CHIEF COMPLAINT: LLE wound infection, pain

PRESENT ILLNESS: 52 M with poorly controlled DM1 complicated by charot's joints,
gastroparesis, orthostatic hypotension, peripheral neuropathy,
and retinopathy with long history of multiple orthopedic
complications. He initially fractured his left midfoot in [**4-11**]
that required external fixation and closed reduction. However,
he ambulated on his leg and fractured the pins and had tibial
fracture. On [**5-12**] pin removed and had ORIF of left tibial
fracture with [**Last Name (un) 101**] plate. Again, after bearing weight on [**7-12**],
he developed a non-[**Hospital1 **] fracture of his tibia and [**Last Name (un) 101**] plate
fracture. He refused surgery and was treated conservatively. On
[**11-11**] he developed bimalleolar fracture of his left ankle which
was treated conservatively. On [**4-15**] his [**Last Name (un) 101**] plate removed, and
tibial rod and nails placed. On [**4-29**], he presented to ortho
clinic with nails exposed through skin and admitted. He had
removal of hardware on [**5-1**] with I+D of left ankle abscess.
Gram stain of abscess grew enterobacter cloacea and he has been
on zosyn for treatment.
Pt was to go back to OR on [**5-7**] for further debridement of his
left foot wounds. Of note, he had been given 4 mg ativan PO, 3
doses of 20mg oxycodone, 5mg ambien after 18:00. He was last
seen well at 03:00 AM and most recent set of floor vitals at MN
100.3 118/72 84 20 95%(RA).
At 4:20 AM [**5-7**] pt found unresponsive, diaphretic, and
pulseless by nurse and code blue called. On arrival, PEA arrest
at 20's, given 2 rounds of epi/atropine, 1 amp of NaHCO3 with
return of pulse to 140's and BP 115/p at 04:35 AM. Right femoral
line placed and pt intubated. Post intubation ABG during code
7.15/85/424, K 4.0, lactate 7.1, and glucose 343. Pt transfered
to ICU.
On arrival to ICU, a-line place and BP 130's systolic HR 70's.
Initiated on A/C 600/20 PEEP 5 FiO2 100%, ABG 7.38/44/379. CXR
(my read) c/w LLL opacity, mild chf, left rib fractures. EKG
shows sinus @ 75, L axis deviation, IVCD, and no ST/T wave
changes compared to baseline.
He was transferred to the medicine service once he became stable
after extubation.

MEDICAL HISTORY: 1. DM1 since age 18
-retinopathy - s/p laser surgery
-peripheral nerve neuropathy
-gastroparesis
2. charcots joint
3. left phrenic nerve neuropathy
4. orthostatic hypotension
5. hypercholesterolemia
6. cath 00': no CAD, EF 65%
7. breathing sleep disorder ?
8. h/o penile implant

MEDICATION ON ADMISSION: 1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
[**Hospital1 **] (2 times a day).
Disp:*60 syringes* Refills:*2*
2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Aspirin

PHYSICAL EXAM: PE  96.7 87 133/78 14 96%
A/C 600/20 (3) PEEP 5 40% PIP 38 Plat 31; 7.42/49/60
Gen: intubated, responds to painful stimuli
HEENT: pupils dilated equally bilaterally, no reflex
NECK: supple
CV: rrr, no m/r/g
PULM: cta anteriorly
ABD: obese, ventral hernia, soft
EXT: left foot in [**Hospital1 **]-valve cast; right antecub PICC c/d/i
NEURO: moves all 4 ext, responds to painful stimuli

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Social History:
Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Cardiac arrest,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Cellulitis and abscess of leg, except foot,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Pressure ulcer, heel,Polyneuropathy in diabetes,Long-term (current) use of insulin,Obesity, unspecified,Gastroparesis,Arthropathy associated with neurological disorders,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Aftercare for healing traumatic fracture of other bone,Aftercare for healing pathologic fracture of lower leg,Sleep disturbance, unspecified
React-oth int ortho dev,Cardiac arrest,DMI neuro nt st uncntrld,Cellulitis of leg,Food/vomit pneumonitis,CHF NOS,Pressure ulcer, heel,Neuropathy in diabetes,Long-term use of insulin,Obesity NOS,Gastroparesis,Arthropathy w nerve dis,Adv eff sedat/hypnot NOS,Aftrce traum fx bone NEC,Aftrcare path fx low leg,Sleep disturbance NOS
Admission Date:  [**2104-5-1**]              Discharge Date:   [**2104-5-26**]

Date of Birth:  [**2051-12-12**]             Sex:   M

Service: MEDICINE

Allergies:
Aspirin

Attending:[**First Name3 (LF) 5973**]
Chief Complaint:
LLE wound infection, pain

Major Surgical or Invasive Procedure:
LLE Incision and drainage [**2104-5-7**], wound debridement, and wound
closure [**2104-5-15**]


History of Present Illness:
52 M with poorly controlled DM1 complicated by charot's joints,
gastroparesis, orthostatic hypotension, peripheral neuropathy,
and retinopathy with long history of multiple orthopedic
complications. He initially fractured his left midfoot in [**4-11**]
that required external fixation and closed reduction. However,
he ambulated on his leg and fractured the pins and had tibial
fracture. On [**5-12**] pin removed and had ORIF of left tibial
fracture with [**Last Name (un) 101**] plate. Again, after bearing weight on [**7-12**],
he developed a non-[**Hospital1 **] fracture of his tibia and [**Last Name (un) 101**] plate
fracture. He refused surgery and was treated conservatively. On
[**11-11**] he developed bimalleolar fracture of his left ankle which
was treated conservatively. On [**4-15**] his [**Last Name (un) 101**] plate removed, and
tibial rod and nails placed. On [**4-29**], he presented to ortho
clinic with nails exposed through skin and admitted. He had
removal of hardware on [**5-1**] with I+D of left ankle abscess.
Gram stain of abscess grew enterobacter cloacea and he has been
on zosyn for treatment.
Pt was to go back to OR on [**5-7**] for further debridement of his
left foot wounds. Of note, he had been given 4 mg ativan PO, 3
doses of 20mg oxycodone, 5mg ambien after 18:00. He was last
seen well at 03:00 AM and most recent set of floor vitals at MN
100.3 118/72 84 20 95%(RA).
At 4:20 AM [**5-7**] pt found unresponsive, diaphretic, and
pulseless by nurse and code blue called. On arrival, PEA arrest
at 20's, given 2 rounds of epi/atropine, 1 amp of NaHCO3 with
return of pulse to 140's and BP 115/p at 04:35 AM. Right femoral
line placed and pt intubated. Post intubation ABG during code
7.15/85/424, K 4.0, lactate 7.1, and glucose 343. Pt transfered
to ICU.
On arrival to ICU, a-line place and BP 130's systolic HR 70's.
Initiated on A/C 600/20 PEEP 5 FiO2 100%, ABG 7.38/44/379. CXR
(my read) c/w LLL opacity, mild chf, left rib fractures. EKG
shows sinus @ 75, L axis deviation, IVCD, and no ST/T wave
changes compared to baseline.
He was transferred to the medicine service once he became stable
after extubation.


Past Medical History:
1. DM1 since age 18
-retinopathy - s/p laser surgery
-peripheral nerve neuropathy
-gastroparesis
2. charcots joint
3. left phrenic nerve neuropathy
4. orthostatic hypotension
5. hypercholesterolemia
6. cath 00': no CAD, EF 65%
7. breathing sleep disorder ?
8. h/o penile implant

Social History:
Social History:

Lives in [**Hospital1 3597**] with wife and kids. Disabled. no tob, no etoh, no
drugs


Family History:
non contributory

Physical Exam:
PE  96.7 87 133/78 14 96%
A/C 600/20 (3) PEEP 5 40% PIP 38 Plat 31; 7.42/49/60
Gen: intubated, responds to painful stimuli
HEENT: pupils dilated equally bilaterally, no reflex
NECK: supple
CV: rrr, no m/r/g
PULM: cta anteriorly
ABD: obese, ventral hernia, soft
EXT: left foot in [**Hospital1 **]-valve cast; right antecub PICC c/d/i
NEURO: moves all 4 ext, responds to painful stimuli

Pertinent Results:
[**2104-5-15**] 09:17AM BLOOD WBC-11.2*# RBC-3.65*# Hgb-10.5*#
Hct-32.1*# MCV-88 MCH-28.9 MCHC-32.8 RDW-15.3 Plt Ct-487*#
[**2104-5-16**] 12:00AM BLOOD Hct-31.6*
[**2104-5-16**] 05:41AM BLOOD WBC-11.1* RBC-3.55* Hgb-10.0* Hct-31.1*
MCV-88 MCH-28.3 MCHC-32.2 RDW-14.6 Plt Ct-565*
[**2104-5-17**] 05:16AM BLOOD WBC-10.0 RBC-3.90* Hgb-10.8* Hct-33.9*
MCV-87 MCH-27.8 MCHC-32.0 RDW-15.0 Plt Ct-624*
[**2104-5-18**] 05:02AM BLOOD WBC-9.1 RBC-3.80* Hgb-10.9* Hct-33.3*
MCV-88 MCH-28.6 MCHC-32.7 RDW-15.0 Plt Ct-561*
[**2104-5-19**] 05:35AM BLOOD WBC-10.5 RBC-3.77* Hgb-10.7* Hct-32.8*
MCV-87 MCH-28.5 MCHC-32.7 RDW-15.1 Plt Ct-550*
[**2104-5-13**] 05:25AM BLOOD Glucose-102 UreaN-14 Creat-0.8 Na-135
K-4.1 Cl-95* HCO3-30 AnGap-14
[**2104-5-14**] 05:20AM BLOOD Glucose-222* UreaN-15 Creat-0.7 Na-133
K-4.1 Cl-94* HCO3-33* AnGap-10
[**2104-5-15**] 05:06AM BLOOD Glucose-193* UreaN-15 Creat-0.8 Na-136
K-4.4 Cl-96 HCO3-33* AnGap-11
[**2104-5-16**] 05:41AM BLOOD Glucose-82 UreaN-17 Creat-0.7 Na-138
K-4.3 Cl-97 HCO3-34* AnGap-11
[**2104-5-17**] 05:16AM BLOOD Glucose-140* UreaN-17 Creat-0.7 Na-137
K-4.2 Cl-95* HCO3-33* AnGap-13
[**2104-5-18**] 05:02AM BLOOD Glucose-99 UreaN-20 Creat-0.8 Na-136
K-4.1 Cl-96 HCO3-32 AnGap-12
[**2104-5-19**] 05:35AM BLOOD Glucose-206* UreaN-20 Creat-0.8 Na-135
K-4.5 Cl-97 HCO3-31 AnGap-12
[**2104-5-8**] 10:12AM BLOOD %HbA1c-7.3*

Brief Hospital Course:
52 year old man with poorly controlled DM1 and peripheral
neuropathy complicated by multiple orthopedic fractures and
infections s/p PEA arrest and wound debridement/closure.
.
# PEA arrest - Differential diagnosis was broad but most likely
etiologies were PE, medication overdose, hypoxia. His body
habitus and multiple medications preclude him to hypoventilation
and hypoxia. His initial acidosis was likely secondary to
hemodynamic collapse and hypoventilation. MI, tamponade, blood
loss, sepsis, hyperkalemia were less likely etiologies. The
patient did not require any pressors and was in fact
hypertensive to the 200s on admission to the ICU on propofol
gtt. His cardiac enzymes were mildly elevated but felt to be
secondary to demand, there were no EKG changes. A stat echo was
performed in the MICU on [**5-6**] which showed no effuson/tamponade.
EF 55-60%. The echo had suboptimal windows given large habitus
so focal wall motion could not be excluded. CTA was negative for
PE but showed bilateral pulmonary infiltrates likely due to
aspiration. His head CT was negative. Ultrasounds of his lower
extremities were negative from venous thromboembolism. His EEG
was negative for seizure activity but showed slow disorganized
background and generalized slowing consistent with metabolic
disorder. Therefore, most likely, his PEA arrest was secondary
to hypoxic/hypercarbic resp distress from oversedation with
narcotics and benzos. Since then, the amount of narcotics the
patient has been receiving has been monitored closely and was
slowly titrated up for optimal pain control.
.
# ID - Notable for growth of Enterobacter from his LLE wound,
pan-sensitive to all abx. Other cx, including blood, stool and
urine have all been NGTD. He did have 1+ GPC in the sputum,
likely [**1-10**] aspiration PNA. He was on IV Zosyn for 2 weeks, and
was recently switched to po Cipro/Flagyl to cover his LLE
infection and ?aspiration PNA given his persistent left lower
lobe consolidation on CXR. He needs to remain on these abx for
6-8 weeks, and will f/u with ID on [**2104-5-28**]. He will need labs
checked and faxed to [**Hospital **] clinic as specified in the d/c
instructions. Currently, no other source of infection has been
indentified. Depending on how his LLE infection responds to abx
and then off abx for at least 4 weeks, amputation is a likely
possiblity if he does not clear the infection. Pt will follow
with Dr. [**Last Name (STitle) 1005**] in [**Hospital 1957**] clinic.
.
# Respiratory failure
His respiratory failure was likely due to excess fluid overload
or hypoventilation secondary to overmedication with narcotics
and OSA. After the patient was extubated and transferred to the
medicine floor, we very cautiously titrated up his narcotics and
continued to monitor his respiratory rate. We continued to
diurese him with Lasix as needed. His respiratory status has
been stable for several days and he has not required any
supplemental oxygen in the last few days.
.
# Delta MS
It remains unclear how long patient was unresponsive and
duration of hypoxic brain injury. He appeared to have fixed and
dilated pupils in ICU with a question of increased tone and
dystonic movement. Therefore, an EEG was performed on [**2104-5-7**]
which showed diffuse slow waves with no epileptiform movement.
No paralytics were given during code. The patient's mental
status improved post extubation. The patient pulled his left
subclavian central line on arrival to the medicine floor but
showed no signs of confusion or delirium. He remained alert and
oriented x3 for the remainder of his hospitalization, and was
back to his baseline status.
.
# DM ??????
An insulin gtt was initiated on admission to the ICU. On arrival
to the medicine floor, the patient??????s blood glucose was poorly
controlled at first but patient was followed by [**Last Name (un) **] and with
the appropriate amounts of fixed and regular insulin, he was
much better controlled during the second half of his
hospitalization. His blood glucose was monitored QACHS by finger
sticks and he remained on a diabetic diet when not NPO. He
should be maintained on his current insulin regimen as specified
in the d/c meds.
.
# Tachypnea:
The patient became tachypneic on a couple of occasions. It was
likely due to fluid overload, pneumonia, or reactive
airways/bronchospasm. He responded well to albuterol nebs and
diuresis. The last episode of tachypnea was due to anxiety about
going to the OR. Patient reported being extremely anxious and
responded to a small amount of Ativan. He did not experience
tachypnea for the last 4-5 days of hospitalization after going
to the OR.
.
#Fever/hypoxia:
The patient had low-grade fevers during his hospitalization with
no growth on blood and urine cultures, negative UA's, and
unchanged CXRs. His fever was likely due to his LE infections or
aspiration pna given his persistent CXR opacities. He has been
afebrile for the last 1 1/2 weeks of his hospital course.
.
# HTN
The patient remained on lopressor 75 mg TID, captopril was added
for better control. He responded well and his SBPs were in the
110s to 130s prior to discharge.
.
#. FEN -
His electrolytes were repleted as needed. When not NPO, he
remained on a low sodium, heart healthy, diabetic diet. He
tolerated POs well.
.
# . Prophylaxis
-patient remained on Lovenox throughout his hospital course

#. Code - FULL CODE

#. Communication - wife, [**Name (NI) **] [**Name (NI) 4318**] [**Telephone/Fax (1) 24959**];
[**Telephone/Fax (1) 24960**]


Medications on Admission:
1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
[**Hospital1 **] (2 times a day).
Disp:*60 syringes* Refills:*2*
2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


3. Becaplermin 0.01 % Gel Sig: One (1) Appl Topical  DAILY
(Daily).
Disp:*1 tube* Refills:*2*
4. Oxycodone 20 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours) for 2
weeks.
Disp:*28 Tablet Sustained Release 12HR(s)* Refills:*0*
5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)

as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Medications:
1. Outpatient Lab Work
Check CBC, ESR, CRP, BUN, and Cr in one week ([**2104-5-23**]) and fax
results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 1419**].
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
Disp:*60 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
every six (6) hours as needed for shortness of breath or
wheezing.
Disp:*30 nebs* Refills:*2*
5. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
Disp:*30 nebs* Refills:*0*
6. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*2*
7. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
Disp:*60 ML(s)* Refills:*0*
8. Tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q8-10H () as needed.
Disp:*20 Tablet(s)* Refills:*0*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
11. Desipramine 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
12. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*250 ML(s)* Refills:*0*
13. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
14. Enoxaparin 30 mg/0.3 mL Syringe Sig: 30 mg  Subcutaneous
Q12H (every 12 hours).
Disp:*qs mg* Refills:*2*
15. Ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q12H
(every 12 hours).
Disp:*180 Tablet(s)* Refills:*2*
16. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*2*
17. Insulin Glargine 100 unit/mL Solution Sig: Twenty Six (26)
units insulin Subcutaneous at bedtime.
Disp:*qs units insulin* Refills:*2*
18. Insulin Regular Human 100 unit/mL Solution Sig: Six (6)
units insulin Injection QAC.
Disp:*QS Units insulin* Refills:*2*
19. Insulin Lispro (Human) 100 unit/mL Solution Sig: Per Sliding
Scale Units insulin Subcutaneous QACHS.
Disp:*QS Units insulin* Refills:*2*
20. Insulin
Please see attached insulin regimen sheet.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Medical Center - [**Hospital1 3597**]

Discharge Diagnosis:
Primary: LLE non [**Hospital1 **] left ankle fracture and wound infection;
s/p PEA arrest
Secondary: Right heel pressure ulcer, IDDM c/b retinopathy,
peripheral neuropathym gastroparesis, HTN, HL


Discharge Condition:
stable, afebrile


Discharge Instructions:
-Take discharge medication as instructed
-Keep wounds dry and clean
-Go to emergency room if temperature greater than 101 or if
purulent drainage occurs from wound
-No weight bearing on left foot
-Please follow up with appointments as listed below

Followup Instructions:
Appointments:

Provider: [**First Name11 (Name Pattern1) 3210**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], DPM Phone:[**Telephone/Fax (1) 543**]
Date/Time:[**2104-5-20**] 11:30
Provider: [**First Name11 (Name Pattern1) 1037**] [**Last Name (NamePattern4) 2335**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2104-5-28**] 9:30



Completed by:[**2104-5-26**]
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Cardiac arrest,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Cellulitis and abscess of leg, except foot,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Pressure ulcer, heel,Polyneuropathy in diabetes,Long-term (current) use of insulin,Obesity, unspecified,Gastroparesis,Arthropathy associated with neurological disorders,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Aftercare for healing traumatic fracture of other bone,Aftercare for healing pathologic fracture of lower leg,Sleep disturbance, unspecified'}


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: LLE wound infection, pain

PRESENT ILLNESS: 52 M with poorly controlled DM1 complicated by charot's joints,
gastroparesis, orthostatic hypotension, peripheral neuropathy,
and retinopathy with long history of multiple orthopedic
complications. He initially fractured his left midfoot in [**4-11**]
that required external fixation and closed reduction. However,
he ambulated on his leg and fractured the pins and had tibial
fracture. On [**5-12**] pin removed and had ORIF of left tibial
fracture with [**Last Name (un) 101**] plate. Again, after bearing weight on [**7-12**],
he developed a non-[**Hospital1 **] fracture of his tibia and [**Last Name (un) 101**] plate
fracture. He refused surgery and was treated conservatively. On
[**11-11**] he developed bimalleolar fracture of his left ankle which
was treated conservatively. On [**4-15**] his [**Last Name (un) 101**] plate removed, and
tibial rod and nails placed. On [**4-29**], he presented to ortho
clinic with nails exposed through skin and admitted. He had
removal of hardware on [**5-1**] with I+D of left ankle abscess.
Gram stain of abscess grew enterobacter cloacea and he has been
on zosyn for treatment.
Pt was to go back to OR on [**5-7**] for further debridement of his
left foot wounds. Of note, he had been given 4 mg ativan PO, 3
doses of 20mg oxycodone, 5mg ambien after 18:00. He was last
seen well at 03:00 AM and most recent set of floor vitals at MN
100.3 118/72 84 20 95%(RA).
At 4:20 AM [**5-7**] pt found unresponsive, diaphretic, and
pulseless by nurse and code blue called. On arrival, PEA arrest
at 20's, given 2 rounds of epi/atropine, 1 amp of NaHCO3 with
return of pulse to 140's and BP 115/p at 04:35 AM. Right femoral
line placed and pt intubated. Post intubation ABG during code
7.15/85/424, K 4.0, lactate 7.1, and glucose 343. Pt transfered
to ICU.
On arrival to ICU, a-line place and BP 130's systolic HR 70's.
Initiated on A/C 600/20 PEEP 5 FiO2 100%, ABG 7.38/44/379. CXR
(my read) c/w LLL opacity, mild chf, left rib fractures. EKG
shows sinus @ 75, L axis deviation, IVCD, and no ST/T wave
changes compared to baseline.
He was transferred to the medicine service once he became stable
after extubation.

MEDICAL HISTORY: 1. DM1 since age 18
-retinopathy - s/p laser surgery
-peripheral nerve neuropathy
-gastroparesis
2. charcots joint
3. left phrenic nerve neuropathy
4. orthostatic hypotension
5. hypercholesterolemia
6. cath 00': no CAD, EF 65%
7. breathing sleep disorder ?
8. h/o penile implant

MEDICATION ON ADMISSION: 1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
[**Hospital1 **] (2 times a day).
Disp:*60 syringes* Refills:*2*
2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Aspirin

PHYSICAL EXAM: PE  96.7 87 133/78 14 96%
A/C 600/20 (3) PEEP 5 40% PIP 38 Plat 31; 7.42/49/60
Gen: intubated, responds to painful stimuli
HEENT: pupils dilated equally bilaterally, no reflex
NECK: supple
CV: rrr, no m/r/g
PULM: cta anteriorly
ABD: obese, ventral hernia, soft
EXT: left foot in [**Hospital1 **]-valve cast; right antecub PICC c/d/i
NEURO: moves all 4 ext, responds to painful stimuli

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Social History: 

### Response:
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Cardiac arrest,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Cellulitis and abscess of leg, except foot,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Pressure ulcer, heel,Polyneuropathy in diabetes,Long-term (current) use of insulin,Obesity, unspecified,Gastroparesis,Arthropathy associated with neurological disorders,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Aftercare for healing traumatic fracture of other bone,Aftercare for healing pathologic fracture of lower leg,Sleep disturbance, unspecified'}
