I just love “MyChart” by Sunnybrook, a wonderful web-based access portal where I can see my lab results, notes written by my surgeon to other doctors, results of radiology tests and so forth. I just LOVE IT!
Here’s what was written with regards to my discharge from my lovely 3 week stay at Sunnybrook in early August 2009. Naturally, all references to me have been changed to “bean” 🙂
PT NAME: Opinionated Bean
ADMIT DATE: 2009/Jul/17
DISCHARGE DATE: 2009/Aug/05
Urosepsis and pneumonia.
HFN: 80 03 53
Miss. Bean is a xx-year-old lady who is well known to Dr. Herschorn. She has a complicated urological history including bladder exstrophy and augmentation. She has a continent catheterizable stoma to her augmentation cystoplasty. In early May
she saw Dr. Herschorn because she had some concerns with urinary obstruction secondary to bladder stones. She was subsequently managed with an indwelling catheter which has been changed monthly. She was last assessed a few days prior to her hospital admission for a catheter change. We understand that a few days before coming to hospital she developed pain at the stoma site, fever, chills, nausea, vomiting and cloudy urine. She presented to the Emergency Room and they diagnosed her with a UTI and subsequently sent her home with Macrobid. However, she came back a few hours later feeling quite unwell.
On examination at the time, she was febrile with a temperature of 39.7. Her blood pressure was 175/99 with a heart rate of 174. She was also tachypneic with a respiratory rate of 24. She was satting 99% on room air. Her abdomen was soft, nondistended
but diffusely tender in particular around her stoma. The Foley catheter was in the stoma and draining cloudy urine.
Laboratory investigations showed a leukocytosis of 16.3 and hemoglobin of 140. Her creatinine was 92 and her lactate was 4.8. A urinalysis showed red blood cells, leukocytes and nitrites. She was subsequently admitted to the Urology Service and was
started on broad spectrum antibiotics. She has multiple drug allergies and was initially started on Levaquin and Macrobid. The next day, she clinically improved however continued to be quite tachycardic. Her antibiotics were subsequently changed to
vancomycin and gentamicin. She continued to improve clinically; however, on July 19 she was persistently tachypneic and we subsequently asked our Medical Consult Team to assess her. At the time of their assessment, she became quit cyanotic with a
lowered level of consciousness. As a result, the Rapid Response Team was called and she was subsequently intubated and admitted to the ICU. While in the ICU, she was followed by Infectious Diseases, Medical Consult and Respirology. She did have a
noncontrast CT scan done which did not demonstrate any acute processes. It was felt by the Infectious Disease doctors that she likely had pneumonia and she was subsequently changed to Levaquin and vancomycin. I should note that her blood cultures
were negative except for a possible contamination. Her urine culture was also negative. She was seen by Respirology who performed a bronchoscopy on July 24. Swabs were sent but there were no abnormalities seen. Her final respiratory cultures were negative. Further investigations demonstrated some pulmonary hypertension which was again followed by Respirology. She eventually clinically improved to the point where she was extubated on July 30. She was then transferred to the D4 ICU Step Down and continued to do well. She was eventually transferred to the Urology Floor and continued to convalesce there. Her final dose of antibiotics was on August 4.
Prior to her discharge, repeat urine cultures and blood cultures were sent off and her Foley catheter was also changed. Our Infectious Disease colleagues felt that she had received adequate dose of antibiotics and she was subsequently discharged home
on August 5. Followup was arranged with Respirology for further workup of her pulmonary hypertension and possible sleep apnea. She will see Dr. Herschorn in his clinic on August 12 for followup.
Thanks very much for involving us in the patient’s care.
Stephanie Tam, MD, for
S. Herschorn, MD, FRCSC
Division of Urology