CHIEF COMPLAINT: fever and cough

PRESENT ILLNESS: Mr. [**Known lastname 95253**] is an 82 y.o. M with CAD, AAA, CKD, recent GIB
discharged from OSH 5 PTA who presented after he went to his PCP
complaining of subjective fever and productive cough and was
noted to be hypoxic to 90% on RA. He was referred in to the ED.
He also reportedly had some angina on the night prior to
admission which responded to 2 sublingual nitroglycerin.
.
In the ED: Tmax 101.5 HR 57 BP 108/40 RR24 O2 sat 100%4L/
EKG showed regular sinus rhythm @70bpm, diffuse ST twave
abnormalities, no change from prior, and frequent pvcs. Labs
showed a troponin of 0.22 (records show it to be chronically
elevated. He was guaiac negative and was given ASA 325 mg x 1.
CXR showed RLL infiltrate. Vancomycin/Levofloxacin were given.
He then had an episode of hypotension with SBP 80s. RIJ and
a-line were placed, he was started on levophed and he was given
a total of 4L NS. Levophed was weaned off at 4:00am. He was
transfused 2U PRBC for hematocrit 23, with post-transfusion hct
28.  He was then transferred to the floor.

MEDICAL HISTORY: 1. CAD - s/p MIs, CABG x2, stents. MI resulting in CHF [**2-/2100**]
and RCA cypher stents placed. Cath [**10-21**] with L subclavian stent
proximal to takeoff of LIMA. Echocard [**10/2102**]: EF 20-25%.
Low hdl syndrome.
2. HTN/bil RAS rx bare stents [**2099**].
3. Gout
4. Prostate nodule with benign bx in past, asymptomatic
5. Chronic decreased vision left eye s/p retinal hemorrhage
6. [**Doctor Last Name 9376**] syndrome
7. Colon adenoma, next colonoscopy due [**2101**]
8. Sexual dysfunction, not a current concern
9. Stage 4 CKD, creat ~3.0
10. Chronic anemia due to renal insufficiency, rx pro-crit
11. AAA, rx endovascular graft repair [**2099**]. MRA [**8-/2100**] was
reviewed by Dr. [**Last Name (STitle) **] and found to be satisfactory
12. PAD with claudication / bilateral iliac stenosis
13. Mitral regurgitation, SBE prophylaxis advised
14. DMII - diet controlled, dx [**2101**]
15. PNA 05
16. R-bicep tendon rupture.
18. Left knee surgery
[**13**]. LBP/sciatica - past
20. Atrial flutter rx cardioversion, [**2101**] / anticoag
21. diverticulosis, ?GIB
22. chemical gastritis thought [**12-16**] ASA/plavix

MEDICATION ON ADMISSION: Calcitriol 0.25 mg qd
Furosemide 40 mg qd
Vitamins, iron not recorded
Procrit 30,000 every 14 days
Carvedilol 6.25 mg [**Hospital1 **]
Nifedipine 30 mg qd
Nifedipine SR 30 mg qd
Lipitor 40 mg qd
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
AMIODARONE 200 mg--1 tablet(s) by mouth once a day
CENTRUM SILVER --1 tablet(s) by mouth once a day
DIOVAN 160 mg--1 tablet(s) by mouth once a day
DOCUSATE SODIUM 100 mg--1 capsule(s) by mouth twice a day as
needed for for constipation
IMDUR 120 mg--1 tablet(s) by mouth daily
Iron (Ferrous Sulfate) 325 mg (65 mg)--one tablet(s) by mouth
twice a day
LIDODERM 5 %(700 mg/patch)--apply 1 patch in the morning, remove

ALLERGIES: Zestril / Penicillins / Integrilin / Hydrochlorothiazide /
Ciprofloxacin

PHYSICAL EXAM: PHYSICAL EXAM:
Vitals - T: 99.8 BP: 142/64 HR: 82 RR: 14 02 sat: 96%
Vent settings: AC, Vt 500, RR 14, PEEP 5, FiO2 100% initially.
GENERAL: Intubated, sedated (prior to intubation, was
tachypneic, cyanotic, in obvious severe respiratory distress).
HEENT: PERRL, MMM, ETT and OGT in place.
CARDIAC: RRR, no m/r/g.
LUNG: Coarse breath sounds b/l, with diffuse wheezes and
bibasilar crackles.
ABDOMEN: +BS, soft, NT/ND.
EXT: 1+ edema b/l. 2+ DP pulses.
SKIN: Dry, no rashes.

FAMILY HISTORY: Father died of an MI at age 53. Son had an MI in his late 40's.

SOCIAL HISTORY: Social history is significant for (-)tobacco use, (+) one glass
of wine every night. Patient is widowed, son lives with him.
Previously worked for [**Company **] as a machinist.
Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Atrial flutter,Acute kidney failure, unspecified,Chronic kidney disease, Stage IV (severe),Severe sepsis,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Disorders of bilirubin excretion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Mitral valve disorders,Atherosclerosis of native arteries of the extremities with intermittent claudication,Anemia in chronic kidney disease,Congestive heart failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use
Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Atrial flutter,Acute kidney failure NOS,Chr kidney dis stage IV,Severe sepsis,Gout NOS,Hy kid NOS w cr kid I-IV,Dis bilirubin excretion,DMII wo cmp nt st uncntr,Mitral valve disorder,Ath ext ntv at w claudct,Anemia in chr kidney dis,CHF NOS,Adv eff medicinal NEC
Admission Date:  [**2103-1-9**]              Discharge Date:   [**2103-1-15**]

Date of Birth:  [**2020-11-13**]             Sex:   M

Service: MEDICINE

Allergies:
Zestril / Penicillins / Integrilin / Hydrochlorothiazide /
Ciprofloxacin

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
fever and cough

Major Surgical or Invasive Procedure:
s/p intubation and extubation


History of Present Illness:
Mr. [**Known lastname 95253**] is an 82 y.o. M with CAD, AAA, CKD, recent GIB
discharged from OSH 5 PTA who presented after he went to his PCP
complaining of subjective fever and productive cough and was
noted to be hypoxic to 90% on RA. He was referred in to the ED.
He also reportedly had some angina on the night prior to
admission which responded to 2 sublingual nitroglycerin.
.
In the ED: Tmax 101.5 HR 57 BP 108/40 RR24 O2 sat 100%4L/
EKG showed regular sinus rhythm @70bpm, diffuse ST twave
abnormalities, no change from prior, and frequent pvcs. Labs
showed a troponin of 0.22 (records show it to be chronically
elevated. He was guaiac negative and was given ASA 325 mg x 1.
CXR showed RLL infiltrate. Vancomycin/Levofloxacin were given.
He then had an episode of hypotension with SBP 80s. RIJ and
a-line were placed, he was started on levophed and he was given
a total of 4L NS. Levophed was weaned off at 4:00am. He was
transfused 2U PRBC for hematocrit 23, with post-transfusion hct
28.  He was then transferred to the floor.


Past Medical History:
1. CAD - s/p MIs, CABG x2, stents. MI resulting in CHF [**2-/2100**]
and RCA cypher stents placed. Cath [**10-21**] with L subclavian stent
proximal to takeoff of LIMA. Echocard [**10/2102**]: EF 20-25%.
Low hdl syndrome.
2. HTN/bil RAS rx bare stents [**2099**].
3. Gout
4. Prostate nodule with benign bx in past, asymptomatic
5. Chronic decreased vision left eye s/p retinal hemorrhage
6. [**Doctor Last Name 9376**] syndrome
7. Colon adenoma, next colonoscopy due [**2101**]
8. Sexual dysfunction, not a current concern
9. Stage 4 CKD, creat ~3.0
10. Chronic anemia due to renal insufficiency, rx pro-crit
11. AAA, rx endovascular graft repair [**2099**]. MRA [**8-/2100**] was
reviewed by Dr. [**Last Name (STitle) **] and found to be satisfactory
12. PAD with claudication / bilateral iliac stenosis
13. Mitral regurgitation, SBE prophylaxis advised
14. DMII - diet controlled, dx [**2101**]
15. PNA 05
16. R-bicep tendon rupture.
18. Left knee surgery
[**13**]. LBP/sciatica - past
20. Atrial flutter rx cardioversion, [**2101**] / anticoag
21. diverticulosis, ?GIB
22. chemical gastritis thought [**12-16**] ASA/plavix


Social History:
Social history is significant for (-)tobacco use, (+) one glass
of wine every night. Patient is widowed, son lives with him.
Previously worked for [**Company **] as a machinist.


Family History:
Father died of an MI at age 53. Son had an MI in his late 40's.


Physical Exam:
PHYSICAL EXAM:
Vitals - T: 99.8 BP: 142/64 HR: 82 RR: 14 02 sat: 96%
Vent settings: AC, Vt 500, RR 14, PEEP 5, FiO2 100% initially.
GENERAL: Intubated, sedated (prior to intubation, was
tachypneic, cyanotic, in obvious severe respiratory distress).
HEENT: PERRL, MMM, ETT and OGT in place.
CARDIAC: RRR, no m/r/g.
LUNG: Coarse breath sounds b/l, with diffuse wheezes and
bibasilar crackles.
ABDOMEN: +BS, soft, NT/ND.
EXT: 1+ edema b/l. 2+ DP pulses.
SKIN: Dry, no rashes.

Pertinent Results:
Labs: see OMR
.
STUDIES:
CXR (PA & LATERAL) [**2103-1-8**] (prelim)
CHEST, TWO VIEWS: Moderate cardiomegaly is stable. The patient
is status post sternotomy and CABG. Mediastinal contours are
unchanged. There is chronic linear opacity at the left lung base
and chronic blunting of the left costophrenic sulcus, presumably
related to post-CABG scarring and pleural thickening. There is
new airspace opacity of the right cardiophrenic angle on the
frontal view, which obscures the right hemidiaphragm consistent
with right lower lobe pneumonia. There is a small right pleural
effusion. The bones are
demineralized. There is no evidence of congestive failure.
IMPRESSION:
1. Right lower lobe pneumonia.
2. Small right pleural effusion.
3. Stable moderate cardiomegaly.
.
CXR [**2103-1-9**]:
IMPRESSION: Increasing parenchymal density in right lower lobe,
new pneumonic infiltrate in right upper lobe. Probably mild
increased congestion but right-sided infiltrates most likely
infectious rather than atypical unilateral edema.
.
TEE [**2102-11-29**]
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. The left atrial appendage
emptying velocity is depressed (<0.2m/s). The right atrial
appendage ejection velocity is depressed (<0.2m/s). A small
secundum atrial septal defect is present with left to right flow
at rest. LV systolic function appears depressed. There are
complex (>4mm) non-mobile atheroma in the aortic arch (clip [**Clip Number (Radiology) **]
frame 68). There are diffuse simple atheroma in the descending
thoracic aorta to 45cm beyond the incisors with some areas of
complex, nonmobile atheroma at 37cm (clips 82/83). The aortic
valve leaflets (3) are mildly thickened. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild to moderate ([**11-15**]+) mitral regurgitation is seen.

IMPRESSION: No intra-atrial thrombus identified. Depressed LV
function. Small secundum ASD with left-to-right flow. Simple
aortic atheroma as described above.
.
CARDIAC CATHERIZATION [**2102-10-20**]
COMMENTS:
1. Selective coronary angiography in this right dominant system
was
performed. The LMCA was not injected because it was known to be

diffusely diseased. The LAD was totally occluded proximally.
Distal to the touch down of the LIMA there was mild disease. A
large OM was seen to fill via collaterals. The RCA had widely
patent stents and a distal 40% stenosis.
2. Venous conduit angiography was not performed because all of
the vein grafts were known to be occluded.
3. Arterial conduit angiography demonstrated a widely patent
LIMA-LAD. There was a 70% proximal subclavian stenosis with a >
20 mmHg gradient.
4. Successful stenting of left subclavian with a 6x24 Genesis
stent
post-dilated to 8mm distally and 9mm proximally. Final
angiography
without complications.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
3. Left subclavian stenosis proximal to takeoff of the LIMA.
4. Successful stenting of left subclavian.
.
.

Brief Hospital Course:
When pt arrived on the floor oxygenation was initially stable on
3L nc. However, he soon developed worsening SOB, tachypneia, and
rhonchi on exam. Due to concern for flash pulmonary edema he was
given 100mg IV lasix, but did not put out much urine and hypoxia
did not improve and he required a NRB, and he was transferred to
the MICU.
.
In the MICU he was imediately intubated.  Hypotension continued
despite fluid boluses so was put on levophed.  Vancomycin,
Cefepime, and Ciprofloxacin were given to treat sepsis [**12-16**] PNA.
Oxygenation and BP improved and [**2103-1-11**] he was weaned off
levophed and extubated yesterday.  He was ruled out for
influenza. Renal has been following for Acute on Chronic renal
failure, likely contrast induced.  Because of recent admission
to OSH for GIB Vascular surgery was consulted for concern about
aortoenteric fistula, who felt it unlikely given his stable hct
and guaiac negative.  Further supporting this is that during
admission to OSH 5 days PTA, pt had an EGD and colonoscopy which
were normal.  The vascular team initially recommended abd US to
rule out endo leak since pt was unable to have a contrast study
with his acute on chronic renal failure.  Radiology advised that
US would not be able to properly characterize an endoleak.  When
this was relayed to vascular surgery they felt that the index of
suspicion for aortoenteric fistula was low enough that further
imaging was not necessary. On [**2103-1-12**] he was called out the the
medicine floor.  Just before transfer his feet were noted to be
purple and cold.  Vascular re-evaluated, and noted that it was
dependent and therefore likely due to vascular insuf. and
ischemia was not a concern.
.
On the floor the pt had no complaints, and cough improved.  He
was discharged on a 10 day course of Levofloxacin.  He was
restarted on Imdur, but all other antihypertensives were held
due to recent hypotension.  During f/u with PCP BP will need to
be checked and antihypertensives slowly added back.  Coumadin
was held due to recent GIB, and pt was told not to restart until
instructed to do so by his PCP ([**Location (un) 1683**]).  He was also given an
appointment to follow up in the renal clinic, where he will need
erythropoetin and for continued management of CRF.

Medications on Admission:
Calcitriol 0.25 mg qd
Furosemide 40 mg qd
Vitamins, iron not recorded
Procrit 30,000 every 14 days
Carvedilol 6.25 mg [**Hospital1 **]
Nifedipine 30 mg qd
Nifedipine SR 30 mg qd
Lipitor 40 mg qd
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
AMIODARONE 200 mg--1 tablet(s) by mouth once a day
CENTRUM SILVER --1 tablet(s) by mouth once a day
DIOVAN 160 mg--1 tablet(s) by mouth once a day
DOCUSATE SODIUM 100 mg--1 capsule(s) by mouth twice a day as
needed for for constipation
IMDUR 120 mg--1 tablet(s) by mouth daily
Iron (Ferrous Sulfate) 325 mg (65 mg)--one tablet(s) by mouth
twice a day
LIDODERM 5 %(700 mg/patch)--apply 1 patch in the morning, remove

12 hours later, as needed for back pain
NITROGLYCERIN 0.3 mg--1 tablet(s) sublingually every 5 minutes x

maximum of 3 doses as needed for angina
vitamin b complex 1 tab daily

Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO BID (2 times a day).
6. Epoetin Alfa 10,000 unit/mL Solution Sig: Three (3)
Injection Q14 days.
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
9. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
10. Sodium Bicarbonate 650 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Furosemide 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
12. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary Diagnosis:
Pneumonia
.
Secondary Diagnoses:
Coronary Artery Disease
Low HDL syndrome
Hypertension
Gout
Prostate nodule with benign bx in past, asymptomatic
Chronic decreased vision left eye s/p retinal hemorrhage
[**Doctor Last Name 9376**] syndrome
Colon adenoma
Stage 4 CKD, baseline Cr ~3.0
Chronic anemia due to renal insufficiency, treated with pro-crit
AAA, s/p endovascular graft repair [**2099**].
PAD with claudication / bilateral iliac stenosis
Mitral regurgitation, SBE prophylaxis advised
DMII - diet controlled, dx [**2101**]
s/p R-bicep tendon rupture
s/p Left knee surgery
LBP/sciatica
Atrial flutter s/p cardioversion [**2102**] and taken off coumadin
[**11-21**] because of GI bleed
Diverticulosis; recent GIB admitted to OSH [**11-21**]

Discharge Condition:
Vital Signs Stable(T 97, BP 108/52, HR 70, RR 16, sat 96%RA).
Breathing without difficulty.  Ambulating.


Discharge Instructions:
You were admitted with pneumonia.  You were treated with
antibiotics.  Because of respiratory distress you were intubated
and went to the ICU.  Your breathing improved, and were
successfully extubated.  You also had low blood pressure that
transiently reqired medications to raise the blood pressure.
Your blood pressure also recovered, and those medications were
stopped.  Because of this period of low blood pressure your
blood presure medications were held.  We restarted imdur, but
your other blood pressure medications have been held.
.
You should not restart Coumadin, Carvedilol, Nifedipine, or
diovan until told to do so by your doctor.
.
Please take the Levofloxacin as perscribed.
.
Because Levofloxacin can have an effect on the heart (prolonged
QT interval), especially when combined with amiodarone) your PCP
should check an EKG.
.
Please keep all of your appointments as written below
.
Please take all of your medications as written below.
.
If you have any symptoms of worsening shortness of breath,
fevers, chest pain, or any other concerning symptoms please go
to the ER.

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet


Followup Instructions:
Provider [**Known firstname **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2103-1-16**]
11:30

Provider [**Name9 (PRE) **],[**First Name8 (NamePattern2) 2352**] [**Last Name (NamePattern1) 2352**] - ADULT MEDICINE (SB)
Phone:[**Telephone/Fax (1) 1144**] Date/Time:[**2103-1-17**] 2:30

Provider [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2540**], RN Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2103-1-31**] 10:00
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Atrial flutter,Acute kidney failure, unspecified,Chronic kidney disease, Stage IV (severe),Severe sepsis,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Disorders of bilirubin excretion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Mitral valve disorders,Atherosclerosis of native arteries of the extremities with intermittent claudication,Anemia in chronic kidney disease,Congestive heart failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use'}


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: fever and cough

PRESENT ILLNESS: Mr. [**Known lastname 95253**] is an 82 y.o. M with CAD, AAA, CKD, recent GIB
discharged from OSH 5 PTA who presented after he went to his PCP
complaining of subjective fever and productive cough and was
noted to be hypoxic to 90% on RA. He was referred in to the ED.
He also reportedly had some angina on the night prior to
admission which responded to 2 sublingual nitroglycerin.
.
In the ED: Tmax 101.5 HR 57 BP 108/40 RR24 O2 sat 100%4L/
EKG showed regular sinus rhythm @70bpm, diffuse ST twave
abnormalities, no change from prior, and frequent pvcs. Labs
showed a troponin of 0.22 (records show it to be chronically
elevated. He was guaiac negative and was given ASA 325 mg x 1.
CXR showed RLL infiltrate. Vancomycin/Levofloxacin were given.
He then had an episode of hypotension with SBP 80s. RIJ and
a-line were placed, he was started on levophed and he was given
a total of 4L NS. Levophed was weaned off at 4:00am. He was
transfused 2U PRBC for hematocrit 23, with post-transfusion hct
28.  He was then transferred to the floor.

MEDICAL HISTORY: 1. CAD - s/p MIs, CABG x2, stents. MI resulting in CHF [**2-/2100**]
and RCA cypher stents placed. Cath [**10-21**] with L subclavian stent
proximal to takeoff of LIMA. Echocard [**10/2102**]: EF 20-25%.
Low hdl syndrome.
2. HTN/bil RAS rx bare stents [**2099**].
3. Gout
4. Prostate nodule with benign bx in past, asymptomatic
5. Chronic decreased vision left eye s/p retinal hemorrhage
6. [**Doctor Last Name 9376**] syndrome
7. Colon adenoma, next colonoscopy due [**2101**]
8. Sexual dysfunction, not a current concern
9. Stage 4 CKD, creat ~3.0
10. Chronic anemia due to renal insufficiency, rx pro-crit
11. AAA, rx endovascular graft repair [**2099**]. MRA [**8-/2100**] was
reviewed by Dr. [**Last Name (STitle) **] and found to be satisfactory
12. PAD with claudication / bilateral iliac stenosis
13. Mitral regurgitation, SBE prophylaxis advised
14. DMII - diet controlled, dx [**2101**]
15. PNA 05
16. R-bicep tendon rupture.
18. Left knee surgery
[**13**]. LBP/sciatica - past
20. Atrial flutter rx cardioversion, [**2101**] / anticoag
21. diverticulosis, ?GIB
22. chemical gastritis thought [**12-16**] ASA/plavix

MEDICATION ON ADMISSION: Calcitriol 0.25 mg qd
Furosemide 40 mg qd
Vitamins, iron not recorded
Procrit 30,000 every 14 days
Carvedilol 6.25 mg [**Hospital1 **]
Nifedipine 30 mg qd
Nifedipine SR 30 mg qd
Lipitor 40 mg qd
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
AMIODARONE 200 mg--1 tablet(s) by mouth once a day
CENTRUM SILVER --1 tablet(s) by mouth once a day
DIOVAN 160 mg--1 tablet(s) by mouth once a day
DOCUSATE SODIUM 100 mg--1 capsule(s) by mouth twice a day as
needed for for constipation
IMDUR 120 mg--1 tablet(s) by mouth daily
Iron (Ferrous Sulfate) 325 mg (65 mg)--one tablet(s) by mouth
twice a day
LIDODERM 5 %(700 mg/patch)--apply 1 patch in the morning, remove

ALLERGIES: Zestril / Penicillins / Integrilin / Hydrochlorothiazide /
Ciprofloxacin

PHYSICAL EXAM: PHYSICAL EXAM:
Vitals - T: 99.8 BP: 142/64 HR: 82 RR: 14 02 sat: 96%
Vent settings: AC, Vt 500, RR 14, PEEP 5, FiO2 100% initially.
GENERAL: Intubated, sedated (prior to intubation, was
tachypneic, cyanotic, in obvious severe respiratory distress).
HEENT: PERRL, MMM, ETT and OGT in place.
CARDIAC: RRR, no m/r/g.
LUNG: Coarse breath sounds b/l, with diffuse wheezes and
bibasilar crackles.
ABDOMEN: +BS, soft, NT/ND.
EXT: 1+ edema b/l. 2+ DP pulses.
SKIN: Dry, no rashes.

FAMILY HISTORY: Father died of an MI at age 53. Son had an MI in his late 40's.

SOCIAL HISTORY: Social history is significant for (-)tobacco use, (+) one glass
of wine every night. Patient is widowed, son lives with him.
Previously worked for [**Company **] as a machinist. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Atrial flutter,Acute kidney failure, unspecified,Chronic kidney disease, Stage IV (severe),Severe sepsis,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Disorders of bilirubin excretion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Mitral valve disorders,Atherosclerosis of native arteries of the extremities with intermittent claudication,Anemia in chronic kidney disease,Congestive heart failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use'}
