![]() Lungs fields clear without rales, rhonchi, or wheezes. Normal S1 and S2 without obvious rub, murmur, or gallop. Vitals: temp 98.8☏, pulse 40 bpm slightly irregular, respirations 16/min, blood pressure 108/60 mm Hg. Yellow/green halos around lights for 3 days. Decreased appetite for 3 days with fatigue and malaise. Medications: furosemide, digoxin, enalapril, carvedilol, tamsulosin. He denies drug allergies but reports blood pressure was low with diltiazem. PMH is significant for congestive heart failure secondary to non-ischemic cardiomyopathy, atrial fibrillation, hypertension, chronic renal insufficiency (with baseline creatinine 2.0), and BPH. 7 days ago, he experienced significant diarrhea for 4 days, with progressively worsening nausea and vomiting since. A 57-year-old man presents to the ED with syncopal spell 1 hour ago. ![]()
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