I am looking for thoughts. I received a LTC patient about 6 | Figure 1

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I am looking for thoughts. I received a LTC patient about 60 days ago. He had a hx of 6 strokes. Has had 1 more since he was admitted. He came to us starting coumadin for the first time 3mg qd plus 150mg lovenox qd with orders to d/c lovenox when INR is above 2.0. His INR has been between 1.0 and 1.6. His Coumadin has been increased several times and he is currently on 7.5mg qd.

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Case 1: 83 year old female

83 year old female with a pmhx of htn, hyperlipidemia, and paroxysmal A. Fib who just started Coumadin and has not had an initial #INR checked. Has been on it for one month. Had it checked STAT. Called her and told her to go to the ER immediately. What's the highest you've all seen!?!

Case 2: Acquired factor X deficiency

A 51 year old male patient, who was about to do bone grafting for dental implants, made pre-op tests and an increase at the activated partial thromboplastin time (aPTT) was found (113,7 seconds).
The prothrombin time was 14,3 seconds. Platelets: 201 000. Lupic anticoagulant: negative. Prekalikrein activity: 96,7 seconds. Factor XI: less than 1% (the test was repeated 3 times, all with the same result). Other tests and coagulation factors were normal.
The patient doesn't have history of bleeding (he has done tooth extraction and didn't have any bleeding).
The patient also has an autoimmune urticaria that has been investigated, but with no discovered cause.
The patient lives in Brazil, but has ancestry in Lebanon and at the Mediterranean region.
What I need to know is if the patient can be subjected to bone graft surgery, if he needs plasma transplant, and what types of care need to be taken.
Many doctors in the South of Brazil have been consulted, but as factor XI deficiency is rare, none of them have seen any case of it.
Do you know any center/hospital/doctor specialized in factor XI deficiency?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Teen patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?