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Case 4 : Introduction


A 75 year old man was admitted to hospital for a fractured hip which he sustained while walking at home. He denies any loss of consciousness or chest pain at the time of the incident.

His past medical history is significant for a long history of coronary artery disease and atrial fibrillation.. Two years ago he underwent angiography which revealed 2 vessel disease. There was a 50% lesion in the circumflex artery and a 75% occlusion of the LAD. At that time an intracoronary drug eluting stent was placed in the LAD.

Five weeks prior to this admission, he underwent a left hemicolectomy for carcinoma. His postoperative cource was complicated by a wound dehiscence and infection. He states that he lost 20 pounds during that admission and had been confined to bed for 2 weeks. Prior to this present admission, he was ambulating with the help of a walker.

Functional inquiry was otherwise unremarkable. He has no known drug allergies and his present medications include coumadin, ASA and metoprolol.

Preoperative laboratory values revealed Hgb 96, Na 139, Cl 97, K 3.3 and INR 2.4. The EKG reveals normal sinus rhythm and nonspecific ST and T wave changes.


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