AFTER VISIT SUMMARY

Christopher P. McGreal  DoB: 12/11/1972  12/14/2019   MHL EMERGENCY DEPT 270-444-2444

What's Next

Instructions Today's Visit

Read the attached information You were seen by ADAM DULEY, MD
1. Chest Pain (English)
Reason for Visit
2. Cellulitis (English) Rash
Diagnoses
Schedule an appointment with Robert J Learch as • Left arm cellulitis
soon as possible for a visit on 12/16/2019 • Acute chest pain
Contact: 2605 KENTUCKY AVE
Bldg 3 STE 602
Paducah KY 42003 Lab Tests Completed
270-575-5990 APTT
CBC Auto Differential
Go to TIMOTHY RANVAL, MD on 12/18/2019 Comprehensive Metabolic Panel
Specialty: Vascular Surgery
Contact: 1532 Lone Oak Rd Protime-INR
Ste 405 Troponin
Paducah KY 42003
270-441-4300
Imaging Tests
EKG 12 Lead
Follow up with Joel D Talley, MD
Why: As needed VL Extremity Venous Left
Specialty: Cardiology XR Chest Portable
Contact: 1532 Lone Oak Rd, Ste 415
Paducah KY 42003
270-442-0103 Done Today
Insert peripheral IV

Your End of Visit Vitals

What's Next Blood Temperature
DEC Follow Up Appointment with MHL LMP WOUND Pressure
CARE CENTER 98.2 °F
18 TIMOTHY RANVAL, MD 124/78
2019 Wednesday December 18 9:30 AM 225 MEDICAL CENTER
Please arrive 15 minutes prior to DR, STE 205 Pulse Respiration
appointment time, bring insurance PADUCAH KY 89 20
card and photo ID. 42003-7934
270-441-4462 Oxygen
Saturation
93%
Opioid Education
Prescription Opioids: What You Need to Know:
 
Prescription opioids can be used to help relieve moderate-to-severe MyChart
pain and are often prescribed following a surgery or injury, or for certain View your After Visit Summary and more
health conditions. These medications can be an important part of online at https://chpepiceweb.health-
treatment but also come with serious risks. Opioids are strong pain partners.org/MyChart/. If you have
medicines. Examples include hydrocodone (VICODIN, NORCO), questions, please call 1-844-552-4278 to
speak with our MyChart staff.

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Opioid Education (continued)
oxycodone (ROXICODONE, OXYCONTIN, PERCOCET), fentanyl (DURAGESIC), and morphine (MS CONTIN).
Heroin is an example of an illegal opioid. It is important to work with your health care provider to make sure you are
getting the safest, most effective care.
 
WHAT ARE THE RISKS AND SIDE EFFECTS OF OPIOID USE?
Prescription opioids carry serious risks of addiction and overdose, especially with prolonged use. An opioid overdose,
often marked by slow breathing, can cause sudden death. The use of prescription opioids can have a number of side
effects as well, even when taken as directed.

• Tolerance-meaning you might need to take more of a medication for the same pain relief
• Physical dependence-meaning you have symptoms of withdrawal when the medication is stopped. Withdrawal
symptoms can include nausea, sweating, chills, diarrhea, stomach cramps, and muscle aches. Withdrawal can
last up to several weeks, depending on which drug you took and how long you took it.
• Increased sensitivity to pain
• Constipation
• Nausea, vomiting, and dry mouth
• Sleepiness and dizziness
• Confusion
• Depression
• Low levels of testosterone that can result in lower sex drive, energy, and strength
• Itching and sweating
 
RISKS ARE GREATER WITH:
• History of drug misuse, substance use disorder, or overdose
• Mental health conditions (such as depression or anxiety)
• Sleep apnea
• Older age (65 years or older)
• Pregnancy
 
Avoid alcohol while taking prescription opioids. Also, unless specifically advised by your health care provider,
medications to avoid include:
• Benzodiazepines (such as alprazolam (Xanax) or diazepam (Valium))
• Muscle relaxants (such as carisoprodol (Soma) or cyclobenzaprine (Flexeril))
• Hypnotics (such as zolpidem (Ambien) or eszopiclone (Lunesta))
• Other prescription opioids
 
KNOW YOUR OPTIONS
Talk to your health care provider about ways to manage your pain that don't involve prescription opioids. Some of
these options may actually work better and have fewer risks and side effects. Consult your physician before adding
or stopping any medications, treatments, or physical activity.
Options may include:
• Pain relievers such as acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)
• Some medications that are also used for depression or seizures
• Physical therapy and exercise
• Counseling to help patients learn how to cope better with triggers of pain and stress.
• Application of heat or cold compress
• Massage therapy
• Relaxation techniques

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Opioid Education (continued)
Be Informed
Make sure you know the name of your medication, how much and how often to take it, and its potential risks & side
effects.
 
IF YOU ARE PRESCRIBED OPIOIDS FOR PAIN:
• Never take opioids in greater amounts or more often than prescribed. Remember the goal is not to be pain-free
but to manage your pain at a tolerable level.
• Follow up with your primary care provider to:
▪ Work together to create a plan on how to manage your pain.
▪ Talk about ways to help manage your pain that don't involve prescription opioids.
▪ Talk about any and all concerns and side effects.
• Help prevent misuse and abuse.
▪ Never sell or share prescription opioids
▪ Help prevent misuse and abuse.
• Store prescription opioids in a secure place and out of reach of others (this may include visitors, children, friends,
and family).
• Safely dispose of unused/unwanted prescription opioids: Find your community drug take-back program or your
pharmacy mail-back program, or flush them down the toilet, following guidance from the Food and Drug
Administration (www.fda.gov/Drugs/ResourcesForYou).
• Visit www.cdc.gov/drugoverdose to learn about the risks of opioid abuse and overdose.
• If you believe you may be struggling with addiction, tell your health care provider and ask for guidance or call
SAMHSA's National Helpline at 1-800-662-HELP.

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ASK your doctor about these medications

Your Medication List

ASK your doctor about these medications
ALPRAZolam 1 MG tablet Take 1 mg by mouth 3 times daily.
Commonly known as: XANAX

aspirin 81 MG EC tablet Take 1 tablet by mouth daily

atorvastatin 40 MG tablet Take 1 tablet by mouth nightly

Commonly known as: LIPITOR

BYSTOLIC 10 MG tablet Take 10 mg by mouth daily

Generic drug: nebivolol

cilostazol 100 MG tablet Take 1 tablet by mouth 2 times daily

Commonly known as: PLETAL

* doxycycline hyclate 100 MG capsule Take 1 capsule by mouth 2 times daily

Commonly known as: VIBRAMYCIN

* doxycycline hyclate 100 MG capsule Take 1 capsule by mouth 2 times daily for 14 days
Commonly known as: VIBRAMYCIN Start taking on: January 12, 2020

ferrous sulfate 325 (65 Fe) MG tablet Take 1 tablet by mouth 3 times daily (with meals)
According to our records, you may have been
taking this medication differently.

folic acid 1 MG tablet Take 4 tablets by mouth daily

Commonly known as: FOLVITE According to our records, you may have been
taking this medication differently.

HYDROcodone-acetaminophen 10-325 MG per Take 5 mLs by mouth every 4 hours as needed for
15ML Soln solution Pain. Dr. Maureen Klenne (Cairo,IL)
Commonly known as: ZAMICET

lidocaine 4 % external solution Apply topically 2 times daily Mix 10 ml in 20 ml NS -

Commonly known as: XYLOCAINE soak wound dressing for 15 minutes prior to
removing dressing.

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Your Medication List (continued)
ASK your doctor about these medications (continued)

oxyCODONE 20 MG immediate release tablet Take 1 tablet by mouth 2 times daily for 7 days. Take
Commonly known as: ROXICODONE 1/2 hour prior to dressing changes.

pregabalin 150 MG capsule Take 150 mg by mouth 2 times daily.

Commonly known as: LYRICA

QUEtiapine 25 MG tablet Take 50 mg by mouth nightly

Commonly known as: SEROQUEL

sertraline 50 MG tablet Take 1 tablet by mouth daily

Commonly known as: ZOLOFT

* This list has 2 medication(s) that are the same as other medications prescribed for you. Read the directions
carefully, and ask your doctor or other care provider to review them with you.

Important information for a smoker

 
THE MOST IMPORTANT ACTION YOU CAN TAKE TO IMPROVE YOUR CURRENT AND FUTURE HEALTH IS TO QUIT
SMOKING.
 
Call the National Quit Smoking Support Hot Line at 1-800-QUIT NOW (784-8669)
 
Smoking harms nonsmokers. When nonsmokers are around people who smoke, they absorb nicotine, carbon monoxide,
and other ingredients of tobacco smoke.
 
DO NOT SMOKE AROUND CHILDREN
 
Children exposed to secondhand smoke are at an increased risk of: Sudden Infant Death Syndrome (SIDS), acute
respiratory infections, inflammation of the middle ear, and severe asthma. Over a longer time, it causes heart disease
and lung cancer. There is no safe level of exposure to secondhand smoke.
 
 

Preventive Care
Date Due
Pneumococcal  (1 of 1 - PPSV23) 12/11/1978
Cholesterol Screening 12/11/1982
Tetanus Combination Vaccine (1 - Tdap) 12/11/1983
HIV screening is recommended for all people regardless of risk factors  aged 15-65 years 12/11/1987
at least once (lifetime) who have never been HIV tested.

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 Preventive Care (continued)
Date Due
Diabetes Screening 12/11/2012
Potassium monitoring 12/07/2020
Creatinine monitoring 12/09/2020

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 Attached Information Chest Pain (English)

Chest Pain: Care Instructions

Your Care Instructions

There are many things that can cause chest pain. Some are not serious and will get better on their own in a few days.
But some kinds of chest pain need more testing and treatment. Your doctor may have recommended a follow-up visit in
the next 8 to 12 hours. If you are not getting better, you may need more tests or treatment.
Even though your doctor has released you, you still need to watch for any problems. The doctor carefully checked you,
but sometimes problems can develop later. If you have new symptoms or if your symptoms do not get better, get
medical care right away.
If you have worse or different chest pain or pressure that lasts more than 5 minutes or you passed out (lost
consciousness), call 911 or seek other emergency help right away.
A medical visit is only one step in your treatment. Even if you feel better, you still need to do what your doctor
recommends, such as going to all suggested follow-up appointments and taking medicines exactly as directed. This will
help you recover and help prevent future problems.

How can you care for yourself at home?

• Rest until you feel better.
• Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your
medicine.
• Do not drive after taking a prescription pain medicine.
When should you call for help?

Call 911 if:

  • You passed out (lost consciousness).
  • You have severe difficulty breathing.

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 • You have symptoms of a heart attack. These may include:
◦ Chest pain or pressure, or a strange feeling in your chest.
◦ Sweating.
◦ Shortness of breath.
◦ Nausea or vomiting.
  ◦ Pain, pressure, or a strange feeling in your back, neck, jaw, or upper belly or in one or
both shoulders or arms.
◦ Lightheadedness or sudden weakness.
◦ A fast or irregular heartbeat.
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose
aspirin. Wait for an ambulance. Do not try to drive yourself.
 Call your doctor today if:
  • You have any trouble breathing.
  • Your chest pain gets worse.
  • You are dizzy or lightheaded, or you feel like you may faint.
  • You are not getting better as expected.
  • You are having new or different chest pain.
Where can you learn more?
Go to https://chpepiceweb.health-partners.org and sign in to your MyChart account. Enter A120 in the Search Health
Information box to learn more about "Chest Pain: Care Instructions."

If you do not have an account, please click on the "Sign Up Now" link.
Current as of: September 23, 2018
Content Version: 12.1
© 2006-2019 Healthwise, Incorporated. Care instructions adapted under license by Mercy Health. If you have questions
about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated
disclaims any warranty or liability for your use of this information.
 
 

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 Attached Information Cellulitis (English)

Cellulitis: Care Instructions

Your Care Instructions

Cellulitis is a skin infection caused by bacteria, most often strep or staph. It often occurs after a break in the skin from a
scrape, cut, bite, or puncture, or after a rash.
Cellulitis may be treated without doing tests to find out what caused it. But your doctor may do tests, if needed, to look
for a specific bacteria, like methicillin-resistant Staphylococcus aureus (MRSA).
The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get
medical treatment right away.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your
doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you
take.

How can you care for yourself at home?

• Take your antibiotics as directed. Do not stop taking them just because you feel better. You need to take the full
course of antibiotics.
• Prop up the infected area on pillows to reduce pain and swelling. Try to keep the area above the level of your
heart as often as you can.
• If your doctor told you how to care for your wound, follow your doctor's instructions. If you did not get
instructions, follow this general advice:
◦ Wash the wound with clean water 2 times a day. Don't use hydrogen peroxide or alcohol, which can slow
healing.
◦ You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
◦ Apply more petroleum jelly and replace the bandage as needed.
• Be safe with medicines. Take pain medicines exactly as directed.
◦ If the doctor gave you a prescription medicine for pain, take it as prescribed.
◦ If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter
medicine.

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To prevent cellulitis in the future
• Try to prevent cuts, scrapes, or other injuries to your skin. Cellulitis most often occurs where there is a break in
the skin.
• If you get a scrape, cut, mild burn, or bite, wash the wound with clean water as soon as you can to help avoid
infection. Don't use hydrogen peroxide or alcohol, which can slow healing.
• If you have swelling in your legs (edema), support stockings and good skin care may help prevent leg sores and
cellulitis.
• Take care of your feet, especially if you have diabetes or other conditions that increase the risk of infection. Wear
shoes and socks. Do not go barefoot. If you have athlete's foot or other skin problems on your feet, talk to your
doctor about how to treat them.
When should you call for help?

Call your doctor now or seek immediate medical care if:

• You have signs that your infection is getting worse, such as:
◦ Increased pain, swelling, warmth, or redness.
  ◦ Red streaks leading from the area.
◦ Pus draining from the area.
◦ A fever.
  • You get a rash.
 Watch closely for changes in your health, and be sure to contact your doctor if:
  • You do not get better as expected.
Where can you learn more?
Go to https://chpepiceweb.health-partners.org and sign in to your MyChart account. Enter X309 in the Search Health
Information box to learn more about "Cellulitis: Care Instructions."

If you do not have an account, please click on the "Sign Up Now" link.
Current as of: April 1, 2019
Content Version: 12.1
© 2006-2019 Healthwise, Incorporated. Care instructions adapted under license by Mercy Health. If you have questions
about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated
disclaims any warranty or liability for your use of this information.
 
 

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