CHIEF COMPLAINT: fall, open left leg wound

PRESENT ILLNESS: 56-year-old man with history of acute myeloid leukemia ([**2142**]),
status post allogeneic stem cell transplant ([**2142**]) complicated
by graft-versus-host disease, also history of pulmonary embolism
on warfarin presents after a recent mechanical fall and
subsequent bleeding from leg wound.
.
On [**2146-9-19**] patient fell onto his left side, bruising his left
lower leg, which became swollen.  He also noted increased pain
in L hip, however this was within the range of his chronic pain
in b/l hips due to AVN.  He noted pain in Left leg, however
decided to monitor the pain an bruising.  On the day of
admission, the swelling worsened, his leg became dusky, after
taking a shower, LE pain worsened . He presented to OSH, where
the hematoma ruptured and bled profusely. He was given vitamin K
10 mg IM x 1 and FFP. Surgicel was applied. He was then
transferred to [**Hospital1 18**].
.
At [**Hospital **] hospital initial VS were 98 130 158/97 22 98% RA w/
SBP to 110s by 1900 and HR 90s - 100s.  INR was 2.8, PTT 42, HCT
was 32, Cr 1.4.  Pt. was given 1 FFP, 10mg IM Vitamin K, 4 mg of
Dilaudid and transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, his vitals were T 97.8, HR 82, BP 126/73, HR 18,
97%
RA.  Pt. was seen by plastics, would was open, and debrided the
wound removing clots, they found "viable muscles" w/o active
bleeding.  Exam post debridement revealed a soft left leg with
palpable distal pulse on the R and dopplerable L. It was felt
not to be consistent with compartment syndrome by orthopedics
who will follow.  In the ED SBP nadired at 82 (although lowest
recorded is 94), HR 80-90s.  Pt. received 2L NS, 10mg IV Vitamin
K, morphine IV and Zofran.   At time of transfer VS were 96/61
86 100% 2 LNC. Left leg Xrays revealed no fracture on
preliminary read.
.
Of note, he was recently admitted to [**Hospital **] hospital for a cat
bite infection, treated w/ IV ABx and sent home on Penicillin.

MEDICAL HISTORY: # Pulmonary embolism x2 ([**2143**] and dx [**5-/2146**] in RML and RLL): on
warfarin
# Acute myeloid leukemia:
- [**3-/2143**]: diagnosed
- [**6-/2143**]: underwent a matched unrelated allogeneic stem cell
transplant.
- post-transplant course c/b bx-proven GVHD of the liver and an
intermittent skin rash, s/p management with cyclosporine,
mycophenolate, rituximab, and currently, steroids.
# type 2 DM: steroid-induced
# hyperlipidemia
# bilateral hip AVN
# HTN
# nephrolithiasis: s/p lithotripsy and previous nephrostomy tube

MEDICATION ON ADMISSION: --acyclovir 400 mg [**Hospital1 **]
--atorvastatin 20 mg daily
--budesonide SR 3 mg tid
--folic acid 1 mg daily
--gabapentin 300 mg qhs
--hydromorphone 2-4 mg q4-6h prn pain
--insulin Humalog sliding scale
--insulin NPH 12 units SC bid
--metoprolol succinate 50 mg daily
--oxycontin SR 60 mg morning, 20 mg afternoon, 60 mg evening
--pantoprazole 40 mg [**Hospital1 **]
--prednisone 10 mg daily
-sulfamethoxazole-trimethoprim 400-80 mg daily - stopped taking
unknown amount of time ago.
--warfarin 3.5mg MWF, otherwise 5mg daily.
--cholecalciferol 400 units daily
--Pen VK 500mg QID.

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: T 97.8, HR 82, BP 126/73, HR 18, 97%RA
General: Eyes closed, opens to voice, awakens but is sleepy at
rest. Oriented, no acute distress
HEENT: Sclera anicteric, dMM, pale conjunctiva, oropharynx clear

FAMILY HISTORY: Mother died suddenly in her 70s.
Father died of unknown cancer.
One sister has thyroid cancer.
One brother has diabetes.
One sister has [**Name (NI) 5895**].

SOCIAL HISTORY: Lives with his wife, and [**Name2 (NI) **].  [**Name2 (NI) **] is retired, worked as a
[**Company 22957**]
technician
Tobacco - 40 pk year hx, quit 5 yrs ago.
EtOH - denies
Drug use - denies.
Secondary and recurrent hemorrhage,Acute myeloid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Precipitous drop in hematocrit,Alkalosis,Contusion of lower leg,Other chronic pain,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bite of other animal except arthropod,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Personal history of other malignant neoplasm of skin,Obstructive sleep apnea (adult)(pediatric),Mononeuritis of lower limb, unspecified,Open wound of hand except finger(s) alone, complicated,Open wound of knee, leg [except thigh], and ankle, complicated,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use
Secondary/recur hemorr,Ac myl leuk wo achv rmsn,Compl marrow transplant,Chronc graft-vs-host dis,Drop, hematocrit, precip,Alkalosis,Contusion of lower leg,Chronic pain NEC,Hx-ven thrombosis/embols,Long-term use anticoagul,Abn react-org transplant,Animal bite NEC,Hyperlipidemia NEC/NOS,Hypertension NOS,Fall from slipping NEC,Hx-skin malignancy NEC,Obstructive sleep apnea,Mononeuritis leg NOS,Opn wound hand-complicat,Open wnd knee/leg-compl,Sec DM wo cmp nt st uncn,Adv eff corticosteroids
Admission Date:  [**2146-9-20**]              [**Month/Day/Year **] Date:   [**2146-9-30**]

Date of Birth:  [**2090-7-16**]             Sex:   M

Service: MEDICINE

Allergies:
Cefepime / Cipro

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
fall, open left leg wound

Major Surgical or Invasive Procedure:
Left leg open wound debridement


History of Present Illness:
56-year-old man with history of acute myeloid leukemia ([**2142**]),
status post allogeneic stem cell transplant ([**2142**]) complicated
by graft-versus-host disease, also history of pulmonary embolism
on warfarin presents after a recent mechanical fall and
subsequent bleeding from leg wound.
.
On [**2146-9-19**] patient fell onto his left side, bruising his left
lower leg, which became swollen.  He also noted increased pain
in L hip, however this was within the range of his chronic pain
in b/l hips due to AVN.  He noted pain in Left leg, however
decided to monitor the pain an bruising.  On the day of
admission, the swelling worsened, his leg became dusky, after
taking a shower, LE pain worsened . He presented to OSH, where
the hematoma ruptured and bled profusely. He was given vitamin K
10 mg IM x 1 and FFP. Surgicel was applied. He was then
transferred to [**Hospital1 18**].
.
At [**Hospital **] hospital initial VS were 98 130 158/97 22 98% RA w/
SBP to 110s by 1900 and HR 90s - 100s.  INR was 2.8, PTT 42, HCT
was 32, Cr 1.4.  Pt. was given 1 FFP, 10mg IM Vitamin K, 4 mg of
Dilaudid and transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, his vitals were T 97.8, HR 82, BP 126/73, HR 18,
97%
RA.  Pt. was seen by plastics, would was open, and debrided the
wound removing clots, they found "viable muscles" w/o active
bleeding.  Exam post debridement revealed a soft left leg with
palpable distal pulse on the R and dopplerable L. It was felt
not to be consistent with compartment syndrome by orthopedics
who will follow.  In the ED SBP nadired at 82 (although lowest
recorded is 94), HR 80-90s.  Pt. received 2L NS, 10mg IV Vitamin
K, morphine IV and Zofran.   At time of transfer VS were 96/61
86 100% 2 LNC. Left leg Xrays revealed no fracture on
preliminary read.
.
Of note, he was recently admitted to [**Hospital **] hospital for a cat
bite infection, treated w/ IV ABx and sent home on Penicillin.


Past Medical History:
# Pulmonary embolism x2 ([**2143**] and dx [**5-/2146**] in RML and RLL): on
warfarin
# Acute myeloid leukemia:
- [**3-/2143**]: diagnosed
- [**6-/2143**]: underwent a matched unrelated allogeneic stem cell
transplant.
- post-transplant course c/b bx-proven GVHD of the liver and an
intermittent skin rash, s/p management with cyclosporine,
mycophenolate, rituximab, and currently, steroids.
# type 2 DM: steroid-induced
# hyperlipidemia
# bilateral hip AVN
# HTN
# nephrolithiasis: s/p lithotripsy and previous nephrostomy tube

and emergent surgery to repair ureteral damage
# BCC s/p excision
# SCC left cheek, s/p Mohs' [**5-/2144**]
# multiple back surgeries: L5-S1 surgery x 3, and cervical spine
fusion (bone graft, no hardware)
# anterior cervical diskectomy and instrument arthrodesis at
C5-C6 and C6-C7 for degenerative cervical spondylitic disease
with spinal cord compression and foraminal stenosis at C5-C6 and

C6-C7 [**2-/2144**]
# chronic numbness, neuropathic pain in left upper extremity
# multilevel compression fractures T11, T12, L1 and mild
compression L3 and L4
# OSA: on BIPAP at home


Social History:
Lives with his wife, and [**Name2 (NI) **].  [**Name2 (NI) **] is retired, worked as a
[**Company 22957**]
technician
Tobacco - 40 pk year hx, quit 5 yrs ago.
EtOH - denies
Drug use - denies.

Family History:
Mother died suddenly in her 70s.
Father died of unknown cancer.
One sister has thyroid cancer.
One brother has diabetes.
One sister has [**Name (NI) 5895**].


Physical Exam:
T 97.8, HR 82, BP 126/73, HR 18, 97%RA
General: Eyes closed, opens to voice, awakens but is sleepy at
rest. Oriented, no acute distress
HEENT: Sclera anicteric, dMM, pale conjunctiva, oropharynx clear

Neck: supple, JVD not assessed, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: no foley
Ext: Cool [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l, L and R equally, there is 1+ edema at L foot,
trace in R foot.  Echymoses on R toes.  Extensive echymoses on
UEs. R hand w/ mark of old cat bite, no purulence, no
fluctuance.
Pulses: 2+ femoral b/l, DP 2+ on R, dopplerable on L.
Neuro: MS - see above.
Motor:
RLE: full at IP/Q/H/TA, [**Last Name (un) 938**] and EDB 5-/5.
LLE: full at IP/Q/H (magnitude of movement limited by pain), [**3-21**]
TA/[**Last Name (un) 938**]/EDB, full G.  DTRs depressed at b/l achilles.
Sensory: sensate LT bilaterally, but decresed on L vs. R, intact
proprioception.


Pertinent Results:
[**2146-9-20**] 08:44PM   COMMENTS-GREEN
[**2146-9-20**] 08:44PM   K+-4.3
[**2146-9-20**] 08:43PM   GLUCOSE-137* UREA N-19 CREAT-1.2 SODIUM-141
POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-30 ANION GAP-11
[**2146-9-20**] 08:43PM   estGFR-Using this
[**2146-9-20**] 08:43PM   WBC-10.2# RBC-2.45*# HGB-9.5*# HCT-28.3*#
MCV-116* MCH-38.8* MCHC-33.5 RDW-15.0
[**2146-9-20**] 08:43PM   NEUTS-81.9* LYMPHS-13.3* MONOS-4.2 EOS-0.3
BASOS-0.3
[**2146-9-20**] 08:43PM   PLT COUNT-168
[**2146-9-20**] 08:43PM   PT-26.0* PTT-26.6 INR(PT)-2.5*

IMAGING:
[**2146-9-21**]
XR of L femur
IMPRESSION: No fracture.

[**2146-9-21**]
b/l lower ext doppler
IMPRESSION: Normal appearance of the common femoral, superficial
femoral, and
popliteal veins bilaterally.
No below knee venous thrombus on the right side.

[**2146-9-21**]
FINDINGS: In comparison with study of [**5-23**], there is little
change and no
evidence of acute cardiopulmonary disease. No pneumonia,
vascular congestion,
or pleural effusion. Of incidental note is a cervical fusion
device.

LABS at [**Date Range **]:

[**2146-9-30**] 05:30AM BLOOD WBC-6.0 RBC-3.05* Hgb-9.9* Hct-31.1*
MCV-102* MCH-32.3* MCHC-31.8 RDW-20.5* Plt Ct-293
[**2146-9-29**] 05:25AM BLOOD Neuts-68 Bands-0 Lymphs-20 Monos-7 Eos-4
Baso-1 Atyps-0 Metas-0 Myelos-0
[**2146-9-30**] 05:30AM BLOOD Plt Ct-293
[**2146-9-30**] 05:30AM BLOOD PT-15.7* PTT-34.4 INR(PT)-1.4*
[**2146-9-30**] 05:30AM BLOOD
[**2146-9-30**] 05:30AM BLOOD Glucose-106* UreaN-15 Creat-1.0 Na-139
K-3.9 Cl-98 HCO3-34* AnGap-11
[**2146-9-30**] 05:30AM BLOOD ALT-12 AST-11 LD(LDH)-192 AlkPhos-100
TotBili-0.4
[**2146-9-30**] 05:30AM BLOOD Albumin-3.4* Calcium-9.2 Phos-3.1 Mg-2.1

Brief Hospital Course:
56-year-old man with history of acute myeloid leukemia, status
post allogeneic stem cell transplant complicated by
graft-versus-host disease, and history of pulmonary embolism
(most recent [**5-/2146**]) now on warfarin presents with bleeding from
a leg wound s/p fall/trauma.
.
# Left leg ruptured hematoma: The patient's lowest hematocrit
was 22. After being transfused 3 units PRBCs, his hct rose to 31
and remained stable thereafter. Plastics reassessed the wound
the day after admission and found it to be clean with viable
muscle. Plastics recommended continued packing of the wound and
healing by second intention. They will consider a skin graft in
the future if required.  His pain was controlled with IV
morphine and Dilaudid as well as his home regimen for chronic
pain (see below).  When the patient's hct was stable and there
were no signs of further bleeding, he was transfered out of the
ICU to the BMT service. On the floor, he received daily dressing
changes. He did not receive a skin graft.
.
# Chronic pain: Home regimen of gabapentin 300 mg qhs,
hydromorphone 2-4 mg q4-6h prn
pain, and oxycodone SR 60 mg morning, 20 mg afternoon, 60 mg
evening.  His home regimen was restarted prior to transfer from
the ICU. He was eventually place on Dilaudid PCA with standing
oxycontin. This was titrated for pain. On [**Year (4 digits) **], he lfet
with oxycontin 80mg TID and Dilaudid PO for breakthrough.
.
# H/o PE: History of bilateral PE on lifelong anticoagulation.
Coumadin held while in ICU.  He has not done well with SQ
therapy in the past ( both lovenox and heparin given how fragile
his skin is).  Restarted Coumadin with Lovenox bridge until
therapeutic. Goal INR is 2-2.5. His INR on [**Year (4 digits) **] was 1.4.
.
# Recent cat bite infection.  Unclear hx and course of ABx or
organisms.  He was on Penicillin on admission.  He was switched
to augmentin on [**9-21**] to cover the cat bite as well as wound ppx.
 He will continue Augmentin for 2 more days following [**Month/Day (4) **].
.
# AML: s/p SCT, now with chronic GVHD.  Continued prednisone 10
mg daily.  Continued prophylaxis with acyclovir 400 mg [**Hospital1 **].
Restarted sulfamethoxazole-trimethoprim 400-80 mg daily on
[**Hospital1 **].
.
# Hyperlipidemia: Continued atorvastatin 20 mg daily.
.
# Hypertension:  Held BB in ICU.
.
# Type 2 DM:  Continued insulin Humalog sliding scale and
insulin NPH 12 units SC bid

Medications on Admission:
--acyclovir 400 mg [**Hospital1 **]
--atorvastatin 20 mg daily
--budesonide SR 3 mg tid
--folic acid 1 mg daily
--gabapentin 300 mg qhs
--hydromorphone 2-4 mg q4-6h prn pain
--insulin Humalog sliding scale
--insulin NPH 12 units SC bid
--metoprolol succinate 50 mg daily
--oxycontin SR 60 mg morning, 20 mg afternoon, 60 mg evening
--pantoprazole 40 mg [**Hospital1 **]
--prednisone 10 mg daily
-sulfamethoxazole-trimethoprim 400-80 mg daily - stopped taking
unknown amount of time ago.
--warfarin 3.5mg MWF, otherwise 5mg daily.
--cholecalciferol 400 units daily
--Pen VK 500mg QID.

[**Hospital1 **] Medications:
1. acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
2. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 2 days.
Disp:*2 Tablet(s)* Refills:*0*
3. atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. budesonide 3 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO TID (3 times a day).
5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
7. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
9. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO TID (3 times a day).
10. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
11. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
12. warfarin 7.5 mg Tablet Sig: One (1) Tablet PO Once Daily at
4 PM.
Disp:*30 Tablet(s)* Refills:*2*
13. enoxaparin 100 mg/mL Syringe Sig: One (1) syringe
Subcutaneous DAILY (Daily).
Disp:*30 syringe* Refills:*2*
14. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
15. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

16. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
17. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
18. oxycodone 40 mg Tablet Sustained Release 12 hr Sig: Two (2)
Tablet Sustained Release 12 hr PO Q8H (every 8 hours).
Disp:*180 Tablet Sustained Release 12 hr(s)* Refills:*0*
19. zolpidem 5 mg Tablet Sig: One (1) Tablet PO ONCE (Once) as
needed for sleep.
20. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
21. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO TID (3 times a day).
22. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for pain.


[**Hospital1 **] Disposition:
Extended Care

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

[**Hospital6 **] Diagnosis:
Left lower leg bleeding wound.

[**Hospital6 **] Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


[**Hospital6 **] Instructions:
Dear Mr. [**Known lastname 47367**],
It was a pleasure participating in your health care.  You were
admitted to the hospital with a leg wound after falling.  The
bleeding from your wound was severe enough to necessitate blood
transfusions.  After being transfused, your blood levels
(hematocrit) rose and stabilized.  Your coumadin was held while
bleeding was aconcern.  The Plastic Surgery team assessed your
wound and dressed it appropriately.  You were started on an
antibiotic called augmentin for the [**Last Name (un) **] bite and to prevent
infection of your leg.  You were transferred out of the ICU to
the BMT floor for continued care. On the floor your red blood
cell count was followed closely but you did not require
transfusions. You were started on coumadin and lovenox to thin
your blood. Your pain was controlled with a combination of
dilaudid pca and oxycontin. Your pain was not fully under
control but lessened by this regimen.

The following changes were made to your medications:
START Augmentin (until - [**10-1**])
START Coumadin 7.5 mg daily
START Lovenox inj 100mcg daily

Followup Instructions:
Please follow-up with Plastic surgery with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 1
weeks. Please call [**Telephone/Fax (1) 6331**] to schedule this appointment.
{'Secondary and recurrent hemorrhage,Acute myeloid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Precipitous drop in hematocrit,Alkalosis,Contusion of lower leg,Other chronic pain,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bite of other animal except arthropod,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Personal history of other malignant neoplasm of skin,Obstructive sleep apnea (adult)(pediatric),Mononeuritis of lower limb, unspecified,Open wound of hand except finger(s) alone, complicated,Open wound of knee, leg [except thigh], and ankle, complicated,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use'}


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: fall, open left leg wound

PRESENT ILLNESS: 56-year-old man with history of acute myeloid leukemia ([**2142**]),
status post allogeneic stem cell transplant ([**2142**]) complicated
by graft-versus-host disease, also history of pulmonary embolism
on warfarin presents after a recent mechanical fall and
subsequent bleeding from leg wound.
.
On [**2146-9-19**] patient fell onto his left side, bruising his left
lower leg, which became swollen.  He also noted increased pain
in L hip, however this was within the range of his chronic pain
in b/l hips due to AVN.  He noted pain in Left leg, however
decided to monitor the pain an bruising.  On the day of
admission, the swelling worsened, his leg became dusky, after
taking a shower, LE pain worsened . He presented to OSH, where
the hematoma ruptured and bled profusely. He was given vitamin K
10 mg IM x 1 and FFP. Surgicel was applied. He was then
transferred to [**Hospital1 18**].
.
At [**Hospital **] hospital initial VS were 98 130 158/97 22 98% RA w/
SBP to 110s by 1900 and HR 90s - 100s.  INR was 2.8, PTT 42, HCT
was 32, Cr 1.4.  Pt. was given 1 FFP, 10mg IM Vitamin K, 4 mg of
Dilaudid and transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, his vitals were T 97.8, HR 82, BP 126/73, HR 18,
97%
RA.  Pt. was seen by plastics, would was open, and debrided the
wound removing clots, they found "viable muscles" w/o active
bleeding.  Exam post debridement revealed a soft left leg with
palpable distal pulse on the R and dopplerable L. It was felt
not to be consistent with compartment syndrome by orthopedics
who will follow.  In the ED SBP nadired at 82 (although lowest
recorded is 94), HR 80-90s.  Pt. received 2L NS, 10mg IV Vitamin
K, morphine IV and Zofran.   At time of transfer VS were 96/61
86 100% 2 LNC. Left leg Xrays revealed no fracture on
preliminary read.
.
Of note, he was recently admitted to [**Hospital **] hospital for a cat
bite infection, treated w/ IV ABx and sent home on Penicillin.

MEDICAL HISTORY: # Pulmonary embolism x2 ([**2143**] and dx [**5-/2146**] in RML and RLL): on
warfarin
# Acute myeloid leukemia:
- [**3-/2143**]: diagnosed
- [**6-/2143**]: underwent a matched unrelated allogeneic stem cell
transplant.
- post-transplant course c/b bx-proven GVHD of the liver and an
intermittent skin rash, s/p management with cyclosporine,
mycophenolate, rituximab, and currently, steroids.
# type 2 DM: steroid-induced
# hyperlipidemia
# bilateral hip AVN
# HTN
# nephrolithiasis: s/p lithotripsy and previous nephrostomy tube

MEDICATION ON ADMISSION: --acyclovir 400 mg [**Hospital1 **]
--atorvastatin 20 mg daily
--budesonide SR 3 mg tid
--folic acid 1 mg daily
--gabapentin 300 mg qhs
--hydromorphone 2-4 mg q4-6h prn pain
--insulin Humalog sliding scale
--insulin NPH 12 units SC bid
--metoprolol succinate 50 mg daily
--oxycontin SR 60 mg morning, 20 mg afternoon, 60 mg evening
--pantoprazole 40 mg [**Hospital1 **]
--prednisone 10 mg daily
-sulfamethoxazole-trimethoprim 400-80 mg daily - stopped taking
unknown amount of time ago.
--warfarin 3.5mg MWF, otherwise 5mg daily.
--cholecalciferol 400 units daily
--Pen VK 500mg QID.

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: T 97.8, HR 82, BP 126/73, HR 18, 97%RA
General: Eyes closed, opens to voice, awakens but is sleepy at
rest. Oriented, no acute distress
HEENT: Sclera anicteric, dMM, pale conjunctiva, oropharynx clear

FAMILY HISTORY: Mother died suddenly in her 70s.
Father died of unknown cancer.
One sister has thyroid cancer.
One brother has diabetes.
One sister has [**Name (NI) 5895**].

SOCIAL HISTORY: Lives with his wife, and [**Name2 (NI) **].  [**Name2 (NI) **] is retired, worked as a
[**Company 22957**]
technician
Tobacco - 40 pk year hx, quit 5 yrs ago.
EtOH - denies
Drug use - denies. 

### Response:
{'Secondary and recurrent hemorrhage,Acute myeloid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Precipitous drop in hematocrit,Alkalosis,Contusion of lower leg,Other chronic pain,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bite of other animal except arthropod,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Personal history of other malignant neoplasm of skin,Obstructive sleep apnea (adult)(pediatric),Mononeuritis of lower limb, unspecified,Open wound of hand except finger(s) alone, complicated,Open wound of knee, leg [except thigh], and ankle, complicated,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use'}
