CHIEF COMPLAINT: Cough, SOB, fever, transferred from OSH for respiratory distress

PRESENT ILLNESS: Ms. [**Known lastname **] is a 50F smoker with ?history of COPD, chronic
headaches on narcotics, fentanyl patch has increased to 75
recently. She also has a history of HLD, ?DM, PVD s/p fem-[**Doctor Last Name **].
She presented to [**Hospital3 7571**]Hospital on [**7-18**] with SOB, fever
and chest pain. She was having 1 week of SOB associated with
non-productive cough, pleuritic chest pain, wheezing,
generalized myalgias and fever/chills. She was treated with nebs
high grade E. coli bactermeia and respiratory failure. On
admission she received a CXR, TTE and a CT. CT was consistent
with diffuse nodular ground glass opacities, small bilateral
effusions([**7-19**]). CTA and LENIs negative. TTE on [**7-18**] showed LVEF
55-60%, mild MVP and mod MR, LAE and mild LV dilation. She was
treated with DuoNeb, Xopenex nebs, Solumedrol 60mg IV Q8hrs and
Dilaudid. 4 out 4 BCx positive for Pan-sensitive E.Coli, she was
treated with various ABx including: Ceftazidime, Levaquin([**7-21**]),
Cipro and Azithromycin. On transfer to [**Hospital1 18**] she was on Levaquin
500mg IV QDay and Azithromycin. Urine and LFTs unremarkable.
[**Date range (1) 45402**] she had increased work of breathing requiring BiPAP,
NRB mask and eventually required intubation for worsening
respiratory acidosis (7.23/55/59 on 5L). She received 2 doses of
Pancuronium for agitation, coughing, dysynchrony, desaturations
and elevating PIPs. She has been having minimal secretions and
tracheal aspirations were negative for organisms. She received
20mg IV Lasix x2 and put out 1.6L.
.
[**7-22**] patient CXR showed developing bilateral fluffy bilateral
infiltrates. She was given 20mg IV Lasix for LE edema, elevatged
BNP and elevated CVP after a Subclavian line was placed. CVP
reduced to 12 after Lasix.

MEDICAL HISTORY: Past Medical History: (Per OSH records)
- ?COPD
- Chronic HAs on Narcotics
- PVD
- ?DM
- HLD
- HTN
- Anemia (unknown etiology, possible UGIB)

MEDICATION ON ADMISSION: Medications: (Per OSH recordS)
- Lisinopril 40mg PO QDay
- Albuterol prn
- Zocor 80mg PO QDay
- Prilosec 20mg PO QDay
- Amitriptylline 100mg PO QDay
- Penicillin- since [**7-17**] 500mg PO TID
- Fentanyl Patch 75
- Tramadol ?2 pills [**Hospital1 **]

ALLERGIES: Compazine

PHYSICAL EXAM: On admission to MICU from transfer:
Vitals: Afebrile BP:162/83 P:104 R:20s O2:98% 60%FiO2
General: Intubated, Sedated on Propofol drip. Does not appear in
any acute distress.
HEENT: Dry mucous membranes, dried blood around nares and lips
surrounds ET tube.
Neck: supple, JVP not elevated, no LAD
Lungs: Anterior exam is limiting though she has course rhonchi
throuhgout with evidence of crackles worse at bases bilaterally
and with end expiratory wheezes apically.
CV: Tachycardic, S1 S2 clear and of good quality though heart
exam limited by lound rhonchorous breah sounds.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: Foley in placve draining moderate-large amount of light
urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Family History:  (From OSH Records)
- NC

SOCIAL HISTORY: Social History:  (From OSH recods)
- Tobacco:  [**12-7**] PPD
- Alcohol:  None
- Illicits:  None
Septicemia due to escherichia coli [E. coli],Acidosis,Polycystic kidney, autosomal dominant,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Headache,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Unspecified essential hypertension,Tobacco use disorder
E coli septicemia,Acidosis,Polycyst kid-autosom dom,Severe sepsis,Chr airway obstruct NEC,Headache,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Periph vascular dis NOS,Esophageal reflux,Hypertension NOS,Tobacco use disorder
Admission Date:  [**2178-7-22**]              Discharge Date:   [**2178-8-4**]

Date of Birth:  [**2127-10-30**]             Sex:   F

Service: MEDICINE

Allergies:
Compazine

Attending:[**First Name3 (LF) 4891**]
Chief Complaint:
Cough, SOB, fever, transferred from OSH for respiratory distress

Major Surgical or Invasive Procedure:
Left Subclavian CVL (at OSH)
Intubation / Extubation
CVL insertion ([**Hospital1 18**])

History of Present Illness:
Ms. [**Known lastname **] is a 50F smoker with ?history of COPD, chronic
headaches on narcotics, fentanyl patch has increased to 75
recently. She also has a history of HLD, ?DM, PVD s/p fem-[**Doctor Last Name **].
She presented to [**Hospital3 7571**]Hospital on [**7-18**] with SOB, fever
and chest pain. She was having 1 week of SOB associated with
non-productive cough, pleuritic chest pain, wheezing,
generalized myalgias and fever/chills. She was treated with nebs
high grade E. coli bactermeia and respiratory failure. On
admission she received a CXR, TTE and a CT. CT was consistent
with diffuse nodular ground glass opacities, small bilateral
effusions([**7-19**]). CTA and LENIs negative. TTE on [**7-18**] showed LVEF
55-60%, mild MVP and mod MR, LAE and mild LV dilation. She was
treated with DuoNeb, Xopenex nebs, Solumedrol 60mg IV Q8hrs and
Dilaudid. 4 out 4 BCx positive for Pan-sensitive E.Coli, she was
treated with various ABx including: Ceftazidime, Levaquin([**7-21**]),
Cipro and Azithromycin. On transfer to [**Hospital1 18**] she was on Levaquin
500mg IV QDay and Azithromycin. Urine and LFTs unremarkable.
[**Date range (1) 45402**] she had increased work of breathing requiring BiPAP,
NRB mask and eventually required intubation for worsening
respiratory acidosis (7.23/55/59 on 5L). She received 2 doses of
Pancuronium for agitation, coughing, dysynchrony, desaturations
and elevating PIPs. She has been having minimal secretions and
tracheal aspirations were negative for organisms. She received
20mg IV Lasix x2 and put out 1.6L.
.
[**7-22**] patient CXR showed developing bilateral fluffy bilateral
infiltrates. She was given 20mg IV Lasix for LE edema, elevatged
BNP and elevated CVP after a Subclavian line was placed. CVP
reduced to 12 after Lasix.

Vitals on transfer from OSH: Afberile, sinus rhythm at 109 bpm.
BPs 110-160s on propofol 100mcg. MAPs 70-80s. Vent settings 400
CMV, PEEP 7.5, RR 25, O2%92%. ABG 7.35/46/86.
.
On the floor, she arrived intubated, on Propofol drip, stable.
Her vent settings were FiO2 60% Vt 400, RR 20, PEEP 8 and her VS
were afebrile, HR 114, BP 168/87, O2%99%, RR mid 20s (breathing
over vent).
.
Review of systems:
Patient is intubated and sedated, unable to attain ROS


Past Medical History:
Past Medical History: (Per OSH records)
- ?COPD
- Chronic HAs on Narcotics
- PVD
- ?DM
- HLD
- HTN
- Anemia (unknown etiology, possible UGIB)


Social History:
Social History:  (From OSH recods)
- Tobacco:  [**12-7**] PPD
- Alcohol:  None
- Illicits:  None


Family History:
Family History:  (From OSH Records)
- NC


Physical Exam:
On admission to MICU from transfer:
Vitals: Afebrile BP:162/83 P:104 R:20s O2:98% 60%FiO2
General: Intubated, Sedated on Propofol drip. Does not appear in
any acute distress.
HEENT: Dry mucous membranes, dried blood around nares and lips
surrounds ET tube.
Neck: supple, JVP not elevated, no LAD
Lungs: Anterior exam is limiting though she has course rhonchi
throuhgout with evidence of crackles worse at bases bilaterally
and with end expiratory wheezes apically.
CV: Tachycardic, S1 S2 clear and of good quality though heart
exam limited by lound rhonchorous breah sounds.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: Foley in placve draining moderate-large amount of light
urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

On Discharge:
Vitals-99.6 (tmax 100.2) 124/68 127 20 96% RA
General-Patient appears well and in NAD
Cardiac-RRR, S1 and S2, no m/r/g
Lung-Diffuse crackles and popping sounds. Improves with cough.
Abdomen-Soft, NT/ND, BSx4
Extremeties-No calf swelling or tenderness
Neuro-A&Ox3, CN II-XII intact, moving all extremeties


Pertinent Results:
Lab Results on Admission
[**2178-7-22**] 04:30PM   GLUCOSE-157* UREA N-30* CREAT-1.1 SODIUM-141
POTASSIUM-4.1 CHLORIDE-105 TOTAL CO2-29 ANION GAP-11
[**2178-7-22**] 04:30PM   CALCIUM-8.8 PHOSPHATE-3.7 MAGNESIUM-2.2
[**2178-7-22**] 04:30PM   WBC-22.2* RBC-3.44* HGB-10.8* HCT-31.4*
MCV-91 MCH-31.5 MCHC-34.5 RDW-14.8
[**2178-7-22**] 04:30PM   NEUTS-93* BANDS-0 LYMPHS-4* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2178-7-22**] 04:30PM   PT-13.1 PTT-24.5 INR(PT)-1.1
[**2178-7-22**] 07:20PM   TYPE-ART RATES-20/0 TIDAL VOL-400 PEEP-8
O2-60 PO2-148* PCO2-49* PH-7.40 TOTAL CO2-31* BASE XS-4
-ASSIST/CON INTUBATED-INTUBATED
[**2178-7-22**] 06:07PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.009
[**2178-7-22**] 06:07PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG

ABGs:
[**2178-7-22**] 07:20PM BLOOD Type-ART Rates-20/0 Tidal V-400 PEEP-8
FiO2-60 pO2-148* pCO2-49* pH-7.40 calTCO2-31* Base XS-4
-ASSIST/CON Intubat-INTUBATED
[**2178-7-23**] 03:26AM BLOOD Temp-37.2 Tidal V-400 FiO2-40 pO2-80*
pCO2-46* pH-7.44 calTCO2-32* Base XS-5

[**2178-7-23**] 02:39AM BLOOD Triglyc-888* HDL-10 CHOL/HD-19.2 (on
Propofol drip)
.
Discharge Labs:
[**2178-8-2**] 06:15AM BLOOD WBC-8.4 RBC-2.61* Hgb-8.1* Hct-23.5*
MCV-90 MCH-31.2 MCHC-34.7 RDW-14.1 Plt Ct-398
[**2178-8-2**] 12:45PM BLOOD Hgb-9.0* Hct-26.6*
[**2178-8-1**] 06:35AM BLOOD Glucose-98 UreaN-13 Creat-0.7 Na-136
K-3.8 Cl-100 HCO3-26 AnGap-14
===========================================
Imaging:
[**7-22**] CXR:
1. Diffuse parenchymal opacification is in keeping with clinical
diagnosis of ARDS.
2. Endotracheal tube in standard position with tip 5.1 cm above
the carina

[**7-22**] CT Abdomen
1. Diffuse patchy opacities within the lung fields along with
wedge-shaped
infarctions along bilateral lung bases, raise the possibility of
septic
emboli.
2. No evidence of intra-abdominal abscess.
3. Numerous renal and liver cystic lesions of various size seen
in polycystic kidney disease.

[**7-23**] CXR: FINDINGS: In comparison with study of [**7-22**], there has
been some decrease in the still prominent diffuse bilateral
pulmonary opacifications. Monitoring and support devices remain
in good position

[**7-27**] CXR: Previously widespread infiltrative pulmonary
abnormality improved
substantially between [**7-25**] and [**7-27**] has not changed,
raising concern for acute pulmonary embolism or other
abnormality not detectable on
conventional radiographs. There is no consolidation or collapse.
No pleural
effusion or pulmonary edema. Heart size is normal. ET tube and
right internal jugular line are in standard placements and a
nasogastric tube passes below the diaphragm and out of view.

[**7-28**] EEG: Abnormal EEG due to diffuse and prolonged slowing in
the delta range with superimposed alpha rhythm, both anteriorly
and posteriorly. The record is consistent with a diffuse mild to
moderate encephalopathy without evidence of focality or of
increased irritability.

[**7-29**] CXR: Single AP view of the chest shows an ET tube 4.2 cm
above the
carina. An OG tube and IJ line are in standard position. Lung
volumes are
low, however, there is no consolidation or collapse. No pleural
effusion or
pneumothorax. Heart size is normal.

[**7-29**] Echo: The left atrium is normal in size. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened. There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Physiologic mitral regurgitation is seen
(within normal limits). There is no pericardial effusion.

No vegetation seen (cannot definitively exclude).

[**7-30**] CXR: As compared to the previous radiograph, the lung
volumes have
slightly increased, potentially reflecting improved ventilation.
The
pre-existing atelectasis at the right lung base is unchanged in
extent. No
interval appearance of new parenchymal opacities. Borderline
size of the
cardiac silhouette, no pleural effusion.

[**7-31**] MRI head: 1. No acute infarction. No evidence of other
intracranial abnormalities on non-contrast MRI.
2. Persistent partial bilateral mastoid air cell opacification.
3. Possible mucus retention cyst in the nasopharynx. If
clinically indicated, this may be further assessed by direct
visualization to exclude other possible etiologies.
========================================
MICROBIOLOGY:
OSH BCx Positive in [**3-9**] bottles for pan-sensitive E.Coli
All BCx negative in house
All UCx negative in house
Sputum Cx negative
Fungal culture preliminary negative


Brief Hospital Course:
HOSPITAL COURSE
50yo F PMHx chronic HA on high dose narcotics who initially
presented to OSH w cough, fevers/chills, found to have Ecoli
bacteremia, with worsening respiratory distress [**1-7**] ARDS
requiring intubation, transferred to [**Hospital1 18**], now status post abx
therapy with improvement in respiratory status and extubation.

# E.Coli sepsis: At OSH, patient with multiple blood cultures
positive for pan-sensitive E.Coli. Treated with azithromycin +
levofloxacin at OSH, transitioned to CTX on transfer given
persistant fevers; source of bacteremia thought to UTI with
concern for seeding of newly identified PCKD. Cultures at [**Hospital1 18**]
remained negative and fever curve / leukocytosis resolved. Plan
for 14d coverage with antibiotics and completed on [**8-4**].

# ARDS - at OSH patient developed increasing hypoxia, with
bilateral infiltrates consistent with ARDS, requiring
intubation.  Underlying etiology was thought to be Ecoli sepsis.
She was maintained on ARDSnet ventilation protocol with
treatment of underlying bacteremia. Sedation was complicated by
high narcotic and benzo requirements, thought to be [**1-7**] chronic
narcotic usage; patient's respiratory status improved and she
was successfully extubated on [**7-30**]. On discharge her respiratory
status is stable at ~97-98% on RA.

# Tachycardia: Patient has been tachycardic while on the floor
to ~120.  Per PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 71168**], baseline is around 80-90.  EKG
shows NSR although patient denies any pain aside from her
chronic HA.  The tachycardia does not appear related to
dehydration, as the patient is tolerating adequate PO fluids.
Tachycardia believed to be related to deconditiong in the
setting of severe illness and intubation, with likely underlying
lung disease and bronchodilator medications. Patient was
initially started on metoprolol with good effect, but it was
discontinued as she did not have indication for beta-blockade.
TSH was checked and was normal. Her tachycardia has been
asmptomatic; the patient denies any CP or palpitations. The PCP
was updated verbally regarding the need for close follow-up of
this issue.

#Chronic HAs: Patient with chronic HAs being treated with
Fentanyl Patch 75mcg as an outpatient. Fentanyl patch was
stopped in setting of intubation. Patient was initially
transitioned to methadone with prn ultram after extubation in
ICU. On the floor, she was transitioned to MS contin given her
preference of MS Contin to methadone. She was also restarted on
her home amitriptyline.  The patient reports her HA pain is
under control and would like to be d/c on her current regimen.
The patient was provided a short supply of her opiate regimen,
enough to reach her follow up appointment with her PCP.

# Polycystic Kidney Disease: Patient with newly identified PCKD
on admission with CTAP showing multiple cysts in her liver. CTA
of head in setting of intubation did not demonstrate large [**Doctor Last Name **]
aneurysms. Patient with normal renal function at this time.
Will follow up with PCP. [**Name10 (NameIs) **] that source of E. Coli sepsis
may be related to cyst seeeding from a UTI as discussed above.
We suggest considering a renal consultation as an outpatient to
clarify this potential diagnosis.

# Hypertension: Held home lisinopril in setting of acute
illness. Patient is being discharged home without lisinopril as
her blood pressure is normotensive at the time.

#. Smoking cessation-Patient has not smoked x16 days.  Doing
well on nicotine patch, without break through cravings.  Will
continue as o/p and follow-up with PCP.

# GERD: continued home omeprazole.

Medications on Admission:
Medications: (Per OSH recordS)
- Lisinopril 40mg PO QDay
- Albuterol prn
- Zocor 80mg PO QDay
- Prilosec 20mg PO QDay
- Amitriptylline 100mg PO QDay
- Penicillin- since [**7-17**] 500mg PO TID
- Fentanyl Patch 75
- Tramadol ?2 pills [**Hospital1 **]

Transfer from [**Location (un) **] Valler Meds:
- Azithromycin 500 mg IV (Day 1=[**7-20**])
- Levaquin 500mg IV QDay
- Solumedrol 60mg IV Q6hours
- Combivent 4 puffs QID
- Lopressor 25 mg [**Hospital1 **]
- Colace 100 mg [**Hospital1 **]
- Simvastatin 80 mg QHS
- Omeprazole 20mg PO QDay
- Arixtra 2.5 mg SC
- [**Last Name (un) **]

Discharge Medications:
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) puff Inhalation every six (6) hours as needed for
shortness of breath or wheezing.
2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. amitriptyline 100 mg Tablet Sig: One (1) Tablet PO at
bedtime.
5. tramadol 50 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours) as needed for pain: please do not take more than 8
tablets per day.
6. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) puff Inhalation twice a day.
7. morphine 15 mg Tablet Extended Release Sig: One (1) Tablet
Extended Release PO every twelve (12) hours as needed for pain:
Please do not drive or operate heavy  machinery while taking
this medication.
Disp:*18 Tablet Extended Release(s)* Refills:*0*
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*30 Capsule(s)* Refills:*2*
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*2*
10. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1)  Transdermal
once a day.
Disp:*10 Patch* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis: acute respiratory distress syndrome
Secondary diagnosis: E. Coli sepsis, polycystic kidney disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname **], it was a pleasure to take care of you at [**Hospital1 1535**]. You were transferred here from
[**Location (un) **] for management of your E. Coli infection and acute
respiratory distress syndrome. You were intubated because of
acute respiratory distress syndrome and your breathing was
helped by the machines. You were treated with antibiotics, and
were extubated when your respiratory status improved. You were
transferred to regular medicine floor and did well.

Please note the following changes to your medicaiton regimen:
1) STOP taking your lisinopril for now because your blood
pressure was normal at the time of discharge. You may need to
restart this medication at later time.
2) STOP using fentanyl patch
3) START MS contin 15 mg twice daily for your headaches. Please
do not drive while you're taking this medication as it can make
you drowsy.
4) CHANGE Zocor to 40 mg daily at bedtime.
5) START Senna 1 tab twice daily as needed for constipation.
6) START 100mg colace twice daily as needed for constipation.

Followup Instructions:
You have an appointment scheduled with Dr. [**Last Name (STitle) 21160**] your Primary
Care Physician fo [**8-13**] at 12:45pm.



Completed by:[**2178-8-4**]
{'Septicemia due to escherichia coli [E. coli],Acidosis,Polycystic kidney, autosomal dominant,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Headache,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Unspecified essential hypertension,Tobacco use disorder'}


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: Cough, SOB, fever, transferred from OSH for respiratory distress

PRESENT ILLNESS: Ms. [**Known lastname **] is a 50F smoker with ?history of COPD, chronic
headaches on narcotics, fentanyl patch has increased to 75
recently. She also has a history of HLD, ?DM, PVD s/p fem-[**Doctor Last Name **].
She presented to [**Hospital3 7571**]Hospital on [**7-18**] with SOB, fever
and chest pain. She was having 1 week of SOB associated with
non-productive cough, pleuritic chest pain, wheezing,
generalized myalgias and fever/chills. She was treated with nebs
high grade E. coli bactermeia and respiratory failure. On
admission she received a CXR, TTE and a CT. CT was consistent
with diffuse nodular ground glass opacities, small bilateral
effusions([**7-19**]). CTA and LENIs negative. TTE on [**7-18**] showed LVEF
55-60%, mild MVP and mod MR, LAE and mild LV dilation. She was
treated with DuoNeb, Xopenex nebs, Solumedrol 60mg IV Q8hrs and
Dilaudid. 4 out 4 BCx positive for Pan-sensitive E.Coli, she was
treated with various ABx including: Ceftazidime, Levaquin([**7-21**]),
Cipro and Azithromycin. On transfer to [**Hospital1 18**] she was on Levaquin
500mg IV QDay and Azithromycin. Urine and LFTs unremarkable.
[**Date range (1) 45402**] she had increased work of breathing requiring BiPAP,
NRB mask and eventually required intubation for worsening
respiratory acidosis (7.23/55/59 on 5L). She received 2 doses of
Pancuronium for agitation, coughing, dysynchrony, desaturations
and elevating PIPs. She has been having minimal secretions and
tracheal aspirations were negative for organisms. She received
20mg IV Lasix x2 and put out 1.6L.
.
[**7-22**] patient CXR showed developing bilateral fluffy bilateral
infiltrates. She was given 20mg IV Lasix for LE edema, elevatged
BNP and elevated CVP after a Subclavian line was placed. CVP
reduced to 12 after Lasix.

MEDICAL HISTORY: Past Medical History: (Per OSH records)
- ?COPD
- Chronic HAs on Narcotics
- PVD
- ?DM
- HLD
- HTN
- Anemia (unknown etiology, possible UGIB)

MEDICATION ON ADMISSION: Medications: (Per OSH recordS)
- Lisinopril 40mg PO QDay
- Albuterol prn
- Zocor 80mg PO QDay
- Prilosec 20mg PO QDay
- Amitriptylline 100mg PO QDay
- Penicillin- since [**7-17**] 500mg PO TID
- Fentanyl Patch 75
- Tramadol ?2 pills [**Hospital1 **]

ALLERGIES: Compazine

PHYSICAL EXAM: On admission to MICU from transfer:
Vitals: Afebrile BP:162/83 P:104 R:20s O2:98% 60%FiO2
General: Intubated, Sedated on Propofol drip. Does not appear in
any acute distress.
HEENT: Dry mucous membranes, dried blood around nares and lips
surrounds ET tube.
Neck: supple, JVP not elevated, no LAD
Lungs: Anterior exam is limiting though she has course rhonchi
throuhgout with evidence of crackles worse at bases bilaterally
and with end expiratory wheezes apically.
CV: Tachycardic, S1 S2 clear and of good quality though heart
exam limited by lound rhonchorous breah sounds.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: Foley in placve draining moderate-large amount of light
urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Family History:  (From OSH Records)
- NC

SOCIAL HISTORY: Social History:  (From OSH recods)
- Tobacco:  [**12-7**] PPD
- Alcohol:  None
- Illicits:  None 

### Response:
{'Septicemia due to escherichia coli [E. coli],Acidosis,Polycystic kidney, autosomal dominant,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Headache,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Unspecified essential hypertension,Tobacco use disorder'}
