CHIEF COMPLAINT: fever and coccygeal pain

PRESENT ILLNESS: 67-year-old man with paraplegia (as a result of an inflammatory
spinal cord process of unknown etiology), a chronic indwelling
Foley catheter, and a known sacral decubitus ulcer was evaluated
on an outpatient basis on [**8-1**] and was found to have a
leukocytosis (WBC 14K); Staph aureus was cultured from his
sacral decub.  Cefpodoxime 200 mg twice daily was started.
Despite this intervention, he remained febrile, and he began
having yellow drainage from his ulcer.  He was therefore brought
to the ED on [**8-10**].  There, he was hypotensive (80s/60s).  Blood
and urine cultures were drawn, dexamethasone was given, empiric
vanc, levoflox, and flagyl were started, and 3.6 liters of fluid
were infused.  He was admitted to the ICU.

MEDICAL HISTORY: 1. Inflammatory disease of the spinal cord of uncertain
etiology.  MRA [**10-15**] negative for vascular malformation.  Initial
CSF analysis showed elevated protein (82) without oligoclonal
bands.  NMO blood titer negative, RPR negative, Lyme serology
negative, [**Doctor First Name **] negative, Ro and La negative, ACE level normal,
neuromyelitis IgG negative, ESR 70, CRP 66.8.  Ultimately
treated with broad spectrum antibiotics, corticosteroids (two
weeks of Solu-Medrol followed by a prednisone taper), and 5 days
of mannitol without improvement.  He is followed by neurology
for a dense paraplegia (T4) with neuropathic pain, restrictive
shoulder arthropathy, and a neurogenic bladder requiring a
chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC
dressing
3. Multiple UTI (including Pseudomonas)
4. Pulmonary embolus [**11-14**] s/p IVC filter placement
5. Asthma
6. Two-vessel coronary artery disease s/p CABG 4-5 years ago
7. Systolic CHF (EF 25-30% on [**2-15**] TTE)
8. Repaired liver laceration
9. Chronic back pain
10. Vitiligo
11. Feeding tube
12. Depression
13. MRSA from sacral swab and sputum
14. Prior transient episodes of leg paralysis
15. Right frontal lobe brain lesion biopsied [**11-14**] and c/w
gliosis; resolved on repeat imaging
16. Abnormal visual evoked potentials

MEDICATION ON ADMISSION: 1. trazadone 25 mg at bedtime
2. coumadin 2 mg qPM
3. tylenol 650 mg q8h prn
4. dilaudid 2 mg q4h prn
5. prostat 30 cc tid
6. xanax 0.25 mg po bid (started [**8-8**])
7. vitamin C 500 mg [**Hospital1 **]
8. aspirin 81 mg po daily
9. baclofen 5 mg po three times daily
10. bisacodyl supp every other day
11. cefpodoxime 200 mg twice daily
12. citalopram 40 mg po daily
13. docusate 100 mg po bid
14. omeprazole 40mg po daily
15. senna 2 tabs [**Hospital1 **]
16. simvastatin 40mg po qhs
17. advair 250/50 [**Hospital1 **]
18. neurontin 800mg tid
19. magnesium gluconate 500mg po bid
20. MVI with minerals daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.7, 98/68, 80, 20, 97%
Gen: Well appearing male in NAD lying in bed.
HEENT: MMM, lips slightly pale, smooth tongue.
Chest: CTA bilaterally, no w/r/r.
CV: RRR, physiologic splitting S2, no m/r/g.
Abd: Soft, nontender/nondistended, g-tube in place, c/d/i.
Extremities: Warm, well perfused, no C/C. Trace pedal edema
bilaterally.
Skin: Vitiligo on hands. Large round 10 cm diameter pressure
decubitus ulcer on sacrum with appropriate dressing. Appears
clean with granulation tissue in center, no s/sx of infection.
Neuro: CN grossly intact. A&O x 3, pleasantly conversant.

FAMILY HISTORY: No stroke, aneurysm, no seizure, no AAA.

SOCIAL HISTORY: He moved here from [**Country 3594**] (after living in many different
countries) in the [**2068**].  He is retired from a job in the
maritime industry.  Divorced 24 years ago.  Three children.
Quit smoking [**2076**].  Quit drinking [**2080**].  No history of illicit
drug use or abuse.
Septicemia due to escherichia coli [E. coli],Septic shock,Chronic systolic heart failure,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pressure ulcer, lower back,Acute osteomyelitis, other specified sites,Severe sepsis,Asthma, unspecified type, unspecified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Paraplegia,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified,Coronary atherosclerosis of native coronary artery
E coli septicemia,Septic shock,Chr systolic hrt failure,Urin tract infection NOS,React-oth vasc dev/graft,Pressure ulcer, low back,Ac osteomyelitis NEC,Severe sepsis,Asthma NOS,Long-term use anticoagul,Hx-ven thrombosis/embols,Phlbts sprfc vn up extrm,Paraplegia NOS,Aortocoronary bypass,Other lung disease NEC,Crnry athrscl natve vssl
Admission Date:  [**2105-8-10**]              Discharge Date:   [**2105-8-20**]

Date of Birth:  [**2038-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
fever and coccygeal pain

Major Surgical or Invasive Procedure:
1. bedside debridement of right ischial necrotic tissue [**2105-8-11**]

History of Present Illness:
67-year-old man with paraplegia (as a result of an inflammatory
spinal cord process of unknown etiology), a chronic indwelling
Foley catheter, and a known sacral decubitus ulcer was evaluated
on an outpatient basis on [**8-1**] and was found to have a
leukocytosis (WBC 14K); Staph aureus was cultured from his
sacral decub.  Cefpodoxime 200 mg twice daily was started.
Despite this intervention, he remained febrile, and he began
having yellow drainage from his ulcer.  He was therefore brought
to the ED on [**8-10**].  There, he was hypotensive (80s/60s).  Blood
and urine cultures were drawn, dexamethasone was given, empiric
vanc, levoflox, and flagyl were started, and 3.6 liters of fluid
were infused.  He was admitted to the ICU.

On further review of systems, the patient reports a history of
progressive night sweats with chills over the past 5-6 months.
He's also had a cough productive of increasing amounts of white
sputum for the two months PTA.  He has limited sensation but has
felt increased pain in his sacral decub recently.  His
left-sided, burning chest pain, right-sided abdominal pain, and
R>L shoulder pain all started with the onset of his paresis and
have progressed steadily since then.

Blood pressure promptly returned to the range of the patient's
relatively low baseline with early goal directed therapy.  He
was admitted to the ICU under the sepsis protocol but required
ICU-level care for less than 48 hours.

Fevers are most likely due to sacral osteomyelitis.  Bone scan
non-diagnostic, but suggestive of osteomyelitis.  MRI likely not
possible due to IVC filter; would confirm this with radiology.
Since we can probe to bone on physical exam, then the diagnosis
becomes increasingly likely.  Referred to orthopedics consult
for bone biopsy and discussion of possible ulcer debridement.
Vancomycin and ciprofloxacin were started pending biopsy.
Continue aggressive wound care.

3. Pulmonary Embolism: Goal INR [**3-14**].  Warfarin currently being
held.  Anticipate resuming it today; will need to monitor INR
closely on combination of warfarin and cipro.

4. Asthma: Continue advair and albuterol.

5. CAD: ASA, simvastatin

6. CHF: Monitor fluid status and respiration; if flashes in
context of fluid loading for sepsis protocol diurese.

7. Depression: continue citalopram.

8. Back Pain/Chronic Pain: Continue Dilaudid, baclofen, and
gabapentin.

9. FEN/GI: On HH diet. Replete lytes as indicated.

10. PPX: Bowel regimen, anti-coagulation with coumadin, PPI.

11. Communication: Patient declines to name family members or
other persons who could make decisions on his behalf or be
contact[**Name (NI) **] regarding this admit.

12. Code: Full-discussed admit, no advanced directives or HCP.

13. Access: RIJ CVC (presep) placed in ED [**8-10**], R AC PIV.

14. Dispo: Pending osteomyelitis work-up.

Past Medical History:
1. Inflammatory disease of the spinal cord of uncertain
etiology.  MRA [**10-15**] negative for vascular malformation.  Initial
CSF analysis showed elevated protein (82) without oligoclonal
bands.  NMO blood titer negative, RPR negative, Lyme serology
negative, [**Doctor First Name **] negative, Ro and La negative, ACE level normal,
neuromyelitis IgG negative, ESR 70, CRP 66.8.  Ultimately
treated with broad spectrum antibiotics, corticosteroids (two
weeks of Solu-Medrol followed by a prednisone taper), and 5 days
of mannitol without improvement.  He is followed by neurology
for a dense paraplegia (T4) with neuropathic pain, restrictive
shoulder arthropathy, and a neurogenic bladder requiring a
chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC
dressing
3. Multiple UTI (including Pseudomonas)
4. Pulmonary embolus [**11-14**] s/p IVC filter placement
5. Asthma
6. Two-vessel coronary artery disease s/p CABG 4-5 years ago
7. Systolic CHF (EF 25-30% on [**2-15**] TTE)
8. Repaired liver laceration
9. Chronic back pain
10. Vitiligo
11. Feeding tube
12. Depression
13. MRSA from sacral swab and sputum
14. Prior transient episodes of leg paralysis
15. Right frontal lobe brain lesion biopsied [**11-14**] and c/w
gliosis; resolved on repeat imaging
16. Abnormal visual evoked potentials

Social History:
He moved here from [**Country 3594**] (after living in many different
countries) in the [**2068**].  He is retired from a job in the
maritime industry.  Divorced 24 years ago.  Three children.
Quit smoking [**2076**].  Quit drinking [**2080**].  No history of illicit
drug use or abuse.

Family History:
No stroke, aneurysm, no seizure, no AAA.

Physical Exam:
97.7, 98/68, 80, 20, 97%
Gen: Well appearing male in NAD lying in bed.
HEENT: MMM, lips slightly pale, smooth tongue.
Chest: CTA bilaterally, no w/r/r.
CV: RRR, physiologic splitting S2, no m/r/g.
Abd: Soft, nontender/nondistended, g-tube in place, c/d/i.
Extremities: Warm, well perfused, no C/C. Trace pedal edema
bilaterally.
Skin: Vitiligo on hands. Large round 10 cm diameter pressure
decubitus ulcer on sacrum with appropriate dressing. Appears
clean with granulation tissue in center, no s/sx of infection.
Neuro: CN grossly intact. A&O x 3, pleasantly conversant.

Pertinent Results:
[**2105-8-20**] 07:25AM BLOOD WBC-7.6 RBC-3.66* Hgb-9.8* Hct-30.4*
MCV-83 MCH-26.9* MCHC-32.3 RDW-18.8* Plt Ct-319
[**2105-8-19**] 05:00AM BLOOD PT-14.3* PTT-30.4 INR(PT)-1.3*
[**2105-8-20**] 07:25AM BLOOD Glucose-142* UreaN-9 Creat-0.5 Na-140
K-4.3 Cl-104 HCO3-29 AnGap-11
[**2105-8-13**] 06:55AM BLOOD ALT-10 AST-8 AlkPhos-100 TotBili-0.1
[**2105-8-20**] 07:25AM BLOOD Calcium-8.9 Phos-3.4 Mg-2.2
[**2105-8-10**] 07:00PM BLOOD Cortsol-7.9
[**2105-8-10**] 07:00PM BLOOD CRP-120.3*
[**2105-8-10**] 08:25PM BLOOD Lactate-0.8
[**2105-8-10**] 07:09PM BLOOD Lactate-0.7
[**2105-8-10**] 02:22PM BLOOD Lactate-2.5*

[**2105-8-17**] 4:00 pm TISSUE      ISCHIAL BONE.

   GRAM STAIN (Final [**2105-8-17**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2105-8-20**]):
      ESCHERICHIA COLI.    RARE GROWTH.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------  =>16 R
IMIPENEM--------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------     4 S
TRIMETHOPRIM/SULFA----  =>16 R

   ANAEROBIC CULTURE (Preliminary):    NO ANAEROBES ISOLATED.

   ACID FAST SMEAR (Final [**2105-8-18**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.

   ACID FAST CULTURE (Pending):

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

   POTASSIUM HYDROXIDE PREPARATION (Final [**2105-8-18**]):
      NO FUNGAL ELEMENTS SEEN.

   URINE CULTURE (Final [**2105-8-12**]):
      ENTEROCOCCUS SP..    >100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------  =>16 R
VANCOMYCIN------------   <=1 S

STUDY: Left upper extremity venous ultrasound.
INDICATION: 67-year-old male with redness, swelling, and pain in
the left upper arm. Assess for DVT.
FINDINGS: Grayscale and Doppler son[**Name (NI) 1417**] of the left internal
jugular, left subclavian, left axillary, left basilic, left
cephalic, and left brachial veins are performed. Normal
compressibility and waveforms are demonstrated.
IMPRESSION: No evidence of deep vein thrombosis of the left
upper extremity.

MRI OF THE PELVIS WITHOUT AND WITH IV CONTRAST:
IMPRESSION:
1. Large right decubitus ulcer involving the right posteromedial
buttock and right proximal medial thigh with right ischial
tuberosity osteomyelitis.
2. Midline sacral decubitus ulcer with probable osteomyelitis
involving the S4 vertebral body and absence of the S5 vertebral
body and coccyx suggesting osseous destruction.
3. No evidence of fistulous connection between the GI tract with
either the sacral or decubitus ulcer. No focal fluid collections
to suggest an abscess are present.
4. Diffuse signal abnormality and enhancement of the visualized
pevlic musculature suggestive of a myositis which may be
inflammatory in nature.

BONE SCAN: IMPRESSION:
Limited study but findings consistent with osteomyelitis of the
distal sacrum, coccyx, and right ischium.

CXR: Clear Chest

Brief Hospital Course:
1. Acute Osteomyelitis secondary to Decubitus Ulcer due to E.
Coli
- S/p Bone Biopsy
- E. Coli -> Vancomycin/Zosyn for total 6 weeks
- Flagyl x 6 weeks
- PRS was consulted for wound care, and recommended Dakins
solution with wtd dressings
- ID consultation
- Follow up with [**Hospital **] clinic 8/20/07@0930

2. Hypotension - Chronic
- Presumed neurogenic due to spinal cord injury

3. UTI - Enterococcal
- Vancomycin day [**10-23**] (for this)

4. Pulmonary Embolism
- IVC Filter
- Coumadin held for biopsy, restarted at 2 QHS

5. Depression
- Antidepressants were continued

6. CAD Native Vessle, Systolic CHF
- Aspirin
- B-Blocker
- ACEI

7. Parapalegia
- Kinaire Bed
- Turns Q2h
- PT evaluation

8. Lung Nodule
- Outpatient Workup

11. Communication: Patient declines to name family members or
other persons who could make decisions on his behalf or be
contact[**Name (NI) **] regarding this admit.

12. Code: Full-discussed admit, no advanced directives or HCP.

Medications on Admission:
1. trazadone 25 mg at bedtime
2. coumadin 2 mg qPM
3. tylenol 650 mg q8h prn
4. dilaudid 2 mg q4h prn
5. prostat 30 cc tid
6. xanax 0.25 mg po bid (started [**8-8**])
7. vitamin C 500 mg [**Hospital1 **]
8. aspirin 81 mg po daily
9. baclofen 5 mg po three times daily
10. bisacodyl supp every other day
11. cefpodoxime 200 mg twice daily
12. citalopram 40 mg po daily
13. docusate 100 mg po bid
14. omeprazole 40mg po daily
15. senna 2 tabs [**Hospital1 **]
16. simvastatin 40mg po qhs
17. advair 250/50 [**Hospital1 **]
18. neurontin 800mg tid
19. magnesium gluconate 500mg po bid
20. MVI with minerals daily

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed.
4. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
5. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
neb Inhalation Q4H (every 4 hours) as needed for wheeze.
6. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
7. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
8. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed.
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
11. Baclofen 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
12. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
15. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
16. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
17. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
18. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
19. Sodium Hypochlorite 0.5 % Solution Sig: One (1) Appl
Miscellaneous ASDIR (AS DIRECTED).
20. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
syringe Injection TID (3 times a day).
21. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q2H (every 2
hours) as needed for pain.
22. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: One (1)
puff Inhalation Q6H (every 6 hours) as needed.
23. Warfarin 2 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
24. Vancomycin 1,000 mg Recon Soln Sig: One (1) gram Intravenous
twice a day for 5 weeks.
25. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: One (1) Recon
Soln Intravenous Q8H (every 8 hours) for 5 weeks.
26. BED
Kinair Bed


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Acute Osteomyelitis
Septic Shock - E. Coli
Decubitus Ulcer
Chronic Hypotension (neurogenic)
UTI Bacterial (Enterococcal)
Pulmonary Embolism
Depression
CAD Native Vessle
Systolic CHF
Parapalegia
Lung Nodule

Discharge Condition:
Good

Discharge Instructions:
Return to the hospital if you experience high fevers, chills,
nausea/vomitting, bleeding from the ulcers

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7447**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2105-9-28**] 9:30
{'Septicemia due to escherichia coli [E. coli],Septic shock,Chronic systolic heart failure,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pressure ulcer, lower back,Acute osteomyelitis, other specified sites,Severe sepsis,Asthma, unspecified type, unspecified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Paraplegia,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified,Coronary atherosclerosis of native coronary artery'}


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 and coccygeal pain

PRESENT ILLNESS: 67-year-old man with paraplegia (as a result of an inflammatory
spinal cord process of unknown etiology), a chronic indwelling
Foley catheter, and a known sacral decubitus ulcer was evaluated
on an outpatient basis on [**8-1**] and was found to have a
leukocytosis (WBC 14K); Staph aureus was cultured from his
sacral decub.  Cefpodoxime 200 mg twice daily was started.
Despite this intervention, he remained febrile, and he began
having yellow drainage from his ulcer.  He was therefore brought
to the ED on [**8-10**].  There, he was hypotensive (80s/60s).  Blood
and urine cultures were drawn, dexamethasone was given, empiric
vanc, levoflox, and flagyl were started, and 3.6 liters of fluid
were infused.  He was admitted to the ICU.

MEDICAL HISTORY: 1. Inflammatory disease of the spinal cord of uncertain
etiology.  MRA [**10-15**] negative for vascular malformation.  Initial
CSF analysis showed elevated protein (82) without oligoclonal
bands.  NMO blood titer negative, RPR negative, Lyme serology
negative, [**Doctor First Name **] negative, Ro and La negative, ACE level normal,
neuromyelitis IgG negative, ESR 70, CRP 66.8.  Ultimately
treated with broad spectrum antibiotics, corticosteroids (two
weeks of Solu-Medrol followed by a prednisone taper), and 5 days
of mannitol without improvement.  He is followed by neurology
for a dense paraplegia (T4) with neuropathic pain, restrictive
shoulder arthropathy, and a neurogenic bladder requiring a
chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC
dressing
3. Multiple UTI (including Pseudomonas)
4. Pulmonary embolus [**11-14**] s/p IVC filter placement
5. Asthma
6. Two-vessel coronary artery disease s/p CABG 4-5 years ago
7. Systolic CHF (EF 25-30% on [**2-15**] TTE)
8. Repaired liver laceration
9. Chronic back pain
10. Vitiligo
11. Feeding tube
12. Depression
13. MRSA from sacral swab and sputum
14. Prior transient episodes of leg paralysis
15. Right frontal lobe brain lesion biopsied [**11-14**] and c/w
gliosis; resolved on repeat imaging
16. Abnormal visual evoked potentials

MEDICATION ON ADMISSION: 1. trazadone 25 mg at bedtime
2. coumadin 2 mg qPM
3. tylenol 650 mg q8h prn
4. dilaudid 2 mg q4h prn
5. prostat 30 cc tid
6. xanax 0.25 mg po bid (started [**8-8**])
7. vitamin C 500 mg [**Hospital1 **]
8. aspirin 81 mg po daily
9. baclofen 5 mg po three times daily
10. bisacodyl supp every other day
11. cefpodoxime 200 mg twice daily
12. citalopram 40 mg po daily
13. docusate 100 mg po bid
14. omeprazole 40mg po daily
15. senna 2 tabs [**Hospital1 **]
16. simvastatin 40mg po qhs
17. advair 250/50 [**Hospital1 **]
18. neurontin 800mg tid
19. magnesium gluconate 500mg po bid
20. MVI with minerals daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.7, 98/68, 80, 20, 97%
Gen: Well appearing male in NAD lying in bed.
HEENT: MMM, lips slightly pale, smooth tongue.
Chest: CTA bilaterally, no w/r/r.
CV: RRR, physiologic splitting S2, no m/r/g.
Abd: Soft, nontender/nondistended, g-tube in place, c/d/i.
Extremities: Warm, well perfused, no C/C. Trace pedal edema
bilaterally.
Skin: Vitiligo on hands. Large round 10 cm diameter pressure
decubitus ulcer on sacrum with appropriate dressing. Appears
clean with granulation tissue in center, no s/sx of infection.
Neuro: CN grossly intact. A&O x 3, pleasantly conversant.

FAMILY HISTORY: No stroke, aneurysm, no seizure, no AAA.

SOCIAL HISTORY: He moved here from [**Country 3594**] (after living in many different
countries) in the [**2068**].  He is retired from a job in the
maritime industry.  Divorced 24 years ago.  Three children.
Quit smoking [**2076**].  Quit drinking [**2080**].  No history of illicit
drug use or abuse. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Septic shock,Chronic systolic heart failure,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pressure ulcer, lower back,Acute osteomyelitis, other specified sites,Severe sepsis,Asthma, unspecified type, unspecified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Paraplegia,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified,Coronary atherosclerosis of native coronary artery'}
