CHIEF COMPLAINT: fever, tachycardia, abdominal pain

PRESENT ILLNESS: 52 yo female history of Hep C, EtOH abuse complicated with
pancreatitis, and potential cirrhosis who was brought in by
ambulance from a nursing home with fever, tachycardia to 150s.
Pt reports abdominal discomfort.
.
In the ED, initial vitals were 101.0 150 110/65 28 100%. She was
given tylenol for fever. She was confused in the ED but her
baseline mental status is alert but confused, she frequently
calls out for family members ([**Name (NI) **] and [**Name (NI) 93401**]). She was
given 0.5mg PO ativan at 6am. CXR showed LLL pna and positive
UA. She was given levofloxacin and vancomycin. A subclavian
central line was placed for access, complicated with left PTX.
Thoracics was consulted and placed pigtail catheter in left
chest. Repeat CXR showed resolving PTX. Pt found to have
pancreatitis and BISAP score [**2-8**], although hard to assess mental
status given poor baseline.
.
On arrival to the MICU, pt appears confused but knows her name.
She is diapharetic, anxious. She reports abominal pain. Short
shallow breaths.

MEDICAL HISTORY: h/o polysubstance abuse (incl heroin and ETOH)
hepatitis C ? cirrhosis
chronic encephalopathy ? etiology
ascites
seizure disorder
chronic dysphagia s/p g tube placement
recurrent aspiration pneumonia (on adm to OSH [**Month (only) 205**] and [**2141-10-6**])
recurrent C diff colitis
h/o alcoholic pancreatitis
bilateral nephrolithiasis
chronic neck dystonia
resides in [**Hospital1 1501**]
chronic anemia
depression
S/P BSO

MEDICATION ON ADMISSION: keppra 1500mg [**Hospital1 **]
divalproex sprinkles 500mg qam and 1000mg qpm
topiramate 100mg qam and 200mg q8pm
lorazepam 0.5mg mg tid
mirtazapine 15mg hs
famotidine suspension 40mg daily
docuate 100 [**Hospital1 **]
asa 81 mg
calcium carb 1250mg [**Hospital1 **]
acetaminophen 325 2 q4 prn
mylanta q4 prn
diazepam 5 im prn seizure
guafenesin 10cc q4 prn
bisacodyl 10 pr prn
fleets enema prn
mom 30 cc daily prn
loperamide 2mg q6 prn
ativan 1mg q6h prn
miralax 17g daily prn

ALLERGIES: Codeine / Heparin Agents / Clonidine / divalproex sodium

PHYSICAL EXAM: Admission physical exam:
Vitals:  HR 115, BP 142/70, 99% on non-rebreather, RR 30
General: confused, screaming out names, anxious
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: tachcyardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: anterior lungs appreciated bilaterally, no crackles on
anterior lungs
Abdomen: tender to palpation, mildly distended
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: unable to get, not cooperative

FAMILY HISTORY: Unavailable at this time.

SOCIAL HISTORY: per OSH- single non-drinker, non-smoker. Lives at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Nursing Home
Septicemia due to pseudomonas,Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Toxic encephalopathy,Pneumonia, organism unspecified,Acute pancreatitis,Acidosis,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Urinary tract infection, site not specified,Portal hypertension,Mechanical complication of gastrostomy,Iatrogenic pneumothorax,Spastic hemiplegia and hemiparesis affecting unspecified side,Delirium due to conditions classified elsewhere,Severe sepsis,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Anemia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified alcohol dependence, in remission,Unspecified persistent mental disorders due to conditions classified elsewhere
Pseudomonas septicemia,Encephalitis NOS,Toxic encephalopathy,Pneumonia, organism NOS,Acute pancreatitis,Acidosis,Psymotr epil w intr epil,Urin tract infection NOS,Portal hypertension,Gastrostomy comp - mech,Iatrogenic pneumothorax,Spstc hmiplga unspf side,Delirium d/t other cond,Severe sepsis,Chrnc hpt C wo hpat coma,Thrombocytopenia NOS,Anemia NOS,Abn react-procedure NEC,Alcoh dep NEC/NOS-remiss,Mental disor NOS oth dis
Admission Date:  [**2143-1-11**]              Discharge Date:   [**2143-1-24**]

Date of Birth:  [**2090-4-3**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Heparin Agents / Clonidine / divalproex sodium

Attending:[**First Name3 (LF) 9160**]
Chief Complaint:
fever, tachycardia, abdominal pain

Major Surgical or Invasive Procedure:
Left subclavian central line placement.
Left pigtail tube thoracostomy.
Right upper extremity peripherally inserted central catheter
(PICC).
Replacement of gastrostomy tube to a 20F tube.
Intubation [**1-17**]


History of Present Illness:
52 yo female history of Hep C, EtOH abuse complicated with
pancreatitis, and potential cirrhosis who was brought in by
ambulance from a nursing home with fever, tachycardia to 150s.
Pt reports abdominal discomfort.
.
In the ED, initial vitals were 101.0 150 110/65 28 100%. She was
given tylenol for fever. She was confused in the ED but her
baseline mental status is alert but confused, she frequently
calls out for family members ([**Name (NI) **] and [**Name (NI) 93401**]). She was
given 0.5mg PO ativan at 6am. CXR showed LLL pna and positive
UA. She was given levofloxacin and vancomycin. A subclavian
central line was placed for access, complicated with left PTX.
Thoracics was consulted and placed pigtail catheter in left
chest. Repeat CXR showed resolving PTX. Pt found to have
pancreatitis and BISAP score [**2-8**], although hard to assess mental
status given poor baseline.
.
On arrival to the MICU, pt appears confused but knows her name.
She is diapharetic, anxious. She reports abominal pain. Short
shallow breaths.

Past Medical History:
h/o polysubstance abuse (incl heroin and ETOH)
hepatitis C ? cirrhosis
chronic encephalopathy ? etiology
ascites
seizure disorder
chronic dysphagia s/p g tube placement
recurrent aspiration pneumonia (on adm to OSH [**Month (only) 205**] and [**2141-10-6**])
recurrent C diff colitis
h/o alcoholic pancreatitis
bilateral nephrolithiasis
chronic neck dystonia
resides in [**Hospital1 1501**]
chronic anemia
depression
S/P BSO


Social History:
per OSH- single non-drinker, non-smoker. Lives at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Nursing Home

Family History:
Unavailable at this time.


Physical Exam:
Admission physical exam:
Vitals:  HR 115, BP 142/70, 99% on non-rebreather, RR 30
General: confused, screaming out names, anxious
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: tachcyardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: anterior lungs appreciated bilaterally, no crackles on
anterior lungs
Abdomen: tender to palpation, mildly distended
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: unable to get, not cooperative

Discharge physical exam:
Vitals: Tmax 99.1 Tc 98.8 BP 110/70 HR 1114 (114-130) RR 20 O2
Sat 95% RA  I/O: 280/675
General: Patient lying in bed in NAD initially, but then
becoming aggitated and appearing preoccupied with visual
hallucination.
HEENT: MMM.
CV: Tachycardia. No murmurs/rubs/gallops
Abd: NABS+. Soft. NT/ND. No rebound/guarding.
Ext: WWP with pneumoboots in place. 2+ DPs bilaterally. No
clubbing, cyanosis. Trace pitting edema to the knees
bilaterally. Bleeding at the PICC site present.
Psych: At times perseverating on one word or one response
despite being asked other questions. In the midst of
conversation, appears occupied with what appears to be visual
hallucinations.


Pertinent Results:
Admission labs:
[**2143-1-11**] 09:21AM BLOOD WBC-26.7*# RBC-4.03*# Hgb-14.2# Hct-41.8#
MCV-104* MCH-35.2*# MCHC-34.0 RDW-11.7 Plt Ct-208
[**2143-1-11**] 09:21AM BLOOD Neuts-86* Bands-0 Lymphs-7* Monos-7 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2143-1-11**] 09:21AM BLOOD PT-15.4* PTT-30.9 INR(PT)-1.4*
[**2143-1-11**] 09:21AM BLOOD Glucose-134* UreaN-31* Creat-0.7 Na-140
K-4.2 Cl-104 HCO3-27 AnGap-13
[**2143-1-11**] 09:21AM BLOOD ALT-17 AST-32 AlkPhos-99 TotBili-0.6
[**2143-1-11**] 09:21AM BLOOD Calcium-9.5 Phos-2.2* Mg-1.8
[**2143-1-11**] 09:21AM BLOOD Valproa-56
[**2143-1-11**] 09:41AM BLOOD Lactate-3.1*

Discharge labs:
[**2143-1-24**] 05:58AM BLOOD WBC-9.3 RBC-2.32* Hgb-7.8* Hct-24.2*
MCV-104* MCH-33.4* MCHC-32.0 RDW-15.3 Plt Ct-282
[**2143-1-24**] 05:58AM BLOOD Glucose-126* UreaN-4* Creat-0.4 Na-141
K-3.9 Cl-111* HCO3-23 AnGap-11
[**2143-1-24**] 05:58AM BLOOD Calcium-8.4 Phos-2.8 Mg-1.5*

Imaging:
CXR [**2143-1-11**]:  Patient is rotated which limits interpretation of
this film. Slight increase in opacity in the left lower lung
field is present. Heart size is normal. No pleural effusions are
seen. No pneumothorax
is seen. IMPRESSION: Opacity in the left lower lung field,
atelectasis vs early pneumonia. PA and lateral films may be
helpful for further evaluation.

CT abd/pelvis/chest [**2143-1-11**]:
 IMPRESSION:
1. Large left pneumothorax.
2. Peripancreatic fluid, consistent with pancreatitis, along
with slight
decrease in attenuation of the body of the pancreas. Early
necrosis of the
pancreas cannot be excluded. There is also an early organizing
fluid
collection in between the stomach and pancreas. This could
represent an early pseudocyst. Calcifications at the tail of the
pancreas are consistent with the history of chronic
pancreatitis.
3. Thickened left adrenal, stable.
4. Interdeterminte density lesion within the left kidney which
attenuates
more than would be expected from a simple renal cyst. Renal
ultrasound
recommended if this lesion has not previously been worked up.
5. Dilated common bile duct. Consider an MRCP for further
evaluation if
distal obstruction is of concern.

[**1-14**] CT head: IMPRESSION: Prominent sulci and asymmetric
enlargement of supratentorial ventricular system consistent with
cortical volume loss of uncertain chronicity. Otherwise, no
evidence of acute intracranial process.

[**1-14**] RUQ gallbladder:
IMPRESSION:
1. Extrahepatic biliary ductal dilation, little changed compared
to [**2143-1-11**] and slightly increased compared to [**2-1**], [**2142**]. No stones are identified in the imaged portion of the
common bile duct, although the most distal duct is not fully
visualized. MRCP could obtain further information if clinically
indicated.
2. Peripancreatic and perihepatic free fluid, consistent with
the given
history of pancreatitis.
3. Left pleural effusion.
4. Gallbladder sludge without evidence of gallstones.

[**1-17**] CT abd:
IMPRESSION: Interval increase in size of bilateral pleural
effusions left
larger than right. Left subclavian line with its tip in the
BC-SVC and needs to be repositioned. Interval decrease in
peripancreatic fluid collections. Persistent fluid collection in
the lesser sac. Prominent peripancreatic lymph nodes which are
stable since previous study, likely reactive.


Brief Hospital Course:
# Pancreatitis: Patient with a known history of pancreatitis and
pancreatic pseudocysts presented with a pancreatitis with a
BISAP score [**2-8**], lipase in the 200s with a CT showing evidence
of acute pancreatitis.  Patient was given IVF, pain medications,
and was made NPO.  She was intially admitted to the MICU,
briefly requiring vasopressors, but then was called out to the
floor in a day.  On the floor she continued to do well with
improving hemodynamics and decreased epigastric tenderness.  She
had a RUQ ultrasound with sludge without stones and CBD
dilitation.  However given the lack of clear obstructive
symptoms, we were also considering medication-induced
pancreatitis, particularly the divalproex.
.
# Sepsis w/ SIRS: On [**2143-1-17**] the patient was transfered back to
the MICU due to abdominal pain, tachycardia, and respiratory
distress with hypotension. She was subsequently intubated.
Although no evidence of interval change was visible on her CT,
blood cultures subsequently grew pan-sensitive pseudomonas, for
which she received cefepime. She was given aggressive fluid
rehydration and pressor support with norepinephrine.  Her
pressures improved over the course of several days, with gradual
weaning of norepinephrine and less aggressive fluid support, and
she had brisk auto-diuresis as her pressures improved. She was
extubated without difficulty on [**1-20**]. Her symptoms of
respiratory distress and hypotension improved.
.
# Seizure Disorder:  The patient used to be a Case Manager for
most of her life, and while she had troubles with
polysubstance/IVDU abuse, she previously had no global
neurological deficits. That changed when in [**2141**] she sustained a
series of generalized tonic clonic seizures that by report
lasted for days and were intractable.  That admission initially
started at [**Hospital1 2177**], but she was later transferred to [**Hospital1 87068**] epilepsy
service.  Ultimately no cause for the seizures could be found,
although it looks like they suspected anti-NMDA receptor
encephilitis, which was ultimately negative.  There are
excellent notes from [**Hospital1 112**] documenting her saga, which should be
scanned into her OMR record now.  After the seizures she had a
PEG tube placed and transferred to [**Hospital1 1501**] where she resides full
time. During her ICU course, she had multi-day EEG monitoring,
which demonstrated no active epileptiform activity. In the ICU,
her anti-epileptic medications were adjusted under the guidance
of her neurology service as depakote can cause pancreatitis. She
is now on Topamax and Keppra. The patient had no seizure
activity during her hospitalization at [**Hospital1 18**].
.
# Tachycardia: Patient with persistent tachycardia through the
admission. Her tachycardia was narrow complex tachycardia and
appeared to originate from the sinus node. Her tachycardia was
in the 110s, and the patient had stable blood pressures. She was
asymptomatic from the tachycardia. Her tachycardia was thought
to be due to aggitation secondary to internal stimuli (see
below).
.
# Paranoid psychosis/altered mental status: Per report from thet
nursing facility where the patient resides, at baseline, she is
confused and alert and oriented only to person. She can track
but is never able to have cogent or fluent conversation. She
appeared to have hallucinations, both auditory and visual, which
upon conversation with staff at the nursing home is also her
baseline. She also required frequent re-direction during this
hospitalization, which per report from the nursing home is also
her baseline. She would call out to a man named [**Name (NI) **] and
would have internal conversations with [**Doctor Last Name **]. At times, she
would become very agitated, and her tachycardia would be
exacerbated during these episodes of aggitation. Psychiatry saw
the patient while in house and recommended discontinuing the
patient's Ativan that she was previously receiving and that
instead she receive IV haldol twice to three times daily as
needed.
.
# Thrombocytopenia: Patient initially presented with
thrombocytpenia likely from sepsis and acute stress. Her
platelet count improved while she was on the floor, from a nadir
96,000. HIT Ab negative on this admission, though patient has a
documented episode of HIT.  Heparin products were not used in
this patient. Patient platelet count improved though through the
admission. She was given fondaparinux and pneumoboots for DVT
prophylaxis.
.
# Pneumothorax: Patient had a left-sided pneumothorax secondary
to placement of a left subclavian line, which was treated with
pig tail tube thoracostomy [**2-7**] complication of subclavian
placement.  Pigtail was subseqeuently removed. On day of
discharge, patient was saturating well on room air.
.
TRANSITIONAL ISSUES:
- Complete 14-day course of Cefepime via PICC line.
- Follow-up with outpatient Neurologist to guide management of
seizure meds.
- Ativan was discontinued. Haldol can be used as needed for
paranoid ideation.


Medications on Admission:
keppra 1500mg [**Hospital1 **]
divalproex sprinkles 500mg qam and 1000mg qpm
topiramate 100mg qam and 200mg q8pm
lorazepam 0.5mg mg tid
mirtazapine 15mg hs
famotidine suspension 40mg daily
docuate 100 [**Hospital1 **]
asa 81 mg
calcium carb 1250mg [**Hospital1 **]
acetaminophen 325 2 q4 prn
mylanta q4 prn
diazepam 5 im prn seizure
guafenesin 10cc q4 prn
bisacodyl 10 pr prn
fleets enema prn
mom 30 cc daily prn
loperamide 2mg q6 prn
ativan 1mg q6h prn
miralax 17g daily prn

Discharge Medications:
1. topiramate 100 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
2. topiramate 100 mg Tablet Sig: Two (2) Tablet PO QPM (once a
day (in the evening)).
3. cefepime 2 gram Recon Soln Sig: One (1) Recon Soln Injection
Q8H (every 8 hours) for 6 days.
4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
5. levetiracetam 100 mg/mL Solution Sig: Fifteen (15) mL PO BID
(2 times a day).
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
7. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO every four
(4) hours as needed for pain.
8. Mylanta 200-200-20 mg/5 mL Suspension Sig: [**10-26**] mL PO every
four (4) hours as needed for indigestion.
9. diazepam 5 mg/mL Solution Sig: One (1) injection Injection
PRN as needed for seizure.
10. bisacodyl 10 mg Suppository Sig: One (1) suppository Rectal
once a day as needed for constipation.
11. Milk of Magnesia 400 mg/5 mL Suspension Sig: Thirty (30) mL
PO once a day as needed for constipation.
12. Miralax 17 gram Powder in Packet Sig: One (1) packet
packet PO once a day as needed for constipation.
13. calcium carbonate 500 mg calcium (1,250 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO twice a day.
14. guaifenesin 50 mg/5 mL Liquid Sig: Ten (10) mL PO every four
(4) hours as needed for cough.
15. famotidine 40 mg/5 mL Suspension Sig: Five (5) mL PO once a
day.


Discharge Disposition:
Extended Care

Facility:
Roscommon on the Parkway - [**Location 1268**]

Discharge Diagnosis:
PRIMARY DIAGNOSIS:
Pancreatitis
Pseudomonas bacteremia
Sepsis

SECONDARY DIAGNOSIS:
Chronic Encephalopathy
Seizure disorder
HCV
Past alcohol abuse
Past poly-substance abuse
Cirrhosis


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Lethargic but arousable.
Activity Status: Bedbound.


Discharge Instructions:
Dear Ms. [**Known lastname 634**],

It was a pleasure to take care of you during your
hospitalization at [**Hospital1 69**].

You had pancreatitis, an inflammation of an organ in your
abdomen called your pancreas.  We treated your pain and gave you
IV fluids while you were here.  We got some tests to take a look
at what going on in your abdomen, and we determined that there
is no medical or surgical emergency occuring right now. You also
developed Psuedomonas bacteremia while in the hospital, and you
are currently receiving IV antibiotics through the PICC line in
your left arm. You will be receiving antibiotics for another 6
days to complete a full 14 day course.

Continue all of your home medications as prescribed. Please note
that you will be receiving another 6 days of an antibiotic known
as cefepime to complete a full 14-day course. Haldol was also
started during this admission for your underlying anxiety per
the psychiatrists' recommendation. Stop taking Ativan. Also your
depakote was discontinued given the increased risk of
pancreatitis associated with taking this medication. The
medications that you will be taking to prevent seizures are
keppra and phenytoin.



Followup Instructions:
You need to be seen by your neurologist within 2 weeks from
discharge to make sure that your regimen of seizure medications
is appropriate.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 9162**]
{'Septicemia due to pseudomonas,Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Toxic encephalopathy,Pneumonia, organism unspecified,Acute pancreatitis,Acidosis,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Urinary tract infection, site not specified,Portal hypertension,Mechanical complication of gastrostomy,Iatrogenic pneumothorax,Spastic hemiplegia and hemiparesis affecting unspecified side,Delirium due to conditions classified elsewhere,Severe sepsis,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Anemia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified alcohol dependence, in remission,Unspecified persistent mental disorders due to conditions classified elsewhere'}


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: fever, tachycardia, abdominal pain

PRESENT ILLNESS: 52 yo female history of Hep C, EtOH abuse complicated with
pancreatitis, and potential cirrhosis who was brought in by
ambulance from a nursing home with fever, tachycardia to 150s.
Pt reports abdominal discomfort.
.
In the ED, initial vitals were 101.0 150 110/65 28 100%. She was
given tylenol for fever. She was confused in the ED but her
baseline mental status is alert but confused, she frequently
calls out for family members ([**Name (NI) **] and [**Name (NI) 93401**]). She was
given 0.5mg PO ativan at 6am. CXR showed LLL pna and positive
UA. She was given levofloxacin and vancomycin. A subclavian
central line was placed for access, complicated with left PTX.
Thoracics was consulted and placed pigtail catheter in left
chest. Repeat CXR showed resolving PTX. Pt found to have
pancreatitis and BISAP score [**2-8**], although hard to assess mental
status given poor baseline.
.
On arrival to the MICU, pt appears confused but knows her name.
She is diapharetic, anxious. She reports abominal pain. Short
shallow breaths.

MEDICAL HISTORY: h/o polysubstance abuse (incl heroin and ETOH)
hepatitis C ? cirrhosis
chronic encephalopathy ? etiology
ascites
seizure disorder
chronic dysphagia s/p g tube placement
recurrent aspiration pneumonia (on adm to OSH [**Month (only) 205**] and [**2141-10-6**])
recurrent C diff colitis
h/o alcoholic pancreatitis
bilateral nephrolithiasis
chronic neck dystonia
resides in [**Hospital1 1501**]
chronic anemia
depression
S/P BSO

MEDICATION ON ADMISSION: keppra 1500mg [**Hospital1 **]
divalproex sprinkles 500mg qam and 1000mg qpm
topiramate 100mg qam and 200mg q8pm
lorazepam 0.5mg mg tid
mirtazapine 15mg hs
famotidine suspension 40mg daily
docuate 100 [**Hospital1 **]
asa 81 mg
calcium carb 1250mg [**Hospital1 **]
acetaminophen 325 2 q4 prn
mylanta q4 prn
diazepam 5 im prn seizure
guafenesin 10cc q4 prn
bisacodyl 10 pr prn
fleets enema prn
mom 30 cc daily prn
loperamide 2mg q6 prn
ativan 1mg q6h prn
miralax 17g daily prn

ALLERGIES: Codeine / Heparin Agents / Clonidine / divalproex sodium

PHYSICAL EXAM: Admission physical exam:
Vitals:  HR 115, BP 142/70, 99% on non-rebreather, RR 30
General: confused, screaming out names, anxious
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: tachcyardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: anterior lungs appreciated bilaterally, no crackles on
anterior lungs
Abdomen: tender to palpation, mildly distended
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: unable to get, not cooperative

FAMILY HISTORY: Unavailable at this time.

SOCIAL HISTORY: per OSH- single non-drinker, non-smoker. Lives at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Nursing Home 

### Response:
{'Septicemia due to pseudomonas,Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Toxic encephalopathy,Pneumonia, organism unspecified,Acute pancreatitis,Acidosis,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Urinary tract infection, site not specified,Portal hypertension,Mechanical complication of gastrostomy,Iatrogenic pneumothorax,Spastic hemiplegia and hemiparesis affecting unspecified side,Delirium due to conditions classified elsewhere,Severe sepsis,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Anemia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified alcohol dependence, in remission,Unspecified persistent mental disorders due to conditions classified elsewhere'}
