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 10-250mg 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
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 1915 1950 Hydromorphone HCL ERHC 2mg/ml Vial q1hr 2020 (2027) Rocephin ERHC Treats bacterial infections (Sinusitis) 2020 Hydrocodone-APAP 10-250 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
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 6/30/08 120 Hydromorphone HCL ERHC 6/30/08 304 Hydromorphone HCL ERHC 6/30/08 6/30/08 405 415 Hydromorphone HCL ERHC 545 605 Hydromorphone HCL ERHC 6/30/08 714 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. 6/30/08 800 Metformin HCL ERHC bid w/meals Diabetes 6/30/08 845 ERHC Decrease Imitrex; full admission Page 3 of 12
DATE TIME MEDICATION HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 6/30/08 900 Synthroid Tablet ERHC.1mg (.2mg) Thyroid 6/30/08 900 Topiramate Tablet ERHC 100mg Prevents seizures, anticonvulsive 10 meq 6/30/08 900 Potassium CL Tablet ERHC (20meq) Treats low potassium 6/30/08 900 Fungal Nail Wash ERHC b.i.d. 6/30/08 900 Cymbalta Capsule ERHC 30mg b.i.d. 6/30/08 900 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) 6/30/08 1105 Bacid ERHC IN HOSP. Bacteria Lactobacillus acidophilus 6/30/08 1201 Hydromorphone HCL ERHC 2mg IV 6/30/08 1450 Hydromorphone HCL ERHC 2mg IV 6/30/08 1555 Hydromorphone HCL ERHC 6/30/08 1700 Metformin HCL ERHC 500mg b.i.d. Diabetes 6/30/08 1710 Hydromorphone HCL ERHC 6/30/08 1815 Hydromorphone HCL ERHC 6/30/08 1950 Hydromorphone HCL ERHC 6/30/08 2100 Potassium CL Tablet ERHC 10 meq Treats low potassium Page 4 of 12
HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 6/30/08 2100 Fungal Nail Wash ERHC b.i.d. 6/30/08 2100 Rocephin ERHC 1gm q12hr Treats bacterial infections Depression, pain / contraindicated with liver 6/30/08 2100 Cymbalta Capsule ERHC disease 6/30/08 2105 Hydromorphone HCL ERHC 7/1/08 Hydrocodone-APAP ERHC 180 23 Narcotic pain reliever with Acetaminophen 7/1/08 Potassium CL Tablet ERHC 20meq 30 30 Treats low potassium 7/1/08 ERHC Right orbital pain 7/1/08 1950 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 7/1/08 100 Hydromorphone HCL ERHC 7/1/08 415 Hydromorphone HCL ERHC Pain in right orbital 7/1/08 605 Hydromorphone HCL ERHC 7/1/08 745 Hydromorphone HCL ERHC 2mg IV push 7/1/08 930 Hydromorphone HCL ERHC 2mg IV push 7/1/08 1115 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
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 0900 2100 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. 7/3/08 1159 Rocephin 1000mg IV pb Treats bacterial infections Page 6 of 12
HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/4/08 1001 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. 7/4/08 1033: 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. 7/4/08 730 Carafate ERHC For ulcers 7/4/08 815 Zofran ERHC 4mg IV q4hr Prevents nausea and vomiting 7/4/08 900 Protonix ERHC 40mg QAM given For GERD (gastroesophageal reflux disease) 7/4/08 900 Rocephin ERHC 1gm Treats bacterial infections 7/4/08 900 Levaquin Tablet 500mg IV daily Antibiotic for infection 7/4/08 1033 Complaining burning pain in stomach. Requested pain and nausea meds. "Everything 7/4/08 1056 Promethazine 25mg/ml IV Complaining of abdominal burning 1mg/ml amp 7/4/08 1056 Hydromorphone HCL IV 7/4/08 1109 GI Cocktail Abdominal pain 7/4/08 1113 Lidocaine Visc 20ml UDC adm dose 15ml Local anesthetic Page 7 of 12
DATE TIME MEDICATION 7/4/08 1113 Phenylbarbital & Belladonna Alk 7/4/08 1114 Alum & Mag Hydrox-Simethicone 7/4/08 1130 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 7/4/08 1133 Complaining of right facial pain 7/4/08 1218 Continuous facial pain and abdominal pain 7/4/08 1250 B/P 74/50 7/4/08 1256 Ativan Relieves anxiety 7/4/08 1256 Hydromorphone HCL 1mg IV 7/4/08 Complaining of facial pain and abdominal pain 7/4/08 1301 7/4/08 1323 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. 7/4/08 1350 CT 7/4/08 1416 B/P 92/61. Glucose 172. Drowsy. Speech slurred. Page 8 of 12
HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/4/08 1435 Drowsy. Complaining facial pain. 7/4/08 7/4/08 1500 1430 (1435) Hydromorphone HCL 7/4/08 1500 Morphine Rx 7/4/08 1519 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) 7/4/08 1600 Discontinue the Morphine 7/4/08 1600 Rx Dilaudid 2 mg @ 1 hr. PRN IV 7/4/08 1610 Hydromorphone HCL 7/4/08 1610 Rocephin 1gm in dextrose 5% Treats bacterial infections 7/4/08 1615 Protonix 40mg For GERD (gastroesophageal reflux disease) 7/4/08 1623 Admitted to Med-Surg floor 7/4/08 1630 Carafate 1gm 1/2m ac & hs Complained of pain in abdomen for days 7/4/08 1800 Hydromorphone HCL 2mg/ml vial q1hr IV 7/4/08 Vomiting. Dry heaves. Eye pain. 7/4/08 1815 B/P 79/46; 110/50. Complaining of pain behind eyes and upper abdominal pain. 7/4/08 1940 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
DATE TIME MEDICATION 7/4/08 2000 Hydromorphone HCL 2mg/ml vial q1hr IV 7/4/08 2002 Carafate For ulcers 7/4/08 2010 Complaining of pain 7/4/08 2045 HS medications. Vomited immediately. Orders received for Zofran. 7/4/08 2100 Zofran Rx 4mg q4hr IV Ordered for nausea 7/4/08 2100 Carafate 1gm 1/2 m ac & hs For ulcers 7/4/08 2104 Ativan Rx 0.5mg IV 1q8hr Ordered for anxiety 7/4/08 2109 Zofran Prevents nausea and vomiting 7/4/08 2130 Ativan 7/4/08 2159 Levaquin Tablet 7/4/08 2300 Levaquin Tablet 7/4/08 2300 Hydromorphone HCL 7/5/08 120 Hydromorphone HCL.5mg IV 1q8hr 500mg 100ml 500mg IV daily Complaining of pain to bilateral eyes and upper abdomen For infections For infections 7/5/08 308 IV infusing as ordered. 7/5/08 405 Hydromorphone HCL HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE Page 10 of 12
DATE TIME MEDICATION 7/5/08 555 Hydromorphone HCL 7/5/08 700 4mg IV 1qhr Administered at 545, 558, 600. Discontinued 7/5/01. Glucose 39; AST/SGOT 6094/ ALT/SGPT 6999. Negative for Hepatitis. 7/5/08 803 Carafate For ulcers 7/5/08 Make full admission. "Diag. severe drug induced hepatitis" HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE 7/5/08 803 Levaquin Tablet For infections 7/5/08 806 Zofran 4mg IV Prevents nausea and vomiting 7/5/08 807 Ativan 0.5mg Relieves anxiety 857 7/5/08 (807) Hydromorphone HCL 7/5/08 1052 Speech garbled. Vision impairment. Prescriber decreased Hydromorphone HCL IV to 7/5/08 1245 Hydromorphone HCL 2mg 7/5/08 1245 Rx Hydromorphone HCL 7/5/08 1256 Hydromorphone HCL 2mg IV q2hr 7/5/08 1340 Ck liver, urine, cath 7/5/08 1342 Hydromorphone HCL Hospital records: "Patient yelling out. Condition 7/5/08 1510 poor. Unable to talk. Prescriber notified of 7/5/08 1532 Non-responsive. Yelling out frequently. 7/5/08 1536 Not focusing. Not speaking. Page 11 of 12
HEATHER ARMANINI - MEDICAL TIMELINE THE LAST WEEK OF HER LIFE DATE TIME MEDICATION 7/5/2008 1543 Hospital reports notification that hepatitis labs negative. 7/5/08 Hospital records positive for Opiates. Positive for Barbituates. 7/5/08 1645 Acetaminophen level test 7/5/08 1505 Labs positive for opiates and barbiturates 7/5/08 1510 Liver enzymes AST 6094 and ALT 6999. 7/5/08 1650 Prescriber ordered Tylenol liver status Physican's notes: "Transfer patient to ER for 7/5/08 1655 intubation then to Presby Hospital in 7/5/08 1806 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