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: meperidine / oxycodone attending: chief complaint: subarachnoid hemorrhage major surgical or invasive procedure: : r evd placement : cerebral angiogram with partial coiling of r mca : cerebral angiogram with interarterial verapamil to l aca/r ica : cerebral angigram with interarterial verapamil to r mca : l evd placement : l evd catheter exchange : r frontal evd placement : trach placement : peg placement : left vp shunt placement history of present illness: this is a 60 year old female history of htn who woke up this am with acute onset severe headache. her son, , reports that at about noon, pt became more confused around the house. she also had vomited. pt was taken to in where a head ct showed a right ich with sah within the cisterns and right sylvian fissure suspicious for r mca rupture. pt transferred to for further management. past medical history: htn psh: hysterectomy social history: lives with son in . 20-pack year smoking habit. rare etoh, no illicit drug use. family history: non-contributory physical exam: on admission: physical exam: hunt and : 3 : 4 gcs 13 e: 4 v: 5 motor:5 o: t: 97.2 hr 53 140-190/70-90s rr 16 98% ra gen: wd/wn, combative and confused --> intubated/sedated heent: atraumatic, normocephalic, eyes clear, nasal passages patent, oropharynx pink without exudate pupils: perrl eoms - full neck: supple. lungs: cta bilaterally, no murmurs. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. no c/c/e. neuro: gcs 13 then intubated/sedated pupils are bilaterally, + gag, + corneals moving all extremities equally reflexes: b t br pa ac right 2+ --------- left 2+ --------- on discharge: eo spont, interactive, smiling, perrl, eom intact, rue purposeful, lue hand movements, ble spont/withdraws. + commands: thumbs up, two fingers on rue; squeezes hand lightly on lue; wiggles toes. patient has history of intermittently not following commands. pertinent results: cta head/neck : impression: extensive sah centered in the right sylvian fissure. no large vascular territorial infarction. no hydrocephalus or shift of the midline structures. there is a 3.5 mm aneurysm at the junction of right m1/m2 segments. bilobed/irregular appearance of the aneurysm, likely due to rupture. head ct : impression: 1. large subarachnoid hemorrhage, predominantly layering in the sylvian fissure, basal cisterns and right hemispheric sulci. 2. stable intraventricular extension of blood. mild interval decrease in the ventricular size, status post placement of an evd. 3. diffuse cerebral edema. head ct : impression: highly limited exam due to head motion. allowing for such overall stable distribution and extent of large subarachnoid hemorrhage, right temporal intra-axial hematoma, and intraventricular extension of blood into occipital horns and third ventricle. status post right frontal approach catheter, with a decreased caliber of ventricular system as compared to one day prior. no evidence of new hemorrhage. head cta/ctp : impression: 1. unchanged right frontal intraparenchymal hemorrhage with bilateral subarachnoid hemorrhage. 2. interval diminution of the right a1 segment of the anterior cerebral artery and both a2 segments of the anterior cerebral arteries as well as the m3/m4 segments of the right mca consistent with vasospasm. head ct : impression: 1. vasogenic edema around a right frontal intraparenchymal hemorrhage is essentially unchanged; however, this limits evaluation for underlying infarct. if this continues to be a clinical concern, an mri may be obtained for further evaluation. 2. redistribution of known subarachnoid and intraventricular hemorrhage with no significant change. lower extremity dopplers : no evidence of deep venous thrombosis in bilateral lower extremities. ct/cta head : 1. increased mass effect on the right lateral ventricle secondary to increased edema around the sylvian fissure hematoma compared to the prior ct of with a new infarct in the right occipital lobe in the posterior cerebral artery territory. 2. improvement in vasospasm since the previous cta examination echo : the left atrium is elongated. the estimated right atrial pressure is 0-5 mmhg. the estimated right atrial pressure is 0-10mmhg (patient may be volume depleted). there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. ct/cta head : impression: 1. unchanged right temporal parenchymal hematoma and bilateral sulcal subarachnoid hemorrhage since . 2. partial reexpansion of the frontal of the right lateral ventricle, with continued effacement of its other components. 3. the right ventriculostomy catheter tip now terminates in the body of the right lateral ventricle abutting the septum pellucidum, as opposed to the left frontal on the prior study. the left lateral ventricle is stable in size. 4. no change in the caliber of intracranial arteries in comparison to . no evidence of new vasospasm. ct head : impression: 1. replacement of previously visualized right frontal ventriculostomy catheter with a new left frontal ventriculostomy catheter with the catheter tip terminating in the third ventricle. clinical correlation is recommended. 2. continued partial re-expansion of the frontal of the right lateral ventricle with effacement of the other components of the right lateral ventricle. 3. unchanged right temporal parenchymal hematoma and bilateral subarachnoid hemorrhage. ct/cta head : overall, minimal change from the comparison study with no arterial caliber change to suggest vasospasm and unchanged parenchymal hematoma in the right temporal lobe. the ventriculostomy catheter has been replaced, now positioned via a left frontal approach. ct head : 1. overall, minimal change in comparison to prior study. continued visualization of the right temporal parenchymal hemorrhage with stable adjacent mass effect. 2. left frontal ventriculostomy catheter with the catheter tip terminating in the third ventricle. ct head : ct perfusion demonstrates abnormal perfusion in the right > left temporal lobe, right occipital lobe and left parietal lobe, which could be related to vasospasm. ct head : impression: 1. multifocal strokes including the bilateral cerebellar hemispheres, the right occipital hemisphere. there is no new mass effect. 2. left frontal approach ventriculostomy catheter remains in place with its tip in the region of the foramen of . 3. right temporoparietal hematoma adjacent to a coil mass is becoming progressively hypodense over time as expected. there is no new hemorrhage. cta head : worsening vasospasm in bilateral vertebral and right a1 arteries. persistent vasospasm noted in bilateral a2 branches. again seen are multiple infarcts with evolution of the left cerebellar infarct. head ct : ventriculostomy catheter in unchanged position with tip terminating within the third ventricle. unchanged ventricular system size. continued interval increase in intraventricular hemorrhage extending left greater than right, now extending to involve the entire left occipital and the left lateral ventricle. continued evolution of multifocal infarction including bilateral cerebellar infarcts. echo : focused saline contrast study. no thrombus/mass is seen in the body of the left atrium. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. lue ultrasound : impression: no evidence of deep vein thrombosis seen within the veins of the left arm. note is made of a flattened waveform in the left subclavian vein which could suggest the presence of a more centrally located thrombus. ble ultrasound : no dvts noted ct head : impression: 1. ventriculostomy catheter in unchanged position with its tip terminating within the third ventricle. 2. however, there has been significant short-interval dilatation of the ventricular chain, including marked enlargement of the fourth ventricle. for example, the third ventricle has increased from 3 mm to 7 mm in maximal transverse dimension. findings are consistent with the clinical impression of evd malfunction. 3. continued evolution of multifocal infarction. ct head: 1. new right frontal approach ventriculostomy catheter with tip terminating within the medial aspect of the frontal of the right lateral ventricle. 2. mildly increased ventricular system size since the most recent examination. continued increased clot burden within the ventricles with new clot demonstrated within the third ventricle, surrounding the prior catheter at the foramen of , and extending along the entire left lateral ventricle. 3. continued evolution of multifocal infarction involving the bilateral cerebellar hemispheres and a right pca territorial distribution. 4. continued evolution of right parenchymal hemorrhage with no new foci of hemorrhage. eeg: impression: this is an abnormal continuous icu monitoring study because of moderate diffuse background slowing, frontal intermittent rhythmic delta activity, and attenuation of faster frequencies with more severe focal slowing over the right hemisphere. the findings are indicative of a moderate diffuse encephalopathy, which is etiologically nonspecific. the right hemisphere shows slower activity than the left, indicative of superimposed right hemispheric dysfunction. compared to the prior continuous recording on , there was mild increase in left hemisphere slow activity but improvement in background over the right hemisphere. there were no electrographic seizures. eeg: impression: this is an abnormal continuous icu monitoring study because of moderate diffuse background slowing, frontal intermittent rhythmic delta activity, and attenuation of faster frequencies with more severe focal slowing over the right hemisphere. the findings are indicative of a moderate diffuse encephalopathy, which is etiologically nonspecific. the right hemisphere shows slower activity than the left, indicative of superimposed right hemispheric dysfunction. compared to the prior days recording, the periods of frontal intermittent rhythmic delta activity are more prominent, suggesting worsening diffuse encephalopathy, midline structural lesion, hydrocephalus, or increased intracranial pressure. eeg: impression: this is an abnormal continuous icu monitoring study because of moderate diffuse background slowing, frontal intermittent rhythmic delta activity, and attenuation of faster frequencies with more severe focal slowing over the right hemisphere. after 8:20 am, the background shows sudden deterioration with severe diffuse slowing and attenuation of faster frequencies. these changes could be secondary a diffuse insult or to medication effect. compared to the prior days recording, background activity became slower at the end of the recording, suggesting worsening cerebral dysfunction or medication effect. no electrographic seizures were present. cxr: heart size is normal. mediastinum is normal. lungs are clear with resolution of previously demonstrated vascular engorgement. no appreciable pleural effusion or pneumothorax is noted. ct head: impression: 1. blood clot around the tip of the right frontal intraventricular catheter within the frontal of the right lateral ventricle, and increased blood in the right occipital . enlargement of the right lateral ventricle. new parenchymal hemorrhage along the right frontal course of the catheter with surrounding edema. 2. decreased blood in the left lateral and third ventricle. unchanged blood in the fourth ventricle. 3. continued evolution of right temporal parenchymal hemorrhage. 4. recent bilateral cerebellar hemispheric infarcts are again noted. ct brain findings: there is interval decrease in the size of a right temporal lobe parenchymal hematoma and bilateral occipital intraventricular hemorrhage. a left frontal approach ventriculostomy catheter terminates appropriately in the region of the foramen of . a right frontal parenchymal hemorrhage is unchanged compared to the prior examination. no new focus of hemorrhage are noted. there is a coil-pack in the region of the right mca with associated artifact. there is right posterior ethmoidal air cell fluid-opacification, unchanged. impression: 1. decrease in the extent of intraventricular and right temporal parenchymal hemorrhage. 2. unchanged right frontal parenchymal hemorrhage. 3. evolving bilateral cerebellar infarcts, with no finding to suggest new infarction. lenis : findings: grayscale, color and doppler images were obtained of bilateral common femoral, superficial femoral, popliteal and tibial veins. normal flow, compression, and augmentation is seen in all of the vessels. impression: no evidence of deep vein thrombosis in either leg. head ct: impression: 1. conversion to a vp shunt from a left frontal approach with stable appearance of ventricles and redistribution of intraventricular hemorrhage in the bilateral occipital horns. 2. unchanged right frontal intraparenchymal hemorrhage with surrounding vasogenic edema. 3. right mca coils. 4. unchanged evolving bilateral cerebellar infarcts. head ct: 1. no new hemorrhage or infarct. 2. left frontal approach ventricular shunt catheter terminating in the frontal of the left lateral ventricle, unchanged in position from prior study. 3. hydrocephalus, interval decrease in vent size. 4. right frontal lobe intraparenchymal hematoma, slightly decreased in size from prior study. 5. area of hypodensity in the right temporal lobe, representing evolution of prior intraparenchymal hemorrhage in that area. coil pack in the right mca with artifact at that level. brief hospital course: 60f admitted with an aneurysmal sah. initial exam was stable but patient's exam became more concerning and a evd was placed in the er as well as being intubated. she was then transported to the neuro icu where she was closely monitored. nimodipine was started and her sbp was kept < 140. early she was taken to angiogram for coiling. her aneurysm was only partially coiled as any additional coils would not stay in place. as the dome of the aneurysm was secured, immediate risk of rerupture was eliminated. patient was angiosealed and sent back to the icu. a repeat head ct was done which was stable, some mild hydrocephalus was noted but evd had been placed earlier with exam change. the evd was then dropped to 15. blood pressure recommendations were 90-160. nicardipine was started. eeg was ordered per sah protocol. post-angio exam was stable with no worsening. a central line and alsius catheter was placed for potential cooling needs. she was extubated on and required some sedation due to aggitation. she was not following commands on the left side so a head ct was obtained. this was stable and the following am her exam was greatly improved. her dilantin level was nontherapeutic and she was bolused. on , a bedside speech and swallow evaluation was done which she passed and she placed on a regular diet. there was some concern for aspiration so a formal evaluation was done on . her diet was modified to purees and thin liquids. she was febrile to 101.7 and a fever work-up was initiated. a cxr showed an area concerning for aspiration but had remained stable from previous imaging, so no antibiotics were initiated. tcds on and were relatively normal. there was some slower velocities on the bilateral mcas but this could be due to limited temporal windows. on , her exam remained stable. her dilantin level was 10.8 with a normal albumin level. on eve patient was noted to have a new left sided weakness, a head cta/ctp was done which showed some moderate vasospasm. her sbp was driven to 180-200 with good effect some improvement was noted to her motor exam. she remained oriented. she was also febrile and csf was sent. on , she underwent a cerebral angiogram for interarterial verapamil. she received 15mg to the l aca and 10 mg to the r ica. she had some moderate spasm distally and this was concerning so the sheath was kept in place for a repeat angio the next morning. post-angio, she had a head ct to evaluate for a r mca infarct which was negative. post-angio she was monitored closely and kept intubated as she was to return to angio the next morning. post-angio exam was stable, she was briskly localizing with her lue and then would move to command. her sbp was driven to 200-220 if able, but 180-200 was acceptable. repeat csf was sent for a fever. sputum cultures were ordered. on she went to angiogram to re-evaluate the spasm and it appeared improved. verapamil 10 mg was injected into the r mca. the aca and ica appeared improved from yesterday. the sheath was removed and pressure was held. the patient returned to the icu with a sbp goal of 180-220 (favoring 200-220). our plan was to extubate and monitor her exam closely. on post-angio exam she was stable. the alsius cath was removed. she was extubated on . post-extubation, she received 500 cc fluid bolus after neo gtt maxed to get sbp >180 goal. on , she required multiple fluid boluses to keep her sbp > 180. she was placed on a second - vasopressin and phenylephrine at max doses. her sbp parameters were lowered to 150-200 without incident. we also liberalized her neuro checks to q 3hrs to promote rest and reduce the risk for delerium. keppra 500mg was started and dilantin to wean off. screening lenis were done which were negative. she was febrile again on and csf was sent, gram stain was negative. on a ct/cta of the head was obtained and this did show improvement in her vasospasm. ct head showed a right occipital infarct. on physical exam she was noted to have a left hemianopsia. her sbp were kept in the range of 150-200 and did require the help of pressors. on she was seen and doing well, her evd was raised to 20cm above the tragus and she had no episodes of increased icp. she was febrile and csf was sent which was positive for gram negative rods. on , early morning csf was resent to confirm previous gram stain, and vancomycin and cefepime was started. id was consulted. the patient again developed left sided hemiparesis, a cta was performed that didn't show any evidence of spasm or stroke. the evd was clamped but her icp rose to 25 and she was re-opened. given the findings of meningitis with gram negative rods growing in her csf, we removed the right frontal evd on and placed a new evd on the left. csf culture grew back acinetobacter baumannii and her blood culture from had gram negative rods. id recommended vancomycin, tobramycin, and meropenem. overnight, she again was not following commands on the left. a ct/cta was done which was stable. her sbp was driven to 200. she also had some aflutter and tachycardia which could have been from electrolyte imbalance, her k was repleted. on am her exam was improved from the night prior. we allowed her sbp to return to 150-200. her evd remains at 20cm. overnight they noted a new rash on her back that appeared to be zoster. early , the evd was not draining as well, the drain was flushed distally but did not improve the drain so a head ct was done to confirm cath tip placement. the ct showed the cath terminated in the third ventricle as before. we pulled back the evd about 1-2cm and the evd was functioning. later in the afternoon, she appeared more somnolent but her exam remained within her usual wax/wane pattern, but her icp rose to 30. tcd was negative for mca vasospasm. a stat head ct/ctp was ordered, this showed general hypoperfusion. a po2 and pco2 was checked. although her pco2 was 30, her po2 was low. she was intubated for airway protection. we also increased her keppra to 1000 mg as a precaution for seizure as she is on meropenem which can lower the seizure threshold. on she was awake and following commands with the upper extrmities. csf was sent for surveillance per id recommendations. on , her icps again rose to the mid 30's, a ct/cta was done which showed bilateral cerebellar infarcts. the evd cath tip was terminating in the foramen of and was pulled back 1cm. stroke was consulted. tpa was flushed x1 with good effect. icps returned to . her sbp was liberalized to 115 and attempting to wean her off the neo gtt. in the evening, her urine na was 68 and osm 215. overnight, her evd continued to drain on and off. she was flushed distally multiple times. her exam became more somnolent but noted to be febrile. her sbp was driven up to 180 and her exam improved. on , her evd stopped draining again at 4:30, she received tpa at 6am. on reassessment at 07:30, her drain was draining at 0cm and below. her exam was stable and her sbp was liberalized to 115-200. she had a echo which showed an ef > 55%. in the afternoon, her icp waveform dampened and her icp was 30. her exam remained unchanged. after multiple attempts to improve this, we changed out her evd catheter as we suspected it was clogged. a repeat head ct showed proper placement of the evd catheter, it was noted she had some increase in ivh. her exam remained unchanged. on , she was off her pressors and her evd was raised from 0 to 15cm. she had a lue ultrasound to rule out infectious phlebitis. this was negative for dvt but did demonstrate a dampened waveform suggestive of a more proximal thrombus. the icu attending was asked to weigh in on this. their plan was to nothing as the dampened waveform is most likely from her left subclanian line and no definitive thrombus was seen. her lines were changed out per id recommendations as her blood cultures remained positive. tips were sent for culture. a new r subclavian was placed. stroke neurology recs for mri and asa are on hold at this time pending possible extubation and possible need for vps if she fails clamping trial on her evd. on , she was febrile and recultured but no csf was sent. she received a 750cc bolus from the previous night for low bp. her evd stopped draining and she received 1mg of tpa through her evd with little improvement around 1pm. she then again received 2mg at 4:30pm with improvement. evd was kept at 0 with adequate output and patient's exam was improved. her hct was noted to be 23 and patient appeared symptomatic with an elevated hr and low bp. she recieved two units of prbc and her hr and bp improved. her tobramycin dose was also increased according to id recommendations/tobramycin levels. early , her evd began to drain sluggishly and her waveform was absent. she was distally flushed and her transducer was flushed. although her evd began draining but only when dropped down to the floor, her waveform remained absent. surveillance csf was sent. 2mg of tpa was flushed at 03:30 am and the drain had not put out any csf. a new evd was placed on the right on which functioned well. we administered 2mg of tpa on the left and it also started to drain. the patient was noted to have a focal motor seizure charecterized by mouth twitching, for confirmation and monitoring the patient was placed on a 24 hour eeg and her keppra was increased to 1500 mg . she continued to improve with bilateral drainage. she continued to require mechanical ventillation. family wanted to wait over the weekend to see if she could wean off the ventillation. on , her left evd was clamped but a few hours later her exam was noted to be more lethargic so it was reopened with return to baseline exam. id increased her dose of vancomycin according to her level. as csf cultures cleared the vancomycin was d/c'd on . tpa was used intrathecal periodically to assist in the clearance of the intraventricular hemorrhage from through . on , the r evd was not functioning and a ct head was performed which showed a new clot around the evd catheter. on , the r evd was discontinued as it continued to not function. on , she underwent a trach and peg placement without any difficulty. her exam remained unchanged. on , she continued on the vent with the goal to wean down to trach mask. she appeared more lethargic but stable. on , she underwent a head ct which remained stable. there was no acute findings that could account for her lethargy. on , she remained lethargic and her evd was dropped to 5cm and csf was sent. on , her exam improved and we continued a weaning trial of the ventilator. leni's were negtaive for dvt. her evd was raised to 15. on , she went to the or for a vp shunt placement. she remained stable post opertively and was able to tolerate some trach mask trials on the 29th. the icu team will continue to wean her vent. on , she was febrile and required the vent again. she was pancultured but no source noted. on , she again was febrile and lfts were sent which were not impressive. on , early am she became suddenly hypotensive and her exam worsened, she was given a small dose of neo and her bp came up and her exam improved. she was not febrile at that time. during the day she appeared brighter and no further issues were had. on , she remained bright and following commands. a repeat head ct was done for follow-up. her ct showed interval decrease in her vent size. her hct remained low at 25.4 but asymptomatic. given her improved clinical exam it was decided to persue further treatment of the aneurysm at a later time. she was discharged on to rehab. medications on admission: unknown antihypertensive discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 2. senna 8.8 mg/5 ml syrup sig: 1-2 tablets po daily (daily). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. potassium chloride 20 meq packet sig: packets po prn (as needed) as needed for low k. 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 6. potassium & sodium phosphates 280-160-250 mg powder in packet sig: one (1) powder in packet po tid (3 times a day). 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 8. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for groin rash. 11. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 12. ibuprofen 100 mg/5 ml suspension sig: 400-800 mg po q8h (every 8 hours) as needed for fever. 13. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for fever. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: subarachnoid hemorrhage r mca aneurysm (ruptured) r intercerebral hemorrhage hydrocephalus intraventricular hemorrhage hypertension cerebral edema failed airway (requiring intubation) fever vasospasm meningitis hypokalemia aflutter bilateral occipital infarcts cerebellar infarcts intracranial hypertension sepsis respiratory failure herpes zoster anemia oral thrush discharge condition: mental status: confused - always. level of consciousness: alert and interactive with periods of lethargy. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: angiogram with embolization and/or stent placement medications: ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort. ?????? no heavy lifting, pushing or pulling (greater than 10 lbs) ???????????? keep incision dry until staples/sutures are out. what to report to office: ?????? changes in vision (loss of vision, blurring, double vision, half vision) ?????? slurring of speech or difficulty finding correct words to use ?????? severe headache or worsening headache not controlled by pain medication ?????? a sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? trouble swallowing, breathing, or talking ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site *sudden, severe bleeding or swelling (groin puncture site) lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call our office. if bleeding does not stop, call 911 for transfer to closest emergency room! followup instructions: please follow-up with dr in 4 weeks for a follow-up, no imaging is required for this appointment. at this appointment we will discuss repeating a cerebral angiogram for treatment planning. please call to make this appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube other bronchoscopy laparoscopy percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries arteriography of cerebral arteries arteriography of cerebral arteries injection or infusion of other therapeutic or prophylactic substance injection or infusion of other therapeutic or prophylactic substance ventricular shunt to abdominal cavity and organs intravascular imaging of intrathoracic vessels intravascular imaging of intrathoracic vessels arterial catheterization temporary tracheostomy endovascular embolization or occlusion of vessel(s) of head or neck using bare coils diagnoses: other iatrogenic hypotension anemia, unspecified obstructive hydrocephalus tobacco use disorder unspecified essential hypertension unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia other convulsions subarachnoid hemorrhage atrial flutter sepsis candidiasis of mouth intracerebral hemorrhage hypopotassemia acute respiratory failure alkalosis cerebral edema mechanical complication due to other implant and internal device, not elsewhere classified other septicemia due to gram-negative organisms other and unspecified special symptoms or syndromes, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation encephalopathy, unspecified hyperosmolality and/or hypernatremia cerebral artery occlusion, unspecified with cerebral infarction tachycardia, unspecified hemiplegia, unspecified, affecting unspecified side other alteration of consciousness apnea homonymous bilateral field defects herpes zoster without mention of complication meningitis due to gram-negative bacteria, not elsewhere classified 

Answer: The patient is high likely exposed to