Summary Of Alana Kosches
Alana Kosches
I) HISTORY AND PHYSICAL EXAMINATION: Chief Complaint: “My left arm feels weak and numb.”.
History of Present Illness: The patient is an 81-year-old man with HTN, HLD, Type 2 DM, and atrial fibrillation on Xarelto. He presented to Maimonides Hospital emergency department complaining of left arm weakness, tingling and numbness for the past 5 hours. He reports that he felt normal this morning at around 6:00 am when he woke up, but at around 8:00 am while he was eating breakfast, he began experiencing progressive left arm weakness, tingling and numbness from the fingers to the elbow. These symptoms have remained constant, without improvement or worsening since their onset. He has never had similar symptoms in the past. One day prior to presentation, the patient discontinued his Xarelto due to an upcoming dental tooth extraction. This morning, when he started to experience these symptoms, he decided to take a dose of Xarelto. He denies any speech difficulties, changes in vision, dizziness, loss of consciousness, weakness or numbness in his other limbs or his face, chest pain, palpitations, or shortness of breath. He states that he is …show more content…
He denies any symptoms in his right upper extremity, face, or lower extremities, as well as visual disturbances or speech difficulties. On physical examination, he has mild left pronator drift with reduced sensation to light touch, pinprick and vibration as well as 45 strength in the muscles of the left upper extremity from the fingers to the elbow and 3+ upper extremity reflexes. Mental status, cranial nerve, reflex, coordination, gait, right upper extremity, and lower extremity exams were
I) HISTORY AND PHYSICAL EXAMINATION: Chief Complaint: “My left arm feels weak and numb.”.
History of Present Illness: The patient is an 81-year-old man with HTN, HLD, Type 2 DM, and atrial fibrillation on Xarelto. He presented to Maimonides Hospital emergency department complaining of left arm weakness, tingling and numbness for the past 5 hours. He reports that he felt normal this morning at around 6:00 am when he woke up, but at around 8:00 am while he was eating breakfast, he began experiencing progressive left arm weakness, tingling and numbness from the fingers to the elbow. These symptoms have remained constant, without improvement or worsening since their onset. He has never had similar symptoms in the past. One day prior to presentation, the patient discontinued his Xarelto due to an upcoming dental tooth extraction. This morning, when he started to experience these symptoms, he decided to take a dose of Xarelto. He denies any speech difficulties, changes in vision, dizziness, loss of consciousness, weakness or numbness in his other limbs or his face, chest pain, palpitations, or shortness of breath. He states that he is …show more content…
He denies any symptoms in his right upper extremity, face, or lower extremities, as well as visual disturbances or speech difficulties. On physical examination, he has mild left pronator drift with reduced sensation to light touch, pinprick and vibration as well as 45 strength in the muscles of the left upper extremity from the fingers to the elbow and 3+ upper extremity reflexes. Mental status, cranial nerve, reflex, coordination, gait, right upper extremity, and lower extremity exams were