allergies: iodine - nausea and flushing, ms04 - nausea pmed hx: met renal ca, s/p r nephrectomy , s/p high dose il2 , s/p r pulm nodual resection, s/p il2 , 9/00-11/00, s/p thalidamide, biliary obstruction s/p stent , s/p new biliary stent , portal vein thrombosis12/15, peripheral neuropathy due to thalidamide, ct on showed masses of pancreatic and peripancreatic region, masses of adrenals bilat, spenomegally w/spleen mass, splenic vein obliterated by tumer w/collateral varicies, lesion l kidney, inguinal and pelvic lns, , extrinsic occlusion of portal vein, ercp 7/01malignant looking cbd strictors with multi filling defects - 7cm stent placed. systems review: cv: on arrival hr 140, sbp 140-150s, denies any cp, denies feeling lightheaded with standing but his hr increases by 20 pts with standing. rec ca because he is receiving blood products and he has a low normal ca. pulm: ls clear, 02 sat on ra 85%, 98% on 5 liters while awake and breathing through his nose, he denies feeling sob with his lower 02 sat gi: vomited 500cc brb while enroute, he has had multiple melanotic stools. he has thus far rec 2 units prbc and 2 ffp, to rec an additional 2 unis prbc. he has a liver us done to show hepatic flow which was pos for flow, a ct was done to look at the same and it found the same; he now may be able to have a tips done today. gu: low u/o prob due to the lg amount of stooling neuro: a&o, the intern talked to him about dnr, he said that he was scared by the discussion and wants to have everything done. Procedure: Continuous invasive mechanical ventilation for less than 96 consecutive hours Venous catheterization, not elsewhere classified Insertion of endotracheal tube Angioplasty of other non-coronary vessel(s) Insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) Other percutaneous procedures on biliary tract Diagnoses: Pneumonia, organism unspecified Acute kidney failure with lesion of tubular necrosis Secondary malignant neoplasm of other specified sites Pulmonary collapse Personal history of malignant neoplasm of bladder Esophageal varices with bleeding Varices of other sites Obstruction of bile duct