CHIEF COMPLAINT: Tachypnea/OSH transfer for cathterization

PRESENT ILLNESS: 34 year old F with Angelman's syndrome and baseline mental
retardation developed tachypnea at group home on day of
admission.  911 was called and she was taken to an OSH ED at
4PM.  Per her caretakers, she had spiked a fever to 104 F on the
day PTA and seemed lethargic.  On the day of admission, she
remained in bed until 2PM and then was noted to be tachypnic.
Upon arrival to the ER, she had sinus tach to 160s.  EKG
revealed ST elevation in V2-V5.  She was given Lopressor 5 mg IV
x3, heparin bolus and gtt, plavix 600 mg, aspirin 325 mg.  Her
BP then fell to 68/43 with HR 120s, satting 92% 4L NC.  She was
given IVF bolus and started on dobutamine before being
transferred to [**Hospital1 18**] for catheterization and treatment.
.
In the cath lab, she was found to have 100% occlusion of the
proximal LAD.  No intervention was performed as the infarction
was likely several days old with the myocardium no long viable.
She was in cardiogenic shock with cardiac index of 1.7 and PCWP
27. A Balloon pump placed.  BP was labile and decreased with
versed; she was started on levophed.  She was satting 100% on
NRB.
.
Due to her MR, we were unable to obtain ROS directly from the
patient.  However, per her caretakers, she had increased
lethargy over the last few weeks with decreased PO intake.  She
had a UTI few weeks ago and was treated with a course of Bactrim
and then cirpofloxacin for ten days.  Her psychiatrist recently
started [**Hospital1 74959**] for mood stabilization.

MEDICAL HISTORY: Cardiac Risk Factors: -Diabetes, -Dyslipidemia, -Hypertension
.
Cardiac History: NONE
.
Other PMH:
Mental Retardation
Seizure disorder (?--listed in chart, but questionable per
caretakers, [**Name (NI) 74959**] added recently for mood)
Recurrent UTIs

MEDICATION ON ADMISSION: Buspar 30 mg [**Hospital1 **]
Cipro 500 [**Hospital1 **]- Day 1 [**2147-2-25**]
Fish oil 1 g TID
Mirtazapine-30 mg qHS
MVI
[**Month/Day/Year **] 150 mg [**Hospital1 **]
Lactulose PRN
SEASONALE (oral contraception)
Tylenol PRN
Pamprin Cramp relief PRN (acetominophen, Magnesium salicylate,
pamabrom (diuretic))
Dimetapp PRN
Robutussin PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION:
VS: T 100.0 (ax) , BP 94/69*, HR 126, RR 20, O2 96% on RA
*IABP 1:1 Assisted Systole 90 Augmented Diastole 91 BAEDP 64
IABP mean 81
Gen: WDWN female, agitated, yelling, in 4 point restraints, not
ill appearing.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with distended neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachy, RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Exam
limited by pt positioning, agitation, grossly clear to
auscultation anteriorally.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits or hematoma b/l. Sheath/IABP in
L groin.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: Family history unknown.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Pt resides in group
home.
Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Pneumonia, organism unspecified,Pulmonary collapse,Other specified congenital anomalies,Coronary atherosclerosis of native coronary artery,Unspecified intellectual disabilities,Other convulsions
AMI anterolateral, init,Cardiogenic shock,Pneumonia, organism NOS,Pulmonary collapse,Specfied cong anomal NEC,Crnry athrscl natve vssl,Intellect disability NOS,Convulsions NEC
Admission Date:  [**2147-3-7**]              Discharge Date:   [**2147-3-18**]

Date of Birth:  [**2112-10-29**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Tachypnea/OSH transfer for cathterization

Major Surgical or Invasive Procedure:
Cardiac catheterization with placement of an intra-aortic
balloon pump
midline catheter placed.

PICC line placement in left arm.


History of Present Illness:
34 year old F with Angelman's syndrome and baseline mental
retardation developed tachypnea at group home on day of
admission.  911 was called and she was taken to an OSH ED at
4PM.  Per her caretakers, she had spiked a fever to 104 F on the
day PTA and seemed lethargic.  On the day of admission, she
remained in bed until 2PM and then was noted to be tachypnic.
Upon arrival to the ER, she had sinus tach to 160s.  EKG
revealed ST elevation in V2-V5.  She was given Lopressor 5 mg IV
x3, heparin bolus and gtt, plavix 600 mg, aspirin 325 mg.  Her
BP then fell to 68/43 with HR 120s, satting 92% 4L NC.  She was
given IVF bolus and started on dobutamine before being
transferred to [**Hospital1 18**] for catheterization and treatment.
.
In the cath lab, she was found to have 100% occlusion of the
proximal LAD.  No intervention was performed as the infarction
was likely several days old with the myocardium no long viable.
She was in cardiogenic shock with cardiac index of 1.7 and PCWP
27. A Balloon pump placed.  BP was labile and decreased with
versed; she was started on levophed.  She was satting 100% on
NRB.
.
Due to her MR, we were unable to obtain ROS directly from the
patient.  However, per her caretakers, she had increased
lethargy over the last few weeks with decreased PO intake.  She
had a UTI few weeks ago and was treated with a course of Bactrim
and then cirpofloxacin for ten days.  Her psychiatrist recently
started [**Hospital1 74959**] for mood stabilization.


Past Medical History:
Cardiac Risk Factors: -Diabetes, -Dyslipidemia, -Hypertension
.
Cardiac History: NONE
.
Other PMH:
Mental Retardation
Seizure disorder (?--listed in chart, but questionable per
caretakers, [**Name (NI) 74959**] added recently for mood)
Recurrent UTIs

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Pt resides in group
home.


Family History:
Family history unknown.


Physical Exam:
ADMISSION PHYSICAL EXAMINATION:
VS: T 100.0 (ax) , BP 94/69*, HR 126, RR 20, O2 96% on RA
*IABP 1:1 Assisted Systole 90 Augmented Diastole 91 BAEDP 64
IABP mean 81
Gen: WDWN female, agitated, yelling, in 4 point restraints, not
ill appearing.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with distended neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachy, RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Exam
limited by pt positioning, agitation, grossly clear to
auscultation anteriorally.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits or hematoma b/l. Sheath/IABP in
L groin.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP



Pertinent Results:
ADMISSION LABS:
[**2147-3-7**] 07:30PM BLOOD WBC-16.5* RBC-3.99* Hgb-11.9* Hct-34.5*
MCV-87 MCH-29.8 MCHC-34.4 RDW-13.3 Plt Ct-373
[**2147-3-7**] 07:30PM BLOOD Neuts-80* Bands-5 Lymphs-12* Monos-3
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2147-3-7**] 07:30PM BLOOD Plt Smr-NORMAL Plt Ct-373
[**2147-3-7**] 09:53PM BLOOD PT-14.3* PTT-38.9* INR(PT)-1.2*
[**2147-3-7**] 07:30PM BLOOD Glucose-177* UreaN-13 Creat-1.2* Na-132*
K-4.3 Cl-100 HCO3-22 AnGap-14
[**2147-3-7**] 07:30PM BLOOD ALT-88* AST-238* CK(CPK)-380* AlkPhos-46
Amylase-27 TotBili-0.4
[**2147-3-7**] 07:30PM BLOOD CK-MB-42* MB Indx-11.1* cTropnT-7.39*
[**2147-3-7**] 07:30PM BLOOD Albumin-3.1* Calcium-8.5
[**2147-3-7**] 07:30PM BLOOD %HbA1c-6.2*
[**2147-3-7**] 07:39PM BLOOD Type-ART pO2-155* pCO2-28* pH-7.48*
calTCO2-21 Base XS-0 Intubat-NOT INTUBA Comment-O2 DELIVER
[**2147-3-7**] 07:39PM BLOOD Glucose-158* Lactate-1.7 Na-135 K-4.3
Cl-103
[**2147-3-7**] 07:39PM BLOOD Hgb-12.7 calcHCT-38 O2 Sat-98
[**2147-3-7**] 07:39PM BLOOD freeCa-1.04*
.
URINE STUDIES:
[**2147-3-7**] 09:53PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.024
[**2147-3-7**] 09:53PM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-250 Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2147-3-7**] 09:53PM URINE RBC-0-2 WBC-[**4-12**] Bacteri-OCC Yeast-NONE
Epi-[**4-12**]
[**2147-3-7**] 09:53PM URINE CastGr-0-2 CastHy-[**7-18**]*
.
MICROBIOLOGY:
[**2147-3-7**] Urine culture: NGTD
[**2147-3-9**] Urine culture: 4000 CFU's Gram positive bacteria
[**2147-3-10**] Urine culture: 10,000 - 100,000 CFu's Gram positive
bacteria
[**3-12**], [**2147-3-16**] Urine cultures: NGTD
[**2147-3-9**] Influenza DFA: negative
[**3-8**], [**3-8**], [**3-10**], [**3-11**], [**3-12**], [**3-15**], [**2147-3-16**] Blood cultures: NGTD
.
EKG demonstrated sinus tach at 123 with Left axis, incomplete
RBBB, ST elevation in II, V2-V5, TWI I, aVL.
.
[**2147-3-7**] CARDIAC CATHETERIZATION:
1.  Selective coronary angiography of this left dominant system
revealed
single vessel coronary artery disease.  The LMCA had no
angiographically
significant coronary artery disease.  The LAD had a total
proximal
occlusion, with distal vessel injection revealing an atretic
vessel with
contrast pooling in the myocardium.
2.  Resting hemodynamics revealed elevated left and right sided
filling
pressures with RVEDP of 16 mm Hg and PCWP mean of 25 mm Hg.
There was
mild pulmonary arterial hypertension of 39/29 mm Hg.  There was
evidence
of cardiogenic shock with a cardiac index of 1.8 l/min/m2.
There was
systemic arterial hypotension of 96/76 mm Hg.
3.  Left ventriculogrpahy was deferred.
4. Distal injection past the occusion in LAD consistent with
myocardial
infarction of greater than 48 hours duration with non-viable
myocardium.
5. Placement of IABP for cardiogenic shock
6. Difficult initial access requiring use of smart needle to
access LFA.
FINAL DIAGNOSIS:
1. Single vessel coronary artery disease.
2. Cardiogenic shock.
3. Systemic hypotension.
4. Placement of IABP
.
[**2147-3-8**] TTE: EF 25%
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
are normal. The left ventricular cavity size is normal. There is
severe regional left ventricular systolic dysfunction with
septal, anterior and apical akinesis. The basal to mid inferior
and lateral walls are hyperdynamic. No masses or thrombi are
seen in the left ventricle. There is no ventricular septal
defect. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion.
.
[**2147-3-16**] TTE: EF 30%
The left atrium is elongated. Left ventricular wall thicknesses
are normal. The left ventricular cavity size is top
normal/borderline dilated. Overall left ventricular systolic
function is moderately-to-severely depressed (LVEF= 30 %)
secondary to akinesis of the interventricular septum and
anterior free wall, and dyskinesis of the apex. There is no
ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. 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 left ventricular inflow pattern suggests a
restrictive filling abnormality, with elevated left atrial
pressure. There is mild pulmonary artery systolic hypertension.
There is no pericardial effusion. Compared with the findings of
the prior study (images reviewed) of [**2147-3-8**], the
findings are similar.
.
[**2147-3-11**] CXR:
There is a region of patchy alveolar infiltrate in the left
upper lobe.  Otherwise lungs are clear.
.
[**2147-3-16**] CXR:
1.  New mild pulmonary edema.
2.  Left retrocardiac opacity slightly worse since last exam;
this may
represent atelectasis, pneumonia, or both.

Brief Hospital Course:
(1) MYOCARDIAL INFARCTION
Ms. [**Known lastname 74960**] is without known history of cardiac disease and
has few cardiac risk factors.  She did start a OCP's several
months ago, which appears to be her only risk factor for an MI.
On cardiac catheterization from [**2147-3-7**], she was found to have a
100% stenosis of the LAD; no intervention was performed as it
was thought that her MI had occurred 3-4 days prior to admission
and the myocardium was dead by the time of catheterization.
.
Her course was complicated by cardiogenic shock, for which she
was temporarily treated with an intra-aortic balloon pump,
levophed and milrinone.  She was eventually weaned off all
these.  She was started on aspirin, atorvastatin and digoxin,
and OCP's were discontinued.  Low dose metoprolol tartrate and
captopril were started once blood pressures normalized, and she
was discharged on metoprolol succinate 100 mg PO QAM, lisinopril
10 mg QPM, spironolactone 25 mg PO QD, and digoxin 0.125 mg PO
daily.  She remained in sinus tachycardia with HR 100 - 120's
for most of the admission.
.
TTE was performed on [**2147-3-8**] and showed an EF of 25% with
septal, anterior and apical akinesis.  A repeat TTE was
performed on [**2147-3-16**] to assess for interval improvement, but
there was no change in cardiac function.
.
She was also discharged on coumadin for prophylaxis against LV
thrombus given the location and extent of her infarction.  INR
was labile while in the hospital and must be followed closely as
an out-patient until it stabilizes.
.
She was also discharged on lasix 40 mg PO QD to maintain an even
fluid balance with her cardiac disease.
.
(2) FEVERS and LEUKOCYTOSIS
She had a low-grade temperature throughout her hospitalization.
Prior to admission, she was treated with a full course of
ciprofloxacin for a UTI.  Unfortunately, she was not able to
confirm or refute localizing symptoms because of her baseline
mental retardation, and her clinical exam never revealed a
source of infection.  Furthermore, all blood cultures were
negative, and urine cultures grew gram positive bacteria which
were thought to be a colonizer (given her negative UA's and low
CFU count).  She was put on a five day course of vancomycin
empirically for possible line infection (it was thought that
maybe she had transient bacteremia from the catherization
instrumentation, even thought cultures were negative).  She was
also put on a five day course of azithromycin for a possible
community acquired PNA given a LUL infiltrate on CXR.  After the
course of azithromycin, her fevers persisted and there was
worsening of the left retrocardiac opacity.  She was started on
a seven day course of IV cefepime and vancomycin for hospital
acquired pneumonia.  A PICC line was placed in the left arm on
[**2147-3-18**] for out-patient administration of IV antibiotics.
.
.
(3) POSSIBLE ANTI-PHOSPHOLIPID ANTIBODIES
It was noted that her PTT was elevated throughout her admission
(ranging mostly in the 50 - 60's) and there was concern for
antiphospholipid antibody syndrome, especially given her MI at a
young age and with few cardiac risk factors.  Testing for
antiphospholipid antibodies was deferred in the in-patient
setting because of possible false positive results with acute
illness and anticoagulation.  This should be tested as an
out-patient once she is off anticoagulation.
.
.
.
ISSUES FOR FOLLOW-UP:
(1) Follow PTT with possible testing for antiphospholipid
antibodies after anticoagulation is discontinued.  Testing for
APL antibodies was deferred during this admission because of
concern for false results with anticoagulation and in the
setting of acute illness.
(2) INR was labile in throughout the admission and needs to be
followed twice a week as an out-patient until stable.
(3) OCP's were discontinued for increased clotting risk
associated with their use.
(4) Pull PICC after completion of IV antibiotics.

Medications on Admission:
Buspar 30 mg [**Hospital1 **]
Cipro 500 [**Hospital1 **]- Day 1 [**2147-2-25**]
Fish oil 1 g TID
Mirtazapine-30 mg qHS
MVI
[**Month/Day/Year **] 150 mg [**Hospital1 **]
Lactulose PRN
SEASONALE (oral contraception)
Tylenol PRN
Pamprin Cramp relief PRN (acetominophen, Magnesium salicylate,
pamabrom (diuretic))
Dimetapp PRN
Robutussin PRN


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Omega-3 Fatty Acids 240-360-5 mg-mg-unit Capsule Sig: One (1)
Capsule PO TID (3 times a day).
4. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Oxcarbazepine 300 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. BuSpar 30 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO at bedtime.

11. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
12. Lactulose 10 gram Packet Sig: [**2-8**] Packets PO twice a day as
needed for constipation.
13. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
14. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain, fever.
15. Vancomycin 1,000 mg Recon Soln Sig: One (1) gram Intravenous
Q 12H (Every 12 Hours) for 6 days.
16. Cefepime 2 gram Recon Soln Sig: Two (2) grams Injection Q12H
(every 12 hours) for 6 days.
17. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Primary
1. ST elevation myocardial infarction
2. Cardiogenic shock
3. Pneumonia
Secondary
1. Mental retardation


Discharge Condition:
Stable - ambulating without difficulty and without getting short
of breath.  Appears comfortable and at baseline mental status.


Discharge Instructions:
You were admitted to [**Hospital1 18**] for a heart attack. You underwent a
cardiac catheterization, which showed that you had already had a
heart attack. A balloon pump was placed for shock from the heart
attack, which was then weaned off as you were placed on the
appropriate medications. You did well after you were extubated
and weaned off the balloon pump.
.
You should take all your medications as prescribed. You should
follow-up at the appointments listed below. Please return to the
emergency department if [**Known firstname **] becomes severely short of breath,
has trouble breathing or complains of chest pain.
.
Please take all of your medications as directed.

Your INR should be closely monitored given that your coumadin
level is being adjusted.

Followup Instructions:
PCP [**Name Initial (PRE) 648**]: (Dr. [**Last Name (STitle) 29721**] Wednesday, [**2147-3-29**] @
9:30AM. Phone: [**Telephone/Fax (1) 74961**]. At that time you should have your
blood electrolyte and kidney function checked.  You should also
discuss a work-up of antiphospholipid syndrome with you doctor
after you are off blood thinners.  You may need to be referred
to a hematologist.
.
Cardiology: You should follow-up with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **] on
Thursday, [**2147-3-30**], @ 9:30AM.
Location: [**Location (un) **] ([**Location (un) 5069**]), [**Location (un) **];
[**Location (un) 86**], [**Numeric Identifier 6422**]
Phone: [**Telephone/Fax (1) 5068**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Pneumonia, organism unspecified,Pulmonary collapse,Other specified congenital anomalies,Coronary atherosclerosis of native coronary artery,Unspecified intellectual disabilities,Other convulsions'}


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: Tachypnea/OSH transfer for cathterization

PRESENT ILLNESS: 34 year old F with Angelman's syndrome and baseline mental
retardation developed tachypnea at group home on day of
admission.  911 was called and she was taken to an OSH ED at
4PM.  Per her caretakers, she had spiked a fever to 104 F on the
day PTA and seemed lethargic.  On the day of admission, she
remained in bed until 2PM and then was noted to be tachypnic.
Upon arrival to the ER, she had sinus tach to 160s.  EKG
revealed ST elevation in V2-V5.  She was given Lopressor 5 mg IV
x3, heparin bolus and gtt, plavix 600 mg, aspirin 325 mg.  Her
BP then fell to 68/43 with HR 120s, satting 92% 4L NC.  She was
given IVF bolus and started on dobutamine before being
transferred to [**Hospital1 18**] for catheterization and treatment.
.
In the cath lab, she was found to have 100% occlusion of the
proximal LAD.  No intervention was performed as the infarction
was likely several days old with the myocardium no long viable.
She was in cardiogenic shock with cardiac index of 1.7 and PCWP
27. A Balloon pump placed.  BP was labile and decreased with
versed; she was started on levophed.  She was satting 100% on
NRB.
.
Due to her MR, we were unable to obtain ROS directly from the
patient.  However, per her caretakers, she had increased
lethargy over the last few weeks with decreased PO intake.  She
had a UTI few weeks ago and was treated with a course of Bactrim
and then cirpofloxacin for ten days.  Her psychiatrist recently
started [**Hospital1 74959**] for mood stabilization.

MEDICAL HISTORY: Cardiac Risk Factors: -Diabetes, -Dyslipidemia, -Hypertension
.
Cardiac History: NONE
.
Other PMH:
Mental Retardation
Seizure disorder (?--listed in chart, but questionable per
caretakers, [**Name (NI) 74959**] added recently for mood)
Recurrent UTIs

MEDICATION ON ADMISSION: Buspar 30 mg [**Hospital1 **]
Cipro 500 [**Hospital1 **]- Day 1 [**2147-2-25**]
Fish oil 1 g TID
Mirtazapine-30 mg qHS
MVI
[**Month/Day/Year **] 150 mg [**Hospital1 **]
Lactulose PRN
SEASONALE (oral contraception)
Tylenol PRN
Pamprin Cramp relief PRN (acetominophen, Magnesium salicylate,
pamabrom (diuretic))
Dimetapp PRN
Robutussin PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION:
VS: T 100.0 (ax) , BP 94/69*, HR 126, RR 20, O2 96% on RA
*IABP 1:1 Assisted Systole 90 Augmented Diastole 91 BAEDP 64
IABP mean 81
Gen: WDWN female, agitated, yelling, in 4 point restraints, not
ill appearing.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with distended neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachy, RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Exam
limited by pt positioning, agitation, grossly clear to
auscultation anteriorally.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits or hematoma b/l. Sheath/IABP in
L groin.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: Family history unknown.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Pt resides in group
home. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Pneumonia, organism unspecified,Pulmonary collapse,Other specified congenital anomalies,Coronary atherosclerosis of native coronary artery,Unspecified intellectual disabilities,Other convulsions'}
