CHIEF COMPLAINT: respiratory failure/tylenol OD

PRESENT ILLNESS: This is a 51 y/o female with PMH significant for HTN, NIDDM,
hypothyroidism, who presented to an OSH early this morning with
URI sx and cough x 2 weeks. Per the patient's husband, and later
verified by the patient, she had been having URI sx and a
non-productive cough for 2 weeks and occasionally low-grade
temperature. She saw [**Name8 (MD) **] NP recently, who recommended OTC meds
and also prescribed a "cough medicine", the name of which is not
known. Her symptoms did not improve however and her cough
progressed with symptoms of respiratory distress as well,
prompting her to present at an OSH early this AM around 3 am. At
the OSH, she was noted to be tachypneic in moderate distress,
with VS of T 97.7, HR 77, BP 120's systolic, RR 26, SaO2 91%/RA.
Her labs there was significant for WBC 17, Hct 31, tylenol level
of 70 (at 4:40 am), Na 115 and ABG of 7.4/28/48 on ?room air.
She received 400 mg moxifloxacin there, 125 mg IV solumedrol x
1, unknown dose of lasix, and a loading dose of IV NAC (10.5
gm).
.
Upon further history, the husband states that the patient has
been taking NyQuil frequently due to her symptoms, however he is
not sure how much she was taking as he is at work most of the
day when she is at home. He notes that he thinks she finished an
entire bottle of NyQuil on Friday (300 mL) and another half a
bottle on Saturday (150 mL). It is unknown what formulation of
NyQuil this was. He also does not know whether she was taking
other cough/URI medications containing tylenol. Patient has a
history of depression, however the husband denies any prior SI
and does not believe the patient was trying to hurt herself with
the NyQuil.
.
The patient was transferred to the [**Hospital1 18**] ED at 7 am due to lack
of ICU beds at the OSH. Initial VS were T afebrile, BP 120's, HR
80's, 95%/4 L. The patient was in moderate resp distress with
somnolent MS, so was electively intubated and set at AC 450x16,
PEEP 5, FiO2 100%. An ABG was unable to be obtained prior to
intubation. Tylenol level in the ED at 7:30 am was 45 (3 hours
later from the initial level). She received vancomycin and
doxycycline in the ED for CAP/ca-MRSA coverage. The patient was
sent to the MICU for further management. Upon arrival, her ABG
was 7.23/65/400's on the initial vent settings, so her RR was
increased and TV was decreased. IV NAC was also started.
.
ROS unable to be obtained at this time.

MEDICAL HISTORY: PMH (per husband) -
DM II
Hypothyroidism
HTN
Asthma
Depression
h/o Diverticulitis

MEDICATION ON ADMISSION: (doses confirmed with the husband)
Levothyroxine 50 mcg daily
Singulair 10 mg po daily
Atenolol 25 mg daily
Lorazepam 2 mg PO QID prn (taking at least 3x/day)
Metformin 500 mg [**Hospital1 **]
Effexor XR 225 mg daily

ALLERGIES: Codeine

PHYSICAL EXAM: VS: Tc 96.6, BP 111/59, HR 70, RR 24, SaO2 95% on AC
350x30/0.6/5
General: intubated, sedated female
HEENT: Pupils pinpoint and minimally reactive. Anicteric
sclerae. ETT in place.
Neck: supple, no JVD
Chest: diffuse rhonchi throughout, no wheezes
CV: RRR distant, no m/g/r
Abd: soft, NT/ND, NABS, no HSM
Ext: 1+ pitting pedal edema
Neuro: sedated, does not withdraw to pain

FAMILY HISTORY: FH - NC

SOCIAL HISTORY: SH - Lives with her husband and son in [**Name (NI) **]. Does not work.
Smokes 1 ppd x >20 years. Drinks approx 6 beers/week. Admits
cocaine use, which was positive on tox screen at time of
admission.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Other ascites,Hyposmolality and/or hyponatremia,Poisoning by aromatic analgesics, not elsewhere classified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Benign essential hypertension,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder
Acute respiratry failure,Food/vomit pneumonitis,Toxic encephalopathy,Delirium d/t other cond,Ascites NEC,Hyposmolality,Pois-arom analgesics NEC,Acc poison-arom analgesc,Benign hypertension,Cocaine abuse-unspec,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Hypothyroidism NOS,DMII wo cmp nt st uncntr,Dysthymic disorder
Admission Date:  [**2174-11-13**]              Discharge Date:   [**2174-11-27**]

Date of Birth:  [**2123-8-16**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
respiratory failure/tylenol OD

Major Surgical or Invasive Procedure:
Endotracheal intubation
arterial line

History of Present Illness:
This is a 51 y/o female with PMH significant for HTN, NIDDM,
hypothyroidism, who presented to an OSH early this morning with
URI sx and cough x 2 weeks. Per the patient's husband, and later
verified by the patient, she had been having URI sx and a
non-productive cough for 2 weeks and occasionally low-grade
temperature. She saw [**Name8 (MD) **] NP recently, who recommended OTC meds
and also prescribed a "cough medicine", the name of which is not
known. Her symptoms did not improve however and her cough
progressed with symptoms of respiratory distress as well,
prompting her to present at an OSH early this AM around 3 am. At
the OSH, she was noted to be tachypneic in moderate distress,
with VS of T 97.7, HR 77, BP 120's systolic, RR 26, SaO2 91%/RA.
Her labs there was significant for WBC 17, Hct 31, tylenol level
of 70 (at 4:40 am), Na 115 and ABG of 7.4/28/48 on ?room air.
She received 400 mg moxifloxacin there, 125 mg IV solumedrol x
1, unknown dose of lasix, and a loading dose of IV NAC (10.5
gm).
.
Upon further history, the husband states that the patient has
been taking NyQuil frequently due to her symptoms, however he is
not sure how much she was taking as he is at work most of the
day when she is at home. He notes that he thinks she finished an
entire bottle of NyQuil on Friday (300 mL) and another half a
bottle on Saturday (150 mL). It is unknown what formulation of
NyQuil this was. He also does not know whether she was taking
other cough/URI medications containing tylenol. Patient has a
history of depression, however the husband denies any prior SI
and does not believe the patient was trying to hurt herself with
the NyQuil.
.
The patient was transferred to the [**Hospital1 18**] ED at 7 am due to lack
of ICU beds at the OSH. Initial VS were T afebrile, BP 120's, HR
80's, 95%/4 L. The patient was in moderate resp distress with
somnolent MS, so was electively intubated and set at AC 450x16,
PEEP 5, FiO2 100%. An ABG was unable to be obtained prior to
intubation. Tylenol level in the ED at 7:30 am was 45 (3 hours
later from the initial level). She received vancomycin and
doxycycline in the ED for CAP/ca-MRSA coverage. The patient was
sent to the MICU for further management. Upon arrival, her ABG
was 7.23/65/400's on the initial vent settings, so her RR was
increased and TV was decreased. IV NAC was also started.
.
ROS unable to be obtained at this time.


Past Medical History:
PMH (per husband) -
DM II
Hypothyroidism
HTN
Asthma
Depression
h/o Diverticulitis


Social History:
SH - Lives with her husband and son in [**Name (NI) **]. Does not work.
Smokes 1 ppd x >20 years. Drinks approx 6 beers/week. Admits
cocaine use, which was positive on tox screen at time of
admission.

Family History:
FH - NC

Physical Exam:
VS: Tc 96.6, BP 111/59, HR 70, RR 24, SaO2 95% on AC
350x30/0.6/5
General: intubated, sedated female
HEENT: Pupils pinpoint and minimally reactive. Anicteric
sclerae. ETT in place.
Neck: supple, no JVD
Chest: diffuse rhonchi throughout, no wheezes
CV: RRR distant, no m/g/r
Abd: soft, NT/ND, NABS, no HSM
Ext: 1+ pitting pedal edema
Neuro: sedated, does not withdraw to pain


Pertinent Results:
[**11-13**] EKG - NSR at 70 bpm, normal intervals and axis. No
ischemic changes noted. Compared to OSH EKG [**2174-11-13**]. No prior
available for comparison.
.
[**2174-11-13**] BLOOD WBC-15.7* RBC-4.45 Hgb-11.0* Hct-34.5* MCV-78*
MCH-24.7* MCHC-31.7 RDW-20.4* Plt Ct-245
Neuts-93.4* Bands-0 Lymphs-3.4* Monos-2.5 Eos-0.6 Baso-0
PT-21.3* PTT-33.0 INR(PT)-2.0*
Glucose-108* UreaN-9 Creat-0.4 Na-118* K-4.2 Cl-83* HCO3-23
AnGap-16
ALT-25 AST-74* AlkPhos-150* Amylase-16 TotBili-2.1*
DirBili-1.1* Lipase-18
Calcium-7.6* Phos-4.9* Mg-1.5*
Albumin-2.2*
Ammonia-41
TSH-0.44
HBsAg-NEGATIVE HBsAb-POSITIVE HBcAb-POSITIVE IgM HAV-NEGATIVE
HCV Ab-POSITIVE
AMA-NEGATIVE Smooth-NEGATIVE
[**Doctor First Name **]-NEGATIVE
AFP-1.7
IgG-2070* IgA-272 IgM-392*
BLOOD ASA-NEG Ethanol-NEG Acetmnp-45.6* Bnzodzp-NEG Barbitr-NEG
Tricycl-NEG
.
[**2174-11-13**] BLOOD pO2-413* pCO2-65* pH-7.23* calTCO2-29 Base XS--1
[**2174-11-13**] URINE bnzodzp-POS barbitr-NEG opiates-NEG cocaine-POS
amphetm-NEG mthdone-NEG
.
[**2174-11-23**] BLOOD WBC-8.3 RBC-3.71* Hgb-9.2* Hct-29.9* MCV-81*
MCH-24.7* MCHC-30.7* RDW-22.2* Plt Ct-136*
PT-16.9* PTT-34.4 INR(PT)-1.5*
Glucose-160* UreaN-11 Creat-0.5 Na-135 K-3.8 Cl-99 HCO3-34*
AnGap-6*
ALT-61* AST-154* AlkPhos-204* TotBili-1.6*
Calcium-7.9* Phos-3.3 Mg-1.8
.
[**2174-11-13**] URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015
Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-TR
Bilirub-NEG Urobiln-0.2 pH-7.0 Leuks-NEG
RBC-0 WBC-0-2 Bacteri-NONE Yeast-NONE Epi-0-2
Urine Osmolal-395
.
HCV VIRAL LOAD (Final [**2174-11-21**]):
      1,490,000 IU/mL.
.
HCV GENOTYPE (Final [**2174-11-23**]):
      Hepatitis C genotype,  1.
.
[**2174-11-13**] CXR:
FINDINGS:  A single AP upright view of the chest is lordotic.
The lateral
aspect of the right costophrenic angle is excluded from the
film.  The cardiac silhouette appears normal in size.  There is
significant prominence of the interstitial markings bilaterally.
 There are ill-defined fluffy airspace opacities throughout both
lung fields. Fullness at the hila bilaterally could represent an
element of pulmonary edema.  There is significant scoliosis of
the thoracic spine.
IMPRESSION:  Findings consistent with a diffuse bilateral,
multifocal airspace process, such as ARDS or multifocal
pneumonia.  Component of interstitial edema is likely.
.
[**2174-11-13**] RUQ U/S:
RIGHT UPPER QUADRANT ULTRASOUND: The liver is heterogeneous in
echotexture and shrunken with a nodular contour, consistent with
cirrhosis.  A subcentimeter simple cyst is noted within the
hepatic dome.  Additionally, within the right lobe, there is a
subtle, ill-defined hypoechoic lesion measuring 1.7 x 2.8 x 2.6
cm. Remaining liver appears unremarkable.  The gallbladder
displays evidence of cholelithiasis, along with mild-to-moderate
wall thickening and wall edema. A moderate amount of ascites is
noted surrounding the liver and within the lower quadrants
bilaterally.
DOPPLER ULTRASOUND:  Portal vein is patent with normal
hepatopetal flow.
Hepatic venous and arterial systems display appropriate
waveforms with a
slightly increased resistive indices noted within the main
hepatic artery,
likely related to underlying parenchymal disease.  Common bile
duct is normal measuring approximately 0.35 and 0.5 cm. No
intrahepatic ductal dilatation is identified.
IMPRESSION:
1.  Shrunken and nodular liver, consistent with cirrhosis.
Cholelithiasis with wall thickening and wall edema, most likely
secondary to third spacing from underlying liver disease.
2.  Unremarkable hepatic vascular doppler ultrasound.
3.  Moderate amount of intra-abdominal ascites.
4.  Possible abnormal hypoechoic lesion within the right lobe.
This could be further assessed with dedicated MRI or
contrast-enhanced multiphasic CT.
.
[**2174-11-14**] TTE:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy with normal cavity size and systolic
function (LVEF>55%). Right ventricular chamber size and free
wall motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is no mitral valve prolapse.
The estimated pulmonary artery systolic pressure is normal.
There is no pericardial effusion.
.
IMPRESSION: Normal global and regional biventricular systolic
function. No pathologic valvular abnormality seen.
.
[**2174-11-21**] CXR:
CHEST PA AND LATERAL:  There continues to be improvement of
multifocal air
space consolidation with residual areas of opacification.
Diffuse bilateral
reticular opacities are coarser with slightly improved aeration
in the right lung base.  This could represent the beginnings of
a fibrotic repair with post-inflammatory bronchiectasis.  No
pleural effusion. Cardiomediastinal silhouette is unchanged.
IMPRESSION:  Diffuse bilateral reticular opacities with slight
improved
aeration of the right lung base, which could represent
post-inflammatory
bronchiectasis and beginnings of a fibrotic repair.

Brief Hospital Course:
# Respiratory failue - Bilateral airspace disease on CXR, most
likely secondary to community acquired PNA, +/- [**Doctor Last Name **], given
PaO2/FiO2 ratio. She was intubated and started on ABX
(vancomycin and levofloxacin).  Urine legionella was negative.
After 4 days, vancomycin was discontinued as cultures remained
negative.  She was diuresed and treated for reactive airways
with nebulizers and solumedrol.  She was extubated on day 5, and
did well.  She completed a 7 day course of levofloxacin. Oxygen
was gradually titrated down over the course of several days.
Lasix (initially lasix gtt in ICU, then 40mg IV bid, then 80 PO
BID at time of discharge) for component of pulmonary edema, with
good effect and brisk diuresis. Subsequent CXR demonstrated
improved aeration with coarsening of interstitial markings,
perhaps indicating an element of fibrotic repair. By the time of
discharge she was weaned off oxygen and able to ambulate without
shortness of breath, though still satting only in the low 90's.
She was discharged with the intent of continuing diuresis and
with close follow-up in place.
.
# Tylenol toxicity - Initially treated with NAC protocol.  After
her history became more clear, it was felt that this was an
accidental overdose. Psychiatry was consulted, who agreed there
was no evidence of intention to harm. She should be instructed
to limit her acetaminophen use in the future to 2gm/day.
.
# HCV cirrhosis - Imaging demonstrated a cirrhotic-appearing
liver on RUQ ultrasound. Subsequent workup demonstrated that
Mrs. [**Known lastname 5987**] was HCV positive, with HCV VL of 1.5 million,
genotype 1. She was previously unaware of her HCV status or
diagnosis of cirrhosis. She was HAV Ab negative, HBV sAB and cAB
positive. She did have evidence of hepatic dysfunction, with INR
between 1.5-2.0 (although component of acetaminophen toxicity
makes it difficult to assess her baseline), albumin 2.2, and
hyponatremia as below. AFP was 1.7. She was set up with an
appointment with a hepatologist near her home, Dr. [**Last Name (STitle) **], on
[**12-1**] for follow-up. An EGD was not done in-house to assess
for varices. She did have moderate ascites, and was discharged
on maintenance Lasix, though it is unclear whether she will need
to remain on this long-term. Of note, RUQ U/S also demonstrated
a 1.7 x 2.8 x 2.6 cm hypoechoic lesion in the right lobe of the
liver, which will need to be followed up as an outpatient by CT
or MRI.
.
# Hyponatremia - Markedly hyponatremic on admission to 118.
Thought to be a mixed picture at first, and in retrospect likely
complicated by concommittant cirrhosis. Urine Na was 10,
elevated urine osms of 400, FeNa 0.1%.  After a brief trial of
normal saline, which did not raise her sodium, it was thought
that she was hypervolemic, and diureseis was initiated via Lasix
drip, with good effect. After cessation of Lasix drip, her
sodium again began to drop to 130, and again responded to
maintainance Lasix IV and then PO.
.
# DM - Metformin was held while in-house.  She was initially
covered with glargine and humalog sliding scale, but did require
an insulin gtt while she was on solumedrol.  After solumedrol
was stopped, she was converted back to standing and sliding
scale insulin.
.
# Hypothyroidism - The patient was continued on home dose of
levothyroxine, 50mcg daily.
.
# HTN - Her home atenolol was held initially but restarted after
her extubation and she became hypertensive.
.
# Depression/Delerium - Effexor were held during her ICU stay
due to mild to moderate delerium, and was restarted at the time
of discharge. The patient's mental status cleared significantly
over the course of her hospital stay.
.
# F/E/N - Diabetic diet. Electrolytes were repleted as needed.
.
# Pneumoboots were used for DVT prophylaxis .
.
# Communication - With husband, [**Name (NI) **] [**Name (NI) 5987**] (c)
[**Telephone/Fax (1) 76459**]; (h) [**Telephone/Fax (1) 76460**]
.
# The patient was a full code.


Medications on Admission:
(doses confirmed with the husband)
Levothyroxine 50 mcg daily
Singulair 10 mg po daily
Atenolol 25 mg daily
Lorazepam 2 mg PO QID prn (taking at least 3x/day)
Metformin 500 mg [**Hospital1 **]
Effexor XR 225 mg daily

Discharge Medications:
1. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID prn as
needed for anxiety or back spasm.
Disp:*21 Tablet(s)* Refills:*0*
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*2 Disk with Device(s)* Refills:*2*
5. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.
6. Lasix 80 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
7. Albuterol 90 mcg/Actuation Aerosol Sig: One (1) puff
Inhalation Every 4 hours as needed for shortness of breath,
coughing or wheezing.
Disp:*1 * Refills:*2*
8. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Effexor XR 150 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO once a day.
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
-respiratory failure
-acetaminophen toxicity
-hepatitis C
-cirrhosis
-hyponatremia
-delerium
-hypothyroidism
-DM
-HTN
-depression/anxiety


Discharge Condition:
Good. Mental status improved, LFTs stable, respiratory status at
baseline.


Discharge Instructions:
-It is important that you continue to take your medications as
directed.
- Your Effexor was stopped during your hospitalization and
restarted at discharge at a lower dose.  You should discuss with
your new PCP whether this dose needs to be titrated.
-Contact your doctor or come to the Emergency Room should your
symptoms return. Also seek medical attention if you develop any
new fever, chills, trouble breathing, chest pain, nausea,
vomiting or unusual stools.

Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) 39375**], internal medicine,
[**12-12**] at 2pm. WE WOULD LIKE YOU TO SEE A DOCTOR WITHIN A
FEW DAYS AFTER DISCHARGE. IF YOU ARE NOT GOING TO SEE DR. [**Last Name (STitle) **]
ON [**2173-12-2**], PLEASE CALL DR. [**Last Name (STitle) **] AT [**0-0-**] FOR AN EARLIER
APPOINTMENT.
.
You have an appointment with Dr. [**Last Name (STitle) **] in liver clinic on [**12-1**] at 4pm. Please call [**Telephone/Fax (1) 76461**] for directions.
.
Dr. [**Last Name (STitle) 497**] of the liver department at [**Hospital1 18**] will have his office
call to schedule a follow up appointment with him in the next
[**1-1**] wks.
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Other ascites,Hyposmolality and/or hyponatremia,Poisoning by aromatic analgesics, not elsewhere classified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Benign essential hypertension,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder'}


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: respiratory failure/tylenol OD

PRESENT ILLNESS: This is a 51 y/o female with PMH significant for HTN, NIDDM,
hypothyroidism, who presented to an OSH early this morning with
URI sx and cough x 2 weeks. Per the patient's husband, and later
verified by the patient, she had been having URI sx and a
non-productive cough for 2 weeks and occasionally low-grade
temperature. She saw [**Name8 (MD) **] NP recently, who recommended OTC meds
and also prescribed a "cough medicine", the name of which is not
known. Her symptoms did not improve however and her cough
progressed with symptoms of respiratory distress as well,
prompting her to present at an OSH early this AM around 3 am. At
the OSH, she was noted to be tachypneic in moderate distress,
with VS of T 97.7, HR 77, BP 120's systolic, RR 26, SaO2 91%/RA.
Her labs there was significant for WBC 17, Hct 31, tylenol level
of 70 (at 4:40 am), Na 115 and ABG of 7.4/28/48 on ?room air.
She received 400 mg moxifloxacin there, 125 mg IV solumedrol x
1, unknown dose of lasix, and a loading dose of IV NAC (10.5
gm).
.
Upon further history, the husband states that the patient has
been taking NyQuil frequently due to her symptoms, however he is
not sure how much she was taking as he is at work most of the
day when she is at home. He notes that he thinks she finished an
entire bottle of NyQuil on Friday (300 mL) and another half a
bottle on Saturday (150 mL). It is unknown what formulation of
NyQuil this was. He also does not know whether she was taking
other cough/URI medications containing tylenol. Patient has a
history of depression, however the husband denies any prior SI
and does not believe the patient was trying to hurt herself with
the NyQuil.
.
The patient was transferred to the [**Hospital1 18**] ED at 7 am due to lack
of ICU beds at the OSH. Initial VS were T afebrile, BP 120's, HR
80's, 95%/4 L. The patient was in moderate resp distress with
somnolent MS, so was electively intubated and set at AC 450x16,
PEEP 5, FiO2 100%. An ABG was unable to be obtained prior to
intubation. Tylenol level in the ED at 7:30 am was 45 (3 hours
later from the initial level). She received vancomycin and
doxycycline in the ED for CAP/ca-MRSA coverage. The patient was
sent to the MICU for further management. Upon arrival, her ABG
was 7.23/65/400's on the initial vent settings, so her RR was
increased and TV was decreased. IV NAC was also started.
.
ROS unable to be obtained at this time.

MEDICAL HISTORY: PMH (per husband) -
DM II
Hypothyroidism
HTN
Asthma
Depression
h/o Diverticulitis

MEDICATION ON ADMISSION: (doses confirmed with the husband)
Levothyroxine 50 mcg daily
Singulair 10 mg po daily
Atenolol 25 mg daily
Lorazepam 2 mg PO QID prn (taking at least 3x/day)
Metformin 500 mg [**Hospital1 **]
Effexor XR 225 mg daily

ALLERGIES: Codeine

PHYSICAL EXAM: VS: Tc 96.6, BP 111/59, HR 70, RR 24, SaO2 95% on AC
350x30/0.6/5
General: intubated, sedated female
HEENT: Pupils pinpoint and minimally reactive. Anicteric
sclerae. ETT in place.
Neck: supple, no JVD
Chest: diffuse rhonchi throughout, no wheezes
CV: RRR distant, no m/g/r
Abd: soft, NT/ND, NABS, no HSM
Ext: 1+ pitting pedal edema
Neuro: sedated, does not withdraw to pain

FAMILY HISTORY: FH - NC

SOCIAL HISTORY: SH - Lives with her husband and son in [**Name (NI) **]. Does not work.
Smokes 1 ppd x >20 years. Drinks approx 6 beers/week. Admits
cocaine use, which was positive on tox screen at time of
admission. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Other ascites,Hyposmolality and/or hyponatremia,Poisoning by aromatic analgesics, not elsewhere classified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Benign essential hypertension,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder'}
