The most defense spending was during the Cuban Missile Crisi…
Questions
The mоst defense spending wаs during the Cubаn Missile Crisis (1959).
Histоry оf Present Illness: 67 y/о M with significаnt pаst history for recurrent foot ulcers, prior left 2nd toe аmputation (6wks post op), right lower extremity stent placement (2016). Patient had a lower extremity angiogram showing significant disease. Patient was admitted for planned lower extremity revascularization procedure, underwent right femoral to popliteal bypass. Post op course was complicated by diabetic ketoacidosis and acute kidney injury. Patient had c/o nausea, vomiting, hemoglobin dropped to 7.0 from 13.0 pre- op and was transfused. Telemetry showed ST depression, Left Bundle Branch Block (LBBB), elevated Troponin so patient then underwent a Left Heart Catheterization (LHC), had a percutaneous coronary intervention (PCI) received stent to LAD, patient recovered well, troponin trended down, kidney function returned with normalizing serum creatinine. Past Medical History: Diabetes Mellitus, Hyperlipidemia, Hypertension, Peripheral arterial disease, TIA Past Surgical History Shoulder surgery (2015), LLE atherectomy and stent placement (2016), Left foot 2nd toe amputation (6 weeks ago) Social History: Former smoker of 1PPD x20 years, quit in 1999. Patient is married, lives with his spouse who can assist him as needed. Living Environment: Patient lives in a single-story house, no steps to enter, patient has built in ramp. Patient has walk in shower with grab bars and shower chair. Owns RW, W/C. Prior Level of Function: Patient was limited distance ambulator due to ongoing LE pain /claudication with ambulation. Patient was ambulating with RW and heel strike shoe since left foot 2nd toe amputation. Patient was using wheel chair for distances over 100' due to claudication and fatigue. Patient goal: To be able to walk, feel better and stronger. Patient is willing to participate in a regular exercise program to improve fitness. Medications: Aspirin 81mg daily Lisinopril 5mg tab daily Metoprolol 25 mg bid Insulin 100 units/ml, 5-22 units on sliding scale ( 6 times a day) Percocet 325mg) tab every 4 hr as needed Labs Pre Surgery Surgery POD 1 WBCs (3.5 - 10.5 billion cells/L) 13.43 11.90 12.11 HGB (13.5- 17.5 gm/dl) 13 7.0 10.0 HCT (38.8- 50%) 32.3 31.8 31.5 CREATININE (0.6- 1.3 mg/dl) 2.0 3.0 2.5 TROPONINE (