0630 handoff. Mr. T, 64, was admitted two days ago with atrial fibrillation with rapid ventricular response and NSTEMI and had PCI with a drug-eluting stent yesterday. He receives aspirin, ticagrelor, a weight-based heparin infusion, and a morphine PCA (1 mg demand dose, 8-minute lockout, 20 mg four-hour limit, no continuous basal infusion, patient-only activation). Potassium chloride 40 mEq in 100 mL labeled CENTRAL LINE ONLY is running through a peripheral antecubital IV. At 0200 he was drowsy but conversant and rated pain 3 of 10. Now: temperature 36.9 C, heart rate 78 in sinus rhythm, respirations 10 and shallow, blood pressure 108/62 mm Hg, similar to overnight readings, and SpO2 92 percent on 2 L/min. Pain is 1 of 10. He arouses only to firm voice; pupils are 2 mm and reactive. His wife says she used the PCA while he slept, pressing the button because he looked uncomfortable. The PCA history shows 18 demands, 14 deliveries in four hours, within the programmed limit. His son relays that Mr. T complained of burning at the IV site for the past 30 minutes. An aPTT of 92 seconds at 0200 exceeded the 60 to 90 second target; the repeat is due at 0800, and there is no overt bleeding at any site.
0630 handoff. Mr. T, 64, was admitted two days ago with atrial fibrillation with rapid ventricular response and NSTEMI and had PCI with a drug-eluting stent yesterday. He receives aspirin, ticagrelor, a weight-based heparin infusion, and a morphine PCA (1 mg demand dose, 8-minute lockout, 20 mg four-hour limit, no continuous basal infusion, patient-only activation). Potassium chloride 40 mEq in 100 mL labeled CENTRAL LINE ONLY is running through a peripheral antecubital IV. At 0200 he was drowsy but conversant and rated pain 3 of 10. Now: temperature 36.9 C, heart rate 78 in sinus rhythm, respirations 10 and shallow, blood pressure 108/62 mm Hg, similar to overnight readings, and SpO2 92 percent on 2 L/min. Pain is 1 of 10. He arouses only to firm voice; pupils are 2 mm and reactive. His wife says she used the PCA while he slept, pressing the button because he looked uncomfortable. The PCA history shows 18 demands, 14 deliveries in four hours, within the programmed limit. His son relays that Mr. T complained of burning at the IV site for the past 30 minutes. An aPTT of 92 seconds at 0200 exceeded the 60 to 90 second target; the repeat is due at 0800, and there is no overt bleeding at any site.