85 y/o F with PMHx of HTN, HL, h/o breast CA and 3cm renal pelvis
   transitional cell tumor who presented for nephrectomy on [**2575-8-15**].  Her
   post op course was complicated by agitation thought due to narcotics.
   Today, she was restarted on her home meds and while on telemetry, pt
   was noted to be bradycardic to 40s.  Pt was triggered for SBP of 70 and
   HR of 40 during which she remained asymptomatic.  She was given 1L IVF
   and her HR/BP trended back up to baseline.  However, there was a second
   event an hour later when she sat up and became bradycardic in the 30s
   with associated hypotension. Second episode occurred with position change
   and again, pt developped junctional rhythm in 30s. 
   
   home meds:
   Verapamil 240mg daily
   Lisinopril 5mg
   Rosuvastatin 10mg
   Meclizine 25 TID PRN
   Imipramine 25 QHS
   Colace 100mg 
   Loratidine 10mg daily

   Physical Examination
   T: 98 BP: 111/47 P: 74 R: 16 O2: 98% on 2L NC
   General: oriented to person only, NAD, comfortable
   HEENT: Sclera anicteric, dry MM, oropharynx clear
   Neck: supple, unable to appreciate JVP due to habitus
   Lungs: poor effort but [**Month (only) 199**] BS at bases and some audible airway
   secretion in upper airways
   CV: Regular rate and rhythm, no m/r/g, diff to auscult [**2-13**] habitus
   Abdomen:  diffusely tender, bowel sounds present, multiple surgical
   incisions, clean dry and intact, abd binder in place
   GU: foley in place
   Ext: cool, no edema, 1+ pulses, pneumoboots in place