View Patient Profiles

Brooks, Gavin

MRN: 420165

Room: 810

DOB: 2/8/1957

Age: 68

Gender: Male

Allergies: No known drug allergies

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Medical ICU (MICU)
Scenario	After being intubated, Mr. Brooks is admitted to the intensive care unit for further treatment. You have assessed his pain/agitation/sedation and vasopressor regimens; these are appropriate and will not need adjustments. The medical resident asks for your recommendations regarding acute problems as well as any other pharmacotherapy recommendations you may have to optimize this patient’s care in the hospital and at discharge.
Admission note taken on 10/19/25
CC	“I’m having difficulty breathing”
HPI	Mr. Brooks is a 68-year-old Caucasian male presenting to the Emergency Department yesterday. He complains of shortness of breath and chest pain. Two hours after presentation to the Emergency Department, he becomes hypotensive requiring vasopressor administration and intubation.
PMH	Unprovoked left lower extremity DVT (2 months ago) Coronary artery disease Osteoarthritis (bilateral knees) Epilepsy (last seizure 5 years ago)
Social History	Alcohol: drinks 4-6 beers per day, several shots of whiskey on weekends Tobacco: denies Illicit drugs: denies	Family History	Father: prostate cancer, diabetes, and hypertension; still living Mother: hypertension, died of a myocardial infarction at age 73
Vaccine History	Received all recommended immunizations through age 18 Tdap (7 years ago) Influenza (last season)	Surgical History	PCI (one drug eluting stent placed in the LAD coronary artery) 2 years ago
Physical Exam	ROS: Shortness of breath (+), Right sided chest pain described as “crushing 9/10 pain”, Minor bilateral knee pain 1/10, Denies other pain, Denies nausea/vomiting/diarrhea, Last BM this morning, Denies fever/chills General: appears in significant distress HEENT: PERRLA Respiratory: bilateral rales, tachypnea Cardiovascular: normal rate, regular rhythm, no murmur Abdomen: soft, normal bowel sounds Genitourinary: WNL Extremities: +1 LLE pitting edema Neuro: alert/oriented x3, cranial nerves II-XII intact, no nystagmus, no signs of seizure Psych: cooperative, appropriate affect

Clinical Laboratory Report

Test Name	10/20/25	10/19/25	Range
Sodium (Na⁺)		137	136-145 mEq/L
Potassium (K⁺)		4.0	3.5-5 mEq/L
Chloride (Cl^-)		101	98-106 mEq/L
Bicarbonate (HCO₃^-)		24	23-28 mEq/L
Urea nitrogen (BUN)		14	8-20 mg/dL
Creatinine		0.8	0.5-1.3 mg/dL
Glucose		93	70-115 mg/dL
Hemoglobin A1c			5.3-7.5 %
Calcium,Total		8.7	8.6-10.2 mg/dL
Phosphate		3.5	3-4.5 mg/dL
Magnesium		2.1	1.6-2.6 mEq/L
Protein, total		4.8	5.5-9 g/dL
Albumin		2.0	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)		81	10-40 units/L
Aminotransferase,alanine (ALT)		114	10-40 units/L
Lactic dehydrogenase (LDH)		112	80-225 units/L
Alkaline phosphatase		177	30-120 units/L
Bilirubin, Total		1.3	0.3-1 mg/dL
Leukocytes (WBC)		6.9	4.5-11 x10³/mcL
Red blood cells (RBC), Male		4.2	3.8-5.1 x10⁸/mcL
Hemoglobin, Male		13.8	14-18 g/dL
Hematocrit, Male		41.6	42-50 %
Mean corpuscular hemoglobin (MCH)		29	27-33 picogram
Mean corpuscular volume (MCV)		83	76-100 mcm³
Platelets		121	150-450 x10³/mcL
International normalized ratio (INR)		1.3	0.8-1.2
Prothrombin time (PT)		16.1	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)		32.5	25-35 sec

Additional Labs:

Other Labs (yesterday)	Result
Direct bili (mg/dL)	0.5
Indirect bili (mg/dL)	0.8
Troponin (ng/mL)	3.3
D-dimer (ng/mL)	1,200

Fasting Lipid Panel (yesterday)	Result
Total cholesterol (mg/dL)	185
LDL (mg/dL)	117
HDL (mg/dL)	48
Triglycerides (mg/dL)	98

Cultures:

SARS-CoV2 (COVID-19) PCR: not detected

Imaging Studies:

Test	Date	Result
Genetic thrombophilia panel, including protein C and S, factor V Leiden, G20210A prothrombin mutation, homocysteine, factor VIII, anticardiolipin antibodies, and lupus anticoagulant	3 weeks ago	All negative
Phenytoin trough level	7 days ago	8.3 mcg/mL
EKG	yesterday	normal sinus rhythm, no ST elevation, QTc 407 msec
Echocardiogram	yesterday	dilated right ventricle with RV/LV ratio of 1.1
CT angiography	yesterday	bilateral pulmonary embolism

Vital Sign	10/20/25 09:57	23:46	15:43	10/19/25 07:14
Height (cm)	170.2			170.2
Weight (kg)	122.7			125
Body Temperature (°C)	37	35.9	36.3	37
Blood Pressure (mmHg)	80 / 45	130/77	129/77	128/77
Heart Rate (bpm)	89	72	71	72
Respiratory Rate (bpm)	23	18	17	18
Oxygen Saturation (%)	82	94	94	94

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES
			titrate to goal MAP > 65 mmHg (currently running at 6 mcg/min, may titrate up by 2 mcg/min every 5 min to max of 35 mcg/min, may wean by 0.5 mcg/min every 10 minutes until off)

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES
			titrate to CPOT score less than 2 (currently running at 25 mcg/hr, may titrate up by 25 mcg/hr every 15 min to max of 300 mcg/hr)

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES
			titrate to RASS -2 to 0 (currently running at 5 mcg/kg/min, may titrate up by 5 mcg/kg/min every 10 min to max of 50 mcg/kg/min)

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN mild pain (1-3)
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN nausea/vomiting
CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, see notes
CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES
			CIWA-Ar protocol – give 2 mg for CIWA-Ar score 10 – 25, give 4 mg for CIWA-Ar score >25

Medication
History

Medication fills are confirmed with Publix by a pharmacy technician on the hospital medication history service.
Mr. Brooks reports adherence with all medications including nonprescription, and he uses a medication box.
He reports taking his docusate / senna a few days per month, and thinks he last took it around the July 4th holiday.
His last dose of medication was this morning; however, he forgot to pick up his apixaban refill earlier in the week so has not taken this medication for the past two days.

Home Medication List: verified by pharmacy on admit (10/19/25)

Patient Name: Brooks, Gavin Date of Birth: 2/8/1957 Room#: 810	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	NOTES	MED REC ACTION
Apixaban 5 mg tablet	1 PO BID	no	started 2 months ago
Lovastatin 10 mg tablet	1 PO HS	no
Meloxicam 15 mg tablet	1 PO QD	no
Carvedilol 12.5 mg tablet	1 PO BID	no
Lisinopril 10 mg tablet	1 PO QD	no
Phenytoin 200 mg CR capsule	1 PO BID	no
Levetiracetam 1,500 mg tablet	1 PO BID	no
Aspirin 325 mg tablet	1 PO QD	no
Docusate/senna 50 mg/8.6 mg tablet	1 PO BID	yes, constipation
				Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	10/20/25	10/19/25
Norepinephrine 6 mcg/min IV continuous Rate: see notes		17:40
Fentanyl 25 mcg/hr IV continuous Rate: see notes		17:54
Propofol 5 mcg/kg/min IV continuous Rate: see notes		17:25
Phenytoin 100 mg IV Q6H Rate: 100 mL/hr		06:11 12:43 18:14 23:42
Levetiracetam 1,500 mg IV Q12H Rate: 400 mL/hr		09:25 21:59
Pantoprazole 40 mg IV Q24H Rate: 400 mL/hr		09:17
Acetaminophen 650 mg PR Q6H PRN PRN mild pain (1-3)
Ondansetron 4 mg IV Q8H PRN PRN nausea/vomiting Rate: 2 minutes
Lorazepam 2-4 mg IV Q2H PRN PRN yes, see notes Rate: 1-2 minute(s)		17:49

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Brooks, Gavin

Date of Birth: 2/8/1957

Room: 810

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	170.2 cm
Actual Body Weight (ABW)	122.7 kg
Ideal Body Weight (IBW)	66.1 kg
ABW % of IBW	186 %
Adjusted Body Weight (AjBW)	88.7 kg
Body Surface Area (BSA)	2.41 m²
Body Mass Index (BMI)	42.4 kg/m²