CHIEF COMPLAINT: Urosepsis

PRESENT ILLNESS: Mr [**Known lastname 8840**] is a 46 year-old man with a history of complex pelvic
fracture and ruptured bladder after an MVA, who presents with
fever/sepsis.
.
Recently admitted ([**4-19**] - [**4-21**]) after a 56 day hospitalization
in [**State 4565**] following an MVA complicated by open book pelvic
fracture and right T12-L5 transverse process fracture. While in
[**State 4565**], he had a cystogram and CT cystogram that showed
extraperitoneal bladder rupter to bladder neck (repaired by a
suprapubic tube). That stay was complicated by ARDS requiring
intubation. Following extubation, he developed a soft tissue
infection of his perineum involving his scrotum with subsequent
debridement and exploration for a necrotizing infection,
followed by ex-lap with diverting sigmoid colonostomy.
.
Since discharge to [**Location (un) 38**], he has been feeling improved. He
remains non-weight bearing on his right hip and has had
resulting lower extremity weakness.
.
Seen by Dr. [**Last Name (STitle) **] on [**5-3**]; the [**Location (un) 1661**]-[**Location (un) 1662**] drain was removed
at this appointment. Seen by urology on [**5-4**], after having
failed a clamping of the suprapubic tube due to penile pain. Per
Dr.[**Initials (NamePattern4) 825**] [**Last Name (NamePattern4) **] note, the SPT was unable to be extracted, felt
to be due ot calcificatoins of the balloon.
.
On the day prior to admission, he underwent OR replacement of
his SPT by urology. The tube was clamped at that time. On the
morning of admission, he started having shaking chills at rehab
and was febrile to 104. Also noted nausea and increasing dysuria
(has mild urethral dysuria at baseline). After placing foley he
reports that the pain worsened. He was transferred to the [**Hospital1 18**]
ER.
.
In the ED, initial vitals included T 102.8, HR 116, BP 141/80.
He was treated with vancomycin IV and zosyn IV. For pain,
morphine, then dilaudid were given. After his BP dropped to the
80s, a CVL was placed.
.
At the time of arrival to the MICU, he was feeling signicantly
better.

MEDICAL HISTORY: 1. History of MVA with multiple surgery:
- Open book pelvic fracture, s/p ORIC
- Prophylactic IVF filter placed
- Right T12-L5 transverse process fracture
- Extraperitoneal bladder rupter to bladder neck, s/p pelvic
binder and SPT placement
- Ex-lap with no evidence of intra-abdominal injuries
- Diverting sigmoid colonostomy
- Right gracilis flap followed by split thickness skin graft
- Multiple split-thickness skin grafts
- Reimplantation of the left testicle into a neoscrotum.
2. Fourniers gangrene
3. History of ARDS
4. GERD
5. Depression
6. History of sacroiliitis

MEDICATION ON ADMISSION: 1. Citalopram 20mg daily
2. Omeprazole 20mg daily
3. Trazodone 50mg QHS
4. Oxybutynin ER 10mg daily
5. Penazopydridine 100mg TID
6. Diazepam 5mg daily PRN muscle spasm
7. Ferrous Sulfate 325 mg TID
8. Colace 200mg [**Hospital1 **]
9. Senna
10. Bisacodyl
11. Multivitamin daily
12. Simethicone 80mg Q4H PRN
13. Ondansetron 4mg Q4H PN
14. Oxycodone 5mg Q4H PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: BP 102/55, HR 113, O2 95%
GEN: Awake, alert. Shaking chills during exam.
HEENT: Anicteric. No pallor. RIJ in place. Dry MM.
CV: Tachycardic and regular. No murmurs.
PULM: Clear.
ABD: Soft. Midline scar noted. Left sided ostomy noted with air
but without stool.
GU: 22F SPT draining yellow urine; site is slightly
erythematous; perineum without crepitus, minimal tenderness;
RECTAL (performed in ED by surgery): Normal tone. No masses. No
gross or occult blood.
EXT: Warm. No edema.
NEURO: Alert. Oriented to person, "[**Hospital1 18**]", "[**5-18**]". CNII-XII
intact. Strength 5/5 in upper extremities. RLE [**4-10**] at hip and
knee and 5-/5 at ankle.  LLE is 4-/5 at hip and 5-/5 at knee and
ankle. Patellar refexes are 1+ and equal.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Worked as a curator for city of [**Location (un) 86**]. Smoked 1ppd from age
18-40.  Drinks 2 beers per night.  Currently living at [**Hospital 38**]
Rehab.  Has a girlfriend.  Mother is medical decision maker but
not official HCP.
Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Septicemia due to pseudomonas,Sepsis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Attention to colostomy,Esophageal reflux,Late effect of fracture of spine and trunk without mention of spinal cord lesion,Late effects of motor vehicle accident,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Other urogenital trichomoniasis,Backache, unspecified,Abdominal pain, generalized,Unspecified disorder of penis,Chronic pain due to trauma
React-oth genitourin dev,Pseudomonas septicemia,Sepsis,Urin tract infection NOS,Pneumonia, organism NOS,Abn react-external stoma,Atten to colostomy,Esophageal reflux,Late eff spine/trunk fx,Late eff motor vehic acc,Depressive disorder NEC,Iron defic anemia NOS,Urogenital trichomon NEC,Backache NOS,Abdmnal pain generalized,Disorder of penis NOS,Chronc pain d/t trauma
Admission Date:  [**2101-5-18**]              Discharge Date:   [**2101-6-1**]

Date of Birth:  [**2055-4-3**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Urosepsis

Major Surgical or Invasive Procedure:
right internal jugular line placement
PICC line placement
takedown colostomy [**2101-5-27**]

History of Present Illness:
Mr [**Known lastname 8840**] is a 46 year-old man with a history of complex pelvic
fracture and ruptured bladder after an MVA, who presents with
fever/sepsis.
.
Recently admitted ([**4-19**] - [**4-21**]) after a 56 day hospitalization
in [**State 4565**] following an MVA complicated by open book pelvic
fracture and right T12-L5 transverse process fracture. While in
[**State 4565**], he had a cystogram and CT cystogram that showed
extraperitoneal bladder rupter to bladder neck (repaired by a
suprapubic tube). That stay was complicated by ARDS requiring
intubation. Following extubation, he developed a soft tissue
infection of his perineum involving his scrotum with subsequent
debridement and exploration for a necrotizing infection,
followed by ex-lap with diverting sigmoid colonostomy.
.
Since discharge to [**Location (un) 38**], he has been feeling improved. He
remains non-weight bearing on his right hip and has had
resulting lower extremity weakness.
.
Seen by Dr. [**Last Name (STitle) **] on [**5-3**]; the [**Location (un) 1661**]-[**Location (un) 1662**] drain was removed
at this appointment. Seen by urology on [**5-4**], after having
failed a clamping of the suprapubic tube due to penile pain. Per
Dr.[**Initials (NamePattern4) 825**] [**Last Name (NamePattern4) **] note, the SPT was unable to be extracted, felt
to be due ot calcificatoins of the balloon.
.
On the day prior to admission, he underwent OR replacement of
his SPT by urology. The tube was clamped at that time. On the
morning of admission, he started having shaking chills at rehab
and was febrile to 104. Also noted nausea and increasing dysuria
(has mild urethral dysuria at baseline). After placing foley he
reports that the pain worsened. He was transferred to the [**Hospital1 18**]
ER.
.
In the ED, initial vitals included T 102.8, HR 116, BP 141/80.
He was treated with vancomycin IV and zosyn IV. For pain,
morphine, then dilaudid were given. After his BP dropped to the
80s, a CVL was placed.
.
At the time of arrival to the MICU, he was feeling signicantly
better.

Past Medical History:
1. History of MVA with multiple surgery:
- Open book pelvic fracture, s/p ORIC
- Prophylactic IVF filter placed
- Right T12-L5 transverse process fracture
- Extraperitoneal bladder rupter to bladder neck, s/p pelvic
binder and SPT placement
- Ex-lap with no evidence of intra-abdominal injuries
- Diverting sigmoid colonostomy
- Right gracilis flap followed by split thickness skin graft
- Multiple split-thickness skin grafts
- Reimplantation of the left testicle into a neoscrotum.
2. Fourniers gangrene
3. History of ARDS
4. GERD
5. Depression
6. History of sacroiliitis


Social History:
Worked as a curator for city of [**Location (un) 86**]. Smoked 1ppd from age
18-40.  Drinks 2 beers per night.  Currently living at [**Hospital 38**]
Rehab.  Has a girlfriend.  Mother is medical decision maker but
not official HCP.

Family History:
Noncontributory

Physical Exam:
VITALS: BP 102/55, HR 113, O2 95%
GEN: Awake, alert. Shaking chills during exam.
HEENT: Anicteric. No pallor. RIJ in place. Dry MM.
CV: Tachycardic and regular. No murmurs.
PULM: Clear.
ABD: Soft. Midline scar noted. Left sided ostomy noted with air
but without stool.
GU: 22F SPT draining yellow urine; site is slightly
erythematous; perineum without crepitus, minimal tenderness;
RECTAL (performed in ED by surgery): Normal tone. No masses. No
gross or occult blood.
EXT: Warm. No edema.
NEURO: Alert. Oriented to person, "[**Hospital1 18**]", "[**5-18**]". CNII-XII
intact. Strength 5/5 in upper extremities. RLE [**4-10**] at hip and
knee and 5-/5 at ankle.  LLE is 4-/5 at hip and 5-/5 at knee and
ankle. Patellar refexes are 1+ and equal.


Pertinent Results:
LABS ON ADMISSION:

.
[**5-18**] CT ab/pelvis w/ contrast
CT ABDOMEN WITH CONTRAST: The lung bases are clear. Cardiac apex
is
unremarkable. The stomach, proximal small bowel, adrenal glands,
pancreas,
spleen, gallbladder, liver are unremarkable. Small hypodensity
at the upper
pole of the left kidney (2:21) is too small to characterize. The
kidneys are
otherwise unremarkable. Note is made of an infrarenal IVC
filter. There is no
retroperitoneal or mesenteric lymphadenopathy. A linear
hyperdensity at the
midline ventral abdominal wall (2:30) most likely represents
suture material
or post-op calcification.

CT PELVIS WITH CONTRAST: A suprapubic catheter is positioned
with its tip in
the bladder. The urinary bladder and distal ureters are
unremarkable. Post-
surgical defects of the scrotum are noted. There is no
subcutaneous gas. There
is no pelvic or inguinal lymphadenopathy. Along the lower pelvic
anterior wall
just above the level of the pubic symphysus, there is
heterogeneous
soft tissue thickening along. In the same area is a 28 x 17mm
fluid collection
(300b:34), ?? seroma versus abscess.

There is a left lower quadrant diverting colostomy with mucus
fistula. The
rectum contains a small amount of barium. The appendix is
normal. Steak
artifact from pelvic hardware limits evaluuation at the
symphysis pubis.

OSSEOUS FINDINGS: Patient is status post ORIF of a diastasis of
the symphysis
pubis and surgical hardware appears in appropriate position. A
fixation screw
also transverses both sacroiliac joints, also appearing in
appropriate
position. Old fracture of the left femoral head is unchanged.
There is new
lucency at the posterior aspect of the left femoral head with
adjacent soft
tissue calcification (2:83). The cortex of bone is ill-defined
in this region,
raising concern for osteomyelitis.

IMPRESSION:
1. Extensive post-surgical changes following scrotal debridement
without
definite evidence of Fournier gangrene. Heterogeneous thickening
along the
lower anterior pelvic wall with small seroma versus small
abscess. Evaluation
limited due to streak artifact from ORIF hardware.
2. Osseous lucency at the left posterior femoral head. Findings
are worrisome
for osteomyelitis. Recommend clinical correlation.
3. Status post diverting colostomy with mucus fistula.
4. Old pelvic fractures s/p ORIF, left femoral head fracture,
old right
lumbar transverse process fractures.
.
[**5-18**] CXR
FINDINGS: Frontal view of the chest is obtained. Right IJ
central venous
catheter is seen with its tip in the expected region of the SVC.
Lungs are
clear bilaterally without evidence of consolidation or
pneumothorax.
Cardiomediastinal silhouette is normal. Bony structures appear
intact. The
very upper portion of the IVC filter is noted at the lower edge
of the film.

IMPRESSION: Right IJ central venous catheter in appropriate
position. No
pneumothorax.

[**2101-5-18**] 04:10PM URINE  COLOR-Amber APPEAR-Hazy SP [**Last Name (un) 155**]-1.010
[**2101-5-18**] 04:10PM URINE  BLOOD-LG NITRITE-POS PROTEIN-100
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-1 PH-8.0 LEUK-MOD
[**2101-5-18**] 04:10PM URINE  RBC-[**11-25**]* WBC-21-50* BACTERIA-MOD
YEAST-NONE EPI-0
[**2101-5-18**] 03:58PM   LACTATE-2.6*
[**2101-5-18**] 03:55PM   GLUCOSE-101 UREA N-12 CREAT-0.8 SODIUM-137
POTASSIUM-3.2* CHLORIDE-101 TOTAL CO2-25 ANION GAP-14
[**2101-5-18**] 03:55PM   WBC-8.2# RBC-3.99* HGB-11.1* HCT-32.3*
MCV-81* MCH-27.9 MCHC-34.4 RDW-15.5
[**2101-5-18**] 03:55PM   NEUTS-85.6* LYMPHS-12.5* MONOS-1.6* EOS-0.2
BASOS-0.1

Brief Hospital Course:
In brief, Mr [**Known lastname 8840**] is a 46M w h/o recent MVA resulting complex
pelvic fx, bladder rupture requiring SPT, admitted for
Pseudomonas urosepsis, w MICU stay c/b HAP.
.
# Pseudomonas UTI: Pt w prior bladder trauma/surgeries, w recent
suprapubic tube replacement, p/w F/C, found to have urosepsis.
S/p MICU stay. Urine cx grew Pseudomonas (Cipro resistant, Zosyn
sensitive), treated w a 14-day course of Zosyn ([**Date range (1) 40253**]).
Outpatient urology f/u scheduled (Dr [**Last Name (STitle) 770**]. 3-day course of
pyridium, as well as tolterodine and percocet for
bladder/urinary discomfort. Clear urine on discharge.
.
# Hospital-Acquired PNA: Pt developed mild hypoxemia while in
the MICU, w possible new RLL infiltrate on CXR. Treated w zosyn
for 7 days. Vanc course ([**Date range (1) 40254**]), stopped early given low
suspicion for MRSA. Zosyn continued through [**5-31**] for Pseudomonas
UTI. Afebrile, SaO2 > 95% on RA on discharge.
.
# Pain control: Chronic back pain, abdominal and penile
discomfort, likely [**2-7**] prior trauma, prolonged bed-stay, bladder
spams. Given dilaudid IV PRN in hospital, transitioned to
Percocet PRN.
.
# s/p Pelvic fx: Pt has IVC filter and was systemically
anticoagulated prior to SPT replacement. Held coumadin
throughout stay. Discharged on 1mg coumadin for PPx, patient has
IVC filter
.
# Anemia: Baseline Hct ~30. Mildly microcytic and stable from
[**Month (only) 547**] admission. On iron as outpatient. No transfusions required
as inpatient.
.
# Diverting colostomy: Required s/p MVA earlier in [**2100**]. Pt had
barium enema as inpatient to evaluate for rectal pouch,
colostomy revision done on [**5-27**] and patient tolerated diet well
after surgery. He had multiple small bowel movements with
relief. He did complain of some minor gas pain throughout his
postoperative course but responded well with simethicone wafers.
He was tolerating a normal diet on discharge and not on any
antibiotics.

Medications on Admission:
1. Citalopram 20mg daily
2. Omeprazole 20mg daily
3. Trazodone 50mg QHS
4. Oxybutynin ER 10mg daily
5. Penazopydridine 100mg TID
6. Diazepam 5mg daily PRN muscle spasm
7. Ferrous Sulfate 325 mg TID
8. Colace 200mg [**Hospital1 **]
9. Senna
10. Bisacodyl
11. Multivitamin daily
12. Simethicone 80mg Q4H PRN
13. Ondansetron 4mg Q4H PN
14. Oxycodone 5mg Q4H PRN

Discharge Medications:
1. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
q4h:prn as needed for pain for 30 days.
Disp:*30 Tablet(s)* Refills:*0*
4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for pain.
Disp:*25 Adhesive Patch, Medicated(s)* Refills:*0*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID:prn as needed
for constipation.
7. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
8. Warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: as directed by Dr. [**Last Name (STitle) **].
Disp:*30 Tablet(s)* Refills:*2*
9. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
10. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO once a day.
11. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for indigestion.
Disp:*200 ML(s)* Refills:*0*
12. Phenazopyridine 100 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 3 days.
Disp:*9 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Pseudomonas urosepsis
Hospital acquired pneumonia
.
diverting colostomy s/p closure
s/p bladder rupture w suprapubic tube
anemia
GERD
depression


Discharge Condition:
improved


Discharge Instructions:
You were admitted to the hospital with a urinary tract
infection. While you were in the hospital, you also developed a
lung infection. We treated you with antibiotics for both.
Surgery and urology evaluated you as well, they will continue
seeing you as an outpatient for further management of your
suprapubic tube. Your colostomy was taken down by Dr. [**Last Name (STitle) **] and
you are now able to have bowel movements on your own. You
completed your course of antibiotics as deemed necessary by the
Urology Team.
.
We changed your medications as follows:
1. Started antibiotics - vancomycin and zosyn
2. Continued your coumadin - you will need to have your INR
checked regularly
3. Percocet and lidocaine patch for pain
4. Tolterodine for bladder spasms
.
If you have fevers, chills, shortness of breath, chest pain,
abdominal pain, or any other concerning symptoms, please call
your physician [**Name Initial (PRE) 2227**].

Followup Instructions:
Appointment #1
MD: Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Specialty: Surgery - re: colostomy reversal
Date and time: call for an appointment, follow up in [**1-7**] weeks
Location: [**Hospital **] medical Building, [**Hospital Unit Name **]
Phone number: [**Telephone/Fax (1) 6429**]
.
Appointment #2
MD: Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 770**]
Specialty: Urology
Date and time: follow up in [**1-7**] weeks after discharge, call for
an appointment
Location: [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 470**]
Phone number:  [**Telephone/Fax (1) 5727**]
.
Follow up with Dr. [**Last Name (STitle) **] in 4 weeks, orthopaedic Surgery,
([**Telephone/Fax (1) 2007**]



Completed by:[**2101-6-1**]
{'Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Septicemia due to pseudomonas,Sepsis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Attention to colostomy,Esophageal reflux,Late effect of fracture of spine and trunk without mention of spinal cord lesion,Late effects of motor vehicle accident,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Other urogenital trichomoniasis,Backache, unspecified,Abdominal pain, generalized,Unspecified disorder of penis,Chronic pain due to trauma'}


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: Urosepsis

PRESENT ILLNESS: Mr [**Known lastname 8840**] is a 46 year-old man with a history of complex pelvic
fracture and ruptured bladder after an MVA, who presents with
fever/sepsis.
.
Recently admitted ([**4-19**] - [**4-21**]) after a 56 day hospitalization
in [**State 4565**] following an MVA complicated by open book pelvic
fracture and right T12-L5 transverse process fracture. While in
[**State 4565**], he had a cystogram and CT cystogram that showed
extraperitoneal bladder rupter to bladder neck (repaired by a
suprapubic tube). That stay was complicated by ARDS requiring
intubation. Following extubation, he developed a soft tissue
infection of his perineum involving his scrotum with subsequent
debridement and exploration for a necrotizing infection,
followed by ex-lap with diverting sigmoid colonostomy.
.
Since discharge to [**Location (un) 38**], he has been feeling improved. He
remains non-weight bearing on his right hip and has had
resulting lower extremity weakness.
.
Seen by Dr. [**Last Name (STitle) **] on [**5-3**]; the [**Location (un) 1661**]-[**Location (un) 1662**] drain was removed
at this appointment. Seen by urology on [**5-4**], after having
failed a clamping of the suprapubic tube due to penile pain. Per
Dr.[**Initials (NamePattern4) 825**] [**Last Name (NamePattern4) **] note, the SPT was unable to be extracted, felt
to be due ot calcificatoins of the balloon.
.
On the day prior to admission, he underwent OR replacement of
his SPT by urology. The tube was clamped at that time. On the
morning of admission, he started having shaking chills at rehab
and was febrile to 104. Also noted nausea and increasing dysuria
(has mild urethral dysuria at baseline). After placing foley he
reports that the pain worsened. He was transferred to the [**Hospital1 18**]
ER.
.
In the ED, initial vitals included T 102.8, HR 116, BP 141/80.
He was treated with vancomycin IV and zosyn IV. For pain,
morphine, then dilaudid were given. After his BP dropped to the
80s, a CVL was placed.
.
At the time of arrival to the MICU, he was feeling signicantly
better.

MEDICAL HISTORY: 1. History of MVA with multiple surgery:
- Open book pelvic fracture, s/p ORIC
- Prophylactic IVF filter placed
- Right T12-L5 transverse process fracture
- Extraperitoneal bladder rupter to bladder neck, s/p pelvic
binder and SPT placement
- Ex-lap with no evidence of intra-abdominal injuries
- Diverting sigmoid colonostomy
- Right gracilis flap followed by split thickness skin graft
- Multiple split-thickness skin grafts
- Reimplantation of the left testicle into a neoscrotum.
2. Fourniers gangrene
3. History of ARDS
4. GERD
5. Depression
6. History of sacroiliitis

MEDICATION ON ADMISSION: 1. Citalopram 20mg daily
2. Omeprazole 20mg daily
3. Trazodone 50mg QHS
4. Oxybutynin ER 10mg daily
5. Penazopydridine 100mg TID
6. Diazepam 5mg daily PRN muscle spasm
7. Ferrous Sulfate 325 mg TID
8. Colace 200mg [**Hospital1 **]
9. Senna
10. Bisacodyl
11. Multivitamin daily
12. Simethicone 80mg Q4H PRN
13. Ondansetron 4mg Q4H PN
14. Oxycodone 5mg Q4H PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: BP 102/55, HR 113, O2 95%
GEN: Awake, alert. Shaking chills during exam.
HEENT: Anicteric. No pallor. RIJ in place. Dry MM.
CV: Tachycardic and regular. No murmurs.
PULM: Clear.
ABD: Soft. Midline scar noted. Left sided ostomy noted with air
but without stool.
GU: 22F SPT draining yellow urine; site is slightly
erythematous; perineum without crepitus, minimal tenderness;
RECTAL (performed in ED by surgery): Normal tone. No masses. No
gross or occult blood.
EXT: Warm. No edema.
NEURO: Alert. Oriented to person, "[**Hospital1 18**]", "[**5-18**]". CNII-XII
intact. Strength 5/5 in upper extremities. RLE [**4-10**] at hip and
knee and 5-/5 at ankle.  LLE is 4-/5 at hip and 5-/5 at knee and
ankle. Patellar refexes are 1+ and equal.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Worked as a curator for city of [**Location (un) 86**]. Smoked 1ppd from age
18-40.  Drinks 2 beers per night.  Currently living at [**Hospital 38**]
Rehab.  Has a girlfriend.  Mother is medical decision maker but
not official HCP. 

### Response:
{'Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Septicemia due to pseudomonas,Sepsis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Attention to colostomy,Esophageal reflux,Late effect of fracture of spine and trunk without mention of spinal cord lesion,Late effects of motor vehicle accident,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Other urogenital trichomoniasis,Backache, unspecified,Abdominal pain, generalized,Unspecified disorder of penis,Chronic pain due to trauma'}
