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: zestril attending: chief complaint: sob major surgical or invasive procedure: none history of present illness: per micu admit note hpi: 52yo m w/hx of motorcycle trauma w/bl open monteggia fractures, admitted during which time had ex lap, trach and peg admitted s/p pe arrest. per his wife, he was feeling dyspnicon the day of admission, + b/l swelling. she notes that on leaving that he had increased upper airway sounds that she attributed to respiratory distress. the patient and his wife proceeded to his outpt appointments. at his last appointment, dr. noted that the patient appeared to have labored breathing and recommended that ems take him to the ed. on the way out of the building, the patient requested to go to the bathroom. he had a bowel movement and was pale, diaphoretic per his wife. the patient himself reports feeling dizzy. as he was getting back onto the stretcher, he slumped over. per ems, he was pulseless. code blue was called. cpr was intitiated and continued for 3min w/o defibrillation or medication administration. he was placed on a monitor and found to be bradycardic to 40's, bp was 100/50. pt was given 1mg iv atropine x 1 with hr response to 135. during this episode, he was noted to have vomited and vomitous was suctioned from his trach. sent to ed. . in ed, the patient was arousable but drowsy. cxr was read as normal. cta neg for pe. no ekg changes. the patient received levo/flagyl for aspiration pna. past medical history: motorcycle trauma with bl open monteggia fractures, r knee degloving injury, hypotension, facial laceration s/p ex-lap, orif r and l elbows, trach and peg acute on chronic renal failure (previous baseline creatinine 2.0, now 2.7) hypernatremia anemia of chronic renal disease morbid obesity s/p lap gastric band () , now removed dm2 cad s/p stenting x2 ( at ) htn hypercholesterolemia chf, diastolic osa- did not tolerate cpap/bipap back pain psoriatic arthritis l shoulder pain social history: lives with wife, 3 children. on disability, former truck driver. former smoker, quit after 80 pack year history. no current etoh, former heavy drinker. no illicits. family history: father - leukemia, heart disease. mother - . sister - . physical exam: exam on admission: vs temp 100.6 hr65 bp 128/63 rr 63 gen: drowsy but arousable - > later awake, alert, communicative heent: no jvd but diff ass with thick neck, trach in place w/o erythema or swelling pulm: no labored breathing, rhonchi on lll and coarse crackles in rll cv: regular rate and rhythm, no murmurs, rubs, gallops abd: soft, somewhat ttp along midline inciscion, incision with erythema but no discharge, dressing in place ext: + edema, but more diffusely swollen; pt has various surgical incisions that are starting to heal well skin: psoriasis pertinent results: 01:35pm blood wbc-8.5 rbc-3.07* hgb-9.1* hct-27.3* mcv-89 mch-29.6 mchc-33.3 rdw-14.1 plt ct-195 01:35pm blood neuts-80.9* lymphs-12.0* monos-5.2 eos-1.9 baso-0.1 01:35pm blood pt-16.2* ptt-32.6 inr(pt)-1.4* 01:35pm blood glucose-198* urean-35* creat-2.0* na-138 k-4.8 cl-99 hco3-25 angap-19 01:35pm blood alt-24 ast-26 ld(ldh)-225 ck(cpk)-72 alkphos-143* totbili-0.4 01:35pm blood lipase-46 01:35pm blood ctropnt-0.06* 01:35pm blood ck-mb-notdone probnp-2260* 10:09pm blood ck-mb-notdone ctropnt-0.10* 04:21am blood ck-mb-notdone ctropnt-0.11* 01:35pm blood calcium-8.6 phos-5.5* mg-2.3 04:21am blood hapto-410* 02:31am blood wbc-8.3 rbc-2.66* hgb-8.1* hct-23.7* mcv-89 mch-30.4 mchc-34.1 rdw-14.0 plt ct-154 02:31am blood glucose-109* urean-31* creat-2.3* na-140 k-4.3 cl-102 hco3-30 angap-12 05:31am blood wbc-4.7 rbc-2.61* hgb-7.7* hct-22.6* mcv-87 mch-29.3 mchc-33.8 rdw-13.6 plt ct-205 05:31am blood pt-15.7* ptt-32.1 inr(pt)-1.4* 05:31am blood glucose-105 urean-33* creat-1.8* na-138 k-4.7 cl-101 hco3-31 angap-11 . head ct: no acute intracranial process . : chest xray: bilateral diffuse alveolar opacities, which could represent pulmonary edema, aspiration, or diffuse infectious process. satisfactory positioning of tracheostomy tube. no pneumothorax. . cta chest/abd/pelvis: no pe, bilateral basilar consolidation suggestive of atelectasis, pneumonia, or aspiration. mild pulmonary vascular congestion but no pleural effusion. interval removal of gastric band; however, gastrostomy tube is still present within the stomach. mild anasarca. multiple mediastinal and hilar nodes which could be reactive, but would recommend follow up imaging evaluation for resolution. left anterior intraabdominal nodule, not seen on prior study and may represent a lymph node. follow up examination is recommended to evaluate for interval change. . ct abd/pelvis: 1. minimal amount of free fluid in the perihepatic space and deep pelvis, new when compared to prior exam. no evidence of retroperitoneal bleed. 2. otherwise, no significant change. discharge labs: 06:19am blood wbc-4.9 rbc-2.86* hgb-8.3* hct-25.2* mcv-88 mch-29.2 mchc-33.1 rdw-14.0 plt ct-218 05:31am blood wbc-4.7 rbc-2.61* hgb-7.7* hct-22.6* mcv-87 mch-29.3 mchc-33.8 rdw-13.6 plt ct-205 06:19am blood glucose-113* urean-33* creat-1.8* na-139 k-4.6 cl-101 hco3-32 angap-11 05:31am blood glucose-105 urean-33* creat-1.8* na-138 k-4.7 cl-101 hco3-31 angap-11 06:19am blood calcium-8.7 phos-4.3 mg-2.1 brief hospital course: the patient was admitted to the hospital with loss of conscious and bradycardia. he was thought to have possibly had a mucous plug in the setting of pneumonia and chf with edema. it is unclear if he was pulseless, however a pulse could not be felt and chest compressions were started. when hooked up to the monitor, he was in sinus rhythm at a rate of 40. he was given atropine and hr improved. in the ed, a cta of the chest showed no pe and ct of the abd/pelvis showed no intra-abdominal pathology. on arrival to the micu, he was given vanc/zosyn for possible pneumonia. the zosyn was stopped the following day and the vancomycin continued for mrsa in the sputum, later felt to be a contaminate or colonization given his improvement. his cxr showed pulmonary edema and he was given lasix for diuresis. telemetry showed no arrhythmias. ecg showed no ischemic changes and cardiac enzymes were negative. he was diuresed and improved. echo showed normal systolic function but severe diastolic dysfunction. it was felt that he did not have a pneumonia and that his sputum was likely colonization and the vancomycin was stopped. he improved with diuresis and he likely had pulmonary edema contributing to his respiratory status. he was weaned from the ventilator over 4 days and tolerated a trach mask for several days before discharge. his metoprolol was initially held due to his bradycardia but this was restarted prior to discharge as his heart rate tolerated it. he was restarted on a lower dose of metoprolol of 25mg po bid due to bradycardia on admission. this can be titrated up as tolerated to his home dose of 50mg po bid. he was restarted on 25 mg cozar on for blood pressure control. his aspirin, imdur, amlodipine and hydralazine were continued for blood pressure control and coronary artery disease. he was continued on his lantus and insulin sliding scale for diabetes management. . he was anemic upon admission which was not new. his hematocrit trended down to 19 on and he was transfused 1 unit prbcs. his hematocrit increased to 23. he was stable without symptoms and no source of bleeding. he was guaiac negative. iron studies showed iron-deficiency and he was started on iron. his retic count was 2%. he was transfused a second unit of prbcs on and his hematocrit came up to 25.2 on . he was discharged with instructions for a repeat cbc within days, and also has a follow-up appointment with outpatient hematology to further assess this. . mr. had a worsening creatinine on admission to 2.3 which improved to 1.8 at the time of discharge. he has a history of renal failure associated with his prior trauma. . the trauma surgery team evaluated his wounds and recommended wet to dry dressings . he was evaluated by the wound care nursing team who recommended aquacel dressings to the abdominal incision. this was discussed with the surgery team who agreed. he should have aquacel dressings placed on his abdominal incisions as described below. . wound recommendations: recommendations are as follows: pressure relief per pressure ulcer guidelines support surface: atmos air turn and reposition every 1-2 hours and prn off back heels off bed surface at all times if oob, limit sit time to one hour at a time and sit on a pressure relief cushion, 4" foam elevate le's while sitting. moisturize b/l le's and feet with aloe vesta moisture barrier ointment. . abd and right groin incisional wounds: commercial wound cleanser to irrigate/cleanse abd and rightgroin wounds. pat the tissue dry with dry gauze. apply moisture barrier ointment to the periwound tissue with each drg change. apply aquacel ag (silver ion)dsg to decrease local bacterial bioburden, absorb drainage and provide for moist wound healing. cover with dry gauze, abd secure with soft cloth tape. change dressing daily. . keep skin folds clean and dry. apply critic aid clear moisture barrier ointment to skin foldsand intergluteal, gluteal tissue daily and prn support nutrition and hydration. . for abd and right groin wounds: after applying aquacel ag, dampen with normal saline. upon removal, if the aquacel ag is adhered to the wound bed or dry, moisten with normal saline prior to removal. . recommendations regarding passy-muir valve: 1. always deflate cuff prior to placing the passy-muir valve! 2. monitor o2 sats / respiration while valve is in place. 3. do not allow the patient to sleep with the valve in place. 4. if the patient is taking po's, please deflate the cuff and place the pmv for eating and drinking. 5. pmv wear schedule is up to the discretion of the nurse and/or respiratory therapist. . recommendations regarding nutrition: 1. suggest a po diet of thin liquids and soft consistency solids. 2. pmv in place for all pos. 3. pills whole with thin liquids. . follow-up the patient should follow-up with dr. from general surgery, dr. from vascular surgery, and dr. from orthopedics as scheduled. he has appointments scheduled in 4 weeks. he has an appointment with hematology to evaluate his anemia in as per discharge plan. it is likely he will be able to have the tracheostomy gradually reduced and removed as well as the g-tube in the future. this was discussed with the surgery team and will be done as an outpatient. medications on admission: albuterol inhaler q2 hours as needed amlodipine 5mg po qday phoslo 667mg po tid lasix 20mg po qday gemfibrozil 600mg po qday hydralazine 25mg po tid hydromorphone .5-2mg iv q3hours prn for pain glargine 25 units sc qhs imdur 20mg po qday lactulose 30ml po bid lorazepam .5-1mg po qhs prn insomnia metoclopramide 5mg/ml solution 1 q6 hours metoprolol 50mg po bid nystatin suspension po qid prn seroquel 12.5mg po qhs ranitidine 150 po qday triamcinolone 0.025% cream acetaminophen solution q6hours prn asa ec 81mg po qday bisacodyl 10mg 1 suppository pr qday prn colace liquid 100mg po bid regular insulin sliding scale mvi senna 1 tab thiamine 100mg po qday discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation every 6-8 hours as needed for sob, wheezing. 2. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 3. gemfibrozil 600 mg tablet sig: one (1) tablet po daily (daily). 4. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 5. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 11. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous qday at dinner. 12. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 14. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 15. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day). 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for hr<55 or sbp<100. 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 18. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 19. 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. 20. humalog 100 unit/ml solution sig: one (1) unit subcutaneous qachs: as per sliding scale. 21. losartan 25 mg tablet sig: one (1) tablet po daily (daily): hold for sbp < 100 or hr < 60. 22. acetaminophen 160 mg/5 ml solution sig: five (5) ml po q6h (every 6 hours) as needed. 23. sliding scale insulin please see attached sliding scale discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: 1. loss of consciousness . secondary diagnoses: 2. congestive heart failure 3. diabetes mellitus 4. s/p motorcycle accident 5. anemia 6. coronary artery disease discharge condition: afebrile, hemodynamically stable, tracheostomy mask without ventilator, able to eat discharge instructions: you were admitted to the hospital after losing consciousness. you were found to have worsening heart failure and were given diuretics to remove fluid from your lungs. you were given 3 days of antibiotics but these were stopped after you improved and you were not felt to have a pneumonia. . you were evaluated by the trauma surgery service, the orthopedic service, the wound care team and the nutrition team. you should follow-up as an outpatient with orthopedics and trauma surgery and you have appointments in 4 weeks. you should see a hematologist for your anemia in . . you were started on iron during this admission and should continue to take this 325mg by mouth every day. you should take a stool softener to prevent constipation. your metoprolol was decreased to 25mg po twice per day. you should continue to take this lower dose unless instructed by your doctors. . you should return to the hospital or call your primary care doctor for any fevers > 100.4, chills, night sweats, shortness of breath, chest pain, abdominal pain, dizziness or lightheadedness, swelling in your legs, blood in your stool, nausea or vomiting, or any other symptoms that concern you. followup instructions: you should follow up with your primary care doctor within a week of discharge from rehab. hematology appointment for anemia workup: , md. . date/time: 2pm, 9b. . provider: , md phone: date/time: 1:00 provider: xray (scc 2) phone: date/time: 1:55 provider: , md phone: date/time: 2:15 you should have your cbc checked within 3-4 days of leaving the hospital. please have this done at rehab. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more transfusion of packed cells diagnoses: anemia in chronic kidney disease pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified pneumonitis due to inhalation of food or vomitus other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iron deficiency anemia, unspecified carrier or suspected carrier of methicillin resistant staphylococcus aureus accidents occurring in residential institution foreign body accidentally entering other orifice tracheostomy status hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified bariatric surgery status non-healing surgical wound foreign body in trachea psoriatic arthropathy 

Answer: The patient is high likely exposed to