Severity SINUS RHYTHM - 55 EKG Severity RAA, CONSIDER BIATRIAL

ABNORMALITIES - 55

EKG Severity NONSPECIFIC INTRAVENTRICULAR CONDUCTION DELAY

- 55

** END OF REPORT **

Component Value Ref Range Flag Comment Lab Heart Rate 79 - 55 RR 759 - 55 P-R Interval 100 - 55

Component Value Ref Range Flag Comment Lab Heart Rate 98 - 55 RR 612 - 55 P-R Interval 96 - 55 QRSD Interval 88 - 55 QT Interval 388 - 55 QTc Interval 496 - 55 P Axis 35 - 55 I: 40 Axis 95 - 55 T: 40 Axis 135 - 55 QRS Axis 103 - 55 ST Axis -61 - 55 T Wave Axis 33 - 55 EKG Severity - ABNORMAL ECG - - 55 EKG Severity -------------------- PEDIATRIC ECG

INTERPRETATION -------------------- - 55

QRSD Interval 98 -

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

EKG - Results (continued)

A WIRE [39540158] (continued) Resulted: 08/22/13 1221, Result Status: Final result

ECHO - Results

ECHO [39516812] Resulted: 08/19/13 1043, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0621 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 88

RIGHT VENTRICULAR HYPERTROPHY

- 55

EKG Severity INTRAVENTRICULAR CONDUCTION DELAY

- 55

EKG Severity PROLONGED QT, PROBABLY SECONDARY TO WIDE QRS

- 55

EKG Severity SINUS RHYTHM

Component Value Ref Range Flag Comment Lab ECHO - -

Result: Procedure: Transthoracic Echocardiogram Patient: DOB(Age): 3y) Med Rec#: Sex: M Date: 08/19/2013 Height: 96.7(cm)/38(in) Pt. Loc: Clinic Weight: 12.4(kg)/27(lbs Order#: 39516812 BSA: 0.58 m2

Referring: Outpatient Reading: Uyen Troung, MD Attending: Faith Fisher Technician: Lora Ringgenberg, RDCS

INDICATION: History: Single ventricle (morphologic left ventricle on right side of heart, l-looped ventricles) with l-malposed great vessels. Status post bilateral bidirectional Glenn anastomoses atrial septectomy and ligation of main pulmonary artery with resection of pulmonary valve tissue. General Comments: A complete two-dimensional, conventional and color Doppler echocardiographic study is obtained with fair image quality. Unsedated patient. Very active patient.

CONCLUSIONS Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right and left Glenn shunts. The branch pulmonary arteries are well visualized with low velocity, phasic flow from their respective Glenns. Multiple small aortopulmonary collaterals; most prominent one arises from descending aorta entering region of left pulmonary artery. Wide open atrial communication Unobstructed bulboventricular foramen. Trivial atrioventricular valve regurgitation.

- 55 EKG Severity

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516812] (continued) Resulted: 08/19/13 1043, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 89

Trace infufficiency through the native pulmonary valve. Stump of native MPA seen No aortic valve stenosis, trace aortic insufficiency. Unobstructed aortic arch. Subjectively normal right-sided, morphologic left ventricular systolic function.

FINDINGS

Situs and Relations: There is levocardia with visceral and atrial situs solitus. (There is L-looping with L-malposed great vessels.)

Venous Connections: The hepatic veins and IVC drain to the right atrium. Unable to identify all pulmonary veins. No evidence of abnormal pulmonary venous connections. There are bilateral bidirectional Glenn shunts noted. There is normal color flow in the right Glenn shunt. There is normal color flow in the left Glenn shunt.

Atria: There is a common atrium with no identifiable atrial septum. (Status post atrial septectomy.)

Atrial Septum: There is a wide open atrial communication following atrial septectomy.

AV Valves: The mitral valve annulus appears large. There is normal antegrade mitral valve flow. There is a trace amount of mitral regurgitation. There is atresia of the tricuspid valve.

Semilunar Valves: There is moderate dilation of the aortic valve annulus. There is normal antegrade flow across the aortic valve. There is a trace of aortic valve regurgitation.

Aortic Pulmonary Root: The pulmonary root is post surgical plication.

Thoracic Arteries: The aortic arch is left-sided with normal brachiocephalic vessels. The ascending aorta is normal in size, without dilation, narrowing or

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516812] (continued) Resulted: 08/19/13 1043, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 90

aneurysm. The RPA is well seen and appears widely patent at the Glenn anastomosis and is of adequate size. The LPA is well visualized and appears widely patent. There is continuous flow in the branch pulmonary arteries. There is unobstructed antegrade flow in the branch pulmonary arteries. The patent ductus arteriosus is post surgical ligation. There is no residual patent ductus arteriosus. There is Doppler color flow consistent with the presence of collaterals.

Coronary Arteries: The coronary arteries are not seen with this study.

Effusion: There is no pericardial or pleural effusion noted.

MEASUREMENTS

VITALS: Name Value Normal Range ZSCORE BSA 0.58 m2 None None

AORTA : Name Value Normal Range ZSCORE AAo pk vel 0.81 m/sec (0.79 to 1.55) -1.92 AAo pk grad 2.62 mmHg None None DAo distal pk vel 1.21 m/sec (0.82 to 1.67) -0.17 DAo pk grad 5.86 mmHg None None

Professional Billing CPT Codes(s): Color Doppler (93325) Echo CHD; Compl. (93303) Doppler; Compl. (93320)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516812] (continued) Resulted: 08/19/13 1043, Result Status: Final result

ECHO [39516813] Resulted: 08/20/13 0859, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0621 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 91

Component Value Ref Range Flag Comment Lab ECHO - -

Result: Procedure: Transthoracic Echocardiogram Patient: DOB(Age): 3y) Med Rec#: Sex: M Date: 08/20/2013 Height: 96.7(cm)/38(in) Pt. Loc: Weight: 12.4(kg)/27(lbs Order#: 39516813 BSA: 0.58 m2

Referring: TEE-OR Reading: Adel Younoszai, MD Technician: Matthew Demecs, RDCS Performing: Adel Younoszai, MD

CONCLUSIONS Pre-operative TEE in CVOR-2 prior to Fontan completion. Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right Glenn shunt. The left Glenn could not be optimally visualized. The branch pulmonary arteries are well visualized with low velocity, phasic flow. Unobstructed inferior vena cava. Multiple small aortopulmonary collaterals. Wide open atrial communication Trivial atrioventricular valve regurgitation. Trace infufficiency through the native pulmonary valve. Stump of

BIAGIO PIETRA, M.D. (546-3042) SHELLEY MIYAMOTO, M.D. (546-5238) DENNIS CHANG, M.D. (546-5294) BRIAN FONSECA, M.D. (546-6028) BRUCE LANDECK, M.D. (546-6008) Electronically signed at 08/19/2013 16:22:16 by: Uyen Troung, MD

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516813] (continued) Resulted: 08/20/13 0859, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 92

native MPA seen. No aortic valve stenosis or insufficiency. Subjectively low-normal right-sided, morphologic left ventricular systolic function.

FINDINGS

Situs and Relations: There is levocardia with visceral and atrial situs solitus. (There is L-looping with L-malposed great vessels.)

Venous Connections: The hepatic veins and IVC drain to the right atrium. There is normal pulmonary venous drainage to the left atrium. There is a right sided bidirectional Glenn shunt. (There are bidirectional Glenn shunts. Unable to visualize the left Glenn shunt.) There is normal color flow in the right Glenn shunt.

Atria: There is a common atrium with no identifiable atrial septum. (Status post atrial septectomy.)

Atrial Septum: There is a wide open atrial communication following atrial septectomy.

AV Valves: The mitral valve annulus appears large. There is normal antegrade mitral valve flow. There is a trace amount of mitral regurgitation. There is atresia of the tricuspid valve.

Semilunar Valves: There is moderate dilation of the aortic valve annulus. There is normal antegrade flow across the aortic valve.

Aortic Pulmonary Root: The pulmonary root is post surgical plication.

Thoracic Arteries: The aortic arch is left-sided with normal brachiocephalic vessels. The ascending aorta is normal in size, without dilation, narrowing or aneurysm. The RPA is well seen and appears widely patent at the Glenn anastomosis and is of adequate size. The LPA is well visualized and appears widely patent. There is continuous flow in the branch pulmonary arteries. There is unobstructed antegrade flow in the branch pulmonary

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516813] (continued) Resulted: 08/20/13 0859, Result Status: Final result

ECHO [39516814] Resulted: 08/20/13 1246, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0621 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 93

Component Value Ref Range Flag Comment Lab ECHO - -

Result: Procedure: Transthoracic Echocardiogram Patient: DOB(Age): 3y)

arteries. The patent ductus arteriosus is post surgical ligation. There is Doppler color flow consistent with the presence of collaterals.

Coronary Arteries: The coronary arteries are not seen with this study.

Effusion: There is no pericardial or pleural effusion noted.

MEASUREMENTS

VITALS: Name Value Normal Range ZSCORE BSA 0.58 m2 None None

Professional Billing CPT Codes(s): Color Doppler (93325) Echo CHD; Compl. (93303) Doppler; Compl. (93320)

I certify that (1) all services on this form were rendered and are hereby approved for billing, (2) the medical record has been documented for these services, (3) the rendering of the services and the documentation in the medical record are in accordance with UPI guidelines. Interpreted by: ADEL YOUNOSZAI, M.D. (546-5518) ELIZABETH M. SHAFFER, M.D.(546-1823) KARRIE VILLAVICENCIO, M.D.(546-4970) D. DUNBAR IVY, M.D. (546-2613) BIAGIO PIETRA, M.D. (546-3042) SHELLEY MIYAMOTO, M.D. (546-5238) DENNIS CHANG, M.D. (546-5294) BRIAN FONSECA, M.D. (546-6028) BRUCE LANDECK, M.D. (546-6008) Electronically signed at 08/20/2013 09:41:04 by: Adel Younoszai, MD

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516814] (continued) Resulted: 08/20/13 1246, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 94

Med Rec#: Sex: M Date: 08/20/2013 Height: 96.7(cm)/38(in) Pt. Loc: CVOR Weight: 12.4(kg)/27(lbs Order#: 39516814 BSA: 0.58 m2

Referring: TEE-OR Reading: Adel Younoszai, MD Technician: Carlie Bremen, RDCS Performing: Adel Younoszai, MD

INDICATION: History: Single ventricle (morphologic left ventricle on right side of heart, l-looped ventricles) with l-malposed great vessels. Status post bilateral bidirectional Glenn anastomoses atrial septectomy and ligation of main pulmonary artery with resection of pulmonary valve tissue. Fontan (8/20/13). General Comments: A complete two-dimensional, conventional and color Doppler echocardiographic study is obtained with good image quality.

CONCLUSIONS Fontan baffle is well seen with unobstructed flow. There is a fenestration with phasic forward flow (unable to calculate a mean gradient due to poor Doppler angle). Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right Glenn shunt. The left Glenn could not be optimally visualized. The branch pulmonary arteries are well visualized with low velocity, phasic flow. Unobstructed inferior vena cava. Multiple small aortopulmonary collaterals. Wide open atrial communication Trivial-to-mild atrioventricular valve regurgitation. Normal right-sided, morphologic left ventricular systolic function.

FINDINGS

Situs and Relations: There is levocardia with visceral and atrial situs solitus. (There is L-looping with L-malposed great vessels.)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516814] (continued) Resulted: 08/20/13 1246, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 95

Unable to visualize the left Glenn shunt.) There is normal color flow in the right Glenn shunt. There is a fenestrated extracardiac Fontan connection. The Fontan baffle has non-turbulent flow, and appears unobstructed.

Atria: There is a common atrium with no identifiable atrial septum. (Status post atrial septectomy.)

Atrial Septum: There is a wide open atrial communication following atrial septectomy.

AV Valves: The mitral valve annulus appears large. There is normal antegrade mitral valve flow. There is a trace amount of mitral regurgitation. ((Trivial-to-mild).) There is atresia of the tricuspid valve.

Semilunar Valves: There is moderate dilation of the aortic valve annulus. There is normal antegrade flow across the aortic valve.

Aortic Pulmonary Root: The pulmonary root is post surgical plication.

Thoracic Arteries: The RPA is well seen and appears widely patent at the Glenn anastomosis and is of adequate size. The LPA is well visualized and appears widely patent. There is continuous flow in the branch pulmonary arteries. There is unobstructed antegrade flow in the branch pulmonary arteries. The patent ductus arteriosus is post surgical ligation. There is Doppler color flow consistent with the presence of collaterals.

Coronary Arteries: The coronary arteries are not seen with this study.

Effusion: There is no pericardial or pleural effusion noted.

MEASUREMENTS

VITALS: Name Value Normal Range ZSCORE BSA 0.58 m2 None None Diastolic BP 42 mmHg None None

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39516814] (continued) Resulted: 08/20/13 1246, Result Status: Final result

ECHO [39644588] Resulted: 08/26/13 0837, Result Status: Final result

Ordering provider: Tiernan, Kendra D. 08/26/13 0747 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 96

Component Value Ref Range Flag Comment Lab ECHO - -

Result: Procedure: Transthoracic Echocardiogram Patient: DOB(Age): 3y) Med Rec#: Sex: M Date: 08/26/2013 Height: 96.7(cm)/38(in) Pt. Loc: CPCU Weight: 12.4(kg)/27(lbs Order#: 39644588 BSA: 0.58 m2

Referring: Inpatient Reading: Julio Lutterbach Technician: Carlie Bremen, RDCS

INDICATION:

HR BP 85/42

Professional Billing CPT Codes(s): Color Doppler (93325) Echo CHD; Compl. (93303) Doppler; Compl. (93320)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39644588] (continued) Resulted: 08/26/13 0837, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 97

History: Single ventricle (morphologic left ventricle on right side of heart, l-looped ventricles) with l-malposed great vessels. Status post bilateral bidirectional Glenn anastomoses atrial septectomy and ligation of main pulmonary artery with resection of pulmonary valve tissue. S/P Fontan with fenestration (8/20/13). General Comments: A complete two-dimensional, conventional and color Doppler echocardiographic study is obtained with fair image quality. Unsedated patient. Patient was agitated during the study. Very active patient.

CONCLUSIONS Technically study secondary to uncooperative, agitated and active patient. Fontan with laminar flow and a mean gradient of 6.8 mmHg through the fenestration. Bilateral Glenn anastomoses with unobstructed, phasic low velocity antegrade flow in right and left Glenn shunts. The proximal branch pulmonary arteries are well visualized with low velocity, phasic flow from their respective Glenns. Collaterals are not visualized secondary to patient agitation on this study. Wide open atrial communication Unobstructed bulboventricular foramen. Trivial atrioventricular valve regurgitation. Trace insufficiency through the native pulmonary valve. Stump of native MPA seen No aortic valve stenosis, trace aortic insufficiency. Unobstructed aortic arch. Subjectively normal right-sided, morphologic left ventricular systolic function. No appreciable pericardial effusion or pleural effusions.

FINDINGS

Situs and Relations: There is levocardia with visceral and atrial situs solitus. (There is L-looping with L-malposed great vessels.)

Venous Connections: Unable to identify all pulmonary veins. No evidence of abnormal pulmonary venous connections. There are bilateral bidirectional Glenn shunts noted. There is normal color flow in the right Glenn shunt. There

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39644588] (continued) Resulted: 08/26/13 0837, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 98

is normal color flow in the left Glenn shunt. There is a fenestrated extracardiac Fontan connection. The mean gradient in the Fontan is 6.8 meters/second.

Atria: There is a common atrium with no identifiable atrial septum. (Status post atrial septectomy.)

Atrial Septum: There is a wide open atrial communication following atrial septectomy.

AV Valves: The mitral valve annulus appears large. There is normal antegrade mitral valve flow. There is a trace amount of mitral regurgitation. There is atresia of the tricuspid valve.

Semilunar Valves: There is moderate dilation of the aortic valve annulus. There is normal antegrade flow across the aortic valve. There is a trace of aortic valve regurgitation.

Aortic Pulmonary Root: The pulmonary root is post surgical plication.

Coronary Arteries: The coronary arteries are not seen with this study.

Effusion: There is no pericardial or pleural effusion noted.

MEASUREMENTS

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ECHO - Results (continued)

ECHO [39644588] (continued) Resulted: 08/26/13 0837, Result Status: Final result

Imaging - Results

X-RAY 1 VIEW AP CHEST - VENTILATOR [39560399] Resulted: 0000, Result Status: In process

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 99

VITALS: Name Value Normal Range ZSCORE BSA 0.58 m2 None None Diastolic BP 67 mmHg None None

AORTA : Name Value Normal Range ZSCORE AAo pk vel 0.58 m/sec (0.79 to 1.55) -3.13 DAo distal pk vel 1.26 m/sec (0.82 to 1.67) 0.07

GLENN/FONTAN: Name Value Normal Range ZSCORE Fontan mn grad 6.8 mmHg None None

HR BP 86/67

Professional Billing CPT Codes(s): Color Doppler (93325) Echo CHD; Compl. (93303) Doppler; Compl. (93320)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Imaging - Results (continued)

X-RAY 1 VIEW AP CHEST - VENTILATOR [39560399] (continued) Resulted: 0000, Result Status: In process

Ordering provider: Farina, Mark A. 08/21/13 0145 Order Status: Canceled Discontinued by: Brett, Jean 08/21/13 0625 [RIS Clerical Error] Performed: 08/21/13 0436 - 08/21/13 0436 Resulting Lab: TCH RADIOLOGY

X-RAY CHEST 2 VIEW [39520535] Resulted: 08/19/13 1025, Result Status: Edited Result - FINAL

Ordering provider: Fisher, Faith A. 08/19/13 0951 Order Status: Completed Resulted by: Browne, Lorna Performed: 08/19/13 0959 - 08/19/13 1007 Addenda: Impression should read: Stable appearance of postoperative chest

Electronic Signature by: Lorna Browne; Authenticated signature date and time: 8/19/2013 10:25 AM; Reviewed and Interpreted by Attending Radiologist: Lorna Browne

Signed: 08/19/13 1025 by Browne, Lorna

Narrative: X-RAY CHEST 2 VIEW:

comparison is made with the most recent previous CXR dated June 1

FINDINGS: Stable appearance of sternotomy wires mediastinal clips and embolization coils. Stable lung volumes with stable interstitial prominence. There is no evidence of consolidation or pleural effusion.

No bony abnormalities identified.

Impression: Impression:

Normal chest

End of impression:

Electronic Signature by: Lorna Browne; Authenticated signature date and time: 8/19/2013 10:23 AM; Reviewed and Interpreted by Attending Radiologist: Lorna Browne

X-RAY 1 VIEW AP CHEST - VENTILATOR [39552541] Resulted: 08/20/13 1512, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 1446 Order Status: Completed Resulted by: Dannull, Kimberly A. Performed: 08/20/13 1446 - 08/20/13 1501 Narrative: X-RAY 1 VIEW AP CHEST - VENTILATOR

COMPARISON: 8/19/13

FINDINGS: Findings concerning for ventilator associated pneumonia: No

There is been interval cardiothoracic surgery. An ET tube is present which terminates in the midthoracic trachea. Right internal jugular catheter terminates near expected right brachiocephalic vein. Esophagogastric tube is at least within the body of the stomach. Epicardial pacing wires are present in addition to mediastinal and bilateral chest drains. There are now 5 sternotomy wires. Vascular coils and clips are relatively similar. No obvious pneumothorax. There is mild pulmonary vascular congestion. No focal lung opacity.

Impression: IMPRESSION: No unexpected finding status post recent cardiothoracic surgery.

Electronic Signature by: Kimberly A Dannull, MD; Authenticated signature date and time: 8/20/2013 3:12 PM; Reviewed and Interpreted by Attending Radiologist: Kimberly A Dannull, MD

X-RAY CHEST 1 VIEW [39561467] Resulted: 08/21/13 0844, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0145 Order Status: Completed Resulted by: Swerdlow, Mathew P.

Hay, Thomas C. Provider, Tch

Performed: 08/21/13 0515 - 08/21/13 0525

Narrative: X-RAY CHEST 1 VIEW

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 100

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Imaging - Results (continued)

X-RAY CHEST 1 VIEW [39561467] (continued) Resulted: 08/21/13 0844, Result Status: Final result

Comparison: 8/20/2013

Findings: The patient has been extubated. Right central venous port, bilateral chest tubes, and epicardial pacer leads are unchanged. Vascular coils are again demonstrated in the mediastinum. The lungs are hypoexpanded with a new right apical pneumothorax. Hazy opacity of the lungs appears more conspicuous which could be due to lower lung volumes. There is increased atelectasis in the right lung base. Suspect a small right pleural effusion. Heart size is stable.

Impression: Impression:

New, right apical pneumothorax without evidence of tension. Interval extubation with hypoexpansion and increasing atelectasis in the right lung.

Dr. Swerdlow discussed the findings with the CICU resident at the time of dictation.

Electronic Signature by: Thomas Hay; Authenticated signature date and time: 8/21/2013 8:44 AM; Reviewed and Interpreted by Attending Radiologist: Thomas Hay

X-RAY CHEST 1 VIEW [39582643] Resulted: 08/22/13 0901, Result Status: Final result

Ordering provider: Kim, John S. 08/22/13 0022 Order Status: Completed Resulted by: Swerdlow, Mathew P.

Monson, Matthew A. Provider, Tch

Performed: 08/22/13 0455 - 08/22/13 0505

Narrative: X-RAY CHEST 1 VIEW

Comparison: 8/21/13

Findings: Epicardial pacer leads have been removed. The remainder of the support lines and tubes are unchanged. Vascular coils are again demonstrated in the mediastinum. The lungs remain hypoexpanded with increased atelectasis in the left lung base. Aeration of the right lung base has slightly improved. Right upper lobe opacity is probably unchanged. The right pneumothorax is no longer visualized. Heart size is stable.

Impression: Impression: Resolution of small right apical pneumothorax. Worsening left lower lobe atelectasis with improved atelectasis in the right lung base. Right upper lobe opacity is similar.

Electronic Signature by: Matthew Monson, DO; Authenticated signature date and time: 8/22/2013 9:01 AM; Reviewed and Interpreted by Attending Radiologist: Matthew Monson, DO

IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE [39606212] Resulted: 08/23/13 0924, Result Status: Final result

Ordering provider: Kim, John S. 08/23/13 0741 Order Status: Completed Resulted by: Hay, Thomas C. Performed: 08/23/13 0823 - 08/23/13 0917 Narrative: IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE

CLINICAL HISTORY: Long-term IV access needed. PICC requested.

COMPARISON: None

PROCEDURE/FINDINGS: Catheter placement was performed by the PICC nurse. High frequency sonography was used to evaluate the veins of the upper arm for potential access sites.

A spot fluoroscopic image was obtained and demonstrates the tip of the PICC in the region of a left superior vena cava. Median sternotomy changes.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 101

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Imaging - Results (continued)

IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE [39606212] (continued) Resulted: 08/23/13 0924, Result Status: Final result

Multiple vascular coils noted. The left lower hemithorax chest tube. Lung volumes hypoexpanded with patchy atelectasis and cardiomegaly.

Impression: IMPRESSION: The left upper extremity PICC line superimposed over the left mediastinum, possibly in a persistent left superior vena cava.

Electronic Signature by: Thomas Hay; Authenticated signature date and time: 8/23/2013 9:24 AM; Reviewed and Interpreted by Attending Radiologist: Thomas Hay

IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD [39610304] Resulted: 08/23/13 1010, Result Status: Final result

Ordering provider: Blalock, Wayne J. 08/23/13 1010 Order Status: Completed Narrative: Blalock, Wayne J. 8/23/2013 10:12 AM

PROCEDURE NOTE

Title of Procedure: PICC Line Placement

Date Performed: 8/23/2013

Performed by: Wayne J. Blalock Assistants: Jason Justice RT (R) Supervised by: None

Size: 3 French Single Lumen

Catheter Type: BioFlo

Catheter Length: 14 cm

Tip Position: SVC

Complications: None

Follow up: Report given to Cardiology Service. Wayne Blalock MS, RN, VA-BC Interventional Radiology - PICC Service 720-777-9772

X-RAY CHEST 2 VIEW [39612891] Resulted: 08/23/13 1155, Result Status: Final result

Ordering provider: Church, Jessica C. 08/23/13 1129 Order Status: Completed Resulted by: Weinman, Jason P. Performed: 08/23/13 1129 - 08/23/13 1137 Narrative: X-RAY CHEST 2 VIEW

Comparison: 8/22/13

Findings: Sternotomy wires mediastinal clips and endovascular coils are unchanged. A left-sided PIC catheter has been placed with its tip likely within left-sided superior vena cava. The right-sided chest tube has been removed. A left-sided chest tube has been repositioned. The heart size appears

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 102

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Imaging - Results (continued)

X-RAY CHEST 2 VIEW [39612891] (continued) Resulted: 08/23/13 1155, Result Status: Final result

stable. There is decreased central vascular prominence/edema. Bibasilar opacities are present which likely reflect atelectasis decreased compared to prior exam. No definite pneumothorax is present.

Impression: Impression:

Interval removal of the right chest tube. Decreased edema. Decreased bibasilar atelectasis.

Electronic Signature by: Jason P Weinman; Authenticated signature date and time: 8/23/2013 11:55 AM; Reviewed and Interpreted by Attending Radiologist: Jason P Weinman

X-RAY CHEST 2 VIEW [39628617] Resulted: 08/24/13 1355, Result Status: Final result

Ordering provider: Church, Jessica C. 08/24/13 0931 Order Status: Completed Resulted by: Swerdlow, Mathew P.

Fadell, Michael F. II Provider, Tch

Performed: 08/24/13 0931 - 08/24/13 0940

Narrative: X-RAY CHEST 2 VIEW

Comparison: 8/23/13

Findings: Left PICC is likely unchanged allowing for differences in rotation and image projection. Left chest tube, mediastinal clips and median sternotomy wires are again demonstrated.

The lungs are hypoexpanded without focal consolidation. Mild pulmonary edema and a small left pleural effusion are unchanged. Heart size is stable. Improved aeration of the lung bases bilaterally.

Impression: Impression: Persistent hypoexpansion with improved bibasilar aeration. Similar mild pulmonary edema and a small left pleural effusion.

Electronic Signature by: Michael Fadell, MD; Authenticated signature date and time: 8/24/2013 1:55 PM; Reviewed and Interpreted by Attending Radiologist: Michael Fadell, MD

X-RAY CHEST 1 VIEW [39636616] Resulted: 08/25/13 1247, Result Status: Final result

Ordering provider: Diamond, Bethany A. 08/25/13 0914 Order Status: Completed Resulted by: Swerdlow, Mathew P.

Ingram, James D. Provider, Tch

Performed: 08/25/13 0921 - 08/25/13 0939

Narrative: X-RAY CHEST 1 VIEW

Comparison: 8/24/2013

Findings: Left PICC is unchanged in position. Vascular coils and median sternotomy wires are again demonstrated. The left chest tube has been removed.

The lungs remain hypoexpanded without focal consolidation, pleural effusion, or pneumothorax. Heart is normal in size.

Impression: Impression: Interval removal of left chest tube without pneumothorax.

Electronic Signature by: David Ingram; Authenticated signature date and time: 8/25/2013 12:47 PM; Reviewed and Interpreted by Attending Radiologist: David Ingram

X-RAY CHEST 2 VIEW [39647649] Resulted: 08/26/13 1056, Result Status: Final result

Ordering provider: Diamond, Bethany A. 08/26/13 0943 Order Status: Completed Resulted by: Weinman, Jason P. Performed: 08/26/13 0943 - 08/26/13 0947 Narrative: X-RAY CHEST 2 VIEW

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 103

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Imaging - Results (continued)

X-RAY CHEST 2 VIEW [39647649] (continued) Resulted: 08/26/13 1056, Result Status: Final result

Comparison: 8/25/13

Findings: A left-sided central venous catheter with its tip likely within the left side the vena cava is unchanged. Sternotomy wires mediastinal clips and endovascular coils are unchanged. The heart size appears stable. There is improved expansion of the chest compared to the prior exam. Hazy left perihilar opacity is again present which may reflect edema although airspace disease is not entirely excluded. There is similar to slightly decreased central vascular prominence/edema. No definite pneumothorax or drainable pleural effusion is present.

Impression: Impression:

Improved expansion the chest. Similar to slightly decreased vascular prominence/edema. Hazy left perihilar opacity which may reflect edema although pneumonia is not entirely excluded.

Electronic Signature by: Jason P Weinman; Authenticated signature date and time: 8/26/2013 10:56 AM; Reviewed and Interpreted by Attending Radiologist: Jason P Weinman

Lab - Results

CBC WITH DIFF [39521224] (Abnormal) Resulted: 08/19/13 1026, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:H00097R] Lab Specimen 08/19/13 0946

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 104

White Blood Count 5.1 4.0-12.0 10 3/uL - TCH MAIN LAB

Red Blood Count 6.20 4.00-5.30 10 6/uL H - TCH MAIN LAB

Hemoglobin 17.1 11.5-14.5 g/dL H - TCH MAIN LAB

Hematocrit 50.2 33-43 % H - TCH MAIN LAB

Mean Cell Volume 81.1 76-90 FL - TCH MAIN LAB

MCH 27.6 27-31 pg - TCH MAIN LAB

MCHC 34.0 32-36 g/dL - TCH MAIN LAB

RDW 13.1 11.5-15.0 % - TCH MAIN LAB

Plt Ct 269 150-500 10 3/uL - TCH MAIN LAB

MPV 7.8 fL - TCH MAIN LAB

% Segmented Neutrophils

52.9 18-62 % - TCH MAIN LAB

% Lymphocytes 29.2 21-49 % - TCH MAIN LAB

% Monocytes 10.3 0-10 % H - TCH MAIN LAB

% Eosinophils 6.8 0.0-10.0 % - TCH MAIN LAB

% Basophils 0.8 0-5 % - TCH MAIN LAB

Segmented Neutrophils (ABS #)

2.70 1.40-6.60 10 3/uL - TCH MAIN LAB

ABS Neutrophil CT 2.70 1.40-6.60 10 3/uL - TCH MAIN LAB

Lymphocytes (ABS #) 1.49 1.00-5.50 10 3/uL - TCH MAIN LAB

Monocytes (ABS #) 0.53 0.00-1.00 10 3/uL - TCH MAIN LAB

Eosinophils (ABS #) 0.35 0.00-0.70 10 3/uL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

CBC WITH DIFF [39521224] (Abnormal) (continued) Resulted: 08/19/13 1026, Result Status: Final result

BASIC METABOLIC PANEL [39521228] Resulted: 08/19/13 1032, Result Status: Final result

Ordering provider: Fisher, Faith A. 08/19/13 0946 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0819:C00248R] Lab Specimen 08/19/13 0946

ACTIVATED CLOTTING TIME [39540689] Resulted: 08/20/13 0825, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0820 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00171R] Lab Specimen 08/20/13 0820

LACTATE, WHOLE BLOOD [39540786] Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0825 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00173R] Lab Specimen 08/20/13 0825

BLOOD GASES, ARTERIAL [39540789] (Abnormal) Resulted: 08/20/13 0828, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 105

- TCH MAIN LAB

Component Value Ref Range Flag Comment Lab NA/Sodium 139 134-143 mmol/L - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

132 82-152 Seconds - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

K/Potassium 3.8 3.4-4.7 mmol/L - TCH MAIN LAB

Chloride 103 96-109 mmol/L - TCH MAIN LAB

Bicarb/HCO3,S 24 20-31 MMOL/L - TCH MAIN LAB

Glucose,S 62 60-105 mg/dL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Lactate Whole Blood 1.34 MMOL/L TCH MAIN

LAB Comment: Reference Range (ISTAT Analyzer)

Arterial: 0.36 - 1.25 mmol/L Venous: 0.90 - 1.70 mmol/L

Lactate WB Conversion 12 MG/DL - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

BUN 13 5-17 MG/DL - TCH MAIN LAB

Creatinine,S 0.37 0.23-0.61 mg/dL - TCH MAIN LAB

Calcium,S 9.4 8.7-9.8 MG/DL - TCH MAIN LAB

Basophils (ABS #) 0.04 0.00-0.10 10 3/uL -

Component Value Ref Range Flag Comment Lab PH, Arterial 7.33 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 41 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 67 65-75 MM HG - TCH MAIN

LAB HCO3-Arterial 22 18-22 MEQ/L - TCH MAIN

LAB

TCH MAIN LAB

CBC Differential Charge Option

AUTOMATED DIFF

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BLOOD GASES, ARTERIAL [39540789] (Abnormal) (continued) Resulted: 08/20/13 0828, Result Status: Edited Result - FINAL

HCT (ISTAT) [39540791] Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

SODIUM - WHOLE BLOOD [39540793] Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

POTASSIUM - WHOLE BLOOD [39540795] (Abnormal) Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

GLUCOSE - WHOLE BLOOD [39540797] Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

IONIZED CALCIUM - WHOLE BLOOD [39540799] (Abnormal) Resulted: 08/20/13 0828, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 0821 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00174R] Lab Specimen 08/20/13 0821

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 106

User ID 315617-CVOR2 A

Component Value Ref Range Flag Comment Lab Total Hemoglobin (CHEM)

14.6 13.0-18.0 g/dl - TCH MAIN LAB

Hematocrit (CALC- CHEM)

43 37-54 % - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB K (Whole Blood) 3.3 3.5-5.5 MMOL/L L TCH MAIN

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

POCT SITE - TCH MAIN LAB

Total CO2, Arterial 23 20-24 MEQ/L - TCH MAIN LAB

Base Excess-Arterial -4.0 -3-3 L - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

84 60-105 MG/DL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

O2 Saturation-Arterial 92 94-96 % L - TCH MAIN LAB

Patient Temp for Gases

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

143 135-145 MMOL/L - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB

37.0 35-39 C - TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

IONIZED CALCIUM - WHOLE BLOOD [39540799] (Abnormal) (continued) Resulted: 08/20/13 0828, Result Status: Final result

ACTIVATED CLOTTING TIME [39544899] (Abnormal) Resulted: 08/20/13 1038, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1027 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00261R] Lab Specimen 08/20/13 1027

BLOOD GASES, ARTERIAL [39545421] (Abnormal) Resulted: 08/20/13 1051, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

HCT (ISTAT) [39545423] (Abnormal) Resulted: 08/20/13 1051, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

SODIUM - WHOLE BLOOD [39545425] Resulted: 08/20/13 1051, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

POTASSIUM - WHOLE BLOOD [39545427] (Abnormal) Resulted: 08/20/13 1051, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 107

35-39 C - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

1.2-1.4 MMOL/L L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

IONIZED CALCIUM (WHOLE BLOOD)

1.16

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

586 82-152 Seconds H - TCH MAIN LAB

User ID 300903-CVOR-2

Component Value Ref Range Flag Comment Lab Total Hemoglobin (CHEM)

11.6 13.0-18.0 g/dl L - TCH MAIN LAB

Hematocrit (CALC- CHEM)

34 37-54 % L - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab PH, Arterial 7.34 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 42 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 223 65-75 MM HG H -

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

140 135-145 MMOL/L - TCH MAIN LAB

TCH MAIN LAB

HCO3-Arterial 23 18-22 MEQ/L H - TCH MAIN LAB

Total CO2, Arterial 24 20-24 MEQ/L - TCH MAIN LAB

Base Excess-Arterial -3.0 -3-3 L - TCH MAIN LAB

O2 Saturation-Arterial 100 94-96 % H - TCH MAIN LAB

Patient Temp for Gases 37.0

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

POTASSIUM - WHOLE BLOOD [39545427] (Abnormal) (continued) Resulted: 08/20/13 1051, Result Status: Final result

GLUCOSE - WHOLE BLOOD [39545429] (Abnormal) Resulted: 08/20/13 1051, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

IONIZED CALCIUM - WHOLE BLOOD [39545431] (Abnormal) Resulted: 08/20/13 1051, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00270R] Lab Specimen 08/20/13 1048

ACTIVATED CLOTTING TIME [39545636] (Abnormal) Resulted: 08/20/13 1056, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1048 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00274R] Lab Specimen 08/20/13 1048

ACTIVATED CLOTTING TIME [39546890] (Abnormal) Resulted: 08/20/13 1131, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1120 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00318R] Lab Specimen 08/20/13 1120

BLOOD GASES, ARTERIAL [39547481] (Abnormal) Resulted: 08/20/13 1150, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 108

Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

551 82-152 Seconds H - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

- TCH MAIN LAB

K (Whole Blood) 2.7 3.5-5.5 MMOL/L L TCH MAIN LAB

Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

Component

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

723 82-152 Seconds H - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

IONIZED CALCIUM (WHOLE BLOOD)

1.09 1.2-1.4 MMOL/L L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

128

Component Value Ref Range Flag Comment Lab PH, Arterial 7.32 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 47 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 354 65-75 MM HG H - TCH MAIN

LAB HCO3-Arterial 24 18-22 MEQ/L H - TCH MAIN

LAB Total CO2, Arterial 26 20-24 MEQ/L H - TCH MAIN

60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BLOOD GASES, ARTERIAL [39547481] (Abnormal) (continued) Resulted: 08/20/13 1150, Result Status: Edited Result - FINAL

HCT (ISTAT) [39547483] (Abnormal) Resulted: 08/20/13 1150, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

SODIUM - WHOLE BLOOD [39547485] Resulted: 08/20/13 1150, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

POTASSIUM - WHOLE BLOOD [39547487] (Abnormal) Resulted: 08/20/13 1150, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

GLUCOSE - WHOLE BLOOD [39547489] (Abnormal) Resulted: 08/20/13 1150, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

IONIZED CALCIUM - WHOLE BLOOD [39547492] (Abnormal) Resulted: 08/20/13 1150, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1146 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00333R] Lab Specimen 08/20/13 1146

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 109

User ID 315617-CVOR2 A

Component Value Ref Range Flag Comment Lab Total Hemoglobin (CHEM)

11.2 13.0-18.0 g/dl L - TCH MAIN LAB

Hematocrit (CALC- CHEM)

33 37-54 % L - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB K (Whole Blood) 3.3 3.5-5.5 MMOL/L L TCH MAIN

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

POCT SITE - TCH MAIN LAB

LAB Base Excess-Arterial -2.0 -3-3 - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

186 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

O2 Saturation-Arterial 100 94-96 % H - TCH MAIN LAB

Patient Temp for Gases

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

140 135-145 MMOL/L - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB IONIZED CALCIUM 1.19 1.2-1.4 MMOL/L L IONIZED CALCIUM RESULT IS TCH MAIN

37.0 35-39 C - TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

IONIZED CALCIUM - WHOLE BLOOD [39547492] (Abnormal) (continued) Resulted: 08/20/13 1150, Result Status: Final result

ACTIVATED CLOTTING TIME [39547913] (Abnormal) Resulted: 08/20/13 1206, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1158 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00348R] Lab Specimen 08/20/13 1158

BLOOD GASES, ARTERIAL [39548580] (Abnormal) Resulted: 08/20/13 1229, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

HCT (ISTAT) [39548582] (Abnormal) Resulted: 08/20/13 1229, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

SODIUM - WHOLE BLOOD [39548584] Resulted: 08/20/13 1229, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

POTASSIUM - WHOLE BLOOD [39548586] Resulted: 08/20/13 1229, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 110

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

DIRECTLY AFFECTED BY PH. LAB(WHOLE BLOOD)

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

494 82-152 Seconds H - TCH MAIN LAB

User ID 300903-CVOR-2

Component Value Ref Range Flag Comment Lab Total Hemoglobin (CHEM)

11.2 13.0-18.0 g/dl L - TCH MAIN LAB

Hematocrit (CALC- CHEM)

33 37-54 % L - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab PH, Arterial 7.38 7.35-7.45 - TCH MAIN

LAB PCO2, Arterial 41 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 257 65-75 MM HG H -

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

138 135-145 MMOL/L - TCH MAIN LAB

TCH MAIN LAB

HCO3-Arterial 24 18-22 MEQ/L H - TCH MAIN LAB

Total CO2, Arterial 25 20-24 MEQ/L H - TCH MAIN LAB

Base Excess-Arterial -1.0 -3-3 - TCH MAIN LAB

O2 Saturation-Arterial 100 94-96 % H - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab

Patient Temp for Gases 37.0 35-39 C - TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

POTASSIUM - WHOLE BLOOD [39548586] (continued) Resulted: 08/20/13 1229, Result Status: Final result

GLUCOSE - WHOLE BLOOD [39548588] (Abnormal) Resulted: 08/20/13 1229, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

IONIZED CALCIUM - WHOLE BLOOD [39548590] (Abnormal) Resulted: 08/20/13 1229, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1225 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00369R] Lab Specimen 08/20/13 1225

ACTIVATED CLOTTING TIME [39548828] (Abnormal) Resulted: 08/20/13 1238, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1224 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00378R] Lab Specimen 08/20/13 1224

ACTIVATED CLOTTING TIME [39549646] Resulted: 08/20/13 1313, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00397R] Lab Specimen 08/20/13 1309

BLOOD GASES, ARTERIAL [39549732] (Abnormal) Resulted: 08/20/13 1316, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 111

- TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

878 82-152 Seconds H - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

K (Whole Blood) 3.6 3.5-5.5 MMOL/L

Component Value Ref Range Flag Comment Lab User ID

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab Activated Clotting Time - ACT

142 82-152 Seconds - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

IONIZED CALCIUM (WHOLE BLOOD)

1.03 1.2-1.4 MMOL/L L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

315617-CVOR2 A POCT SITE - TCH MAIN LAB

GLUCOSE (WHOLE BLOOD)

187 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

Component Value Ref Range Flag Comment Lab PH, Arterial 7.33 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 43 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 88 65-75 MM HG H - TCH MAIN

LAB HCO3-Arterial 22 18-22 MEQ/L - TCH MAIN

LAB Total CO2, Arterial 24 20-24 MEQ/L - TCH MAIN

LAB Base Excess-Arterial -4.0 -3-3 L - TCH MAIN

User ID 315617-CVOR2 A POCT SITE

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BLOOD GASES, ARTERIAL [39549732] (Abnormal) (continued) Resulted: 08/20/13 1316, Result Status: Edited Result - FINAL

HCT (ISTAT) [39549734] Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

SODIUM - WHOLE BLOOD [39549736] Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

POTASSIUM - WHOLE BLOOD [39549738] (Abnormal) Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

GLUCOSE - WHOLE BLOOD [39549740] (Abnormal) Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

IONIZED CALCIUM - WHOLE BLOOD [39549742] Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1309 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00401R] Lab Specimen 08/20/13 1309

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 112

TCH MAIN LAB

Hematocrit (CALC- CHEM)

40 37-54 % - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB K (Whole Blood) 2.9 3.5-5.5 MMOL/L L TCH MAIN

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

LAB O2 Saturation-Arterial 96 94-96 % - TCH MAIN

LAB Patient Temp for Gases 37.0 35-39 C - TCH MAIN

LAB User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

189 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

142 135-145 MMOL/L - TCH MAIN LAB

Component Value Ref Range

Component Value Ref Range Flag Comment Lab User ID 315617-CVOR2 A POCT SITE - TCH MAIN

LAB IONIZED CALCIUM (WHOLE BLOOD)

1.23 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

Flag Comment Lab Total Hemoglobin (CHEM)

13.6 13.0-18.0 g/dl -

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

LACTATE, WHOLE BLOOD [39549745] Resulted: 08/20/13 1316, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1313 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00402R] Lab Specimen 08/20/13 1313

BLOOD GASES, ARTERIAL [39550128] (Abnormal) Resulted: 08/20/13 1330, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

HCT (ISTAT) [39550130] Resulted: 08/20/13 1330, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

SODIUM - WHOLE BLOOD [39550132] Resulted: 08/20/13 1330, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

POTASSIUM - WHOLE BLOOD [39550134] (Abnormal) Resulted: 08/20/13 1330, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 113

Patient Temp for Gases 37.0 35-39 C - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

- TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Lactate Whole Blood 1.86 MMOL/L TCH MAIN

LAB Comment: Reference Range (ISTAT Analyzer)

Arterial: 0.36 - 1.25 mmol/L Venous: 0.90 - 1.70 mmol/L

Lactate WB Conversion 17 MG/DL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Total Hemoglobin (CHEM)

14.3 13.0-18.0 g/dl - TCH MAIN LAB

Hematocrit (CALC- CHEM)

42 37-54 % - TCH MAIN LAB

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

User ID 315617-CVOR2 A POCT SITE

Component Value Ref Range Flag Comment Lab PH, Arterial 7.33 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 42 34-40 MM HG H - TCH MAIN

LAB PO2-Arterial 84 65-75 MM HG

Component Value Ref Range Flag Comment Lab User ID 300903-CVOR-2 POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

142 135-145 MMOL/L - TCH MAIN LAB

H - TCH MAIN LAB

HCO3-Arterial 22 18-22 MEQ/L - TCH MAIN LAB

Total CO2, Arterial 23 20-24 MEQ/L - TCH MAIN LAB

Base Excess-Arterial -4.0 -3-3 L - TCH MAIN LAB

O2 Saturation-Arterial 95 94-96 % - TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

POTASSIUM - WHOLE BLOOD [39550134] (Abnormal) (continued) Resulted: 08/20/13 1330, Result Status: Final result

GLUCOSE - WHOLE BLOOD [39550136] (Abnormal) Resulted: 08/20/13 1330, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

IONIZED CALCIUM - WHOLE BLOOD [39550138] Resulted: 08/20/13 1330, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1326 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00415R] Lab Specimen 08/20/13 1326

PLATELET COUNT [39550226] (Abnormal) Resulted: 08/20/13 1339, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:H00188S] Lab Specimen 08/20/13 1320

PLATELET FUNCT. ANAL. (EPI) [39550236] Resulted: 08/20/13 1347, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:HC00031S] Lab Specimen 08/20/13 1320

INR AND PROTHROMBIN TIME [39550228] (Abnormal) Resulted: 08/20/13 1357, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:HC00031S] Lab Specimen 08/20/13 1320

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 114

Comment Lab User ID 300903-CVOR-2 POCT SITE

Component Value Ref Range Flag Comment Lab Plt Ct 122 150-500 10 3/uL L Delta: 269 on 08/19/13-0946 TCH MAIN

LAB

- TCH MAIN LAB

K (Whole Blood) 3.1 3.5-5.5 MMOL/L L TCH MAIN LAB

Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

Component

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab Platelet Funct.Anal. (EPI) Test not performed 70-167 SECONDS TCH MAIN

LAB Comment: The received specimen cannot be used for the requested

analysis due to SPECIMEN ACCIDENTALLY BEING SPUN BEFORE TESTING. Please reorder testing and recollect the specimen as necessary. RN FAITH BEAZER was notified. 08/20/13 1347 by 109021HH.

User ID 300903-CVOR-2 POCT SITE - TCH MAIN LAB

IONIZED CALCIUM (WHOLE BLOOD)

1.23 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

Value Ref Range Flag Comment Lab User ID 300903-CVOR-2 POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

169

Component Value Ref Range Flag Comment Lab PT 18.2 12.0-15.0 SECONDS H - TCH MAIN

LAB INR 1.50 TCH MAIN

LAB Comment: Recommended INR for treatment of thrombosis: 2.0-3.5

Recommended INR for prosthetic heart valves: 2.5-4.0

60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

Value Ref Range Flag

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

FIBRINOGEN [39550232] Resulted: 08/20/13 1357, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:HC00031S] Lab Specimen 08/20/13 1320

D-DIMER [39550234] Resulted: 08/20/13 1409, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:HC00031S] Lab Specimen 08/20/13 1320

PT 1:1 CORRECTION [39550230] Resulted: 08/20/13 1429, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1320 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:HC00031S] Lab Specimen 08/20/13 1320

BLOOD GASES, ART (RAPIDPOINT) [39552349] (Abnormal) Resulted: 08/20/13 1439, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

HCT (ISTAT) [39552351] Resulted: 08/20/13 1439, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 115

Component Value Ref Range Flag Comment Lab Fibrinogen 223 150-400 MGS/DL - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab PH, Arterial 7.30 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 45 34-40 H - TCH MAIN

LAB PO2-Arterial 74 65-75 MM HG - TCH MAIN

LAB HCO3-Arterial 22 18-22 MEQ/L - TCH MAIN

LAB Total CO2, Arterial 23 20-24 MEQ/L - TCH MAIN

LAB Base Excess-Arterial -5.0 -3-3 L - TCH MAIN

LAB O2 Saturation-Arterial 94 94-96 % - TCH MAIN

LAB Patient Temp for Gases 36.2 35-39 C - TCH MAIN

LAB User ID 03086-CICU A POCT SITE - TCH MAIN

LAB

D-Dimer LESS THAN 0.22 <0.48 ug/mL TCH MAIN LAB

Component Value Ref Range Flag Comment Lab PT 1:1 Correction 14.5 SECONDS TCH MAIN

LAB Comment: NORMAL POOL (Seconds): 12.6

If results of the mixing study are prolonged, the presence of anticoagulant inhibitor drugs such as heparin or direct thrombin inhibitors cannot be excluded.

Component Value Ref Range Flag Comment Lab Hematocrit (CALC- CHEM)

44 37-54 % - TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

Comment: Cut-off value of 0.50 ug/mL has been established for DVT/PE in adult populations. No pediatric cut-off value has been determined.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

HCT (ISTAT) [39552351] (continued) Resulted: 08/20/13 1439, Result Status: Final result

SODIUM - WHOLE BLOOD [39552353] Resulted: 08/20/13 1439, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

POTASSIUM - WHOLE BLOOD [39552355] Resulted: 08/20/13 1439, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

GLUCOSE - WHOLE BLOOD [39552357] (Abnormal) Resulted: 08/20/13 1439, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

IONIZED CALCIUM - WHOLE BLOOD [39552359] Resulted: 08/20/13 1439, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1434 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00464R] Lab Specimen 08/20/13 1434

BASIC METABOLIC PANEL [39540151] (Abnormal) Resulted: 08/20/13 1506, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:C00465S]

Lab Specimen 08/20/13 1440

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 116

Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB K (Whole Blood) 3.5 3.5-5.5 MMOL/L TCH MAIN

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB IONIZED CALCIUM (WHOLE BLOOD)

1.27 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

NA/Sodium (Whole Blood)

144 135-145 MMOL/L - TCH MAIN LAB

Component Value Ref Range

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab NA/Sodium 144 134-143 mmol/L H - TCH MAIN

LAB K/Potassium 3.5 3.4-4.7 mmol/L - TCH MAIN

LAB Chloride 109 96-109 mmol/L - TCH MAIN

LAB Bicarb/HCO3,S 21 20-31 MMOL/L - TCH MAIN

LAB Glucose,S 117 60-105 mg/dL H GLUCOSE NORMALS ARE BASED ON

FASTING SPECIMEN TCH MAIN LAB

BUN 12 5-17 MG/DL - TCH MAIN LAB

Creatinine,S 0.33 0.23-0.61 mg/dL - TCH MAIN

GLUCOSE (WHOLE BLOOD)

121 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BASIC METABOLIC PANEL [39540151] (Abnormal) (continued) Resulted: 08/20/13 1506, Result Status: Final result

MAGNESIUM (SERUM) [39540152] (Abnormal) Resulted: 08/20/13 1506, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:C00465S]

Lab Specimen 08/20/13 1440

PHOSPHORUS, SERUM [39540153] Resulted: 08/20/13 1506, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:C00465S]

Lab Specimen 08/20/13 1440

FIBRINOGEN [39540156] Resulted: 08/20/13 1507, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:HC00035S]

Lab Specimen 08/20/13 1440

INR AND PROTHROMBIN TIME [39540154] (Abnormal) Resulted: 08/20/13 1508, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:HC00035S]

Lab Specimen 08/20/13 1440

PARTIAL THROMBOPLASTIN [39540155] Resulted: 08/20/13 1508, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:HC00035S]

Lab Specimen 08/20/13 1440

CBC WITH DIFF [39540150] (Abnormal) Resulted: 08/20/13 1511, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 117

Component Value Ref Range Flag Comment Lab PT 17.2 12.0-15.0 SECONDS H - TCH MAIN

LAB INR 1.39 TCH MAIN

LAB Comment: Recommended INR for treatment of thrombosis: 2.0-3.5

Recommended INR for prosthetic heart valves: 2.5-4.0

8.7-9.8 MG/DL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab Fibrinogen 208 150-400 MGS/DL - TCH MAIN

LAB

Phosphorus,Serum 5.7 3.0-6.0 mg/dL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab PTT 35 22-37 SECONDS TCH MAIN

LAB Comment: Heparin assay recommended for following heparin

therapy instead of PTT

LAB

Component Value Ref Range Flag Comment Lab Magnesium (Serum) 2.6 1.5-2.4 mg/dL H - TCH MAIN

LAB

Calcium,S 9.4

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

CBC WITH DIFF [39540150] (Abnormal) (continued) Resulted: 08/20/13 1511, Result Status: Final result

Collected by: HALL-PERRY, GILLIAN Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:H00213S]

Lab Specimen 08/20/13 1440

BLOOD GASES, ART (RAPIDPOINT) [39554189] (Abnormal) Resulted: 08/20/13 1538, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 118

Mean Cell Volume 81.4 76-90 FL - TCH MAIN LAB

MCH 27.6 27-31 pg - TCH MAIN LAB

MCHC 33.9 32-36 g/dL - TCH MAIN LAB

RDW 13.3 11.5-15.0 % - TCH MAIN LAB

Plt Ct 128 150-500 10 3/uL L - TCH MAIN LAB

MPV 7.0 fL - TCH MAIN LAB

% Segmented Neutrophils

85.1 18-62 % H - TCH MAIN LAB

% Lymphocytes 6.6 21-49 % L - TCH MAIN LAB

% Monocytes 7.3 0-10 % - TCH MAIN LAB

% Eosinophils 1.0 0.0-10.0 % - TCH MAIN LAB

Segmented Neutrophils (ABS #)

6.76 1.40-6.60 10 3/uL H - TCH MAIN LAB

ABS Neutrophil CT 6.76 1.40-6.60 10 3/uL H - TCH MAIN LAB

Lymphocytes (ABS #) 0.53 1.00-5.50 10 3/uL L - TCH MAIN LAB

Monocytes (ABS #) 0.58 0.00-1.00 10 3/uL - TCH MAIN LAB

Eosinophils (ABS #) 0.08 0.00-0.70 10 3/uL - TCH MAIN LAB

RBC Morphology NORMAL - TCH MAIN LAB

WBC Morphology SMEAR REVIEW BY TECH - TCH MAIN LAB

Platelet Estimate (Smear) DECREASED 50-130,000 - TCH MAIN LAB

CBC Differential Charge Option

AUTO DIFF+SLIDE REV - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab White Blood Count 7.9 4.0-12.0 10 3/uL - TCH MAIN

LAB Red Blood Count 5.38 4.00-5.30 10 6/uL H - TCH MAIN

LAB Hemoglobin 14.9 11.5-14.5 g/dL H - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab PH, Arterial 7.29 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 43 34-40 H - TCH MAIN

LAB PO2-Arterial 67 65-75 MM HG - TCH MAIN

LAB HCO3-Arterial 21 18-22 MEQ/L - TCH MAIN

LAB Total CO2, Arterial 22 20-24 MEQ/L - TCH MAIN

LAB Base Excess-Arterial -6.1 -3-3 L - TCH MAIN

LAB O2 Saturation-Arterial 92 94-96 % L - TCH MAIN

Hematocrit 43.8 33-43 % H Delta: 50.2 on 08/19/13-0946 TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BLOOD GASES, ART (RAPIDPOINT) [39554189] (Abnormal) (continued) Resulted: 08/20/13 1538, Result Status: Edited Result - FINAL

HCT (ISTAT) [39554191] Resulted: 08/20/13 1538, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

SODIUM - WHOLE BLOOD [39554193] Resulted: 08/20/13 1538, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

POTASSIUM - WHOLE BLOOD [39554195] Resulted: 08/20/13 1538, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

GLUCOSE - WHOLE BLOOD [39554197] (Abnormal) Resulted: 08/20/13 1538, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

IONIZED CALCIUM - WHOLE BLOOD [39554199] Resulted: 08/20/13 1538, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1534 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00495R] Lab Specimen 08/20/13 1534

LACTATE, WHOLE BLOOD [39540157] Resulted: 08/20/13 1718, Result Status: Final result

Ordering provider: Farina, Mark A. 08/20/13 0805 Order Status: Completed

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 119

K (Whole Blood) 3.6 3.5-5.5 MMOL/L TCH MAIN LAB

Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

LAB

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE -

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

132 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

NA/Sodium (Whole Blood)

145 135-145 MMOL/L - TCH MAIN LAB

Hematocrit (CALC- CHEM)

46 37-54 % - TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

Patient Temp for Gases

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB IONIZED CALCIUM (WHOLE BLOOD)

1.26 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

36.1 35-39 C - TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

LACTATE, WHOLE BLOOD [39540157] (continued) Resulted: 08/20/13 1718, Result Status: Final result

Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0820:C00540R]

Lab Specimen 08/20/13 1440

BLOOD GASES, ART (RAPIDPOINT) [39557027] (Abnormal) Resulted: 08/20/13 1734, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

HCT (ISTAT) [39557029] Resulted: 08/20/13 1734, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

SODIUM - WHOLE BLOOD [39557031] Resulted: 08/20/13 1734, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

POTASSIUM - WHOLE BLOOD [39557033] Resulted: 08/20/13 1734, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 120

- TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

- TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Lactate Whole Blood 0.87 MMOL/L TCH MAIN

LAB Comment: Reference Range (ISTAT Analyzer)

Arterial: 0.36 - 1.25 mmol/L Venous: 0.90 - 1.70 mmol/L

Lactate WB Conversion 8 MG/DL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Hematocrit (CALC- CHEM)

47 37-54 % - TCH MAIN LAB

User ID 03086-CICU A POCT SITE - TCH MAIN LAB

User ID 345857-CICU 2 POCT SITE

Component Value Ref Range Flag Comment Lab PH, Arterial 7.31 7.35-7.45 L - TCH MAIN

LAB PCO2, Arterial 41 34-40 H - TCH MAIN

LAB PO2-Arterial 62 65-75 MM HG

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

144 135-145 MMOL/L - TCH MAIN LAB

L - TCH MAIN LAB

HCO3-Arterial 20 18-22 MEQ/L - TCH MAIN LAB

Total CO2, Arterial 21 20-24 MEQ/L - TCH MAIN LAB

Base Excess-Arterial -6.2 -3-3 L - TCH MAIN LAB

O2 Saturation-Arterial 91 94-96 % L -

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB K (Whole Blood) 3.8 3.5-5.5 MMOL/L TCH MAIN

TCH MAIN LAB

Patient Temp for Gases 36.2 35-39 C

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

POTASSIUM - WHOLE BLOOD [39557033] (continued) Resulted: 08/20/13 1734, Result Status: Final result

GLUCOSE - WHOLE BLOOD [39557035] (Abnormal) Resulted: 08/20/13 1734, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

IONIZED CALCIUM - WHOLE BLOOD [39557037] Resulted: 08/20/13 1734, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1729 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00550R] Lab Specimen 08/20/13 1729

BLOOD GASES, ART (RAPIDPOINT) [39557756] (Abnormal) Resulted: 08/20/13 1838, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/20/13 1833 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0820:C00572R] Lab Specimen 08/20/13 1833

BLOOD GASES, ART (RAPIDPOINT) [39561310] (Abnormal) Resulted: 08/21/13 0547, Result Status: Edited Result - FINAL

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 121

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

Component Value Ref Range Flag Comment Lab User ID

Component Value Ref Range Flag Comment Lab PH, Arterial 7.36 7.35-7.45 - TCH MAIN

LAB PCO2, Arterial 43 34-40 H - TCH MAIN

LAB PO2-Arterial 60 65-75 MM HG L - TCH MAIN

LAB HCO3-Arterial 24 18-22 MEQ/L H - TCH MAIN

LAB Total CO2, Arterial 25 20-24 MEQ/L H - TCH MAIN

LAB Base Excess-Arterial -2.1 -3-3 - TCH MAIN

LAB O2 Saturation-Arterial 91 94-96 % L - TCH MAIN

LAB Patient Temp for Gases 36.2 35-39 C - TCH MAIN

LAB User ID 03086-CICU A POCT SITE - TCH MAIN

LAB

03086-CICU A POCT SITE - TCH MAIN LAB

GLUCOSE (WHOLE BLOOD)

Component Value Ref Range Flag Comment Lab User ID 03086-CICU A POCT SITE - TCH MAIN

LAB IONIZED CALCIUM (WHOLE BLOOD)

1.31 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

Component Value Ref Range Flag Comment Lab PH, Arterial 7.36 7.35-7.45 - TCH MAIN

LAB PCO2, Arterial 36 34-40 - TCH MAIN

LAB PO2-Arterial 70 65-75 MM HG - TCH MAIN

LAB HCO3-Arterial 20 18-22 MEQ/L - TCH MAIN

LAB Total CO2, Arterial 21 20-24 MEQ/L - TCH MAIN

LAB Base Excess-Arterial -4.8 -3-3 L - TCH MAIN

121 60-105 MG/DL H GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BLOOD GASES, ART (RAPIDPOINT) [39561310] (Abnormal) (continued) Resulted: 08/21/13 0547, Result Status: Edited Result - FINAL

HCT (ISTAT) [39561312] Resulted: 08/21/13 0547, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

SODIUM - WHOLE BLOOD [39561314] Resulted: 08/21/13 0547, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

POTASSIUM - WHOLE BLOOD [39561316] Resulted: 08/21/13 0547, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

GLUCOSE - WHOLE BLOOD [39561318] Resulted: 08/21/13 0547, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

IONIZED CALCIUM - WHOLE BLOOD [39561320] Resulted: 08/21/13 0547, Result Status: Final result

Ordering provider: Kaufman, Jonathan M. 08/21/13 0549 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00099R] Lab Specimen 08/21/13 0549

LACTATE, WHOLE BLOOD [39560566] Resulted: 08/21/13 0550, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 122

Value Ref Range Flag Comment Lab User ID 03603-CICU B POCT SITE - TCH MAIN

LAB K (Whole Blood) 3.5 3.5-5.5 MMOL/L TCH MAIN

LAB Comment: WHOLE BLOOD POTASSIUM RESULTS MAY BE FALSELY ELEVATED DUE TO

UNDETERMINED HEMOLYSIS--IF CAPILLARY DRAW, PLEASE EVALUATE POTASSIUM RESULT ACCORDINGLY.

O2 Saturation-Arterial 94 94-96 % - TCH MAIN LAB

Patient Temp for Gases 36.6 35-39 C - TCH MAIN LAB

User ID 03603-CICU B POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag Comment

Component Value Ref Range Flag Comment Lab User ID 03603-CICU B POCT SITE - TCH MAIN

LAB GLUCOSE (WHOLE BLOOD)

85 60-105 MG/DL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

Lab User ID 03603-CICU B POCT SITE - TCH MAIN

LAB NA/Sodium (Whole Blood)

137 135-145 MMOL/L - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab Hematocrit (CALC- CHEM)

45 37-54 %

Component Value Ref Range Flag Comment Lab User ID 03603-CICU B POCT SITE - TCH MAIN

LAB IONIZED CALCIUM (WHOLE BLOOD)

1.22 1.2-1.4 MMOL/L IONIZED CALCIUM RESULT IS DIRECTLY AFFECTED BY PH.

TCH MAIN LAB

- TCH MAIN LAB

User ID 03603-CICU B POCT SITE - TCH MAIN LAB

LAB

Component

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

LACTATE, WHOLE BLOOD [39560566] (continued) Resulted: 08/21/13 0550, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:C00101R] Lab Specimen 08/21/13 0537

CBC WITH DIFF [39560561] (Abnormal) Resulted: 08/21/13 0609, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:H00045S]

Lab Specimen 08/21/13 0530

COOXIMETRY STUDIES [39561351] Resulted: 08/21/13 0613, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0558 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:C00109R]

Lab Specimen 08/21/13 0530

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 123

Ref Range Flag Comment Lab White Blood Count 14.0 4.0-12.0 10 3/uL H - TCH MAIN

LAB Red Blood Count 5.54 4.00-5.30 10 6/uL H - TCH MAIN

LAB Hemoglobin 15.3 11.5-14.5 g/dL H - TCH MAIN

LAB Hematocrit 45.5 33-43 % H - TCH MAIN

LAB Mean Cell Volume 82.1 76-90 FL - TCH MAIN

LAB MCH 27.7 27-31 pg - TCH MAIN

LAB MCHC 33.7 32-36 g/dL - TCH MAIN

LAB RDW 13.4 11.5-15.0 % - TCH MAIN

LAB Plt Ct 167 150-500 10 3/uL - TCH MAIN

LAB MPV 7.6 fL - TCH MAIN

LAB % Segmented Neutrophils

84.3 18-62 % H - TCH MAIN LAB

% Lymphocytes 5.4 21-49 % L - TCH MAIN LAB

% Monocytes 10.3 0-10 % H - TCH MAIN LAB

Segmented Neutrophils (ABS #)

11.83 1.40-6.60 10 3/uL H - TCH MAIN LAB

ABS Neutrophil CT 11.83 1.40-6.60 10 3/uL H - TCH MAIN LAB

Lymphocytes (ABS #) 0.76 1.00-5.50 10 3/uL L - TCH MAIN LAB

Monocytes (ABS #) 1.44 0.00-1.00 10 3/uL H - TCH MAIN LAB

RBC Morphology NORMAL - TCH MAIN LAB

WBC Morphology SMEAR REVIEW BY TECH - TCH MAIN LAB

Platelet Estimate (Smear) NORMAL 150-500,000 - TCH MAIN LAB

CBC Differential Charge Option

AUTO DIFF+SLIDE REV - TCH MAIN LAB

Comment Lab Lactate Whole Blood 1.72 MMOL/L TCH MAIN

LAB Comment: Reference Range (ISTAT Analyzer)

Arterial: 0.36 - 1.25 mmol/L Venous: 0.90 - 1.70 mmol/L

Lactate WB Conversion 16 MG/DL - TCH MAIN LAB

User ID 345857-CICU 2 POCT SITE - TCH MAIN LAB

Component Value Ref Range Flag

Component Value

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

COOXIMETRY STUDIES [39561351] (continued) Resulted: 08/21/13 0613, Result Status: Final result

Narrative: SPECIMEN SOURCE (Arterial / Venous) V

INR AND PROTHROMBIN TIME [39560567] (Abnormal) Resulted: 08/21/13 0616, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:HC00009S]

Lab Specimen 08/21/13 0530

Narrative:

PARTIAL THROMBOPLASTIN [39560568] Resulted: 08/21/13 0616, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:HC00009S]

Lab Specimen 08/21/13 0530

Narrative:

BASIC METABOLIC PANEL [39560562] (Abnormal) Resulted: 08/21/13 0619, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:C00094S]

Lab Specimen 08/21/13 0530

Narrative:

MAGNESIUM (SERUM) [39560563] Resulted: 08/21/13 0619, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:C00094S]

Lab Specimen 08/21/13 0530

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 124

Comment: Recommended INR for treatment of thrombosis: 2.0-3.5 Recommended INR for prosthetic heart valves: 2.5-4.0

Specimen Type CO-OX (ART/VEN)

VENOUS - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab O2 Saturation, Measured 82.5 % - TCH MAIN

LAB

Component Value Ref Range

Component Value Ref Range Flag Comment Lab NA/Sodium 139 134-143 mmol/L - TCH MAIN

LAB K/Potassium 3.6 3.4-4.7 mmol/L - TCH MAIN

LAB Chloride 102 96-109 mmol/L - TCH MAIN

LAB Bicarb/HCO3,S 19 20-31 MMOL/L L - TCH MAIN

LAB Glucose,S 81 60-105 mg/dL GLUCOSE NORMALS ARE BASED ON

FASTING SPECIMEN TCH MAIN LAB

BUN 16 5-17 MG/DL - TCH MAIN LAB

Creatinine,S 0.38 0.23-0.61 mg/dL - TCH MAIN LAB

Calcium,S 9.4 8.7-9.8 MG/DL - TCH MAIN LAB

Flag Comment Lab PT 15.4 12.0-15.0 SECONDS H - TCH MAIN

LAB

Component Value Ref Range Flag Comment Lab PTT 28 22-37 SECONDS TCH MAIN

LAB Comment: Delta: 35 on 08/20/13-1440

Heparin assay recommended for following heparin therapy instead of PTT

INR 1.20 TCH MAIN LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

MAGNESIUM (SERUM) [39560563] (continued) Resulted: 08/21/13 0619, Result Status: Final result

Narrative:

PHOSPHORUS, SERUM [39560564] (Abnormal) Resulted: 08/21/13 0619, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:C00094S]

Lab Specimen 08/21/13 0530

Narrative:

HEPATIC FUNCTION PANEL [39560565] (Abnormal) Resulted: 08/21/13 0619, Result Status: Final result

Ordering provider: Farina, Mark A. 08/21/13 0201 Order Status: Completed Collected by: TREADWELL, RYANN A Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0821:C00094S]

Lab Specimen 08/21/13 0530

Narrative:

URINALYSIS WITH MICROSCOPIC [39581630] (Abnormal) Resulted: 08/21/13 2247, Result Status: Final result

Ordering provider: Nicolarsen, Jeremy R. 08/21/13 2152 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0821:HF00120R] Lab Specimen; Clean Catch/Bag 08/21/13 2225

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 125

Ref Range Flag Comment Lab Total Protein,S 6.2 5.9-7.0 g/dL - TCH MAIN

LAB Albumin,S 3.9 3.4-4.2 g/dL - TCH MAIN

LAB Bilirubin,Total,S 0.9 0.2-1.2 MG/DL - TCH MAIN

LAB Direct Bilirubin 0.0 0-0.3 MG/DL - TCH MAIN

LAB Bilirubin Indirect 0.5 0.2-1.2 MG/DL - TCH MAIN

LAB Alk Phos,S 90 129-291 U/L L - TCH MAIN

LAB GOT/AST,S 53 20-60 U/L - TCH MAIN

LAB GPT/ALT,S 40 5-45 U/L - TCH MAIN

LAB

TCH MAIN LAB

Component Value Ref Range Flag Comment Lab

Component Value Ref Range Flag Comment Lab Phosphorus,Serum 6.1 3.0-6.0 mg/dL H - TCH MAIN

LAB

Magnesium (Serum)

Component Value Ref Range Flag Comment Lab Color (1) YELLOW - TCH MAIN

LAB Character (2) CLEAR - TCH MAIN

LAB Glucose-UA NEGATIVE NEGATIVE MG/DL - TCH MAIN

LAB Bilirubin,Urine NEGATIVE NEGATIVE - TCH MAIN

LAB Ketones, Urine NEGATIVE NEGATIVE mg/dL - TCH MAIN

LAB SP - Urine 1.015 1.003-1.030 - TCH MAIN

LAB Chemical Blood-Urine TRACE-LYSED NEGATIVE - TCH MAIN

LAB PH-Urine 6.0 5.0-9.0 - TCH MAIN

LAB Protein, Urine NEGATIVE NEGATIVE MG/DL - TCH MAIN

1.8 1.5-2.4 mg/dL -

Component Value

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

URINALYSIS WITH MICROSCOPIC [39581630] (Abnormal) (continued) Resulted: 08/21/13 2247, Result Status: Final result

TRIGLYCERIDE, MISC FLUID [39582823] Resulted: 08/22/13 0147, Result Status: Final result

Ordering provider: Nicolarsen, Jeremy R. 08/22/13 0107 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0822:CF00001R] Lab Specimen 08/22/13 0100

PLEURAL FLD CC&DIFF(CYTOSPIN) [39582824] Resulted: 08/22/13 0205, Result Status: Final result

Ordering provider: Nicolarsen, Jeremy R. 08/22/13 0107 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0822:HF00003R] Lab Specimen 08/22/13 0100

RENAL FUNCTION PANEL [39584372] Resulted: 08/22/13 0854, Result Status: Final result

Ordering provider: Farina, Mark A. 08/22/13 0709 Order Status: Completed Collected by: SHIRAZI, MONA L Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0822:C00161S]

Lab Specimen 08/22/13 0810

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 126

243 mg/dL NO NORMALS AVAILABLE TCH MAIN LAB

0-5 /hpf - TCH MAIN LAB

RBC-Urine 4-10 0-3 /hpf H - TCH MAIN LAB

RBC Morphology, UA NORMAL NORMAL - TCH MAIN LAB

Bacteria, Urine None Seen None Seen /hpf - TCH MAIN LAB

Comments, Urine Micro Volume = 12 ML

Component Value Ref Range Flag Comment Lab TOTAL PLEURAL FLUID VOLUME

8.0 ML - TCH MAIN LAB

PLEURAL FLUID VOLUME

6.5 ML - TCH MAIN LAB

PLEURAL FLUID COLOR

RED - TCH MAIN LAB

PLEURAL FLUID CHARACTER

CLOUDY - TCH MAIN LAB

PLEURAL FLUID NUCLEATED CELLS

900 MM/3 No established pediatric reference range.

TCH MAIN LAB

PLEURAL FLUID RBC 30000 MM/3 No established pediatric reference range.

TCH MAIN LAB

PLEURAL FLUID SEGS 51 % - TCH MAIN LAB

PLEURAL FLUID LYMPHS

4 % - TCH MAIN LAB

PLEURAL FLUID MONOCYTES

43 % - TCH MAIN LAB

PLEURAL FLUID MACROPHAGES

1 % - TCH MAIN LAB

MESOTHELIAL CELLS, PLEURAL FL

1 % - TCH MAIN LAB

PLEURAL FLUID CYTO COUNT

100 - TCH MAIN LAB

- TCH MAIN LAB

LAB Urobilinogen-UA 0.2 0.2-1.0 E.U./dL - TCH MAIN

LAB Nitrite-Urine NEGATIVE NEGATIVE - TCH MAIN

LAB Leukocytes NEGATIVE NEGATIVE - TCH MAIN

LAB WBC, Urine None Seen

Component Value

Component Value Ref Range Flag Comment Lab NA/Sodium 138 134-143 mmol/L - TCH MAIN

LAB K/Potassium 4.1 3.4-4.7 mmol/L - TCH MAIN

LAB

Ref Range Flag Comment Lab Triglyceride,Misc Fluid

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

RENAL FUNCTION PANEL [39584372] (continued) Resulted: 08/22/13 0854, Result Status: Final result

PLEURAL FLD CC&DIFF(CYTOSPIN) [39606409] Resulted: 08/23/13 1259, Result Status: Final result

Ordering provider: Church, Jessica C. 08/23/13 0748 Order Status: Completed Collected by: VAN POUCKE, REGINA V Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0823:HF00033R]

Lab Specimen 08/23/13 1144

TRIGLYCERIDE, MISC FLUID [39606408] Resulted: 08/23/13 1303, Result Status: Final result

Ordering provider: Church, Jessica C. 08/23/13 0748 Order Status: Completed Collected by: VAN POUCKE, REGINA V Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen: [0823:CF00010R]

Lab Specimen 08/23/13 1144

BASIC METABOLIC PANEL [39626499] (Abnormal) Resulted: 08/24/13 0650, Result Status: Final result

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 127

- TCH MAIN LAB

Calcium,S 9.2 8.7-9.8 MG/DL -

Component Value Ref Range Flag Comment Lab TOTAL PLEURAL FLUID VOLUME

1.5 ML - TCH MAIN LAB

PLEURAL FLUID VOLUME

1.5 ML - TCH MAIN LAB

PLEURAL FLUID COLOR

AMBER - TCH MAIN LAB

PLEURAL FLUID CHARACTER

CLOUDY - TCH MAIN LAB

PLEURAL FLUID NUCLEATED CELLS

807 MM/3 No established pediatric reference range.

TCH MAIN LAB

PLEURAL FLUID RBC 8050 MM/3 No established pediatric reference range.

TCH MAIN LAB

PLEURAL FLUID RBC MORPH

NORMAL - TCH MAIN LAB

PLEURAL FLUID RBC MORPH

NORMAL - TCH MAIN LAB

PLEURAL FLUID SEGS 41 % - TCH MAIN LAB

PLEURAL FLUID EOS 1 % - TCH MAIN LAB

PLEURAL FLUID LYMPHS

26 % - TCH MAIN LAB

PLEURAL FLUID MONOCYTES

24 % - TCH MAIN LAB

MESOTHELIAL CELLS, PLEURAL FL

8 % - TCH MAIN LAB

PLEURAL FLUID COMMENTS

SEE PATH REPORT - TCH MAIN LAB

PLEURAL FLUID CYTO COUNT

100 - TCH MAIN LAB

TCH MAIN LAB

Phosphorus,Serum 3.5 3.0-6.0 mg/dL TCH MAIN LAB

Comment: Delta: 6.1 on 08/21/13-0530 CONFIRMED IN DUPLICATE

Albumin,S 3.6 3.4-4.2 g/dL - TCH MAIN LAB

Chloride 98 96-109 mmol/L - TCH MAIN LAB

Bicarb/HCO3,S 29 20-31 MMOL/L - TCH MAIN LAB

Glucose,S 99

Component Value Ref Range Flag Comment Lab Triglyceride,Misc Fluid 138 mg/dL NO NORMALS AVAILABLE TCH MAIN

LAB

60-105 mg/dL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

BUN 16 5-17 MG/DL - TCH MAIN LAB

Creatinine,S 0.30 0.23-0.61 mg/dL

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

Lab - Results (continued)

BASIC METABOLIC PANEL [39626499] (Abnormal) (continued) Resulted: 08/24/13 0650, Result Status: Final result

Ordering provider: Church, Jessica C. 08/24/13 0201 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0824:C00036R] Lab Specimen 08/24/13 0615

BASIC METABOLIC PANEL [39635122] (Abnormal) Resulted: 08/25/13 0658, Result Status: Final result

Ordering provider: Diamond, Bethany A. 08/25/13 0201 Order Status: Completed Resulting Lab: CHILDREN'S HOSPITAL COLORADO LABORATORY Specimen:

[0825:C00032R] Lab Specimen 08/25/13 0620

Testing Performed By Lab - Abbreviation Name Director Address Valid Date Range 7 - TCH MAIN LAB CHILDREN'S HOSPITAL

COLORADO LABORATORY

Mark A. Lovell MD, Medical Director, eff 7/1/2011

13123 East 16th Avenue Aurora CO 80045

10/20/11 1552 - Present

8 - Unknown TCH RADIOLOGY Unknown Unknown Create - Present 55 - Unknown TRACEMASTER Unknown Unknown 02/18/09 1433 - Present

All Meds and Administrations

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 128

K/Potassium 5.7 3.4-4.7 mmol/L H TCH MAIN LAB

Comment: Delta: 4.1 on 08/22/13-0810 Specimen has 1+ hemolysis, which may affect values for the following tests:K,BUN Interpret results for these assays with caution. Hemolysis index = 184

Chloride 93 96-109 mmol/L L

Component Value Ref Range Flag Comment Lab NA/Sodium 136 134-143 mmol/L - TCH MAIN

LAB K/Potassium 5.7 3.4-4.7 mmol/L H TCH MAIN

LAB Comment: Specimen has 1+ hemolysis, which may affect values

for the following tests:K,BUN Interpret results for these assays with caution. Hemolysis index = 120

Chloride 95 96-109 mmol/L L - TCH MAIN LAB

Bicarb/HCO3,S 31 20-31 MMOL/L - TCH MAIN LAB

Glucose,S 89 60-105 mg/dL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

BUN 23 5-17 MG/DL H - TCH MAIN LAB

Creatinine,S 0.30 0.23-0.61 mg/dL - TCH MAIN LAB

Calcium,S 9.9 8.7-9.8 MG/DL H - TCH MAIN LAB

- TCH MAIN LAB

Bicarb/HCO3,S 34 20-31 MMOL/L H - TCH MAIN LAB

Glucose,S 89 60-105 mg/dL GLUCOSE NORMALS ARE BASED ON FASTING SPECIMEN

TCH MAIN LAB

BUN 24 5-17 MG/DL H - TCH MAIN LAB

Creatinine,S 0.23 0.23-0.61 mg/dL - TCH MAIN LAB

Calcium,S 9.4 8.7-9.8 MG/DL - TCH MAIN LAB

Component Value Ref Range Flag Comment Lab NA/Sodium 134 134-143 mmol/L - TCH MAIN

LAB

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 129

milrinone 6 mg in D5W (dextrose 5 %) 30 mL [39516788] Status: Discontinued (Past End Date/Time)

chlorhexidine gluconate (HIBICLENS) 4% topical liquid [39516795] Status: Verified (Past End Date/Time)

NS (sodium chloride 0.9%) 500mL with heparin 1,000 units [39516786] Status: Discontinued (Past End Date/Time)

ceFAZolin in dextrose (20 mg/mL) 520 mg [39516796] Status: Discontinued (Past End Date/Time)

DOPamine 96 mg in D5W (dextrose 5 %) 30 mL [39516787] Status: Discontinued (Past End Date/Time)

Admin Instructions: *Premixed Bag* Comments:

Administration Status Dose Route Site Given By 08/20/13 0700 Canceled

Entry Intravenous Robertson, Carolina A.

Ordering Provider: Fisher, Faith A.

Administration Status Dose Route Site

Ordering Provider: Fisher, Faith A. Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0600 - 08/20/13 1507 Dose (Remaining/Total): 0.25-0.75 mcg/kg/min (1/1) Frequency: ONCE IN OR Route: Intravenous Rate/Duration: 0.98-2.93 mL/hr / - Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due.

Comments:

Given By

Administration Status Dose Route Site Given By 08/20/13 0600 Canceled

Entry Intravenous Robertson, Carolina A.

08/20/13 0700 Canceled Entry

Intravenous Robertson, Carolina A.

Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0630 - 08/20/13 1507

Ordering Provider: Fisher, Faith A. Ordered On: 08/19/13 0621 Starts/Ends: 08/19/13 1900 - 08/20/13 0659 Dose (Remaining/Total): - (1/1) Frequency: PREOP Route: Topical Rate/Duration: - / - Admin Instructions: The night before and the morning of surgery to surgical site.

Comments:

Dose (Remaining/Total): - (1/1)

Administration Status Dose Route Site Given By 08/19/13 1900 Canceled

Entry Topical Robertson, Carolina A.

Frequency: ONCE IN OR Route: Intravenous Rate/Duration: - / -

Ordering Provider: Fisher, Faith A. Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0700 - 08/20/13 1507

Ordering Provider: Fisher, Faith A. Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0600 - 08/20/13 1507 Dose (Remaining/Total): 40 mg/kg/dose (1/1) Frequency: ONCE IN OR Route: Intravenous Rate/Duration: - / - Admin Instructions: Infuse over 10-60 minutes Comments: Recommended dose: 40 mg/kg/dose (max dose: 2

grams/dose) x 1 dose for non-bypass patients; Order a second dose for bypass patients

Dose (Remaining/Total): 3-7 mcg/kg/min (1/1)

Administration Status Dose Route Site Given By 08/20/13 0600 Canceled

Entry Intravenous Robertson, Carolina A.

Frequency: ONCE IN OR Route: Intravenous Rate/Duration: 0.73-1.71 mL/hr / - Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due.

Comments:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 130

dexmedetomidine 100 mcg in NS (0.9% sodium chloride) 25 mL [39538818] Status: Dispensed (Past End Date/Time)

nitroprusside sodium 15 mg in D5W (dextrose 5 %) 30 mL [39538819] Status: Discontinued (Past End Date/Time)

ceFAZolin in dextrose (20 mg/mL) 520 mg [39516797] Status: Discontinued (Past End Date/Time)

mannitol 25% (conc: 0.25 g/mL) injectable 6.2 g [39539078] Status: Discontinued (Past End Date/Time)

cardioplegia irrigation solution [39516798] Status: Discontinued (Past End Date/Time)

Admin Instructions: Infuse over 10-60 minutes Comments: Recommended dose: 40 mg/kg/dose (max dose: 2 grams/dose); Order 2 doses for patients on bypass.

(No admins scheduled or recorded for this medication)

Ordering Provider: Fisher, Faith A.

Administration Status Dose Route Site

Ordering Provider: Bjur, Kara Ordered On: 08/20/13 0617 Starts/Ends: 08/20/13 0700 - 08/20/13 1859 Dose (Remaining/Total): 0.7 mcg/kg/hr (1/1) Frequency: Once in CVOR Route: Intravenous Rate/Duration: 2.17 mL/hr / - Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due. TO CVOR2

Comments:

Given By

Administration Status Dose Route Site Given By 08/20/13 1924 Pump Check 0.3 mcg/kg/hr Intravenous Hall-Perry, Gillian N.

Rate: 0.93 mL/hr Comments: verified by R Treadwell RN

08/20/13 1830 Pump Check 0.3 mcg/kg/hr Intravenous Hall-Perry, Gillian N. Rate: 0.93 mL/hr Comments: verified by M Detrick

08/20/13 1400 Verified 8.68 mcg/hr Intravenous Hall-Perry, Gillian N. Rate: 2.17 mL/hr Comments: verified with M. Kerr, RN

08/20/13 0700 Canceled Entry

Intravenous Robertson, Carolina A.

08/20/13 0600 Canceled Entry

Intravenous Robertson, Carolina A.

Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0600 - 08/20/13 1507

Ordering Provider: Bjur, Kara Ordered On: 08/20/13 0617 Starts/Ends: 08/20/13 0700 - 08/20/13 1507 Dose (Remaining/Total): 1 mcg/kg/min (1/1) Frequency: Once in CVOR Route: Intravenous Rate/Duration: 1.49 mL/hr / - Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due. TO CVOR2

Comments:

Dose (Remaining/Total): 40 mg/kg/dose (1/1)

Administration Status Dose Route Site Given By 08/20/13 0700 Canceled

Entry Intravenous Robertson, Carolina A.

Frequency: ONCE IN OR Route: Intravenous Rate/Duration: - / -

Ordering Provider: Fisher, Faith A. Ordered On: 08/19/13 0621 Starts/Ends: 08/20/13 0600 - 08/20/13 1507

Ordering Provider: Twite, Mark D. Ordered On: 08/20/13 0700 Starts/Ends: 08/20/13 0800 - 08/20/13 1507 Dose (Remaining/Total): 0.5 g/kg/dose (1/1) Frequency: ONCE IN OR Route: Perfusion Rate/Duration: - / - Admin Instructions: Comments:

Dose (Remaining/Total): 1,059.3 mL (-/-)

Administration Status Dose Route Site Given By 08/20/13 0800 Canceled

Entry Perfusion Robertson, Carolina A.

Frequency: AS NEEDED IN OR Route: Irrigation Rate/Duration: - / - Admin Instructions: *for perfusion only* Comments:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 131

NS (sodium chloride 0.9%) 500mL with heparin 1,000 units [39540075] Status: Discontinued (Past End Date/Time)

ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL [39540079] Status: Discontinued (Past End Date/Time)

midazolam (conc: 2mg/mL) oral syrup 6 mg [39539106] Status: Completed (Past End Date/Time)

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 3.72 mEq [39540080] Status: Discontinued (Past End Date/Time)

D5W-1/2NS (dextrose 5% in 0.45% sodium chloride) 500 mL [39540074] Status: Discontinued (Past End Date/Time)

Dose (Remaining/Total): - (-/-) Frequency: CONTINUOUS Route: Intravenous Rate/Duration: - / - Admin Instructions: Rate Recommendation: Open Heart Cases: infuse at 1/2 maintenance

Comments:

Admin Instructions: Give 1 dose pre-op. This is a HIGH ALERT medication. Comments: Recommended dose: 0.25-0.3 mg/kg/dose (max dose: 20 mg)

Administration Status Dose Route Site Given By 08/21/13 1200 Not Given Intravenous Hall-Perry, Gillian N.

Reason: Discontinued 08/20/13 1508 Given Intravenous Hall-Perry, Gillian N.

Ordering Provider: Nichols, Christopher S.

Administration Status Dose Route Site

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1024 Dose (Remaining/Total): - (-/-) Frequency: CONTINUOUS Route: Intravenous Rate/Duration: - / - Admin Instructions: Pressure Line Bag Comments: *Premixed Bag*

Given By

Administration Status Dose Route Site Given By 08/20/13 1723 Given 500 mL Intravenous Hall-Perry, Gillian N.

08/20/13 0705 Given 6 mg Oral Decoster, Angela D. 08/20/13 0700 Verified 6 mg Oral

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1700 - 08/22/13 0108 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: EVERY 8 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: Comments: Recommended dose: 1 mg/kg/dose (max dose: 50 mg/dose)

IV q8h

Decoster, Angela D.

Administration Status Dose Route Site Given By 08/22/13 0100 Not Given 12.4 mg Intravenous Monaco, Anne

Reason: Discontinued 08/21/13 1702 Given 12.4 mg Intravenous Hall-Perry, Gillian N. 08/21/13 0905 Given 12.4 mg Intravenous Hall-Perry, Gillian N. 08/21/13 0023 Given 12.4 mg Intravenous Treadwell, Ryann A. 08/20/13 1635 Given 12.4 mg Intravenous Hall-Perry, Gillian N. 08/20/13 0900 Canceled

Entry Intravenous Robertson, Carolina A.

Dual Signoff by: Dennis, Cortney L.

Ordered On: 08/20/13 0703 Starts/Ends: 08/20/13 0800 - 08/20/13 0705

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 0.3 mEq/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / 2 Hours Admin Instructions: Infuse over 2 hours via CENTRAL LINE only Comments: Recommended dose: 0.3 mEq/kg/dose (max dose: 10 mEq)

prn for K+ less than 3.8 mmol/L; infuse over 2 hours This is a HIGH ALERT medication.

Dose (Remaining/Total): 6 mg (0/1) Frequency: ONCE

(No admins scheduled or recorded for this medication)

Route: Oral Rate/Duration: - / -

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/22/13 0108

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 132

calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL [39540083] Status: Discontinued (Past End Date/Time)

calcium chloride 124 mg in NS (0.9% sodium chloride) 6.2 mL [39540084] Status: Discontinued (Past End Date/Time)

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 6.2 mEq [39540081] Status: Discontinued (Past End Date/Time)

calcium chloride 248 mg in NS (0.9% sodium chloride) 12.4 mL [39540085] Status: Discontinued (Past End Date/Time)

potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 12.4 mEq [39540082] Status: Discontinued (Past End Date/Time)

magnesium sulfate (conc: 80 mg/mL) injectable 310 mg [39540086] Status: Discontinued (Past End Date/Time)

(No admins scheduled or recorded for this medication)

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 5 mg/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / - Admin Instructions: Infuse slowly; Comments: Recommended dose for ionized calcium less than 1.4 mmol/L:

5 mg/kg/dose (max dose: 500 mg/dose); Administer IV slowly Infuse thru CENTRAL only.This is HIGH ALERT medication.

(No admins scheduled or recorded for this medication)

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 0.5 mEq/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / 2 Hours

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 10 mg/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / - Admin Instructions: Infuse slowly; Comments: Recommended dose for ionized calcium less than 1.2 mmol/L:

10 mg/kg/dose (max dose: 500 mg/dose); Administer IV slowly Infuse thru CENTRAL only.This is HIGH ALERT medication.

Ordering Provider: Farina, Mark A.

(No admins scheduled or recorded for this medication)

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 1 mEq/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / 2 Hours

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 20 mg/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / - Admin Instructions: Infuse slowly; Comments: Recommended dose for ionized calcium less than or equal to 1

mmol/L: 20 mg/kg/dose (max dose: 1000 mg/dose); Administer IV slowly Infuse thru CENTRAL only.This is HIGH ALERT medication.

Admin Instructions: Infuse over 2 hours via CENTRAL LINE only Comments: Recommended dose: 1 meq/kg/dose (max dose: 40 mEq/dose) prn if K+ less than 3 mmol/L; Infuse over 2 hours

(No admins scheduled or recorded for this medication)

This is a HIGH ALERT medication.

Admin Instructions: Infuse over 2 hours via CENTRAL LINE only Comments: Recommended dose: 0.5 mEq/kg/dose (max dose: 20 mEq/dose) prn for K+ less than 3.4 mmol/L; Infuse over 2 hours

(No admins scheduled or recorded for this medication)

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019 Dose (Remaining/Total): 25 mg/kg/dose (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / 2 Hours Admin Instructions: Administer over 2 hours. This is a HIGH ALERT medication.

Comments: Recommended dose: 25 mg/kg/dose (max dose: 2000mg/dose) IV prn for serum magnesium less than 1.7 mEq/L ; infuse over 2 hours

(No admins scheduled or recorded for this medication)

This is a HIGH ALERT medication.

Ordering Provider: Farina, Mark A.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 133

DOPamine 128 mg in D5W (dextrose 5 %) 40 mL [39540113] Status: Discontinued (Past End Date/Time)

milrinone 12 mg in D5W (dextrose 5 %) 60 mL [39540114] Status: Discontinued (Past End Date/Time)

Route Site Given By 08/20/13 1926 Pump Check 5 mcg/kg/min Intravenous Hall-Perry, Gillian N.

Rate: 1.16 mL/hr Dual Signoff by: Treadwell, Ryann A. 08/20/13 1400 Pump Check 5 mcg/kg/min Intravenous Hall-Perry, Gillian N.

Rate: 1.16 mL/hr Dual Signoff by: Kerr, Michelle R. 08/20/13 1300 Rate Change 5 mcg/kg/min Intravenous Bjur, Kara

Rate: 1.16 mL/hr 08/20/13 1257 Rate Change 8 mcg/kg/min Intravenous Nichols, Christopher S.

Rate: 1.86 mL/hr 08/20/13 1230 Rate Change 10 mcg/kg/min Intravenous Bjur, Kara

Rate: 2.33 mL/hr 08/20/13 1223 New Bag 5 mcg/kg/min Intravenous Bjur, Kara

Rate: 1.16 mL/hr 08/20/13 0900 Canceled

Entry Intravenous Robertson, Carolina A.

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0900 - 08/21/13 0750 Dose (Remaining/Total): 3-10 mcg/kg/min (-/-) Frequency: CONTINUOUS Route: Intravenous Rate/Duration: 0.7-2.33 mL/hr / -

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0900 - 08/22/13 0108 Dose (Remaining/Total): 0.3-1 mcg/kg/min (-/-) Frequency: CONTINUOUS Route: Intravenous Rate/Duration: 1.12-3.72 mL/hr / - Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due.

Comments: Recommended dose: 0.3 - 1 mcg/kg/min

Admin Instructions: Send Inbasket message to pharmacy 2 hours before syringe is due.

Comments: Recommended dose: 3-15 mcg/kg/min

Administration Status Dose Route Site Given By 08/21/13 0700 Pump Check 0.5 mcg/kg/min Intravenous Treadwell, Ryann A.

Rate: 1.86 mL/hr Dual Signoff by: Hall-Perry, Gillian N. 08/21/13 0023 New Bag 0.5 mcg/kg/min Intravenous Treadwell, Ryann A.

Rate: 1.86 mL/hr Dual Signoff by: Katz, Jaime S. 08/20/13 1926 Pump Check 0.5 mcg/kg/min Intravenous Hall-Perry, Gillian N.

Rate: 1.86 mL/hr Dual Signoff by: Treadwell, Ryann A. 08/20/13 1400 Pump Check 0.5 mcg/kg/min Intravenous Hall-Perry, Gillian N.

Rate: 1.86 mL/hr Dual Signoff by: Kerr, Michelle R. 08/20/13 1223 New Bag 0.5 mcg/kg/min Intravenous Bjur, Kara

Rate: 1.86 mL/hr 08/20/13 0900 Canceled

Entry Intravenous Robertson, Carolina A.

Ordering Provider: Farina, Mark A.

Administration Status Dose

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 134

morphine (conc: 2mg/mL) injectable 0.62-1.24 mg [39540115] Status: Discontinued (Past End Date/Time)

acetaminophen (conc: 160mg/5mL) oral suspension 160 mg [39540116] Status: Discontinued (Past End Date/Time), Reason: Patient

Discharged

Route Site Given By 08/21/13 2002 Given 0.62 mg Intravenous Monaco, Anne 08/21/13 1953 Verified 0.62 mg Intravenous King, Suzanne

Dual Signoff by: Monaco, Anne 08/21/13 1712 Given 0.62 mg Intravenous Hall-Perry, Gillian N. 08/21/13 1711 Verified 0.62 mg Intravenous Hall-Perry, Gillian N.

Dual Signoff by: Alpern, Jennifer R. 08/21/13 0802 Given 0.62 mg Intravenous Hall-Perry, Gillian N. 08/21/13 0801 Verified 0.62 mg Intravenous Hall-Perry, Gillian N.

Dual Signoff by: Detrick, Meghan A. 08/21/13 0716 Given 0.62 mg Intravenous Treadwell, Ryann A. 08/21/13 0707 Verified 0.62 mg Intravenous Treadwell, Ryann A.

Dual Signoff by: Hall-Perry, Gillian N.

08/21/13 0436 Given 0.62 mg Intravenous Dodt, Katherine B. 08/21/13 0435 Verified 0.62 mg Intravenous Dodt, Katherine B.

Dual Signoff by: Korus, Tayler R. 08/21/13 0107 Given 0.62 mg Intravenous Treadwell, Ryann A. 08/21/13 0103 Verified 0.62 mg Intravenous Treadwell, Ryann A.

Dual Signoff by: Katz, Jaime S. 08/20/13 2223 Given 0.62 mg Intravenous Treadwell, Ryann A. 08/20/13 2218 Verified 0.62 mg Intravenous Treadwell, Ryann A.

Dual Signoff by: Dodt, Katherine B. 08/20/13 2035 Given 0.62 mg Intravenous Treadwell, Ryann A. 08/20/13 2033 Verified 0.62 mg Intravenous Treadwell, Ryann A.

Dual Signoff by: Gahring, Kim R. 08/20/13 1851 Given 0.62 mg Intravenous Hall-Perry, Gillian N. 08/20/13 1850 Verified 0.62 mg Intravenous Detrick, Meghan A.

Dual Signoff by: Hall-Perry, Gillian N.

08/20/13 1631 Given 1 mg Intravenous Hall-Perry, Gillian N. 08/20/13 1630 Pump Check 1 mg Intravenous Detrick, Meghan A.

Dual Signoff by: Hall-Perry, Gillian N.

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0800 - 08/22/13 0821 Dose (Remaining/Total): 0.05-0.1 mg/kg/dose (-/-) Frequency: EVERY 2 HOURS PRN Route: Intravenous Rate/Duration: - / -

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0800 - 08/26/13 1334 Dose (Remaining/Total): 160 mg (-/-) Frequency: EVERY 4 HOURS PRN Route: Oral Rate/Duration: - / - Admin Instructions: This dose has been standardized per hospital policy. Comments: Recommended dose: 15 mg/kg/dose (max dose:

650mg/dose) every 4 hours prn

Admin Instructions: Comments: Recommended Dose Range: 0.05 - 0.1mg/kg/dose (max dose: 5 mg/dose) IV q1-2 hrs prn

Administration Status Dose Route Site Given By 08/26/13 0902 Given 160 mg Oral Overholt, Julie A. 08/24/13 2057 Given 160 mg Oral Maddux, Joely D. 08/24/13 1535 Given 160 mg Oral Van Poucke, Regina V. 08/24/13 0223 Given 160 mg Oral Maddux, Joely D. 08/23/13 1750 Given 160 mg Oral Van Poucke, Regina V. 08/23/13 1250 Given 160 mg Oral Van Poucke, Regina V. 08/23/13 0455 Given 160 mg Oral Johnson, Leesa A. 08/23/13 0058 Given 160 mg Oral Johnson, Leesa A. 08/22/13 2125 Given 160 mg Oral Johnson, Leesa A. 08/22/13 1240 Given 160 mg Oral Shirazi, Mona L. 08/21/13 1924 Given 160 mg Oral Monaco, Anne

Ordering Provider: Farina, Mark A.

Administration Status Dose

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 135

ceFAZolin in dextrose (20 mg/mL) 372 mg [39540119] Status: Completed (Past End Date/Time)

ondansetron (conc: 2mg/mL) injectable 1.9 mg [39540120] Status: Discontinued (Past End Date/Time)

acetaminophen rectal suppository 120 mg [39540117] Status: Discontinued (Past End Date/Time)

albumin 5% (conc: 5 g/100 mL) injectable 3-6 g [39540121] Status: Discontinued (Past End Date/Time)

ketorolac (conc: 30mg/mL) injectable 6.2 mg [39540118] Status: Completed (Past End Date/Time)

Route Site Given By 08/22/13 1730 Given 6.2 mg Intravenous Van Poucke, Regina V. 08/22/13 1032 Given 6.2 mg Intravenous Shirazi, Mona L. 08/22/13 0457 Given 6.2 mg Intravenous Monaco, Anne 08/21/13 2257 Given 6.2 mg Intravenous Monaco, Anne 08/21/13 1700 Given 6.2 mg Intravenous Hall-Perry, Gillian N. 08/21/13 1146 Given 6.2 mg Intravenous Hall-Perry, Gillian N. 08/21/13 0516 Given 6.2 mg Intravenous Treadwell, Ryann A. 08/20/13 2334 Given 6.2 mg Intravenous Treadwell, Ryann A. 08/20/13 0900 Canceled

Entry Intravenous Robertson, Carolina A.

Ordering Provider: Farina, Mark A.

(No admins scheduled or recorded for this medication)

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1800 - 08/21/13 0214 Dose (Remaining/Total): 30 mg/kg/dose (0/2) Frequency: EVERY 8 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: Infuse over 10-60 minutes Comments: Recommended dose for patients less than 7 days & wt greater

than 2000g: 20 mg/kg/dose every 8 hours x 2 doses ** start first dose 8 hours after last administered dose **

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019

Administration Status Dose Route Site Given By 08/21/13 0214 Given 372 mg Intravenous Treadwell, Ryann A. 08/20/13 1723 Given 372 mg Intravenous Hall-Perry, Gillian N. 08/20/13 0900 Canceled

Entry Intravenous Robertson, Carolina A.

Dose (Remaining/Total): 120 mg (-/-) Frequency: EVERY 4 HOURS PRN Route: Rectal Rate/Duration: - / -

Ordering Provider: Farina, Mark A.

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0802 - 08/21/13 0750 Dose (Remaining/Total): 0.15 mg/kg/dose (-/-) Frequency: EVERY 6 HOURS PRN Route: Intravenous Rate/Duration: - / - Admin Instructions: Comments: Recommended dose: Standard dose (max dose: 4 mg/dose)

q6h PRN

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 2000 - 08/22/13 1730

(No admins scheduled or recorded for this medication)

Dose (Remaining/Total): 0.5 mg/kg/dose (0/8) Frequency: EVERY 6 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: Start when bleeding stops. Comments: Recommended dose: 0.5 mg/kg/dose (max dose:

30mg/dose) q6h x 48 hours

Ordering Provider: Farina, Mark A. Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 0802 - 08/21/13 1019 Dose (Remaining/Total): 60-120 mL (-/-) Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / - Admin Instructions: Comments: Recommended dose: 5 -10 mL/kg

Maximum duration 48 hours per hospital policy.

Administration Status Dose Route Site Given By 08/20/13 1902 Given 60 mL Intravenous Hall-Perry, Gillian N.

Admin Instructions: Comments: Recommended dose: 15 mg/kg/dose (max dose: 650 mg/dose) q4h PRN

Administration Status Dose

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 136

furosemide (conc: 10mg/mL) injectable 12.4 mg [39559005] Status: Discontinued (Past End Date/Time)

ondansetron oral disintegrating tablet 2 mg [39559023] Status: Discontinued (Past End Date/Time)

sodium bicarbonate 8.4 % (conc: 1 mEq/mL) injectable 12 mEq [39540122] Status: Discontinued (Past End Date/Time)

midazolam (conc: 5mg/mL) injectable 1.24 mg [39562205] Status: Discontinued (Past End Date/Time)

bacitracin injection [39549540] Status: Discontinued (Past End Date/Time)

Admin Instructions: Comments:

Administration Status Dose Route Site Given By 08/20/13 1258 Given 100,000 units Irrigation Operative Site Stowers, Annamarie For - Mitchell, Max

Ordering Provider: Farina, Mark A.

Administration Status Dose Route Site

Ordering Provider: Alvarez, Rita Ordered On: 08/20/13 2130 Starts/Ends: 08/20/13 2200 - 08/21/13 1012 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: EVERY 8 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: max infusion rate 4mg/min and 0.5mg/kg/min Comments:

Given By

Administration Status Dose Route Site Given By 08/21/13 0612 Given 12.4 mg Intravenous Treadwell, Ryann A. 08/20/13 2334 Given 12.4 mg Intravenous Treadwell, Ryann A.

08/20/13 1756 Given 12 mEq Intravenous Hall-Perry, Gillian N.

Ordered On: 08/20/13 0805 Starts/Ends: 08/20/13 1200 - 08/21/13 1019

Ordering Provider: Alvarez, Rita Ordered On: 08/20/13 2132 Starts/Ends: 08/20/13 2132 - 08/25/13 1239 Dose (Remaining/Total): 2 mg (-/-) Frequency: EVERY 8 HOURS PRN Route: Oral Rate/Duration: - / - Admin Instructions: With dry hands, peel back foil backing from blister and remove tablet. Do not push tablet through foil backing.

Comments:

Dose (Remaining/Total): 12 mEq (-/-)

Administration Status Dose Route Site Given By 08/20/13 2240 Given 2 mg Oral Treadwell, Ryann A.

Frequency: AS NEEDED Route: Intravenous Rate/Duration: - / -

Ordering Provider: Mitchell, Max B. Ordered On: 08/20/13 1306 Starts/Ends: 08/20/13 1258 - 08/20/13 1507

Ordering Provider: Kim, John S. Ordered On: 08/21/13 0748 Starts/Ends: 08/21/13 0748 - 08/21/13 1024 Dose (Remaining/Total): 0.1 mg/kg/dose (-/-) Frequency: EVERY 1 HOUR PRN Route: Intravenous Rate/Duration: - / - Admin Instructions: This is a HIGH ALERT medication. Comments:

Dose (Remaining/Total): - (-/-)

Administration Status Dose Route Site Given By 08/21/13 0805 Verified 1 mg Intravenous Hall-Perry, Gillian N.

Dual Signoff by: Detrick, Meghan A. 08/21/13 0804 Given 1 mg Intravenous Hall-Perry, Gillian N.

Frequency: PROCEDURAL Route: - Rate/Duration: - / - Admin Instructions: Comments:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 137

furosemide (conc: 10mg/mL) injectable 12.4 mg [39566235] Status: Discontinued (Past End Date/Time)

spironolactone (conc: 2mg/mL) oral suspension 5 mg [39566274] Status: Discontinued (Past End Date/Time)

aspirin chewable tablet 40.5 mg [39562213] Status: Discontinued (Past End Date/Time)

furosemide (conc: 10mg/mL) injectable 12.4 mg [39566099] Status: Discontinued (Past End Date/Time)

Route: Oral Rate/Duration: - / -

Ordering Provider: Kim, John S. Ordered On: 08/21/13 1012 Starts/Ends: 08/21/13 1800 - 08/21/13 1017 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: EVERY 12 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: max infusion rate 4mg/min and 0.5mg/kg/min Comments:

Admin Instructions: Comments:

(No admins scheduled or recorded for this medication)

Ordering Provider: Kim, John S.

Administration Status Dose Route Site

Ordering Provider: Kim, John S. Ordered On: 08/21/13 1017 Starts/Ends: 08/21/13 1400 - 08/22/13 0924 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: EVERY 8 HOURS Route: Intravenous Rate/Duration: - / - Admin Instructions: max infusion rate 4mg/min and 0.5mg/kg/min Comments:

Given By

Administration Status Dose Route Site Given By 08/22/13 0516 Given 12.4 mg Intravenous Monaco, Anne 08/21/13 2126 Given 12.4 mg Intravenous Monaco, Anne 08/21/13 1432 Given 12.4 mg Intravenous Hall-Perry, Gillian N.

08/22/13 0900 Canceled Entry

Oral Shirazi, Mona L.

08/21/13 1201 Given 40.5 mg Oral

Ordering Provider: Kim, John S. Ordered On: 08/21/13 1019 Starts/Ends: 08/21/13 1100 - 08/24/13 1112 Dose (Remaining/Total): 5 mg (-/-) Frequency: TWICE A DAY Route: Oral Rate/Duration: - / - Admin Instructions: Comments:

Hall-Perry, Gillian N.

Administration Status Dose Route Site Given By 08/24/13 0900 Given 5 mg Oral Van Poucke, Regina V. 08/24/13 0752 Given 5 mg Oral Van Poucke, Regina V. 08/23/13 2016 Given 5 mg Oral Perry, Cami S. 08/23/13 1110 Given 5 mg Oral Van Poucke, Regina V. 08/22/13 2125 Given 5 mg Oral Johnson, Leesa A. 08/22/13 1016 Given 5 mg Oral Shirazi, Mona L. 08/21/13 2001 Given 5 mg Oral Monaco, Anne 08/21/13 1152 Given 5 mg Oral Hall-Perry, Gillian N.

Ordered On: 08/21/13 0750 Starts/Ends: 08/21/13 0900 - 08/22/13 0916 Dose (Remaining/Total): 40.5 mg (-/-) Frequency: EVERY DAY

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 138

oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg [39582816] Status: Discontinued (Past End Date/Time), Reason: Patient

Discharged

aspirin chewable tablet 81 mg [39586959] Status: Discontinued (Past End Date/Time), Reason: Patient

Discharged

Route Site Given By 08/24/13 2057 Given 1.25 mg Oral Maddux, Joely D. 08/24/13 2054 Verified 1.25 mg Oral Maddux, Joely D.

Dual Signoff by: Courtway, Lauren 08/24/13 0223 Given 1.25 mg Oral Maddux, Joely D. 08/24/13 0221 Verified 1.25 mg Oral Maddux, Joely D.

Dual Signoff by: Franks, Valerie L. 08/23/13 2107 Given 1.25 mg Oral Perry, Cami S. 08/23/13 2105 Verified 1.25 mg Oral Perry, Cami S.

Dual Signoff by: Fischer, Judith M. 08/23/13 0455 Given 1.25 mg Oral Johnson, Leesa A. 08/23/13 0453 Verified 1.25 mg Oral Strumpfer, Alissa D.

Dual Signoff by: Johnson, Leesa A. 08/23/13 0058 Given 1.25 mg Oral Johnson, Leesa A. 08/23/13 0055 Verified 1.25 mg Oral Johnson, Leesa A.

Dual Signoff by: Barnes, Emily E. 08/22/13 2125 Given 1.25 mg Oral Johnson, Leesa A. 08/22/13 2121 Verified 1.25 mg Oral Johnson, Leesa A.

Dual Signoff by: Fischer, Judith M. 08/22/13 1243 Verified 1.25 mg Oral Shirazi, Mona L.

Dual Signoff by: Alpern, Jennifer R. 08/22/13 1242 Given 1.25 mg Oral Shirazi, Mona L. 08/22/13 0746 Given 1.25 mg Oral Shirazi, Mona L. 08/22/13 0744 Verified 1.25 mg Oral Shirazi, Mona L.

Dual Signoff by: Reichert, Kelly D. 08/22/13 0200 Given 1.25 mg Oral Monaco, Anne 08/22/13 0157 Verified 1.25 mg Oral King, Suzanne

Dual Signoff by: Monaco, Anne

Ordered On: 08/22/13 0104 Starts/Ends: 08/22/13 0104 - 08/26/13 1334 Dose (Remaining/Total): 0.1 mg/kg/dose (-/-) Frequency: EVERY 4 HOURS PRN Route: Oral Rate/Duration: - / -

Ordering Provider: Farina, Mark A. Ordered On: 08/22/13 0916 Starts/Ends: 08/22/13 1000 - 08/26/13 1334 Dose (Remaining/Total): 81 mg (-/-) Frequency: EVERY DAY Route: Oral Rate/Duration: - / - Admin Instructions: Comments:

Admin Instructions: This is a HIGH ALERT medication. Comments:

Administration Status Dose Route Site Given By 08/26/13 0854 Given 81 mg Oral Overholt, Julie A. 08/25/13 0947 Given 81 mg Oral Cook, Brigitte E. 08/24/13 0900 Given 81 mg Oral Van Poucke, Regina V. 08/24/13 0752 Given 81 mg Oral Van Poucke, Regina V. 08/23/13 1109 Given 81 mg Oral Van Poucke, Regina V. 08/22/13 1017 Given 81 mg Oral Shirazi, Mona L.

Ordering Provider: Nicolarsen, Jeremy R.

Administration Status Dose

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 139

acetaminophen (conc: 160mg/5mL) oral suspension 186 mg [39607171] Status: Verified (Past End Date/Time)

spironolactone (conc: 2mg/mL) oral suspension 5 mg [39629662] Status: Discontinued (Past End Date/Time)

furosemide (conc: 10mg/mL) oral solution 12.4 mg [39587153] Status: Discontinued (Past End Date/Time)

midazolam (conc: 1mg/mL) injectable 1 mg [39636264] Status: Discontinued (Past End Date/Time)

ibuprofen (conc: 100mg/5mL) oral suspension 120 mg [39605811] Status: Discontinued (Past End Date/Time), Reason: Patient

Discharged

Oral Van Poucke, Regina V. 08/24/13 0900 Given 12.4 mg Oral Van Poucke, Regina V. 08/24/13 0748 Given 12.4 mg Oral Van Poucke, Regina V. 08/23/13 2016 Given 12.4 mg Oral Perry, Cami S. 08/23/13 1548 Given 12.4 mg Oral Van Poucke, Regina V. 08/23/13 1109 Given 12.4 mg Oral Van Poucke, Regina V. 08/22/13 2125 Given 12.4 mg Oral Johnson, Leesa A. 08/22/13 1437 Given 12.4 mg Oral Van Poucke, Regina V.

Ordered On: 08/22/13 0924 Starts/Ends: 08/22/13 1500 - 08/26/13 0959 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: THREE TIMES A DAY Route: Oral Rate/Duration: - / -

Ordering Provider: Burkett, Dale A. Ordered On: 08/23/13 0706 Starts/Ends: 08/23/13 0706 - 08/26/13 1334 Dose (Remaining/Total): 120 mg (-/-) Frequency: EVERY 8 HOURS PRN Route: Oral Rate/Duration: - / - Admin Instructions: This dose has been standardized per hospital policy. Comments:

Admin Instructions: Comments:

Administration Status Dose Route Site Given By 08/26/13 0858 Not Given 120 mg Oral Overholt, Julie A.

Reason: Other (see comment) 08/26/13 0224 Given 120 mg Oral Johnson, Leesa A. 08/25/13 1605 Given 120 mg Oral Cook, Brigitte E. 08/25/13 0018 Given 120 mg Oral Maddux, Joely D. 08/24/13 0748 Given 120 mg Oral Van Poucke, Regina V.

Ordering Provider: Kim, John S.

Administration Status Dose Route Site

Ordering Provider: Twite, Mark D. Ordered On: 08/23/13 0825 Starts/Ends: 08/23/13 0825 - 08/23/13 2359 Dose (Remaining/Total): 15 mg/kg/dose (1/1) Frequency: PRN IN PACU Route: Oral Rate/Duration: - / - Admin Instructions: May give x 1 dose in PACU if patient did not receive a pre- op acetaminophen dose

Comments: Recommended dose: 15 mg/kg/dose (max dose: 650 mg/dose) x 1 dose

Given By

(No admins scheduled or recorded for this medication)

08/26/13 0854 Given 12.4 mg Oral Overholt, Julie A. 08/25/13 2051 Given 12.4 mg Oral

Ordering Provider: Diamond, Bethany A. Ordered On: 08/24/13 1112 Starts/Ends: 08/25/13 0900 - 08/25/13 1239 Dose (Remaining/Total): 5 mg (-/-) Frequency: EVERY DAY Route: Oral Rate/Duration: - / - Admin Instructions: Comments:

Johnson, Leesa A.

Administration Status Dose Route Site Given By 08/25/13 0947 Given 5 mg Oral Cook, Brigitte E.

08/25/13 1444 Given 12.4 mg Oral Cook, Brigitte E. 08/25/13 0947 Given 12.4 mg Oral

Ordering Provider: Mackie, Sara M. Ordered On: 08/25/13 0807 Starts/Ends: 08/25/13 0900 - 08/25/13 0808 Dose (Remaining/Total): 1 mg (1/1) Frequency: ONCE Route: Intravenous Rate/Duration: - / - Admin Instructions: This is a HIGH ALERT medication. Comments:

Cook, Brigitte E.

(No admins scheduled or recorded for this medication)

08/24/13 2057 Given 12.4 mg Oral Maddux, Joely D. 08/24/13 1535 Given 12.4 mg

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

All Meds and Administrations (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 140

furosemide (conc: 10mg/mL) oral solution 12.4 mg [39648120] Status: Discontinued (Past End Date/Time), Reason: Patient

Discharged

fentanyl (conc: 50mcg/mL) injectable 10 mcg [39636265] Status: Completed (Past End Date/Time)

midazolam (conc: 1mg/mL) injectable 0.5 mg [39636270] Status: Discontinued (Past End Date/Time)

Dual Signoff by: Cook, Brigitte E.

Ordered On: 08/25/13 0807 Starts/Ends: 08/25/13 0900 - 08/25/13 0845 Dose (Remaining/Total): 10 mcg (0/1) Frequency: ONCE Route: Intravenous Rate/Duration: - / -

Ordering Provider: Mackie, Sara M. Ordered On: 08/25/13 0808 Starts/Ends: 08/25/13 0900 - 08/25/13 1239 Dose (Remaining/Total): 0.5 mg (1/1) Frequency: ONCE Route: Intravenous Rate/Duration: - / - Admin Instructions: This is a HIGH ALERT medication. Comments:

Admin Instructions: This is a HIGH ALERT medication. Comments:

Administration Status Dose Route Site Given By 08/25/13 0900 Not Given 0.5 mg Intravenous Cook, Brigitte E.

Reason: Held Dose

Ordering Provider: Mackie, Sara M.

Administration Status Dose Route Site

Ordering Provider: Tiernan, Kendra D. Ordered On: 08/26/13 0959 Starts/Ends: 08/26/13 2100 - 08/26/13 1334 Dose (Remaining/Total): 1 mg/kg/dose (-/-) Frequency: TWICE A DAY Route: Oral Rate/Duration: - / - Admin Instructions: Comments:

Given By

(No admins scheduled or recorded for this medication)

08/25/13 0845 Given 6 mcg Intravenous Cook, Brigitte E. 08/25/13 0819 Verified 6.2 mcg Intravenous Lohmeier, Carrie A.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER

Patient Information

Patient Name: MRN: HAR: 204990349

General Information Date: 8/20/2013 Time: 7:30 AM Status: Posted Location: CVOR Room: CVOR 2 Service: Cardiothoracic Patient class: Surgery Admit Case classification:

Op Notes and Brief Op Notes

CARDIOTHORACIC SURGERY POST OP NOTE

Patient Name: MRN: DOB: Date of Surgery: 8/20/2013

OR Nursing Notes Jump to OR Nursing Notes

Patient Diagnosis Pre-op diagnosis: DOLV (double outlet left ventricle) [745.19] Post-op diagnosis: DOLV (double outlet left ventricle) [745.19]

Panel Information

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 141

Log ID: 124062

OP Note signed by Mitchell, Max B. at 8/20/2013 1:28 PM Author: Mitchell, Max B. Service: Surgery-Cardio/Thoracic Author Type: Physician

Panel 1

Surgeon Role Service Start Time

E n d T i m e

Mitchell, Max B. Primary Cardiothoracic 7:26 AM

Filed: 8/20/2013 1:28 PM Note Time: 8/20/2013 1:25 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Panel Information (continued)

Scheduling Questions

Link to Scheduling Questions

Staff Information Staff Type Staff Member Start End OT Circulator Stowers, Annamarie 7:26 AM 11:50 AM Circulator Stowers, Annamarie 12:11 PM 1:30 PM Scrub McGlasson, Joseph C. 7:26 AM 1:20 PM Patient Liaison Carpenter, Esther V. 7:26 AM 1:51 PM Circulator Champagne, Elizabeth K. 11:50 AM 12:20 PM Circulator Champagne, Elizabeth K. 9:12 AM 9:28 AM Scrub Tendell, Ulyssess 1:20 PM 1:51 PM Circulator Beazer, Faith D. 1:20 PM 1:51 PM

Anesthesia Staff Information Type Staff Start End Anes Fellow Bjur, Kara Cardiac Anesthesiologist Nichols, Christopher S. Perfusionist Mejak, Brian L.

Visitors Type Time In Time Out

Shauna Maty premed Student

ADMIT/DISCHARGE TO OPERATING ROOM HANDOFF (all recorded)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 142

Panel 2

Surgeon Role Service Start Time

E n d T i m e

Younoszai, Adel K. Primary Cardiology 1 : 5 1 P M

Periop Handoff/ Trnspt Info

08/20/13 0821 Perioperative Hand-off Report Handoff Report per Policy?

Y -AS

Clinician Giving Report.

A DeCoster RN -AS

Report type received written -AS Transfer In Information Transport to: Cardio-Vascular OR 2 -AS Transferred Via: Being carried -AS Equipment in Place Other - see comment

3 stuffed animals and blanket -AS Safety Precautions Blankets applied;Held -AS Parents Present for Induction?

No -AS

Interpreter Present? N/A -AS NPO Status Yes -AS

N/A Clean Contaminated General Esophagus

General Chest

Procedure: FONTAN PROCEDURE

Laterality Wound Class Anesthesia Op Region Bilateral Clean

Procedure: TRANSESOPHAGEAL ECHOCARDIOGRAM

Laterality Wound Class Anesthesia Op Region

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

ADMIT/DISCHARGE TO OPERATING ROOM HANDOFF (all recorded) (continued)

Counts Type Which? Correct? X-Ray? MD Notif? Counted By Verified By Sponge Initial McGlasson, Joseph C. Stowers, Annamarie Needles/Sharps Initial McGlasson, Joseph C. Stowers, Annamarie Instruments Initial McGlasson, Joseph C. Stowers, Annamarie Other Initial McGlasson, Joseph C. Stowers, Annamarie Sponge Close Yes No Yes McGlasson, Joseph C. Stowers, Annamarie Needles/Sharps Close Yes No Yes McGlasson, Joseph C. Stowers, Annamarie Instruments Close Yes No Yes McGlasson, Joseph C. Stowers, Annamarie Other Close Yes No Yes McGlasson, Joseph C. Stowers, Annamarie Sponge Final Yes No Yes Tendell, Ulyssess Beazer, Faith D. Needles/Sharps Final Yes No Yes Tendell, Ulyssess Beazer, Faith D. Other Final Yes No Yes Tendell, Ulyssess Beazer, Faith D.

Patient Prep

Positioning Information

Lines, Drains, and Airways PICC Single Lumen- - Upper;Arm;Brachial Placed: 8/23/13 0920 Removed: 8/26/13 1200

( tip intact, removed at 14cm) Type: BioFlo

PICC Size: 3.0 Fr. Side: Left Site Prep: ChloraPrep Local Anesthetic: Lidocaine Technique: Ultrasound guidance for line placement: All relevant anatomy identified. Needle position and guidewire visualized inside of target vessel lumen. Inadvertent cannulation of adjacent structures avoided. An image was obtained and attached. Attempts: 1

Tip Placement: Central Length (cm):: 14 cm Cath. Lot # (Radiology only):: 4645966 Inserting provider (if applicable): Blalock, Wayne RN

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 143

TRANSESOPHAGEAL ECHOCARDIOGRAM (N/A) - Position 1

Checked?

User Key (r) = User Recd, (t) = User Taken, (c) = User Cosigned

Initials Name

Panel-1 Information

FONTAN PROCEDURE (Bilateral) - Position 1

AS Stowers, Annamarie

Panel-2 Information

Flexed Slightly

Head: Aligned Donut

Gel Pad, z-flo small

Left Leg: Flexed Slightly Gel Pad, z-flo small

Right Leg: Flexed Slightly Gel Pad, z-flo small

Right Leg: Flexed Slightly

Positioned by:

Mitchell, Max B.

Nichols, Christopher S. Stowers, Annamarie

Comments: shoulder roll under gel pad tubing/connectors padded with gauze heels suspended external defib patches applied

Gel Pad, z-flo small

Left Arm: At Side

Positioned by:

Mitchell, Max B.

Nichols, Christopher S. Stowers, Annamarie

Comments: shoulder roll under gel pad tubing/connectors padded with gauze heels suspended external defib patches applied

Gel Pad, z-flo small Body: Right Arm: At Side

Gel Pad, z-flo small Supine

Head: Aligned Donut

K-Thermia Pad, Gel Pad Body, Shoulder Roll

Body: Supine K-Thermia Pad, Gel Pad Body, Shoulder Roll

Left Arm: At Side Gel Pad, z-flo small

Left Leg:

Right Arm: At Side Gel Pad, z-flo small

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Lines, Drains, and Airways (continued) Removal Reason: No clinical need/ end of therapy ( tip intact, removed at 14cm)

Mask Only Placed: 8/23/13 0740 Removed: --- *Masked Airway: Easy *Airway Adjunct: Nasal Cannula

GI Tube- Placed: 8/20/13 1330 Removed: 8/20/13 1700 Category: OG

Size/Diameter: 12 Fr Removal Reason: No clinical need/planned removal

Chest Tube- - Left;Pleural Placed: 8/20/13 1252 Removed: 8/25/13 0855 Type: Chest Tube

Size: 16 Removal Reason: No clinical need/planned removal (removed by J.Jaggers MD)

Chest Tube- - Right;Pleural Placed: 8/20/13 1252 Removed: 8/23/13 0815 Type: Chest Tube

Size: 16 Removal Reason: No clinical need/planned removal

Chest Tube- - Mediastinal Placed: 8/20/13 1252 Removed: 8/21/13 0825 Type: Blake

Size: 15 Removal Reason: No clinical need/planned removal

Urine Drain- - Urethra Placed: 8/20/13 0822 Removed: 8/21/13 0810 Urine Drain Type/Size: Foley;8 fr.;Other - see comment (temp) Removal Reason: No clinical need/planned removal

CVC Double Lumen- - Femoral Placed: 8/20/13 0815 Removed: 8/21/13 2130 Category: Nontunneled

Size: 5 Fr. 8cm Side: Right Site Prep: ChloraPrep Technique: Landmark;Guidewire Attempts: 1

Removal Reason: No clinical need/ end of therapy

Arterial Line- - Radial Placed: 8/20/13 0800 Removed: 8/21/13 0830 Size: 2.5fr x 5 cm Side: Left Site Prep: ChloraPrep Technique: Landmark;Guidewire Attempts: 2

Removal Reason: No clinical need/planned removal

CVC Single Lumen- - IJ Placed: 8/20/13 0750 Removed: 8/21/13 0830 Category: Nontunneled

Size: 3 Fr. 5cm Side: Right Site Prep: ChloraPrep Technique: Ultrasound guidance for line placement: All relevant anatomy identified. Needle position and guidewire visualized inside of target vessel lumen. Inadvertent cannulation of adjacent structures avoided. An image was obtained and attached.;Guidewire Attempts: 2

Removal Reason: No clinical need/ end of therapy

Orotracheal Airway Placed: 8/20/13 0735 Removed: 8/20/13 1845 *Masked Airway: Easy

Size: 4.5 Type: Microcuff

Technique: Laryngoscope Blade Type: Wisconsin Blade Size: 1.5 Cm @ Teeth/Gums: 14 Leak: 25 cm H20 Leak with cuff: 25 cm H20

Confirmation: +EtCO2;Breathing Equal & Symetric Removal Reason: Planned Removal

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 144

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Lines, Drains, and Airways (continued)

PIV- - Hand Placed: 8/20/13 0734 Removed: 8/24/13 2200 PIV Size: 20G Side: Left Site Prep: ChloraPrep Technique: Landmark Attempts: 1

Removal Reason: No clinical need/planned removal

Timeouts

Timeouts Pre-Procedure Timeout

Comments: confirmed with POC

Pre-incision Timeout

Electro Surgery Units ESU Type ESU Blend Setting Mode Pad Loc Laterality Coag Set Cut Set Applied By ESU VALLEYLAB BOVIE CVOR 2 -

200700021878 Monopol ar

Buttocks Bilateral 15 Stowers, Annamarie

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 145

Stowers, Annamarie at Tue Aug 20, 2013 7:12 AM

Stowers, Annamarie at Tue Aug 20, 2013 8:38 AM

Anesthesia Staff Bjur, Kara, Nichols, Christopher S., Mejak, Brian L. Staff Stowers, Annamarie, McGlasson, Joseph C.

History

Staff Performed Verified Stowers, Annamarie Tue Aug 20, 2013 8:38 AM Tue Aug 20, 2013 9:06 AM

Staff

Staff Stowers, Annamarie

Timeout type Pre-procedure

History

Staff Performed Verified Stowers, Annamarie Tue Aug 20, 2013 7:12 AM Tue Aug 20, 2013 8:23 AM

Timeout Details

Procedures

Panel 1: Bilateral FONTAN PROCEDURE with Mitchell, Max B.

Timeout Details

Timeout type Pre-incision

Procedures

Panel 1: Bilateral FONTAN PROCEDURE with Mitchell, Max B.

Staff

Surgeons Mitchell, Max B., Fisher, Faith A.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Tourniquets Warming Devices

Device Type Device Setting Area Lateralit y Temp Applied By

Solution Warmer SOLUTION WARMER CVOR #2 43.3 °C (110 °F) McGlasson, Joseph C. Sorin 3T SORIN 3T CVOR 2 200700031658 Variable - see

perfusion record

Full body Bilateral Mejak, Brian L.

Implants

Specimens None

PNDS Information

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 146

Yes The patient is free from signs and symptoms of injury caused by extraneous objects. (O2) Yes Applies safety devices. (I11) Yes Records devices implanted during the operative or invasive procedure. (I112) Yes Uses supplies and equipment within safe parameters. (I122) Yes Maintains continuous surveillance. (I128) Yes Implements protective measures prior to operative or invasive procedure. (I138) Yes Evaluates for signs and symptoms of physical injury to skin and tissue. (I152) Yes Confirms identity before the operative or invasive procedure. (I26) Yes Implements protective measures to prevent injury due to laser sources. (I73) Yes Implements protective measures to prevent skin or tissue injury due to thermal sources. (I76) Yes Implements protective measures to prevent skin/tissue injury due to mechanical sources. (I77)

Manages specimen handling and disposition. (I84) Yes Performs required counts. (I93)

Performs venipuncture. (I95) Yes The patient is free from signs and symptoms of chemical injury. (O3)

Implements latex allergy precautions as needed. (I139) Yes Evaluates for signs and symptoms of chemical injury. (I36) Yes Implements protective measures to prevent skin and tissue injury due to chemical sources. (I75)

Yes The patient is free from signs and symptoms of injury related to positioning. (O5) Verifies presence of prosthetics or corrective devices. (I127)

Yes Evaluates for signs and symptoms of injury as a result of positioning. (I38) Yes Identifies physical alterations that require additional precautions for procedure-specific positioning. (I64) Yes Positions the patient. (I96)

Yes The patient is free from signs and symptoms of injury related to transfer/transport. (O8) Yes Transports according to individual needs. (I118) Yes Evaluates for signs and symptoms of skin and tissue injury as a result of transfer or transport. (I42)

Yes The patient receives appropriate medication(s), safely administered during the perioperative period. (O9) Yes Verifies allergies. (I123)

Yes The patient is free from signs and symptoms of infection. (O10) Yes Assesses susceptibility for infection. (I21) Yes Classifies surgical wound. (I22) Yes Implements aseptic technique. (I70) Yes Initiates traffic control. (I81)

Manages culture specimen collection. (I83) Yes Minimizes the length of invasive procedure by planning care. (I85) Yes Monitors for signs and symptoms of infection. (I88) Yes Performs skin preparations. (I94) Yes Protects from cross-contamination. (I98)

Yes The patient is at or returning to normothermia at the conclusion of the immediate postoperative period. (O12) Yes Assesses risk for inadvertent hypothermia. (I131) Yes Evaluates response to thermoregulation measures. (I55) Yes Implements thermoregulation measures. (I78) Yes Monitors body temperature. (I86)

Yes The patient's care is consistent with the individualized perioperative plan of care. (O24) Yes Verifies consent for planned procedure. (I124) Yes Verifies operative procedure, surgical site, and laterality. (I143) Yes Confirms identity before the operative or invasive procedure. (I26) Yes Ensures continuity of care. (I27) Yes Develops individualized plan of care. (I30)

Yes The patient's right to privacy is maintained. (O25)

Outcomes - Intra-op

Description (Code)Used?

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

PNDS Information (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 147

Yes Provides care respecting worth and dignity regardless of diagnosis, disease process, procedure, or projected outcome. (I100) Yes Provides care without prejudicial behavior. (I102) Yes Shares patient information only with those directly involved in care. (I116)

Yes The patient demonstrates knowledge of the expected responses to the operative or invasive procedure. (O31) Provides status reports to family members.. (I109)

Yes Identifies barriers to communication. (I134) Yes Elicits perceptions of surgery. (I32) Yes Explains expected sequence of events. (I56) Yes Notes sensory impairments. (I90)

Yes Maintains patient's dignity and privacy. (I150)

Outcomes - Post-op

Yes The patient has wound/tissue perfusion consistent with or improved from baseline levels established preoperatively. (O11) Yes Functions as first assistant during surgical incision, excision, and repair of pathology (RNFA). (I129) Yes Evaluates progress of wound healing. (I130) Yes Assesses factors related to risks for ineffective tissue perfusion. (I15) Yes Evaluates postoperative tissue perfusion. (I46) Yes Identifies baseline tissue perfusion. (I60)

Yes The patient's respiratory function is consistent with or improved from baseline levels established preoperatively. (O14) Yes Recognizes and reports deviation in arterial blood gas studies. (I110) Yes Uses monitoring equipment to assess respiratory status. (I121) Yes Evaluates postoperative respiratory status. (I45) Yes Monitors changes in respiratory status. (I87)

Yes The patient's cardiovascular status is consistent with or improved from baseline levels established preoperatively. (O15) Yes Uses monitoring equipment to assess cardiac status. (I120) Yes Evaluates postoperative cardiac status. (I44) Yes Identifies and reports the presence of implantable cardiac devices. (I58) Yes Identifies baseline cardiac status. (I59)

Yes The patient is the recipient of competent and ethical care within legal standards of practice. (O26) Yes Acts as a patient advocate by protecting the patient from incompetent, unethical, or illegal practices. (I1) Yes Provides care respecting worth and dignity regardless of diagnosis, disease process, procedure, or projected outcome. (I100) Yes Provides care without prejudicial behavior. (I102) Yes Shares patient information only with those directly involved in care. (I116)

Yes The patient demonstrates and/or reports adequate pain control throughout the perioperative period. (O29) Yes Assesses pain control. (I16) Yes Collaborates in initiating patient-controlled analgesia. (I24) Yes Evaluates response to pain management interventions. (I54) Yes Implements alternative methods of pain control. (I69) Yes Implements pain guidelines. (I71)

Yes The patient's neurological status is consistent with or improved from baseline levels established preoperatively. (O30) Yes Assesses baseline neurological status. (I144) Yes Implements protective measures during neurosurgical procedures. (I145) Yes Evaluates postoperative neurological status. (I146) Yes Identifies physiological status. (I66)

Yes Maintains patient confidentiality. (I151)

Diagnoses

Yes Anxiety (X4) Ineffective breathing pattern (X7) Decreased cardiac output (X8) Acute confusion (X11)

Yes Risk for infection (X28) Risk for injury (X29) Deficient knowledge (X30) Acute pain (X38) Risk for impaired skin integrity (X51)

Used? Description (Code)

Present? Description (Code)

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

PNDS Information (continued)

Post-op Info

Case Tracking Events Event Time In Patient In - Facility (Arrived) 6:00 AM Patient In - Pre-op/Holding Area 6:03 AM Patient Assessed Surgeon Cleared Room Ready 7:20 AM Patient In - OR 7:26 AM Procedure Start 8:51 AM Procedure Stop 1:32 PM Patient Out - OR 1:51 PM Handoff to Unit 2:00 PM Patient In - PACU Ready for Parents Phase I Complete Handoff to Floor Patient In - Phase II End of Periop Care In Radiology Anesthesia Start 7:26 AM Anesthesia Stop 2:09 PM Anesthesia Available

Event Tracking

Transplant Info None

Log Verified By Beazer, Faith D. 8/20/2013 3:21 PM

Hospital Admission for this Surgery Date Department Provider Description 08/20/2013 - 8/20/2013 9CPCU Truong, Uyen T. Single Ventricle (Primary Dx); Dolv (Double

Outlet Left Ventricle); Bilateral Svc's; Mapca (Major Aortopulmonary Collaterals) Without Pa-Vsd

Scheduling History

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 148

Risk for imbalanced body temperature (X57)

Panel 2

Nausea (X73)

POST PROCEDURE INFO

Question Answer Comment Documented procedure verified with surgeon?: Yes: Final counts verified?: Yes: Correct labeling of specimen verified?: N/A: Key concerns addressed?: Yes: EBL and likelihood of ongoing blood loss?: Yes: Communication of key recovery issues for handoff?:

Yes:

Was blood returned to the blood bank?: Yes:

Panel 1

Patient out of OR 1:51 PM

Procedure Start 8:51 AM Procedure Stop 1:51 PM Patient out of OR 2:00 PM

Procedure : FONTAN PROCEDURE

Event Start Time End Time Time Elapsed Patient in OR 7:26 AM

Procedure : TRANSESOPHAGEAL ECHOCARDIOGRAM

Event Start Time End Time Time Elapsed Patient in OR 7:26 AM Procedure Start 8:51 AM Procedure Stop 1:32 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Scheduling History (continued) Scheduling Date Scheduling Time Scheduled by Scheduled in Room Case Date Case Time 6/14/2013 11:04 AM Voung, Mardy CVOR 2 8/20/2013 7:30 AM

Patient Information

Patient Name: MRN: HAR: 204990349

General Information Date: 8/23/2013 Time: 8:00 AM Status: Posted Location: CARDIAC PRE POST Room: CPPU 6 Service: Cardiology Patient class: Inpatient Case classification:

Op Notes and Brief Op Notes

No notes of this type exist for this encounter.

OR Nursing Notes Jump to OR Nursing Notes

Patient Diagnosis Pre-op diagnosis: Single ventricle [745.3] Post-op diagnosis:

Case Notes PICC PLACEMENT

Panel Information

Scheduling Questions

Link to Scheduling Questions

Staff Information None

Anesthesia Staff Information Type Staff Start End Cardiac Anesthesiologist (Not assigned) Anes Attending Twite, Mark D.

ADMIT/DISCHARGE TO OPERATING ROOM HANDOFF (all recorded)

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Kaufman, Jonathan M. Primary Cardiology

Log ID: 130608

Panel 1

Periop Handoff/ Trnspt Info

08/20/13 0821 Perioperative Hand-off Report Handoff Report per Policy?

Y -AS

Clinician Giving Report.

A DeCoster RN -AS

Report type received written -AS Transfer In Information Transport to: Cardio-Vascular OR 2 -AS Transferred Via: Being carried -AS Equipment in Place Other - see comment

Provider Role Service Start Time

E n d T i m e

Laterality Wound Class Anesthesia Op Region N/A General Chest

Procedure: PICC LINE PLACEMENT

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

ADMIT/DISCHARGE TO OPERATING ROOM HANDOFF (all recorded) (continued)

Counts Type Which? Correct? X-Ray? MD Notif? Counted By Verified By Instruments Initial Needles/Sharps Initial Sponge Initial Other Initial Instruments Close Needles/Sharps Close Sponge Close Other Close Instruments Final Needles/Sharps Final Sponge Final Other Final

Patient Prep

Positioning Information

Lines, Drains, and Airways PICC Single Lumen- - Upper;Arm;Brachial Placed: 8/23/13 0920 Removed: 8/26/13 1200

( tip intact, removed at 14cm) Type: BioFlo

Tip Placement: Central Length (cm):: 14 cm Cath. Lot # (Radiology only):: 4645966 Inserting provider (if applicable): Blalock, Wayne RN Removal Reason: No clinical need/ end of therapy ( tip intact, removed at 14cm)

Mask Only Placed: 8/23/13 0740 Removed: --- *Masked Airway: Easy *Airway Adjunct: Nasal Cannula

GI Tube- Placed: 8/20/13 1330 Removed: 8/20/13 1700 Category: OG

Size/Diameter: 12 Fr Removal Reason: No clinical need/planned removal

Chest Tube- - Left;Pleural Placed: 8/20/13 1252 Removed: 8/25/13 0855 Type: Chest Tube

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 150

PICC LINE PLACEMENT (N/A) - Position 1

Safety Precautions Blankets applied;Held -AS Parents Present for Induction?

No -AS

Interpreter Present? N/A -AS NPO Status Checked?

Yes -AS

3 stuffed animals and blanket -AS

User Key (r) = User Recd, (t) = User Taken, (c) = User Cosigned

Initials Name AS Stowers, Annamarie

Panel-1 Information

Left Arm: Left Leg: Right Leg:

Body: Right Arm: Head:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Lines, Drains, and Airways (continued) Size: 16 Removal Reason: No clinical need/planned removal (removed by J.Jaggers MD)

Chest Tube- - Right;Pleural Placed: 8/20/13 1252 Removed: 8/23/13 0815 Type: Chest Tube

Size: 16 Removal Reason: No clinical need/planned removal

Chest Tube- - Mediastinal Placed: 8/20/13 1252 Removed: 8/21/13 0825 Type: Blake

Size: 15 Removal Reason: No clinical need/planned removal

Urine Drain- - Urethra Placed: 8/20/13 0822 Removed: 8/21/13 0810 Urine Drain Type/Size: Foley;8 fr.;Other - see comment (temp) Removal Reason: No clinical need/planned removal

CVC Double Lumen- - Femoral Placed: 8/20/13 0815 Removed: 8/21/13 2130 Category: Nontunneled

Size: 5 Fr. 8cm Side: Right Site Prep: ChloraPrep Technique: Landmark;Guidewire Attempts: 1

Removal Reason: No clinical need/ end of therapy

Arterial Line- - Radial Placed: 8/20/13 0800 Removed: 8/21/13 0830 Size: 2.5fr x 5 cm Side: Left Site Prep: ChloraPrep Technique: Landmark;Guidewire Attempts: 2

Removal Reason: No clinical need/planned removal

CVC Single Lumen- - IJ Placed: 8/20/13 0750 Removed: 8/21/13 0830 Category: Nontunneled

Removal Reason: No clinical need/ end of therapy

Orotracheal Airway Placed: 8/20/13 0735 Removed: 8/20/13 1845 *Masked Airway: Easy

Size: 4.5 Type: Microcuff

Technique: Laryngoscope Blade Type: Wisconsin Blade Size: 1.5 Cm @ Teeth/Gums: 14 Leak: 25 cm H20 Leak with cuff: 25 cm H20

Confirmation: +EtCO2;Breathing Equal & Symetric Removal Reason: Planned Removal

PIV- - Hand Placed: 8/20/13 0734 Removed: 8/24/13 2200 PIV Size: 20G Side: Left Site Prep: ChloraPrep Technique: Landmark Attempts: 1

Removal Reason: No clinical need/planned removal

Timeouts Pre-Procedure Timeout

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

Pre-Procedure Timeout (continued)

Comments: confirmed with POC

Pre-incision Timeout

Tourniquets Implants

Specimens None

PNDS Information No outcomes documented

Post-op Info None

Case Tracking Events Event Time In Patient In - Facility (Arrived) Tue Aug 20, 2013 6:00 AM Patient In - Pre-op/Holding Area Fri Aug 23, 2013 7:31 AM Patient Assessed Surgeon Cleared Procedure Start Fri Aug 23, 2013 8:07 AM Procedure Stop Fri Aug 23, 2013 8:49 AM Handoff to Unit Fri Aug 23, 2013 9:40 AM Patient In - PACU Ready for Parents Patient In - Phase II End of Periop Care Anesthesia Start Fri Aug 23, 2013 8:01 AM Anesthesia Stop Fri Aug 23, 2013 8:51 AM Anesthesia Available

Event Tracking

Transplant Info None

Hospital Admission for this Surgery Date Department Provider Description 08/20/2013 - 8/20/2013 9CPCU Truong, Uyen T. Single Ventricle (Primary Dx); Dolv (Double

Outlet Left Ventricle); Bilateral Svc's; Mapca (Major Aortopulmonary Collaterals) Without Pa-Vsd

Scheduling History Scheduling Date Scheduling Time Scheduled by Scheduled in Room Case Date Case Time 8/22/2013 1:56 PM Henry, Reginald L CPPU 6 8/23/2013 8:00 AM

ANESTHESIA RECORD

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 152

No diagnosis documented Diagnoses

Panel 1

Start Time End Time Time Elapsed Patient in OR Procedure Start 8:07 AM Procedure Stop 8:49 AM Patient out of OR

Procedure : PICC LINE PLACEMENT

Event

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

SURGICAL/PROCEDURAL INFO ON ENCOUNTER (continued)

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

< Male 3 year old Current as of 08/23/13 0740 Height Weight BMI ASA Status 96.7 cm (08/20/13) 12.4 kg (08/20/13) Not recorded 3

Allergies

Downtime - Elements of Record Charted on Paper:

No data filed

Procedure Summary Date Anesthesia Start Anesthesia Stop Room / Location 08/23/13 0801 0851 CPPU 6 / CARDIAC PRE POST

Procedure Diagnosis Provider Responsible Provider PICC LINE PLACEMENT (N/A Chest) Single ventricle Kaufman, Jonathan M. Twite, Mark D.

Intraprocedure Grid/Graph

Staff Responsible times on 08/23/13 Name Role Begin End Twite, Mark D. Anes Attend 0801 0851

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 154

No Known Allergies

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Events Date Time Event 08/23/13 0801 Anesthesia Start

Patient re-identified and reevaluated immediately prior to anesthetic.

0801 Start Data Collection 0804 Induction 0806 Ready for Case 0806 Quick Note

Chest Tube removal by Dr. Mitchell 0807 Quick Note

Neuron Capsule not putting data into EPIC. Called EREX - placed on hold for more than 5 minutes so called Dr. Guffey. Reboot pf Capsule resolved issue. All VSS during first 20 mins of case - unable to record into EPIC as directly monitoring patient.

0850 Stop Data Collection 0851 Anesthesia Handoff Complete

Patient transported to recovery in stable condition. Handoff communication complete to receiving team according to protocol. All questions answered, patient in stable conditon. Contact information confirmed.

Lines and Airways Type Details Placement Removal Peripheral IV 08/20/13; 0734; 20G; Left; Hand; ChloraPrep;

Landmark; 1; 08/24/13; 2200; No clinical need/planned removal

08/20/13 0734 by Bjur, Kara 08/24/13 2200 by Maddux, Joely D.

Chest Tube- 08/20/13; 1252; Chest Tube; Left, Pleural; 16; 08/25/13; 0855; No clinical need/planned removal (removed by J.Jaggers MD)

08/20/13 1252 by Stowers, Annamarie 08/25/13 0855 by Cook, Brigitte E.

Chest Tube- 08/20/13; 1252; Chest Tube; Right, Pleural; 16; 08/23/13; 0815; No clinical need/planned removal

08/20/13 1252 by Stowers, Annamarie 08/23/13 0815 by Inman, Candace M.

Mask Only Mask: Easy; Nasal Cannula 08/23/13 0740 by Twite, Mark D.

Procedure Notes

No procedure notes have been written.

Attestation Information Staff Name Date Time Type Twite, Mark D. 8/23/2013 8:24 AM Attending Attestation

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 155

Not indicated per surgeon Patient Position Supine Checklist Pressure Pad Breath Sounds Left Clear Breath Sounds Right Clear Assessment PP;eyes PP;eyes

Assess

08/23/13 0830 08/23/13 0824

Equipment

08/23/13 0824 Bair Hugger Off K-Thermia off Temp Source Skin NIBP Site Leg R

Attending Attestation Initial attestation: I performed the pre-anesthetic exam and evaluation myself or reviewed and approved the pre-anesthetic exam and evaluation performed by another qualified anesthesia provider. I personally performed or was immediately available throughout the anesthesia service, and I personally performed or was present during the most demanding or key portions of the procedure, including induction and emergence (when indicated). I personally performed or directly supervised all other separately billable anesthesia services.

Comment --

Cardiac 3 lead EKG

Antibiotics

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Pre Signoff Ready for Procedure marked on 08/23/13 at 0740 by Twite, Mark D.. 08/23/13 at 0740 by Twite, Mark D.

Pre Note

HPI: Single ventricle (left) with tricuspid valve atresia, L-malposed great vessels, severe pulmonary valve stenosis, bilateral SVC s/p Fontan completion 8/20. Chylous effusions. Presents now for PIC line.

Anesthetic History: no history or family history of anesthetic complications

Review of Systems / Medical History: Anesthetic History:

Patient Summary has been reviewed Nursing notes have been reviewed.

Growth and Development Within Normal Limits

Cardiology

Congenital Heart Defect Status: congenital heart disease surgically repaired Structural Defects: transposition of the great vessels

Pulmonary Within Normal Limits

Hepatic Within Normal Limits

GI Within Normal Limits

GU/Renal Within Normal Limits

Heme/Onc Within Normal Limits

Neuro Within Normal Limits

Endo/Metabolic Within Normal Limits

Other

Physical Exam: Airway normal external anatomy Mallampati: I TM distance: normal Jaw ROM: full Neck ROM: full

Cardiovascular Rhythm: regular

Dental

Pulmonary breath sounds equal and clear to auscultation

Abdominal GI exam normal

Other

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Last edited 08/23/13 0739 by Twite, Mark D.

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Anesthesia Plan:

ASA Physical Status: 3 ASA Justification: Complex congenital heart disease s/p Fontan Anesthetic: general Induction: inhalational Airway: nasal cannula Plan Comments: PIV - IV induction, NC O2

Informed Consent: Minor risks of anesthesia: sore throat, decreased blood pressure, nausea and/or vomiting and dental damage Serious risks of anesthesia: cardiovascular and respiratory complications, organ damage, nerve injury, infection and death Anesthetic plan and risks discussed with: father and mother

Anesthesia History single ventricle Chylothorax

Pre Vitals

Surgical History ATRIAL SEPTOSTOMY,XVENOUS,BALLOON CIRCUMCISION SHUNT SVC TO PA, BOTH LUNGS REPR (SIMPLE FONTAN) IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD

Substance History Smoking Status: Never Assessed Smokeless Tobacco Status: Unknown Alcohol use: Not Asked Drug use: Not Asked

Problem List Single ventricle severe pulmonary stenosis DOLV (double outlet left ventricle) Bilateral SVC's MAPCA (major aortopulmonary collaterals) without PA-VSD

Blood Orders Ordered in last 14 days.

Ordered On Ordering Provider BLOOD TYPE (ABO/RH) [39520684] 08/19/13 Mitchell, Max B. ANTIBODY SCREEN [39520686] 08/19/13 Mitchell, Max B. HOLD CLOT FOR TYPE AND SCREEN [39520717] 08/19/13 Fisher, Faith A. PACKED CELL [39522397] 08/19/13 Mitchell, Max B. FRESH FROZEN PLASMA [39539119] 08/19/13 Mitchell, Max B. CRYOPRECIPITATE [39548228] 08/19/13 Mitchell, Max B. APHERESED PLATELET [39548230] 08/19/13 Mitchell, Max B.

NPO Date & Time 8/20/2013 8/23/2013

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SpO2: 85 Temp: 36.3 °C (97.3 °F) Ht: 96.7 cm (08/20/13) Wt: 12.4 kg (08/20/13) BMI: -- IBW: -- Last edited 08/23/13 0740 by CI

BP: -- Pulse: 88 Resp: 18

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

NPO Date & Time (continued) 8/20/2013 8/23/2013

Date: 08/19/13 08/23/13 Time: 2130 0500

Prescription Medications Within last 14 days from 08/23/13

Last Taken Last Updated acetaminophen (TYLENOL) 160 MG/5ML Suspension aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab stopped 2 weeks ago 08/19/13 1121

Facility Administered Medications Taken on 08/23/13 oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg aspirin chewable tablet 81 mg furosemide (conc: 10mg/mL) oral solution 12.4 mg spironolactone (conc: 2mg/mL) oral suspension 5 mg acetaminophen (conc: 160mg/5mL) oral suspension 160 mg

Hematology Labs Hematocrit Hemoglobin 45.5 ! 08/21/13 15.3 ! 08/21/13 43.8 ! 08/20/13 14.9 ! 08/20/13 50.2 ! 08/19/13 17.1 ! 08/19/13

Blood Gases pH Art PO2 PCO2 Base Excess 7.36 08/21/13 70 08/21/13 36 08/21/13 -4.8 ! 08/21/13 7.36 08/20/13 60 ! 08/20/13 43 ! 08/20/13 -2.1 08/20/13 7.31 ! 08/20/13 62 ! 08/20/13 41 ! 08/20/13 -6.2 ! 08/20/13 7.29 ! 08/20/13 67 08/20/13 43 ! 08/20/13 -6.1 ! 08/20/13 7.30 ! 08/20/13 74 08/20/13 45 ! 08/20/13 -5.0 ! 08/20/13 7.33 ! 08/20/13 84 ! 08/20/13 42 ! 08/20/13 -4.0 ! 08/20/13 7.33 ! 08/20/13 88 ! 08/20/13 43 ! 08/20/13 -4.0 ! 08/20/13 7.38 08/20/13 257 ! 08/20/13 41 ! 08/20/13 -1.0 08/20/13 7.32 ! 08/20/13 354 ! 08/20/13 47 ! 08/20/13 -2.0 08/20/13 7.34 ! 08/20/13 223 ! 08/20/13 42 ! 08/20/13 -3.0 ! 08/20/13 7.33 ! 08/20/13 67 08/20/13 41 ! 08/20/13 -4.0 ! 08/20/13

Coagulation Labs PTT 28 08/21/13 35 08/20/13

Electrolyte Labs

Na K Cl Glucos e

Bicarb onate BUN Mg P

136 08/25/ 13

5.7 ! 08/25/ 13

95 ! 08/25/ 13

89 08/25/ 13

20 08/21/ 13

23 ! 08/25/ 13

1.8 08/21/ 13

3.5 08/22/ 13

134 08/24/ 13

5.7 ! 08/24/ 13

93 ! 08/24/ 13

89 08/24/ 13

24 ! 08/20/ 13

24 ! 08/24/ 13

2.6 ! 08/20/ 13

6.1 ! 08/21/ 13

138 08/22/ 13

4.1 08/22/ 13

98 08/22/ 13

99 08/22/ 13

20 08/20/ 13

16 08/22/ 13

5.7 08/20/ 13

139 08/21/ 13

3.6 08/21/ 13

102 08/21/ 13

81 08/21/ 13

21 08/20/ 13

16 08/21/ 13

144 ! 08/20/ 13

3.5 08/20/ 13

109 08/20/ 13

117 ! 08/20/ 13

22 08/20/ 13

12 08/20/ 13

139 08/19/ 13

3.8 08/19/ 13

103 08/19/ 13

62 08/19/ 13

22 08/20/ 13

13 08/19/ 13

22 08/20/ 13

24 ! 08/20/ 13

23 ! 08/20/ 13

22 08/20/ 13

Post-Op Note

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Anesthesia Post-op Evaluation signed by Twite, Mark D. at 8/23/2013 10:44 AM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Post-Op Note (continued)

POST ANESTHESIA EVALUATION

Perioperative course reviewed.

Patient evaluation in the PACU.

Airway: Patent and clear Hemodynamics: Stable Emergence: Smooth Mental Status: Awake and alert Analgesia/Pain: Adequately controlled Nausea/Vomiting: None Postoperative Hydration: Taking oral fluids

Disposition: Inpatient floor - planned (re)admission

Close Encounter Information Closed By Date Closed TWITE, MARK Aug 23, 2013

Follow-up notes No postoperative notes have been written.

PACU Handoff Notes No postoperative notes have been written.

Go to the Billing and Compliance Report for this case.

Case Tracking Events Event Time In Procedure Start Fri Aug 23, 2013 8:07 AM Procedure Stop Fri Aug 23, 2013 8:49 AM Handoff to Unit Fri Aug 23, 2013 9:40 AM

Staff Information None

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 159

8/23/2013 10:44 AM Author: Twite, Mark D. Service: (none) Author Type: Anesthesiologist Filed: 8/23/2013 10:44 AM Note Time:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

< Male 3 year old Current as of 08/20/13 0703 Height Weight BMI ASA Status 96.7 cm (08/20/13) 12.4 kg (08/20/13) Not recorded 4

Allergies

Downtime - Elements of Record Charted on Paper:

No data filed

Procedure Summary Date Anesthesia Start Anesthesia Stop Room / Location 08/20/13 0726 1409 CVOR 2 / CVOR

Procedure Diagnosis Surgeon Responsible Provider FONTAN PROCEDURE (Bilateral Chest); TRANSESOPHAGEAL ECHOCARDIOGRAM (N/A Esophagus)

DOLV (double outlet left ventricle) Mitchell, Max B.; Younoszai, Adel K. Nichols, Christopher S.

Intraprocedure Grid/Graph

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No Known Allergies

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Intraprocedure Grid/Graph (continued)

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ANESTHESIA RECORD (continued)

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ANESTHESIA RECORD (continued)

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ANESTHESIA RECORD (continued)

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ANESTHESIA RECORD (continued)

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IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 166

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 167

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Staff Responsible times on 08/20/13 Name Role Begin End Nichols, Christopher S. CARDIAC ANES 0726 1409 Bjur, Kara ANES FELLOW 0726 1409 Mejak, Brian L. Perfusionist 0920 1409

Events Date Time Event 08/20/13 0726 Anesthesia Start

Patient re-identified and reevaluated immediately prior to anesthetic.

0726 Start Data Collection 0726 Induction 0735 Airway Secured 0750 CV Line Placed 0800 A Line Placed 0815 CV Line Placed 0821 Ready for Case 0821 Quick Note

ABG: 7.33 / 41 / 67 / -4 / 22 / 92%

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 168

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Events (continued) Date Time Event

Na 143 K 3.3 ICa 1.16 Glu 84 14.6/43

0824 TEE placed by anesthesiologist TEE placed by anesthesiologist at surgeon's request.

0856 Quick Note incision

1032 CV Bypass Initiated 1033 Quick Note

ON cardiopulmonary bypass via RA and aorta - will continue to ventilate patient until both SVCs are cannulated.

1034 Cool to 32° 1058 Quick Note

Ventilation stopped per Dr. Mitchell. 1059 Cool to 18° 1059 pH Stat 1104 Ice On Head 1114 Quick Note

Hold cooling 1125 DHCA Start 1126 DHCA Stop 1139 DHCA Start 1141 DHCA Stop 1154 Rewarm 1155 Ice Off Head 1224 Quick Note 1225 Quick Note

Milrinone 50mcg/kg load. ETT suctioned 1244 CV Bypass Ended 1346 Transport Depart 1407 Transport Arrived 1407 Stop Data Collection 1409 Anesthesia Handoff Complete

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 169

08/20/13 1245 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 1230 08/20/13 1215 08/20/13 1205 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 1155 08/20/13 1130 08/20/13 1115 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 1105 08/20/13 1045 08/20/13 1030 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 1015 08/20/13 1000 08/20/13 0945 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 0940 08/20/13 0930 08/20/13 0915 Assessment PP;eyes PP;eyes PP;eyes

08/20/13 0900 08/20/13 0851 08/20/13 0845 Antibiotics Complete prior to incision Patient Position Supine Checklist Eyes Taped;Eyes Lubed;Pressure Pad Breath Sounds Left Clear Breath Sounds Right Clear Assessment PP;eyes PP;eyes PP;eyes

08/20/13 0830 08/20/13 0824 Antibiotics Complete prior to incision Patient Position Supine Checklist Eyes Taped;Eyes Lubed Breath Sounds Left Clear Breath Sounds Right Clear Assessment PP;eyes PP;eyes

Assess

08/20/13 1315 08/20/13 1300

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Lines and Airways Type Details Placement Removal Peripheral IV 08/20/13; 0734; 20G; Left; Hand; ChloraPrep;

Landmark; 1; 08/24/13; 2200; No clinical need/planned removal

08/20/13 0734 by Bjur, Kara 08/24/13 2200 by Maddux, Joely D.

Orotracheal Tube Mask: Easy; 4.5; Microcuff; Laryngoscope; Wisconsin; Blade Size: 1.5; cm @Teeth: 14; Leak: 25 cm H20; w /cuff: 25 cm H20; +EtCO2, Breathing Equal & Symetric

08/20/13 0735 by Bjur, Kara 08/20/13 1845 by Campbell, Thomas W. Jr.

CVC Single Lumen 08/20/13; 0750; Nontunneled; 3 Fr. 5cm; Right; IJ; ChloraPrep; Ultrasound guidance for line placement: All relevant anatomy identified. Needle position and guidewire visualized inside of target vessel lumen. Inadvertent cannulation of adjacent structures avoided. An image was obtained and attached., Guidewire; 2; 08/21/13; 0830; No clinical need/ end of therapy

08/20/13 0750 by Bjur, Kara 08/21/13 0830 by Hall-Perry, Gillian N.

Arterial Line 08/20/13; 0800; 2.5fr x 5 cm; Left; Radial; ChloraPrep; Landmark, Guidewire; 2; 08/21/13; 0830; No clinical need/planned removal

08/20/13 0800 by Bjur, Kara 08/21/13 0830 by Hall-Perry, Gillian N.

CVC Double Lumen 08/20/13; 0815; Nontunneled; 5 Fr. 8cm; Right; Femoral; ChloraPrep; Landmark, Guidewire; 1; 08/21/13; 2130; No clinical need/ end of therapy

08/20/13 0815 by Bjur, Kara 08/21/13 2130 by Treadwell, Ryann A.

Urine Drain- 08/20/13; 0822; Foley, 8 fr., Other - see comment (temp); Urethra; 08/21/13; 0810; No clinical need/planned removal

08/20/13 0822 by Stowers, Annamarie 08/21/13 0810 by Hall-Perry, Gillian N.

Chest Tube- 08/20/13; 1252; Chest Tube; Left, Pleural; 16; 08/25/13; 0855; No clinical need/planned removal (removed by J.Jaggers MD)

08/20/13 1252 by Stowers, Annamarie 08/25/13 0855 by Cook, Brigitte E.

Chest Tube- 08/20/13; 1252; Chest Tube; Right, Pleural; 16; 08/23/13; 0815; No clinical need/planned removal

08/20/13 1252 by Stowers, Annamarie 08/23/13 0815 by Inman, Candace M.

Chest Tube- 08/20/13; 1252; Blake; Mediastinal; 15; 08/21/13; 0825; No clinical need/planned removal

08/20/13 1252 by Stowers, Annamarie 08/21/13 0825 by Hall-Perry, Gillian N.

GI Tube 08/20/13; 1330; OG; 12 Fr; 08/20/13; 1700; No clinical need/planned removal

08/20/13 1330 by Kerr, Michelle R. 08/20/13 1700 by Treadwell, Ryann A.

Procedure Notes

No procedure notes have been written.

Attestation Information Staff Name Date Time Type Nichols, Christopher S. 8/20/2013 9:01 AM Attending Attestation

Beazer, Faith D. 8/20/2013 3:21 PM Intra-Op

Pre Signoff Ready for Procedure marked on 08/20/13 at 0703 by Bjur, Kara. 08/20/13 at 0703 by Bjur, Kara

Pre Note

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 170

08/20/13 0852 08/20/13 0824 Bair Hugger Off

Comment --

Off K-Thermia off Medium - 38 C Fluid Warming Hot Line Temp Source Nasopharynx Bladder;Nasopharynx NIBP Site Arm R Arm R Cardiac 5 lead EKG 5 lead EKG

Equipment

Last edited 08/19/13 1412 by Bjur, Kara

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Pre Note (continued)

HPI: 3yo boy with Complex congenital heart disease (single ventricle, DOLV, pulmonary stenosis), s/p bilateral Glenn shunts. He is doing well with good activity level. Echocardiogram demonstrates satisfactory ventricular function, good flow at low pressure in PAs, multiple AP collaterals. Now here for completion fontan

Anesthetic History: no history or family history of anesthetic complications

Review of Systems / Medical History:

Growth and Development Within Normal Limits

Cardiology

Congenital Heart Defect Status: congenital heart disease surgically repaired

Pulmonary Within Normal Limits

Hepatic Within Normal Limits

GI Within Normal Limits

GU/Renal Within Normal Limits

Heme/Onc Within Normal Limits

Neuro Within Normal Limits

Endo/Metabolic Within Normal Limits

Other

Additional ROS/Med Hx Notes:

Small with slow weight gain.

Physical Exam: Airway normal external anatomy TM distance: normal Jaw ROM: full Neck ROM: full

Cardiovascular Rhythm: regular (+) systolic murmur, 1 and murmur

Dental All dental anatomy normal. Present teeth are solid.

Pulmonary breath sounds equal and clear to auscultation

Abdominal Other

Anesthesia Plan:

ASA Physical Status: 4 ASA Justification: Single ventricle Anesthetic: general

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 171

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Induction: inhalational Airway: OTT Lines: arterial and CVP Plan Comments: Midazolam premed.

Anesthesia History single ventricle Chylothorax

Pre Vitals

Surgical History ATRIAL SEPTOSTOMY,XVENOUS,BALLOON CIRCUMCISION SHUNT SVC TO PA, BOTH LUNGS REPR (SIMPLE FONTAN)

Substance History Smoking Status: Never Assessed Smokeless Tobacco Status: Unknown Alcohol use: Not Asked Drug use: Not Asked

Problem List Single ventricle severe pulmonary stenosis DOLV (double outlet left ventricle) Bilateral SVC's MAPCA (major aortopulmonary collaterals) without PA-VSD

Blood Orders Ordered in last 14 days.

Ordered On Ordering Provider TYPE & SCREEN [39516800] 08/19/13 Fisher, Faith A. CROSSMATCH RBC REQUEST [39516801] 08/19/13 Fisher, Faith A. Platelets Request [39516802] 08/19/13 Fisher, Faith A. Fresh Frozen Plasma Request [39516803] 08/19/13 Fisher, Faith A. Cryoprecipitate Request [39516804] 08/19/13 Fisher, Faith A. BLOOD TYPE (ABO/RH) [39520684] 08/19/13 Mitchell, Max B. ANTIBODY SCREEN [39520686] 08/19/13 Mitchell, Max B. HOLD CLOT FOR TYPE AND SCREEN [39520717] 08/19/13 Fisher, Faith A. PACKED CELL [39522397] 08/19/13 Mitchell, Max B. FRESH FROZEN PLASMA [39539119] 08/19/13 Mitchell, Max B. CRYOPRECIPITATE [39548228] 08/19/13 Mitchell, Max B. APHERESED PLATELET [39548230] 08/19/13 Mitchell, Max B.

NPO Date & Time 8/20/2013 8/23/2013

Date: 08/19/13 08/23/13 Time: 2130 0500

Prescription Medications Within last 14 days from 08/20/13

Last Taken Last Updated acetaminophen (TYLENOL) 160 MG/5ML Suspension aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab stopped 2 weeks ago 08/19/13 1121

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 172

Pulse: 92 Resp: 22 SpO2: 80 Temp: 36.5 °C (97.7 °F) Ht: 96.7 cm (08/20/13) Wt: 12.4 kg (08/20/13) BMI: -- IBW: -- Last edited 08/20/13 0619 by KC

BP: 85/42

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Facility Administered Medications Taken on 08/20/13 midazolam (conc: 2mg/mL) oral syrup 6 mg rocuronium (conc: 10 mg/mL) injectable fentanyl (conc: 50mcg/mL) injectable NS (0.9% sodium chloride) IV

Hematology Labs Hematocrit Hemoglobin 45.5 ! 08/21/13 15.3 ! 08/21/13 43.8 ! 08/20/13 14.9 ! 08/20/13 50.2 ! 08/19/13 17.1 ! 08/19/13

Coagulation Labs PTT 28 08/21/13 35 08/20/13

Electrolyte Labs

Na K Cl Glucos e

Bicarb onate BUN Mg P

136 08/25/ 13

5.7 ! 08/25/ 13

95 ! 08/25/ 13

89 08/25/ 13

20 08/21/ 13

23 ! 08/25/ 13

1.8 08/21/ 13

3.5 08/22/ 13

134 08/24/ 13

5.7 ! 08/24/ 13

93 ! 08/24/ 13

89 08/24/ 13

24 ! 08/20/ 13

24 ! 08/24/ 13

2.6 ! 08/20/ 13

6.1 ! 08/21/ 13

138 08/22/ 13

4.1 08/22/ 13

98 08/22/ 13

99 08/22/ 13

20 08/20/ 13

16 08/22/ 13

5.7 08/20/ 13

139 08/21/ 13

3.6 08/21/ 13

102 08/21/ 13

81 08/21/ 13

21 08/20/ 13

16 08/21/ 13

144 ! 08/20/ 13

3.5 08/20/ 13

109 08/20/ 13

117 ! 08/20/ 13

22 08/20/ 13

12 08/20/ 13

139 08/19/ 13

3.8 08/19/ 13

103 08/19/ 13

62 08/19/ 13

22 08/20/ 13

13 08/19/ 13

22 08/20/ 13

24 ! 08/20/ 13

23 ! 08/20/ 13

22 08/20/ 13

Post-Op Note

POST ANESTHESIA EVALUATION

Perioperative course reviewed.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 173

Anesthesiologist Filed: 8/20/2013 3:49 PM Note Time: 8/20/2013 2:09 PM Related Notes: Original Note by Bjur, Kara filed at 8/20/2013 2:10 PM

Anesthesia Post-op Evaluation signed by Nichols, Christopher S. at 8/20/2013 3:49 PM Author: Nichols, Christopher S. Service: (none) Author Type:

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Post-Op Note (continued)

Patient evaluated in the intensive care unit.

Airway: Kept intubated, direct admit to ICU Hemodynamics: Stable Emergence: N/A Mental Status: Obtunded/minimal responses Analgesia/Pain: Adequately controlled Nausea/Vomiting: None Postoperative Hydration: NPO, IV hydration

Disposition: ICU - planned (re)admission

Attending: completed own physical examination and agree with the above evaluation. Pt remains critically ill at this time, yet hemodynamically stable on Dopamine and Milrione and oral ETT in situ. Pt ventilating on his own and appears comfortable.

POST ANESTHESIA EVALUATION

Perioperative course reviewed.

Patient evaluated in the intensive care unit.

Disposition: ICU - planned (re)admission

Close Encounter Information Closed By Date Closed BJUR, KARA Aug 20, 2013

Follow-up notes No postoperative notes have been written.

PACU Handoff Notes No postoperative notes have been written.

Go to the Billing and Compliance Report for this case.

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 174

Cosign Required:

Yes

Anesthesia Post-op Evaluation signed by Bjur, Kara at 8/20/2013 2:10 PM Author: Bjur, Kara Service: (none) Author Type: Fellow Filed: 8/20/2013 2:10 PM Note Time: 8/20/2013 2:09 PM Status: Revised Related Notes: Addendum by Nichols, Christopher S. filed at 8/20/2013 3:49 PM

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Case Tracking Events Event Time In Room Ready 7:20 AM Patient In - OR 7:26 AM Procedure Start 8:51 AM Procedure Stop 1:32 PM Patient Out - OR 1:51 PM Handoff to Unit 2:00 PM

There are no active problems.

Patient Education

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 175

Multi-Disciplinary Problems (Active)

Title: CICU/CPCU EDUCATION CHECKLIST (Active)

Learning Progress Summary

Point: Tour of CICU/CPCU (Active) Learning Progress Summary

Point: Visit/Explanation of post-op patient (Active) Learning Progress Summary

Point: Visitor policy (Active) Learning Progress Summary

Topic: Pre-op Cardiac Surgery (Active)

Point: Cardiac defect (Active)

Documented by Status Patient Acceptance E,D VU

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status

Active

Learner Readiness Method Response Comment

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 176

Point: CICU/CPCU routines (Active) Learning Progress Summary

Point: General discharge expectations (Active) Learning Progress Summary

Topic: Post-op Cardiac Surgery (Active)

Point: Lines/Drains (Active) Learning Progress Summary

Point: Ventilator (Active) Learning Progress Summary

Point: Waiting rooms (Active) Learning Progress Summary

EC 08/19/13 1531 Active

Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress EC 08/19/13 1531 Active

Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 177

Learning Progress Summary

Point: Chest closure (Active) Learning Progress Summary

Point: Pain assessment and management (Active) Learning Progress Summary

Point: Equipment (Active) Learning Progress Summary

Point: Sternal precautions (Active) Learning Progress Summary

Point: Wound care (Active) Learning Progress Summary

Point: Pacemaker (Active)

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Active note

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 178

Point: Rehabilitation (Active) Learning Progress Summary

Point: Daily plan of care (Active) Learning Progress Summary

Topic: Medications (Active)

Point: Administering medications (Active) Learning Progress Summary

Topic: Safety (Active)

Point: Fall risk education (Active) Learning Progress Summary

Point: Post-op activity expectations (Active) Learning Progress Summary

EC 08/19/13 1531 Active

see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU

Learner Readiness Method Response Comment

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 179

Topic: Nutrition (Active)

Point: TPN/Lipids (Active) Learning Progress Summary

Point: PO feeding post cardiac surgery (Active) Learning Progress Summary

Point: Diet (Active) Learning Progress Summary

Topic: Tests and Procedures (Active)

Point: Daily x-rays (Active) Learning Progress Summary

Point: Other (Active) Learning Progress Summary

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress EC 08/19/13 1531 Active

Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 180

Point: ECHO (Active) Learning Progress Summary

Point: Sedation for procedures (Active) Learning Progress Summary

Point: Other (Active) Learning Progress Summary

Point: Daily labs (Active) Learning Progress Summary

Topic: Resources (Active)

Point: EKG (Active) Learning Progress Summary

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Active note

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 181

Point: Case Management (Active) Learning Progress Summary

Point: Chaplin (Active) Learning Progress Summary

Point: Child Life Therapy (Active) Learning Progress Summary

Point: Cardiac Kids Program (Active) Learning Progress Summary

Point: Cardiac Coffee Hour (Active) Learning Progress Summary

Point: Social Work (Active) Learning Progress Summary

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Active

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

IP Encounter Report MRN: DOB: Sex: M Adm:8/20/2013, D/C:8/26/2013

ANESTHESIA RECORD (continued)

Patient Education (continued)

END OF REPORT

(MR # Printed by [103311] at 10/11/13 9:48 AM Page 182

Name Provider Type Discipline EC 02/16/13 - Carpenter, Esther V. Registered Nurse RN

User Key

Initials Effective Dates

Learning Progress Summary

Topic: Discharge (Active)

Point: Post operative cardiac surgery home care instructions (Active) Learning Progress Summary

Point: Home 02 (Active) Learning Progress Summary

Point: Other (Active)

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

Learner Readiness Method Response Comment Documented by Status

Learner Readiness Method Response Comment Documented by Status Patient Acceptance E,D VU see RN progress

note EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Patient Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Family Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

MOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

FOC Acceptance E,D VU see RN progress note

EC 08/19/13 1531 Active

Hospital Encounter on 8/20/2013

ED Arrival Information
ED Disposition
Discharge Summaries

Discharge Summaries signed by Truong, Uyen T. at 8/27/2013 11:38 AM

H&P signed by Fisher, Faith A. at 8/20/2013 5:34 AM
H&P signed by Mitchell, Max B. at 8/20/2013 6:43 AM

Consults

Consults signed by Rodgers, Jennifer F. at 8/21/2013 2:13 PM
Consults signed by Jacobs, Charle' S. at 8/21/2013 9:41 PM

Procedures

Procedures signed by Blalock, Wayne J. at 8/23/2013 10:12 AM

Progress Notes

Progress Notes signed by Kaufman, Jonathan M. at 8/22/2013 12:59 PM
Progress Notes signed by Baltazar, Sarah H. at 8/21/2013 12:11 PM
Progress Notes signed by Kaufman, Jonathan M. at 8/26/2013 2:03 PM
Progress Notes signed by Dutcher, Debra L. at 8/21/2013 2:24 PM
Progress Notes signed by Church, Jessica C. at 8/23/2013 2:55 PM
Progress Notes signed by Dutcher, Debra L. at 8/23/2013 4:45 PM
Progress Notes signed by Diamond, Bethany A. at 8/24/2013 12:46 PM
Progress Notes signed by Diamond, Bethany A. at 8/25/2013 12:59 PM
Progress Notes signed by Baltazar, Sarah H. at 8/26/2013 11:50 AM

RN Progress

RN Progress signed by Carpenter, Esther V. at 8/19/2013 3:30 PM
RN Progress signed by Carpenter, Esther V. at 8/22/2013 8:53 AM
RN Progress signed by Overholt, Julie A. at 8/26/2013 1:00 PM

OP Note

OP Note signed by Mitchell, Max B. at 8/20/2013 1:28 PM
OP Note signed by Mitchell, Max B. at 8/27/2013 3:57 PM

Transfer Summary

Transfer Summary signed by Kaufman, Jonathan M. at 8/26/2013 2:10 PM

All Orders

08/26/13 1130 - 08/24/13 1301

COMMUNICATION TO NURSING
aspirin (ST. JOSEPH ASPIRIN) 81 MG Chew Tab
furosemide (LASIX) 10 MG/ML Solution
INPATIENT DISCHARGE
DISCHARGE F/U APPOINTMENT
DISCHARGE ACTIVITY
DISCHARGE DIET
DISCHARGE INSTRUCTIONS
HOME OXYGEN
furosemide (conc: 10mg/mL) oral solution 12.4 mg
ECHO
X-RAY CHEST 2 VIEW
X-RAY CHEST 1 VIEW
midazolam (conc: 1mg/mL) injectable 0.5 mg
midazolam (conc: 1mg/mL) injectable 1 mg
fentanyl (conc: 50mcg/mL) injectable 10 mcg
QCS=DRAINAGE CHEST INFAN
BASIC METABOLIC PANEL
X-RAY CHEST 2 VIEW
spironolactone (conc: 2mg/mL) oral suspension 5 mg
WEIGHT, HEIGHT AND OFC
OXYGEN
X-RAY CHEST 2 VIEW
DIET
DIET

08/23/13 1229 - 08/23/13 0706

DIET
CYTOPATHOLOGY REPORT
BASIC METABOLIC PANEL
X-RAY CHEST 2 VIEW
IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD
DIET
COMMUNICATION TO NURSING
DISCONTINUE PACU ORDERS
PACU DISCHARGE
acetaminophen (conc: 160mg/5mL) oral suspension 186 mg
VITAL SIGNS
OXYGEN
COMMUNICATION TO NURSING
TRIGLYCERIDE, MISC FLUID
PLEURAL FLD CC&DIFF(CYTOSPIN)
ibuprofen (conc: 100mg/5mL) oral suspension 120 mg
DIET.
TRANSFER PATIENT
furosemide (conc: 10mg/mL) oral solution 12.4 mg
aspirin chewable tablet 81 mg
CHEST TUBE
VITAL SIGNS
CARDIAC PRE/POST PROCEDURE SCHEDULING
WOUND CARE
IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE

08/22/13 0817 - 08/21/13 1017

PICC LINE PROCEDURE SCHEDULING
DIET
DIET.
RENAL FUNCTION PANEL
CYTOPATHOLOGY REPORT
TRIGLYCERIDE, MISC FLUID
PLEURAL FLD CC&DIFF(CYTOSPIN)
oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg
URINALYSIS WITH MICROSCOPIC
DIET.
X-RAY CHEST 1 VIEW
CHEST TUBE
DIET.
spironolactone (conc: 2mg/mL) oral suspension 5 mg
furosemide (conc: 10mg/mL) injectable 12.4 mg
furosemide (conc: 10mg/mL) injectable 12.4 mg
aspirin chewable tablet 40.5 mg
midazolam (conc: 5mg/mL) injectable 1.24 mg
BLOOD GASES, ART (RAPIDPOINT)
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
DIET.

08/20/13 2132 - 08/20/13 1434

ondansetron oral disintegrating tablet 2 mg
furosemide (conc: 10mg/mL) injectable 12.4 mg
BLOOD GASES, ART (RAPIDPOINT)
BLOOD GASES, ART (RAPIDPOINT)
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
BLOOD GASES, ART (RAPIDPOINT)
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
BLOOD GASES, ART (RAPIDPOINT)
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD

08/20/13 1326 - 08/20/13 1225

GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
PLATELET COUNT
INR AND PROTHROMBIN TIME
PT 1:1 CORRECTION
FIBRINOGEN
D-DIMER
PLATELET FUNCT. ANAL. (EPI)
LACTATE, WHOLE BLOOD
ACTIVATED CLOTTING TIME
BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
bacitracin injection
BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
ACTIVATED CLOTTING TIME
ACTIVATED CLOTTING TIME

08/20/13 1146 - 08/20/13 0805

BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
ACTIVATED CLOTTING TIME
BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
ACTIVATED CLOTTING TIME
ACTIVATED CLOTTING TIME
LACTATE, WHOLE BLOOD
BLOOD GASES, ARTERIAL
HCT (ISTAT)
SODIUM - WHOLE BLOOD
POTASSIUM - WHOLE BLOOD
GLUCOSE - WHOLE BLOOD
IONIZED CALCIUM - WHOLE BLOOD
ACTIVATED CLOTTING TIME
X-RAY 1 VIEW AP CHEST - VENTILATOR
X-RAY 1 VIEW AP CHEST - VENTILATOR

08/20/13 0805 - 08/20/13 0805

A WIRE
ECG
MIXED VENOUS OXYGEN SAT (SVO2)
POSITIONING
DOPamine 128 mg in D5W (dextrose 5 %) 40 mL
milrinone 12 mg in D5W (dextrose 5 %) 60 mL
morphine (conc: 2mg/mL) injectable 0.62-1.24 mg
acetaminophen (conc: 160mg/5mL) oral suspension 160 mg
acetaminophen rectal suppository 120 mg
ketorolac (conc: 30mg/mL) injectable 6.2 mg
ceFAZolin in dextrose (20 mg/mL) 372 mg
ondansetron (conc: 2mg/mL) injectable 1.9 mg
albumin 5% (conc: 5 g/100 mL) injectable 3-6 g
sodium bicarbonate 8.4 % (conc: 1 mEq/mL) injectable 12 mEq
X-RAY CHEST 1 VIEW
D5W-1/2NS (dextrose 5% in 0.45% sodium chloride) 500 mL
NS (sodium chloride 0.9%) 500mL with heparin 1,000 units
FEEDING & SWALLOWING CONSULTATION
CONSULT INPT LACTATION NURSE
CONSULT INPT PHYSICAL THERAPY
ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 3.72 mEq
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 6.2 mEq
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 12.4 mEq
calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL

08/20/13 0805 - 08/20/13 0805

calcium chloride 124 mg in NS (0.9% sodium chloride) 6.2 mL
calcium chloride 248 mg in NS (0.9% sodium chloride) 12.4 mL
magnesium sulfate (conc: 80 mg/mL) injectable 310 mg
POINT OF CARE CRIT CARE PROF
CBC WITH DIFF
BASIC METABOLIC PANEL
MAGNESIUM (SERUM)
PHOSPHORUS, SERUM
INR AND PROTHROMBIN TIME
PARTIAL THROMBOPLASTIN
FIBRINOGEN
LACTATE, WHOLE BLOOD
LACTATE, WHOLE BLOOD
COOXIMETRY STUDIES
CBC WITH DIFF
BASIC METABOLIC PANEL
MAGNESIUM (SERUM)
PHOSPHORUS, SERUM
HEPATIC FUNCTION PANEL
LACTATE, WHOLE BLOOD
INR AND PROTHROMBIN TIME
PARTIAL THROMBOPLASTIN
POINT OF CARE CRIT CARE PROF
ADMISSION
VITAL SIGNS

08/20/13 0805 - 08/19/13 0621

ARTERIAL LINE
ACTIVITY
ELEVATE HEAD OF BED
INTAKE AND OUTPUT
CARDIORESPIRATORY MONITORING
CATHETER
CHEST TUBE
FEEDING TUBE
COMMUNICATION TO NURSING
COMMUNICATION TO NURSING
WOUND CARE
IMPLEMENT MEDICAL/NON-VIOLENT RESTRAINT (WITH MED-EQUIP)
PULSE OXIMETRY
VENTILATOR VOLUME MODE
ELEVATE HEAD OF BED
ORAL CARE
COMMUNICATION TO NURSING
COMMUNICATION TO NURSING
COMMUNICATION TO NURSING
IMPLEMENT MEDICAL/NON-VIOLENT RESTRAINT (WITH MED-EQUIP)
TOTAL FLUIDS
midazolam (conc: 2mg/mL) oral syrup 6 mg
mannitol 25% (conc: 0.25 g/mL) injectable 6.2 g
dexmedetomidine 100 mcg in NS (0.9% sodium chloride) 25 mL
nitroprusside sodium 15 mg in D5W (dextrose 5 %) 30 mL

08/19/13 0946 - 08/19/13 0621

BLOOD TYPE (ABO/RH)
ANTIBODY SCREEN
HOLD CLOT FOR TYPE AND SCREEN
CBC WITH DIFF
MRSA PCR QUAL
BASIC METABOLIC PANEL
PACKED CELL
FRESH FROZEN PLASMA
CRYOPRECIPITATE
APHERESED PLATELET
ADMISSION
WEIGHT, HEIGHT AND OFC
VITAL SIGNS
DIET.
NS (sodium chloride 0.9%) 500mL with heparin 1,000 units
DOPamine 96 mg in D5W (dextrose 5 %) 30 mL
milrinone 6 mg in D5W (dextrose 5 %) 30 mL
CBC WITH DIFF
BASIC METABOLIC PANEL
ECHO
ECHO
ECHO
STANDARD PRECAUTIONS ONLY
chlorhexidine gluconate (HIBICLENS) 4% topical liquid
ceFAZolin in dextrose (20 mg/mL) 520 mg

08/19/13 0621 - 08/19/13 0621

ceFAZolin in dextrose (20 mg/mL) 520 mg
cardioplegia irrigation solution
MRSA PCR QUAL
TYPE & SCREEN
CROSSMATCH RBC REQUEST
PLATELETS REQUEST
FRESH FROZEN PLASMA REQUEST
CRYOPRECIPITATE REQUEST
X-RAY CHEST 2 VIEW
ECG

Microbiology

MRSA PCR QUAL - Final result

Blood Bank

PACKED CELL - Edited Result - FINAL
FRESH FROZEN PLASMA - Edited Result - FINAL
CRYOPRECIPITATE - Edited Result - FINAL
APHERESED PLATELET - Edited Result - FINAL
HOLD CLOT FOR TYPE AND SCREEN - Final result
ANTIBODY SCREEN - Edited Result - FINAL
BLOOD TYPE (ABO/RH) - Edited Result - FINAL

Pathology

CYTOPATHOLOGY REPORT - Final result
CYTOPATHOLOGY REPORT - Final result

ECG - Final result
A WIRE - Final result

ECHO

ECHO - Final result
ECHO - Final result
ECHO - Final result
ECHO - Final result

Imaging

X-RAY 1 VIEW AP CHEST - VENTILATOR - In process
X-RAY CHEST 2 VIEW - Edited Result - FINAL
X-RAY 1 VIEW AP CHEST - VENTILATOR - Final result
X-RAY CHEST 1 VIEW - Final result
X-RAY CHEST 1 VIEW - Final result
IR-PICC UNDER 5 YEARS PLACED AT BEDSIDE - Final result
IR-PICC PLACED BY RN IN OR/PC UNDER 5 YEARS OLD - Final result
X-RAY CHEST 2 VIEW - Final result
X-RAY CHEST 2 VIEW - Final result
X-RAY CHEST 1 VIEW - Final result
X-RAY CHEST 2 VIEW - Final result

08/19/13 1026 - 08/20/13 1131

CBC WITH DIFF - Final result
BASIC METABOLIC PANEL - Final result
ACTIVATED CLOTTING TIME - Final result
LACTATE, WHOLE BLOOD - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
ACTIVATED CLOTTING TIME - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
ACTIVATED CLOTTING TIME - Final result
ACTIVATED CLOTTING TIME - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result

08/20/13 1206 - 08/20/13 1330

ACTIVATED CLOTTING TIME - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
ACTIVATED CLOTTING TIME - Final result
ACTIVATED CLOTTING TIME - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
LACTATE, WHOLE BLOOD - Final result
BLOOD GASES, ARTERIAL - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
PLATELET COUNT - Final result
PLATELET FUNCT. ANAL. (EPI) - Final result
INR AND PROTHROMBIN TIME - Final result

08/20/13 1357 - 08/20/13 1538

FIBRINOGEN - Final result
D-DIMER - Final result
PT 1:1 CORRECTION - Final result
BLOOD GASES, ART (RAPIDPOINT) - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
BASIC METABOLIC PANEL - Final result
MAGNESIUM (SERUM) - Final result
PHOSPHORUS, SERUM - Final result
FIBRINOGEN - Final result
INR AND PROTHROMBIN TIME - Final result
PARTIAL THROMBOPLASTIN - Final result
CBC WITH DIFF - Final result
BLOOD GASES, ART (RAPIDPOINT) - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
LACTATE, WHOLE BLOOD - Final result
BLOOD GASES, ART (RAPIDPOINT) - Edited Result - FINAL
HCT (ISTAT) - Final result

08/20/13 1734 - 08/21/13 0619

SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
BLOOD GASES, ART (RAPIDPOINT) - Final result
BLOOD GASES, ART (RAPIDPOINT) - Edited Result - FINAL
HCT (ISTAT) - Final result
SODIUM - WHOLE BLOOD - Final result
POTASSIUM - WHOLE BLOOD - Final result
GLUCOSE - WHOLE BLOOD - Final result
IONIZED CALCIUM - WHOLE BLOOD - Final result
LACTATE, WHOLE BLOOD - Final result
CBC WITH DIFF - Final result
COOXIMETRY STUDIES - Final result
INR AND PROTHROMBIN TIME - Final result
PARTIAL THROMBOPLASTIN - Final result
BASIC METABOLIC PANEL - Final result
MAGNESIUM (SERUM) - Final result
PHOSPHORUS, SERUM - Final result
HEPATIC FUNCTION PANEL - Final result
URINALYSIS WITH MICROSCOPIC - Final result
TRIGLYCERIDE, MISC FLUID - Final result
PLEURAL FLD CC&DIFF(CYTOSPIN) - Final result
RENAL FUNCTION PANEL - Final result
PLEURAL FLD CC&DIFF(CYTOSPIN) - Final result

08/23/13 1303 - 08/25/13 0658

TRIGLYCERIDE, MISC FLUID - Final result
BASIC METABOLIC PANEL - Final result
BASIC METABOLIC PANEL - Final result

All Meds and Admins

NS (sodium chloride 0.9%) 500mL with heparin 1,000 units
DOPamine 96 mg in D5W (dextrose 5 %) 30 mL
milrinone 6 mg in D5W (dextrose 5 %) 30 mL
chlorhexidine gluconate (HIBICLENS) 4% topical liquid
ceFAZolin in dextrose (20 mg/mL) 520 mg
ceFAZolin in dextrose (20 mg/mL) 520 mg
cardioplegia irrigation solution
dexmedetomidine 100 mcg in NS (0.9% sodium chloride) 25 mL
nitroprusside sodium 15 mg in D5W (dextrose 5 %) 30 mL
mannitol 25% (conc: 0.25 g/mL) injectable 6.2 g
midazolam (conc: 2mg/mL) oral syrup 6 mg
D5W-1/2NS (dextrose 5% in 0.45% sodium chloride) 500 mL
NS (sodium chloride 0.9%) 500mL with heparin 1,000 units
ranitidine 12.4 mg in NS (0.9% sodium chloride) 6.2 mL
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 3.72 mEq
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 6.2 mEq
potassium chloride (conc: 0.4 mEq/mL) (central line) injectable 12.4 mEq
calcium chloride 62 mg in NS (0.9% sodium chloride) 3.1 mL
calcium chloride 124 mg in NS (0.9% sodium chloride) 6.2 mL
calcium chloride 248 mg in NS (0.9% sodium chloride) 12.4 mL
magnesium sulfate (conc: 80 mg/mL) injectable 310 mg
DOPamine 128 mg in D5W (dextrose 5 %) 40 mL
milrinone 12 mg in D5W (dextrose 5 %) 60 mL
morphine (conc: 2mg/mL) injectable 0.62-1.24 mg
acetaminophen (conc: 160mg/5mL) oral suspension 160 mg
acetaminophen rectal suppository 120 mg
ketorolac (conc: 30mg/mL) injectable 6.2 mg
ceFAZolin in dextrose (20 mg/mL) 372 mg
ondansetron (conc: 2mg/mL) injectable 1.9 mg
albumin 5% (conc: 5 g/100 mL) injectable 3-6 g
sodium bicarbonate 8.4 % (conc: 1 mEq/mL) injectable 12 mEq
bacitracin injection
furosemide (conc: 10mg/mL) injectable 12.4 mg
ondansetron oral disintegrating tablet 2 mg
midazolam (conc: 5mg/mL) injectable 1.24 mg
aspirin chewable tablet 40.5 mg
furosemide (conc: 10mg/mL) injectable 12.4 mg
furosemide (conc: 10mg/mL) injectable 12.4 mg
spironolactone (conc: 2mg/mL) oral suspension 5 mg
oxyCODONE (conc: 1mg/mL) oral solution 1.25 mg
aspirin chewable tablet 81 mg
furosemide (conc: 10mg/mL) oral solution 12.4 mg
ibuprofen (conc: 100mg/5mL) oral suspension 120 mg
acetaminophen (conc: 160mg/5mL) oral suspension 186 mg
spironolactone (conc: 2mg/mL) oral suspension 5 mg
midazolam (conc: 1mg/mL) injectable 1 mg
fentanyl (conc: 50mcg/mL) injectable 10 mcg
midazolam (conc: 1mg/mL) injectable 0.5 mg
furosemide (conc: 10mg/mL) oral solution 12.4 mg

OP Note signed by Mitchell, Max B. at 8/20/2013 1:28 PM
Periop Handoff/ Trnspt Info

08/20/13 0821

User Key
Periop Handoff/ Trnspt Info

08/20/13 0821

User Key
Procedure Summary
Intraprocedure Grid/Graph
Staff
Events
Assess

08/23/13 0830 -- 08/23/13 0824

Equipment

08/23/13 0824

Procedure Notes
Attestation Information
Anesthesia Post-op Evaluation signed by Twite, Mark D. at 8/23/2013 10:44 AM
Procedure Summary
Intraprocedure Grid/Graph
Staff
Events
Assess

08/20/13 1315 -- 08/20/13 1245
08/20/13 1230 -- 08/20/13 1205
08/20/13 1155 -- 08/20/13 1115
08/20/13 1105 -- 08/20/13 1030
08/20/13 1015 -- 08/20/13 0945
08/20/13 0940 -- 08/20/13 0915
08/20/13 0900 -- 08/20/13 0845
08/20/13 0830 -- 08/20/13 0824

Equipment

08/20/13 0852 -- 08/20/13 0824

Procedure Notes
Attestation Information
Anesthesia Post-op Evaluation signed by Nichols, Christopher S. at 8/20/2013 3:49 PM
Anesthesia Post-op Evaluation signed by Bjur, Kara at 8/20/2013 2:10 PM
Care Plan
Patient Education