CHIEF COMPLAINT: GI bleed

PRESENT ILLNESS: 76M with ESRD on HD, CAD s/p cabg, afib, copd, dm2 presents from
rehab on the day after being discharged from [**Hospital1 18**] on cardiac
[**Doctor First Name **] service. The patient underwent elective cabg/MVR by Dr.
[**Last Name (STitle) **] on [**5-12**]. He had a complicated course developing sepsis on
[**5-19**] and found to have mesenteric ischemia requiring exploratory
laparotomy and right colectomy by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He also
developed a PNA and c.diff. He was discharged to [**Hospital1 9494**] on [**6-11**] with a plan to continue 7 days of vanc/CTX for PNA
and 10 days of flaygyl for c diff. At the rehab, the patient was
evaluated by a moonlighter who noted reddish output from g-tube
that was found to be guaiac+. The patient's wife was [**Name (NI) 653**]
regarding concern for an intestinal bleed and the patient was
transferred to [**Hospital1 18**] for further evaluation.
In [**Hospital1 18**] ED the hct was found to be 33.9, up from 30.2 at
discharge on [**6-11**]. VS p 90 132/66 12 100% on vent. He was
evaluated by gen [**Doctor First Name **] and cardiac [**Doctor First Name **] in the ED in whose
assessment the patient, aside from the concern for bleeding,
appeared with similar clinical status to the point where he was
discharged to rehab.

MEDICAL HISTORY: ESRD on HD
HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-16**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH

MEDICATION ON ADMISSION: 1. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q4H (every

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 97.2 BP: 93/52 HR: 80 RR: 16 O2sat 100% on vent
AC 500 x 12 5 0.4
GEN: eyes open spontaneously, attends to stimuli, nods to
questions
HEENT: pupils reactive, edentulous
CHEST: R HD line, midline substernal incision well healing,
clear to auscultation
CV: RR, S1 and S2 wnl, no m/r/g
ABD: soft, NT, ileostomy with some black eschar and pink tissue
as well, midline abd wound with packing, thick yellow secretions
in wound, pink tissue
EXT: no c/c/e

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day
Other gastrostomy complications,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Chronic respiratory failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other postoperative infection,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atherosclerosis of native arteries of the extremities, unspecified,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Other late effects of cerebrovascular disease, facial weakness,Infection with microorganisms resistant to penicillins,Tracheostomy status,Aortocoronary bypass status,Personal history of colonic polyps,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Gastrostomy comp NEC,Meth sus pneum d/t Staph,Comp-ren dialys dev/grft,End stage renal disease,Chronic respiratory fail,Hyp kid NOS w cr kid V,Other postop infection,Atrial fibrillation,Cor ath unsp vsl ntv/gft,Athscl extrm ntv art NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Facial weakness,Inf mcrg rstn pncllins,Tracheostomy status,Aortocoronary bypass,Prsnl hst colonic polyps,Abn react-renal dialysis,Abn react-external stoma
Admission Date:  [**2134-6-13**]              Discharge Date:   [**2134-6-17**]

Date of Birth:  [**2057-9-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
GI bleed

Major Surgical or Invasive Procedure:
VAC changed

History of Present Illness:
76M with ESRD on HD, CAD s/p cabg, afib, copd, dm2 presents from
rehab on the day after being discharged from [**Hospital1 18**] on cardiac
[**Doctor First Name **] service. The patient underwent elective cabg/MVR by Dr.
[**Last Name (STitle) **] on [**5-12**]. He had a complicated course developing sepsis on
[**5-19**] and found to have mesenteric ischemia requiring exploratory
laparotomy and right colectomy by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He also
developed a PNA and c.diff. He was discharged to [**Hospital1 9494**] on [**6-11**] with a plan to continue 7 days of vanc/CTX for PNA
and 10 days of flaygyl for c diff. At the rehab, the patient was
evaluated by a moonlighter who noted reddish output from g-tube
that was found to be guaiac+. The patient's wife was [**Name (NI) 653**]
regarding concern for an intestinal bleed and the patient was
transferred to [**Hospital1 18**] for further evaluation.
In [**Hospital1 18**] ED the hct was found to be 33.9, up from 30.2 at
discharge on [**6-11**]. VS p 90 132/66 12 100% on vent. He was
evaluated by gen [**Doctor First Name **] and cardiac [**Doctor First Name **] in the ED in whose
assessment the patient, aside from the concern for bleeding,
appeared with similar clinical status to the point where he was
discharged to rehab.


Past Medical History:
ESRD on HD
HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-16**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH


Social History:
Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day


Family History:
Non-contributory

Physical Exam:
VS: Temp: 97.2 BP: 93/52 HR: 80 RR: 16 O2sat 100% on vent
AC 500 x 12 5 0.4
GEN: eyes open spontaneously, attends to stimuli, nods to
questions
HEENT: pupils reactive, edentulous
CHEST: R HD line, midline substernal incision well healing,
clear to auscultation
CV: RR, S1 and S2 wnl, no m/r/g
ABD: soft, NT, ileostomy with some black eschar and pink tissue
as well, midline abd wound with packing, thick yellow secretions
in wound, pink tissue
EXT: no c/c/e


Pertinent Results:
[**2134-6-13**] 01:15AM BLOOD WBC-12.6* RBC-3.34* Hgb-10.3* Hct-33.9*
MCV-102* MCH-31.0 MCHC-30.5* RDW-20.2*
[**2134-6-13**] 01:15AM BLOOD Neuts-70.4* Lymphs-22.7 Monos-6.1 Eos-0.6
Baso-0.2
[**2134-6-13**] 08:36AM BLOOD WBC-13.0* RBC-3.40* Hgb-10.3* Hct-34.6*
MCV-102* MCH-30.4 MCHC-29.9* RDW-20.2* Plt Ct-420
[**2134-6-14**] 08:38AM BLOOD WBC-14.1* RBC-3.17* Hgb-10.0* Hct-32.3*
MCV-102* MCH-31.6 MCHC-30.9* RDW-21.3* Plt Ct-386
[**2134-6-13**] 08:36AM BLOOD PT-16.3* PTT-28.0 INR(PT)-1.5*
[**2134-6-14**] 12:15PM BLOOD PT-19.2* PTT-41.0* INR(PT)-1.8*
[**2134-6-13**] 01:15AM BLOOD [**Month/Day/Year **]-92 UreaN-58* Creat-2.9* Na-141
K-4.5 Cl-110* HCO3-21* AnGap-15
[**2134-6-13**] 08:36AM BLOOD [**Month/Day/Year **]-72 UreaN-64* Creat-3.1* Na-144
K-4.3 Cl-112* HCO3-19* AnGap-17
[**2134-6-14**] 08:38AM BLOOD [**Month/Day/Year **]-242* UreaN-82* Creat-3.9* Na-145
K-4.8 Cl-115* HCO3-15* AnGap-20
[**2134-6-14**] 08:38AM BLOOD Albumin-2.4* Calcium-8.8 Phos-4.4 Mg-2.4
[**2134-6-14**] 08:38AM BLOOD Vanco-6.7*
.
CHEST (PORTABLE AP)  [**2134-6-13**] 12:18 AM
AP SEMI-UPRIGHT CHEST: The extreme left costophrenic angle is
excluded from the radiograph. The tracheostomy tip terminates 5
cm above the carina. Median sternotomy wires and right central
venous catheter are unchanged in position. The heart size,
mediastinal and hilar contours are stable. There is interval
decrease in perihilar interstitial opacity consistent with
improving pulmonary venous pressure. Small bilateral pleural
effusions persist. Mild retrocardiac opacity likely reflects a
combination of atelectasis and effusion, although underlying
infectious process is not excluded.
IMPRESSION:
1. Improving pulmonary interstitial edema.
2. Unchanged small pleural effusions and retrocardiac opacity
representing atelectasis or pneumonia.
.
CHEST (PORTABLE AP)  [**2134-6-14**] 2:44 AM
SINGLE BEDSIDE AP RADIOGRAPH OF THE CHEST: Prominent
interstitial markings may represent chronic vascular congestion.
Overall, these are unchanged since multiple prior studies dating
back to [**2132-9-13**]. There is no obvious pleural effusion.
There is no pneumothorax. The cardiomediastinal silhouette is
normal. There are no focal consolidations. Triple lumen tunneled
dialysis catheter terminating in the mid SVC is noted.
Tracheostomy tube is in unchanged location.
IMPRESSION: Prominent bilateral interstitial markings may
represent chronic vascular congestion. No acute cardiopulmonary
process identified.

[**2134-6-17**] 03:21AM BLOOD WBC-12.1* RBC-3.11* Hgb-9.6* Hct-31.0*
MCV-100* MCH-31.0 MCHC-31.1 RDW-20.1* Plt Ct-275
[**2134-6-13**] 01:15AM BLOOD Neuts-70.4* Lymphs-22.7 Monos-6.1 Eos-0.6
Baso-0.2
[**2134-6-17**] 03:21AM BLOOD Plt Ct-275
[**2134-6-17**] 03:21AM BLOOD PT-18.9* PTT-32.0 INR(PT)-1.7*
[**2134-6-17**] 03:21AM BLOOD [**Month/Day/Year **]-191* UreaN-33* Creat-2.3*# Na-138
K-3.9 Cl-104 HCO3-23 AnGap-15
[**2134-6-16**] 04:24PM BLOOD [**Month/Day/Year **]-214* UreaN-64* Creat-3.6* Na-137
K-4.2 Cl-108 HCO3-16* AnGap-17
[**2134-6-15**] 03:55PM BLOOD [**Month/Day/Year **]-213* UreaN-53* Creat-3.0* Na-139
K-4.1 Cl-109* HCO3-18* AnGap-16
[**2134-6-14**] 10:02PM BLOOD ALT-34 AST-48* LD(LDH)-381* AlkPhos-221*
TotBili-0.8
[**2134-6-17**] 03:21AM BLOOD Calcium-7.5* Phos-1.7* Mg-1.6
.
.
Upper extremity US:
IMPRESSION:
1. Right internal jugular vein not clearly visualized. No
evidence of deep venous thrombosis seen
.
Gastrograffin G-tube study:
IMPRESSION: Tube with contrast injection indicative of gastric
placement.


Brief Hospital Course:
# GI Bleed:
HCT on admission was stable from previous and remained stable.
G-tube was examined by medical and surgical teams and no
evidence of bleed was observed. The G-tube was changed. A PPI
was started for gastritis prevention. The patient should have
daily hematocrit checks.

# Respiratory failure:
The patient was at the rehab facility with a trach for vent
weaning. His vent settings were weaned to CPAP w/ & w/o PS with
pressure support level: 14 cm/h2o PEEP: 5 cm/h2o FIO2: 40 %.

# PNA:
Sputum grew MRSA and E. Coli. Plan was to continue
vanc/ceftriaxone for 7 days at discharge [**6-11**]. The patient
developed a fever and had an infiltrate on CXR.  He was switched
to vancomycin/piperacillin-tazobactam/metronidazole and will be
treated for a seven day course ending on [**2134-6-22**].

# Gastric Tube Placement:
The patient has his gastric tube replaced during this
hospitalization.  The location of the tube was confirmed
radiographically.  The patient had bleeding around the site of
his gastric tube, with no bleeding from within the G tube, the
day prior to discharge that resolved with pressure.

# Abdominal Wound:
The patient had a vacuum dressing applied by surgery.  The
dressing needs to be changed every four days.

# C. Diff infection:  The patient was continued on flagyl.
Given the extended duration of abx therapy he will need to
continue taking Flagyl though [**2134-7-2**].

# CAD/CABG:
No evidence of active ischemia. He was continued on [**Month/Day/Year **], BB,
statin.

# ESRD on HD:
Renal team aware, he was continued on HD by renal team. His HD
line was clotted for which he received TPA multiple times with
improvement in line function.

# Afib/ ?history of DVT
Now in sinus rhythm. He was continued on coumadin and BB for
rate control.  His coumadin was increased for subtherapeutic
INR.  He should have his INR checked on a daily basis and his
medications titrated appropriately.

# mouth sore:
The patient has irritation of the upper gum in the tooth line
(ofcourse he has no teeth). The plan is for nursing to check
this area frequently and keep it clean

# Code Status: FULL CODE

Medications on Admission:
1. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q4H (every

4 hours) as needed for temperature >38.0.
2. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable

PO DAILY (Daily).
5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Famotidine 20 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,

Rapid Dissolve PO Q24H (every 24 hours).
7. Warfarin 1 mg Tablet Sig: adjust dose to INR Tablet PO DAILY

(Daily) as needed for afib: Target INR 2-2.5
last dose 5/26-1mg.
8. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
10. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl
Topical QID (4 times a day) as needed for nose.
11. Fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every

24 hours) for 2 days.
12. Vancomycin 1,000 mg Recon Soln Sig: 1000 (1000) mg
Intravenous HD PROTOCOL (HD Protochol) for 7 days.
13. Ceftriaxone 1 gram Recon Soln Sig: One (1) gm Intravenous
Q24H (every 24 hours) for 7 days.
14. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: as directed
below ML Intravenous PRN (as needed) as needed for line flush:
Heparin Flush (10 units/ml) 2 mL IV PRN line flush
Mid-line, heparin dependent: Flush with 10 mL Normal Saline
followed by Heparin as above, daily and PRN per lumen.
Order was filled by pharmacy with a dosage form of Syringe and a

strength of 10 UNIT/ML .
15. Metronidazole in NaCl (Iso-os) 500 mg/100 mL Piggyback Sig:

Five Hundred (500) mg Intravenous Q8H (every 8 hours) for 10
days.
16. Lantus 100 unit/mL Solution Sig: Ten (10) units Subcutaneous

once a day.
17. Insulin Regular Human 100 unit/mL Solution Sig: sliding
scale Injection Q AC&HS.
18. Maalox/Diphenhydramine/Lidocaine Sig: Five (5) cc every
six (6) hours as needed.
19. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-13**]
Drops Ophthalmic PRN (as needed).
20. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**6-20**]

Puffs Inhalation Q4H (every 4 hours) as needed for when on vent.



Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale
units Injection ASDIR (AS DIRECTED): at breakfast, lunch, dinner
and HS, give 4 oz juice for [**Hospital1 **] 0-50, nothing for 51-150, 2
units for 151-200, 4 units for 201-250, 6 units for 251-300, 8
units for 301-350, 10 units for 351-400, [**Name8 (MD) 138**] MD [**First Name (Titles) **] [**Last Name (Titles) **]
>400.
7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 11 days: complete course on [**7-2**].
8. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
gm Intravenous HD PROTOCOL (HD Protochol) for 3 days: complete
course [**6-22**].
9. Pantoprazole 40 mg Recon Soln Sig: One (1) Recon Soln
Intravenous Q24H (every 24 hours).
10. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day).
11. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**6-20**]
puffs Inhalation every four (4) hours as needed: while on vent.

12. Piperacillin-Tazobactam 2.25 gram Recon Soln Sig: 2.25 gram
Recon Solns Intravenous Q12H (every 12 hours) for 4 days: end
date [**6-22**].
13. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: adjust [**Name8 (MD) **] MD.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Primary
1. non-bleeding G-tube
2. temporarily clotted dialysis line

Secondary
1. hospital acquire pneumonia
2. history of c. difficile infection
3. respiratory failure with tracheostomy tube
4. end stage renal disease on dialysis
5. coronary artery disease status post CABG
6. atrial fibrillation
7. history of mesenteric ischemia with post-laparotomy scar


Discharge Condition:
Afebrile, VSS, awake and nods head in response to questions


Discharge Instructions:
You were admitted to the hospital because of concern that there
might be bleeding from your G-tube. You were evaluated by
medical and surgical doctors who [**Name5 (PTitle) 2985**] there was no bleeding from
your G-tube, and your G-tube was changed. Your blood levels were
followed and remained stable. While you were here you were
followed by renal specialists who oversaw your hemodialysis.
Your hemodialysis line was felt to be clotted, for which you
received TPA and the clot resolved. Your wound vac was changed
by the surgery team.
.
You also developed a fever so one of your antibiotics was
changed from ceftriaxone to zosyn to provide broader coverage
for hospital acquired infections. You had a CXR which showed a
possible new LLL infiltrate which could suggest a new PNA. You
should continue to to take the vancomycin with dialysis and the
zosyn to complete a 7 day course on [**6-20**]. You should continue to
take the flagyl for c. diff infection until [**6-27**].
.
Please take all medications as prescribed. Please go to all
follow up appointments. You should follow up with surgery for
evaluation of your abdominal wound. You should have a repeat CXR
after completion of antibiotics. If you have fevers, bleeding,
or any other concerning symptoms, please call the doctor or come
to the hospital.

Followup Instructions:
PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] [**2-14**] wks after discharge from rehab
[**Telephone/Fax (1) 26190**]
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] 2 wks after discharge from rehab [**Telephone/Fax (1) 170**]
Dr. [**First Name (STitle) **] [**Name (STitle) **] [**2-14**] wks after discharge from rehab
Pt has numerous actinic keratoses (precancerous lesions) which
will need to be treated as an outpatient. He agrees to follow up
with his new primary dermatologist as scheduled in [**Month (only) **].

Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]  (General Surgery Clinic) in [**2-14**] weeks.
Dr.[**Name (NI) 670**] nurse will contact you regarding an appointment.
You can call ([**Telephone/Fax (1) 3618**] if you have further questions.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]

Completed by:[**2134-6-23**]
{'Other gastrostomy complications,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Chronic respiratory failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other postoperative infection,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atherosclerosis of native arteries of the extremities, unspecified,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Other late effects of cerebrovascular disease, facial weakness,Infection with microorganisms resistant to penicillins,Tracheostomy status,Aortocoronary bypass status,Personal history of colonic polyps,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: GI bleed

PRESENT ILLNESS: 76M with ESRD on HD, CAD s/p cabg, afib, copd, dm2 presents from
rehab on the day after being discharged from [**Hospital1 18**] on cardiac
[**Doctor First Name **] service. The patient underwent elective cabg/MVR by Dr.
[**Last Name (STitle) **] on [**5-12**]. He had a complicated course developing sepsis on
[**5-19**] and found to have mesenteric ischemia requiring exploratory
laparotomy and right colectomy by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He also
developed a PNA and c.diff. He was discharged to [**Hospital1 9494**] on [**6-11**] with a plan to continue 7 days of vanc/CTX for PNA
and 10 days of flaygyl for c diff. At the rehab, the patient was
evaluated by a moonlighter who noted reddish output from g-tube
that was found to be guaiac+. The patient's wife was [**Name (NI) 653**]
regarding concern for an intestinal bleed and the patient was
transferred to [**Hospital1 18**] for further evaluation.
In [**Hospital1 18**] ED the hct was found to be 33.9, up from 30.2 at
discharge on [**6-11**]. VS p 90 132/66 12 100% on vent. He was
evaluated by gen [**Doctor First Name **] and cardiac [**Doctor First Name **] in the ED in whose
assessment the patient, aside from the concern for bleeding,
appeared with similar clinical status to the point where he was
discharged to rehab.

MEDICAL HISTORY: ESRD on HD
HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-16**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH

MEDICATION ON ADMISSION: 1. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q4H (every

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 97.2 BP: 93/52 HR: 80 RR: 16 O2sat 100% on vent
AC 500 x 12 5 0.4
GEN: eyes open spontaneously, attends to stimuli, nods to
questions
HEENT: pupils reactive, edentulous
CHEST: R HD line, midline substernal incision well healing,
clear to auscultation
CV: RR, S1 and S2 wnl, no m/r/g
ABD: soft, NT, ileostomy with some black eschar and pink tissue
as well, midline abd wound with packing, thick yellow secretions
in wound, pink tissue
EXT: no c/c/e

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day 

### Response:
{'Other gastrostomy complications,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Chronic respiratory failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other postoperative infection,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atherosclerosis of native arteries of the extremities, unspecified,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Other late effects of cerebrovascular disease, facial weakness,Infection with microorganisms resistant to penicillins,Tracheostomy status,Aortocoronary bypass status,Personal history of colonic polyps,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
