Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: left upper extremity gangrene, cirrhosis, recurrent respiratory failure major surgical or invasive procedure: multiple paracenteses cardiopulmonary rescusitation hemodialysis ultrafiltration brachial artery bipass surgery history of present illness: mr. is a 55 year-old man with hcv cirrhosis, esrd, dm, cad s/p perioperative mi and pvd who was originally admitted for upper extremity gangrene to vascular surgery service and underwent left brachial to radial bypass on . the procedure was complicated by perioperative mi and cardiac arrest. . he was transferred to medicine on for ascites and bradycardia. in the two days prior to admission to the micu, he was noted to have increased oxygen requirement (95% on 5l from 2l previously) and sbps dropping from the 100s -> 80s. he underwent a diagnostic paracentesis on the day of transfer after receiving albumin 50g (initially planned for therapeutic tap given increased abdominal distention); the tap was consistent with sbp and he was started on ceftriaxone. . of note, he has developed new ascites after having been told that he "cleared" his hep c years ago after tx with ribaviron/interferon in at . noted to have a significant alcohol history as well, but quit drinking approximately 21 years ago. abdominal distension has been progressive over the last month. had tap on negative for sbp; cytology not sent. ruq us on showed evidence of cirrhosis and hypoechoic lesion concerning for hcc. . then on he was transfered to micu for bradycardia, hypotension, demand ischemia, and sepsis. he was intubated at the time of transfer to micu. in the micu he was initially on pressors. cvvh was initiated. he came off pressors on . he was extubated . pressors were restarted on and the pt was reintubated on with worsening mental status. . blood pressure measurement was a constant issue. bps are obtained on the right foreman and are approximately 10mmhg below the a-line. . repeat paracentesis showed sbp, culture negative, and he was given meropenem, which he remained on for esbl klebsiella uti. he was also on empiric vancomycin at that time for possible vap. . the patient's respiratory status remains dependent on the level of abdominal ascites. o2 sats were as low at 33% from the femoral and improved with paracentesis leading to a dx of abdominal compartment syndrome. sats improved with paracentesis. abd distension also worsens his respiratory effort and leads to hypercarbia for which cpap is used qhs. to prevent worsening of respiratory status low volume paracentesis has been recommended q2-4days. . he was extubated again on and off pressors since . cvvh was discontinued and the pt tolerated hd . multiple goals of care conversations have been had however the pt remains full code. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies cough, or wheezes. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes. no numbness/tingling in extremities. no feelings of depression or anxiety. past medical history: * cad and mi s/p cardiac cath with diffuse, minor lad disease, om1 80% and rca 70-99%. his most recent echo () showed there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate global left ventricular hypokinesis with more prominent inferior severe hypokinesis (lvef = 30-35 %). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there is abnormal septal motion/position pvd * h/o parafalcine hemorrhage * hypertension * hyperlipidemia * ?fatty liver * esrd on dialysis * diabetes mellitus on insulin * chronic hepatitis c (type 2 genotype) * s/p cholecystectomy * s/p l rotator cuff surgery * r aka, l bka * revision r bka * b/l le guillotine amputations social history: 30 pack year history, officially quit . h/o heavy daily alcohol consumption from - as patient was a roadie in several bands during this time. extensive drug history during this time as well admitting to cocaine, heroin, and lsd. was living with his brother, has been in rehab since . family history: no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. siblings with cabg in their 40s. physical exam: vs: tc 98.3, tm 98.6, bp 126/65 (93-141/43-76) via a line. bp on right forearm 90s/50s (approximately 10 pts lower than a-line). hr 96(86-103), rr 24(), sat 100% on 2lnc (92-100%) on 2lnc vs cpap w/ 1l. heent: non-icteric, r pupil nonresponsive, left minimally responsive and pinpoint. op with ulcer on left palate. cv: rrr, no m/r/g pulm: rhonchi left upper lobe. clear otherwise abd: bloody guaze on rlq. nt, mild distension. + fluid wave. limbs: right aka, left bka, dry gangreen on left 1 and 2nd digit, right 4th digit. well healling bypass wound on left upper arm. picc in right upper arm. hd cath in left subclavian. skin: stage ii ulcer on coccyx. neuro: a+ox2, cn intact except pupils as above, able to move all 4 ext. pertinent results: labs on admission: 05:30pm blood wbc-9.7 rbc-4.54*# hgb-11.2* hct-38.6*# mcv-85# mch-24.7*# mchc-29.1* rdw-16.7* plt ct-332# 07:30am blood neuts-76.1* lymphs-13.8* monos-6.7 eos-3.0 baso-0.4 05:30pm blood pt-13.1 ptt-28.5 inr(pt)-1.1 05:30pm blood glucose-240* urean-25* creat-2.9* na-137 k-3.9 cl-98 hco3-23 angap-20 04:00pm blood alt-16 ast-24 alkphos-87 05:12am blood lipase-8 04:00pm blood ck-mb-6 ctropnt-0.82* 05:30pm blood calcium-8.6 phos-4.2# mg-1.7 02:35pm blood vanco-27.9* 11:25am blood type-art temp-37 rates-10/ tidal v-550 fio2-100 po2-317* pco2-55* ph-7.34* caltco2-31* base xs-2 aado2-352 req o2-62 intubat-intubated vent-controlled comment-ett . labs on discharge: 06:50am blood wbc-6.7 rbc-4.13* hgb-10.8* hct-37.0* mcv-90 mch-26.1* mchc-29.1* rdw-18.2* plt ct-150 04:53am blood neuts-62.8 lymphs-20.6 monos-6.9 eos-9.4* baso-0.3 06:50am blood glucose-115* urean-23* creat-2.7* na-138 k-5.0 cl-101 hco3-31 angap-11 06:50am blood calcium-8.9 phos-4.2 mg-2.1 . ascites fluid . test name value units reference range 03:00pm analysis wbc, ascites 7000* #/ul 0 - 0 performed at west stat lab rbc, ascites * #/ul 0 - 0 performed at west stat lab polys 58* % 0 - 0 performed at west stat lab bands 2* % 0 - 0 lymphocytes 10* % 0 - 0 performed at west stat lab monocytes 10* % 0 - 0 performed at west stat lab macrophage 20* % 0 - 0 . imaging . cxr findings: as compared to the previous radiograph, there is an unchanged course of the left-sided double-lumen central venous access line on the right-sided picc line. unchanged low lung volumes. unchanged moderate cardiomegaly with minimal overhydration and retrocardiac atelectasis. on today's image, there is minimal blunting of the left costophrenic sinus, so that the presence of a minimal left-sided pleural effusion cannot be excluded. no other changes. . ct abdomen with intravenous contrast: . there is left lower lobe atelectasis with minimal right-sided atelectasis. trace bilateral pleural effusions. there is severe cardiomegaly and a central venous catheter is partially imaged, with tip seen within the right atrium. . there are two arterial enhancing lesions within the liver. the first is best seen on (3a:24) measuring 14 x 11 mm and the second is best seen on (3a:45) measuring 8 x 11 mm with the first located within segment vi/vii and the second located within segment v/viii of the liver. both of these lesions have homogeneous arterial enhancement and persistent enhancement in portal venous phases, though with washout and more delayed imaging, best appreciated on (6:20). overall, enhancement characteristics of these lesions are suspicious for hepatocellullar carcinoma. . there is a nodular contour to liver, compatible with known cirrhosis. there is no intra- or extra-hepatic biliary dilatation. the main portal vein and its major branches are patent. the patient is status post cholecystectomy. there is a marked amount of ascites, splenomegaly measuring up to 13.8 cm, and varices that are compatible with sequelae of portal hypertension. differential perfusion is noted within the spleen in the area of hypoperfusion in the posterior edge of the spleen seen in both arterial, and slightly delayed phases, though is not apparent in longer delays and is thought to be related to perfusion. this can be best appreciated on (3b:152). . both adrenal glands are unremarkable. the pancreas enhances homogeneously. the visualized portions of the intra-abdominal small and large bowel are unremarkable with no bowel wall thickening and no caliber changes to suggest acute obstruction. note is made of a small fluid-filled umbilical hernia. both kidneys appear atrophic in nature and demonstrate delayed enhancement compatible with known end stage renal disease. there is poor excretion of contrast there is an arterially enhancing focus in the right kidney, of uncertain etiology, may represent a focal lesion. there is extensive intra-abdominal ascites. there is no intra-abdominal free air. there is no mesenteric or retroperitoneal lymphadenopathy. . cta examination: the celiac axis has conventional anatomy and is patent. the sma is patent. the portal vein, smv, and splenic veins are patent. there is extensive atherosclerotic disease involving the abdominal aorta and its major branches. . ct of the pelvis with intravenous contrast: bladder is difficult to visualize, though likely collapsed anteriorly from compression of severe ascites(as no known surgical history provided) (501b:41), with several foci of likely intraluminal air, of uncertain etiology. the rectum, sigmoid colon, prostate, and seminal vesicles are unremarkable with a rectal catheter in place. there is extensive intra-abdominal ascites tracking through to the pelvis. there is no pelvic or inguinal lymphadenopathy. . bone windows: no suspicious lytic or sclerotic foci are identified. there is extensive degenerative change involving the thoracolumbar spine manifested by endplate sclerosis, marginal osteophytic formation, and disc desiccation and loss of intervertebral disc height. . impression: 1. two arterially enhancing lesions, the larger of which measures 14 mm located in segment vi/vii, and the second of which measures 11 mm located in segment v/viii that demonstrate delayed washout that are suspicious for hepatoma. 2. nodular appearance of the liver compatible with cirrhosis. sequelae of portal hypertension with splenomegaly, massive ascites, and varices. 3. bladder is collapsed. several intraluminal foci of air of uncertain etiology, recommend correlation with instrumentation, and infection is not excluded as etiology. 4. atrophic appearance of the kidneys compatible with known end stage renal disease. 5mm area of arterial enhancement in the right kidney may represent focal lesion such as aml or rcc and if clinically indicated mr could be considered although this may be limited by the small size of the lesion 5. severe cardiomegaly. . cardiac echo . the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with akinesis of the anterior, septal and apical segments, as well as the inferior wall (multivessel cad). basal nferolateral segments contract best (overall lvef = 20%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . impression: severe regional left ventricular systolic dysfunction, c/w multivessel cad. moderate right ventricular systolic dysfunction. mild mitral regurgitation. moderate tricuspid regurgitation. mild pulmonary hypertension. . compared with the prior study (images reviewed) of , there has been further deterioration of lv systolic function. . micro . 11:07 am urine source: catheter. **final report ** urine culture (final ): klebsiella pneumoniae. 10,000-100,000 organisms/ml.. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. . sensitivities: mic expressed in mcg/ml . _________________________________________________________ klebsiella pneumoniae | amikacin-------------- 16 s ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- r ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- 64 i piperacillin/tazo----- =>128 r tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r brief hospital course: 55 y/o with hcv cirrhosis, esrd, dm, cad s/p perioperative mi and pvd who was admitted for worsening pvd, underwent left brachial to radial bypass on complicated by perioperative mi, with abdominal compartment syndrome, recurrent respiratory failure, spontaneous bacterial peritonitis, sepsis, and refractory ascites. . micu course: he was transferred to the micu for management of hypotension and likely sepsis. he was managed intermittently with vasopressors and treated with mereopenem for esbl klebsiella uti and empirically for sbp, and his subclavian line was removed because of concern for possible line infection. he developed hypercapneic respiratory failure x 2 in the setting of ascites and elevated abdominal pressures (peaked at 28) and was extubated both times after large abdominal paracentesis (volumes of 2l - 4l were removed). he also underwent cvvh because of hypotension but was transitioned to hemodialysis prior to transfer to medicine. multiple family meetings were held to discuss goals of care. lines placed included a r picc on and a r femoval cvl and l femoral a-line on . . overall floor course: pt arrived to the floor remarkably asymptomatic and feeling well. throughout his course the patient became increasingly dyspneic, and his ascites and abdominal distension increased. the patient's symptoms were thought to be secondary to end-stage nyha class 4 systolic congestive heart failure. the patient was started on a 1l fluid restriction and began aggressive ultrafiltration nearly daily for a goal of 1-2l negative per session. unfortunately, the patient's dyspnea and ascites continued to worsen and the patient required q2-4 day paracenteses. the patient's dyspnea improved and he was continued on nearly daily ultrafiltration, although ultrafiltration was limited by hypotension and eventually stopped since it was not felt to be successful in reducing ascites fluid. the patient had two liver lesions that were suspicious for hepatoma. fortunately, the patient spoke with his old hepatologist at who said these same two lesions were biopsied in and were negative for malignancy. a records request was made at to confirm this. . a goals of care family meeting was held where the patient and family were told very clearly of his very poor prognosis and progressive multi-organ failure. despite this the patient was hoping to get better and wanted to live to work on his charity organization. therefore, he was told that we would do our best to help him achieve those goals. . problem : . # dyspnea: multifactorial but primarily from stage 4 chf (30-40% 1 year mortality) and cirrhosis (meld score 22) leading to refractory ascites and hypercarbic respiratory failure. chf suspected given volume status on exam and bnp > 70,000. hypercarbic respiratory failure occured at times due to worsening ascites/abdominal distension. respiratory dynamics also aggravated by pleural effusions, muscular weakness from critical illness, and underlying lung disease from smoking history. patient was maintained on oxygen for sat > 90%, had cpap at night to prevent hypercarbia, underwent mwf hemodialysis with occasional sessions of ultrafiltration, and was fluid restricted to 1 liter per day as tolerated. unfortunately his bp did not allow for acei or bb or diuretic therapy. on discharge, patient will require 3x/week hd with albumin and midodrine to maintain bp. he will also require 1-2x/week paracenteses for refractory ascites, felt to be from liver disease and cardiac ascites. . # hypotension: multiple components felt to be contributing. likely from poor cardiac output from systolic chf as well as from intravascular low volumes in setting of poor oncotic pressure and low cardiac output. patient was continued on midodrine 5 mg po before hd as well as albumin with hd, and will require this on discharge to maintain bp. he was normotensive in between hd sessions. . # hypercarbic resp failure: two intubations throughout admission. respiratory effort limited by abdominal distension. respiratory dynamics also aggravated by pleural effusions, muscular weakness from critical illness, and underlying lung disease from smoking history. respiratory status was improved by frequent (2x/week) paracentesis. . # s/p cardiac arrest: patient had cardiac arrest on three occasions, and felt to be related to volume shifts. his echo confirmed severe systolic dysfunction (ef 20%) after his nstemi. he was continued on aspirin 81, plavix, statin. he was not started on bb or acei as he would not tolerate any further drop in blood pressure. volume status was controlled with hd 3x/week. . # hcv cirrhosis/ abdominal compartment syndrome / liver mass / refractory ascites: meld score 22 (30% 1 yr mortality). has cirrhosis and ascites with 4l tap on associated with hypotension and nstemi. history of hcv treatment at . 1.8 cm hypoechoic liver lesion on us concerning for hcc. apparently per patient's prior hepatologist, pt had these same masses in , which were biopsied and cancer negative. this makes malignancy less likely. hcv viral load normal suggesting that the etiology of his subacute ascites (increased in last month per pt) may be occult hcc obstructing a major vessel of the portal vein. unlikely given normal portal doppler studies. overall, likely that refractory ascites is from worsening cardiac disease in setting of his nstemi and potentially from worsening liver disease. patient was continued on lactulose/rifaximin. with regard to refractory ascites, discussed case with liver team and no additional medication/intervention felt to substantially improve patient's symptoms. also discussed possibility of daily uf, although per renal, this has not proved to be an effective management strategy. . # esrd: ? from dm. ? hepato-renal. initially on cvvh, but discharged on hd regimen with albumin/midodrine. . # anemia: likely in setting of cri and stable throughout admission . # sacral decubitus ulcer: currently stage 2. wound care was consulted and performed q2h repositioning. . # pvd/left brachial to radial bypass/right 4th pip osteomyelitis: also with r bka and l aka. for pain control, patient was discharged with oxycontin standing, as well as iv morphine and po dilaudid prn. . # esbl klebsiella urosepsis and positive sbp on tap on : treated empirically with vancomycin and meropenem (7 days). . # goals of care: numerous goals of care discussion were had with patient, palliative care team, social work team, primary medicine team, liver team, and renal team, given that patient has multiple organ system failure. these are documented in chart and omr. despite these conversations, patient confirmed his full code status. . # dispo: discharged to rehab with 3x/week hd and prn paracentesis medications on admission: dilaudid 1mg po q3h prn arm pain (switched from fentanyl ) meropenem 500mg iv q24h on hd days (to be continued 7 days after last foley pulled) lidocaine patch 2 to left arm, 2 to lower back midodrine 5mg po tid rifaximin 400mg po tid lactulose 30ml po tid 81 mg po daily sodium chloride nasal spray insulin ss clopidogrel 75mg po daily heparin sc tid glucagon prn nephrocaps 1 cap daily simvastatin 40mg po daily discharge medications: 1. shrinker sig: one (1) once a day: 2 elastic shrinkers for l aka and 2 elastic shinkers for r bka. . disp:*2 * refills:*2* 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: two (2) adhesive patch, medicated topical daily (daily). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): sliding scale. 8. sodium chloride 0.65 % aerosol, spray sig: sprays nasal daily (daily) as needed for dry nares. 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 11. bacitracin-polymyxin b ointment sig: one (1) appl topical daily (daily). 12. midodrine 5 mg tablet sig: one (1) tablet po please give 30min prior to hd (). 13. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed) as needed for catheterization. 14. lactulose 10 gram/15 ml syrup sig: 15-30 mls po bid (2 times a day) as needed for constipation. 15. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 16. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 19. morphine 2 mg/ml syringe sig: 1-2 mg injection every hours as needed for flank pain. 20. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 21. hydromorphone 2 mg tablet sig: 0.5-1 tablet po q3h (every 3 hours) as needed for arm pain. 22. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 23. procrit 40,000 unit/ml solution sig: one (1) injection once a week. 24. hd protocol albumin 25% (12.5g / 50ml) 25 g iv. please give with dialysis in morning. discharge disposition: extended care facility: medical center - discharge diagnosis: 1) non-st elevation myocardial infarction 2) acute on chronic systolic congestive heart failure 3) end stage liver disease 4) end stage renal disease 5) spontaneous bacterial peritonitis 6) hypercarbic respiratory failure 7) cardiac arrest 8) stage ii decubitus ulcer 9) urosepticemia discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: out of bed with assistance to chair or wheelchair discharge instructions: it was a pleasure to take care of you here at . you were admitted for a bypass procedure for the arteries in your arm. unfortunately, you developed a heart attack after the procedure and had 3 cardiac arrests. you also developed an infection of the abdomen, which lead to respiratory failure only relieved by tapping the fluid from your belly. you were suffering from multisystem organ failure including your heart, liver, kidneys, and vascular system that was progressing. fortunately, you remained stable and were able to go to a rehabiliation facility. . your medications are listed on the discharge plan. . please seek medical attention for fevers, chest pain, abdominal pain, increasing fluid/volume build-up not relieved by dialysis and paracentesis, shortness of breath, or any other concerns. followup instructions: you should follow up with your new pcp, , md () within 1-2 weeks. . we have scheduled an appointment for you with your hepatologist, dr. . please attend this appointment as directed: dr. 2:30 medical specialties on fax . you have an appointment with the vascular team. provider vascular lab phone: date/time: 10:00 . provider , md phone: date/time: 10:30 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis other (peripheral) vascular shunt or bypass percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization aortography arteriography of other specified sites diagnoses: acidosis anemia in chronic kidney disease end stage renal disease renal dialysis status subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma severe sepsis cardiac complications, not elsewhere classified peripheral vascular disease, unspecified acute respiratory failure other specified cardiac dysrhythmias cardiac arrest disorders of phosphorus metabolism surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction pressure ulcer, lower back other sequelae of chronic liver disease other septicemia due to gram-negative organisms other ascites diarrhea kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure ventilator associated pneumonia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with gangrene diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status hypotension of hemodialysis umbilical hernia without mention of obstruction or gangrene above knee amputation status dependence on respirator, status pressure ulcer, stage ii diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled spontaneous bacterial peritonitis chronic ulcer of other specified sites shock, unspecified unspecified osteomyelitis, hand 

Answer: The patient is high likely exposed to