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: cardiac arrest major surgical or invasive procedure: placement of l tibial intraosseous line by ems intubation and mechanical ventilation by ems artic sun protocol eeg right ij placement r arterial line placement history of present illness: history of presenting illness: 23yom with dilated cardiomyopathy (reported ef 16%) s/p pacemaker placement and aicd at after previous cardiac arrest, reportedly with witnessed collapse and pea for initial rhythm, now with rosc after acls (received epinephrine x 3). intubated, not following commands per ed team. . per report, patient had been watching a rugby game with a friend, then began feeling tired, dropped to one knee. he then felt his heart was beating fast and collapsed. a friend started cpr, which police took over when they arrived on the scene. ems then took over acls and intubated him without medications. per their report, he was found to be in asystole (though device interrogation revealed vt). he received 3 rounds of epi and had spontaneous return of circulation by the time he reached the er. . in the ed, he was intubated and sedated with propofol, then switched to versed/fentanyl, as well as vecuronium 10mg for induction. he was started on norepinephrine 0.3mg peripherally for pressor support with blood pressures. initial abg on cmv/assist with fio2 100%, rr 20, tv 550, peep 5 was 7.30/32/395/16. lactate was 10. other remarkable labs: k=3.0, glu=190, hct=48.5, wbc=13.7, bun/cr=27/1.7, inr 1.2. cxr showed no acute pulm process, cardiomyopathy. ct head was deferred per cards attending given low risk. his access is a 16g and 18g piv and an i/o line. ep interrogated device, which showed he was in vtach at a rate of 180 (though icd not set to fire until rate>220). in er, not moving anything, intact gag with og tube, chewing on tube (not purposeful). pupils 3-->2mm. . unable to obtain ros due to intubation. past medical history: -idiopathic cm with ef 16% s/p vvir ppm ( ) -htn -dyslipidemia -dm -previous cardiac arrest social history: unable to obtain family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical exam vs: t=36c bp 162/94 hr=66 rr=22 o2 sat= 98% (40% o2) general: intubated, paralyzed heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: lungs were clear to auscultation b/l abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. cold, clammy. pulses: right: carotid 2+ femoral 2+ dp dopplerable pt 1+ left: carotid 2+ femoral 2+ dp dopplerable pt 1+ discharge physical exam 100.6 37.9c (100.2) p71 sbp's 100-113 rr19-24 99% on ac 50% peep 8 550 x22 intubated, alert, following commands. perrla, no scleral icterus r cvl in place rrr without murmurs, gallops lightly rhonchorous breath sounds abd soft nt nd no ble edema, l tibial io line has been removed skin cool, no worrisome lesions pertinent results: 10:10pm fibrinoge-233 10:10pm pt-14.0* ptt-22.6 inr(pt)-1.2* 10:10pm wbc-13.7* rbc-5.58 hgb-17.5 hct-48.5 mcv-87 mch-31.3 mchc-36.0* rdw-14.1 10:10pm plt count-219 10:10pm ctropnt-0.03* 10:10pm lipase-52 10:10pm urea n-27* creat-1.7* 10:22pm freeca-1.28 10:22pm hgb-17.6 calchct-53 o2 sat-83 carboxyhb-2 met hgb-0 10:22pm glucose-190* lactate-10.0* na+-137 k+-3.0* cl--92* tco2-19* 10:22pm ph-7.12* 11:23pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:23pm albumin-5.1 11:23pm ck-mb-14* 11:23pm lipase-42 11:23pm alt(sgpt)-51* ast(sgot)-47* ld(ldh)-251* alk phos-57 tot bili-0.7 11:23pm urea n-29* creat-1.7* . ekg : artifact is present. ectopic atrial rhythm. ventricular ectopy. left axis deviation. non-specific intraventricular conduction delay. st-t wave changes may be related to underlying left ventricular hypertrophy, although myocardial ischemia or myocardial infarction cannot be excluded. no previous tracing available for comparison. rate pr qrs qt/qtc p qrs t 77 / 22 . cxr ap : endotracheal tube is located above the level of the clavicles, 8.8 cm above the carina. orogastric tube is seen coursing into and terminating in the stomach. the lungs are clear without focal opacity, pleural effusion, or pneumothorax. low lung volumes limit assessment. cardiac size is enlarged with a globular configuration compatible with cardiomyopathy. cardiomediastinal silhouette is unremarkable. a single lead pacer defibrillator is seen projecting over the right ventricle. trauma board and other overlying structures limit assessment. . cxr ap : in comparison with the study of , the tip of the endotracheal tube measures approximately 6.5 cm above the carina. nasogastric tube extends to the distal stomach and icd device is in the region of the apex of right ventricle. substnatial enlargement of the cardiac silhouette persists. there appears to be some increasing fullness of pulmonary vessels as well as increased opacification at the bases suggestive of pleural effusions with compressive atelectasis. . 0300: wbc 23.6, rbc 6.49, hgb 19.6 hct 56.3 0155: wbc 17.8, rbc 5.66, hgb 17.3, hct 47.9 0800: wbc 8.9, rbc 5.6, hgb 17.3, hct 46.9 0155: pt 14.2, ptt 26.3, inr 1.2 1200: glu 121, bun 26, cre 0.7, na 138, k 4.1, cl 103, hco3 24 . : alt 58, ast 70, ldh 369, ck 253, alkphos 68, tbili 1.0 : alt 31, ast 39, alk phos 53, tbili 0.6 . : ck-mb 66, mb indx 41, ctrop 0.34 : ck-mb 59, mb indx 50.4, ctrop 0.28 . : lactate 10.0 : lactate 4.4 : lactate 1.3 . bcx x3 pnd ucx neg sputum cx and pnd brief hospital course: assessment and plan: . in brief, is a 23 yo with an idiopathic dilated cardiomyopathy (ef 16% per report) s/p icd placement and prior cooling protocol for cardiac arrest who had a witnessed collapse and pea with rosc after acls; pacer interrogation showed vtach degenerating to vfib; pt was resuscitated and initiated on cooling protocol in the ccu, now s/p rewarming with good neurologic recovery at present. . course has been complicated by brief episode of hyperkalemia with widening of qrs that responded well to medications; hypoxia, likely due to pulmonary edema that has responded well to iv lasix; bandemia with low concern for true infection however being empirically treated for ? rll aspiration; and currently with rising cr to 1.7. . by problem: . 1. cardiac arrest: patient was seen to have sudden collapse and had cpr initiated in the field. when ems arrived patient was intubated and monitor read as asystole (subsequently found to have vt leading to vfib on device interrogation), 3 rounds of epinephrine were administered with spontaneous return of circulation prior to arrival in the ed. unclear how long patient was down prior to return of circulation. in the ed patient was sedated with versed /fentanyl and paralyzed with vecuronium. patient was stared on norepinephrine drip, initial abg 7.30/32/395/16 on cmv/assist fio2 100%, rr 20, tv 550, peep 5. lactate on presentation was 10.0. cxr was unremarkable for an acute process. ct head was defered per cardiology attending. device interrogation in the ed demonstrated vtach at a rate of 180, device had previously been set not to fire until rate >220. patient did not have spontaneous movements of his limbs while in the ed and no purposeful movements. artic sun cooling protocol was begun in the ed. initially io access was achieved in the ed and changed to a right ij in the ccu, and the io was removed. . 2. therapeutic hypothermia: patient did not have purposeful movements and was unresponsive in the ed after rosc and was begun on the artic sun cooling protocol within 2 hours after arrest. patient was noted to have increasing episodes of bradycardia not responsive to increased pacing and rewarming was begun after 18 hours of therapeutic cooling per the cardiology attending. patient had episode of elevated temp while on the cooling protocol which was interpreted by the post-arrest team to be a sign of possible febrile response. blood, urine and sputum cultures were sent and the patient given iv tyelonol. patient's initial eeg's on hypothermic protocol did not show seizure or epileptic activity, burst supression was pressent throughout entire initial eeg. as patient was rewarmed eeg normalized with no pressence of seizures or ectopy. as of 1630 on hd2 patient had been rewarmed, weaned from sedation and was following simple commands such as squeeze my hand and mouthing words over the et tube. . 3. hypotn, concern for sepsis: pt with baseline low blood pressures ~sbp 90. on hd 2 during the late afternoon patient was noted to have increased cooling requirements on the artic sun (concerning for fever) with a rising lactate from 1.2->2.1->4.4. cultures were sent and cxr showed new rll opacity (aspiration pneumonitis vs pna, vap felt less likely) as well as increased cardiac sillouette. patient was started on vanc/zosyn/cipro on . cbc at that time showed a wbc of 7.7 with a new bandemia of 26%. patient's systloic pressures were seen to decrease from 100's to 80's with cvp drop from 14 to . fluid boluses were attempted in order to maintain cvp per rivers protocol, but due to family refusal were initially held. as cvp remained low and patient was started on levophed drip fluid boluses were given at 250 cc increments out of concern for patient's low ef. lactate initially began trending down from 4.4 -> 3.4 -> 2.8, but then rose to 3.0-3.3. . given new precordial voltages apparent on ekg and hypotension, pt received stat echo just before transfer to to rule out tamponade physiology which did not show any effusion or diastolic collapse. . 4. acute renal failure: patient with a creatinine of 1.7 at the time of presentation, urine electrolytes were suggestive of a pre-renal etiology vs atn. diuretics and ace inhibitor were held and renal function improved to baseline of 0.7, however early in the am of his cr then began to increase again to 1.7, possibly due to hypotn and need for levophed (see above under sepsis), for which he was given small ivf boluses. urine lytes were planned but not done by time of transfer to and should be followed up on. . 5. rate: patient presented with device interogation showing vt at a rate of 180 interrogation showed threshold for defibrillation was 220. ep reset defibrillation threshold to 180 while in the ed. patient had episode of bradycardia to the 40's on hd 1, with ekg showing wide complexes concerning for hyperkalemia despite k only mildly elevated to 5.7, which was medically treated with improvement. ep was unable to set higher rate on patient's pacer and patient was started on isoproterenol at 1 mcg/hr, this was discontinued as patient was rewarmed. electrolytes were checked q6h and k and mg repleated as needed to goal k>4.0, mg>2.0. patient did not have any subsequent runs of vtach and did not have any firing of his icd prior to transfer. he remained in nsr by time of transfer with rates in the 60-70's. . 6. hypoxemia: on hd patient was noted to be desating to the mid 80s after repositioning in bed. peak preassures rose from 24 to 33 and was rhonchourous on exam. cxr showed r sided pulmonary edema and patient was given 40 mg iv lasix with good urine output. thick secretions were suctioned, though while initially improving vent settings were increased and patient placed on cmv with peak 27, peep 10, vt 550 by rr 22, fi02 50%. his peep was decreased to 8 by the time of discharge after his most recent abg showed 7.42/co2 33/pao2 138/hco3 22. . 7. dilated cardiomyopathy: patient presented with know dialated cardiomyopathy of unknown origin, per the patient's family ef was 15% at time of last echo. patient was on asa 81 mg, caverdilol 12.5 mg , lisinopril 20mg, lasix 40 mg, aldactone 50 mg daily at home. these medications were held in setting of the patient's hypotension and renal failure. he is being transferred back to where he is well known for further evaluation. . . transitional issues: -r arterial line noted to have dampened waveforms just before transfer, plan was to change over a wire. sbp's noted to be ~10 mmhg lower than non-invasive cuff bp -monitor o2 requirements and volume status and assess need for daily iv diuresis -cr currently uptrending to 1.7, planned urine lytes and cautious volume challenge -eeg strips have been sent on cd with patient -> continue neurologic w/u to assist with prognosis -icd defibrilation threshold reset from 220 to 180 -further workup for cardiac transplant per primary cardiologists at medications on admission: -asa 81 mg qd -carvediol 12.5 mg -lisinopri 20 mg qd -lasix 40 mg po daily -aldactone 50 mg daily discharge medications: 1. acetaminophen iv 1000 mg iv q8h:prn fever 2. ciprofloxacin 400 mg iv q8h 3. piperacillin-tazobactam 4.5 g iv q8h 4. vancomycin 1000 mg iv q 12h 5. pantoprazole 40 mg iv q24h 6. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) u u injection tid (3 times a day). 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: six (6) puff inhalation q4h (every 4 hours) as needed for wheeze. 9. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 10. norepinephrine bitartrate-d5w 8 mg/250 ml (32 mcg/ml) solution sig: infusion titrated to map intravenous titrate to (titrate to desired clinical effect (please specify)). discharge disposition: extended care discharge diagnosis: cardiac arrest cardiac arrest ventricular tachycardia ventilator associated pneumonia acute renal failure idiopathic cardiomyopathy discharge condition: stable, intubated mental status/level of consciousness: medically sedated activity status: n/a . discharge instructions: dear mr. , it was a pleasure taking care of you. you were admitted to the hospital for ventricular tachycardia/cardiac arrest. prior to reaching the emergency room, you were given cpr, intubated and given epinephrine. by the time you reached to hospital your pulse had returned and the arrhythmia had stopped. we initiated hypothermia protocol and did continuous eeg monitoring. the eegs did not reveal any seizure activity and as you were rewarmed, your eegs showed improving electrical activity. we interrogated your pacemaker and it showed that during your cardiac arrest you were in ventricular tachycardia at a rate below your defibrillator setting. your icd settings were adjusted to deliver shocks at a lower threshold. . your hospital course was complicated by pulmonary edema, renal injury with a rising creatinine, and a rll opacity that was concerning for aspiration pneumonitis vs pneumonia. we started you on broad spectrum antibiotics, gave you iv diuresis, and your ventilator settings were adjusted because you were becoming hypoxic. . the rewarming protocol has been completed and your eegs have not shown any seizure activity. we believe that it is now safe to transfer you to . . for your transfer medication list, please see the attached sheet followup instructions: please follow up with your outpatient cardiologist please follow up with your outpatient cardiologist md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours infusion of vasopressor agent central venous catheter placement with guidance diagnoses: other primary cardiomyopathies hyperpotassemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus cardiac arrest ventricular fibrillation automatic implantable cardiac defibrillator in situ 

Answer: The patient is high likely exposed to