1. 31218913-Version:2
</PREOPERATIVE DIAGNOSES/>
1. Persistent fever and positive blood cultures with MediPort in place.
2. History of supraglottic cancer with metastasis to lung.
</HISTORY OF PRESENT ILLNESS/>
The patient is a 57-year-old white female patient who has a supraglottic cancer with metastasis to lung,
currently undergoing chemotherapy. She is also anticoagulated on Arixtra. She has had persistent fevers
for the past several weeks and recently, she has been found to have positive blood cultures for gram-
positive cocci. She has a previous hospitalization at Physicians Regional and a MediPort placement at
that facility. I have been asked to see her at this time for MediPort removal.
</PAST MEDICAL HISTORY/>
Remarkable for:
1. Stage IV supraglottic carcinoma, T3N2M1 and non-small-cell squamous cancer of the lung.
2. History of left upper lobectomy.
3. History of _____ radiation therapy to the head and neck.
4. History of bilateral pulmonary emboli.
5. History of DVT in left lower extremity.
6. History of IVC filter placement.
7. History of multiple pneumothoraces following procedures.
</CURRENT MEDICATIONS/>
Listed in the PowerChart and not repeated.
</FAMILY HISTORY/>
Noncontributory to this admission.
</SOCIAL HISTORY/>
The patient stopped smoking approximately two years ago. She has a past history of alcohol abuse, but
stopped over 10 years ago by the chart.
</REVIEW OF SYSTEMS/>
Remarkable for high fever, generalized fatigue, weight loss, and occasional shortness of breath. All other
systems reported as negative on full 14-point review other than previously noted in this dictation.
</PHYSICAL EXAMINATION/>
GENERAL: This is a well-developed, well-nourished, white female, alert and oriented x3, currently in no
distress.
VITAL SIGNS: Blood pressure is 142/72, pulse 68 and regular, and respiratory rate 14.
HEENT: Alopecia noted. PERRLA. EOMI. Nose and throat are clear.
NECK: Without mass, thyromegaly, or lymphadenopathy. Evidence of radiation therapy noted.
CHEST: Clear anteriorly and posteriorly. No accessory muscle use.
CARDIAC: Regular rate and rhythm without murmurs, gallops, or rubs. MediPort is palpable in right
subclavian area with no erythema or tenderness.
ABDOMEN: Soft and benign. No mass or organomegaly noted.
EXTREMITIES: Without cyanosis, clubbing, or edema.
NEUROLOGIC: Awake, alert and oriented x3. No deficits.
SKIN: Without lesions or rash.
</LABORATORY DATA/>

2. All reviewed.
</IMPRESSION AND RECOMMENDATIONS/>
I have discussed this at great length with the patient. We are planning to proceed with MediPort removal
at this time. Unfortunately, she is on Arixtra, and I would discontinue today to proceed with MediPort
removal tomorrow. Risks including bleeding, problems with wound infarction, and ongoing bacteremia
have been discussed. This will be under local standby anesthesia as her airway may be difficult. She
appears to fully understand and agrees.