CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 35246**] is a 57-year-old man
with a complicated past medical history including
cerebrovascular accident, seizure disorder, coronary artery
disease, congestive heart failure and recurrent aspiration
pneumonia who was discharged from [**Hospital6 649**] on [**3-24**] with aspiration pneumonia.  He
was at his nursing home where he desaturated to 70% on 5
liters nasal cannula and became tachypneic and uncomfortable.
 He was also febrile and transferred back to [**Hospital6 1760**] for further management.  In
the Emergency Department, he was given albuterol and Atrovent
nebulizers with some relief.  His most recent hospital course
was significant for Methicillin resistant Staphylococcus
aureus pneumonia diagnosed on BAL washings.  He was started
on vancomycin for a six week course of treatment.  He also
had a video swallowing study which showed a high risk of
aspiration, however at that time the patient elected to take
continued po intake with thickened liquids.

MEDICAL HISTORY: 1.  Cerebrovascular accident in [**2189**] with residual left sided
hemiparesis
2.  History of seizure disorder
3.  Borderline diabetes mellitus
4.  Coronary artery disease
5.  Depression
6.  Congestive heart failure with an ejection fraction of
30%.
7.  Hypertension
8.  Hypothyroidism
9.  Bilateral hip fractures.
10. Paroxysmal atrial fibrillation, status post cardioversion
in [**2193-7-21**]
11. Recurrent aspiration pneumonia

MEDICATION ON ADMISSION: 

ALLERGIES: THE PATIENT HAS DOCUMENTED HEPARIN INDUCED
THROMBOCYTOPENIA.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is currently a resident of
[**Hospital3 2558**].  He denies alcohol or tobacco use.  His code
status is do not resuscitate, however intubation, unit and
pressors are permitted.
Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Acute respiratory failure,Other convulsions,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified pleural effusion,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side
Food/vomit pneumonitis,CHF NOS,Acute respiratry failure,Convulsions NEC,Thrombocytopenia NOS,Atrial fibrillation,Pleural effusion NOS,Late ef-hemplga side NOS
Admission Date:  [**2194-3-14**]       Discharge Date:  [**2194-3-25**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:  [**Hospital1 212**] INTERNAL MEDICINE FIRM

ADDENDUM:

The following describes the [**Hospital 228**] hospital course from
[**2194-3-21**] through [**2194-3-24**].

1.  INFECTIOUS DISEASE/PULMONARY:  BAL washings from the
patient's bronchoscopy on [**3-20**] were positive for
Methicillin resistant Staphylococcus aureus.  The patient was
continued on vancomycin with an anticipated six week course
of treatment.  He was also continued on metronidazole to
cover aspiration organisms.  This was to be continued for a
total of two weeks, ending on [**2194-3-26**].
Transesophageal continued to improve from a pulmonary
standpoint and had returned to his baseline at the
anticipated time of discharge.

2.  PAIN CONTROL:  The patient was seen by the pain service
who recommended starting him on Neurontin, Celebrex and
standing dose Tylenol in addition to his oxycodone.  The
patient reported significant improvement in his hip and back
pain on this pain control regimen.

3.  FLUIDS, ELECTROLYTES AND NUTRITION:  The patient
underwent a video swallowing study on [**2194-3-24**].  This
study indicated the patient remains a high aspiration risk
and it was recommended to him that he receive all nutrition
via tube feeds at this time however, the patient, cognizant
of the risks of doing so, is electing to continue po intake
of thickened liquids at this time.  It was recommended that
the patient have his po intake carefully monitored by the
speech and swallow department at [**Hospital3 2558**] upon his
return there, as well as a repeat video swallowing study in
one to two months as his condition improves.

4.  HEMATOLOGY:  On [**3-24**], the patient was noted to have
a slowly diminishing hematocrit to a level of 24.7.  No
active bleeding source was identified.  The patient was
transfused 2 units of packed red blood cells and a post
transfusion hematocrit was pending at the time of this
dictation.  The patient's INR was also noted to be
supertherapeutic on [**3-24**] at 4.5.  His Coumadin dose was
held and he was to have follow up INR checks.  His Coumadin
was to be restarted at 1 mg po q hs when his INR returned to
a therapeutic range of 2 to 3.

5.  DISPOSITION:  At the time of this dictation, it was
anticipated that the patient would return to [**Hospital3 2558**]
on [**2194-3-25**] where he was to follow up with his primary
care provider, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**].

DISCHARGE DIAGNOSES:
1.  Pneumonia
2.  Aspiration risk
3.  Status post cerebrovascular accident with left sided
residual hemiparesis
4.  History of seizure disorder
5.  Congestive heart failure
6.  Coronary artery disease
7.  Depression
8.  History of bilateral hip fractures
9.  History of paroxysmal atrial fibrillation status post
cardioversion

DISCHARGE MEDICATIONS:
1.  Oxycodone 10 mg po q6h prn
2.  Celebrex 200 mg po bicarbonate
3.  Tylenol 500 mg po tid
4.  Neurontin 300 mg po bid x3 days, then 300 mg po tid
5.  Vancomycin 1 gm intravenous q 24 hours x5 weeks
6.  Flagyl 500 mg po tid x2 days
7.  Colace 100 mg po bid
8.  Spironolactone 25 mg po q day
9.  Valproic acid 500 mg po q a.m., 750 mg po q noon, 500 mg
po q hs
10. Enteric coated aspirin 81 mg po q day
11. Synthroid 0.125 mg po q day
12. Multivitamin 1 tablet po q day
13. Protonix 40 mg po q day
14. Dulcolax 10 mg po q od
15. Captopril 50 mg po tid
16. Lasix 20 mg po bid
17. Zoloft 200 mg po q day
18. Vitamin C 500 mg po q day
19. BuSpar 10 mg po q day
20. Senna 2 tablets po q day
21. Zinc sulfate 220 mg po q day
22. Combivent metered dose inhalers 2 puffs q6h

The patient was to have a daily INR check until his level was
found to be 2 to 3 and then restart Coumadin at 1 mg po q hs.

DISCHARGE DISPOSITION:  The patient was to be discharged to
[**Hospital3 2558**].

DISCHARGE CONDITION:  Improved




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 35244**]
MEDQUIST36

D:  [**2194-3-24**]  16:49
T:  [**2194-3-24**]  18:54
JOB#:  [**Job Number 35245**]


Admission Date:  [**2194-3-26**]       Discharge Date:  [**2194-4-5**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:  [**Hospital1 212**] INTERNAL MEDICINE

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 35246**] is a 57-year-old man
with a complicated past medical history including
cerebrovascular accident, seizure disorder, coronary artery
disease, congestive heart failure and recurrent aspiration
pneumonia who was discharged from [**Hospital6 649**] on [**3-24**] with aspiration pneumonia.  He
was at his nursing home where he desaturated to 70% on 5
liters nasal cannula and became tachypneic and uncomfortable.
 He was also febrile and transferred back to [**Hospital6 1760**] for further management.  In
the Emergency Department, he was given albuterol and Atrovent
nebulizers with some relief.  His most recent hospital course
was significant for Methicillin resistant Staphylococcus
aureus pneumonia diagnosed on BAL washings.  He was started
on vancomycin for a six week course of treatment.  He also
had a video swallowing study which showed a high risk of
aspiration, however at that time the patient elected to take
continued po intake with thickened liquids.

PAST MEDICAL HISTORY:
1.  Cerebrovascular accident in [**2189**] with residual left sided
hemiparesis
2.  History of seizure disorder
3.  Borderline diabetes mellitus
4.  Coronary artery disease
5.  Depression
6.  Congestive heart failure with an ejection fraction of
30%.
7.  Hypertension
8.  Hypothyroidism
9.  Bilateral hip fractures.
10. Paroxysmal atrial fibrillation, status post cardioversion
in [**2193-7-21**]
11. Recurrent aspiration pneumonia

ADMISSION MEDICATIONS:
1.  Oxycodone 10 mg q6h prn
2.  Celebrex 200 mg po q day
3.  Tylenol 500 mg po tid
4.  Neurontin 300 mg po bid
5.  Vancomycin 1 gm intravenous q 24 hours
6.  Flagyl 500 mg po tid
7.  Colace 100 mg po bid
8.  Spironolactone 25 mg po q day
9.  Valproic acid 500 mg po q a.m., 750 mg po q noon, 500 mg
po q p.m.
10. Enteric coated aspirin 81 mg po q day
11. Synthroid 0.125 mg po q day
12. Dulcolax prn
13. Captopril 50 mg po tid
14. Lasix 20 mg po bid
15. Zoloft 200 mg po q day
16. Vitamin C 500 mg po q day
17. BuSpar 10 mg po bid
18. Senna 2 tablets po q hs
19. Zinc sulfate 220 mg po q day
20. Combivent metered dose inhaler 2 puffs q6h
21. Multivitamin 1 tablet po q day
22. Protonix 40 mg po q day

ALLERGIES:  THE PATIENT HAS DOCUMENTED HEPARIN INDUCED
THROMBOCYTOPENIA.

SOCIAL HISTORY:  The patient is currently a resident of
[**Hospital3 2558**].  He denies alcohol or tobacco use.  His code
status is do not resuscitate, however intubation, unit and
pressors are permitted.

PHYSICAL EXAMINATION:
VITAL SIGNS:  Temperature 100.8??????, heart rate 79, blood
pressure 94/63, oxygen saturation 90% on a 100%
nonrebreather, respiratory rate 22.
GENERAL:  The patient was a middle aged man in mild
respiratory distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Pupils were equal, round
and reactive to light.  Sclerae were anicteric.  Oromucosa
was dry.  The oropharynx was without lesion.
NECK:  Supple with no lymphadenopathy or jugular venous
distention.
CHEST:  Notable for rancorous breath sounds with no wheezes.
CARDIOVASCULAR:  Irregularly irregular rhythm with a normal
S1 and S2 and a 2/6 systolic ejection murmur.
ABDOMEN:  The abdomen was soft, nontender, nondistended with
hypoactive bowel sounds and no hepatosplenomegaly.
EXTREMITIES:  The patient had palpable peripheral pulses with
no cyanosis, clubbing or edema.
NEUROLOGIC:  The patient was somnolent, but arousable and not
cooperative with neurologic exam.  He was moving all four
extremities.

INITIAL LABORATORY STUDIES:  Chest x-ray indicated near
complete opacification of the left hemithorax with a small
portion of minimally aerated lungs seen laterally at the apex
with progression of left upper lobe air space opacification
since the prior study.  There is also diffuse increased
density of the right hemithorax with apical capping most
likely representing a layering pleural effusion on the right.
Arterial blood gases indicated a pH of 7.43, PACO2 of 48 and
PAO2 of 36.  CBC was notable for a white count of 6.6 and a
history of 29.3.  INR was elevated a 4.8.  PTT was 58.7.
Chem-7 was notable for a BUN of 15, creatinine of 1.0,
bicarbonate of 31 and glucose of 59.  Phosphate was elevated
at 4.6.

HOSPITAL COURSE:  The patient was transferred to the Medical
Intensive Care Unit within hours of his admission secondary
to worsening hypoxia and respiratory distress.  Following is
a description of the [**Hospital 228**] hospital course in the Medical
Intensive Care Unit by system.

1.  PULMONARY:  The patient's oxygen saturation remained
stable on a 100% face mask and shovel mask.  A chest CT
indicated severe tracheomalacia involving the carina and
origin of the main stem bronchus bilaterally.  Bilateral
pleural effusions which were increased since the last study
were also noted, as well as widespread atelectasis in the
right lower lobe, right middle lobe, lingula and left lower
lobe.  There were scattered ground glass opacities and
enlarged pulmonary arteries.  The patient was weaned down to
a 70% face mask with oxygen saturation in the mid 90s.  The
medical team felt that the patient's respiratory status would
not significantly improve with thoracentesis.

2.  CARDIOVASCULAR:  The patient was noted to be hypotensive
in the Medical Intensive Care Unit with a systolic blood
pressure of 70.  He was therefore started on Levophed.  His
hypertension was thought to be most likely related to his
circulating volume.  He was therefore treated with
intravenous fluids and Levophed was weaned.  He was also
evaluated by the cardiac electrophysiology service for an
episode of asymptomatic nonsustained ventricular tachycardia
as well as for the question of whether the patient would
benefit from cardioversion given his atrial fibrillation and
hypotension.  The electrophysiology service elected not to
place a defibrillator secondary to the patient's do not
resuscitate wishes.  The also did not believe the patient
would benefit from cardioversion.

3.  RENAL:  The patient remained stable from a renal
perspective with his creatinine in the range of 1.1 to 1.4.

4.  INFECTIOUS DISEASE:  The patient was continued on
vancomycin and Flagyl for treatment of his aspiration
pneumonia.  Blood cultures were sent and were negative.
Sputum cultures were sent and grew out only oropharyngeal
flora and sparse gram negative rods.  Flagyl was discontinued
on hospital day #5.  The patient's white blood count remained
stable and he remained afebrile.

5.  FLUIDS, ELECTROLYTES AND NUTRITION:  The patient remained
NPO while he was in the Intensive Care Unit receiving only D5
normal saline for nutrition.

6.  HEMATOLOGY:  The patient remained coagulopathic initially
with an INR of 4.8.  He was corrected to a value of 2.6 with
vitamin K.  His coagulopathy was thought likely secondary to
his decreased nutrition.  The patient's hematocrit remained
stable.

7.  ENDOCRINE:  Given the patient's persistent hypotension,
an a.m. cortisol was sent and found to be 5.  However, on
repeat testing with a cosyntropin stimulation test, the
patient ruled out for adrenal insufficiency.  He was
continued on regular insulin sliding scale and Synthroid.

8.  NEUROPSYCHIATRIC:  The patient was continued on valproic
acid.  Pain control was initially achieved with a patient
controlled analgesic pump which was weaned.  The patient's
pain control was adequately treated subsequently with a
fentanyl patch and Dilaudid prn for breakthrough pain.
Psychiatry was consulted and the patient was found to be
competent to make decisions about his medical care.

9.  DERMATOLOGY:  Plastic surgery service was consulted and
debrided a left elbow pressure ulcer.  The patient was to k2
having dressing changes wet to dry [**Hospital1 **].

10. PROPHYLAXIS:  The patient was maintained on Protonix and
auto anticoagulated.

On hospital day #5, the patient was transferred to the floor
for continued management.  Interventional radiology was
consulted for placement of a gastrojejunostomy tube.  The
interventional radiology service was not able to place the
tube until the patient's INR fell to a level of approximately
1.5.  The patient's Coumadin continued to be held and on
hospital day #9 he was taken to the interventional radiology
suite for placement of the GJ tube.  The patient tolerated
the procedure well and there were no complications.  The
patient was subsequently started on Coumadin 1 mg po q hs and
started on tube feeds the following morning.

At the time of this discharge dictation, it was planned that
the patient would be transferred back to [**Hospital3 2558**].

DISCHARGE DIAGNOSES:
1.  Recurrent aspiration pneumonia
2.  Status post cerebrovascular accident
3.  Methicillin resistant Staphylococcus aureus pneumonia and
bacteremia
4.  Atrial fibrillation
5.  Tracheomalacia
6.  Code status do not resuscitate, may intubate
7.  Seizure disorder
8.  Borderline diabetes mellitus
9.  Coronary artery disease
10. Congestive heart failure
11. Hypertension
12. Hypothyroidism
13. History of bilateral hip fractures

DISCHARGE MEDICATIONS:
1.  Coumadin 1 mg per GJ tube q hs
2.  Vancomycin 1 gm intravenous q 24 hours x26 days for a
total course of 6 weeks
3.  Morphine sulfate 1 mg intravenous q4h prn pain
4.  Tylenol 650 mg per GJ tube q 4 to 6 hours prn
5.  Fentanyl 25 mcg transdermal q 72 hours
6.  Synthroid 0.125 mg per GJ tube q day
7.  Dulcolax 10 mg pr prn constipation
8.  Nystatin powder prn groin rash
9.  ASA 81 mg per GJ tube q day
10. Atrovent metered dose inhaler 2 puffs qid
11. Albuterol metered dose inhaler 2 puffs q4h prn
12. Protonix 40 mg per GJ tube q day
13. Zinc sulfate 220 mg per GJ tube q day
14. Senna 2 tablets per GJ tube q hs prn
15. Vitamin C 500 mg per GJ tube q day
16. Zoloft 200 mg per GJ tube q day
17. Multivitamin 1 tablet per GJ tube q day
18. Valproic acid 500 mg q a.m., 750 mg q noon, 500 mg q hs
via GJ tube
19. Colace 100 mg per GJ tube [**Hospital1 **]
20. Neurontin 300 mg per GJ tube tid

The patient would need daily dressing changes for his GJ tube
and [**Hospital1 **] wet to dry dressing changes for his left elbow
pressure ulcer.  The patient would also require chest
physical therapy [**Hospital1 **].  His tube feeds were started at ProMod
with fiber with a goal of 55 cc per hour, hold for abdominal
distention or abdominal pain.  The patient also required
oxygen via 70% face mask.

DISCHARGE CONDITION:  Stable

DISPOSITION:  The patient was transferred back to [**Hospital3 7511**].




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 194**]
MEDQUIST36

D:  [**2194-4-4**]  13:51
T:  [**2194-4-4**]  14:28
JOB#:  [**Job Number **]


Admission Date:  [**2194-3-26**]       Discharge Date:  [**2194-4-5**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:  [**Hospital1 212**] I








                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 194**]
MEDQUIST36

D:  [**2194-4-4**]  13:51
T:  [**2194-4-4**]  14:26
JOB#:  [**Job Number **]


Name:  [**Known lastname 6260**], [**Known firstname 947**]                     Unit No:  [**Numeric Identifier 6261**]

Admission Date:  [**2194-3-26**]       Discharge Date:  [**2194-4-16**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:  [**Hospital1 1098**] I

ATTENDING:[**Name8 (MD) 6283**]
ADDENDUM:  The following is a discharge summary covering the
period from [**2194-3-26**] through [**2194-4-5**].

HISTORY:  On [**4-5**], the patient was noted to desaturate to
78% on a 70% face mask.  Oxygen saturation improved only to
88% on 100% nonrebreather, although there was some
improvement with further suctioning.  Chest x-ray indicated
worsening congestive heart failure.  The patient was
subsequently given IV Lasix with good diuresis.  The patient
was also noted to be coagulopathic with thrombocytopenia.
DIC labs were sent and they were negative.  Aspirin was
discontinued.  It was suggested that the patient's
thrombocytopenia might be secondary to his valproic acid.
The patient was, therefore, loaded on Dilantin and his
valproic acid was slowly weaned.

On [**4-10**], the patient was noted to be increasingly
lethargic with increasing oxygen requirement and arterial
blood gas indicated a pH of 7.27 with PACO2 of 75 and pAO2 of
63.  The patient was, therefore, transferred to the Medical
Intensive Care Unit for hypercarbic respiratory failure.  He
was maintained on 100 nonrebreather in the Intensive Care
Unit, where he was subsequently subject to bronchoscopy,
which indicated diffuse mucous plugging.  The patient's
respiratory status improved following additional suctioning,
as well as the initiation of BiPAP at night.  The patient was
also started on a Lasix drip for additional diuresis and
started on Ceftriaxone and Flagyl to broaden coverage of his
aspiration pneumonia.  As the patient's pulmonary status and
mental status improved, he was transferred back to the floor
on [**4-13**].  On [**4-14**], the patient underwent a
left-sided thoracentesis during which 1800 cc of
serosanguinous fluid was removed.  This fluid was found to be
transudative.

The patient's respiratory status continued to improve.  On
[**4-15**], a sputum culture revealed moderate grow of the
Acinetobacter baumannii, as well Morganella morganii
sensitive to Ceftriaxone.

At the time of this discharge dictation, it was anticipated
that the patient would be discharged back to [**Location (un) 6284**].
He was to continued triple antibiotic treatment for his
pneumonia, continuing Vancomycin for a total of a six-week
course and Ceftriaxone and Flagyl for a total of a two-week
course.

MEDICATIONS ON DISCHARGE:  (revised medications on
discharge).
1.  Coumadin 1 mg per J tube q.h.s.
2.  Vancomycin 1 gram IV dose per level of less than 15
through [**5-1**] and then discharged.
3.  Valproic acid taper, currently 500 mg per GJ tube q.a.m.;
250 mg per GJ tube q noon, 500 mg per GJ tube q.p.m.; reduce
total daily dose by 250 mg q.5 days until off with the next
scheduled reduction on [**4-18**].
4.  Free-water bolus 150 cc per GJ tube t.i.d.
5.  Lasix 60 mg per GJ tube q.d.
6.  Synthroid 0.125 mg per GJ tube q.d.
7.  Ceftriaxone 1 gram IV q.24 hours times 7 days.
8.  Flagyl 500 mg per GJ tube t.i.d. times 7 days.
9.  Ultram 50 mg per GJ tube q.4h. to 6h.p.r.n.
10. Dilantin 100 mg per GJ tube b.i.d. and 150 mg per GJ tube
q. noon.
11. Captopril 12.5 mg per GJ tube t.i.d., hold for systolic
blood pressure of less than 90.
12. Promote with fiber tube feeds at 70 cc over 18 hours per
day, hold one hour pre and post Dilantin doses.
13. Neurontin 100 mg per GJ tube t.i.d.
14. Vitamin C 500 mg p.o. GJ tube b.i.d.
15. Prevacid 30 mg p.o. GJ tube q.d.
16. Tylenol 500 mg per GJ tube q.8h. around the clock.
17. Silvadene cream to the left elbow b.i.d. with Xeroform
dressing changes b.i.d.
18. Fentanyl patch 25 mcg transdermal q.72 hours.
19. Atrovent metered dose inhaler 2 puffs q.i.d.
20. Colace 100 mg per GJ tube b.i.d.
21. Multivitamin one tablet per GJ tube q.d.
22. Senna two tablets per GJ tube q.h.s.p.r.n.
23. Albuterol MDI 2 puffs q.4h.p.r.n.
24. Dulcolax 10 mg pr, p.r.n. constipation.


                            [**First Name8 (NamePattern2) 3294**] [**Last Name (NamePattern1) 3295**], M.D.  [**MD Number(1) 6285**]

Dictated By:[**Last Name (NamePattern1) 5798**]
MEDQUIST36

D:  [**2194-4-15**]  15:52
T:  [**2194-4-15**]  16:02
JOB#:  [**Job Number 6286**]
{'Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Acute respiratory failure,Other convulsions,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified pleural effusion,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 35246**] is a 57-year-old man
with a complicated past medical history including
cerebrovascular accident, seizure disorder, coronary artery
disease, congestive heart failure and recurrent aspiration
pneumonia who was discharged from [**Hospital6 649**] on [**3-24**] with aspiration pneumonia.  He
was at his nursing home where he desaturated to 70% on 5
liters nasal cannula and became tachypneic and uncomfortable.
 He was also febrile and transferred back to [**Hospital6 1760**] for further management.  In
the Emergency Department, he was given albuterol and Atrovent
nebulizers with some relief.  His most recent hospital course
was significant for Methicillin resistant Staphylococcus
aureus pneumonia diagnosed on BAL washings.  He was started
on vancomycin for a six week course of treatment.  He also
had a video swallowing study which showed a high risk of
aspiration, however at that time the patient elected to take
continued po intake with thickened liquids.

MEDICAL HISTORY: 1.  Cerebrovascular accident in [**2189**] with residual left sided
hemiparesis
2.  History of seizure disorder
3.  Borderline diabetes mellitus
4.  Coronary artery disease
5.  Depression
6.  Congestive heart failure with an ejection fraction of
30%.
7.  Hypertension
8.  Hypothyroidism
9.  Bilateral hip fractures.
10. Paroxysmal atrial fibrillation, status post cardioversion
in [**2193-7-21**]
11. Recurrent aspiration pneumonia

MEDICATION ON ADMISSION: 

ALLERGIES: THE PATIENT HAS DOCUMENTED HEPARIN INDUCED
THROMBOCYTOPENIA.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is currently a resident of
[**Hospital3 2558**].  He denies alcohol or tobacco use.  His code
status is do not resuscitate, however intubation, unit and
pressors are permitted. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Acute respiratory failure,Other convulsions,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified pleural effusion,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}
