HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE

Transcription

1 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION Patient reported taking 4 Hydrocodone tablets prior to going to ER for headache and facial pain. Severe distress. Medication administration record label comments reports "Maximum dose of Tylenol = 4 gm per 24 hr." Imitrex Nasal Spray ERHC IN HOSP. Migraine headaches Hydrocodone-APAP ERHC 745(800) Hydromorphone HCL ERHC 800 Glucophage ERHC mg q4hr 2mg/ml q1hr/iv 500mg 2/day/P.O. Narcotic pain reliever with Acetaminophen Diabetes 845 Zofran ERHC q8hr/ IV Prevents nausea and vomiting 900 Cymbalta Capsule ERHC 30mg b.i.d. 900 Rocephin ERHC 1gm IV q12hr (or 2/day) Depression, pain / contraindicated with liver disease Treats bacterial infections 900 Topomax ERHC 100mg daily Prevents seizures, anticonvulsive 900 Amphotericin B Nasal Wash ERHC b.i.d. Nasal wash 900 Fungal Med Nasal Wash ERHC b.i.d. Nasal wash 900 Synthroid ERHC 930 (1055) Hydromorphone HCL ERHC 1110 Hydromorphone HCL ERHC 200mcg P.O. daily 2mg/ml q1hr/iv 2mg/ml q1hr/iv Thyroid Page 1 of 12

2 DATE TIME MEDICATION 1235 Hydromorphone HCL ERHC 2mg/ml q1hr/iv 1300 Hydromorphone HCL ERHC 2mg/ml q1hr/iv 1515 (1450) 1517 Hydromorphone HCL ERHC 1 mg IM Headache. Facial pain. (1528) Phenergan ERHC 25mg IM Depression HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 1528 (1555) Hydromorphone HCL ERHC 1614 (1710) Hydromorphone HCL ERHC 1mg/ml amp adm 1mg/ml IV adm 1700 Glucophage ERHC 500mg b.i.d. Diabetes 1816 (1814) Hydromorphone HCL ERHC 1 mg IV 1816 (1814) Zofran ERHC 4mg/2ml IV Prevents nausea and vomiting Hydromorphone HCL ERHC 2mg/ml Vial q1hr 2020 (2027) Rocephin ERHC Treats bacterial infections (Sinusitis) 2020 Hydrocodone-APAP ERHC q4hr Narcotic pain reliever with Acetaminophen 2020 Hydromorphone HCL ERHC q1hr IV 2100 Cymbalta Capsule ERHC 30mg 2 day Depression, pain / contraindicated with liver disease 2100 Mucinex DM ERHC Sinuses 2100 Fungal Med Nasal Wash ERHC b.i.d. Fungal infection nasal wash 2100 Amphotericin B Nasal Wash ERHC b.i.d. Fungal infection nasal wash Page 2 of 12

3 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 2100 Rocephin ERHC 2107 (2110) Hydromorphone HCL ERHC 2235 Hydromorphone HCL ERHC 1gm IV q12hr 2mg/ml vial IV 2mg/ml vial IV Treats bacterial infections 2300 Hydromorphone HCL ERHC 2345 Hydromorphone HCL ERHC 2mg IVq1hr 6/30/08 Imitrex Nasal Spray ERHC IN HOSP. 20mg 2R 6 20 Migraine headaches 6/30/ Hydromorphone HCL ERHC 6/30/ Hydromorphone HCL ERHC 6/30/08 6/30/ Hydromorphone HCL ERHC Hydromorphone HCL ERHC 6/30/ Hydromorphone HCL ERHC 6/30/08 Zofran ERHC 4mg IV Prevents nausea and vomiting 6/30/08 Protonix ERHC 40mg IV daily For GERD (gastroesophageal reflux disease) 500mg tab. 6/30/ Metformin HCL ERHC bid w/meals Diabetes 6/30/ ERHC Decrease Imitrex; full admission Page 3 of 12

4 DATE TIME MEDICATION HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 6/30/ Synthroid Tablet ERHC.1mg (.2mg) Thyroid 6/30/ Topiramate Tablet ERHC 100mg Prevents seizures, anticonvulsive 10 meq 6/30/ Potassium CL Tablet ERHC (20meq) Treats low potassium 6/30/ Fungal Nail Wash ERHC b.i.d. 6/30/ Cymbalta Capsule ERHC 30mg b.i.d. 6/30/ Hydrocodone-APAP (10-650) Tab. ERHC Rx 1 tab q4hr Depression, pain / contraindicated with liver disease Clarification Dx chronic severe sinusitis 6/30/08 Opthalmologist diagnosis: Severe maxillary sinusitis. Rx drainage for C & S ASAP (no indication opthalmogist knew of opiate addition or upper right quandrant pain (liver) 6/30/ Bacid ERHC IN HOSP. Bacteria Lactobacillus acidophilus 6/30/ Hydromorphone HCL ERHC 2mg IV 6/30/ Hydromorphone HCL ERHC 2mg IV 6/30/ Hydromorphone HCL ERHC 6/30/ Metformin HCL ERHC 500mg b.i.d. Diabetes 6/30/ Hydromorphone HCL ERHC 6/30/ Hydromorphone HCL ERHC 6/30/ Hydromorphone HCL ERHC 6/30/ Potassium CL Tablet ERHC 10 meq Treats low potassium Page 4 of 12

5 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 6/30/ Fungal Nail Wash ERHC b.i.d. 6/30/ Rocephin ERHC 1gm q12hr Treats bacterial infections Depression, pain / contraindicated with liver 6/30/ Cymbalta Capsule ERHC disease 6/30/ Hydromorphone HCL ERHC 7/1/08 Hydrocodone-APAP ERHC Narcotic pain reliever with Acetaminophen 7/1/08 Potassium CL Tablet ERHC 20meq Treats low potassium 7/1/08 ERHC Right orbital pain 7/1/ Hydromorphone HCL ERHC 4g q1/2hr Rx Increase Hydromorphone HCL to 4 g q1/2hr 7/1/08 Levaquin Tablet ERHC 500g IV / day For infections 7/1/08 Hydrocodone-APAP ERHC 180 Rx filled 7/1/08 Potassium CL Tablet ERHC 20meq 30 Rx filled 7/1/ Hydromorphone HCL ERHC 7/1/ Hydromorphone HCL ERHC Pain in right orbital 7/1/ Hydromorphone HCL ERHC 7/1/ Hydromorphone HCL ERHC 2mg IV push 7/1/ Hydromorphone HCL ERHC 2mg IV push 7/1/ Hydromorphone HCL ERHC 2mg IV push 7/1/08 Hydrocodone-APAP (10-650) Tab. ERHC Page 5 of 12 10mg combo q4hr Rx Narcotic pain reliever with Acetaminophen

6 DATE TIME MEDICATION 7/1/08 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 7/1/08 Prescriber discharges patient from hospital. Diagnosis: "Chronic severe sinusitis" periorbital pain Hx thyroid CA., insulin resistance, hypothyroidism, Hx celiac spur, surgeries allergies. Medications upon discharge from hospital: ERHC Hydrocodone-APAP (10-650) 1 combo q4hr, 1 or 2 max 8 / day ERHC Narcotic pain reliever with Acetaminophen Rocephin 1gm IV daily ERHC Treats bacterial infections Synthroid 0.2mcg day (had) ERHC Thyroid Glucophage 500 b.i.d. (had one, take again) ERHC Diabetes Topamax 100 q day (had) ERHC Prevents seizures, anticonvulsive Cymbalta 30 b.i.d. (had one, take Depression, pain / contraindicated with liver again) ERHC disease Imitrex nasal spray ERHC Migraine headaches Amphotericin B Nasal Spray Stresstabs daily ERHC ERHC Mucinex DM at night (take tonight) ERHC Micro K20, 1 daily (had one) ERHC Bacid 1 cap b.i.d. PO (had one, take again) ERHC Bacteria Lactobacillus acidophilus 7/2/08 Outpatient visit to Pittsburgh ENT for sinus surgery pre-op. ENT noted taking Rocephin 2-1/2 weeks (no opiates noted from referral from Dr. Sorg). Surgery scheduled for July 10. 7/3/08 Hospital for abdominal pain and vomiting. Diagnosis: Gastroenteritis. Zofran and Phenergan. Daily Rocephin. 7/3/ Rocephin 1000mg IV pb Treats bacterial infections Page 6 of 12

7 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/4/ Ambulance Report: Transported by ambulance to hospital for abdominal pain, dry heaves, abdominal soft and tender in upper quadrants. Menses lasted 3 weeks, from June 1 - June 21. Weak. Diaphoretic and dry mouth. IV linein left arm for Rocephin treatments. She stated she was at hospital yesterday for abdominal pain and they stated she had gastroenteritis. 7/4/ : Admitted to hospital. Prescriber's report: " presents to the ER with a severe upset stomach and headache. Enzymes show acute hepatitis. She is admitted to acute care for treatment of the same." " admitted to ERHC for 23 hour observation for abdominal pain, acute gastroenteritis, hepatitis, sinusitis...admitted to medical floor from ER at ERHC because of abdominal pain, facial pain, slightly weak, sweaty, sick for weeks." LIVER ENZYMES 2089 AST AND 2645 ALT; GLUCOSE 54; billi 4.90, Diagnosis: Dehydration, Hepatitis. Complaining bitterly of abdominal pain." PRESCRIBER'S IMPRESSIONS: 1. Acute Hepatitis. Probably chemical Rochephin, Cymbalta, or other medications. 7/4/ Carafate ERHC For ulcers 7/4/ Zofran ERHC 4mg IV q4hr Prevents nausea and vomiting 7/4/ Protonix ERHC 40mg QAM given For GERD (gastroesophageal reflux disease) 7/4/ Rocephin ERHC 1gm Treats bacterial infections 7/4/ Levaquin Tablet 500mg IV daily Antibiotic for infection 7/4/ Complaining burning pain in stomach. Requested pain and nausea meds. "Everything 7/4/ Promethazine 25mg/ml IV Complaining of abdominal burning 1mg/ml amp 7/4/ Hydromorphone HCL IV 7/4/ GI Cocktail Abdominal pain 7/4/ Lidocaine Visc 20ml UDC adm dose 15ml Local anesthetic Page 7 of 12

8 DATE TIME MEDICATION 7/4/ Phenylbarbital & Belladonna Alk 7/4/ Alum & Mag Hydrox-Simethicone 7/4/ Carafate HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 120ml bot.stkmed/one/po 5ml 30ml udc.stkmed/one/po dose 15ml 1gm 1/2m ac (or IV) & hs To relieve cramping and spasms of stomach For stomach distress (GERD) For ulcers 7/4/ Complaining of right facial pain 7/4/ Continuous facial pain and abdominal pain 7/4/ B/P 74/50 7/4/ Ativan Relieves anxiety 7/4/ Hydromorphone HCL 1mg IV 7/4/08 Complaining of facial pain and abdominal pain 7/4/ /4/ B/P 100/63. Pushing contrast for CT. Complains of abdominal pain and can't drink any more. Hospital notes: prescriber continues 200 mcg Synthroid once a day. No Topamax. No Cymbalta. Continues Zofran 4 mg q4hr. Continues IV Rocephin 1 gm once a day. Start Levaquin at 500mg once a day. 7/4/ CT 7/4/ B/P 92/61. Glucose 172. Drowsy. Speech slurred. Page 8 of 12

9 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/4/ Drowsy. Complaining facial pain. 7/4/08 7/4/ (1435) Hydromorphone HCL 7/4/ Morphine Rx 7/4/ Protonix 1mg/ml amp IV 4mg q1hr 40mg now and qam Diagnosis: Acute gastroenteritis and Hepatitis. Admit to Med-Surg floor Opiod pain reliever For GERD (gastroesophageal reflux disease) 7/4/ Discontinue the Morphine 7/4/ Rx Dilaudid 2 1 hr. PRN IV 7/4/ Hydromorphone HCL 7/4/ Rocephin 1gm in dextrose 5% Treats bacterial infections 7/4/ Protonix 40mg For GERD (gastroesophageal reflux disease) 7/4/ Admitted to Med-Surg floor 7/4/ Carafate 1gm 1/2m ac & hs Complained of pain in abdomen for days 7/4/ Hydromorphone HCL 2mg/ml vial q1hr IV 7/4/08 Vomiting. Dry heaves. Eye pain. 7/4/ B/P 79/46; 110/50. Complaining of pain behind eyes and upper abdominal pain. 7/4/ Prescriber: "Moderate tenderness in the midepigastric region, right upper quandrant, ACUTE HEPATITIS, PROBABLY CHEMICAL FROM ROCEPHIN, CYMBALTA OR OTHER MEDICATIONS." Decrease Topamax, Glucophage, Cymbalta, and Rocephin. Switch her to Levaquin. Page 9 of 12

10 DATE TIME MEDICATION 7/4/ Hydromorphone HCL 2mg/ml vial q1hr IV 7/4/ Carafate For ulcers 7/4/ Complaining of pain 7/4/ HS medications. Vomited immediately. Orders received for Zofran. 7/4/ Zofran Rx 4mg q4hr IV Ordered for nausea 7/4/ Carafate 1gm 1/2 m ac & hs For ulcers 7/4/ Ativan Rx 0.5mg IV 1q8hr Ordered for anxiety 7/4/ Zofran Prevents nausea and vomiting 7/4/ Ativan 7/4/ Levaquin Tablet 7/4/ Levaquin Tablet 7/4/ Hydromorphone HCL 7/5/ Hydromorphone HCL.5mg IV 1q8hr 500mg 100ml 500mg IV daily Complaining of pain to bilateral eyes and upper abdomen For infections For infections 7/5/ IV infusing as ordered. 7/5/ Hydromorphone HCL HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE Page 10 of 12

11 DATE TIME MEDICATION 7/5/ Hydromorphone HCL 7/5/ mg IV 1qhr Administered at 545, 558, 600. Discontinued 7/5/01. Glucose 39; AST/SGOT 6094/ ALT/SGPT Negative for Hepatitis. 7/5/ Carafate For ulcers 7/5/08 Make full admission. "Diag. severe drug induced hepatitis" HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 7/5/ Levaquin Tablet For infections 7/5/ Zofran 4mg IV Prevents nausea and vomiting 7/5/ Ativan 0.5mg Relieves anxiety 857 7/5/08 (807) Hydromorphone HCL 7/5/ Speech garbled. Vision impairment. Prescriber decreased Hydromorphone HCL IV to 7/5/ Hydromorphone HCL 2mg 7/5/ Rx Hydromorphone HCL 7/5/ Hydromorphone HCL 2mg IV q2hr 7/5/ Ck liver, urine, cath 7/5/ Hydromorphone HCL Hospital records: "Patient yelling out. Condition 7/5/ poor. Unable to talk. Prescriber notified of 7/5/ Non-responsive. Yelling out frequently. 7/5/ Not focusing. Not speaking. Page 11 of 12

12 HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/5/ Hospital reports notification that hepatitis labs negative. 7/5/08 Hospital records positive for Opiates. Positive for Barbituates. 7/5/ Acetaminophen level test 7/5/ Labs positive for opiates and barbiturates 7/5/ Liver enzymes AST 6094 and ALT /5/ Prescriber ordered Tylenol liver status Physican's notes: "Transfer patient to ER for 7/5/ intubation then to Presby Hospital in 7/5/ Hydromorphone HCL 250mg/5ml 7/5/08 Stat MedEvac Helicopter Critical Care Transfer Report: "The patient has developed liver failure with noted AST/ALT in the 6000's and INR of 5 The patient has been receiving Hydromorphone HCL and Ativan per medication administration record with positive toxicology as such. The patient's Tylenol level is greater than 10 per report. The patient is found on a Med Surg floor without cardiac monitoring or resources for airway securance." NOTE: The St. Marys hospital waited until Heather was brain dead before life flighting her to Pittsburgh UPMC Presby on 7/5/2008. They sent her there with NO medical records! Page 12 of 12