CHIEF COMPLAINT: Headache

PRESENT ILLNESS: PER ADMITTING RESIDENT:
This is a 61 yo female with h/o hypertension, CAD, s/p
stents, who developed shortness of breath and lightheadedness
and
headache over the past 3 days.  She was being treated for
pneumonia and UTI by her primary care doctor [**First Name (Titles) 151**] [**Last Name (Titles) **] and
predisone which both started on [**2108-1-18**].  She developed severe
headaches subsequently which the family were due to the [**Date Range **].
The PCP changed the medication to Levaquin on [**2108-1-20**], but the
headache persisted.  She presented to OSH ([**Hospital 84338**]) with shortness of breath and lightheadedness.
When she initally presented to the OSH ED, she was awake and
alert.  However, code stroke was called when she suddenly
developed left sided facial droop and weakness in the right arm
and leg.  She had a brief episode of eye blinking and shaking of
both arms.  Head CT showed an acute subarachnoid hemorrhage
along
the convexity of the left parietal lobe and a suggestion of
intraparencymal subtle hemorrhagic area in the left parietal
lobe. Prioir to transfer she was received lopressor 5 mg IV,
fosphenytoin 1 g, and 2 mg Ativan.  Chest X-ray showed changed
flattening the diaphragm and some mild blunting of the
costophrenic angles.  EKG showed sinus tachycardia with poor
R-wave progression in the anterior leads which is consistnet
with
her previous MI.  Upon arrival to [**Hospital1 18**], she was noted to be
agitated.  She developed agonal breathing and was then
intubated.
CT/CTA was performed.

MEDICAL HISTORY: - htn
- hyperlip
- COPD
- PVD s/p bilateral iliac
- s/p left renal stents
- CAD s/p STEMI [**7-18**] with stenting x 3.

MEDICATION ON ADMISSION: ranexa
hctz
metoprolol
plavix
singulair
lisinopril
ASA
crestor
mucinex
colace
senna
zantac
MVI
Buspar
carafate
ativan
APAP
albuterol
advair
spiriva
miralax
robitussin
maalox
Niroglycerin SL
Levaquin
prednisone
.
Allergies: opoid-morphine related medications

ALLERGIES: Opioids-Morphine & Related

PHYSICAL EXAM: ON ADMISSION:
Physical Exam:
Vitals: T: 99.0 P:101  R: 22  BP:  138/86 SaO2: 100% on FiO2 40%
General: intubated and sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: No family history of early MI, arrhythmia,
cardiomyopathies, or sudden cardiac death; otherwise
non-contributory

SOCIAL HISTORY: - She lives with her husband who is the primary care
giver.  She was ambulating independently
prior to admission.
.
HABITS
- Tobacco history: 40 pack yr, quit 3 yrs ago
-ETOH: None
-Illicit drugs: None
Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Subdural hemorrhage,Other late effects of cerebrovascular disease, facial weakness,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of tobacco use,Personal history of allergy to narcotic agent
Subarachnoid hemorrhage,Crbl art ocl NOS w infrc,Pneumonia, organism NOS,Unsp hemiplga unspf side,Urin tract infection NOS,Hyposmolality,Subdural hemorrhage,Facial weakness,Hypertension NOS,Crnry athrscl natve vssl,Status-post ptca,Old myocardial infarct,Athscl extrm ntv art NOS,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,History of tobacco use,Hx-narcotic allergy
Admission Date:  [**2108-1-21**]              Discharge Date:   [**2108-2-4**]

Date of Birth:  [**2046-11-6**]             Sex:   F

Service: NEUROLOGY

Allergies:
Opioids-Morphine & Related

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
* intubation

History of Present Illness:
PER ADMITTING RESIDENT:
This is a 61 yo female with h/o hypertension, CAD, s/p
stents, who developed shortness of breath and lightheadedness
and
headache over the past 3 days.  She was being treated for
pneumonia and UTI by her primary care doctor [**First Name (Titles) 151**] [**Last Name (Titles) **] and
predisone which both started on [**2108-1-18**].  She developed severe
headaches subsequently which the family were due to the [**Date Range **].
The PCP changed the medication to Levaquin on [**2108-1-20**], but the
headache persisted.  She presented to OSH ([**Hospital 84338**]) with shortness of breath and lightheadedness.
When she initally presented to the OSH ED, she was awake and
alert.  However, code stroke was called when she suddenly
developed left sided facial droop and weakness in the right arm
and leg.  She had a brief episode of eye blinking and shaking of
both arms.  Head CT showed an acute subarachnoid hemorrhage
along
the convexity of the left parietal lobe and a suggestion of
intraparencymal subtle hemorrhagic area in the left parietal
lobe. Prioir to transfer she was received lopressor 5 mg IV,
fosphenytoin 1 g, and 2 mg Ativan.  Chest X-ray showed changed
flattening the diaphragm and some mild blunting of the
costophrenic angles.  EKG showed sinus tachycardia with poor
R-wave progression in the anterior leads which is consistnet
with
her previous MI.  Upon arrival to [**Hospital1 18**], she was noted to be
agitated.  She developed agonal breathing and was then
intubated.
CT/CTA was performed.

On neuro ROS, as above.

On general review of systems,her husband denies [**Name2 (NI) **] shehad
fever,
chills, neuasea, vomting, or other cymptoms.


Past Medical History:
- htn
- hyperlip
- COPD
- PVD s/p bilateral iliac
- s/p left renal stents
- CAD s/p STEMI [**7-18**] with stenting x 3.


Social History:
- She lives with her husband who is the primary care
giver.  She was ambulating independently
prior to admission.
.
HABITS
- Tobacco history: 40 pack yr, quit 3 yrs ago
-ETOH: None
-Illicit drugs: None


Family History:
No family history of early MI, arrhythmia,
cardiomyopathies, or sudden cardiac death; otherwise
non-contributory


Physical Exam:
ON ADMISSION:
Physical Exam:
Vitals: T: 99.0 P:101  R: 22  BP:  138/86 SaO2: 100% on FiO2 40%
General: intubated and sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: sedated, eyes closed, unable to follow commands.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 2.5to 2mm and brisk.  Funduscopic exam revealed no
papilledema, exudates, or hemorrhages.
III, IV, VI: unable to attest
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: unable
IX, X: + corneals bilaterallyl=
[**Doctor First Name 81**]: unable
XII: unable.

-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
 Moves all extremities to noxious stimuli
-Sensory: withdraws to painful stimuli

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   2
R  2  2    2    2   2
Plantar response mute bilaterally.

-Coordination: unable
-Gait: unable


Pertinent Results:
Admission Labs:
.
WBC-32.0*# RBC-4.16* HGB-12.8 HCT-40.9 MCV-99* PLT-620
GLUCOSE-207* UREA N-18 CREAT-0.6 SODIUM-129* POTASSIUM-5.6*
CHLORIDE-99 TOTAL CO2-18* ANION GAP-18
CK-MB-NotDone  cTropnT-<0.01
ALT(SGPT)-156* AST(SGOT)-202* CK(CPK)-76 ALK PHOS-49 TOT
BILI-0.2
ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG
tricyclic-NEG
.
URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG
amphetmn-NEG mthdone-NEG
URINE  BLOOD-LG NITRITE-NEG PROTEIN-500 GLUCOSE-NEG KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-MOD
.
[**2-3**] WBC 9.2, HCT 29.7, plts 958

ESR 75, lupus anticoagulant negative, hepatitis panel neg, HIV
Ab neg, ANCA neg, [**Doctor First Name **] neg, RF 12, beta-2 microglobulin 1.3, C3
166, C4 52

.
IMAGING
.
CTA ([**2108-1-21**]):
IMPRESSION: Unchanged small volume of focal subdural and
subarachnoid
hemorrhage with no underlying vascular malformation, cerebral
venous
thrombosis or aneurysm identified.
.
CXR ([**2108-1-21**]):
IMPRESSION:
1. ETT 5 cm from the carina.
2. No acute cardiopulmonary abnormality identified

CT head [**2108-1-26**]
FINDINGS: A non-contrast CT of the head was obtained. Again
noted is a small
amount of subdural hemorrhage layering along the
interhemispheric falx and
subarachnoid hemorrhage within the bilateral frontotemporal
sulci at the
cerebral convexities, mildly reduced in extent when compared to
the prior
study. There has been interval development of cortical and
subcortical
hypodensities within the bilateral posterior parietal lobes
extending
inferiorly into the occipital lobes, left greater than right.
There is no
evidence of intraparenchymal hemorrhage. No masses or shift of
midline
structures is identified. The ventricles are stable in size. The
basilar
cisterns are patent. The calvarium is intact. There is partial
opacification
of the left anterior ethmoidal air cells and mucosal thickening
within the
sphenoid sinuses.

IMPRESSION:
1. Interval development of cortical and subcortical
hypodensities within the
posterior parietal and occipital lobes. Differential diagnosis
includes PRES
versus bilateral infarctions, possibly secondary to venous sinus
thrombosis.
No definite CT evidence of venous sinus thrombosis is
identified. MRI and MRV
are recommended for further characterization.
2. Slight interval decrease in extent of subdural and
subarachnoid hemorrhage
within the bilateral frontotemporal regions at the cerebral
convexities.

MRI/V [**2108-1-27**]
1. Non-arterial distribution infarcts with large regions of
restricted
diffusion involving the left parietooccipital lobes, right
parietal lobe, and
additional scattered punctate foci within the right frontal
lobe. Stable
subarachnoid and subdural hemorrhage, as described above.

No evidence of arterial thrombosis, medium-to-large intracranial
vessel
vasospasm or vasculitis (though MRI/MRA may be insensitive), or
cerebral
venous thrombosis.

2. Mucosal thickening and fluid with near-complete opacification
of the left
maxillary sinus and partial opacification of the anterior left
ethmoid air
cells, not significantly changed in extent compared to CTA of
one day prior.

These findings were discussed at-length with Dr. [**Last Name (STitle) **] (Stroke
service), by
Dr. [**Last Name (STitle) **], on [**2108-1-27**] at 4:30 PM; by exclusion, this may
represent a severe
case of Call-[**Doctor Last Name 8271**] pathophysiology, proceding to infarction,
in a patient
with severe underlying vascular disease.

TTE [**2108-1-31**]
No atrial septal defect or patent foramen ovale is seen by 2D,
color Doppler or saline contrast with maneuvers. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF 70%). The aortic valve is not
well seen. No masses or vegetations are seen on the aortic
valve, but cannot be fully excluded due to suboptimal image
quality. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. No
masses or vegetations are seen on the mitral valve, but cannot
be fully excluded due to suboptimal image quality. Mild to
moderate ([**1-14**]+) mitral regurgitation is seen. No masses or
vegetations are seen on the tricuspid valve, but cannot be fully
excluded due to suboptimal image quality. There is apparently
severe pulmonary artery systolic hypertension (however, due to
the technically suboptimal nature of this study, a falsely
elevated pulmonary artery systolic pressure measurement caused
by contamination of the tricuspid regurgitation signal by the
mitral regurgitation cannot be excluded with certainty). There
is no pericardial effusion.

TEE [**2108-2-2**]
No mass/thrombus is seen in the left atrium or left atrial
appendage. No atrial septal defect or patent foramen ovale is
seen by 2D, color Doppler or saline contrast with maneuvers.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are complex (>4mm) atheroma in the aortic arch. There are
complex (>4mm) atheroma in the descending thoracic aorta. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is no pericardial effusion.

IMPRESSION: PFO, ASD or intracardiac thrombus seen. Significant
thoracic aortic atherosclerosis.

CTA head/neck [**2108-2-2**]
Patent bilateral vertebral and carotid arteries. Mild narrowing
of the right
anterior carotid artery, new since prior CTA representing an
area of non-flow
limiting vasospasm

Discharge Labs:

136 | 99 | 6
-------------< 128
4.0 | 31 | 0.5

      9.2
9.2 >------< 958
     29.7


Brief Hospital Course:
Ms. [**Known lastname 4702**] is a 61 year-old woman with a past medical history
including hypertension, hyperlipidemia, CAD s/p STEMI, and PVD
s/p bilateral iliac stenting who initially presented to Caritas
with a three day history of headache, shortness of breath, and
lightheadedness. An emergent CT was performed when she developed
acute left facial droop, right hemiparesis, and apparent
convulsive movements; the imaging demonstrated a left parietal
subarachnoid hemorrhage and subdural hematoma in the falx
region.  She was given ativan and fosphenytoin before transfer
to the [**Hospital1 18**] for further evaluation and care.  She was admitted
to the stroke service from [**2108-1-21**] to [**2108-2-3**].
.
NEURO
Upon her arrival at the [**Hospital1 18**], a repeat CT was performed to
evaluate for any evolution of the lesions.  The CT demonstrated
stability of the focal subdural and subarachnoid hemorrhage.  CT
Angiography showed no underlying vascular malformation, cerebral
venous thrombosis or aneurysm identified.  A repeat CT head
revealed bilateral parieto-occipital hypodensities, possibly
consistent with venous sinus thrombosis or PRES.  However, no
evidence of thrombosis was seen on CTV.  A TTE did not reveal a
cardioembolic source for her infarcts, however TEE was notable
for complex >4mm atheroma in the aortic arch.  MRI with contrast
was performed which revealed no underlying malignancy, and
negative for venous sinus thrombosis.  It was hypothesized her
presentation was most consistent with cerebral vasoconstriction
syndrome (Call [**Last Name (un) 8273**]).  She was started on verapamil and
tolerating this [**Doctor Last Name 360**] well.  A vasculitis panel was sent as
well, which was unrevealing and an LP showed 0 wbc, protein 30,
glucose 84.  She was continued on her plavix and aspirin.  In
response to her atheroma noted on TEE, it was decided to
increase the dose of her statin and continue her antiplatelet
agents rather than proceed with anticoagulation, primarily as it
was still thought unlikely that this was the cause of her
presentation.
.
Throughout the hospitalization, phenytoin was transitioned to
keppra for seizure prophylaxis.  There were no further clinical
events noted and she has remained on 750 mg [**Hospital1 **].  It is
recommended that she continue the keppra for at least six
months.
.
RESP
Following her arrival at the [**Hospital1 18**], the patient developed agonal
breathing and was intubated for airway protection.  She was
successfully extubated within 48 hours.  She continued to have
intermittent difficulty with her respiratory status, likely due
to her COPD and pneumonia.  Her nebulizers were increased in
frequency to q4h and she did require 2-3L O2 via NC.  Her O2 was
weaned off and she is currently doing well on room air.
.
CVS
In the inital part of the hospitalization, the patient's blood
pressure dropped, requiring the support or pressors.  The
hypotension was thought to be related to analgesics and the
sedatives required for intubation.  She has been normotensive
for several days and her home beta blocker and ace-inhibitor
were restarted.  An echocardiogram (TTE and TEE) were performed;
please see results section for details.
.
ID
To address the urinary tract infection diagnosed prior to
admission, ceftriaxone and pyridium were administered.  Blood
cultures ([**2108-1-22**]) showed no growth. She completed a ten day
course of ceftriaxone (switched to cefpoxidime on day #8) given
her recent pneumonia as well as urinary tract infection.


Medications on Admission:
ranexa
hctz
metoprolol
plavix
singulair
lisinopril
ASA
crestor
mucinex
colace
senna
zantac
MVI
Buspar
carafate
ativan
APAP
albuterol
advair
spiriva
miralax
robitussin
maalox
Niroglycerin SL
Levaquin
prednisone
.
Allergies: opoid-morphine related medications


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for wheezing.

3. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours).
5. Levetiracetam 750 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Rosuvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.

10. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. Acetaminophen-Codeine 300-30 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
12. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for Fever/pain.
15. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
17. Verapamil 120 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
18. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q6H (every 6 hours) as needed for headache.
19. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Left parietal subarachnoid hemorrhage
Bilateral parieto-occipital infarcts
Likely cerebral vasoconstriction syndrome (Call [**Last Name (un) 8273**])


Discharge Condition:
A&Ox3, speech fluent.  Naming, repetition, comprehension itact.
EOMI, VFF, face symmetric, tongue midline.  Moves all
extremities antigravity and against resistance.  Sensation
intact to light touch.


Discharge Instructions:
You were admitted for evaluation of headache, seizure, and
right-sided weakness.  You were found to have a bleed in the
left side of your brain.  A repeat CT scan showed infarcts on
both sides of your brain.  This may have been due to a cerebral
vasoconstriction syndrome.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] (neurology).  You may call
([**Telephone/Fax (1) 7394**] to schedule an appointment within 4-6 weeks.

We would recommend that you have a follow up MRI of your brain
in three months.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Subdural hemorrhage,Other late effects of cerebrovascular disease, facial weakness,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of tobacco use,Personal history of allergy to narcotic agent'}


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: Headache

PRESENT ILLNESS: PER ADMITTING RESIDENT:
This is a 61 yo female with h/o hypertension, CAD, s/p
stents, who developed shortness of breath and lightheadedness
and
headache over the past 3 days.  She was being treated for
pneumonia and UTI by her primary care doctor [**First Name (Titles) 151**] [**Last Name (Titles) **] and
predisone which both started on [**2108-1-18**].  She developed severe
headaches subsequently which the family were due to the [**Date Range **].
The PCP changed the medication to Levaquin on [**2108-1-20**], but the
headache persisted.  She presented to OSH ([**Hospital 84338**]) with shortness of breath and lightheadedness.
When she initally presented to the OSH ED, she was awake and
alert.  However, code stroke was called when she suddenly
developed left sided facial droop and weakness in the right arm
and leg.  She had a brief episode of eye blinking and shaking of
both arms.  Head CT showed an acute subarachnoid hemorrhage
along
the convexity of the left parietal lobe and a suggestion of
intraparencymal subtle hemorrhagic area in the left parietal
lobe. Prioir to transfer she was received lopressor 5 mg IV,
fosphenytoin 1 g, and 2 mg Ativan.  Chest X-ray showed changed
flattening the diaphragm and some mild blunting of the
costophrenic angles.  EKG showed sinus tachycardia with poor
R-wave progression in the anterior leads which is consistnet
with
her previous MI.  Upon arrival to [**Hospital1 18**], she was noted to be
agitated.  She developed agonal breathing and was then
intubated.
CT/CTA was performed.

MEDICAL HISTORY: - htn
- hyperlip
- COPD
- PVD s/p bilateral iliac
- s/p left renal stents
- CAD s/p STEMI [**7-18**] with stenting x 3.

MEDICATION ON ADMISSION: ranexa
hctz
metoprolol
plavix
singulair
lisinopril
ASA
crestor
mucinex
colace
senna
zantac
MVI
Buspar
carafate
ativan
APAP
albuterol
advair
spiriva
miralax
robitussin
maalox
Niroglycerin SL
Levaquin
prednisone
.
Allergies: opoid-morphine related medications

ALLERGIES: Opioids-Morphine & Related

PHYSICAL EXAM: ON ADMISSION:
Physical Exam:
Vitals: T: 99.0 P:101  R: 22  BP:  138/86 SaO2: 100% on FiO2 40%
General: intubated and sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: No family history of early MI, arrhythmia,
cardiomyopathies, or sudden cardiac death; otherwise
non-contributory

SOCIAL HISTORY: - She lives with her husband who is the primary care
giver.  She was ambulating independently
prior to admission.
.
HABITS
- Tobacco history: 40 pack yr, quit 3 yrs ago
-ETOH: None
-Illicit drugs: None 

### Response:
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Subdural hemorrhage,Other late effects of cerebrovascular disease, facial weakness,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of tobacco use,Personal history of allergy to narcotic agent'}
