CHIEF COMPLAINT: hypoxia/hypotension

PRESENT ILLNESS: 81 yom CAD, pacemaker, reportedly in USOH until approx 2 weeks
PTA --> non-productive cough, persistent.  No apparent fevers or
myalgias.  Development of malaise, fatigue, generalized weakness
and reduced appetite prompted office visit to usual PCP (G.
[**Doctor Last Name **]) --> noted to be ill-appearing, mild resp. distress,
crackles on lung exam and BP= 68/40.  Transported to [**Hospital1 18**] ER
for further evaluation.

MEDICAL HISTORY: * CAD with hx of CABG in [**2146**] s/p multiple caths, most recently
in [**2157**] with stent to ramus intermedius
* CHB s/p DDD PCM, defibrillator in [**2160**]
* atrial fibrillation
* high cholesterol
* prostate cancer
* ocular melanoma
* CRI (baseline 2.8)
* gout
* OA
* GERD

MEDICATION ON ADMISSION: Allopurinol 200 mg daily
Amiodarone 200 mg daily
Atorvastatin 20 daily
Digoxin 125 mcg daily
Fexofenadine 50 mcg, 2 sprays each nostril daily
Furosemide 10 md every other day
Hytrin 2 mg qhs
Lisinopril 5 mg daily
Omeprazole 20 mg twice daily
Tylenol 650 mg tid prn pain
Aspirin 325 mg daily
MVI

ALLERGIES: Cholestyramine / Niacin / Iodine; Iodine Containing /
Ciprofloxacin / Heparin Agents

PHYSICAL EXAM: Endotracheal tube
Ventilator mode: CMV/ASSIST/AutoFlow
Vt (Set): 400 (400 - 400) mL
RR (Set): 25
RR (Spontaneous): 0
PEEP: 5 cmH2O
FiO2: 60%
.
ICU Admission Exam:
General Appearance: No(t) Well nourished, No(t) No acute
distress, Overweight / Obese, No(t) Thin, No(t) Anxious, No(t)
Diaphoretic, Toxic
Eyes / Conjunctiva: PERRL, No(t) Pupils dilated, No(t)
Conjunctiva pale, No(t) Sclera edema

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse.
Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute and subacute necrosis of liver,Defibrination syndrome,Acute kidney failure with lesion of tubular necrosis,Peritoneal abscess,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Ventilator associated pneumonia,Non-autoimmune hemolytic anemia, unspecified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Chronic kidney disease, unspecified,Other transfusion reaction,Diverticulosis of small intestine (without mention of hemorrhage),Anemia of other chronic disease,Esophageal reflux,Other voice and resonance disorders
Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Septic shock,Acute necrosis of liver,Defibrination syndrome,Ac kidny fail, tubr necr,Peritoneal abscess,Int inf clstrdium dfcile,Systolic hrt failure NOS,Ventltr assoc pneumonia,Nonauto hem anemia NOS,Severe sepsis,Crnry athrscl natve vssl,Aortocoronary bypass,Status autm crd dfbrltr,Atrial fibrillation,Chronic kidney dis NOS,Transfusion reaction NEC,Dvrtclo sml int w/o hmrg,Anemia-other chronic dis,Esophageal reflux,Voice/resonance dis NEC
Admission Date:  [**2167-3-17**]              Discharge Date:   [**2167-4-29**]

Date of Birth:  [**2085-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Cholestyramine / Niacin / Iodine; Iodine Containing /
Ciprofloxacin / Heparin Agents

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
hypoxia/hypotension

Major Surgical or Invasive Procedure:
intubation/extubation/reintubation, trachostomy, HD line
placement, multiple central line placements, PEG tube placement,
intra-abdominal abscess drainage w/ pigtail placement

History of Present Illness:
81 yom CAD, pacemaker, reportedly in USOH until approx 2 weeks
PTA --> non-productive cough, persistent.  No apparent fevers or
myalgias.  Development of malaise, fatigue, generalized weakness
and reduced appetite prompted office visit to usual PCP (G.
[**Doctor Last Name **]) --> noted to be ill-appearing, mild resp. distress,
crackles on lung exam and BP= 68/40.  Transported to [**Hospital1 18**] ER
for further evaluation.



In [**Hospital1 18**] ER, BP= 74/32 --> peripheral dopamine started.  RIght
IJ central line placed (CVP=4) -- attempts at left IJ central
line placement.  Received 5L NS, iv decadron. Anuric renal
failure. Dopamine substituted with Norepinephrine and then added
phenylephrine for persistent hypotension.  Empirically received
Ceftriaxone, Azithromycin and Vanco (reportedly with Levoquin
allergy).  Intubated (traumatic), and transferred to MICU
service for further evaluation and management.



Upon arrival to MICU, intubated, mechanically ventillated,
sedated.  Vasopressin added as third vasopressor with good
effect.  Remains anuric.  Hypothermia (T= 94)


Past Medical History:
* CAD with hx of CABG in [**2146**] s/p multiple caths, most recently
in [**2157**] with stent to ramus intermedius
* CHB s/p DDD PCM, defibrillator in [**2160**]
* atrial fibrillation
* high cholesterol
* prostate cancer
* ocular melanoma
* CRI (baseline 2.8)
* gout
* OA
* GERD

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse.


Family History:
There is no family history of premature coronary artery disease
or sudden death

Physical Exam:
Endotracheal tube
Ventilator mode: CMV/ASSIST/AutoFlow
Vt (Set): 400 (400 - 400) mL
RR (Set): 25
RR (Spontaneous): 0
PEEP: 5 cmH2O
FiO2: 60%
.
ICU Admission Exam:
General Appearance: No(t) Well nourished, No(t) No acute
distress, Overweight / Obese, No(t) Thin, No(t) Anxious, No(t)
Diaphoretic, Toxic
Eyes / Conjunctiva: PERRL, No(t) Pupils dilated, No(t)
Conjunctiva pale, No(t) Sclera edema

Head, Ears, Nose, Throat: Normocephalic, No(t) Poor dentition,
Endotracheal tube, No(t) NG tube, OG tube

Lymphatic: Cervical WNL, No(t) Supraclavicular WNL, No(t)
Cervical adenopathy

Cardiovascular: (PMI Normal, No(t) Hyperdynamic), (S1: Normal,
No(t) Absent), (S2: Normal, No(t) Distant, No(t) Loud, No(t)
Widely split , No(t) Fixed), No(t) S3, No(t) S4, No(t) Rub,
(Murmur: Systolic, No(t) Diastolic)

Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)

Respiratory / Chest: (Expansion: Symmetric, No(t) Paradoxical),
(Percussion: Resonant : , No(t) Hyperresonant: , No(t) Dullness
: ), (Breath Sounds: No(t) Clear : , Crackles : Bilateral, No(t)
Bronchial: , Wheezes : , No(t) Diminished: , No(t) Absent : ,
No(t) Rhonchorous: )

Abdominal: Soft, Non-tender, No(t) Bowel sounds present, No(t)
Distended, No(t) Tender: , No(t) Obese, Distended

Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t)
Clubbing

Musculoskeletal: No(t) Muscle wasting, Unable to stand

Skin:  Warm, No(t) Rash: , No(t) Jaundice

Neurologic: No(t) Attentive, Follows simple commands, Responds
to: Verbal stimuli, No(t) Oriented (to): , Movement: Purposeful,
Sedated, No(t) Paralyzed, Tone: Normal


Pertinent Results:
[**2167-3-17**] 05:10PM   NEUTS-94.6* LYMPHS-3.0* MONOS-2.3 EOS-0
BASOS-0.1
[**2167-3-17**] 05:10PM   WBC-32.5*# RBC-3.09* HGB-10.1* HCT-30.2*
MCV-98 MCH-32.6* MCHC-33.3 RDW-16.9*
[**2167-3-17**] 05:10PM   ALT(SGPT)-295* AST(SGOT)-305* ALK PHOS-150*
TOT BILI-4.2*
[**2167-3-17**] 09:32PM   PT-24.8* PTT-42.9* INR(PT)-2.4*
[**2167-3-17**] 11:08PM   LACTATE-1.3

CXR [**2167-3-17**]:
FINDINGS: There are marked dramatic changes from the prior scan
with at least three discrete foci of patchy opacity in the right
mid, right lower, and left lower lungs. There are less apparent
foci noted in the left mid and left upper lung zones as well.
There are changes consistent with prior median sternotomy and
CABG. An indwelling dual-chamber pacemaker is stable in course
and position. Numerous surgical clips are identified in the
right upper quadrant. No definite effusion or pneumothorax is
seen. The visualized osseous structures are otherwise
unremarkable.
IMPRESSION: Given history, the interval development of patchy
opacities in
the distribution described above are presumably multifocal
pneumonia.
Correlate clinically, and if indicated, continue with close
interval
surveillance.

[**2167-4-8**] UENI:
LEFT UPPER EXTREMITY VENOUS ULTRASOUND: [**Doctor Last Name **]-scale and color and
pulse wave Doppler examination was performed over the left
internal jugular, subclavian, axillary, brachial, and basilic
veins, demonstrating normal flow, compressibility, respiratory
variation, and augmentation were unremarkable. No evidence of
intraluminal thrombus is seen. The cephalic vein is not seen.
IMPRESSION: No DVT seen in the left upper extremity. The
cephalic vein is
not well visualized, but the basilic vein remains patent.

[**2167-4-15**] CT ABDOMEN:
Fluid collection containing small bubbles of gas as described
above,
situated between the duodenum and pancreatic head and uncinate
process.

Differential considerations include perforation of a duodenal
ulcer or
duodenal diverticulum with resultant abscess. Much less likely,
given the
proximity of the pancreas, a pancreatic process such as an
infected pseudocyst (given the presence of gas) is a
differential consideration. No definite mass is identified.
.
[**2167-4-22**] CT Abdomen w/out IV contrast:
1. The pigtail catheters sits within an air and fluid collection
along the
medial aspect of the second portion of the duodenum in the
region of a
previously visualized duodenal diverticulum. This air and fluid
collection is smaller than on the prior study and currently
measures 5.3 x 2.9 cm.
2. New hypoattenuating lesions are seen in the periphery of the
right lobe of the liver as well as in the spleen. The
differential diagnosis for these findings together includes
infarcts. Additional etiologies that could explain the liver
findings include infectious causes such as cholangitis or
evolving hepatic abscesses. There is no drainable fluid
collection in the liver or spleen at this time.
3. Stable small amount of ascites in the perihepatic and
perisplenic regions which tracks along the right paracolic
gutter into the pelvis.
4. Unchanged large bilateral pleural effusions.
5. Colonic diverticulosis without evidence of diverticulitis.
6. Anasarca.
.
[**2167-4-23**] Renal U/S:
No hydronephrosis. Multiple small right renal cysts.
.
[**2167-4-25**] CT Abdomen w/ IV contrast:
1. Residual paraduodenal phlegmon with a pigtail in place.
2. Multiple hypodense areas in the liver and spleen. The liver
findings are again worrisome for small abscesses, although there
is no definite change and no drainable collection. Differential
considerations for the splenic lesions again include abscesses,
infarcts or both.
.
[**2167-4-27**] ECHO:
The left atrium is mildly dilated. No thrombus/mass is seen in
the body of the left atrium. No atrial septal defect is seen by
2D or color Doppler. Left ventricular wall thicknesses are
normal. The left ventricular cavity is mildly dilated. No masses
or thrombi are seen in the left ventricle. Overall left
ventricular systolic function is severely depressed (LVEF= 20 %)
with global hypokinesis and regional akinesis of the inferior
wall. There is no ventricular septal defect. with depressed free
wall contractility. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No masses or
vegetations are seen on the aortic valve. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. No mass or vegetation is seen on the mitral valve.
Mild to moderate ([**2-13**]+) mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.

Compared with the prior study (images reviewed) of [**2167-4-6**], no
change.
.


Brief Hospital Course:
ICU Course:
#.Leukocytosis/fever ?????? The patient was admitted with septic
shock and had ongoing leukocytosis and fevers from the day of
admission. Sputum cultures from [**4-5**] showed pansensitive
serratia and klebsiella oxytoca and stool cultures were positive
for c.diff on [**4-8**] in the setting of prolonged antibiotic
administration. For the repeat PNA on the [**4-7**], there were not
significant radiographic findings, but with increased secretions
and needing to be placed back on the vent, started treating for
hospital aquired pneumonia with vanco/zosyn, until [**4-10**], when
repeat sputum cultures showed GNR. At this time, vancomycin was
switched from zosyn to meropenem. KUB did not show any evidence
of megacolon. For his C. diff infection, he was maintained on PO
Vancomycin and IV flagyl. This regimen should be continued for
14 days after all other antibiotics are discontinued.

In addition, on [**2167-4-16**] a CT Abdomen showed an intra-abdominal
air/fluid collection, adjacent to the duodenum, thought to be
the result of a ruptured duodenal diverticulum. Surgery was
consulted and did not want to take the patient to the O.R. This
collection was drained by Interventional Radiology and a pigtail
catheter was placed on [**2167-4-17**]. The collection grew pan-sensitive
serratia and fluconazole-sensitive [**Female First Name (un) **] parapsilosis. He was
started on fluconazole on [**4-16**] and cefepime on [**4-17**] for this
abscess.

A repeat CT was obtained on [**4-22**] to look for evolution of the
paraduodenal abscess, which showed new hypoattenuations in the
liver and spleen, possible consistent with ischemia or septic
infarct. None of these collections were large enough to drain,
and the patient was afebrile, so cefepime/fluconazole were
continued. The patient developed severe abdominal pain on the
morning of [**4-27**], and CT abdomen was again repeated, this time
with IV contrast, which showed persistent hypoattenuations in
the liver and spleen. An ECHO was repeated and was negative for
vegetations. Pain resolved with morphine and fentanyl. The
pigtail drain was clamped on [**4-29**] because it was draining
minimal amounts of clear green fluid.

#.Septic Shock/Hypotension: Initially hypotensive in setting of
septic shock. He had Early Goal Directed Therapy with Apache IV
score of 114.  Initial sputum with GNRs and GPCs in pairs and
initial community-acquired PNA was treated.  Then patient
developed what was thought to be hospital-acquired pneumonia as
well as c.diff colitis, and an intra-abdominal abscess. Daily
attempts were made to wean the patient from pressors once his
infections appeared adequately treated. His hypotension was
treated with levophed, midodrine, and vasopressin as needed. In
addition, as there was a question of a cardiogenic component to
his shock, given known low EF and low mixed venous O2
saturation, the patient had a trial of dobutamine, with no
improvement in his blood pressure. The patient had an A-line
placed, but developed arterial occlusion and A-line had to be
pulled. He was not able to have further invasive BP monitoring.
BP was monitored with lower UE and thigh cuff, and mental status
and serum lactate were used as parameters of tissue perfusion.
In order to maximize the patient's cardiac function, EP was
consulted on [**4-27**] to increase the patient's paced rate from
78->90. With a HR of 90, the patient was able to be weaned from
levophed. He was also restarted on digoxin, which he takes at
home, on [**4-29**].
.
#Respiratory failure/ARDS: In the setting of his hospital
acquired pneumonia, the patient developed ARDS. He had a
percutanous tracheostomy on [**4-1**] for ongoing mechanical
ventilation. As his pneumonia was treated, his pulmonary status
stabilized and each day he had pressure support trials, which he
tolerated for a few hours each day. His ongoing respiratory
failure was also likely due to CHF and fluid overload.
.
#Anemia ?????? Patient had severe anemia with hematocrits around 20
upon admission to the ICU. He was found to be super Coombs
positive and to have many antibodies to donor blood. In
addition, he has a component of anemia of chronic disease.
Hematology consult was obtained, and heme followed the patient
throughout his stay. Epogen 10000U 3x/week, iron, and folate
supplements were given consistently. In addition, daily
hemolysis labs were checked, which showed evidence of ongoing
low-grade DIC. Given the patient's antibodies, he was transfused
only for a goal Hct of 21%. A repeat Super-Coombs was done, and
the patient was found to be negative on repeat testing.
.
#LUE swelling ?????? The patient had 2 episodes of asymmetric LUE
swelling. He had 2 ultrasounds to evaluate for thromboses, which
were both negative. Strength and  sensation were symmetric in R
and L arms. Despite negative LENIs, clinical suspicion for clot
remained very high. Swelling resolved without intervention.
.
#Dysphonia ?????? due to cuffed 8.0 trach, will change on [**4-13**] and
then get ENT consult as needed as outpatient, confirmed with ENT
and IP on [**2167-4-7**]. Got PMV on [**4-6**].
- Will hold off until resp status improves
.
#Coagulopathy: Patient had elevated PT/PTT and thrombocytopenia.
Coagulopathy likely mulifactorial, with components of shock
liver, low vitamin K absorption, and sub-acute DIC. Stool was
guaiac negative. The patient was found to be Heparin antibody
positive, and all heparin products were held. Serotonin Release
Antibody was negative, thereby confirming clinical suspicion
that patient did not have HIT. He was not anti-coagulated with
argatroban.
.
#Transaminitis: Likely due to shock liver in setting of
distributive picture with decreased EF. RUQ u/s shows known CBD
dialation, s/p chole. LFT??????s improving.
.
#Oliguric, acute on chronic ARF/Uremia: Baseline Cr 2.3.
Patient in ARF from acute tubular necrosis in setting of
hypotension.  Patient was given CVVH through L femoral line then
HD. Renal pulled fem HD line with resolution of leukocytosis,
tip culture pending, but could suggest line infection. [**3-31**],
placed IR HD line on Tuesday with VIP port, non-tunneled since
was spiking. In the setting of ongoing pressor requirements, the
patient was maintained on CVVH until [**4-27**], when intermittent HD
was started per family request, as CVVH made the patient very
uncomfortable. He had a renal ultrasound which showed no
evidence of obstruction or hydronephrosis. He had a tunnelled
hemodialysis line placed on [**4-29**] with IR, and his Right IJ
central line was pulled.
.
#Mental Status: awake, following commands. Initially, mental
status did not immediately return once sedation removed because
of shock liver and decreased metabolism of sedatives on initial
presentation.
MS much improved, cont zyprexa as needed for agitation
.
#Coronary Artery Disease: The patient had a CABG in [**2146**] with
multiple PCI stent placements as well as AICD placement in [**2160**].
He was continued on ASA and statin, but all antihypertensives
were held in the setting of persistently low blood pressures.
Goal Hct was set at 21 rather than 25 due to significant issues
with transfusions, as above.
.
Hypoalbuminemia: decreased in the setting of sepsis
.
Nutrition: The patient had a PEG placed on [**4-3**] due to prolonged
intubation and need for prolonged tube feeds. This was advanced
to a G-J tube after the discovery of his para-duodenal abscess.
He was maintained on tube feeds.
.
On HOD 43, the patient returned from getting a tunneled catheter
in IR and had a witnessed run of ventricular tachycardia that
was caught on telemetry. It resolved spontaneously within [**2-13**]
minutes without intervention. A faint pulse was palpated in the
radial artery. The patient became unresponsive to voice. [**2-13**]
minutes later, the patient had another run of ventricular
tachycardia that was seen on EKG. During this episode, the
patient had no pulse. The blood pressure dropped to zero and no
CPR was performed as the patient was made DNR previously. The
patient was pronounced at 2218 on [**2167-4-29**].

Medications on Admission:
Allopurinol 200 mg daily
Amiodarone 200 mg daily
Atorvastatin 20 daily
Digoxin 125 mcg daily
Fexofenadine 50 mcg, 2 sprays each nostril daily
Furosemide 10 md every other day
Hytrin 2 mg qhs
Lisinopril 5 mg daily
Omeprazole 20 mg twice daily
Tylenol 650 mg tid prn pain
Aspirin 325 mg daily
MVI

Discharge Medications:
None

Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary:
Septic shock
ARDS
community acquired pneumonia
ventilator associated pneumonia
acute on chronic renal failure requiring dialysis

Secondary:
chronic delayed hemolytic transfusion reaction with anemia
dysphonia secondary to prolonged intubation


Discharge Condition:
Expired

Discharge Instructions:
NONE

Followup Instructions:
NONE


Completed by:[**2167-4-29**]

Name:  [**Known lastname **],[**Known firstname **] A                 Unit No:   [**Numeric Identifier 17325**]

Admission Date:  [**2167-3-17**]              Discharge Date:   [**2167-4-29**]

Date of Birth:  [**2085-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Cholestyramine / Niacin / Iodine; Iodine Containing /
Ciprofloxacin / Heparin Agents

Attending:[**First Name3 (LF) 1015**]
Addendum:
The patient expired after a cardiopulmonary arrest. The previous
Discharge summary states that the patient was discharged to an
extended care facility. This was written in error.

Discharge Disposition:
Expired

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1016**] MD [**MD Number(2) 1017**]

Completed by:[**2167-6-25**]
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute and subacute necrosis of liver,Defibrination syndrome,Acute kidney failure with lesion of tubular necrosis,Peritoneal abscess,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Ventilator associated pneumonia,Non-autoimmune hemolytic anemia, unspecified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Chronic kidney disease, unspecified,Other transfusion reaction,Diverticulosis of small intestine (without mention of hemorrhage),Anemia of other chronic disease,Esophageal reflux,Other voice and resonance disorders'}


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: hypoxia/hypotension

PRESENT ILLNESS: 81 yom CAD, pacemaker, reportedly in USOH until approx 2 weeks
PTA --> non-productive cough, persistent.  No apparent fevers or
myalgias.  Development of malaise, fatigue, generalized weakness
and reduced appetite prompted office visit to usual PCP (G.
[**Doctor Last Name **]) --> noted to be ill-appearing, mild resp. distress,
crackles on lung exam and BP= 68/40.  Transported to [**Hospital1 18**] ER
for further evaluation.

MEDICAL HISTORY: * CAD with hx of CABG in [**2146**] s/p multiple caths, most recently
in [**2157**] with stent to ramus intermedius
* CHB s/p DDD PCM, defibrillator in [**2160**]
* atrial fibrillation
* high cholesterol
* prostate cancer
* ocular melanoma
* CRI (baseline 2.8)
* gout
* OA
* GERD

MEDICATION ON ADMISSION: Allopurinol 200 mg daily
Amiodarone 200 mg daily
Atorvastatin 20 daily
Digoxin 125 mcg daily
Fexofenadine 50 mcg, 2 sprays each nostril daily
Furosemide 10 md every other day
Hytrin 2 mg qhs
Lisinopril 5 mg daily
Omeprazole 20 mg twice daily
Tylenol 650 mg tid prn pain
Aspirin 325 mg daily
MVI

ALLERGIES: Cholestyramine / Niacin / Iodine; Iodine Containing /
Ciprofloxacin / Heparin Agents

PHYSICAL EXAM: Endotracheal tube
Ventilator mode: CMV/ASSIST/AutoFlow
Vt (Set): 400 (400 - 400) mL
RR (Set): 25
RR (Spontaneous): 0
PEEP: 5 cmH2O
FiO2: 60%
.
ICU Admission Exam:
General Appearance: No(t) Well nourished, No(t) No acute
distress, Overweight / Obese, No(t) Thin, No(t) Anxious, No(t)
Diaphoretic, Toxic
Eyes / Conjunctiva: PERRL, No(t) Pupils dilated, No(t)
Conjunctiva pale, No(t) Sclera edema

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute and subacute necrosis of liver,Defibrination syndrome,Acute kidney failure with lesion of tubular necrosis,Peritoneal abscess,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Ventilator associated pneumonia,Non-autoimmune hemolytic anemia, unspecified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Chronic kidney disease, unspecified,Other transfusion reaction,Diverticulosis of small intestine (without mention of hemorrhage),Anemia of other chronic disease,Esophageal reflux,Other voice and resonance disorders'}
