CHIEF COMPLAINT: UGI bleeding

PRESENT ILLNESS: 53 y/o male with esophageal cancer and h/o PE's on Lovenox who
presented to the ED after melena and an episode of coffee ground
emesis at home. States that he had one episode of formed black
stool approximately 3-4 days ago. No associated dizziness,
CP/SOB. Two days ago he had 3 epidoses of dark stool, with the
final one begin more diarrheal in nature. He never saw any BRB
in or coating the stool. He admits to beginning to feel more
fatigued and short of breath with minimal exertion, but denies
orthostatic or presyncopal symptoms. Was still tolerated normal
po intake without nausea, vomiting or abdominal pain. However,
on the evening prior to admission he vomited approximately 200cc
of "coffee ground" emesis at home. In total he vomited
approximately 4-5 times per his wife. [**Name (NI) **] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 62047**] or
clots. Endorses pleuritic CP that was associated only with
vomiting and coughing. Denied any radition of CP or associated
nausea or diaphoresis. This AM, when his visiting nurse came,
she stated that he looked pale, and upon hearing his story,
placed a phone call to pt's oncologist Dr. [**Last Name (STitle) 3274**], who advised
going to the ED.
Of note, pt had a recent admission from [**2104-12-31**] to [**2105-1-3**] for
UGIB, including an EGD on [**1-1**] without obvious upper etiology for
bleeding.
In the ED, vitals on presention were T 98.1 HR 124 BP 98/62 RR
20 99%RA. He was given 2 units of PRBCs and 2 liters of NS. Had
rpt episode of coffee ground emesis. EKG was without any acute
ST changes. 18G was placed in right hand and left chest port was
accessed. He received 1mg Dilaudid for chest pain related to
cough and vomiting. GI was consulted and he was admitted to the
[**Hospital Unit Name 153**] for further care.

MEDICAL HISTORY: PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-30**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**].  Developed
PE [**2103-11-18**], since then is on Lovenox. Changed to Taxotere [**1-1**]
due to insufficient palliative response in esophagus despite
apparent systemic control; An esophageal stent was placed in
[**2104-1-24**], however, he soon returned to the hospital with
increased esophageal area pain and was found to have an abscess.
 During this hospitalization, he was diagnosed with atrial
fibrillation and found to have a pericardial effusion which
required drainage, balloon pericardiotomy and pericardial
window. He was hospitalized from [**2104-7-5**] - [**2104-7-15**] for
fever, shortness of breath, and enlarging pleural effusion.
During this hospitalization he underwent talc pleurodesis of the
right effusion.  Cytology was negative.  His primary oncologist
is Dr. [**Last Name (STitle) 3274**].
2. Hyperlipidemia
3. PE as above
4. h/o afib w/ rvr in setting of pericard effusion and window

MEDICATION ON ADMISSION: 1. Prochlorperazine 10 mg PO Q6H as needed.
2. Fentanyl 200 mcg/hr Patch q72 hr
3. Erythromycin 250 mg Tablet, Delayed Release PO TID.
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Mirtazapine 22.5 mg PO HS (at bedtime) as needed for
insomnia.
5. Atorvastatin 10 mg Tablet PO DAILY
6. Lorazepam 1 mg Tablet PO HS
7. Lovenox 80 mg Subcutaneous twice a day.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
9. Pantoprazole 40 mg PO BID
10. Methylphenidate 5 mg Tablet PO twice a day.
11. Benzonatate 200 mg Capsule PO TID
12. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
PO once a day.
13. Trazodone 50 mg PO QHS PRN insomnia
14. Maalox 225-200 mg/5 mL Suspension 15-30 MLs PO QID as
needed.
15. Docusate Sodium 100 mg PO BID
16. Bisacodyl 10 mg Tablet PO BID
17. Liquid morphine 10-20 mg QID PRN pain
18. Zofran 4 mg PO TID PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 98.3 BP 99/60 HR 97 RR 18 O2sat 97% 2L NC
Gen: Pale, chronically ill appearing man in NAD
HEENT: MM slighly dry, pale conjunctivae
Neck: JVP 7cm, veins not distended, No cervical LAD appreciated

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.

SOCIAL HISTORY: Married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. occasional EtOH. Independent w/ ADLs at home.
Hemorrhage of gastrointestinal tract, unspecified,Pressure ulcer, lower back,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of retroperitoneum and peritoneum,Gastroparesis,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia
Gastrointest hemorr NOS,Pressure ulcer, low back,Mal neo esophagus NEC,Sec mal neo peritoneum,Gastroparesis,Atrial fibrillation,Long-term use anticoagul,Hx-ven thrombosis/embols,Hyperlipidemia NEC/NOS
Admission Date:  [**2105-1-14**]              Discharge Date:   [**2105-1-21**]

Date of Birth:  [**2051-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
UGI bleeding

Major Surgical or Invasive Procedure:
Transfusions x 8

History of Present Illness:
53 y/o male with esophageal cancer and h/o PE's on Lovenox who
presented to the ED after melena and an episode of coffee ground
emesis at home. States that he had one episode of formed black
stool approximately 3-4 days ago. No associated dizziness,
CP/SOB. Two days ago he had 3 epidoses of dark stool, with the
final one begin more diarrheal in nature. He never saw any BRB
in or coating the stool. He admits to beginning to feel more
fatigued and short of breath with minimal exertion, but denies
orthostatic or presyncopal symptoms. Was still tolerated normal
po intake without nausea, vomiting or abdominal pain. However,
on the evening prior to admission he vomited approximately 200cc
of "coffee ground" emesis at home. In total he vomited
approximately 4-5 times per his wife. [**Name (NI) **] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 62047**] or
clots. Endorses pleuritic CP that was associated only with
vomiting and coughing. Denied any radition of CP or associated
nausea or diaphoresis. This AM, when his visiting nurse came,
she stated that he looked pale, and upon hearing his story,
placed a phone call to pt's oncologist Dr. [**Last Name (STitle) 3274**], who advised
going to the ED.
Of note, pt had a recent admission from [**2104-12-31**] to [**2105-1-3**] for
UGIB, including an EGD on [**1-1**] without obvious upper etiology for
bleeding.
In the ED, vitals on presention were T 98.1 HR 124 BP 98/62 RR
20 99%RA. He was given 2 units of PRBCs and 2 liters of NS. Had
rpt episode of coffee ground emesis. EKG was without any acute
ST changes. 18G was placed in right hand and left chest port was
accessed. He received 1mg Dilaudid for chest pain related to
cough and vomiting. GI was consulted and he was admitted to the
[**Hospital Unit Name 153**] for further care.


Past Medical History:
PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-30**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**].  Developed
PE [**2103-11-18**], since then is on Lovenox. Changed to Taxotere [**1-1**]
due to insufficient palliative response in esophagus despite
apparent systemic control; An esophageal stent was placed in
[**2104-1-24**], however, he soon returned to the hospital with
increased esophageal area pain and was found to have an abscess.
 During this hospitalization, he was diagnosed with atrial
fibrillation and found to have a pericardial effusion which
required drainage, balloon pericardiotomy and pericardial
window. He was hospitalized from [**2104-7-5**] - [**2104-7-15**] for
fever, shortness of breath, and enlarging pleural effusion.
During this hospitalization he underwent talc pleurodesis of the
right effusion.  Cytology was negative.  His primary oncologist
is Dr. [**Last Name (STitle) 3274**].
2. Hyperlipidemia
3. PE as above
4. h/o afib w/ rvr in setting of pericard effusion and window

Social History:
Married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. occasional EtOH. Independent w/ ADLs at home.


Family History:
Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.


Physical Exam:
PE: T 98.3 BP 99/60 HR 97 RR 18 O2sat 97% 2L NC
Gen: Pale, chronically ill appearing man in NAD
HEENT: MM slighly dry, pale conjunctivae
Neck: JVP 7cm, veins not distended, No cervical LAD appreciated

CV: borderline Sinus tachy, no m/r/g appreciated
Resp: No increased WOB noted. fine rales left lung base, no
wheezes nor rhonchi
Abd: +BS, soft, NT, ND
Rectal: black stool guaiac positive
Ext: WWP, 2+ DP/PT pulses b/l, no c/c/e
Neuro: CN 2-12, strength, sensation grossly intact


Pertinent Results:
[**2105-1-14**] 11:51AM   PT-13.9* PTT-31.3 INR(PT)-1.2*
[**2105-1-14**] 11:51AM   PLT SMR-NORMAL PLT COUNT-294
[**2105-1-14**] 11:51AM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-1+
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL SCHISTOCY-1+
[**2105-1-14**] 11:51AM   NEUTS-88.7* BANDS-0 LYMPHS-7.4* MONOS-3.5
EOS-0.2 BASOS-0.1
[**2105-1-14**] 11:51AM   WBC-8.9 RBC-2.26*# HGB-6.7*# HCT-20.0*#
MCV-88 MCH-29.6 MCHC-33.5 RDW-15.5
[**2105-1-14**] 11:51AM   PHOSPHATE-3.6 MAGNESIUM-1.5*
[**2105-1-14**] 11:51AM   CK-MB-NotDone
[**2105-1-14**] 11:51AM   cTropnT-<0.01
[**2105-1-14**] 11:51AM   ALT(SGPT)-20 AST(SGOT)-24 CK(CPK)-9*
[**2105-1-14**] 11:51AM   estGFR-Using this
[**2105-1-14**] 11:51AM   GLUCOSE-115* UREA N-20 CREAT-0.6 SODIUM-133
POTASSIUM-4.0 CHLORIDE-97 TOTAL CO2-30 ANION GAP-10
[**2105-1-14**] 08:38PM   PT-13.8* PTT-26.4 INR(PT)-1.2*
[**2105-1-14**] 08:38PM   PLT COUNT-292
[**2105-1-14**] 08:38PM   WBC-9.8 RBC-2.76* HGB-8.2* HCT-25.2*# MCV-91
MCH-29.8 MCHC-32.6 RDW-15.0
[**2105-1-14**] 08:38PM   CK-MB-1 cTropnT-<0.01
[**2105-1-14**] 08:38PM   CK(CPK)-10*
[**2105-1-14**] 08:38PM   GLUCOSE-99 UREA N-16 CREAT-0.6 SODIUM-136
POTASSIUM-4.0 CHLORIDE-102 TOTAL CO2-25 ANION GAP-13
.
CXR [**1-14**]: 1. Dense left retrocardiac opacification possibly
secondary to a combination of atelectasis and effusion, less
likely pneumonia.
2. Persistent right mid lung opacity which may reflect sequela
of chronic aspiration.

Brief Hospital Course:
A/P: 53 yo M with metastatic esophageal cancer and h/o GIB, h/o
PE anticoagulated with lovenox on admission, presenting with 4
day h/o fatigue in association with melena and coffee ground
emesis, admitted to ICU for management of GIB, then transferred
to OMED, then back to the ICU and then back to OMED.

Hospital Course by Problem:

Upper GI Bleed: This is secondary to known fungating esophageal
CA with gastric fundal extension of mass. GI consult team
followed patient. He had EGD [**1-1**] without obvious source of
bleeding. No intervention possible to stop bleeding from this
mass. Has recieved total of 8U PBRC since admission, with hct
dropping despite transfusions. He had continued episode of
hematemesis and was taken to endoscopy again. He had substantial
tumor burden in the esophagus and GE junction. The tumor is
friable and was oozing blood at several sites. There is no
endoscopic intervention which is effective in reducing the
chance of bleeding. Per GI, it is likely his bleeding and
occasional hematemesis will continue. They recommend against
further endoscopies as they are unlikely to impact his
management. Argon plasma coagulation was considered, but given
the vascularity of tumor and location of stent, it is not a
feasible option for him at this time. He was maintained on an IV
PPI while in the hospital, PO on dischage. For the nausea, he
was given compazine and zofran. His Hct was checked
2-3times/day, and he was transfused for Hct >25. The Lovenox for
his hx of PE was discontinued given the persistent bleeding.

Esophageal Cancer: Patient is s/p multiple rounds of
chemotherapy, radiation and cyberknife. Per patient is not a
candidate for further therapy given poor health status. No
further intervention for tumor. For pain he had been on fentanyl
patch 200mcg/hr q72h, and morphine IV prn, PO on discharge.

H/o PE: He has a history of upper extremity DVT the embolized.
He had been on Lovenox, but this is been discontinued in the
setting of continued bleeding from esophageal mass.

SVT: The patient has h/o atrial flutter to HR > 160. Patient's
heart rate stable in metoprolol, but increases to 160 when even
on dose of metoprolol is held. He had several episodes of SVT
while on service tha twere trated with 5mg IV metoprolol pushes.
they were generally controlled on this. He was continued on
metoprolol TID, with a high threshold to hold completely.
Patient also had tendency to become hypotensive with metoprolol
IV  pushes, so gets 500cc NS boluses with metoprolol.

Gastroparesis: Patient on erythromycin which was initially held
on admission. on  [**1-18**] patient complained of early satiety and
cramping in abdomen which resolved [**1-19**]. He was restarted on
erythromycin.

Hyperlipidemia: Initially held, continued on discharge

Insomnia: Initially held po trazodone and remeron, but then
readded with the addition of ativan PRN

Medications on Admission:
1. Prochlorperazine 10 mg PO Q6H as needed.
2. Fentanyl 200 mcg/hr Patch q72 hr
3. Erythromycin 250 mg Tablet, Delayed Release PO TID.
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Mirtazapine 22.5 mg PO HS (at bedtime) as needed for
insomnia.
5. Atorvastatin 10 mg Tablet PO DAILY
6. Lorazepam 1 mg Tablet PO HS
7. Lovenox 80 mg Subcutaneous twice a day.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
9. Pantoprazole 40 mg PO BID
10. Methylphenidate 5 mg Tablet PO twice a day.
11. Benzonatate 200 mg Capsule PO TID
12. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
PO once a day.
13. Trazodone 50 mg PO QHS PRN insomnia
14. Maalox 225-200 mg/5 mL Suspension 15-30 MLs PO QID as
needed.
15. Docusate Sodium 100 mg PO BID
16. Bisacodyl 10 mg Tablet PO BID
17. Liquid morphine 10-20 mg QID PRN pain
18. Zofran 4 mg PO TID PRN


Discharge Medications:
1. Compazine 10 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for nausea.
Disp:*10 Tablet(s)* Refills:*1*
2. Remeron 15 mg Tablet Sig: One (1) Tablet PO once a day.
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.

4. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
5. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours.
Disp:*30 Tablet(s)* Refills:*0*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Ritalin 5 mg Tablet Sig: One (1) Tablet PO twice a day.
8. Benzonatate 200 mg Capsule Sig: Two (2) Capsule PO three
times a day.
9. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
10. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO once a day.
11. Maalox 200-200-20 mg/5 mL Suspension Sig: [**11-26**]  PO once a day
as needed for nausea.
12. Morphine 10 mg/5 mL Solution Sig: 10-20 mg PO every six (6)
hours as needed for pain.
13. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.
Disp:*10 Tablet, Rapid Dissolve(s)* Refills:*0*
14. Mirtazapine 15 mg Tablet Sig: 1.5 Tablets PO HS (at
bedtime).
15. Heparin Flush 10 unit/mL Kit Sig: One (1)  Intravenous once
a day.
Disp:*30 Flushes* Refills:*2*
16. Normal Saline Flush 0.9 % Syringe Sig: One (1)  Injection
once a day.
Disp:*30 Flushes* Refills:*2*
17. Other  Sig: One (1)   once a day: Please give POC Care per
NEHT Protocol. .
Disp:*qs Other* Refills:*2*
18. Needle (Disp) 20 G 20 x [**1-27**]   Needle Sig: One (1)
Miscellaneous once a week: To be used to access port weekly. .
Disp:*30 needle* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Primary: Esophageal cancer
Secondary: Hypotension, hyperlipidemia


Discharge Condition:
Hemodynamically stable & afebrile.


Discharge Instructions:
You were admitted for low blood counts and low blood pressure
due to bleeding from you GI tract. You were treated with several
blood transfusions. You had an endoscopy, the results of which
were discussed with you.

Please take all medications as prescribed.  Your medications
have not been changed while you were in the hospital. You will
also be prescribed some anti-nausea medications.

Please keep all your outpatient appointments.

Please return to the hospital or seek medical advice if you
notice new lightheadedness, bloody vomit, black or bloody
stools, rapid heart rate, fever, chills or any other symptom for

which you are concerned.


Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2105-1-27**] 9:00
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**0-0-**]
Date/Time:[**2105-1-27**] 10:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6050**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2105-1-27**] 10:00


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]

Completed by:[**2105-2-4**]
{'Hemorrhage of gastrointestinal tract, unspecified,Pressure ulcer, lower back,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of retroperitoneum and peritoneum,Gastroparesis,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: UGI bleeding

PRESENT ILLNESS: 53 y/o male with esophageal cancer and h/o PE's on Lovenox who
presented to the ED after melena and an episode of coffee ground
emesis at home. States that he had one episode of formed black
stool approximately 3-4 days ago. No associated dizziness,
CP/SOB. Two days ago he had 3 epidoses of dark stool, with the
final one begin more diarrheal in nature. He never saw any BRB
in or coating the stool. He admits to beginning to feel more
fatigued and short of breath with minimal exertion, but denies
orthostatic or presyncopal symptoms. Was still tolerated normal
po intake without nausea, vomiting or abdominal pain. However,
on the evening prior to admission he vomited approximately 200cc
of "coffee ground" emesis at home. In total he vomited
approximately 4-5 times per his wife. [**Name (NI) **] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 62047**] or
clots. Endorses pleuritic CP that was associated only with
vomiting and coughing. Denied any radition of CP or associated
nausea or diaphoresis. This AM, when his visiting nurse came,
she stated that he looked pale, and upon hearing his story,
placed a phone call to pt's oncologist Dr. [**Last Name (STitle) 3274**], who advised
going to the ED.
Of note, pt had a recent admission from [**2104-12-31**] to [**2105-1-3**] for
UGIB, including an EGD on [**1-1**] without obvious upper etiology for
bleeding.
In the ED, vitals on presention were T 98.1 HR 124 BP 98/62 RR
20 99%RA. He was given 2 units of PRBCs and 2 liters of NS. Had
rpt episode of coffee ground emesis. EKG was without any acute
ST changes. 18G was placed in right hand and left chest port was
accessed. He received 1mg Dilaudid for chest pain related to
cough and vomiting. GI was consulted and he was admitted to the
[**Hospital Unit Name 153**] for further care.

MEDICAL HISTORY: PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-30**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**].  Developed
PE [**2103-11-18**], since then is on Lovenox. Changed to Taxotere [**1-1**]
due to insufficient palliative response in esophagus despite
apparent systemic control; An esophageal stent was placed in
[**2104-1-24**], however, he soon returned to the hospital with
increased esophageal area pain and was found to have an abscess.
 During this hospitalization, he was diagnosed with atrial
fibrillation and found to have a pericardial effusion which
required drainage, balloon pericardiotomy and pericardial
window. He was hospitalized from [**2104-7-5**] - [**2104-7-15**] for
fever, shortness of breath, and enlarging pleural effusion.
During this hospitalization he underwent talc pleurodesis of the
right effusion.  Cytology was negative.  His primary oncologist
is Dr. [**Last Name (STitle) 3274**].
2. Hyperlipidemia
3. PE as above
4. h/o afib w/ rvr in setting of pericard effusion and window

MEDICATION ON ADMISSION: 1. Prochlorperazine 10 mg PO Q6H as needed.
2. Fentanyl 200 mcg/hr Patch q72 hr
3. Erythromycin 250 mg Tablet, Delayed Release PO TID.
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Mirtazapine 22.5 mg PO HS (at bedtime) as needed for
insomnia.
5. Atorvastatin 10 mg Tablet PO DAILY
6. Lorazepam 1 mg Tablet PO HS
7. Lovenox 80 mg Subcutaneous twice a day.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
9. Pantoprazole 40 mg PO BID
10. Methylphenidate 5 mg Tablet PO twice a day.
11. Benzonatate 200 mg Capsule PO TID
12. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
PO once a day.
13. Trazodone 50 mg PO QHS PRN insomnia
14. Maalox 225-200 mg/5 mL Suspension 15-30 MLs PO QID as
needed.
15. Docusate Sodium 100 mg PO BID
16. Bisacodyl 10 mg Tablet PO BID
17. Liquid morphine 10-20 mg QID PRN pain
18. Zofran 4 mg PO TID PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 98.3 BP 99/60 HR 97 RR 18 O2sat 97% 2L NC
Gen: Pale, chronically ill appearing man in NAD
HEENT: MM slighly dry, pale conjunctivae
Neck: JVP 7cm, veins not distended, No cervical LAD appreciated

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.

SOCIAL HISTORY: Married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. occasional EtOH. Independent w/ ADLs at home. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Pressure ulcer, lower back,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of retroperitoneum and peritoneum,Gastroparesis,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia'}
