CHIEF COMPLAINT: Syncope ? cardiac arrest - cooled as per protocol

PRESENT ILLNESS: 74 yo M with unknown past medical history suffered an episode on
unresponsiveness at a casino, underwent 5 minutes of chest
compressions prior to regaining a pulse without defibrillation,
and was ultimately started on a cooling protocol at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
prior to transfer to our ED.
.
Records of the event and his initial treatment are limited. We
know that he was standing when he collapsed and suffered a minor
laceration to his head. Chest compressions were started
immediately and were continued for 5 minutes prior to rhythm
analysis by an AED which did not advise shock. 300cc NS given by
EMS and he was intubated prior to transport; unknown if any meds
were given by the initial EMS team.
.
At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], cooling protocol was started and pt given a
dilantin load for question of seizure-like activity. NCHCT in
OSH ED showed significant chronic microvascular changes, but
nothing acute. CT PA showed no PE and borderline aneurysmal
dilation of the ascending aorta (4cm). EKG showed atrial
fibrillation with a ventricular response in the 120s, occ PVCs,
IVCD (QRS 120).
.
Pt transported by [**Location (un) **] to [**Hospital1 18**]. Enroute he received 350mg
fentanyl, 8mg pancuronium, 1mg ativan, 20/kg/min propofol.
Cooling continued.
.
In our ED, he received 4.5 g zosyn IV for possible LUL
infiltrate, ASA 325, plavix 300, heparin drip, metoprolol 25 po
x1 and tylenol 1g PR. His EKGs were c/w atypical atrial flutter
with 2:1 conduction. By the time he arrived in the CCU, he had
converted to sinus rhythm.
.
Initial labs were notable for trop 0.23, ck 288, mb pending, cr
1.2, leukocytosis witha left shift, noraml coags.

MEDICAL HISTORY: Pos H pylori 2 weeks before admission, treated with prevacid
pack
Hyperlipidemia
Hypertension

MEDICATION ON ADMISSION: Lisinopril 5mg QD
Prevastatin 80mg QD
Vitamin D unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: alert, oriented x [**3-1**], corrected wrong answers, poor recall
of hospital events.
HEENT: supple, no JVD
CV: RRR, no M/R/G
RESP: crackles left base, no wheezes.
ABD: soft, NT, pos bs
EXTR: feet warm, trace diffuse peripheral edema.
NEURO: no focal defects, speech clear, poor short term memory
but improving distant memory
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: intact
Access: PIV
Tubes: Foley, placed 2 days ago for urinary retention.

FAMILY HISTORY: positive for early cardiac disease

SOCIAL HISTORY: He and his wife own a frame shop
Functionally Independent before admission.
pt is usually active at baseline, plays cards after work, goes
to casino often
WIFE: [**Name (NI) **] [**Known lastname 4777**] [**Telephone/Fax (1) 85049**]
[**Location (un) 4047**], MA ([**Hospital1 **] / [**Hospital1 3597**])
Pneumonia due to Klebsiella pneumoniae,Atrial flutter,Closed fracture of multiple ribs, unspecified,Other specified retention of urine,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Contusion of hip,Leukocytosis, unspecified,Long-term (current) use of aspirin,Other overexertion and strenuous and repetitive movements or loads,Nontraumatic hematoma of soft tissue,Anticoagulants causing adverse effects in therapeutic use
K. pneumoniae pneumonia,Atrial flutter,Fx mult ribs NOS-closed,Oth spcf retention urine,Hyperlipidemia NEC/NOS,Hypertension NOS,Contusion of hip,Leukocytosis NOS,Long-term use of aspirin,Overexert reptv mvmt NEC,Nontrauma hema soft tiss,Adv eff anticoagulants
Admission Date:  [**2130-7-28**]              Discharge Date:   [**2130-8-11**]

Date of Birth:  [**2056-5-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1515**]
Chief Complaint:
Syncope ? cardiac arrest - cooled as per protocol

Major Surgical or Invasive Procedure:
Pulmonary Intubation


History of Present Illness:
74 yo M with unknown past medical history suffered an episode on
unresponsiveness at a casino, underwent 5 minutes of chest
compressions prior to regaining a pulse without defibrillation,
and was ultimately started on a cooling protocol at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
prior to transfer to our ED.
.
Records of the event and his initial treatment are limited. We
know that he was standing when he collapsed and suffered a minor
laceration to his head. Chest compressions were started
immediately and were continued for 5 minutes prior to rhythm
analysis by an AED which did not advise shock. 300cc NS given by
EMS and he was intubated prior to transport; unknown if any meds
were given by the initial EMS team.
.
At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], cooling protocol was started and pt given a
dilantin load for question of seizure-like activity. NCHCT in
OSH ED showed significant chronic microvascular changes, but
nothing acute. CT PA showed no PE and borderline aneurysmal
dilation of the ascending aorta (4cm). EKG showed atrial
fibrillation with a ventricular response in the 120s, occ PVCs,
IVCD (QRS 120).
.
Pt transported by [**Location (un) **] to [**Hospital1 18**]. Enroute he received 350mg
fentanyl, 8mg pancuronium, 1mg ativan, 20/kg/min propofol.
Cooling continued.
.
In our ED, he received 4.5 g zosyn IV for possible LUL
infiltrate, ASA 325, plavix 300, heparin drip, metoprolol 25 po
x1 and tylenol 1g PR. His EKGs were c/w atypical atrial flutter
with 2:1 conduction. By the time he arrived in the CCU, he had
converted to sinus rhythm.
.
Initial labs were notable for trop 0.23, ck 288, mb pending, cr
1.2, leukocytosis witha left shift, noraml coags.


Past Medical History:
Pos H pylori 2 weeks before admission, treated with prevacid
pack
Hyperlipidemia
Hypertension

Social History:
He and his wife own a frame shop
Functionally Independent before admission.
pt is usually active at baseline, plays cards after work, goes
to casino often
WIFE: [**Name (NI) **] [**Known lastname 4777**] [**Telephone/Fax (1) 85049**]
[**Location (un) 4047**], MA ([**Hospital1 **] / [**Hospital1 3597**])


Family History:
positive for early cardiac disease

Physical Exam:
Gen: alert, oriented x [**3-1**], corrected wrong answers, poor recall
of hospital events.
HEENT: supple, no JVD
CV: RRR, no M/R/G
RESP: crackles left base, no wheezes.
ABD: soft, NT, pos bs
EXTR: feet warm, trace diffuse peripheral edema.
NEURO: no focal defects, speech clear, poor short term memory
but improving distant memory
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: intact
Access: PIV
Tubes: Foley, placed 2 days ago for urinary retention.


Pertinent Results:
[**2130-8-10**] 06:30AM BLOOD WBC-14.6* RBC-2.85* Hgb-8.8* Hct-26.1*
MCV-91 MCH-30.7 MCHC-33.6 RDW-15.4 Plt Ct-477*
[**2130-8-9**] 04:59AM BLOOD WBC-15.4* RBC-3.06* Hgb-9.5* Hct-27.7*
MCV-90 MCH-31.0 MCHC-34.3 RDW-15.1 Plt Ct-465*
[**2130-8-8**] 05:45AM BLOOD WBC-15.8* RBC-2.98* Hgb-9.2* Hct-27.0*
MCV-91 MCH-30.7 MCHC-33.9 RDW-15.1 Plt Ct-346
[**2130-7-28**] 08:50PM BLOOD WBC-18.4* RBC-5.29 Hgb-16.1 Hct-49.9
MCV-94 MCH-30.5 MCHC-32.3 RDW-13.8 Plt Ct-215
[**2130-8-10**] 06:30AM BLOOD Glucose-110* UreaN-21* Creat-1.0 Na-139
K-4.1 Cl-103 HCO3-29 AnGap-11
[**2130-8-9**] 04:59AM BLOOD Glucose-122* UreaN-18 Creat-1.0 Na-137
K-3.6 Cl-99 HCO3-28 AnGap-14
[**2130-7-28**] 08:50PM BLOOD Glucose-106* UreaN-17 Creat-1.2 Na-140
K-3.8 Cl-107 HCO3-23 AnGap-14
[**2130-8-4**] 06:00AM BLOOD ALT-58* AST-93* LD(LDH)-338* AlkPhos-49
TotBili-0.3
[**2130-7-28**] 08:50PM BLOOD ALT-61* AST-87* CK(CPK)-288 AlkPhos-69
TotBili-0.6
[**2130-7-29**] 06:07PM BLOOD CK-MB-29* MB Indx-9.5*
[**2130-7-29**] 11:22AM BLOOD CK-MB-30* MB Indx-8.7* cTropnT-0.29*
[**2130-7-29**] 02:03AM BLOOD CK-MB-26* MB Indx-6.8* cTropnT-0.44*
[**2130-8-10**] 06:30AM BLOOD Calcium-8.8 Phos-3.8 Mg-2.0 Iron-PND
.
Carotid ultrasound [**8-7**]:
FINDINGS: Minimal calcific plaque at the origin of both internal
carotid
arteries. The peak systolic velocities bilaterally are normal as
are the
ICA/CCA ratios. There is normal antegrade flow involving both
vertebral
arteries.
IMPRESSION: Minimal bilateral ICA plaque, no appreciable
associated stenosis,
however (graded as less than 40%).
.
ECHO [**8-7**]:
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thicknesses and cavity size are normal. There
is mild regional left ventricular systolic dysfunction with
hypokinesis/dysnnchrony of the inferior and inferiolateral
walls. The remaining segments contract normally (LVEF = 45-50
%). The estimated cardiac index is normal (>=2.5L/min/m2). Right
ventricular chamber size and free wall motion are normal. The
aortic root is moderately dilated at the sinus level. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. No aortic regurgitation is seen. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no mitral valve prolapse. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.

Compared with the prior study (images reviewed) of [**2130-7-29**],
biventricular systolic function is much improved with mild
residual regional dysfunction.
.
CT Chest/ABD/Pelvis [**8-5**]:
IMPRESSION:

1. Moderate-sized bilateral psoas hematomas extending into right
iliopsoas
muscle.
2. Minimally displaced fractures involving the right third
through eleventh
ribs and left third through sixth ribs.
3. Cholelithiasis without secondary findings of acute
cholecystitis.
4. Bilateral predominantly hypoattenuating renal lesions some of
which are
too small to definitely characterize and others which are
clearly simple
cysts. Largest 3cm lesion on the right appears more solid and
can be better assessed with a dedicated renal ultrasound on a
non-emergent basis to evaluate for renal cell carcinoma.
5. Mild-to-moderate bilateral pleural effusions with probable
adjacent
compression atelectasis. Superinfection cannot be excluded and
should be
correlated with clinical suspicion for underlying pneumonia.
6. Single 2-mm left upper lobe pulmonary nodule. If patient is
at high risk for intrathoracic malignancy this can be followed
with a follow-up chest CT in one year otherwise no further
surveillance is necessary [**First Name8 (NamePattern2) **] [**Last Name (un) 8773**] Society guidelines.
.
ECG [**8-9**]:
Sinus rhythm. Occasional ventricular premature beats. Compared
to the previous
tracing of [**2130-8-8**] no definite change.


Brief Hospital Course:
This 74-year-old male was initially admitted following an
episode of collapse while at a casino. It is unclear whether
this was a cardiac arrest but after 5 minutes of CPR there was
evidence of a pulse and AED showed a viable rhythm with no shock
advised. He was never defibrillated. During his fall, he hit his
head and sustained a minor laceration to his forehead. At the
OSH he was intubated and cooled as per protocol and loaded with
phenytoin for ? seizures, a CT-head showed only small vessel
disease with no acute changes. In addition, CT-[**MD Number(3) 85050**] OSH
showed no evidence of PE and a borderline dilation of the aorta.
ECG showed AF in 120s. He was tehn transported via [**Location (un) **] to
teh [**Hospital1 18**] ED and was given a stat dose of Pip/Tazo 4.5g IV for
LUL infiltrates present on CXR, was loaded with aspirin 325mg
and clopidogrel 300mg, commenced on a heparin infusion and
metoprolol was started. At this point ECG shoewd AF/A-flutter w/
2:1 block and he was transferred to the CCU. Initial cardiac
enzymes were TnT 0.44 CK-MB 26. And treatment for possible
pneumonia was continued. He was cooled for 24-hours and there
was no evidence of seizure activity on EEG following neurology
review. An echo performed in the context of cooling showed a
mildly dilated LA and severe biventricular systolic dysfunction
with LVEF <20%. When paralytics were weaned, Mr [**Known lastname **] was seen
to be shaking and tehre was no EEG correlate to suggest
seizures. He was weaned off ventilatory supportand CXR showed
resolution of the pulmonary infiltrates. Continued EEG
monitoring was discontinued and neurology were happy that there
was no evidence of seizures. He was extubated on [**2130-8-1**] and
was neurologically appropriate. He required IV hydralazine for
labile BP and his metoprolol was up-titrated. His HB also was
noted to trend down and although stool was guaiac -ve it was
gastroccult +ve and pepcid was changed to PPI. Klebsiella was
grown on sputum from [**2130-8-2**] and IV ceftiaxone was started. He
was weaned off the NG tube and by [**8-4**] passed swallow assessment
and was able to eat and drink. He had mild pulmonary edema
requiring Iv furosemide. Labetalol IV was titrated to BP and
weaned. He complained of rib pain and a CT-chest showed
bilateral psoas hematomas and minimally displaced rib fractures
on 3rd to 11th ribs on R and 3rd to 6th ribs on the left. This
also demonstrated bilateral renal cysts including the largest on
the R which was more solid measuring 34x36mm and suggested o/p
U/S to visualise. In addition there was evidence of bilateral
pleural effusions and a 4mm L upper lobe pulmonary nodule which
should be followed up with a repeat CT in 1 year. He
subsequently developed delirium which required PRN haloperidol
and there was no recurrence of his AF. He pulled out his urinary
catheter on [**2130-8-7**] and failed trial without catheter
resulting in replacement. A repeat echo on [**2130-8-7**] was much
improved with mild regional left ventricular systolic
dysfunction with hypokinesis/dysnnchrony of the inferior and
inferiolateral walls and LVEF 45-50%. Due to a rising WBC of 14
and positive urinalysis he was commenced on oral ciprofloxacin
for a presumed UTI. There was evidence of a mild R carotid buit
and carotid U/S demonstrated  mild bilateral disease. He was
commence on amiodarone and warfarin and ECG showed persistent SR
and PVCs. His confusion improved and he had a trial without
catheter on [**8-11**] which was successful and was transferred to
rehab.

# Neurological ?????? Mr [**Known lastname **] was thought initially to be
potentially having seizures and was loaded with phenytoin
although there was no EEG evidence of this. On neurology review,
they were happy that he was not having seizures and one episode
of shaking post weaning sedation was felt to represent rigors.
Following extubation, Mr [**Known lastname **] improved well neurologically
although he developed a delirium picture which was presumed
likely secondary to acute illness. Head CT at the outside
hospital showed no acute changes and although urinalysis x1 was
positive, there has been no growth on urine culture. He also had
urinary retention and the feeling was that this is likely
contributing, as patient??????s mental status significantly improved
after Foley was placed. Patient completed course of ceftriaxone
after sputum culture positive for Klebsiella and CT showed
atelectasis but no frank consolidation, in addition patient has
no clinical signs and symptoms of pneumonia. Haloperidol was
used PRN and he required minimal doses. On discharge he was only
very mildly confused and generally oriented.
.
#. Cardiac arrest: Mr [**Known lastname **] had a collapse while standing at a
casino where he had 5 minutes of CPR and AED showed no shockable
rhythm. It is unknown if pt was truly pulseless or merely
unresponsive. He was cooled as per protocol and although initial
echo while cooled showed a depressed EF <20%, post-rewarming,
this had increased to 40-45% which is very reassuring. Cardiac
enzymes peaked at 0.44 on admission and have trended down since.
No shocks were given throughout course. Only documented rhythms
were AFIB/A-flutter, although has latterly been in sinus. He was
given a loading dose of aspirin and clopidogrel and has been
continued on these. He was commenced on warfarin and will be
slowly increased with INR as of [**8-11**] 1.3.
.
#HTN: Very good BP control latterly although required IV
labetalol/hydralazine as above for labile BP. We will continue
on HCTZ, Lisinopril and toprol.
.
# Afib/A-flutter. On presentation to [**Hospital1 18**] Mr [**Known lastname **] was found
to be in AF/A-Flutter and this has not persisted he was started
on amiodarone [**8-9**] and warfarin was loaded although his INRs
latterly have been low and he will likely need an increased
dose. He need close INR monitoring and we are aiming for a goal
range INR [**3-1**]. We will continue Toprol XL. On discharge he was
in SR with PVCs.
.
# New carotid bruit noted - A new right carotid bruit was noted
on [**8-7**] and Carotid series revealed minimal bilateral ICA
plaque, with no appreciable stenosis (graded as less than 40%)
and therefore there is no need for intervention at this time
.
# Rib/hip pain: Pt is s/p CPR and continues to have pain in
hip/lower abdominal area. CT scan shows psoas hematomas which
may be contributing to pain and multiple minimally displaced
bilateral rib fractures. Mr [**Known lastname **] pain has been improving.
.
# New CT-findings. On CT-C/A/P there was evidence of bilateral
renal cysts, the largest on the R which was more solid measuring
34x36mm and suggested o/p U/S to which should be arranged. In
addition there was evidence of bilateral pleural effusions and a
4mm L upper lobe pulmonary nodule which should be followed up
with a repeat CT in 1 year given his smoking history.
.
#Anemia ?????? Mr [**Known lastname **] was noted to have a small drop in HCt and
this was trended and now stable. It is unclear whether this may
be due to poor nutritional state and freq phlebotomy although
guaiac stool was -ve, there was positive guiaic of gastric
contents while intubated. He has now been started on a PPI which
has been increased to [**Hospital1 **]. Of note he was rrecently treated for
H Pylori according to wife so this may also be contributing.
.
# Leukocytosis: Mr [**Known lastname **] had pulmonary infiltrates on CXR and
was treated initially with a stat dose of Pip/Tazo and latterly
ceftriaxone when cultures of sputum grew Klebsiella. He had
previously had low grade temps and has now been apyrexial. Most
recently CXR showed atelectasis with no frank consolidation. All
further cultures and BCs have been negative. He was started on
ciprofloxacin for ? UTI when urinalysis was positive.
.
# Urinary retention: Pt pulled out Foley catheter and subsequent
to re-insertion had urinary retention which resolves. He was
voiding post trial without catheter on [**8-11**] although if he does
go back into retention he will clearly need further
catheterisation and urology follow-up. He was commenced on
tamsulosin.
.
# Dyslipidemia: continue high dose statin

Medications on Admission:
Lisinopril 5mg QD
Prevastatin 80mg QD
Vitamin D unknown dose


Discharge Medications:
1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day:
Hold SBP < 100.
3. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
4. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times
a day) for 5 days: Last day is [**8-15**], then decrease to 200 mg
daily on [**2130-8-16**].
6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/fever.
8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
9. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4
PM.
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Rehab Hospital @ [**Location (un) 4047**]

Discharge Diagnosis:
Possible cardiac arrest
Atrial Fibrillation/Flutter
Pneumonia - klebsiella on sputum
Urinary Retention


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You collapsed and received CPR on [**2130-7-28**]. It is unclear if your
heart stopped but you did not receive a shock that we know of.
some ribs were cracked during the CPR. You had a small heart
attack during this episode. We treated you for a pneumonia with
intravenous antibiotics. You also developed a blood collection
in your pelvis from the blood thinners, this is getting better.
Your blood count is low because of the pelvic bleeding and some
bleeding in your bowels. You could not urinate after we took the
foley catheter out of your bladder so we replaced it and started
you on a medicine called Flomax to help shrink your prostate. We
took the catheter out on [**2130-8-11**] although if you are further
unable to pass urine you will have to have the catheter
re-inserted and will have to be seen by urology as an
outpatient.
Medication changes:
1. Stop taking Pravastatin, start Atorvastatin instead to lower
your cholesterol
2. Increase Lisinopril to 40 mg to lower your blood pressure
3. Start Hydrchlorothiazide to lower your blood pressure
4. Metoprolol Succinate
5. Start Amiodarone
6. Start Haldol to help you relax if you feel anxious
7. Start pantoprazole to protect your stomach
8. Start Aspirin to prevent blood clots
9. Start Coumadin to prevent a stroke from your atrial
fibrillation. You will need to have blood drawn frequently to
make sure the level is not too high or too low.
10. Start Tamulosin to help you urinate
11. Start tylenol as needed for the rib pain
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs in 1 day or 6 pounds in 3 days.

Followup Instructions:
Department: CARDIAC SERVICES
When: TUESDAY [**2130-9-19**] at 9:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Pneumonia due to Klebsiella pneumoniae,Atrial flutter,Closed fracture of multiple ribs, unspecified,Other specified retention of urine,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Contusion of hip,Leukocytosis, unspecified,Long-term (current) use of aspirin,Other overexertion and strenuous and repetitive movements or loads,Nontraumatic hematoma of soft tissue,Anticoagulants 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: Syncope ? cardiac arrest - cooled as per protocol

PRESENT ILLNESS: 74 yo M with unknown past medical history suffered an episode on
unresponsiveness at a casino, underwent 5 minutes of chest
compressions prior to regaining a pulse without defibrillation,
and was ultimately started on a cooling protocol at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
prior to transfer to our ED.
.
Records of the event and his initial treatment are limited. We
know that he was standing when he collapsed and suffered a minor
laceration to his head. Chest compressions were started
immediately and were continued for 5 minutes prior to rhythm
analysis by an AED which did not advise shock. 300cc NS given by
EMS and he was intubated prior to transport; unknown if any meds
were given by the initial EMS team.
.
At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], cooling protocol was started and pt given a
dilantin load for question of seizure-like activity. NCHCT in
OSH ED showed significant chronic microvascular changes, but
nothing acute. CT PA showed no PE and borderline aneurysmal
dilation of the ascending aorta (4cm). EKG showed atrial
fibrillation with a ventricular response in the 120s, occ PVCs,
IVCD (QRS 120).
.
Pt transported by [**Location (un) **] to [**Hospital1 18**]. Enroute he received 350mg
fentanyl, 8mg pancuronium, 1mg ativan, 20/kg/min propofol.
Cooling continued.
.
In our ED, he received 4.5 g zosyn IV for possible LUL
infiltrate, ASA 325, plavix 300, heparin drip, metoprolol 25 po
x1 and tylenol 1g PR. His EKGs were c/w atypical atrial flutter
with 2:1 conduction. By the time he arrived in the CCU, he had
converted to sinus rhythm.
.
Initial labs were notable for trop 0.23, ck 288, mb pending, cr
1.2, leukocytosis witha left shift, noraml coags.

MEDICAL HISTORY: Pos H pylori 2 weeks before admission, treated with prevacid
pack
Hyperlipidemia
Hypertension

MEDICATION ON ADMISSION: Lisinopril 5mg QD
Prevastatin 80mg QD
Vitamin D unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: alert, oriented x [**3-1**], corrected wrong answers, poor recall
of hospital events.
HEENT: supple, no JVD
CV: RRR, no M/R/G
RESP: crackles left base, no wheezes.
ABD: soft, NT, pos bs
EXTR: feet warm, trace diffuse peripheral edema.
NEURO: no focal defects, speech clear, poor short term memory
but improving distant memory
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: intact
Access: PIV
Tubes: Foley, placed 2 days ago for urinary retention.

FAMILY HISTORY: positive for early cardiac disease

SOCIAL HISTORY: He and his wife own a frame shop
Functionally Independent before admission.
pt is usually active at baseline, plays cards after work, goes
to casino often
WIFE: [**Name (NI) **] [**Known lastname 4777**] [**Telephone/Fax (1) 85049**]
[**Location (un) 4047**], MA ([**Hospital1 **] / [**Hospital1 3597**]) 

### Response:
{'Pneumonia due to Klebsiella pneumoniae,Atrial flutter,Closed fracture of multiple ribs, unspecified,Other specified retention of urine,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Contusion of hip,Leukocytosis, unspecified,Long-term (current) use of aspirin,Other overexertion and strenuous and repetitive movements or loads,Nontraumatic hematoma of soft tissue,Anticoagulants causing adverse effects in therapeutic use'}
