CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 86 [**Hospital **] [**Hospital 45534**] transferred from [**Hospital3 **] after
unwitnessed fall/L hip fracture & ? C-spine injury (? fracture
of C1 and C2), initially scheduled for [**Hospital3 **]-trauma hip surgery.

MEDICAL HISTORY: 1.  Alzheimer's with significant brain atrophy
2.  Afib for 8 yrs on coumadin
3.  Cirrhosis
4.  urinary and fecal incontinence
5.  depression
6.  Asthma
7.  Chronic CHF - alcoholic cardiomyopathy
8.  chronic constipation
9.  previous fracture of the cervical bends - stabilized by
neurosurgery. Healed.
10. hx of falls
11. GERD
12. osteoarthritis

MEDICATION ON ADMISSION: Warfarin 3 mg DAILY
Coreg 6.35 mg [**Hospital1 **]
Capoten 25 mg [**Hospital1 **]
Lasix 20 mg DAILY
Potassium Cholride 20 mEq DAILY
Duragesic Patch 50 mcg Q3days
Oxycodone/Acetominophen 10/325 mg [**Hospital1 **]
Omperazole 20 mg DAILY
Fluoxetine 20 mg DAILY
Mag Citrate qwednesday
Nortryptyline 25 mg QHS
Aricept 10 mg QHS
Duo Neb
Lactulose 60 ml DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:BP 95/57 HR95 RR13-17, sats 100% on RA AC TV 500 RR 14 Fio2
40%.  CVP 22-26.
GEN: WDWN elderly male in NAD.
HEENT: NCAT, pupils 2mm, nonreactive, no scleral icterus. OP
clear, MM dry.
NECK: No LAD, no carotid bruits.
CV: Irreg irreg, tachy. Cannot appreciate any murmurs.
PULM: CTA anteriorly, at bases. No crackles/wheezes.
ABD: Soft, NTND, + BS, no HSM.
EXT: Cool upper/lower extremities.  2+ DP pulses bilaterally.
Has warmth and some tightness but no visible ecchymosis over L
thigh.  ?livedo reticularis anterior right thigh.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives in [**Location (un) 5503**]. He is demented at baseline and wheelchair
bound.  Granddaughter [**Name (NI) **] #[**Telephone/Fax (1) 75243**].
Closed fracture of intertrochanteric section of neck of femur,Cardiac arrest,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute on chronic systolic heart failure,Pneumonia due to escherichia coli [E. coli],Septicemia due to gram-negative organism, unspecified,Severe sepsis,Unspecified fall,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Personal history of alcoholism,Other iatrogenic hypotension,Other and unspecified complications of medical care, not elsewhere classified,Diarrhea,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]
Intertrochanteric fx-cl,Cardiac arrest,Acute kidney failure NOS,Urin tract infection NOS,Acute respiratry failure,Ac on chr syst hrt fail,Pneumonia e coli,Gram-neg septicemia NOS,Severe sepsis,Fall NOS,Hypertension NOS,Alzheimer's disease,Dementia w/o behav dist,Hx of alcoholism,Iatrogenc hypotnsion NEC,Complic med care NEC/NOS,Diarrhea,Elev transaminase/ldh
Admission Date:  [**2168-10-14**]              Discharge Date:   [**2168-11-3**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
ORIF of left hip

History of Present Illness:
86 [**Hospital **] [**Hospital 45534**] transferred from [**Hospital3 **] after
unwitnessed fall/L hip fracture & ? C-spine injury (? fracture
of C1 and C2), initially scheduled for [**Hospital3 **]-trauma hip surgery.

   In ED, [**Hospital3 **]/trauma surgery plan for L femoral neck fracture
and ? cervical vertebrae injury, admitted to medicine for
syncopal episode and pre-op assessment.
   On [**10-15**] AM, medicine administered beta blockade in
preparation for OR, SBPs/HR and hemodynamics stable overnight,
with admission hct 38.  In PACU, noted to have SBP in 70s,
required peripheral dobutamine and neosynephrine to maintain
MAPs >60, hct drop to 26.4 --> transfused 1 unit, given 1L [**Hospital **]
transferred to MICU.
   Upon transfer to MICU at 1130am, left subclavian/axillary
line placed with stabilization of systolic pressures >100,
transitioned to levophed.  At 12:31, pt had bradycardia -->
asystolic arrest, had immediate CPR with intubation, 2 epi, 1
atropine, with resumption of pulse and pressure at 12:39pm.  EKG
showed st-depressions v3-v5, transfused 1 unit PRBCs with hct
rise to 26.7, given 1L NS, repleted calcium/magnesium, levophed
administered to maintain MAPs>60, lactate 4.0 - 5.0, R-A line
placed.  CXR showed no pulmonary edema, ?globular heart, bedside
echo initial read showed no tamponade with EF~30%.

Past Medical History:
1.  Alzheimer's with significant brain atrophy
2.  Afib for 8 yrs on coumadin
3.  Cirrhosis
4.  urinary and fecal incontinence
5.  depression
6.  Asthma
7.  Chronic CHF - alcoholic cardiomyopathy
8.  chronic constipation
9.  previous fracture of the cervical bends - stabilized by
neurosurgery. Healed.
10. hx of falls
11. GERD
12. osteoarthritis

Social History:
Lives in [**Location (un) 5503**]. He is demented at baseline and wheelchair
bound.  Granddaughter [**Name (NI) **] #[**Telephone/Fax (1) 75243**].

Family History:
Non-contributory

Physical Exam:
VS:BP 95/57 HR95 RR13-17, sats 100% on RA AC TV 500 RR 14 Fio2
40%.  CVP 22-26.
GEN: WDWN elderly male in NAD.
HEENT: NCAT, pupils 2mm, nonreactive, no scleral icterus. OP
clear, MM dry.
NECK: No LAD, no carotid bruits.
CV: Irreg irreg, tachy. Cannot appreciate any murmurs.
PULM: CTA anteriorly, at bases. No crackles/wheezes.
ABD: Soft, NTND, + BS, no HSM.
EXT: Cool upper/lower extremities.  2+ DP pulses bilaterally.
Has warmth and some tightness but no visible ecchymosis over L
thigh.  ?livedo reticularis anterior right thigh.

Pertinent Results:
STUDIES:
[**2168-10-12**]: report from [**Hospital3 15402**] head CT [**10-12**]
[**2168-10-13**]: CT head scan w/o contrast at [**Hospital3 15402**] : No hemorrhage
or mass effect. See report in chart.
.
[**2168-10-13**]: CT of cervical spine at [**Hospital3 15402**]: Good healing of the
fracture at the base of the odontoid process. There is evidence
of a fracture on the right side of the body of C2 posteriorly
and superiorly wher there was a fracture previously so I do not
know if this is due to poor healing or a new fracture. There
appears to be an undisplaced fracture involving the right side
of the posterior arach of C2 which I cannot identify on the last
exam. Otherwise, there is a cervical spondylosis.
.
[**2168-10-14**] CXR: No evidence of acute cardiopulmonary process.
.
[**2168-10-14**] L HIP/FEMUR XR:
1. Left intertrochanteric fracture with a medially displaced
lesser
trochanter fracture fragment.
2. Severe left knee osteoarthritis

[**2168-11-2**] 07:00AM BLOOD WBC-6.7 RBC-2.97* Hgb-9.3* Hct-29.3*
MCV-99* MCH-31.2 MCHC-31.6 RDW-19.1* Plt Ct-473*
[**2168-10-25**] 06:50AM BLOOD Neuts-62 Bands-1 Lymphs-25 Monos-10 Eos-1
Baso-0 Atyps-0 Metas-1* Myelos-0
[**2168-11-2**] 07:00AM BLOOD PT-14.6* INR(PT)-1.3*
[**2168-11-2**] 07:00AM BLOOD Glucose-95 UreaN-14 Creat-0.8 Na-141
K-4.2 Cl-108 HCO3-24 AnGap-13
[**2168-11-1**] 06:40AM BLOOD ALT-30 AST-31 LD(LDH)-353* AlkPhos-221*
TotBili-1.7*
[**2168-11-2**] 07:00AM BLOOD TotBili-1.4
[**2168-10-16**] 12:57PM BLOOD CK-MB-6 cTropnT-<0.01
[**2168-10-29**] 10:10AM BLOOD Lipase-44
[**2168-11-2**] 07:00AM BLOOD Mg-1.9
[**2168-10-29**] 10:10AM BLOOD calTIBC-238* Ferritn-397 TRF-183*
.
Microbiology:

AEROBIC BOTTLE (Final [**2168-10-24**]):
      REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] CC6D AT 21:45 ON
[**2168-10-22**].
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         ISOLATED FROM ONE SET ONLY SENSITIVITIES PERFORMED ON
REQUEST..

   ANAEROBIC BOTTLE (Final [**2168-10-24**]):
      CITROBACTER FREUNDII COMPLEX.    FINAL SENSITIVITIES.
         Trimethoprim/Sulfa sensitivity testing available on
request.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             CITROBACTER FREUNDII COMPLEX
                             |
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------   <=1 S
IMIPENEM--------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN----------    32 R
TOBRAMYCIN------------   <=1 S

.

 GRAM STAIN (Final [**2168-10-21**]):
      >25 PMNs and <10 epithelial cells/100X field.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2168-10-23**]):
      OROPHARYNGEAL FLORA ABSENT.
      ESCHERICHIA COLI.    SPARSE GROWTH.
         Trimethoprim/Sulfa sensitivity testing available on
request.

                              SENSITIVITIES: MIC expressed in
MCG/ML

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


Brief Hospital Course:
Overall course:  patient was brought to hospital with hip
fracture, admitted to medicine.  Due to hemodynamic instability
was transferred to MICU where found to have HCT drop of 10pts.
Subsequently had bradycardic arrest, successful resuscitation.
Went to the OR and had ORIF of left hip.  Subsequently became
septic with E coli in sputum, Citrobacter in blood, started on
ABX.  Also started on metronidazole for Cdiff but d/c'd when
toxins came back negative.   Electrophysiology evaluated the
patient and determined that while no intervention is required
now outpatient followup in [**12-29**] months is indicated.

1). Hip Fracture:  According to the family, the patient fell out
of his bed while trying to get up; he is non-ambulatory at
baseline. The patient was taken to the emergency room on [**10-18**]
for an ORIF of his left hip.  He tolerated the procedure well
and was placed on Lovenox prophylaxis afterwards.  He continued
to work with occupation and physical therapy during his stay.
He will continue Lovenox until his INR is therapeutic (between
2.0 and 3.0).

2). Sepsis/Hypotension:  The patient was hypotensive requiring a
MICU transfer for pressors in the setting of a 10 point
hematocrit drop over an 18 hour period shortly after admission.
The HCT drop was thought to be secondary to bleeding into his
left thigh after his fracture.  He has a CTA which was negative
for pulmonary embolus and bilateral lower extremity ultrasounds
that did not show clot.  A cortisol stim test was negative for
adrenal insufficiency.  His blood cultures grew Citrobacter
freundii x 2 and coag negative staph x 1; a sputum culture grew
out E Coli.  The cultures were resistant to piperacillin and
ciprofloxacin; the patient was started on cefepime for coverage.

3). Atrial fibrillation with Rapid Ventricular
Response/Bradycardia/Asystolic Arrest: The patient had a
witnessed bradycardic episode in the MICU with asystole.  Chest
compressions were performed and the patient was resuscitated.
An electrophysiology consult was obtained and the etiology of
his bradycardia was thought to be secondary to excessive beta
blockade and possible sick sinus.  He was stabilized and slowly
restarted on beta blocker therapy and digoxin therapy.  After
transfer from the ICU the patient began to have RVR to the
150's; the digoxin was stopped and he was transitioned to
longer-acting beta blockade with atenolol.  The patient began to
have occasional pauses between 1.5 and 2.8 seconds on telemetry
which were entire asymptomatic.  Electrophysiology was
re-consulted and the patient's beta blockade was titrated
downwards.  He will be discharged on beta blocker therapy with
electrophysiology follow up in [**1-30**] months.  Per the PCP request
the patient the patient was restarted on Coumadin for long-term
anticoagulation.

4).  Anemia: The patient's HCT was low in the context of sepsis,
bleeding and his hip surgery.  It remained stable between 25 and
30 for the last week of his stay.  His iron studies reflect a
mixed picture, but he has a strong reticulocytosis.  He should
follow up with his primary care physician once this acute
episode has resolved.

5). Acute renal failure:  The patient had acute renal failure
upon presentation with a creatinine of 1.4 and a rise to 2.0
post-code.  This was most likely due to poor perfusion and a
hypodynamic state in the context of his bleed.  Once he was
resuscitated his acute renal failure resolved.

6). Alzheimer's Dementia:  The patient has dementia at baseline.
He had occasional episodes of delirium in the context of his
sepsis but he improved with antibiotic therapy.

7). Cardiomyopathy/Chronic Systolic Congestive Heart Failure:
The patient had his medications held but had his beta blocker
and captopril reinitiated when he was on the floor.

8). Elevated liver function tests:  The patient had elevated
liver function tests upon transfer to the floor; a RUQ
ultrasound and CT abdomen were negative.  A liver consult was
obtained and his hepatitis panel was negative.  His Tbili slowly
resolved, but he should have his liver function tested a week
after discharge.

Medications on Admission:
Warfarin 3 mg DAILY
Coreg 6.35 mg [**Hospital1 **]
Capoten 25 mg [**Hospital1 **]
Lasix 20 mg DAILY
Potassium Cholride 20 mEq DAILY
Duragesic Patch 50 mcg Q3days
Oxycodone/Acetominophen 10/325 mg [**Hospital1 **]
Omperazole 20 mg DAILY
Fluoxetine 20 mg DAILY
Mag Citrate qwednesday
Nortryptyline 25 mg QHS
Aricept 10 mg QHS
Duo Neb
Lactulose 60 ml DAILY


Discharge Medications:
1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours): may discontinue once INR is
between 2 and 3.
2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 10ml PO BID (2
times a day) as needed.
3. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
9. Heparin Flush CVL  (100 units/ml) 1 ml IV DAILY:PRN
10ml NS followed by 1ml of 100 units/ml heparin (100 units
heparin) each lumen QD and PRN.  Inspect site every shift
10. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
11. Cefepime 2 gram Recon Soln Sig: One (1) Recon Soln Injection
Q24H (every 24 hours) for 4 days.
12. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift


Discharge Disposition:
Extended Care

Facility:
the highlander

Discharge Diagnosis:
Sepsis
Hip Fracture s/p ORIF
Musculoskeletal Chest Pain
Anemia
Atrial fibrillation with rapid ventricular response
chronic systolic congestive heart failure
Alzheimer's Dementia


Discharge Condition:
stable


Discharge Instructions:
Please continue to take your medications as prescribed.  You
were started on coumadin.  Please have your INR checked every
2-3 days and titrate with a goal INR between 2 and 3.  Once your
INR has reached therapeutic levels you may discontinue the
lovenox therapy.

You should have your liver function tests evaluated in a week.

You will continue to have occasional fast heart beats and
occasional slow beats.  If these are not asymptomatic you should
contact a physician.  [**Name10 (NameIs) **] addition, if you develop fevers,
chills, or any other concerning symptoms please contact a
physician [**Name Initial (PRE) 2227**].

Followup Instructions:
Please follow up with your primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 7568**] [**Telephone/Fax (1) 75244**] in two weeks.

Please follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**] [**Telephone/Fax (1) 902**]
(electrophysiology) in [**1-30**] months.
Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2168-11-10**] 11:10
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1984**], MD Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2168-11-10**] 11:30



Completed by:[**2168-11-3**]

Name:  [**Known lastname 12369**],[**Known firstname 3834**]                      Unit No:   [**Numeric Identifier 12370**]

Admission Date:  [**2168-10-14**]              Discharge Date:   [**2168-11-3**]

Date of Birth:  [**2082-7-30**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 653**]
Addendum:
Medication List updated

1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours): may discontinue once INR is
between 2 and 3.
2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 10ml PO BID (2
times a day) as needed.
3. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
9. Heparin Flush CVL  (100 units/ml) 1 ml IV DAILY:PRN
10ml NS followed by 1ml of 100 units/ml heparin (100 units
heparin) each lumen QD and PRN.  Inspect site every shift
10. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
11. Cefepime 2 gram Recon Soln Sig: One (1) Recon Soln Injection
Q24H (every 24 hours) for 4 days.
12. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
13. Coumadin 3 mg Tablet Sig: One (1) Tablet PO at bedtime:
titrate to INR of [**1-30**].  Check level every day for 4 days until
stable, then check every 2-3 days. Tablet(s)


Discharge Medications:
Medication List updated

1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours): may discontinue once INR is
between 2 and 3.
2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 10ml PO BID (2
times a day) as needed.
3. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
9. Heparin Flush CVL  (100 units/ml) 1 ml IV DAILY:PRN
10ml NS followed by 1ml of 100 units/ml heparin (100 units
heparin) each lumen QD and PRN.  Inspect site every shift
10. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
11. Cefepime 2 gram Recon Soln Sig: One (1) Recon Soln Injection
Q24H (every 24 hours) for 4 days.
12. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
13. Coumadin 3 mg Tablet Sig: One (1) Tablet PO at bedtime:
titrate to INR of [**1-30**].  Check level every day for 4 days until
stable, then check every 2-3 days. Tablet(s)


Discharge Disposition:
Extended Care

Facility:
the highlander

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 655**] MD [**MD Number(2) 656**]

Completed by:[**2168-11-3**]
{"Closed fracture of intertrochanteric section of neck of femur,Cardiac arrest,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute on chronic systolic heart failure,Pneumonia due to escherichia coli [E. coli],Septicemia due to gram-negative organism, unspecified,Severe sepsis,Unspecified fall,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Personal history of alcoholism,Other iatrogenic hypotension,Other and unspecified complications of medical care, not elsewhere classified,Diarrhea,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]"}


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: s/p fall

PRESENT ILLNESS: 86 [**Hospital **] [**Hospital 45534**] transferred from [**Hospital3 **] after
unwitnessed fall/L hip fracture & ? C-spine injury (? fracture
of C1 and C2), initially scheduled for [**Hospital3 **]-trauma hip surgery.

MEDICAL HISTORY: 1.  Alzheimer's with significant brain atrophy
2.  Afib for 8 yrs on coumadin
3.  Cirrhosis
4.  urinary and fecal incontinence
5.  depression
6.  Asthma
7.  Chronic CHF - alcoholic cardiomyopathy
8.  chronic constipation
9.  previous fracture of the cervical bends - stabilized by
neurosurgery. Healed.
10. hx of falls
11. GERD
12. osteoarthritis

MEDICATION ON ADMISSION: Warfarin 3 mg DAILY
Coreg 6.35 mg [**Hospital1 **]
Capoten 25 mg [**Hospital1 **]
Lasix 20 mg DAILY
Potassium Cholride 20 mEq DAILY
Duragesic Patch 50 mcg Q3days
Oxycodone/Acetominophen 10/325 mg [**Hospital1 **]
Omperazole 20 mg DAILY
Fluoxetine 20 mg DAILY
Mag Citrate qwednesday
Nortryptyline 25 mg QHS
Aricept 10 mg QHS
Duo Neb
Lactulose 60 ml DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:BP 95/57 HR95 RR13-17, sats 100% on RA AC TV 500 RR 14 Fio2
40%.  CVP 22-26.
GEN: WDWN elderly male in NAD.
HEENT: NCAT, pupils 2mm, nonreactive, no scleral icterus. OP
clear, MM dry.
NECK: No LAD, no carotid bruits.
CV: Irreg irreg, tachy. Cannot appreciate any murmurs.
PULM: CTA anteriorly, at bases. No crackles/wheezes.
ABD: Soft, NTND, + BS, no HSM.
EXT: Cool upper/lower extremities.  2+ DP pulses bilaterally.
Has warmth and some tightness but no visible ecchymosis over L
thigh.  ?livedo reticularis anterior right thigh.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives in [**Location (un) 5503**]. He is demented at baseline and wheelchair
bound.  Granddaughter [**Name (NI) **] #[**Telephone/Fax (1) 75243**]. 

### Response:
{"Closed fracture of intertrochanteric section of neck of femur,Cardiac arrest,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute on chronic systolic heart failure,Pneumonia due to escherichia coli [E. coli],Septicemia due to gram-negative organism, unspecified,Severe sepsis,Unspecified fall,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Personal history of alcoholism,Other iatrogenic hypotension,Other and unspecified complications of medical care, not elsewhere classified,Diarrhea,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]"}
