Patient: hx chronic at fib, CABG x2, cardiomyopathy, pacemaker, AICD.
7 weeks post op VAD
with hx bleeding in stomach and lungs since VAD surgery.
prior bleeds and post bleed have not produced increase in his INR.
Coumadin 2.5, 5mg, 5mg, 7mg=inr 1.27; 1.06; 1.12, 1.04.
Also hx 3 PICC lines; 2 clotted off.
No other signs symptoms of bleeding irregularity other than platelets slowly dropping 400,000 to current 247,000. Stools + blood (probably old from stomach bleed)
Everything else normal except
pt has c/o of stomach and lower abdominal pain since surgery.
. Took 1 month for bowels to work.
Bowels currently working but unable to get off NG tube d/t n/v.
successful at low rates
but when rate up 50-70cc/hr GI symptoms get worse.
GI symptoms vary to
pinpoint pain LLQ near J-tube insertion, LLQ, RLQ abdominal fullness fairly consistent. Intermittent belching, flatus, Hyperactive bowel sounds now with lots of fliud present upon percussion, abd soft most of time even with fliud. NG drainage varies 450-1000cc/24hr. OU OK
Please comment on coumadin/INR, Persistent symptoms of GI tract not emptying properly. MD's feel problem will resolve. Coumadin being given IV now. Several KUB's. No Cat scans or other tests. Pt on vent with trache (bleeding in lungs prior to trache) Coumadin and AC therapy stopped to get lung bleeding under control. Presently only streaks of blod in NG and ETT small amount bleeding.