CHIEF COMPLAINT: CC: hypercarbic resp failure

PRESENT ILLNESS: 47yo woman w hx of asthma, obesity transferred from [**Location (un) 620**] w
hypercarbic resp failure.  She initially presented on [**7-11**] with
shortness of breath, DOE, increased edema x4d.  She had a pulse
of 160s on presentation.  Thought to be SVT (possibly aflutter).
 Seen by cards and started on digoxin, dilt iv, heparin gtt.
Had improved rate control but remained tachycardic.  She
underwent TEE and cardioversion on [**7-18**] which converted her to
sinus.  She was considered overloaded so was diuresed up to
36kg.  Hosp course also complicated by code blue on [**7-11**] in
setting of PICC line placement.  She became acutely hypoxic w
ABG 7.42/80/50 and improved with sitting upright.  Pt then
experienced right arm numbness which was thought [**2-4**] median
nerve injury with picc.
.
She remained hypercarbic but appeared to refuse BiPAP.  On [**7-19**]
evening following cardioversion, she became lethargic.  Given
arm numbness and apparent HA, neuro was consulted and rec head
ct which was not done [**2-4**] body habitus.  ABG showed 7.27/129/32.
 Pt was placed on BiPAP but remained hypercarbic.  Given
concerns for need for intubation and trach, pt was transferred
to [**Hospital1 18**].

MEDICAL HISTORY: asthma
obesity
per patient: has been on BiPAP once before

MEDICATION ON ADMISSION: ALLERGIES:
To penicillin and codeine.
.
Meds at home:
albuterol prn
advair 2 puffs [**Hospital1 **]
.
Meds on transfer:
Prilosec 20 mg a day;
insulin sliding scale NovoLog;
amiodarone 400 mg p.o. t.i.d.;
Lasix 40 mg p.o. daily;
aspirin 81 mg daily;
senna 2 tabs twice per day;
Colace 100 mg twice per day;
Brovana nebs twice per day;
digoxin 0.25 mg daily;
Solu-Medrol 40 mg IV daily;
Tylenol 650 every 6 hours as needed
Ativan 1 mg every 6 hours as needed

ALLERGIES: Penicillins / Codeine

PHYSICAL EXAM: per Dr. [**First Name (STitle) **] on admission:
VS: 97.7 HR 91 134/92 23 88% on BiPAP 15/5 w FiO2 50%
Gen: obese, NAD
Neuro: able to speak full sentences when off the BiPAP.
- face symmetric
- strength 5/5 bilat upper prox/distal.  no apprec difference in
sensation
- toes down bilat
Heent: MMM, JVP 8
Cards: RRR no MGR
Lungs: decreased bs throughout.  wheezes right sided.
Abd: obese NT ND soft no masses
ext: edema mild and equal bilat

FAMILY HISTORY: Father with a [**Last Name **] problem.  [**Name (NI) **] known if an MI.

SOCIAL HISTORY: No smoking.  Quit 10 years ago.  Prior to that, 1 pack per day
for 20 years.  No alcohol.
Acute respiratory failure,Mixed acid-base balance disorder,Acute posthemorrhagic anemia,Injury to bladder and urethra, without mention of open wound into cavity,Other complications due to other vascular device, implant, and graft,Urethral false passage,Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere,Atrial fibrillation,Morbid obesity,Asthma, unspecified type, unspecified,Polycythemia, secondary,Other mononeuritis of upper limb,Leukocytosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anticoagulants causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution
Acute respiratry failure,Mixed acid-base bal dis,Ac posthemorrhag anemia,Bladder/urethra inj-clos,Comp-oth vasc dev/graft,Urethral false passage,Sleep hypovent oth dis,Atrial fibrillation,Morbid obesity,Asthma NOS,Secondary polycythemia,Mononeuritis arm NEC,Leukocytosis NOS,DMII wo cmp nt st uncntr,Adv eff anticoagulants,Abn react-procedure NEC,Accid in resident instit
Admission Date:  [**2130-7-20**]              Discharge Date:   [**2130-8-3**]

Date of Birth:  [**2083-6-4**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Codeine

Attending:[**First Name3 (LF) 552**]
Chief Complaint:
CC: hypercarbic resp failure

Major Surgical or Invasive Procedure:
1. Initiation of bipap
================================================================
2. TTE [**2130-7-31**]:
Read, "The left atrium is moderately dilated. No left atrial
mass/thrombus seen (best excluded by transesophageal
echocardiography). The right atrium is moderately dilated. There
is mild symmetric left ventricular hypertrophy with normal
cavity size and global systolic function (LVEF>55%). Due to
suboptimal technical quality, a focal wall motion abnormality
cannot be fully excluded. Right ventricular chamber size and
free wall motion are normal. The aortic valve leaflets appear
structurally normal with good leaflet excursion. There is no
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. [Due to acoustic shadowing, the severity of
mitral regurgitation may be significantly UNDERestimated.] There
is borderline pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion.

IMPRESSION: Suboptimal image quality. Mild symmetric left
ventricular hypertrophy with preserved global biventricular
systolic function. Borderline pulmonary artery systolic
hypertension. Biatrial enlargement."
==============================================================
3.Chest CT w IV contrast: [**2130-8-1**]
Read, "IMPRESSION:
1. Significantly large pulmonary arteries consistent with
pulmonary
hypertension, findings that might explain the abnormality
demonstrated on the chest radiograph in the area of the left
hilum.
2. Widespread areas of consolidation as described, some of them
representing atelectasis and some of them representing
consolidation, and may be consistent with multifocal pneumonia.
The evaluation of the patient is recommended for documentation
of clearance of these findings 4-6 weeks after completion of
antibiotic therapy.
3. This study was not designed to exclude pulmonary embolism. If
clinically warranted, evaluation with dedicated study is highly
recommended.
4. Mediastinal and hilar lymphadenopathy as described, most
likely reactive, should be reassessed on the subsequent study. "
===============================================================
4. UPPER EXT CT W/O Contrast: [**2130-7-26**]
Read, "IMPRESSION:
Abnormality along the course of the median nerve, with soft
tissue density and surrounding stranding effacing the components
of the neurovascular bundle in the area of the median nerve. Due
to limitations of intrinsic soft tissue contrast on CT, the
precise extent and nature of this abnormality cannot be
evaluated -- it may extend slightly more distal or proximal and
the nerve itself is not seen as distinct from the soft tissue
density material. However, given the history, the most likely
etiology is a hematoma tracking along the neurovascular bundle.
If clinically indicated, MRI with and without contrast might
help to better delineate and characterize this finding.
Alternatively, reimaging to confirm resolution and exclude a
soft tissue mass is recommended."
==============================================================
5. CT Upper Ext w/ contrast [**2130-8-3**], Impression


History of Present Illness:
47yo woman w hx of asthma, obesity transferred from [**Location (un) 620**] w
hypercarbic resp failure.  She initially presented on [**7-11**] with
shortness of breath, DOE, increased edema x4d.  She had a pulse
of 160s on presentation.  Thought to be SVT (possibly aflutter).
 Seen by cards and started on digoxin, dilt iv, heparin gtt.
Had improved rate control but remained tachycardic.  She
underwent TEE and cardioversion on [**7-18**] which converted her to
sinus.  She was considered overloaded so was diuresed up to
36kg.  Hosp course also complicated by code blue on [**7-11**] in
setting of PICC line placement.  She became acutely hypoxic w
ABG 7.42/80/50 and improved with sitting upright.  Pt then
experienced right arm numbness which was thought [**2-4**] median
nerve injury with picc.
.
She remained hypercarbic but appeared to refuse BiPAP.  On [**7-19**]
evening following cardioversion, she became lethargic.  Given
arm numbness and apparent HA, neuro was consulted and rec head
ct which was not done [**2-4**] body habitus.  ABG showed 7.27/129/32.
 Pt was placed on BiPAP but remained hypercarbic.  Given
concerns for need for intubation and trach, pt was transferred
to [**Hospital1 18**].

Pt did well on bipap in ICU and was diuresed further. Pt was
eventually transitioned to night bipap only and tolerated. Pt
was then transferred to the floor.

ROS: neg for f/c/cp/sob/abd pain/leg swelling.


Past Medical History:
asthma
obesity
per patient: has been on BiPAP once before

Social History:
No smoking.  Quit 10 years ago.  Prior to that, 1 pack per day
for 20 years.  No alcohol.

Family History:
Father with a [**Last Name **] problem.  [**Name (NI) **] known if an MI.


Physical Exam:
per Dr. [**First Name (STitle) **] on admission:
VS: 97.7 HR 91 134/92 23 88% on BiPAP 15/5 w FiO2 50%
Gen: obese, NAD
Neuro: able to speak full sentences when off the BiPAP.
- face symmetric
- strength 5/5 bilat upper prox/distal.  no apprec difference in
sensation
- toes down bilat
Heent: MMM, JVP 8
Cards: RRR no MGR
Lungs: decreased bs throughout.  wheezes right sided.
Abd: obese NT ND soft no masses
ext: edema mild and equal bilat

Pertinent Results:
EKG at OSH: aflutter vs afib
EKG here: NSR NA NI LA enlargement no acute ST-T changes
.
Labs:
7.33/87/286/48 - on arrival w PS 15, FiO2 100%
7.31/99/50/52 - after 1h continuous neb
7.35/89/50/51 86% - after 1h BiPAP 15/5 FiO2 50%

[**2130-8-3**] 06:05AM BLOOD WBC-5.8 RBC-5.39 Hgb-13.5 Hct-45.6 MCV-85
MCH-25.1* MCHC-29.7* RDW-15.4 Plt Ct-174
[**2130-8-2**] 06:25AM BLOOD WBC-6.6 RBC-5.46* Hgb-14.3 Hct-47.1
MCV-86 MCH-26.3* MCHC-30.5* RDW-15.5 Plt Ct-193
[**2130-8-3**] 06:05AM BLOOD PT-26.8* INR(PT)-2.7*
[**2130-8-2**] 06:25AM BLOOD PT-28.9* INR(PT)-2.9*
[**2130-8-1**] 06:15AM BLOOD PT-32.2* INR(PT)-3.3*
[**2130-8-2**] 06:25AM BLOOD Glucose-123* UreaN-9 Creat-0.6 Na-142
K-4.3 Cl-99 HCO3-35* AnGap-12
[**2130-8-1**] 06:15AM BLOOD Glucose-115* UreaN-9 Creat-0.8 Na-143
K-4.3 Cl-98 HCO3-40* AnGap-9
[**2130-7-31**] 06:40AM BLOOD Glucose-133* UreaN-10 Creat-0.7 Na-143
K-4.2 Cl-96 HCO3-39* AnGap-12
[**2130-7-28**] 05:06AM BLOOD Glucose-123* UreaN-10 Creat-0.7 Na-145
K-4.0 Cl-101 HCO3-38* AnGap-10
[**2130-8-2**] 06:25AM BLOOD TSH-5.6*
[**2130-8-2**] 06:25AM BLOOD Free T4-1.3
[**2130-7-27**] 02:27AM BLOOD Digoxin-0.6*
[**2130-7-30**] 07:27AM BLOOD Type-ART pO2-94 pCO2-68* pH-7.37
calTCO2-41* Base XS-10
[**2130-7-28**] 05:35AM BLOOD Type-ART pO2-97 pCO2-78* pH-7.29*
calTCO2-39* Base XS-7

Brief Hospital Course:
47yo woman with hypercarbic resp failure most likely due to
morbid obesity and hypoventilation.  In addition the patient was
recently diagnosed with Afib s/p TEE and cardioversion.  She was
likely chronically hypoxic and hypoventilating for a long period
of time and slowly retained a large amount of fluid.  She
developed Atrial Fib with RVR and presented to OSH.  She was
transferred to the ICU for concern re: need for emergent
intubation vs. tracheostomy.  She did well on bipap in the ICU,
was diuresed aggressively, and transferred to the floor.
1. Hypercarbic resp failure/Hypoxia:  Most likely due to
Obesity-Hypoventilation syndrome and OSA. In the ICU, pts BIPAP
settings were optimized on PSV/PEEP of 15/5.  The patient was
able to sleep well with these settings and her PO2 on morning
ABGs would average 90-100.  Her baseline ABG reflects a
respiratory acidosis with chronic renal compensation.  Part of
worsening hypercarbia on admission was attributed to aggressive
diuresis and relative increase in respiratory dead space.  The
patient was fluid resuscitated initially with improved
respiratory function and then as the patient became less hypoxic
she began to autodiurese.  She was averaging 1-2 L neg per day
without any lasix. Later, pt was started on low dose lasix as
she had persistent BLE edema.  Given hx of asthma, Advair and
ipratropium nebs were continued, pt was told to not take
albuterol inhalers at home given afib. Given persistent
abnormality on CXR, Chest CT was done, which was concerning for
pna but clinically pt had no signs of pneumonia. Pulm was
consulted and thought that changes likely represented
atelectasis and recommended FU Chest CT which has been ordered
for [**9-27**]. PCP is requested to follow up on the
results. Pt was set up with home oxygen w/ goal sats of 90-92%,
home bipap, outpt Sleep study and appt w/ Sleep medicine
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **].

2. Afib: Pt was TEE cardioverted at OSH. The patient was in
sinus on admission to [**Hospital1 18**] ICU but converted back into AFib on
the morning of [**7-24**].  She was treated with digoxin and
amiodarone and beta blockers for rate control. TTE here showed
nl EF but bilateral atrial enlargement. Pt was placed on
coumadin and at discharge INR was 2.7. A steady coumadin dose
has not been established. Pt was on 10mg coumadin daily when
transferred out of ICU but InR was doubling, so coumadin was
briefly held and restared at 5mg QD. Given that pt is on
amiodarone, INR will need to be closely monitored. Pt was set up
with coumadin clinic at [**Location (un) 620**] for INR but prior to that appt,
which is in 10 days, PCP has been requested to check INR before
then. Pt was offered to have outpt Cardiology set up here but
wanted her PCP to set it up closer to home. TSH was checked and
was mildly abn at 5.7 with normal FT4 of 1.3. Pt was rate
controlled w/ metoprolol 50mg TId and Dilt 30mg QID. Pt's HR
used to increase from 80's to 140's w activity but after
addition of dilt, pt's HR w activity was in 100-110's.

3. Bleeding:  The patient's INR was noted to be 4.5 on
admission.  She had multiple sites of bleeding including venous
puncture sites, nasal mucosa, the badder.  She also had large
ecchymoses noted on admission.  Her anticoagulation was held for
several days and she was treated with oral Vitamin K to help
control the bleeding. Pt was then restarted on coumadin, INR was
therapeutic w/o signs of bleeding

4. R hand paresthesias/weakness: right median nerve neuropathy
thought secondary to periph nerve damage in setting of PICC.
Neurology thought this was most likely [**2-4**] hematoma as well. A
CT of the arm was obtained which showed density around median
nerve consistent w hematoma. Repeat CT w contrast was done and
showed the same thing. Her symptoms were improving but not
resolved. PCP should follow up w repeat imaging or Neurology
appt if symptoms persist.

Pt was counselled on common side effects of her medications
including amiodarone which can cause lung, thyroid and liver
toxicity, metoprolol and dilt which can cause low hr and bp, dig
which in high levels can cause arrhythmias and coumadin which in
high levels can cause bleeding. She was told that it was very
important to see a cardiologist to assess how long she would
need to be on amiodarone

Medications on Admission:
ALLERGIES:
To penicillin and codeine.
.
Meds at home:
albuterol prn
advair 2 puffs [**Hospital1 **]
.
Meds on transfer:
Prilosec 20 mg a day;
insulin sliding scale NovoLog;
amiodarone 400 mg p.o. t.i.d.;
Lasix 40 mg p.o. daily;
aspirin 81 mg daily;
senna 2 tabs twice per day;
Colace 100 mg twice per day;
Brovana nebs twice per day;
digoxin 0.25 mg daily;
Solu-Medrol 40 mg IV daily;
Tylenol 650 every 6 hours as needed
Ativan 1 mg every 6 hours as needed

Discharge Medications:
1. Bipap ST
Bipap settings 15/5 w back up rate of 10 w/ 2-4L oxygen to keep
sats between 90-92%
2. Home Oxygen
Oxygen 2-4L/min continuous via NC
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*2*
5. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM as needed for atrial fibrillation.
Disp:*20 Tablet(s)* Refills:*0*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
12. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: [**1-4**]
Inhalation every 4-6 hours as needed for shortness of breath or
wheezing.
Disp:*1 inhaler* Refills:*2*
13. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day): apply to burn areas in back .
Disp:*1 tube* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Obesity Hypoventilation syndrome
Possible OSA
Atrial fibrillation
Morbid Obesity
R arm hematoma [**2-4**] PICC


Discharge Condition:
Good


Discharge Instructions:
You were admitted to the hospital for shortness of breath and
fluid retention. You were found to have an irregular rhythm and
fast heart rate, atrial fibrillation. You were cardioverted
(shocked) at outside hospital but you remained in the irregular
rhythm. We placed you on medication to help control your heart
rate. Atrial fibrillation increases your risk of stroke
therefore you were placed on coumadin. Your coumadin level (INR)
needs to be checked very closely as you are on a medicine that
interacts with it. Please go to your PcP and coumadin clinic as
listed below for INR check. If you notice bleeding anywhere,
please see a doctor immediately. You will also need to be set up
with cardiology by your primary care physician to manage the
atrial fibrillation
You were also noted to have trouble with your oxygenation and
carbon dioxide retention. This is likely because of
obesity-hypoventilation syndrome and obstructive sleep apnea.
You were placed on bipap at night and you did better.
You also had a lot of fluid retention and a lot of it was
diuresed. Your lasix was briefly stopped but it has been
restarted at a low dose and should be titrated by your doctor
You need to use small amount of oxygen 1-2L to keep your oxygen
level above 90 but less than 94. You also need to use bipap
everynight. You have been set up with sleep study and appt w/
lung doctor (pulmonology), please keep these appointments.
You had a chest CT done which showed changes concerning for
pneumonia but you did not have any signs/symptoms of it. This
likely represents areas that are not well aerated because of
your obesity-hypoventilaton syndrome but ensure that these
changes resolve, we have set you up with a repeat Chest CT in
[**Month (only) **]
You had some tingling in the hand on the side that PICC line was
placed. We did CT scans, which showed that likely cause is a
hematoma (bleeding) which appears to be resolving. Please let
your PCP know if your symptoms do not improve or get worse.


Followup Instructions:
1. Appt w/ PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], [**Hospital1 79111**]
[**Location (un) 1411**] [**Numeric Identifier 9311**]. ph([**Telephone/Fax (1) 79112**], Fax ([**Telephone/Fax (1) 79113**] is booked
for Monday, [**8-7**],  2:15pm w/ INR check until seen in coumadin
clinic
2. [**Hospital 197**] clinic in the [**Hospital3 628**] is booked for Next
Thursday [**8-10**] at 1:15pm. This will be a 45 minute appt.
3. CAT SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2130-9-27**] 11:45. Please
show up on [**9-27**] wednedsay at 10:45,  for an 11:45am scan.
Location, [**Hospital Ward Name 452**] bldg, [**Hospital Ward Name 516**] , [**Hospital1 18**], [**Location (un) 470**], and nothing
to eat or drink 3 prior. You can eat up until 8:30am that day.
4. Sleep Study at [**Location (un) 620**], ph ([**Telephone/Fax (1) 79114**]. [**8-9**], at
7:30pm.
5. Pulmonology, Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **], ph ([**Telephone/Fax (1) 513**], appt on
[**9-6**], Wed, 11:00 AM in [**Hospital Ward Name 23**] bldg, [**Location (un) **].
{'Acute respiratory failure,Mixed acid-base balance disorder,Acute posthemorrhagic anemia,Injury to bladder and urethra, without mention of open wound into cavity,Other complications due to other vascular device, implant, and graft,Urethral false passage,Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere,Atrial fibrillation,Morbid obesity,Asthma, unspecified type, unspecified,Polycythemia, secondary,Other mononeuritis of upper limb,Leukocytosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anticoagulants causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution'}


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: CC: hypercarbic resp failure

PRESENT ILLNESS: 47yo woman w hx of asthma, obesity transferred from [**Location (un) 620**] w
hypercarbic resp failure.  She initially presented on [**7-11**] with
shortness of breath, DOE, increased edema x4d.  She had a pulse
of 160s on presentation.  Thought to be SVT (possibly aflutter).
 Seen by cards and started on digoxin, dilt iv, heparin gtt.
Had improved rate control but remained tachycardic.  She
underwent TEE and cardioversion on [**7-18**] which converted her to
sinus.  She was considered overloaded so was diuresed up to
36kg.  Hosp course also complicated by code blue on [**7-11**] in
setting of PICC line placement.  She became acutely hypoxic w
ABG 7.42/80/50 and improved with sitting upright.  Pt then
experienced right arm numbness which was thought [**2-4**] median
nerve injury with picc.
.
She remained hypercarbic but appeared to refuse BiPAP.  On [**7-19**]
evening following cardioversion, she became lethargic.  Given
arm numbness and apparent HA, neuro was consulted and rec head
ct which was not done [**2-4**] body habitus.  ABG showed 7.27/129/32.
 Pt was placed on BiPAP but remained hypercarbic.  Given
concerns for need for intubation and trach, pt was transferred
to [**Hospital1 18**].

MEDICAL HISTORY: asthma
obesity
per patient: has been on BiPAP once before

MEDICATION ON ADMISSION: ALLERGIES:
To penicillin and codeine.
.
Meds at home:
albuterol prn
advair 2 puffs [**Hospital1 **]
.
Meds on transfer:
Prilosec 20 mg a day;
insulin sliding scale NovoLog;
amiodarone 400 mg p.o. t.i.d.;
Lasix 40 mg p.o. daily;
aspirin 81 mg daily;
senna 2 tabs twice per day;
Colace 100 mg twice per day;
Brovana nebs twice per day;
digoxin 0.25 mg daily;
Solu-Medrol 40 mg IV daily;
Tylenol 650 every 6 hours as needed
Ativan 1 mg every 6 hours as needed

ALLERGIES: Penicillins / Codeine

PHYSICAL EXAM: per Dr. [**First Name (STitle) **] on admission:
VS: 97.7 HR 91 134/92 23 88% on BiPAP 15/5 w FiO2 50%
Gen: obese, NAD
Neuro: able to speak full sentences when off the BiPAP.
- face symmetric
- strength 5/5 bilat upper prox/distal.  no apprec difference in
sensation
- toes down bilat
Heent: MMM, JVP 8
Cards: RRR no MGR
Lungs: decreased bs throughout.  wheezes right sided.
Abd: obese NT ND soft no masses
ext: edema mild and equal bilat

FAMILY HISTORY: Father with a [**Last Name **] problem.  [**Name (NI) **] known if an MI.

SOCIAL HISTORY: No smoking.  Quit 10 years ago.  Prior to that, 1 pack per day
for 20 years.  No alcohol. 

### Response:
{'Acute respiratory failure,Mixed acid-base balance disorder,Acute posthemorrhagic anemia,Injury to bladder and urethra, without mention of open wound into cavity,Other complications due to other vascular device, implant, and graft,Urethral false passage,Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere,Atrial fibrillation,Morbid obesity,Asthma, unspecified type, unspecified,Polycythemia, secondary,Other mononeuritis of upper limb,Leukocytosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anticoagulants causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution'}
