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: no known allergies / adverse drug reactions attending: chief complaint: s/p motor vehicle crash major surgical or invasive procedure: open reduction left ankle fracture, open reduction left hip fracture with tfn nail history of present illness: 62m transferred from s/p mvc. pt was restrained driver involved in head on collision with +loc and +head strike. he was biba boarded and collared to the osh where trauma series demonstrated multiple rib fractures. he received 1u prbc and 1u ffp at the osh. he was then transferred to for further evaluation. at this time, pt endorses pain in his right chest, worse with respirations. he also c/o pain in his left hip and left ankle, exacerbated by motion. he denies numbness/tingling distally, and pain elsewhere in his extremities. past medical history: afib on coumadin, htn. s/p bilateral tka in , appendectomy. social history: lives with wife family history: noncontributory physical exam: physical examination: upon admission temp: 96 hr: 122 bp: 170/p resp: 23 o(2)sat: 97 normal constitutional: comfortable heent: normocephalic, atraumatic, pupils equal, round and reactive to light, extraocular muscles intact oropharynx within normal limits chest: clear to auscultation, ttp r chest cardiovascular: regular rate and rhythm, normal first and second heart sounds abdominal: soft, nontender, nondistended gu/flank: no costovertebral angle tenderness extr/back: no cyanosis, clubbing or edema except lle with ecchymosis/edema prox femur, distal nvi bilaterally, soft compartments skin: no rash, warm and dry neuro: speech fluent, mae, strength/sensation symmetric psych: normal mood, normal mentation heme//: no petechiae . physical examination upon discharge: vital signs: t=98.2, bp=116/81, hr=85, resp. rate 18, oxygen sat 96% room air general: nad, conversant, pleasant cv: irreg, ns1, s2, -s 3, -s4 lungs: clear abdomen: soft, non-tender ext: scab right knee, blesdoe brace left leg, edematous left knee and left ankle, + dp bil., no calf tenderness right knee mentation: alert and oriented x 3, speech clear, no tremors. pertinent results: 11:15pm glucose-261* urea n-30* creat-1.2 sodium-138 potassium-4.0 chloride-99 total co2-23 anion gap-20 11:15pm lipase-103* 11:15pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:15pm wbc-13.9* rbc-4.28* hgb-13.7* hct-38.4* mcv-90 mch-32.0 mchc-35.7* rdw-13.6 11:15pm neuts-80* bands-2 lymphs-5* monos-8 eos-0 basos-0 atyps-0 metas-3* myelos-2* 11:15pm plt smr-normal plt count-193 11:15pm pt-21.2* ptt-30.6 inr(pt)-2.0* 11:15pm fibrinoge-284 basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 05:23 13.7*1 1.3* pituitary tsh 09:05 3.0 . cxr: subcutaneous emphysema, right pneuomthorax cxr: no evident pneumothorax. small-to-mild left pleural effusion is unchanged with unchanged adjacent atelectasis. right lower lobe opacities have increased, could be due to atelectasis or pneumoni. pulmonary edema has minimally increased. subcutaneous emphysema has decreased. increase in widened mediastinum could be just due to positioning or rotation. echo: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function (lvef >55%). mild mitral regurgitation with normal valve morphology. mild pulmonary artery hypertension. no effusion. cxr as compared to the previous radiograph, there is no relevant change. bilateral basal parenchymal opacities. small bilateral pleural effusions, slightly more extensive on the left than on the right. at the right lung bases, in the region of the known displaced rib fractures, there are subtle parenchymal opacities that might represent areas of lung contusion. minimal fluid overload. borderline size of the cardiac silhouette. unchanged position and course of the picc line r knee film status post total knee replacement. the prosthetic parts are in correct position. there is no evidence of fracture, luxation or displacement. periarticular calcifications. no cortical damage. brief hospital course: he was admitted to the acute care surgery team. patient subsequently admitted to the trauma sicu. orthopedics consultation was imediately obtained based on his injuries. . neuro: pain control initially with iv narcotics. he was intubated/sedated for ortho procedure . postop manifested clinical instability requiring continued vent dependence. patient became agitated following sbt requiring haldol for sedation. dilaudid was instituted for longer acting pain control. this was used in conjunction with propofol gtt. low dose seroquel was added with poor effect and prn haldol was continued. patient was severely agitated pulling out lines. haldol required to improve sedation. extubated . persistently agitated/delirious. night of patient found having gotten out of bed on floor. given delirium was uncertain as to circumstances of being out of bed. haldol started on standing basis for continued delirium . delirium improved with floor transfer as patient became more oriented though still with intermittent agitation at night. seroquel at bedtime was ordered. other causes of his delirium were worked up to include blood cultures, urine and chemistries. psychiatry consult was placed. their recommendations were to d/c benzo's, seroquel, and round the clock haldol. after 24 hours, his mental status improved and he did not exhibit signs of delirium. because of his injuries and to rule out any neurological event, he underwent a head mri which was normal and did not show signs or hemorrhage. . cv: on arrival, the patient was stable from a cardiovascular standpoint. following or w orthopedics , patient demonstrated elevated lactate up to 5.8, oliguria, hypotension to high 80's sbp. this showed mild to moderate improvement with 4l ivf/albumin. cardiac enzymes sent which were negative. left subclavian and rt a line placed. patient responded well following this. patient manifested afib w/rvr to hr of 160s. given lopressor iv x 2 and diltiazem iv x 1 push with minimal response. diltiazem gtt started. pt had associated hypotension w tachycardia and was started on neo gtt w appropriate bp response. pressors and dilt gtt weaned . tte showed preserved lv fxn. afib w rvr returned and dilt gtt was resumed. diltiazem gtt was again weaned in favor of lopressor po. this was up-titrated but with refractory hypertension. digoxin started for supplemental rate control and tachycardia improved. . pulmonary: post-procedure patient had shock physiology as above. in this setting, patient developed subcutaneous emphysema, right pneumothorax; right 32f chest tube placed to suction; changed to pulmonary protective vent settings (ards). ventilation continued with minimal improvemetn . pt found to have thick secretions in setting of likely ards on bronchoscopy. bal was sent with gram stain showing 4+pmns, no orgs. started on empiric vap coverage (see id). vent was weaned over ensuing days and patient extubated . pulmonary toilet including incentive spirometry and early ambulation were then encouraged. serial cxrs obtained and showed interval improvement. his oxygen saturations on room air have remained stable. . gi/gu: on admission patient made npo w ivf hydration. given persistent intubation following or, enteral access obtained and tube feeds initiated. advanced to goal and tolerated well. patient showed high residuals (300s) and feeds were held initially. reglan was started for bowel motility . following extubation, his diet was advanced as tolerated which was tolerated well. he was also started on a bowel regimen to encourage bowel movement. . foley placed at osh. patient initially presented with cr 1.2. bumped to 1.6 . this improved with iv hydration; returned to 1.0 on . was bolused crystalloid ivf w good effect for oliguria. patient diuresed prn while in icu with lasix. lasix drip started to further facilitate diuresis. drip down-titrated with intermittent bolus for net negative fluid balance . patient stabilized on 40mg daily (home dose 20mg). foley d/c'd and patient voided appropriately. intake and output were closely monitored. . id: patient was covered with ancef periop for ortho procedures. as patient had refractory vent dependence bronchoscopies performed as above (see pulm). vancomycin/zosyn started empirically for vap. bal cx followed. aintibiotics were discontinued with all cultures negative. the patient's temperature was closely watched for signs of infection. . msk: pt sustained orthopedic injuries as above. underwent orif of a left intertrochanteric hip fracture with intramedullary nail, as well as open reduction, internal fixation of a left bimalleolar ankle fracture without complication on . please see operative report for full details. he was made touchdown weight-bearing on his lle in an unlocked with rom as tolerated. of note he was found down in room of icu in setting delirium with complaint of right knee pain; knee films were ordered and were negative. . heme: trauma labs sent off at admission w admit hct 38 and inr 2.0. transfused 2 ffp for inr correction . hct trended down over subsequent days likely from combination hemodilution/blood loss secondary to orthopedic injuries. xfused 2units prbc w marginal improvement 21->25. heparin sq started when hct stable. platelets decreased to 68 from yesterday. hit panel was sent and shown to be negative. heparin gtt started and titrated to goal ptt 60-80. coumadin resumed with inr checked daily. the heaprin drip was stopped on hd #15 and lovenox was started as a bridge to coumadin. once his inr reaches goal of 2.0-3.0 the lovenox can be stopped. . ophtho: patient with hisotry of macular degeneration and was noted with "floater" in right eye on and ophtho consult obtained. no acute issues were identified. follow up with ophtho as an outpatient after discharge from rehab. . he was transferred to the surgical floor on . his vital signs have been stable and he has been afebrile. he is tolerating a regular diet. his white blood cell count is 5 and his hematocrit is stable at 31. he has been started on coumadin with lovenox bridging. his current inr is 1.3. because of his injuries, he was evaluated by physcial therapy who made recommendations for discharge to an extended care facility where he can regain his strength and mobility. medications on admission: - coumadin 5mg qday - losartan 100mg qod - lasix 20mg qday - lopressor er 100mg qday - amlodipine 2.5mg qday discharge medications: 1. colace 100 mg capsule sig: one (1) capsule po twice a day. 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 6. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 7. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 8. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po qid (4 times a day): hold for sbp<100 and hr<60 . 9. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 10. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 11. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). 12. losartan 50 mg tablet sig: two (2) tablet po every other day (every other day). 13. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 14. dilaudid 2 mg tablet sig: 1-3 tablets po every four (4) hours as needed for pain. 15. enoxaparin 150 mg/ml syringe sig: one y (130) mg subcutaneous q12h (every 12 hours): indications: bridge for coumadin. discontinue once inr reaches goal range b/w 2.0-3.0. 16. haloperidol 2 mg tablet sig: one (1) tablet po bid (2 times a day): monitor qtc ( may wean to off when delirium resolved). 17. haloperidol 2 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation/hallucinations: may wean to off once delirium resolves. discharge disposition: extended care facility: rehab skilled nursing center - discharge diagnosis: s/p motor vehicle crash injuries: right rib fractures left femur fracture left bimalleoloar fractures left femoral condyle fracture ventilator associated pneumonia delirium discharge condition: mental status: clear and coherent w/ resolving delirium. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital after an automobile crash where you sustained multiple injuires which include rib fractures, fractures of the left leg and both ankles. you also developed pneumonia while in the icu which is resolving with treatment using antibiotics. * your rib fractures can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * you should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedating take half the dose and notify your physician. * pneumonia is a complication of rib fractures. in order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. this will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * you will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * symptomatic relief with ice packs or heating pads for short periods may ease the pain. * narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * do not smoke * if your doctor allows, non steroidal antiinflammatory drugs are very effective in controlling pain ( ie, ibuprofen, motrin, advil, aleve, naprosyn) but they have their own set of side effects so make sure your doctor approves. * return to the emergency room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs ( crepitus ). followup instructions: * department: orthopedics when: thursday at 10:40 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: thursday at 11:00 am with: , np building: campus: east best parking: garage department: general surgery/ when: thursday at 2:00 pm with: acute care clinic notes: you will need a chest x-ray prior to this appointment. please go to , clinical center, radiology 30 minutes prior to your appointment. building: lm bldg () campus: west best parking: garage procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus open reduction of fracture with internal fixation, tibia and fibula open reduction of fracture with internal fixation, femur closed reduction of fracture with internal fixation, femur diagnoses: thrombocytopenia, unspecified unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation unspecified fall alcohol abuse, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure closed fracture of sternum iatrogenic pneumothorax unspecified disorder of kidney and ureter macular degeneration (senile), unspecified morbid obesity long-term (current) use of anticoagulants surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation emphysema (subcutaneous) (surgical) resulting from procedure other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle ventilator associated pneumonia knee joint replacement delirium due to conditions classified elsewhere closed fracture of condyle, femoral contusion of lung without mention of open wound into thorax traumatic shock closed fracture of eight or more ribs closed fracture of intertrochanteric section of neck of femur acute respiratory failure following trauma and surgery other fluid overload bimalleolar fracture, closed body mass index 40.0-44.9, adult intracranial injury of other and unspecified nature without mention of open intracranial wound, with brief [less than one hour] loss of consciousness 

Answer: The patient is high likely exposed to