Mr. Reed John was broaght to the ED at 0430 this moening. His wife menticned that Mr. Reod had diarthea for the past 3 days and that be had a lor of "dark red" diarrhea last night. This moming he becarse very dizay, disoriented, and physically weak. Mr. Reed Joh, who is 70 years old, 72 inches, 86.4kg. with of BMI 23, Me. Reed has had itioputhe dilated sardiemyopathy for several years. The onset was insidious, but cardiomyoguthy is now severe, as evidenced by an ejoction fractico of 13% found daring a reeent eardiac catheterurutien. Experienced frequent peotlems with HF because of cardiomyopathy and had a cardiac armet that was aceredited to bypokalemia. He las a loeg listory of HIN, Arthritis, and had a peptic alcer since 15 years ago. His current medications are: cnalaptil (Veotec) 5 mg PO bid, warfarin (Coumadin) 5 me day PO, digosin 0.125 me lay PO, KCT 20 mEq PO bid, and solnctin (an NSNID) 400 ang PO bid. Me. Reed VS: syssolic 70 f diastolic inuodile, HR: 120, RR: 20, Temp: 101'F, and Prin 5/10. A 16.gauge IV cathetcr was insertod, and a lactalod Ringer's infusice was started. When counecting Mr. Reed to the cardiac monitoc, it was sesm that he was in A-fich. His skint is pale; at this monsent is sicqping but arousable and oricnted. Still mentiges heing dizxy, hypolensive, and tachypecic. Able to hear $3 and $4 sounds at a grade of 265 syadolic nurner. Peripheral pulses are 2+ bilaterally, and thene is a trace of pedal colema prevent. The lungs are clear bilstenlly. Bowal sounds are peesent with mid-epigatrie hendemess, and the liver margin is 4 cm below the contal margin. Sean-Ganz catheter and an anterial line are cumently inserted. I think that Mr. Williarns is in hypenolentic stock and that be would necd proper blood work and assessment troem the doctor on call, I feel he should have maximum exygen delivery, noods to be able to control blood loss, and needs fluid resuscitatice Results and Symptoens seem that Mer Reed is in hypowolemic shock, and he would neod peoper blood work and assessment from the doctor ea call. He should have maximum Orygen delivery as well as fluid resuscitation to be able to custrol blisod loss..

1. Mr. Reed John was broaght to the ED at 0430 this moening. His wife menticned that Mr. Reod had
diarthea for the past 3 days and that be had a lor of "dark red" diarrhea last night. This moming he
becarse very dizay, disoriented, and physically weak. Mr. Reed Joh, who is 70 years old, 72
inches, 86.4kg. with of BMI 23, Me. Reed has had itioputhe dilated sardiemyopathy for several
years. The onset was insidious, but cardiomyoguthy is now severe, as evidenced by an ejoction
fractico of 13% found daring a reeent eardiac catheterurutien. Experienced frequent peotlems with
HF because of cardiomyopathy and had a cardiac armet that was aceredited to bypokalemia. He
las a loeg listory of HIN, Arthritis, and had a peptic alcer since 15 years ago. His current
medications are: cnalaptil (Veotec) 5 mg PO bid, warfarin (Coumadin) 5 me day PO, digosin 0.125
me lay PO, KCT 20 mEq PO bid, and solnctin (an NSNID) 400 ang PO bid. Me. Reed VS: syssolic
70 f diastolic inuodile, HR: 120, RR: 20, Temp: 101'F, and Prin 5/10. A 16.gauge IV cathetcr was
insertod, and a lactalod Ringer's infusice was started. When counecting Mr. Reed to the cardiac
monitoc, it was sesm that he was in A-fich. His skint is pale; at this monsent is sicqping but
arousable and oricnted. Still mentiges heing dizxy, hypolensive, and tachypecic. Able to hear $3
and $4 sounds at a grade of 265 syadolic nurner. Peripheral pulses are 2+ bilaterally, and thene is
a trace of pedal colema prevent. The lungs are clear bilstenlly. Bowal sounds are peesent with
mid-epigatrie hendemess, and the liver margin is 4 cm below the contal margin. Sean-Ganz
catheter and an anterial line are cumently inserted. I think that Mr. Williarns is in hypenolentic
stock and that be would necd proper blood work and assessment troem the doctor on call, I feel
he should have maximum exygen delivery, noods to be able to control blood loss, and needs fluid
resuscitatice Results and Symptoens seem that Mer Reed is in hypowolemic shock, and he would
neod peoper blood work and assessment from the doctor ea call. He should have maximum
Orygen delivery as well as fluid resuscitation to be able to custrol blisod loss.