CHIEF COMPLAINT: pulseless left hand

PRESENT ILLNESS: 87F s/p unwitnessed fall in driveway this morning.  Her
neighbors found her and called EMS who arrived at 9:40am.  On
the scene she was complaining of left arm pain and per EMS
report she had a palpable pulse with good capillary refill.  She
was taken to [**Hospital1 18**] [**Location (un) 620**] where she was found to have a left
humeral neck fracture.  She was transferred to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: PMH: Alzheimers dementia, falls, anxiety, hyperlipidemia,  ?htn,
depression, DJD, thrombocytopenia, Anemia, ?afib

MEDICATION ON ADMISSION: Ranitidine 150mg daily
Lorazepam 0.5mg daily
Lipitor 5mg daily
B12 1000mcg daily
MVI daily
Calcium and Vitamin D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission [**2108-7-1**]
PE: 72, 184/71, 22, 99% on NRB
HEENT: PERLA, EOMI, bilateral ecchymoses, forhead laceration
Chest: RRR, lungs clear
Abdomen: soft, nontender, nondistended, well healed
infraumbilical midline incision
Ext: bilateral LE edema
Right arm: 2+ radial pulse, motor and sensation intact
Left arm: dopplerable pulse, hand cool, insensate in radial
distribution, no motor function
Pulses: palpable femoral and DP bilaterally, palpable right
radial, dopplerable left radial

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Son is HCP [**Name (NI) 21976**] [**Telephone/Fax (1) 82944**], who lives in [**State 531**].
Lives with husband in [**Name (NI) 620**], has one son.
-Tobacco history:  smoked as teen x 4 years [**12-16**] PPD
-ETOH:  wine on holidays
-Illicit drugs:  none
Injury to axillary artery,Closed fracture of surgical neck of humerus,Atrial flutter,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Unspecified fall,Oliguria and anuria,Unspecified hemorrhoids with other complication,Anemia, unspecified,Other iatrogenic hypotension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Constipation, unspecified,Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of forehead, without mention of complication,Contusion of face, scalp, and neck except eye(s),Other specified forms of chronic ischemic heart disease
Injury axillary artery,Fx surg nck humerus-clos,Atrial flutter,Urin tract infection NOS,Delirium d/t other cond,Fall NOS,Oliguria & anuria,Hemrrhoid NOS w comp NEC,Anemia NOS,Iatrogenc hypotnsion NEC,Alzheimer's disease,Dementia w/o behav dist,Constipation NOS,Inj nerve shldr/arm NOS,Open wound of forehead,Contusion face/scalp/nck,Chr ischemic hrt dis NEC
Admission Date:  [**2108-7-1**]              Discharge Date:   [**2108-7-19**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4071**]
Chief Complaint:
pulseless left hand


Major Surgical or Invasive Procedure:
[**2108-7-1**] Left axillary to brachial artery bypass with reversed
right greater saphenous vein.

[**2108-7-1**] Open reduction left proximal humerus fracture with
manipulation.

[**2108-7-16**] Pacemaker placement


History of Present Illness:
87F s/p unwitnessed fall in driveway this morning.  Her
neighbors found her and called EMS who arrived at 9:40am.  On
the scene she was complaining of left arm pain and per EMS
report she had a palpable pulse with good capillary refill.  She
was taken to [**Hospital1 18**] [**Location (un) 620**] where she was found to have a left
humeral neck fracture.  She was transferred to [**Hospital1 18**] for further
management.

Upon arrival she was noted to have a cool left hand with no
radial pulse, no motor function, and decreased sensation in the
radial distribution.  In the ED at [**Hospital1 18**], orthopedics attempted
to reduce left arm and left hand became a bit warmer yet pulses
were still intermittent.


Past Medical History:
PMH: Alzheimers dementia, falls, anxiety, hyperlipidemia,  ?htn,
depression, DJD, thrombocytopenia, Anemia, ?afib

Past Surgical History: s/p TAH/BSO

Social History:
Son is HCP [**Name (NI) 21976**] [**Telephone/Fax (1) 82944**], who lives in [**State 531**].
Lives with husband in [**Name (NI) 620**], has one son.
-Tobacco history:  smoked as teen x 4 years [**12-16**] PPD
-ETOH:  wine on holidays
-Illicit drugs:  none

Family History:
Noncontributory

Physical Exam:
On admission [**2108-7-1**]
PE: 72, 184/71, 22, 99% on NRB
HEENT: PERLA, EOMI, bilateral ecchymoses, forhead laceration
Chest: RRR, lungs clear
Abdomen: soft, nontender, nondistended, well healed
infraumbilical midline incision
Ext: bilateral LE edema
Right arm: 2+ radial pulse, motor and sensation intact
Left arm: dopplerable pulse, hand cool, insensate in radial
distribution, no motor function
Pulses: palpable femoral and DP bilaterally, palpable right
radial, dopplerable left radial


Pertinent Results:
LABORATORIES:

[**2108-7-15**] 06:45AM BLOOD WBC-9.2 RBC-3.24* Hgb-9.9* Hct-31.9*
MCV-99* MCH-30.6 MCHC-31.0 RDW-21.8* Plt Ct-245
[**2108-7-5**] 04:25AM BLOOD WBC-11.3* RBC-3.13* Hgb-9.5* Hct-28.3*
MCV-90 MCH-30.5 MCHC-33.7 RDW-20.6* Plt Ct-244
[**2108-7-1**] 04:00PM BLOOD WBC-24.5* RBC-3.67* Hgb-12.5 Hct-36.0
MCV-98 MCH-34.1* MCHC-34.8 RDW-21.1* Plt Ct-263

[**2108-7-5**] 04:25AM BLOOD Plt Ct-244
[**2108-7-1**] 04:00PM BLOOD Plt Ct-263

[**2108-7-15**] 06:45AM BLOOD Glucose-84 UreaN-18 Creat-0.7 Na-138
K-4.3 Cl-102 HCO3-27 AnGap-13
[**2108-7-5**] 04:25AM BLOOD Glucose-114* UreaN-17 Creat-0.6 Na-139
K-3.8 Cl-106 HCO3-25 AnGap-12
[**2108-7-1**] 02:38PM BLOOD Glucose-160* UreaN-18 Creat-0.6 Na-140
K-3.5 Cl-107 HCO3-21* AnGap-16

[**2108-7-11**] 06:55AM BLOOD Calcium-8.3* Phos-3.4 Mg-2.1
[**2108-7-5**] 04:25AM BLOOD Calcium-8.1* Phos-1.4* Mg-2.3
[**2108-7-1**] 09:45PM BLOOD Calcium-7.9* Phos-3.5 Mg-1.9

[**2108-7-12**] 07:00AM BLOOD CK(CPK)-23*
[**2108-7-12**] 07:00AM BLOOD CK-MB-3 cTropnT-<0.01
[**2108-7-2**] 12:49AM BLOOD CK(CPK)-231*
[**2108-7-1**] 02:38PM BLOOD CK(CPK)-116

=========================
[**2108-7-3**] Shoulder X-Ray:
FINDINGS: Again seen are comminuted fractures of the left
humeral head and neck with medial displacement of the humeral
diaphysis. Alignment is not significantly changed since the
previous radiograph. The acromioclavicular joint is intact.
There has been placement of staples overlying the anterolateral
left chest.
IMPRESSION:
Comminuted fractures of the proximal left humerus, not
significantly changed.
.
[**2108-7-1**] Shoulder X-ray:
LEFT HUMERUS, PORTABLE FRONTAL VIEW: The severely comminuted
fracture of the humeral head and neck, with marked medial
displacement of the humeral shaft is unchanged.
IMPRESSION: Comminuted fracture of the left humeral head and
neck. Please
refer to subsequent CT for additional details.
.
[**2108-7-1**] CTA OF THE LEFT SHOULDER AND PROXIMAL HUMERUS:
Comparison is made with a left humeral radiograph from earlier
the same day.

FINDINGS: There is a comminuted fracture of the left humeral
head and neck with dislocation of the left humeral head
fragments from the glenoid fossa. The distal shaft of the
humerus is medially and posteriorly displaced. There is
extensive surrounding hematoma. The left AC joint appears well
aligned. No additional fractures are seen.

In the included portion of the left lung, hypoventilatory
changes are noted without frank consolidation or effusion. The
heart is enlarged, though incompletely imaged. There is no
pneumothorax or rib fracture. The scapula appears intact.
CTA: The subclavian artery and proximal segment of the left
axillary artery appear widely patent and normal in course and
caliber. There is a truncated appearance of the distal aspect of
the left axillary artery at the level just distal to the origin
of the posterior circumflex humeral artery. Distal to this
point, the left brachial artery is thrombosed. There is a small
collateral vessel along the medial left humerus, which is
contrast-filled and this likely represents the ulnar collateral
artery. There is no extravascular pooling of contrast to
indicate active extravasation.
IMPRESSION:
1. Thrombosis of the left brachial artery at the level just
distal to the origin of the posterior circumflex humeral artery.

2. Comminuted fracture of the left humeral head with associated
dislocation.
.
[**2108-7-5**] CHEST (PORTABLE AP)
The right subclavian line tip is at the right atrium and should
be pulled back for about 2 cm to secure its position at the
cavoatrial junction or low SVC. Cardiomediastinal silhouette is
unchanged. There are no areas of consolidation worrisome for
interval development of pneumonia. Minimal opacity at the left
lung base is unchanged and most likely representing area of
atelectasis. There is no appreciable pleural effusion or
peumothorax.
The patient is after recent surgery of the left arm, most likely
related to left humerus fracture. Enchondroma of the right
humeral head is noted.
IMPRESSION: The right subclavian line tip is in the proximal
right atrium and should be pulled back for about 2 cm. Known
left humerus fracture.
Enchondroma of the right humerus.
.
[**2108-7-17**] CXR:
As compared to the previous radiograph, the image quality is
improved. There is no evidence of right-sided pneumothorax after
pacemaker implantation. No evidence of overhydration, no pleural
effusions. Unremarkable course of the pacemaker leads. Normal
size of the cardiac silhouette. Known bilateral shoulder
pathologies.

========================
TTE [**2108-7-6**]: The left atrium is mildly dilated. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal(LVEF >55%). Right ventricular chamber size
and free wall motion are normal. The diameters of aorta at the
sinus, ascending and arch levels are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen. There is mild pulmonary artery
systolic hypertension. There is no pericardial effusion.

IMPRESSION: No structural cardiac cause of syncope identified.
Normal global and regional biventricular systolic function. Mild
pulmonary hypertension.


Brief Hospital Course:
87yo woman was admitted after fall with humerus fracture.
.
# L Humeral Fracture: Patient was Transfered from [**Hospital1 18**] [**Location (un) 620**]
after unwitnessed fall. She underwent Left axillary to brachial
artery bypass with reversed right greater saphenous vein by
vascular surgery and open reduction left proximal humerus
fracture with manipulation by orthopedics. The patient has
almost no motor function of the left hand and arm below the
biceps and very limited sensation post-fall and
post-operatively, though the hand is now well perfused with a
good pulse. Patient's pain was very well controlled with
standing tylenol 1000mg TID. Mrs. [**Known lastname 82945**] needs to keep her
followup appointments with the Orthopedic and Vascular surgeons.
 She will also be followed by occupational therapy at acute
rehab.
.
# Tachy-Brady Syndrome: Patient was found to be in afib on
arrival to ED and preop. Because of persistent afib, patient was
transferred to cardiology service on [**7-5**] for better management
of her arrythmia. Metoprolol and ASA were started. Electrolytes
repleted and pain controlled prior to transfer. Upon transfer,
she was given separate trials of PO diltiazem and metoprolol for
rate control, which were both unsuccessful. Her rate initially
had to be controlled on a diltiazem drip; when the diltiazem
drip was used in combination with oral nodal agents, there were
apparent attempts to self-cardiovert with conversion pauses of 2
to 3 seconds and brief episodes of sinus bradycardia in the 30s.
After consultation with the Electrophysiology service,
amiodarone was started; once loaded, the amiodarone appeared to
significantly help control rhythm.  During the first couple of
days, she had conversion pauses lasting up to 4.7 seconds;
however, the patient was soon mostly controlled in sinus
bradycardia with rate in the 50s with frequent PACs and PVCs.
She did have multiple brief episodes of atrial fibrillation into
the 120s-140s, but these were easily controlled with 5mg IV
metoprolol; the IV metoprolol would slow her rate down enough to
allow it to convert itself back to sinus bradycardia.  Due to
the lability of the patient's rate and rhythm, a pacemaker was
placed on [**7-16**]. The pacemaker was not placed until the urinary
tract infection had completely cleared. Since the pacemaker was
placed, patient continued to go into afib episodically, so PO
metoprolol dose was gradually increased. On discharge to acute
rehab, patient's PO metoprolol was at 50mg TID with good blood
pressure. In the discharge instruction, the rehab was informed
that the dose can be increased to 75mg TID if blood pressure
tolerates the higher dose.
.
# Urinary Tract Infection: Mrs. [**Known lastname 82945**] was found to have a
positive urine analysis and treated accordingly with
cephalosporins.  Sulfa drugs were avoided due to a reported
allergy; fluoroquinolones were avoided because the patient had a
prolonged QT initially. She was treated for 14 days for a
complicated UTI; the pacemaker was placed after finishing a full
10 days of antibiotics. The urinary tract infection was likely
largely contributing to the altered mental status of the patient
on admission and post-operatively.
.
# Bright Red Blood Per Rectum: The patient had 1 episode of [**12-16**]
teaspoons of bright red blood per rectum, likely from
hemorrhoids.  Her hematocrit remained stable throughout the rest
of her hospitalization, though she was typed and screened as a
precaution.  The patient appears to have a problem with
constipation, so she was given an escalated bowel regimen.  Her
colonoscopy history was unclear, and she may need a colonoscopy
as an outpatient to rule out other sources of GI bleed.
.
# Hyperlipidemia: Home statin was continued.
.
# Dementia: Patient had significant sundowning and
delirium/agitation. She was confused about where she was most of
the time, and required frequent reorientation. She was out in
[**Female First Name (un) **] chair at the Nursing Station frequently when she was more
agitated which seemed to help.
.
# Anemia: Hct was stable at 28-30, baseline not known.
.
# Anxiety/Depression: Patient was put on sertraline which
appeared to help.
.
# FEN: Patient was put on cardiac diet, she tolerated POs well.
.
Patient was on subcutaneous heparin for DVT ppx. She received
bowel regimen. She was continued on ranitidine given that it is
home med, though no clear h/o GERD. Her code was full (confirmed
with son). Her contact is son [**Name (NI) 21976**] (HCP):
[**Telephone/Fax (5) 82946**] (aware of transfer to medicine);
husband [**Name (NI) **]:  [**Telephone/Fax (1) 82947**].

Medications on Admission:
Ranitidine 150mg daily
Lorazepam 0.5mg daily
Lipitor 5mg daily
B12 1000mcg daily
MVI daily
Calcium and Vitamin D


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: 0.5 ml
Injection TID (3 times a day).
4. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
6. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day): hold for SBP<90 or HR<50.
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day): hold if loose stools.
12. Polyethylene Glycol 3350 100 % Powder Sig: One (1)  PO DAILY
(Daily) as needed for constipation.
13. Lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO Q6H
(every 6 hours) as needed for constipation.
14. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
15. Sertraline 25 mg Tablet Sig: One (1) Tablet PO once a day.
16. B-12 DOTS 500 mcg Tablet Sig: Two (2) Tablet PO once a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Primary Diagnoses:
- s/p fall
- left humeral neck fracture c/b traumatic injury to left
axillary artery
- s/p Left axillary to brachial artery bypass with reversed
right greater saphenous vein and open reduction left proximal
humerus fracture with manipulation
- Atrial Fibrillation s/p Pacemaker placement
- Urinary Tract Infection
- Delirium

Secondary diagnoses:
- Hyperlidipemia
- Dementia--has poor short term memory but is verbal and
interactive
- Anemia (baseline not known)
- Possible Myelodysplastic syndrome
- Anxiety/Depression
- Osteoarthritis


Discharge Condition:
Stable, afebrile, A-V paced. Patient occasionally goes into afib
with HR in the 150s. Patient is asymptomatic when this happens.
If this does occur, please consider giving patient 25mg PO
metoprolol.


Discharge Instructions:
It was a pleasure to be involved in your care, Mrs.
[**Known lastname 82945**]. You were admitted to [**Hospital1 1170**] after having fallen. You had orthopedic and vascular
surgery to fix your Left arm.  You have been having some trouble
moving your left arm since the fall, but an occupational
therapist will help you rehabilitate your arm in the extended
care facility.

While you were in the hospital recovering from surgery, you were
found to have an irregular heart rhythm called Atrial
Fibrillation.  This rhythm was going very fast, and we had some
difficulty controlling it; with medicines, it would go too slow,
so you underwent a procedure to get a pacemaker.

You were also found to have a Urinary Tract Infecton, for which
you were treated with antibiotics.

The following changes were made to your medications:
Lorazepam was discontinued
We added the following medications:
Aspirin 325 mg PO DAILY
Metoprolol Tartrate 50 mg PO TID
Amiodarone 200mg PO DAILY
Tylenol 1000mg TID
Sertraline 25 mg PO DAILY
Heparin 5000 units SubQ TID
TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
Ibuprofen 400 mg PO Q8H:PRN pain

Please follow the following instructions from the Vascular
Surgeons:
Division of Vascular and Endovascular Surgery
Upper Extremity Bypass Surgery Discharge Instructions

What to expect when you go home:
1. It is normal to feel tired, this will last for 4-6 weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	You may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have swelling of the arm you were operated
on:
??????	Elevate your leg above the level of your heart (use [**1-17**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	Unless you were told not to bear any weight on operative arm:
??????	You should get up every day, get dressed and walk
??????	You should gradually increase your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (unless you have stitches) no direct spray on
incision, let the soapy water run over incision, rinse and pat
dry
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks (from
[**7-6**]) for staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your arm or the
ability to feel your arm
??????	Temperature greater than 100.5F for 24 hours
??????	Bleeding, new or increased drainage from incision or white,
yellow or green drainage from incisions

Please be sure to keep all of your followup appointments.

Please seek medical attention if you begin to have dizziness,
chest pain, shortness of breath, palpitations, fevers, or if
experience anything other symptoms that concern you.

Followup Instructions:
Please keep the following appointments that have been scheduled
for you:

Orthopedic Surgery: You have a visit scheduled with Dr.
[**Last Name (STitle) **] on Thursday, [**2108-7-26**] at 9:00pm on the [**Location (un) **] of the [**Hospital Ward Name 23**] Building at [**Hospital1 18**] in [**Location (un) 86**]. Office number:
 [**Telephone/Fax (1) 1228**]. Please arrive at 8:40am to get x-ray done. If Dr.
[**Last Name (STitle) **] needs to change the date of your appointment, he will
call you directly.

You have a visit scheduled with Dr.[**Name (NI) 7446**] office on
Date/Time: [**2108-7-26**] 11:45. [**Telephone/Fax (1) 2625**]. [**Hospital Ward Name **] Office Building,
[**Doctor First Name **] 5B [**Location (un) 86**], [**Numeric Identifier 718**]

You have a visit scheduled in the Device clinic for your
pacemaker check on [**2108-8-6**] at 3pm. [**Location (un) 8661**] building, [**Location (un) 436**],
at [**Hospital1 18**].

Cardiologist:
You have a visit scheduled with Dr. [**Last Name (STitle) 29111**] [**Name (STitle) 11302**]. ([**Telephone/Fax (1) 69986**]
Wed, [**2108-8-1**].  11:00am


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 4074**]
{"Injury to axillary artery,Closed fracture of surgical neck of humerus,Atrial flutter,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Unspecified fall,Oliguria and anuria,Unspecified hemorrhoids with other complication,Anemia, unspecified,Other iatrogenic hypotension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Constipation, unspecified,Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of forehead, without mention of complication,Contusion of face, scalp, and neck except eye(s),Other specified forms of chronic ischemic heart disease"}


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: pulseless left hand

PRESENT ILLNESS: 87F s/p unwitnessed fall in driveway this morning.  Her
neighbors found her and called EMS who arrived at 9:40am.  On
the scene she was complaining of left arm pain and per EMS
report she had a palpable pulse with good capillary refill.  She
was taken to [**Hospital1 18**] [**Location (un) 620**] where she was found to have a left
humeral neck fracture.  She was transferred to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: PMH: Alzheimers dementia, falls, anxiety, hyperlipidemia,  ?htn,
depression, DJD, thrombocytopenia, Anemia, ?afib

MEDICATION ON ADMISSION: Ranitidine 150mg daily
Lorazepam 0.5mg daily
Lipitor 5mg daily
B12 1000mcg daily
MVI daily
Calcium and Vitamin D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission [**2108-7-1**]
PE: 72, 184/71, 22, 99% on NRB
HEENT: PERLA, EOMI, bilateral ecchymoses, forhead laceration
Chest: RRR, lungs clear
Abdomen: soft, nontender, nondistended, well healed
infraumbilical midline incision
Ext: bilateral LE edema
Right arm: 2+ radial pulse, motor and sensation intact
Left arm: dopplerable pulse, hand cool, insensate in radial
distribution, no motor function
Pulses: palpable femoral and DP bilaterally, palpable right
radial, dopplerable left radial

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Son is HCP [**Name (NI) 21976**] [**Telephone/Fax (1) 82944**], who lives in [**State 531**].
Lives with husband in [**Name (NI) 620**], has one son.
-Tobacco history:  smoked as teen x 4 years [**12-16**] PPD
-ETOH:  wine on holidays
-Illicit drugs:  none 

### Response:
{"Injury to axillary artery,Closed fracture of surgical neck of humerus,Atrial flutter,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Unspecified fall,Oliguria and anuria,Unspecified hemorrhoids with other complication,Anemia, unspecified,Other iatrogenic hypotension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Constipation, unspecified,Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of forehead, without mention of complication,Contusion of face, scalp, and neck except eye(s),Other specified forms of chronic ischemic heart disease"}
