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CHIEF COMPLAINT: Fever and shortness of breath. PRESENT ILLNESS: Ms. [**Known lastname **] is an 84 y.o. F with a history of hypertension, gait instability, and memory impairment, who presented to the ED from [**Hospital6 459**] with fever and shortness of breath. Per the patient, her son thought she was "doing something that she shouldn't be doing" and that was why he brought her to the hospital. She is not sure why she is in the hospital. She denies any sick contacts. She denies shortness of breath, chest pain, abdominal pain, and diarrhea. However, the transfer letter from [**Hospital 100**] Rehab states that she was "acutely unwell, falling to one side" and vitals per rehab were the following: T 102, HR 120, BP 150/100, RR 24, and O2 sats 89% RA. Per Rehab letter, she was unresponsive for a few seconds but without any obvious neurologic deficits. Additionally, she was found to be sweating, her face was pale in color, and she became weak. She was given Augmentin 850 mg, ASA 325 mg, and Tylenol as well as oxygen and then sent to [**Hospital1 18**] ER. MEDICAL HISTORY: Pt denies any medical history; however, upon review of [**2176-2-7**] [**Hospital1 18**] Neurology Note: Hypertension Osteoporosis Hypercholesterolemia Aortic valve stenosis MEDICATION ON ADMISSION: Olanzapine 10 mg daily Ativan 0.5 mg q6 hours prn Ativan INJ 0.5 mg TID prn Raloxifene HCl 60 mg daily Cholecalciferol 1000 units daily Calcium Carbonate 650 mg [**Hospital1 **] MOM 30 mL daily prn Venlafaxine HCl 75 mg daily Acetaminophen 975 mg QID prn Miralax 17 grams daily Aspirin EC 81 mg daily Senna 8.6 mg qhs Simvastatin 20 mg qpm Simvastatin 10 mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Temp: 95.6 Ax (97.5 oral) BP: 92/63 HR: 74 RR: 19 O2sat: 100% on NRB --> desated to 90% with NRB off for 5 minutes, in full sentences. GEN: NAD, pleasant, elderly female with NRB, able to answer questions appropriately but appears tired HEENT: EOMI, PERLL, anicteric, OP - no exudate, no erythema, MM appears slightly dry NECK: flat JVD RESP: inspiratory and expiratory rhonchi, coarse breath sounds, no wheezes or rales heard. CV: RRR, nl S1, S2, no r/g, III/VI SEM heard best at LLSB ABD: NDNT, soft, NABS, no HSM noted EXT: no c/c/e SKIN: no rashes, petechiae, ecchymosis NEURO: CN II-XII grossly intact, FTN intact, 2+ bilateral LE patellar reflexes, could not elicit reflexes in upper extremities. Gait not assessed. FAMILY HISTORY: Per [**Hospital1 18**] Neurology Note in [**2176-2-7**]: Cardiovascular disease in her mother. Parkinson's disease in her father. Lost one sister to emphysema, one brother to CV disease and one to suicide. Her son died of AIDS. SOCIAL HISTORY: The patient currently lives at [**Hospital6 459**]. She lives in her own apartment and gets most meals in the cafeteria. She cleans her apartment, does her own grocery shopping, and drives. She used to smoke 1 ppd x 53 years, quitting 1 year ago.

Pneumonia due to respiratory syncytial virus,Obstructive chronic bronchitis with (acute) exacerbation,Vascular dementia, with delirium,Unspecified essential hypertension,Aortic valve disorders,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Bacterial pneumonia, unspecified,Depressive disorder, not elsewhere classified,Cerebral atherosclerosis

Resp syncyt viral pneum,Obs chr bronc w(ac) exac,Vasc dementia w delirium,Hypertension NOS,Aortic valve disorder,Osteoporosis NOS,Hyperlipidemia NEC/NOS,Bacterial pneumonia NOS,Depressive disorder NEC,Cerebral atherosclerosis

Admission Date: [**2180-3-23**] Discharge Date: [**2180-3-29**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 23347**] Chief Complaint: Fever and shortness of breath. Major Surgical or Invasive Procedure: None. History of Present Illness: Ms. [**Known lastname **] is an 84 y.o. F with a history of hypertension, gait instability, and memory impairment, who presented to the ED from [**Hospital6 459**] with fever and shortness of breath. Per the patient, her son thought she was "doing something that she shouldn't be doing" and that was why he brought her to the hospital. She is not sure why she is in the hospital. She denies any sick contacts. She denies shortness of breath, chest pain, abdominal pain, and diarrhea. However, the transfer letter from [**Hospital 100**] Rehab states that she was "acutely unwell, falling to one side" and vitals per rehab were the following: T 102, HR 120, BP 150/100, RR 24, and O2 sats 89% RA. Per Rehab letter, she was unresponsive for a few seconds but without any obvious neurologic deficits. Additionally, she was found to be sweating, her face was pale in color, and she became weak. She was given Augmentin 850 mg, ASA 325 mg, and Tylenol as well as oxygen and then sent to [**Hospital1 18**] ER. On arrival to the [**Hospital1 18**] ER: T 103.3 HR 110 BP 130/80 RR 32 89% on RA ---> 96% with nebulizers. In the ED, her O2 sat was then 94-95% on 4 L NC, then 91% on 5 L NC, and then she was placed on NRB for 95-100% O2 sats. BP was stable throughout the course in the ED with the lowest value of 99/63. A CXR showed no acute cardiopulmonary process. EKG did not show ischemic changes. CT head showed no acute intracranial bleed. She was given levofloxacin 750 mg x 1, flagyl 500 mg x 1, and vancomycin 1 gm x 1 as well as Combivent nebs q 20 minutes x 3. Past Medical History: Pt denies any medical history; however, upon review of [**2176-2-7**] [**Hospital1 18**] Neurology Note: Hypertension Osteoporosis Hypercholesterolemia Aortic valve stenosis Social History: The patient currently lives at [**Hospital6 459**]. She lives in her own apartment and gets most meals in the cafeteria. She cleans her apartment, does her own grocery shopping, and drives. She used to smoke 1 ppd x 53 years, quitting 1 year ago. Family History: Per [**Hospital1 18**] Neurology Note in [**2176-2-7**]: Cardiovascular disease in her mother. Parkinson's disease in her father. Lost one sister to emphysema, one brother to CV disease and one to suicide. Her son died of AIDS. Physical Exam: VS: Temp: 95.6 Ax (97.5 oral) BP: 92/63 HR: 74 RR: 19 O2sat: 100% on NRB --> desated to 90% with NRB off for 5 minutes, in full sentences. GEN: NAD, pleasant, elderly female with NRB, able to answer questions appropriately but appears tired HEENT: EOMI, PERLL, anicteric, OP - no exudate, no erythema, MM appears slightly dry NECK: flat JVD RESP: inspiratory and expiratory rhonchi, coarse breath sounds, no wheezes or rales heard. CV: RRR, nl S1, S2, no r/g, III/VI SEM heard best at LLSB ABD: NDNT, soft, NABS, no HSM noted EXT: no c/c/e SKIN: no rashes, petechiae, ecchymosis NEURO: CN II-XII grossly intact, FTN intact, 2+ bilateral LE patellar reflexes, could not elicit reflexes in upper extremities. Gait not assessed. Pertinent Results: [**2180-3-23**] 05:15PM BLOOD WBC-17.5*# RBC-4.67 Hgb-13.9 Hct-41.6 MCV-89 MCH-29.7 MCHC-33.3 RDW-12.7 Plt Ct-267 [**2180-3-23**] 05:15PM BLOOD Neuts-85* Bands-2 Lymphs-7* Monos-6 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2180-3-23**] 05:15PM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL [**2180-3-23**] 05:15PM BLOOD Plt Smr-NORMAL Plt Ct-267 [**2180-3-23**] 05:15PM BLOOD Glucose-199* UreaN-14 Creat-1.0 Na-140 K-4.4 Cl-101 HCO3-29 AnGap-14 [**2180-3-23**] 05:15PM BLOOD CK(CPK)-137 [**2180-3-23**] 05:15PM BLOOD CK-MB-3 proBNP-2204* [**2180-3-24**] 02:39AM BLOOD Albumin-3.0* Calcium-8.5 Phos-3.8 Mg-2.1 [**2180-3-23**] 05:40PM BLOOD Lactate-2.9* [**2180-3-23**] 11:53PM BLOOD Lactate-1.4 URINES STUDIES: . [**2180-3-23**] 08:35PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.013 [**2180-3-23**] 08:35PM URINE Blood-NEG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2180-3-23**] 08:35PM URINE [**2180-3-23**] 08:35PM URINE Gr Hold-HOLD. . CT HEAD W/O CONTRAST [**2180-3-23**] 7:05 PM . FINDINGS: There is no evidence of acute intracranial hemorrhage, shift of midline structures or hydrocephalus. [**Doctor Last Name **]-white matter differentiation is grossly preserved. Age appropriate atrophy noted. Hypodensity in the periventricular white matter of both cerebral hemispheres is seen, consistent with severe chronic microvascular infarction. Tiny hypodensity in the right basal ganglia likely represents small lacune. Mucosal thickening seen in the maxillary sinuses bilaterally, likely mucus retention cyst in the right maxillary sinus, possible small fluid level in the right maxillary sinus. Aerosolized secretions also seen in the maxillary sinuses. Mucosal thickening also noted within the ethmoid and frontal sinuses. . IMPRESSION: 1. No evidence of acute intracranial hemorrhage. MRI with diffusion-weighted images is more sensitive in evaluation for acute ischemia/infarction and for vascular detail. 2. Severe chronic microvascular infarction. 3. Sinus disease as described. . CHEST (PA & LAT) [**2180-3-27**] 9:29 AM . Lateral view shows a small region of consolidation in the anterior segment of one of the upper lobes, probably the right common, which could be a focus of pneumonia. No other pulmonary abnormalities are present. The heart is top normal size. Lateral view shows heavy calcification in what could be the aortic valve as well as a small right pleural effusion. There is no pulmonary edema, though the mediastinal veins and upper lobe pulmonary vessels are mildly dilated. Thoracic aorta is generally large and tortuous, but not focally dilated. . Brief Hospital Course: 84 y/o female w/ hx of hypertension, gait instability, memory impairment, was admitted to the hospital from [**Hospital **] rehab with Shortness of breath, fever, new oxygen requirement, +RSV titers, healthcare associate pneumonia. . # presumed bacterial pneumonia on top of RSV pneumonia: Patient received 4 days of IV antibiotics (vanc/clinda/cipro), then transitioned over to PO levofloxacin. She responded well to the abx, but still has new oxygen requirment. Patient is on 4L of oxygen, sating 94%. This oxygen should be titrated down at rehab. Pt is scheduled to finish her levofloxacin course on [**4-7**]. Patients leukocytosis has resolved. Patient needs no precautions. . #Undiagnosed COPD: Patient received IV steroids during course. She has been on prednisone for several days. Recommend a steroid taper 60mg x3 days, 40mg x 3 days, 20mg x 3 days. She has responded well to ipratroprium and albuterol nebs standing q 6hours. Pt should be transitioned to as needed inhalers. . #Hematuria: Patient had a foley while in hospital with hematuria. This cleared with flushing and foley was discontinued. . # Depression: Patient has a history of depression and was continued on venlafaxine 75mg daily. . # Agitated delirium: Patient required PRN haldol and a sitter during her stay. She has not been agitated for the past 72 hours. Pt continues to receive daily olanzapine 10mg. . # Dementia [**2-26**] multiple small vessel disease. Patient is at her baseline for memory impairment. . # EKG abnormalities: While in MICU patient Reported symptoms concerning for possible cardiac origin with sweating, pale, and weakness vs demand from early sepsis. ST depressions seen in lateral leads compared to EKG from [**2169**]. Cardiac enzymes x 3 negative. No events on telemetry thus far. Patient is continued on daily aspirin. . #Hyperlipidemia: continued simvastin 20mg . #Anemia: HCT is 31, baseline 35.6. This was stable during hospital source. Guaic negative. . #CODE STATUS: Is DNR/DNI . Medications on Admission: Olanzapine 10 mg daily Ativan 0.5 mg q6 hours prn Ativan INJ 0.5 mg TID prn Raloxifene HCl 60 mg daily Cholecalciferol 1000 units daily Calcium Carbonate 650 mg [**Hospital1 **] MOM 30 mL daily prn Venlafaxine HCl 75 mg daily Acetaminophen 975 mg QID prn Miralax 17 grams daily Aspirin EC 81 mg daily Senna 8.6 mg qhs Simvastatin 20 mg qpm Simvastatin 10 mg Discharge Medications: 1. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO DAILY (Daily). 2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 10. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 11. Olanzapine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 12. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): 60mg x 3 days 40mg x 3 days 20mg x 3. 13. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours): 10 day course. Finish on [**4-7**]. 14. Albuterol Sulfate 0.63 mg/3 mL Solution for Nebulization Sig: One (1) Inhalation every six (6) hours. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - LTC Discharge Diagnosis: Primary Diagonsis 1.RSV infection 2.Pneumonia . Secondary Diagnosis 3.Hypertension 4.Aortic Valve Stenosis 5.Osteoporosis 6.Hyperlipidemia 7.Memory impairment 8.Gait instability Discharge Condition: stable, 94% on 4L Discharge Instructions: Patient was admitted to the hospital from [**Hospital6 **] with Fever and shortness of breath. She was not sure why she was brought to the hospital. She has dementia and short term memory deficits. . She was admitted to the MICU on [**2180-3-23**]. She was found to be positive for the RSV virus. She received several days of vancomycin/clindamycin/cipro. There was a chest xray which shows a possible infiltrate. Patient is being treated for a hospital acquired pna, now on levofloxacin 500mg PO daily. . We believe patient to have undiagnosed COPD. She has responded to duonebs well. Please continue on albuterol nebs and prednisone 60mg x 3days, 40mg x 3 days, 20mg x 3 days. . She has a new oxygen requirement, which should be titrated down at rehab. This o2 requirement is thought to be secondary to pneumonia and should improve with time. . Please send patient back if develops fevers over 101.5, or increased shortness of breath. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 23430**] at [**Telephone/Fax (1) 23431**]. [**Name6 (MD) **] [**Last Name (NamePattern4) 23348**] MD, [**MD Number(3) 23349**]

480,491,290,401,424,733,272,482,311,437

{'Pneumonia due to respiratory syncytial virus,Obstructive chronic bronchitis with (acute) exacerbation,Vascular dementia, with delirium,Unspecified essential hypertension,Aortic valve disorders,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Bacterial pneumonia, unspecified,Depressive disorder, not elsewhere classified,Cerebral atherosclerosis'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Fever and shortness of breath. PRESENT ILLNESS: Ms. [**Known lastname **] is an 84 y.o. F with a history of hypertension, gait instability, and memory impairment, who presented to the ED from [**Hospital6 459**] with fever and shortness of breath. Per the patient, her son thought she was "doing something that she shouldn't be doing" and that was why he brought her to the hospital. She is not sure why she is in the hospital. She denies any sick contacts. She denies shortness of breath, chest pain, abdominal pain, and diarrhea. However, the transfer letter from [**Hospital 100**] Rehab states that she was "acutely unwell, falling to one side" and vitals per rehab were the following: T 102, HR 120, BP 150/100, RR 24, and O2 sats 89% RA. Per Rehab letter, she was unresponsive for a few seconds but without any obvious neurologic deficits. Additionally, she was found to be sweating, her face was pale in color, and she became weak. She was given Augmentin 850 mg, ASA 325 mg, and Tylenol as well as oxygen and then sent to [**Hospital1 18**] ER. MEDICAL HISTORY: Pt denies any medical history; however, upon review of [**2176-2-7**] [**Hospital1 18**] Neurology Note: Hypertension Osteoporosis Hypercholesterolemia Aortic valve stenosis MEDICATION ON ADMISSION: Olanzapine 10 mg daily Ativan 0.5 mg q6 hours prn Ativan INJ 0.5 mg TID prn Raloxifene HCl 60 mg daily Cholecalciferol 1000 units daily Calcium Carbonate 650 mg [**Hospital1 **] MOM 30 mL daily prn Venlafaxine HCl 75 mg daily Acetaminophen 975 mg QID prn Miralax 17 grams daily Aspirin EC 81 mg daily Senna 8.6 mg qhs Simvastatin 20 mg qpm Simvastatin 10 mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Temp: 95.6 Ax (97.5 oral) BP: 92/63 HR: 74 RR: 19 O2sat: 100% on NRB --> desated to 90% with NRB off for 5 minutes, in full sentences. GEN: NAD, pleasant, elderly female with NRB, able to answer questions appropriately but appears tired HEENT: EOMI, PERLL, anicteric, OP - no exudate, no erythema, MM appears slightly dry NECK: flat JVD RESP: inspiratory and expiratory rhonchi, coarse breath sounds, no wheezes or rales heard. CV: RRR, nl S1, S2, no r/g, III/VI SEM heard best at LLSB ABD: NDNT, soft, NABS, no HSM noted EXT: no c/c/e SKIN: no rashes, petechiae, ecchymosis NEURO: CN II-XII grossly intact, FTN intact, 2+ bilateral LE patellar reflexes, could not elicit reflexes in upper extremities. Gait not assessed. FAMILY HISTORY: Per [**Hospital1 18**] Neurology Note in [**2176-2-7**]: Cardiovascular disease in her mother. Parkinson's disease in her father. Lost one sister to emphysema, one brother to CV disease and one to suicide. Her son died of AIDS. SOCIAL HISTORY: The patient currently lives at [**Hospital6 459**]. She lives in her own apartment and gets most meals in the cafeteria. She cleans her apartment, does her own grocery shopping, and drives. She used to smoke 1 ppd x 53 years, quitting 1 year ago. ### Response: {'Pneumonia due to respiratory syncytial virus,Obstructive chronic bronchitis with (acute) exacerbation,Vascular dementia, with delirium,Unspecified essential hypertension,Aortic valve disorders,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Bacterial pneumonia, unspecified,Depressive disorder, not elsewhere classified,Cerebral atherosclerosis'}

CHIEF COMPLAINT: urinary retention PRESENT ILLNESS: HPI: Mr. [**Known lastname 73330**] is an 82 y/o man with PMH of hypertension and BPH admitted for TURP on [**9-12**] now presenting to the [**Hospital Unit Name 153**] for tachycardia. The patient was admitted on [**9-12**] following elective TURP; the patient tolerated the procedure without complication. He was set for discharge earlier today but failed his voiding trial. At about 1600, he had a straight catheterization after bladder scan showed 350 cc in his bladder. At about 1700, the patient was found to be febrile to 102.6 with heartrate in the 180s on routine vitals check; his blood pressure at the time was 110/74. He denied any symptoms at that time and had not been exerting himself. EKG demonstrated ? atrial flutter at 180. . Labs were drawn and the patient was given lopressor 5 mg IV X 2 without success. Cardiology was consulted who felt that the patient should received IV adenosine for supraventricular tachycardia. However, prior to giving adenosine, cardiology was called elsewhere and the patient could not receive adenosine on the floor without cardiology at the bedside. Therefore, the patient was transferred to the [**Hospital Unit Name 153**] for further care. Throughout this time, the patient's blood pressure remained stable in the 110-140s and he was asymptomatic. For his fever, cultures were sent and he was given a dose of vancomycin as his prior urine culture (from [**9-4**]) has MRSE. Foley catheter was placed per urology before transfer. . On arrival to the [**Hospital Unit Name 153**], the patient denies any chest pain, palpitations, dizziness/lightheadedness, or difficulty breathing. Initial heartrate remained in the 160s and blood pressure transiently dropped to the 90s systolic. He received a 500 cc normal saline bolus at that time. . MEDICAL HISTORY: PMH: Hypertension BPH s/p TURP on [**9-12**] Chronic renal insufficiency, recent creatinine 1.7 Anemia (baseline Hct 30-32) h/o varicose vein stripping . MEDICATION ON ADMISSION: . MEDS: HCTZ 12.5 mg daily avodart 0.5 mg daily flomax 0.4 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T: 102 BP: 147/63 HR: 164 RR: 19 O2 95% RA Gen: Pleasant, well appearing gentleman who appears younger than stated age HEENT: No conjunctival pallor. No icterus. Mucous membranes moist. OP clear. NECK: Supple, JVD < 10 cm. No thyromegaly. CV: regular tachycardic rhythm, no murmur appreciated LUNGS: crackles at left base, otherwise clear ABD: soft, nontender, hypoactive bowel sounds EXT: warm & well perfused throughout, DP pulses 2+ bilaterally SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. Speaking clearly and in full sentences, face symmetric, moving all extremities without difficulty. PSYCH: Listens and responds to questions appropriately, pleasant . FAMILY HISTORY: FH: Stroke in patient's father. SOCIAL HISTORY: . SH: Lives with his daughter who is a pediatrics resident at [**Hospital1 **]. Prior smoker but quit in [**2096**]. Has one alcoholic beverage rarely.

Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Hydronephrosis,Chronic kidney disease, unspecified,Urinary complications, not elsewhere classified,Ventricular flutter,Urinary tract infection, site not specified,Infection and inflammatory reaction due to indwelling urinary catheter,Bladder neck obstruction,Retention of urine, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease

BPH w urinary obs/LUTS,Hydronephrosis,Chronic kidney dis NOS,Surg compl-urinary tract,Ventricular flutter,Urin tract infection NOS,React-indwell urin cath,Bladder neck obstruction,Retention urine NOS,Hy kid NOS w cr kid I-IV,Anemia in chr kidney dis

Admission Date: [**2141-9-12**] Discharge Date: [**2141-9-15**] Date of Birth: [**2058-12-27**] Sex: M Service: UROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6736**] Chief Complaint: urinary retention Major Surgical or Invasive Procedure: TURP-trans urethral resection prostate History of Present Illness: HPI: Mr. [**Known lastname 73330**] is an 82 y/o man with PMH of hypertension and BPH admitted for TURP on [**9-12**] now presenting to the [**Hospital Unit Name 153**] for tachycardia. The patient was admitted on [**9-12**] following elective TURP; the patient tolerated the procedure without complication. He was set for discharge earlier today but failed his voiding trial. At about 1600, he had a straight catheterization after bladder scan showed 350 cc in his bladder. At about 1700, the patient was found to be febrile to 102.6 with heartrate in the 180s on routine vitals check; his blood pressure at the time was 110/74. He denied any symptoms at that time and had not been exerting himself. EKG demonstrated ? atrial flutter at 180. . Labs were drawn and the patient was given lopressor 5 mg IV X 2 without success. Cardiology was consulted who felt that the patient should received IV adenosine for supraventricular tachycardia. However, prior to giving adenosine, cardiology was called elsewhere and the patient could not receive adenosine on the floor without cardiology at the bedside. Therefore, the patient was transferred to the [**Hospital Unit Name 153**] for further care. Throughout this time, the patient's blood pressure remained stable in the 110-140s and he was asymptomatic. For his fever, cultures were sent and he was given a dose of vancomycin as his prior urine culture (from [**9-4**]) has MRSE. Foley catheter was placed per urology before transfer. . On arrival to the [**Hospital Unit Name 153**], the patient denies any chest pain, palpitations, dizziness/lightheadedness, or difficulty breathing. Initial heartrate remained in the 160s and blood pressure transiently dropped to the 90s systolic. He received a 500 cc normal saline bolus at that time. . Past Medical History: PMH: Hypertension BPH s/p TURP on [**9-12**] Chronic renal insufficiency, recent creatinine 1.7 Anemia (baseline Hct 30-32) h/o varicose vein stripping . Social History: . SH: Lives with his daughter who is a pediatrics resident at [**Hospital1 **]. Prior smoker but quit in [**2096**]. Has one alcoholic beverage rarely. Family History: FH: Stroke in patient's father. Physical Exam: PE: T: 102 BP: 147/63 HR: 164 RR: 19 O2 95% RA Gen: Pleasant, well appearing gentleman who appears younger than stated age HEENT: No conjunctival pallor. No icterus. Mucous membranes moist. OP clear. NECK: Supple, JVD < 10 cm. No thyromegaly. CV: regular tachycardic rhythm, no murmur appreciated LUNGS: crackles at left base, otherwise clear ABD: soft, nontender, hypoactive bowel sounds EXT: warm & well perfused throughout, DP pulses 2+ bilaterally SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. Speaking clearly and in full sentences, face symmetric, moving all extremities without difficulty. PSYCH: Listens and responds to questions appropriately, pleasant . Pertinent Results: LABS: WBC 11.9, Hct 30.3, Plt 236 sodium 136, K 3.4, Cl 99, HCO3 27, BUN 29, creatinine 2.5 glucose 142 CK 77 CKMB 3 trop < 0.01 Ca 8.5, mg 1.5, Phos 2.7 INR 1.3 . UA: 121 RBCs, 6 WBCs, occasional bacteria, no epis, 30 protein . ABG: 7.49 / 37 / 136 (on O2 via nasal cannula) . Urine culture ([**9-4**]): MRSE urine culture ([**9-13**]): pending blood culture ([**9-13**]): pending . STUDIES: EKG (baseline): sinus brady with PR prolongation, normal axis EKG ([**9-13**], 1700): regular tachycardia with normal axis, ? p waves at rate of 300 and ventricular rate (narrow QRS) at 180 EKG ([**9-13**], 2100): . CXR ([**9-13**]): faint LLL infiltrate (? atelectasis versus pneumonia) . Brief Hospital Course: A/P: This is an 82 y/o M with PMH of hypertension and BPH status post TURP on [**9-12**] who presents to the [**Hospital Unit Name 153**] with tachycardia up to 180s in setting of fever to . # Supraventricular tachycardia: Unclear trigger but did occur in the setting of the fever and following straight catheterization. Patient largely asymptomatic and returned to sinus rhyhtm following 6 mg IV adenosine X 1. Does have PACs on post-adenosine EKG. Could have a primary pulmonary event with right heart strain though ABG on room air demonstrates at PO2 of 88. PE could present with fever and tachycardia, but patient is not tachypneic and has only been in the hospital ~ 36 hours. - continue monitoring on telemetry - 2nd set of enzymes with AM labs - consider echocardiogram in the morning - cardiology consulted by urology, will touch base with consult team in the morning for further recommendations - replete electrolytes as necessary . # Fever: Likely related to recent instrumentation given occurrence just after straight catheterization. He does have MRSE in his urine from [**9-4**] and unclear which antibiotic he was treated with prior to admission. Notes indicate Keflex ([**9-4**]) and prior to this, cipro is listed in his medication list in OMR. Also has ? of infiltrate seen on CXR though absence of oxygen requirement and respiratory symptoms. - add on diff to earlier CBC - vancomycin to cover MRSE - given recent instrumentation of the GU tract and ? of complicated UTI, will also given zosyn - zosyn and vancomycin would also cover potential lung sources of fever - blood & urine cultures pending . # Hypertension: Will hold usual HCTZ given relative hypotension in this setting. . # BPH: s/p TURP yesterday and was doing quite well until his fever spike earlier tonight. Urology to continue following and for now the patient has a foley catheter in place. - continue tamsulosin per urology . # FEN: Regular, low salt diet. Replete lytes prn. . # PPx: Pneumoboots. bowel regimen prn. No need for PPI if eating. . # CODE: Full. . # COMM: With patient and his daughter. . # DISP: ICU overnight for close monitoring. Addendum (Urology) In Brief, patient admitted for TURP. POD 1 developed urinary retention after catheter removal. Pt was straight catheterized and within an hour developed a fever of 102.2 and tachycardia in the 200s. EKG showed SVT. Cards was consulted and recommended adenosine. Due to hospital policy and an emergency that Cardiology had to attend to, it was safest to transfer the patient to the ICU in order to administer the adensoine. The adenosine did break the rhythm and his rate was now 80. Patient was stable and transferred back to the floor the next day. he also received Vancomycin and a dose of Zosyn at this time, with the presumption that this event was triggered by a transiet bacteremia. His foley was removed POD 3 and a voiding trial was performed. He did void and was stable to send home. He would need to continue on 14 days of tetracycline for his bacteruria. Medications on Admission: . MEDS: HCTZ 12.5 mg daily avodart 0.5 mg daily flomax 0.4 mg daily Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: while taking narcotics. Disp:*30 Capsule(s)* Refills:*0* 3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2* 4. Tetracycline 500mg PO bid x 14days Discharge Disposition: Home Discharge Diagnosis: BPH and bilateral hydronephrosis Discharge Condition: stable Discharge Instructions: Call Urology office or go to your local Emergency Room if 1) Temp greater than 101 2) Nauseau and Vomitting for greater than 24 hours 3) Worsening Pain not relieved by Medications 4) Inability to Urinate You may resume your home Medications You may shower Followup Instructions: Call [**Hospital 159**] Clinic at [**Telephone/Fax (1) 164**] for follow up appointment with Dr. [**Last Name (STitle) 3748**] or Dr. [**Last Name (STitle) **]

600,591,585,997,427,599,996,596,788,403,285

{'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Hydronephrosis,Chronic kidney disease, unspecified,Urinary complications, not elsewhere classified,Ventricular flutter,Urinary tract infection, site not specified,Infection and inflammatory reaction due to indwelling urinary catheter,Bladder neck obstruction,Retention of urine, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: urinary retention PRESENT ILLNESS: HPI: Mr. [**Known lastname 73330**] is an 82 y/o man with PMH of hypertension and BPH admitted for TURP on [**9-12**] now presenting to the [**Hospital Unit Name 153**] for tachycardia. The patient was admitted on [**9-12**] following elective TURP; the patient tolerated the procedure without complication. He was set for discharge earlier today but failed his voiding trial. At about 1600, he had a straight catheterization after bladder scan showed 350 cc in his bladder. At about 1700, the patient was found to be febrile to 102.6 with heartrate in the 180s on routine vitals check; his blood pressure at the time was 110/74. He denied any symptoms at that time and had not been exerting himself. EKG demonstrated ? atrial flutter at 180. . Labs were drawn and the patient was given lopressor 5 mg IV X 2 without success. Cardiology was consulted who felt that the patient should received IV adenosine for supraventricular tachycardia. However, prior to giving adenosine, cardiology was called elsewhere and the patient could not receive adenosine on the floor without cardiology at the bedside. Therefore, the patient was transferred to the [**Hospital Unit Name 153**] for further care. Throughout this time, the patient's blood pressure remained stable in the 110-140s and he was asymptomatic. For his fever, cultures were sent and he was given a dose of vancomycin as his prior urine culture (from [**9-4**]) has MRSE. Foley catheter was placed per urology before transfer. . On arrival to the [**Hospital Unit Name 153**], the patient denies any chest pain, palpitations, dizziness/lightheadedness, or difficulty breathing. Initial heartrate remained in the 160s and blood pressure transiently dropped to the 90s systolic. He received a 500 cc normal saline bolus at that time. . MEDICAL HISTORY: PMH: Hypertension BPH s/p TURP on [**9-12**] Chronic renal insufficiency, recent creatinine 1.7 Anemia (baseline Hct 30-32) h/o varicose vein stripping . MEDICATION ON ADMISSION: . MEDS: HCTZ 12.5 mg daily avodart 0.5 mg daily flomax 0.4 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T: 102 BP: 147/63 HR: 164 RR: 19 O2 95% RA Gen: Pleasant, well appearing gentleman who appears younger than stated age HEENT: No conjunctival pallor. No icterus. Mucous membranes moist. OP clear. NECK: Supple, JVD < 10 cm. No thyromegaly. CV: regular tachycardic rhythm, no murmur appreciated LUNGS: crackles at left base, otherwise clear ABD: soft, nontender, hypoactive bowel sounds EXT: warm & well perfused throughout, DP pulses 2+ bilaterally SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. Speaking clearly and in full sentences, face symmetric, moving all extremities without difficulty. PSYCH: Listens and responds to questions appropriately, pleasant . FAMILY HISTORY: FH: Stroke in patient's father. SOCIAL HISTORY: . SH: Lives with his daughter who is a pediatrics resident at [**Hospital1 **]. Prior smoker but quit in [**2096**]. Has one alcoholic beverage rarely. ### Response: {'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Hydronephrosis,Chronic kidney disease, unspecified,Urinary complications, not elsewhere classified,Ventricular flutter,Urinary tract infection, site not specified,Infection and inflammatory reaction due to indwelling urinary catheter,Bladder neck obstruction,Retention of urine, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}

CHIEF COMPLAINT: Neck mass PRESENT ILLNESS: 81 y.o. woman with recent neck trauma, now on ventilator, presents with right neck mass noted at [**Hospital3 **]. The mass was noted yesterday and noted to bulge out during cough or Valsalva. There was concern for a tracheo-subcutaneous fistula so she was sent to ED for evaluation. A neck CT did not show evidence of subc air. It was concerning for either jugular vein dilatation or a mass in the supraclavicular fossa. However, further characterization could not be made based on a non-contrast CT so further imaging would be required. Pt is otherwise at her baseline. There are no acute resp issues and she is hemodynamically stable. She denies pain or dyspnea. MEDICAL HISTORY: 1) s/p fall with neck trauma 2) central cord syndrome 3) Respiratory failure secondary to cord involvement with psuedomonas, serratia and MRSA VAP. 4) HTN 5) Asthma 6) CAD s/o CABG, PAF 7) s/p thyroidectomy in teens 8) s/p hysterectomy MEDICATION ON ADMISSION: Linezolid 600mg [**Hospital1 **] Meropenem 1g q8h Diflucan 400mg qd (to complete [**2-3**]) Digoxin 125mcg every other day Lopressor 12.5 mg PO q6h Spiriva Flovent 220 2 puffs [**Hospital1 **] Albuterol prn Mucomyst nebs Ativan Prevacid Neurontin 300mg tid Questran 4g tid Fragmin 5000U daily ALLERGIES: Levaquin PHYSICAL EXAM: Gen arousable, responsive to commands, communicates nonverbally, in NAD HEENT NCAT, PERRL, anicteric. OP clear with dry MM. Neck: 5x2cm area above right clavicle that bulges with straining, no fluctuance, crepitus, erythema, tenderness, palpable mass. Lungs coarse BS b/l CV: RRR, nml S1S2, 3/6 systolic murmur. Abd: G-tube. soft, NT, ND, naBS Ext: no edema, warm/well perfused. Neuro: moves both upper extrem minimally to command, does not move LE to command (chronic) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: No history of tobacco or recent EtOH. Did not obtain history on former occupation. Currently resides at [**Hospital3 **]. Has multiple children involved in care.

Pneumonia, organism unspecified,Chronic respiratory failure,Atrial fibrillation,Dependence on respirator, status,Quadriplegia, C1-C4, complete,Gastrostomy status,Anemia, unspecified,Tracheostomy status,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Unspecified essential hypertension

Pneumonia, organism NOS,Chronic respiratory fail,Atrial fibrillation,Respirator depend status,Quadrplg c1-c4, complete,Gastrostomy status,Anemia NOS,Tracheostomy status,Aortocoronary bypass,Asthma NOS,Hypertension NOS

Admission Date: [**2118-2-2**] Discharge Date: [**2118-2-4**] Service: MEDICINE Allergies: Levaquin Attending:[**First Name3 (LF) 3326**] Chief Complaint: Neck mass Major Surgical or Invasive Procedure: none History of Present Illness: 81 y.o. woman with recent neck trauma, now on ventilator, presents with right neck mass noted at [**Hospital3 **]. The mass was noted yesterday and noted to bulge out during cough or Valsalva. There was concern for a tracheo-subcutaneous fistula so she was sent to ED for evaluation. A neck CT did not show evidence of subc air. It was concerning for either jugular vein dilatation or a mass in the supraclavicular fossa. However, further characterization could not be made based on a non-contrast CT so further imaging would be required. Pt is otherwise at her baseline. There are no acute resp issues and she is hemodynamically stable. She denies pain or dyspnea. Past Medical History: 1) s/p fall with neck trauma 2) central cord syndrome 3) Respiratory failure secondary to cord involvement with psuedomonas, serratia and MRSA VAP. 4) HTN 5) Asthma 6) CAD s/o CABG, PAF 7) s/p thyroidectomy in teens 8) s/p hysterectomy Social History: No history of tobacco or recent EtOH. Did not obtain history on former occupation. Currently resides at [**Hospital3 **]. Has multiple children involved in care. Family History: Non-contributory Physical Exam: Gen arousable, responsive to commands, communicates nonverbally, in NAD HEENT NCAT, PERRL, anicteric. OP clear with dry MM. Neck: 5x2cm area above right clavicle that bulges with straining, no fluctuance, crepitus, erythema, tenderness, palpable mass. Lungs coarse BS b/l CV: RRR, nml S1S2, 3/6 systolic murmur. Abd: G-tube. soft, NT, ND, naBS Ext: no edema, warm/well perfused. Neuro: moves both upper extrem minimally to command, does not move LE to command (chronic) Pertinent Results: [**2118-2-2**] 02:23AM WBC-15.2* RBC-3.03*# HGB-9.8*# HCT-28.0* MCV-92# PLT COUNT-480* NEUTS-82.9* LYMPHS-9.9* MONOS-3.5 EOS-3.6 BASOS-0.2 . GLUCOSE-98 UREA N-41* CREAT-0.7 SODIUM-137 POTASSIUM-4.0 CHLORIDE-98 TOTAL CO2-28 ANION GAP-11 . PT-12.5 PTT-23.2 INR(PT)-1.0 . Neck CT: 1. There is no air within the subcutaneous tissues of the right supraclavicular fossa to suggest a tracheal subcutaneous fistula. There is likely an enlarged right internal jugular vein v. a mass in the supraclavicular fossa on the right, though IV contrast could not be administered for confirmation. This finding could be confirmed with ultrasound. 2. Small lymph nodes within the neck and superior mediastinum. 3. Heavily calcified aorta. 4. Intralobular septal thickening and possible scarring at the lung apices. 5. Status post anterior fixation of the cervical spine. . Ultrasound: Right supraclavicular lesion represents the bulb of the right internal jugular vein. Brief Hospital Course: 81 y.o. woman with recent neck trauma, now on ventilator without failure to wean, presenting with new neck deformity. Pt is asymptomatic, and there does not appear to be any compromise of airway or circulation. .. 1) Neck Mass: Imaging findings were consistent with a dilatation/aneurysm of the R internal jugular vein. Vascular surgery evaluated the patient and determined no need for intervention at this time. They recommended a repeat ultrasound to evaluate the mass in 1 week. They also suggested a CT with venous phase contrast in 1 week to evaluate for any progression of the aneurysm. .. 2) Respiratory Failure: Pt has reportedly not been able to be weaned at [**Hospital1 **]. We continued her on current vent settings and did not attempt further weaning. She was stable on her current vent settings. .. 3) Ventilator associated pneumonia: She is on meropenem, colistin, and linezolid, which we contined as at rehab. She had a low-grade fever on arrival here, but otherwise showed no evidence of active infection and was afebrile thereafter. Antibiotics should be continued for the planned course (linezolid to be continued until [**2-9**], meropenem until [**2-10**], and colistin until [**2-7**], per the medication list from [**Hospital1 **]). .. 4) CAD: We continued lopressor at her usual dose. It is not clear why she is not on ASA. .. 5) Asthma: Continue spiriva, salmeterol, albuterol, and flovent. We held her mucomyst. . 6) F/E/N: Tube feeds were continued. Electrolytes were repleted as needed. .. 7) PPx: SC heparin for DVT ppx and PPI. Medications on Admission: Linezolid 600mg [**Hospital1 **] Meropenem 1g q8h Diflucan 400mg qd (to complete [**2-3**]) Digoxin 125mcg every other day Lopressor 12.5 mg PO q6h Spiriva Flovent 220 2 puffs [**Hospital1 **] Albuterol prn Mucomyst nebs Ativan Prevacid Neurontin 300mg tid Questran 4g tid Fragmin 5000U daily Discharge Medications: 1. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. 2. Digoxin 50 mcg/mL Elixir Sig: 0.125 mg PO EVERY OTHER DAY (Every Other Day). 3. Bacitracin Zinc Topical 4. Feosol 220 mg/5mL Elixir Sig: Three [**Age over 90 **]y Five (325) mg PO once a day. 5. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device Sig: One (1) cap Inhalation once a day. 6. Xenaderm Ointment Topical 7. Foradil Aerolizer 12 mcg Capsule, w/Inhalation Device Sig: One (1) Inhalation twice a day. 8. Flovent 220 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation twice a day. 9. Proventil 90 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation every four (4) hours as needed for shortness of breath or wheezing. 10. Mycostatin 100,000 unit/g Powder Sig: One (1) application Topical twice a day. 11. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours). 12. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO q2h as needed for agitation. 13. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty (30) mg PO DAILY (Daily). 14. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO three times a day. 15. Fragmin 5,000 anti-Xa u/0.2mL Syringe Sig: 5000 (5000) units Subcutaneous once a day. 16. Cholestyramine-Sucrose 4 g Packet Sig: One (1) Packet PO TID (3 times a day). 17. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: 10-15 MLs Mucous membrane [**Hospital1 **] (2 times a day). 18. Citracal 950 mg Tablet Sig: Two (2) Tablet PO q8h (). 19. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 20. Acetaminophen 500 mg/5 mL Liquid Sig: Six [**Age over 90 1230**]y (650) mg PO every four (4) hours as needed for fever or pain. 21. Meropenem 1 g Recon Soln Sig: 1000 (1000) mg Intravenous Q8H (every 8 hours) for 7 days: End date is 12/2905. 22. Linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 6 days: End date is [**2118-2-9**]. 23. Colistimethate Sodium 150 mg Recon Soln Sig: One (1) Recon Soln Injection [**Hospital1 **] (2 times a day) for 4 days: End date is [**2118-2-7**]. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Primary Diagnosis: right internal jugular aneurysm Discharge Condition: stable Discharge Instructions: 1. For new or concerning symptoms, please call your doctor or return to the emergency room for evaluation. 2. Please continue all medications as prescribed, we have not made any changes to your medications. 3. You will need a repeat ultrasound to evaluate your neck mass in about 1 week. A CT with venous phase contrast in 1 week may also be useful to evaluate the extent of the mass. Followup Instructions: Please obtain repeat ultrasound of neck mass in 1 week. CT with venous phase contrast in 1 week may also be useful.

486,518,427,V461,344,V441,285,V440,V458,493,401

{'Pneumonia, organism unspecified,Chronic respiratory failure,Atrial fibrillation,Dependence on respirator, status,Quadriplegia, C1-C4, complete,Gastrostomy status,Anemia, unspecified,Tracheostomy status,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Neck mass PRESENT ILLNESS: 81 y.o. woman with recent neck trauma, now on ventilator, presents with right neck mass noted at [**Hospital3 **]. The mass was noted yesterday and noted to bulge out during cough or Valsalva. There was concern for a tracheo-subcutaneous fistula so she was sent to ED for evaluation. A neck CT did not show evidence of subc air. It was concerning for either jugular vein dilatation or a mass in the supraclavicular fossa. However, further characterization could not be made based on a non-contrast CT so further imaging would be required. Pt is otherwise at her baseline. There are no acute resp issues and she is hemodynamically stable. She denies pain or dyspnea. MEDICAL HISTORY: 1) s/p fall with neck trauma 2) central cord syndrome 3) Respiratory failure secondary to cord involvement with psuedomonas, serratia and MRSA VAP. 4) HTN 5) Asthma 6) CAD s/o CABG, PAF 7) s/p thyroidectomy in teens 8) s/p hysterectomy MEDICATION ON ADMISSION: Linezolid 600mg [**Hospital1 **] Meropenem 1g q8h Diflucan 400mg qd (to complete [**2-3**]) Digoxin 125mcg every other day Lopressor 12.5 mg PO q6h Spiriva Flovent 220 2 puffs [**Hospital1 **] Albuterol prn Mucomyst nebs Ativan Prevacid Neurontin 300mg tid Questran 4g tid Fragmin 5000U daily ALLERGIES: Levaquin PHYSICAL EXAM: Gen arousable, responsive to commands, communicates nonverbally, in NAD HEENT NCAT, PERRL, anicteric. OP clear with dry MM. Neck: 5x2cm area above right clavicle that bulges with straining, no fluctuance, crepitus, erythema, tenderness, palpable mass. Lungs coarse BS b/l CV: RRR, nml S1S2, 3/6 systolic murmur. Abd: G-tube. soft, NT, ND, naBS Ext: no edema, warm/well perfused. Neuro: moves both upper extrem minimally to command, does not move LE to command (chronic) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: No history of tobacco or recent EtOH. Did not obtain history on former occupation. Currently resides at [**Hospital3 **]. Has multiple children involved in care. ### Response: {'Pneumonia, organism unspecified,Chronic respiratory failure,Atrial fibrillation,Dependence on respirator, status,Quadriplegia, C1-C4, complete,Gastrostomy status,Anemia, unspecified,Tracheostomy status,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Unspecified essential hypertension'}

CHIEF COMPLAINT: Respiratory failure at outside hospital PRESENT ILLNESS: 73 y/o woman presented to OSH in respiratory failure, intubated (for less than 24 hours), diuresed, and transferred to [**Hospital1 18**] on [**2155-2-16**]. Cath revealed 2vCAD, Echo: EF 35%, 2+MR. MEDICAL HISTORY: CAD s/p MI in [**2144**], s/p stent to LAD CHF EF 40% Hypertension Hypecholesterolemia Iron Def Anemia COPD Spinal stenosis, LBP MEDICATION ON ADMISSION: ASA Toprol XL 50' Lisinopril 40' Lasix 40' Lipitor 40' Clonidine patch Albuterol Fluticasone Sertraline Ferrous Sulfate ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: mo: CAD, fa: CAD, [**Last Name (un) **]:DM SOCIAL HISTORY: lives with daughter and grandson, retired, former tobacco, quit [**2144**], 20 pyh, rare alcohol, no drugs

Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Hemorrhage complicating a procedure,Anoxic brain damage,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Iron deficiency anemia, unspecified

CHF NOS,Mitral valve disorder,Surg compl-heart,Cardiogenic shock,Hemorrhage complic proc,Anoxic brain damage,Ac kidny fail, tubr necr,Acute respiratry failure,Chr airway obstruct NEC,Hyp kid NOS w cr kid V,Atrial fibrillation,Crnry athrscl natve vssl,Secundum atrial sept def,Iron defic anemia NOS

Admission Date: [**2155-2-16**] Discharge Date: [**2155-3-17**] Date of Birth: [**2081-10-26**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Respiratory failure at outside hospital Major Surgical or Invasive Procedure: CABG X 2, MV repair, PFO closure on [**2155-2-21**] emergent repair of atrial tear [**2-21**] trach, PEG, tunnelled dialysis catheter [**2155-3-12**] History of Present Illness: 73 y/o woman presented to OSH in respiratory failure, intubated (for less than 24 hours), diuresed, and transferred to [**Hospital1 18**] on [**2155-2-16**]. Cath revealed 2vCAD, Echo: EF 35%, 2+MR. Past Medical History: CAD s/p MI in [**2144**], s/p stent to LAD CHF EF 40% Hypertension Hypecholesterolemia Iron Def Anemia COPD Spinal stenosis, LBP Social History: lives with daughter and grandson, retired, former tobacco, quit [**2144**], 20 pyh, rare alcohol, no drugs Family History: mo: CAD, fa: CAD, [**Last Name (un) **]:DM Pertinent Results: [**2155-3-17**] 02:55AM BLOOD WBC-13.8* RBC-3.14* Hgb-9.5* Hct-29.0* MCV-92 MCH-30.3 MCHC-32.8 RDW-16.5* Plt Ct-251 [**2155-3-17**] 02:55AM BLOOD Plt Ct-251 [**2155-3-17**] 02:55AM BLOOD PT-14.9* PTT-36.8* INR(PT)-1.3* [**2155-3-17**] 02:55AM BLOOD UreaN-40* Creat-3.0* Cl-111* HCO3-25 [**2155-3-16**] 02:35AM BLOOD Glucose-168* UreaN-31* Creat-2.5* Na-140 K-4.4 Cl-107 HCO3-26 AnGap-11 [**2155-3-12**] 02:33AM BLOOD ALT-66* AST-42* LD(LDH)-361* AlkPhos-80 Amylase-242* TotBili-0.7 Brief Hospital Course: 73 y/o woman presented to OSH in respiratory failure, intubated (for less than 24 hours), diuresed, and transferred to [**Hospital1 18**] on [**2155-2-16**]. Cath revealed 2vCAD, Echo: EF 35%, 2+MR. She remained on the medical service, underwent the usual pre-operative testing, and was taken to the OR on [**2155-2-21**]. She was taken to the CSRU on Neo, Epi and propofol gtts. She weaned from the ventilator and was extubated the evening of surgery. She then had an episode of severe coughing, after which she dropped her BP, and had sudden increase in chest tube output. After emergent reintubation, an open chest resuscitation was initiated. A bleeding site was identified and repaired, and her chest was subsequently closed. Over the next few days, she remained somewhat hypotensive, requiring pressors and inotropes. Her renal status deteriorated, the renal medicine service was consulted, and CVVH was initiated. After discontinuation of sedation, she remained unresponsive. A neurology consult was obtained due to continued decreased level of responsiveness. Their opinion was that she had minimal brainstem function, with a very poor prognosis for any meaningful neurologic recovery. This was discussed with the family by Dr. [**Last Name (STitle) **] on multiple occasions throughout the course of the next few weeks. The family wanted to continue aggressive care despite the poor prognosis. She developed atrial fibrillation which was treated with amiodarone. Her vasopressors and inotropes were ultimately weaned off, and she has remained hemodynamically stable. She underwent tracheostomy, PEG, and tunnelled dialysis catheter on [**2155-3-12**]. She remains on ventilator support, being tube fed, and dialyzed 3x/week. She is ready to be transferred to a long term care facility. Medications on Admission: ASA Toprol XL 50' Lisinopril 40' Lasix 40' Lipitor 40' Clonidine patch Albuterol Fluticasone Sertraline Ferrous Sulfate Discharge Medications: 1. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for temperature >38.0. 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. Docusate Sodium 50 mg/5 mL Liquid Sig: Five (5) ml PO BID (2 times a day). 4. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**11-26**] Drops Ophthalmic PRN (as needed). 5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for fungal infection. 6. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 7 days. 7. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff Inhalation [**Hospital1 **] (2 times a day). 8. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**5-2**] Puffs Inhalation Q4H (every 4 hours). 9. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Midodrine 5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 12. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous DAILY (Daily) as needed. 13. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a day for 7 days. 14. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: anoxic brain injury s/p CABG renal failure Discharge Condition: guarded Discharge Instructions: trach care PEG care dialysis Followup Instructions: as needed Completed by:[**2155-3-17**]

428,424,997,785,998,348,584,518,496,403,427,414,745,280

{'Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Hemorrhage complicating a procedure,Anoxic brain damage,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Iron deficiency anemia, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Respiratory failure at outside hospital PRESENT ILLNESS: 73 y/o woman presented to OSH in respiratory failure, intubated (for less than 24 hours), diuresed, and transferred to [**Hospital1 18**] on [**2155-2-16**]. Cath revealed 2vCAD, Echo: EF 35%, 2+MR. MEDICAL HISTORY: CAD s/p MI in [**2144**], s/p stent to LAD CHF EF 40% Hypertension Hypecholesterolemia Iron Def Anemia COPD Spinal stenosis, LBP MEDICATION ON ADMISSION: ASA Toprol XL 50' Lisinopril 40' Lasix 40' Lipitor 40' Clonidine patch Albuterol Fluticasone Sertraline Ferrous Sulfate ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: mo: CAD, fa: CAD, [**Last Name (un) **]:DM SOCIAL HISTORY: lives with daughter and grandson, retired, former tobacco, quit [**2144**], 20 pyh, rare alcohol, no drugs ### Response: {'Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Hemorrhage complicating a procedure,Anoxic brain damage,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Iron deficiency anemia, unspecified'}

CHIEF COMPLAINT: lightheadedness at clinic neutropenic fever myelodypslastic syndrome PRESENT ILLNESS: This is a 78 year old male with a history of aplastic anemia requiring chronic transfusions who presents from clinic where he was getting his labs drawn. Pt states that after getting his blood drawn, he became lightheaded, felt weak and shaky. He was helped down by the staff and an ambulance was called. Pt states that he has felt weak and shaky for about the past week. He has also had some cold sweats and shaking chills, but has not taken his temperature. He states his temperature was elevated at clinic, and was 100.7 orally in ED. Patient admits to a chronic, non-productive cough, but reports no recent increase in its severity. No abdominal pain or diarrhea. Last BM was this morning. Denies dysuria, urinary frequency, or urgency. Denies any sore throat, rash, myalgias, or arthralgias. MEDICAL HISTORY: 1) Aplastic anemia dx [**4-19**] by bone marrow biopsy. Given some questions about a history of TB, he was treated with INH for one month and then started on prednisone 60mg daily on [**2192-7-5**]. He requires platelet transfusions weekly, and blood transfusions every few months. Complicated by retinal hemorrhage. 2) Pt remembers living in a sanitorium from age [**2-25**]. This prompted an investigation for TB, with subsequent sputum and bone marrow negative for acid fast bacilli. However, given a concern for this in face of starting steroids, Mr. [**Known lastname 22093**] is being treated with Isoniazid and Pyridoxine since [**2192-5-29**]. Chest CT showed evidence of granulomatous disease in the past, but no active disease. 3) kyphoscoliosis 4) L inguinal hernia. It is reducable and has been present for a long time. It is not painful MEDICATION ON ADMISSION: Prednisone 60mg PO daily (since [**7-5**]) pantoprazole 40mg PO daily folic acid 1mg PO daily, isoniazid 300mg PO daily (since [**5-29**]) pyridoxone 50mg PO daily (since [**5-29**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VITAL SIGNS: ED: Tmax: 100.7 HR: 111 BP: 126/83 RR: 20 O2: 99% RA T: 98.5 HR: 95 BP: 127/71 RR: 16 O2: 99% RA GENERAL: elderly male, comfortable lying in bed, No acute distress. HEENT: Conjunctivae are pink. Oropharynx is moist and clear, without petechiae. Neck: supple, no JVD, no LAD. LUNGS: Clear to auscultation and percussion bilaterally. HEART: RRR nl s1, s2, no gallops, rubs, or murmurs. ABDOMEN: Soft, distended (unchanged per pt) nontender, normoactive BS. Spleen not enlarged. Groin: reducible large L inguinal hernia. EXTREMITIES: no edema NEUROLOGIC: Alert and oriented with coherent speech and comprehension. CN II-XII nonfocal. Motor [**4-19**] upper and lower bilaterally. FAMILY HISTORY: There is no history of blood disorders. SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Has two grown daughters nearby. [**Name2 (NI) **] tobacco, quit 40 years ago Rare alcohol when he goes out

Septicemia due to pseudomonas,Abscess of anal and rectal regions,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Herpes simplex with other specified complications,Gangrene,Hematoma complicating a procedure,Other encephalopathy,Other and unspecified mycoses,Vascular disorders of male genital organs,Anal fistula,Unspecified hemorrhoids with other complication,Personal history of tuberculosis,Severe sepsis,Long-term (current) use of steroids,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other specified disorders of rectum and anus

Pseudomonas septicemia,Anal & rectal abscess,Unilat ing hernia w obst,H simplex complicat NEC,Gangrene,Hematoma complic proc,Encephalopathy NEC,Mycoses NEC & NOS,Male gen vascul dis NEC,Anal fistula,Hemrrhoid NOS w comp NEC,Prsnl hst tuberculosis,Severe sepsis,Long-term use steroids,Hypertension NOS,Renal & ureteral dis NOS,Rectal & anal dis NEC

Admission Date: [**2192-8-1**] Discharge Date: [**2192-9-5**] Date of Birth: [**2113-8-9**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 11754**] Chief Complaint: lightheadedness at clinic neutropenic fever myelodypslastic syndrome Major Surgical or Invasive Procedure: blood, platelet transfusions IV antibiotics Diverting transverese colosteomy w/ rod placement and removal Permacath placement History of Present Illness: This is a 78 year old male with a history of aplastic anemia requiring chronic transfusions who presents from clinic where he was getting his labs drawn. Pt states that after getting his blood drawn, he became lightheaded, felt weak and shaky. He was helped down by the staff and an ambulance was called. Pt states that he has felt weak and shaky for about the past week. He has also had some cold sweats and shaking chills, but has not taken his temperature. He states his temperature was elevated at clinic, and was 100.7 orally in ED. Patient admits to a chronic, non-productive cough, but reports no recent increase in its severity. No abdominal pain or diarrhea. Last BM was this morning. Denies dysuria, urinary frequency, or urgency. Denies any sore throat, rash, myalgias, or arthralgias. Past Medical History: 1) Aplastic anemia dx [**4-19**] by bone marrow biopsy. Given some questions about a history of TB, he was treated with INH for one month and then started on prednisone 60mg daily on [**2192-7-5**]. He requires platelet transfusions weekly, and blood transfusions every few months. Complicated by retinal hemorrhage. 2) Pt remembers living in a sanitorium from age [**2-25**]. This prompted an investigation for TB, with subsequent sputum and bone marrow negative for acid fast bacilli. However, given a concern for this in face of starting steroids, Mr. [**Known lastname 22093**] is being treated with Isoniazid and Pyridoxine since [**2192-5-29**]. Chest CT showed evidence of granulomatous disease in the past, but no active disease. 3) kyphoscoliosis 4) L inguinal hernia. It is reducable and has been present for a long time. It is not painful Social History: Lives with wife in [**Name (NI) **]. Has two grown daughters nearby. [**Name2 (NI) **] tobacco, quit 40 years ago Rare alcohol when he goes out Family History: There is no history of blood disorders. Physical Exam: PHYSICAL EXAMINATION: VITAL SIGNS: ED: Tmax: 100.7 HR: 111 BP: 126/83 RR: 20 O2: 99% RA T: 98.5 HR: 95 BP: 127/71 RR: 16 O2: 99% RA GENERAL: elderly male, comfortable lying in bed, No acute distress. HEENT: Conjunctivae are pink. Oropharynx is moist and clear, without petechiae. Neck: supple, no JVD, no LAD. LUNGS: Clear to auscultation and percussion bilaterally. HEART: RRR nl s1, s2, no gallops, rubs, or murmurs. ABDOMEN: Soft, distended (unchanged per pt) nontender, normoactive BS. Spleen not enlarged. Groin: reducible large L inguinal hernia. EXTREMITIES: no edema NEUROLOGIC: Alert and oriented with coherent speech and comprehension. CN II-XII nonfocal. Motor [**4-19**] upper and lower bilaterally. Pertinent Results: [**2192-8-1**] 11:25AM BLOOD WBC-0.8*# RBC-2.40* Hgb-7.6* Hct-21.9* MCV-91 MCH-31.6 MCHC-34.7 RDW-17.8* Plt Ct-7*# [**2192-8-1**] 11:25AM BLOOD Neuts-39* Bands-2 Lymphs-50* Monos-9 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2192-8-1**] 11:25AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-NORMAL Macrocy-1+ Microcy-NORMAL Polychr-NORMAL [**2192-8-2**] 03:45PM BLOOD PT-12.8 PTT-22.2 INR(PT)-1.1 [**2192-8-17**] 06:25AM BLOOD Fibrino-649* D-Dimer-1690* [**2192-8-17**] 06:25AM BLOOD FDP-10-40 [**2192-8-1**] 11:25AM BLOOD Gran Ct-310* [**2192-8-2**] 08:15AM BLOOD Glucose-125* UreaN-37* Creat-1.3* Na-137 K-4.8 Cl-102 HCO3-25 AnGap-15 [**2192-8-1**] 11:25AM BLOOD ALT-23 AST-23 LD(LDH)-208 AlkPhos-50 TotBili-0.5 [**2192-8-3**] 07:55AM BLOOD Lipase-29 [**2192-8-1**] 11:25AM BLOOD Albumin-3.2* Calcium-8.9 Phos-2.9 Mg-2.1 [**2192-8-16**] 06:50AM BLOOD Hapto-443* [**2192-8-17**] 06:25AM BLOOD VitB12-1604* Folate-16.3 . CT RECONSTRUCTION [**2192-8-2**] 6:12 PM CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST INDICATION: Gram-negative rod sepsis, febrile neutropenic, on steroids, evaluate for perforation colitis or abscess. COMPARISON: [**2192-5-18**]. IMPRESSION: 1. No evidence of intraabdominal abscess or bowel perforation. 2. Multiple punctate calcifications in the liver and spleen consistent with prior granulomatous infection. 3. Bilateral bowel-containing inguinal hernias without evidence of bowel obstruction. 4. Stable tiny (2 mm) left lower lobe pulmonary nodule. 5. Slight decrease in prominence of the numerous mesenteric lymph nodes. . CT CHEST W/O CONTRAST [**2192-8-6**] 4:12 PM INDICATION: Latent TB, on treatment, but now with steroids and new fevers. COMPARISON: Chest CT scan from [**2192-6-6**]. IMPRESSION: Multiple new ill-defined pulmonary nodules, some of which are located along bronchovascular bundles. The largest is an 11 x 14 mm right middle lobe nodule. Given the rapid appearance of these nodules, an infectious etiology is most likely. Given the patient's TB status, reactivation tuberculosis is high on the differential diagnosis. Additional considerations include fungal organisms, Nocardia, and bacterial pathogens. . CT CHEST W/O CONTRAST [**2192-8-13**] 2:19 PM Reason: ? worsening pulmonary nodules, starting empiric voraconazole Comparison was done to the CT chest of [**2192-8-6**]. IMPRESSION: Decrease in size of the right middle lobe nodule with appearance of a new nodule in the lingula. Mild bilateral lower lobe bronchiectasis with focal bronchiectasis in the lingula. Decrease in the tree-in-[**Male First Name (un) 239**] opacities in the left upper lobe. These findings could all represent [**Doctor First Name **] infection. A fungal infection is less likely given the decrease in size of the nodules within a period of one week. Tuberculous infection and Nocardia still remains in the differential diagnosis. . MR CONTRAST GADOLIN [**2192-8-17**] 12:08 PM Reason: ?infectious lesion or bleed COMPARISONS: None. IMPRESSION: [**Month/Day/Year **] MRI of the brain without evidence of an infectious process, intracranial hemorrhage, or an enhancing mass lesion. . CT CHEST W/CONTRAST [**2192-8-18**] 2:09 PM REASON FOR THIS EXAMINATION: PLEASE INCLUDE PELVIS CT 1) interval change of pulmonary nodules bilaterally 2) pelvic abscess? given scrotal ulcer and large hemorrhoids COMPARISON: [**2192-8-2**] CT of the abdomen and pelvis and chest CT dated [**2192-8-13**]. IMPRESSION: 1. Bilateral pulmonary nodules are stable to decreased in size. Probable stability of centrilobular nodular opacities within the left upper lobe. 2. Large extraluminal gas collection extending from right lateral aspect of the rectum to base of the penis and scrotum. Findings are consistent with perirectal abscess or other gas producing infectious process. 3. Multiple punctate calcifications in the liver and spleen consistent with prior granulomatous infection. Calcified and atrophic left kidney is suggestive of prior tuberculous infection. 4. Stable hypodense lesions in the right kidney and within the left lobe of the liver and caudate lobe of the liver, too small to accurately characterize. 5. Bilateral bowel-containing inguinal hernias without evidence of bowel obstruction. . Procedure date [**2192-8-18**]; Tissue received [**2192-8-21**] PERIANAL TISSUE Skin and subcutaneous tissue with acute inflammation and necrosis. Fungal (GMS) stain is negative. . CHEST PORT. LINE PLACEMENT [**2192-8-19**] 12:01 AM Reason: s/p CVL placement IMPRESSION: Support lines and tubes in satisfactory position, possible lower lobe pneumonia. . CHEST PORT. LINE PLACEMENT [**2192-9-3**] 12:20 PM Reason: r/o pneumothorax History of left subclavian Port-A-Cath placement. The left subclavian CV line overlies the SVC with its tip encroaching on the lateral wall of the SVC. The right jugular CV line is at the cavoatrial junction. No pneumothorax. Apparent widening of the superior mediastinum could be due to the tortuous aorta previously noted and accentuated on the semi-upright AP film, but reevaluate on followup studies. There is a small area of opacity consistent with atelectasis in the left lower lobe. . Microbiology: Blood cx's [**8-1**]: [**1-20**] pseudomonas blood cx [**8-2**]: negative Cryptococcal antigen: negative Galactomannan: negative Histoplasma ag: negative TB PCR - negative . [**2192-8-1**] 11:25 am BLOOD CULTURE LEFT ARM VENIPUNCTURE. **FINAL REPORT [**2192-8-7**]** AEROBIC BOTTLE (Final [**2192-8-4**]): REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 22094**] 7F [**2192-8-2**] AT 1014. PSEUDOMONAS AERUGINOSA. FINAL SENSITIVITIES. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PSEUDOMONAS AERUGINOSA | CEFEPIME-------------- 2 S CEFTAZIDIME----------- 4 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ 2 S IMIPENEM-------------- =>16 R MEROPENEM------------- 8 I PIPERACILLIN---------- 8 S PIPERACILLIN/TAZO----- 8 S TOBRAMYCIN------------ <=1 S ANAEROBIC BOTTLE (Final [**2192-8-7**]): NO GROWTH. . [**2192-8-8**] 6:15 pm BRONCHOALVEOLAR LAVAGE GRAM STAIN (Final [**2192-8-8**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S). ACID FAST SMEAR (Final [**2192-8-10**]): NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. FUNGAL CULTURE (Final [**2192-8-21**]): NO FUNGUS ISOLATED. RESPIRATORY CULTURE (Final [**2192-8-10**]): 10,000-100,000 ORGANISMS/ML. OROPHARYNGEAL FLORA. VIRAL CULTURE (Preliminary): HERPES SIMPLEX VIRUS TYPE 1. CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.. GEN-PROBE AMPLIFIED M. TUBERCULOSIS DIRECT TEST (MTD) (Preliminary): SENT TO STATE FOR M.TB DIRECT TEST [**2192-8-12**]. . [**2192-8-10**] 9:00 am SPUTUM Source: Induced. GRAM STAIN (Final [**2192-8-10**]): >25 PMNs and >10 epithelial cells/100X field. Gram stain indicates extensive contamination with upper respiratory secretions. Bacterial culture results are invalid. PLEASE SUBMIT ANOTHER SPECIMEN. RESPIRATORY CULTURE (Final [**2192-8-10**]): TEST CANCELLED, PATIENT CREDITED. FUNGAL CULTURE (Final [**2192-8-24**]): NO FUNGUS ISOLATED. ACID FAST SMEAR (Final [**2192-8-11**]): NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. . [**2192-8-19**] 12:40 am SWAB Site: PERITONEAL **FINAL REPORT [**2192-8-25**]** GRAM STAIN (Final [**2192-8-19**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CHAINS. WOUND CULTURE (Final [**2192-8-25**]): Due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for Pseudomonas aeruginosa, Staphylococcus aureus and beta streptococcus). SENSIS ON ENTEROCOCCUS PER DR [**Last Name (STitle) **]. GOLD. ENTEROCOCCUS SP.. MODERATE GROWTH STRAIN 1. ENTEROCOCCUS SP.. MODERATE GROWTH STRAIN 2. PSEUDOMONAS AERUGINOSA. RARE GROWTH. CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). RARE GROWTH. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | ENTEROCOCCUS SP. | | AMPICILLIN------------ =>32 R <=2 S CHLORAMPHENICOL------- <=4 S LEVOFLOXACIN---------- =>8 R 1 S PENICILLIN------------ =>64 R 2 S VANCOMYCIN------------ =>32 R <=1 S ANAEROBIC CULTURE (Final [**2192-8-23**]): Mixed bacterial flora-culture screened for B. fragilis, C. perfringens, and C. septicum. None isolated. . Brief Hospital Course: Mr. [**Known lastname 22093**] is a 78 y.o. man with a history of aplastic anemia, who presented with febrile neutropenia. Respiratory status improved on RA and IS to bedside. Hemorrhoidal bleeding stopped and improved with [**Last Name (un) **] baths and topical hydrocortisone. His inguinal hernia has been nonreducible and nontender. Blood sugars have been well controlled on ISS and [**Hospital1 **] FS, now discontinued since off steroids. Portacath placed [**9-3**] and central line pulled, sent for culture. # Febrile neutropenia - Patient initially presented with febrile neutropenia and was started on cefepime. No vancomycin was administered given no history of permanent lines. Blood cultures initially grew out pansensitive pseudomonas. Surveillance cultures were negative. Patient initially stayed afebrile for several days, however then began having low grade fevers. Given concern for immune supression from steroids as well as lack of benefit for his aplastic anemia, his prednisone was tapered off. In addition, Mr. [**Known lastname 22093**] was continued on INH and Vitamin B6 for suppression of his suspected prior tuberculosis. He was also started on atovaquone for PCP [**Name Initial (PRE) 1102**]. Mr. [**Known lastname 22093**] remained hemodynamically stable and asymptomatic. Further work-up of fevers was undertaken. Cryptococcal antigen, galactomannan and histoplasma antigen were sent off and were all negative. A BAL was performed and TB-PCR sent to the state lab given concern for reactivation of his childhood TB in face of decreased immune function. TB-PCR was negative and nothing grew out on BAL cultures, but eventually returned PCR pos for HSV. Acyclovir was started on [**2192-8-16**]. On [**8-13**] liposomal amphotericin was started as empiric coverage for fungal infection and vancomycin was added for broader bacterial coverage. A CT-guided biopsy of the pulmonary nodules seen on chest CT was planned, however patient's platelet count decreased to 6000 and the biopsy was deferred. The right pulmonary nodule had decreased in size on repat chest CT. On [**8-15**], patient had an episode of loss of consciousness with witnessed shaking, no loss of urine or tongue biting. His EKG showed ST segment elevation in leads VI-V3 new from prior and the patient was subsequently taken for emergent ECHO which was unchanged from prior. Cardiac enzymes were negative x3. EEG showed encephalopathy but no epileptiform waveforms. CXR was unchanged from priors. Patient was started on metoprolol 25mg [**Hospital1 **] per cardiology. Psychiatry was consulted secondary to patient depressed affect and change in mental status. Per psychiatry, change in behavior was due to encephalopathy from infection and recommended head MR, haldol IV at night and treating his infection. Head MR [**First Name (Titles) **] [**Last Name (Titles) 11580**]. Patient did not have any subsequent episodes and his vitals continued to be stable. Patient continued to spike low graded fevers and cultures were sent with no growth. Patient was noted to have some diarrhea but no formed bowel movements on [**8-15**]. Nurse noted scrotal edema on [**8-17**] and wound care was consulted regarding skin breakdown in the region of the perineum. On [**8-17**], cefipime was discontinued and tobramycin, clindamycin and zosyn were started for better pseudamonal coverage. On [**8-18**], Mr. [**Known lastname 22093**] had a torso CT which showed findings consistent with a perirectal abscess. Surgery was consulted and found a rectal fistula tracking into the perineaum. The patient was taken emergently to the OR for debridement and a diverting tranverse colostomy. Pathology of skin sample submitted showed acute inflammation and necrosis but no fungus on gram stain. Patient tolerated the surgery well, was extubated and subsequently returned to 7 Feldburg [**8-20**] where he continued to be afebrile, tolerating a full diet and weaned off oxygen. On [**8-21**] G-CSF was started to promote wound healing. Clindamycin and tobramycin were discontinued and changed to ciprofloxacin. Acyclovir was discontinued on [**8-23**], ambisome on [**8-25**], and vancomycin on [**8-26**]. Swab of perineum at time of surgery grew VRE, pseudamonas and corynebacterium. Vancomycin was discontinued and daptomycin was begun on [**8-27**]. Atovaquone was discontinued on [**8-30**] and ciprofloxacillin was discontinued on [**9-4**]. Mr. [**Known lastname 22093**] remained afebrile and no further growth was noted on suubsequent cultures. He will continue to take zosyn and daptomycin until [**9-10**]. He will continue on INH until follow-up at [**Hospital **] clinic on [**10-7**]. . # Rectal abscess/tranverse colostomy - CT abd, pelvis showed perirectal abscess, found to have a rectal fistula into perineal and scrotal region, s/p OR drainage of the abscess and a diverting transverse colostomy; ostomy care and surgery following - rod removed from ostomy [**9-1**] - TID dressing changes of peri-rectal abscess . # Hypertension - on metoprolol 50mg [**Hospital1 **] - consider increasing metoprolol if still hypertensive - disctoniued captopril as it can cause neutropenia . # Anemia, thrombocytopenia, agranulocytosis - pt had gradual worsening of his anemia, requiring several blood transfusions over the course of his admission. He was noted to have some bright red blood originating from an intenal hemorrhoid. Following platelet transfusion, his hemorrhoidal bleeding stopped. Patient continued to require interval transfusions secondary to his aplastic anemia. Mr. [**Known lastname 22093**] was tapered off prednisone in order to promote healing of his rectal wound and started G-CSF, neutropenic, ANC stable. Still requiring intermittent platelet transfusions for counts <10K. . # hx of TB - INH was continued during the hosptial course. Rifampin was discontinued as ID was comfortable with a single [**Doctor Last Name 360**]. TB-PCR was negative, no need additional for additional coverage. He will follow-up in [**Hospital **] clinic regarding duration of INH treatment. . # FEN - neutropenic diet, electrolyte repletion . # PPx - PPI, no need for anticoagulation given thrombocytopenia, avoid all heparin products . # code - full Medications on Admission: Prednisone 60mg PO daily (since [**7-5**]) pantoprazole 40mg PO daily folic acid 1mg PO daily, isoniazid 300mg PO daily (since [**5-29**]) pyridoxone 50mg PO daily (since [**5-29**]) Discharge Medications: 1. Isoniazid 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 6. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for transfusion. 7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H (every 4 to 6 hours) as needed for fever. 8. Hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal TID (3 times a day). 9. Lidocaine HCl 5 % Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 10. Zinc Oxide-Cod Liver Oil 40 % Ointment Sig: One (1) Appl Topical PRN (as needed). 11. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **] () as needed. 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 13. Methylphenidate 5 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 14. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed. 15. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 16. Morphine Sulfate 1-5 mg IV Q4H:PRN 17. Piperacillin-Tazobactam Na 4.5 gm IV Q8H 18. Daptomycin 300 mg IV Q24H 19. Medication zosyn and daptomycin to be continued until [**2192-9-10**] Discharge Disposition: Extended Care Facility: [**Hospital3 **] Hospital Discharge Diagnosis: 1. Pseudomonal sepsis 2. Rectal abscess s/p debridement 3. HTN 4. Aplastic anemia with anemia, thrombocytopenia, and agranulocytosis 5. s/p colonic resection with diverting ostomey 6. Prior tuberculosis Discharge Condition: Afebrile, wound appears clean, pain controlled. Discharge Instructions: If you have fevers/chills, shortness of breath, chest pain, nausea/vomiting, abd pain, please call your PCP or come to the ED for evaluation. 1. Take medications as directed. 2. Complete a total 2 week course of abx. (Please continue daptomycin and zosyn until [**9-10**]). 3. Attend all follow up appointments. 4. Continue isoniazid until ID appointment on [**10-12**]. 5. Continue daily Neupogen injection until follow-up appointment with Dr. [**Last Name (STitle) 410**] [**9-20**]. 6. Check CBC/platelets three times a week and tranfuse if Hct<25, platelets <10. Per the following protocol: Packed RBCs for HCT<25. If <21, [**Name8 (MD) 138**] MD. Platelets: if am (or any other) plt count: <20,000/ul: Recheck plts at 5 PM; <10,000/ul: give one bag plt product. Check post platelet count. If <10,000, repeat procedure above until plts >10,000. if <10,000/ul or bleeding, [**Name8 (MD) 138**] MD. Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 5026**], MD Where: [**Hospital6 29**] HEMATOLOGY/BMT Phone:[**Telephone/Fax (1) 3237**] Date/Time:[**2192-9-20**] 10:00 Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Where: [**Hospital6 29**] HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2192-9-20**] 10:00 Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] TAN Where: LM [**Hospital Unit Name 4337**] DISEASE Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2192-10-12**] 9:30 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD Where: [**Hospital6 29**] SURGICAL SPECIALTIES [**Location (un) **] Phone:[**Telephone/Fax (1) 1231**] Date/Time:[**2192-9-14**] 11:30 Completed by:[**2192-9-5**]

038,566,550,054,785,998,348,117,608,565,455,V120,995,V586,401,593,569

{'Septicemia due to pseudomonas,Abscess of anal and rectal regions,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Herpes simplex with other specified complications,Gangrene,Hematoma complicating a procedure,Other encephalopathy,Other and unspecified mycoses,Vascular disorders of male genital organs,Anal fistula,Unspecified hemorrhoids with other complication,Personal history of tuberculosis,Severe sepsis,Long-term (current) use of steroids,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other specified disorders of rectum and anus'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: lightheadedness at clinic neutropenic fever myelodypslastic syndrome PRESENT ILLNESS: This is a 78 year old male with a history of aplastic anemia requiring chronic transfusions who presents from clinic where he was getting his labs drawn. Pt states that after getting his blood drawn, he became lightheaded, felt weak and shaky. He was helped down by the staff and an ambulance was called. Pt states that he has felt weak and shaky for about the past week. He has also had some cold sweats and shaking chills, but has not taken his temperature. He states his temperature was elevated at clinic, and was 100.7 orally in ED. Patient admits to a chronic, non-productive cough, but reports no recent increase in its severity. No abdominal pain or diarrhea. Last BM was this morning. Denies dysuria, urinary frequency, or urgency. Denies any sore throat, rash, myalgias, or arthralgias. MEDICAL HISTORY: 1) Aplastic anemia dx [**4-19**] by bone marrow biopsy. Given some questions about a history of TB, he was treated with INH for one month and then started on prednisone 60mg daily on [**2192-7-5**]. He requires platelet transfusions weekly, and blood transfusions every few months. Complicated by retinal hemorrhage. 2) Pt remembers living in a sanitorium from age [**2-25**]. This prompted an investigation for TB, with subsequent sputum and bone marrow negative for acid fast bacilli. However, given a concern for this in face of starting steroids, Mr. [**Known lastname 22093**] is being treated with Isoniazid and Pyridoxine since [**2192-5-29**]. Chest CT showed evidence of granulomatous disease in the past, but no active disease. 3) kyphoscoliosis 4) L inguinal hernia. It is reducable and has been present for a long time. It is not painful MEDICATION ON ADMISSION: Prednisone 60mg PO daily (since [**7-5**]) pantoprazole 40mg PO daily folic acid 1mg PO daily, isoniazid 300mg PO daily (since [**5-29**]) pyridoxone 50mg PO daily (since [**5-29**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VITAL SIGNS: ED: Tmax: 100.7 HR: 111 BP: 126/83 RR: 20 O2: 99% RA T: 98.5 HR: 95 BP: 127/71 RR: 16 O2: 99% RA GENERAL: elderly male, comfortable lying in bed, No acute distress. HEENT: Conjunctivae are pink. Oropharynx is moist and clear, without petechiae. Neck: supple, no JVD, no LAD. LUNGS: Clear to auscultation and percussion bilaterally. HEART: RRR nl s1, s2, no gallops, rubs, or murmurs. ABDOMEN: Soft, distended (unchanged per pt) nontender, normoactive BS. Spleen not enlarged. Groin: reducible large L inguinal hernia. EXTREMITIES: no edema NEUROLOGIC: Alert and oriented with coherent speech and comprehension. CN II-XII nonfocal. Motor [**4-19**] upper and lower bilaterally. FAMILY HISTORY: There is no history of blood disorders. SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Has two grown daughters nearby. [**Name2 (NI) **] tobacco, quit 40 years ago Rare alcohol when he goes out ### Response: {'Septicemia due to pseudomonas,Abscess of anal and rectal regions,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Herpes simplex with other specified complications,Gangrene,Hematoma complicating a procedure,Other encephalopathy,Other and unspecified mycoses,Vascular disorders of male genital organs,Anal fistula,Unspecified hemorrhoids with other complication,Personal history of tuberculosis,Severe sepsis,Long-term (current) use of steroids,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other specified disorders of rectum and anus'}

CHIEF COMPLAINT: SOB, transfer for ST elevations PRESENT ILLNESS: Ms. [**Known lastname 72067**] is an 89 year old female with severe asthma, HTN, HL, DM, and CAD who was admitted to the MICU due to acute SOB and ST elevations. She is now being transferred to the floor. MEDICAL HISTORY: - Hypertension - Hyperlipidemia - Diabetes - s/p thyroid surgery - h/o severe asthma, no PFTs in our system, recently on steroid taper - h/o CRI - h/o blood clot in the leg several years ago MEDICATION ON ADMISSION: mdur 60mg PO daily Amlodipine 10mg PO daily Folic acid 1mg PO daily Albuterol nebs q4 hours prn HCTZ 12.5mg Po daily Spiriva 1 cap IH daily Colace 100mg PO BID Prednisone 10mg PO taper (currently 20mg dose (taper [**7-20**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 98.1 84 148/79 23 98%RA General: Disheveled African-American elderly female in NAD. Eyelids with slight drooping bilaterally and eyes with haziness diffusely. HEENT: Sclera anicteric, MMM, oropharynx clear but with poor dentition Neck: Supple with JVP 9-10cm Lungs: Decreased air movement throughout with low-pitched expiratory wheezes bilaterally and faintly. CV: Regular rate with marked ectopy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. Does have extra skin hanging on abdomen suggestive of previous weight loss. Ext: Warm, well perfused, no clubbing, cyanosis. RUE edema just below the elbow. FAMILY HISTORY: OSH transfer note states that she has a family history of premature CAD and that both her parents are deceased. SHe states that parents died of old age and "a natural death." She has 2 sisters who are in NC but she doesn't know about their health. SOCIAL HISTORY: States she smoked 1ppd x most of her life, cannot give quit date history (once she said [**2119**], once she said 1 month ago). Denies EtOH use. Denies other drug use. Lives alone in [**Location (un) **], MA and has a sister in NC. Had one daughter who passed away recently from asthma exacerbation.

Chronic obstructive asthma with (acute) exacerbation,Acute kidney failure, unspecified,Takotsubo syndrome,Hyperosmolality and/or hypernatremia,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified

Ch obst asth w (ac) exac,Acute kidney failure NOS,Takotsubo syndrome,Hyperosmolality,Chr diastolic hrt fail,Delirium d/t other cond,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Chr kidney dis stage III,Anemia in chr kidney dis,Ben hy kid w cr kid I-IV

Admission Date: [**2151-7-26**] Discharge Date: [**2151-7-30**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1943**] Chief Complaint: SOB, transfer for ST elevations Major Surgical or Invasive Procedure: Endotracheal intubation and extubation Mechanical ventilation Cardiac catheterization History of Present Illness: Ms. [**Known lastname 72067**] is an 89 year old female with severe asthma, HTN, HL, DM, and CAD who was admitted to the MICU due to acute SOB and ST elevations. She is now being transferred to the floor. She has frequent exacerbations of her asthma and was recently treated at [**Hospital3 **] for a COPD/asthma exacerbation. She was discharged home and developed acute SOB, diaphoresis, and HTN in the ambulance. Her ECG at the time showed ST elevations in the lateral wall and she was given NTG, lasix, ASA, and taken back to [**Location (un) **]. She was found to be hypoxic and agitated and intubated for airway protection. She was then started on a nitro gtt and heparin gtt due to ST elevations and transferred to [**Hospital1 18**]. In the [**Hospital1 18**] ED, she was found to be hypertensive to 225/118 and was admitted to the MICU on versed and a heparin gtt (nitro gtt had been weaned off due to downtrending BPs). In the MICU, she was noted to have diffuse ST elevations and a code STEMI was called. She was taken to the cath lab and found to have no flow-limiting lesions but elevated filling pressures and was felt to have Takotsubo's cardiomyopathy with an estimated EF 40%. She was diuresed in the MICU with 40mg IV lasix and also given insulin and D50 for hyperkalemia. Her course was also complicated by agitation and the patient pulling out her PICC line and EJ IV access. She was also hitting and scratching the nurses this morning and was given haldol 2mg IM x 1 at 5:30am with excellent calming effect. She also had hypernatremia and was given 1L D5W yesterday. She currently has no IV access and has not had labs drawn since yesterday. She was switched from IV beta blocker to oral this morning. Currently she states that she is mildly short of breath but feeling much better than previous. She has no other complaints, other than wanting to go home. REVIEW OF SYSTEMS: She denies any headaches, confusion, chest pain, palpitations, cough, abdominal pain, nausea, vomiting, diarrhea, constipation, or urinary symptoms. She has a foley catheter in place. Past Medical History: - Hypertension - Hyperlipidemia - Diabetes - s/p thyroid surgery - h/o severe asthma, no PFTs in our system, recently on steroid taper - h/o CRI - h/o blood clot in the leg several years ago Social History: States she smoked 1ppd x most of her life, cannot give quit date history (once she said [**2119**], once she said 1 month ago). Denies EtOH use. Denies other drug use. Lives alone in [**Location (un) **], MA and has a sister in NC. Had one daughter who passed away recently from asthma exacerbation. Family History: OSH transfer note states that she has a family history of premature CAD and that both her parents are deceased. SHe states that parents died of old age and "a natural death." She has 2 sisters who are in NC but she doesn't know about their health. Physical Exam: Vitals: 98.1 84 148/79 23 98%RA General: Disheveled African-American elderly female in NAD. Eyelids with slight drooping bilaterally and eyes with haziness diffusely. HEENT: Sclera anicteric, MMM, oropharynx clear but with poor dentition Neck: Supple with JVP 9-10cm Lungs: Decreased air movement throughout with low-pitched expiratory wheezes bilaterally and faintly. CV: Regular rate with marked ectopy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. Does have extra skin hanging on abdomen suggestive of previous weight loss. Ext: Warm, well perfused, no clubbing, cyanosis. RUE edema just below the elbow. Pertinent Results: Admission Labs: [**2151-7-26**] 04:40AM WBC-13.9*# RBC-3.38* HGB-10.2* HCT-32.9* MCV-97 MCH-30.3 MCHC-31.1 RDW-16.2* [**2151-7-26**] 04:40AM NEUTS-93.9* LYMPHS-3.9* MONOS-1.3* EOS-0.8 BASOS-0.1 [**2151-7-26**] 04:40AM PLT COUNT-224 [**2151-7-26**] 04:40AM PT-11.7 PTT-32.0 INR(PT)-1.0 [**2151-7-26**] 04:40AM ALT(SGPT)-25 AST(SGOT)-42* CK(CPK)-61 ALK PHOS-99 TOT BILI-0.5 [**2151-7-26**] 04:40AM GLUCOSE-124* UREA N-34* CREAT-1.5* SODIUM-142 POTASSIUM-5.4* CHLORIDE-110* TOTAL CO2-24 ANION GAP-13 [**2151-7-26**] 04:40AM cTropnT-0.20* [**2151-7-26**] 04:40AM CK-MB-5 [**2151-7-26**] 03:31PM LACTATE-1.0 K+-5.5* Discharge Labs: [**2151-7-30**] 05:15AM BLOOD WBC-8.3 RBC-3.46* Hgb-10.3* Hct-32.2* MCV-93 MCH-29.7 MCHC-31.9 RDW-15.8* Plt Ct-182 [**2151-7-30**] 05:15AM BLOOD PT-11.5 PTT-27.0 INR(PT)-1.0 [**2151-7-30**] 05:15AM BLOOD Glucose-89 UreaN-50* Creat-1.6* Na-142 K-3.8 Cl-103 HCO3-32 AnGap-11 [**2151-7-27**] 04:31PM BLOOD CK-MB-5 cTropnT-0.55* [**2151-7-30**] 05:15AM BLOOD Calcium-10.6* Phos-2.3* Mg-2.1 Studies: CT Head [**2151-7-26**] : No acute intracranial hemorrhage or mass effect. CXR [**2151-7-28**]:As compared to the previous examination, there is no relevant change. Due to projection effect, the cardiac silhouette appears slightly larger than before. However, no evidence of pulmonary edema is seen. Moderate tortuosity of the thoracic aorta. No newly occurred focal parenchymal opacity suggesting pneumonia. No pleural effusions, no pneumothorax. TTE [**2151-7-27**]: The left atrium is elongated. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction suggested with distal septal and apical hypokinesis. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are moderately thickened. There is mild aortic valve stenosis (valve area 1.2-1.9cm2). Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2149-7-15**], a mild regional wall motion abnormality is now seen suggestive of CAD. CARDIAC CATH [**2151-7-26**]: 1. Coronary angiography of this right dominant system revealed no significant coronary artery disease. The LMCA appeared normal. The LAD, LCx, and RCA had minor luminal irregularities with marked tortuosity. 2. Limited resting hemodynamics demonstrated low-normal systemic arterial blood pressure (SBP 109 mm Hg). There was no gradient upon pullback of the catheter from the LV into the aorta. 3. Left ventriculography revealed marked distal anterior, apical, and distal inferoapical severe hypokinesis/ akinesis with contraction of the basal segments, with an estimated LVEF of 40%. There was no mitral regurgitation. FINAL DIAGNOSIS: 1. No significant angiographically apparent coronary artery disease. 2. Marked LV apical dysfunction consistent with Takotsubo cardiomyopathy. RUE Ultrasound [**2151-7-29**]: No evidence of DVT of the right upper extremity. Brief Hospital Course: 89 year old female with dCHF, HTN and severe asthma requiring recurrent ED visits currently on prednisone taper, transferred from OSH with respiratory distress intubated for airway protection and ECG changes now s/p clean cardiac catheterization. #. Respiratory distress: Patient has had recurrent exacerbations of COPD vs asthma requiring repeated treatment with steroids. She carries diagnosis of asthma and smoked 1 pack per week in past and has been on spiriva. She improved rapidly with steroids IV which were transitioned to oral. There was no documentation of hypercapnia or hypoxia prior to intubation so unclear if she actually had respiratory failure or was just intubated for airway protection given ECG changes. Wheezing and air movement improved with nebulizers and steroids and she extubated without difficulty on [**7-27**]. Given elevated BP requiring nitro gtt prior to intubation, may have had some component of flash pulmonary edema as well but CXR was clear without evidence of volume overload or pneumonia. She was also given lasix 40 IV x 1 and then 20 PO x 1 for some mild component of volume overlaod but was satting well on room air prior to trasnfer to floor. She is being discharged on a prednisone taper as well as standing nebulizer treatments. #. ECG changes/Takotsubo's Cardiomyopathy: ECG with ST elevations in V2-6 and positive troponins which peaked at 0.58 then trended down. Cardiology was consulted and Code STEMI was called on arrival to the MICU and she was taken for cardiac catheteterization. She was also initially started on heparin gtt and integrillin drip. There were no flow limiting lesions so heparin and integrillin stopped. ECG changes and positive troponin felt to be due to Takotsubo's cardiomyopathy. She was started on ASA 325 daily, metoprolol, and an ACE-inhibitor. She should have an repeat TTE in [**5-18**] weeks. #. HTN: Was initially hypertensive on nitro gtt prior to trasnfer which was quickly weaned off in ED and BP remained improved and normalized back on home regimen HCTZ, Imdur and amlodipine. She was also started on an ACE-inhibitor and beta blocker, which can be uptitrated after discharge as needed. #. Chronic diastolic CHF: Known diastolic dysfunction with EF >55% in the past and EF now depressed 40% on LV gram done in cath lab but repeat formal TTE with improved EF. BB and ACE were started. #. [**Last Name (un) **]: Cr 1.7 from baseline 1.2-1.3 which improved slightly with gentle diuresis. FEurea 34%. It was felt that her renal function was likely worsened by dye load but stable at time of transfer. She was given NAC after her contrast load. #. Hyperkalemia: K 6.8 increased from 5.4 on admission. Possibly related to worsening renal function vs acidemia from progressive hypercarbia. Improved with insulin/D50, lasix, bicarb and calcium gluconate. #. Anemia: Hematocrit remained at baseline 32. #. Delirium: Was combative and agitated [**7-28**] post-extubation which responded well to 2mg IM haldol and she was alert oriented and cooperative at time of floor transfer and subsequently thereafter. #. Code Status: She was full code during this hospitalization Medications on Admission: mdur 60mg PO daily Amlodipine 10mg PO daily Folic acid 1mg PO daily Albuterol nebs q4 hours prn HCTZ 12.5mg Po daily Spiriva 1 cap IH daily Colace 100mg PO BID Prednisone 10mg PO taper (currently 20mg dose (taper [**7-20**]) Discharge Medications: 1. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 2. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Nebulization Inhalation Q6H (every 6 hours). 5. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 6. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO twice a day. 7. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO once a day for 1 days: Take 3 tablets (60mg) daily for 1 day, then take 2 tablets (40mg) daily for 3 days, then take 1 tablet (20mg) daily for 3 days, then take 10mg daily for 3 days. 8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 10. Ipratropium Bromide 0.02 % Solution Sig: One (1) Nebulization Inhalation Q6H (every 6 hours). 11. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Insulin Lispro 100 unit/mL Solution Sig: Per sliding scale Subcutaneous ASDIR (AS DIRECTED). Discharge Disposition: Extended Care Facility: [**Hospital6 25759**] & Rehab Center - [**Location (un) **] Discharge Diagnosis: Primary Diagnoses: - Chronic obstructive pulmonary disease exacerbation - Takotsubo's cardiomyopathy - Hyperkalemia - Delirium - Anemia - Acute kidney injury Secondary Diagnoses: - Hypertension - Type 2 diabetes mellitus - Hyperlipidemia - Chronic kidney disease, stage 3 - H/o blood clot in the leg several years ago Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted to the hospital with shortness of breath. You were intubated and placed on a ventilator for a few days. You underwent a cardiac catheterization which showed that you did not have a heart attack and you do not have significant coronary artery disease. You were also treated for an exacerbation of your COPD. Changes to your medications: ADDED albuterol nebulizers every 4 hours ADDED ipratropium nebulizers every 4 hours ADDED lisinopril 2.5mg by mouth daily ADDED metoprolol tartrate 12.5mg by mouth twice daily STOP Spiriva (you should restart this medication when you stop taking ipratropium nebulizers) ADDED aspirin 325mg by mouth daily START insulin sliding scale while at rehab Followup Instructions: You are being discharged to a rehabilitation facility. You should be followed by the physician at your rehab facility while you are there. You should have your electrolytes checked in one week and creatinine checked in one week. You should have follow-up echocardiogram in 1 week. When you are discharged, please call your primary care provider, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17029**], to schedule a follow-up appointment at [**Telephone/Fax (1) 17030**].

493,584,429,276,428,293,272,250,585,285,403

{'Chronic obstructive asthma with (acute) exacerbation,Acute kidney failure, unspecified,Takotsubo syndrome,Hyperosmolality and/or hypernatremia,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: SOB, transfer for ST elevations PRESENT ILLNESS: Ms. [**Known lastname 72067**] is an 89 year old female with severe asthma, HTN, HL, DM, and CAD who was admitted to the MICU due to acute SOB and ST elevations. She is now being transferred to the floor. MEDICAL HISTORY: - Hypertension - Hyperlipidemia - Diabetes - s/p thyroid surgery - h/o severe asthma, no PFTs in our system, recently on steroid taper - h/o CRI - h/o blood clot in the leg several years ago MEDICATION ON ADMISSION: mdur 60mg PO daily Amlodipine 10mg PO daily Folic acid 1mg PO daily Albuterol nebs q4 hours prn HCTZ 12.5mg Po daily Spiriva 1 cap IH daily Colace 100mg PO BID Prednisone 10mg PO taper (currently 20mg dose (taper [**7-20**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 98.1 84 148/79 23 98%RA General: Disheveled African-American elderly female in NAD. Eyelids with slight drooping bilaterally and eyes with haziness diffusely. HEENT: Sclera anicteric, MMM, oropharynx clear but with poor dentition Neck: Supple with JVP 9-10cm Lungs: Decreased air movement throughout with low-pitched expiratory wheezes bilaterally and faintly. CV: Regular rate with marked ectopy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. Does have extra skin hanging on abdomen suggestive of previous weight loss. Ext: Warm, well perfused, no clubbing, cyanosis. RUE edema just below the elbow. FAMILY HISTORY: OSH transfer note states that she has a family history of premature CAD and that both her parents are deceased. SHe states that parents died of old age and "a natural death." She has 2 sisters who are in NC but she doesn't know about their health. SOCIAL HISTORY: States she smoked 1ppd x most of her life, cannot give quit date history (once she said [**2119**], once she said 1 month ago). Denies EtOH use. Denies other drug use. Lives alone in [**Location (un) **], MA and has a sister in NC. Had one daughter who passed away recently from asthma exacerbation. ### Response: {'Chronic obstructive asthma with (acute) exacerbation,Acute kidney failure, unspecified,Takotsubo syndrome,Hyperosmolality and/or hypernatremia,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified'}

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Mrs. [**Known firstname 2894**] [**Known lastname 2895**] is a very nice 62 year-old woman with significant past medical history of diabtes mellitus type 2, hypertension, hyperlipidemia, CAD s/p CABG who comes with three weeks of shortness of breath and dyspnea on excertion. Patient states that she is not very active at home given baseline shortness of breath, which is thought to be secondarely to her heart disease and COPD/Asthma, but she is able to do 1 flight of stairs with difficulty. However, during the last 3 weeks she has noted progressive SOB with less activity such as 10 steps. She denies any nausea, vomit, cough, chest pain, palpitations, wheezing associated with the SOB. She still uses either 1 or no pillows at night and can lie flat without difficulty. She weights herself daily and has been with diet to try to lose wieght. There have been no sick contacts and she denies any fever, chills, rigors, cough, rhinorrhea, arthralgias, muscle pains, diarrhea, dysuria, urinary frequency. She went to see her endocrinologist that follows her for her diabetes mellitus and was asked to come to our emergency room. Her VS at that time were: BP 167/71 mmHg, P 72 BPM, SpO2 O2 93% oN RA. . Per patient's report she had a stress test done in [**Month (only) **] last year, but could not walk for more than a couple of minutes. There was no imaging done. She had not had a cardiac cath since her CABG. . In the ER her initial VS were BP 163/61 mmHg, P63 BPM, RR 17, 94% on RA, T 98.4 F. She had an ECG that showed occasional PVCs with LVH by Sokolow-[**Doctor Last Name **] cirteria with TWI in I, II avL and V5-V6 as well as <1mm ST depression in I, II and V5-V6 without any dynamic changes. Patient was admitted for ROMI. On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: . CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: ~10 years ago. Anatomy unknown. -PERCUTANEOUS CORONARY INTERVENTIONS: None. -PACING/ICD: None. CAD PAST MEDICAL HISTORY: * Hypertension * Hyperlipidemia * Diabetes Mellitus Type 2 on insulin * H/o Left thyroid macro-follicular nodule s/p lobectomy in [**2133**] by Dr. [**Last Name (STitle) 2896**] Asthma/COPD GERD Colonic Adenoma CURRENT [**Last Name (un) **] MEDICATION ON ADMISSION: Avapro 300 mg PO Daily Vytorin 10/40 mg PO Daily Lantus 30 am 50 PM Novolog 30 u with meals Almodipine 10 mg PO Daily Vitamin D (cholecalciferol) 1,000 mg PO Daily Furosemide 40 mg PO Daily Carvedilol 25 mg PO BID Omeprazole 20 mg PO BID Spiriva with HandiHaler 18 mcg IH Daily Aspirin 325 mg PO Daily ALLERGIES: Lisinopril / Bupropion / Rosiglitazone Derivatives PHYSICAL EXAM: VITAL SIGNS - Temp 96.1 F, BP 154/74 mmHg, HR 58 BPM, RR 16 X', O2-sat 98% RA. Glucose 106 GENERAL - well-appearing african-american woman in NAD, Oriented x3, comfortable, Mood, affect appropriate. HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK - supple, no thyromegaly, JVD 7 cm, no carotid bruits LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs), No c/c/e. No femoral bruits. SKIN - no rashes or lesions. No stasis dermatitis, ulcers, scars, or xanthomas. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**4-17**] throughout, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Mother died of chronic kidney disease secondarely to DM; father died of "old age". No family history of cancer. SOCIAL HISTORY: She lives in [**Location 2268**] with her husband. History of smoking and quit in [**2136**] with 12.5 pack-years aproximately. Denies any current or past history of alcohol intake or illegal substance use.

Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux

Crnry athrscl natve vssl,Chr airway obstruct NEC,Chronic kidney dis NOS,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Obesity NOS,DMII wo cmp nt st uncntr,Esophageal reflux

Admission Date: [**2148-1-2**] Discharge Date: [**2148-1-6**] Date of Birth: [**2085-9-6**] Sex: F Service: MEDICINE Allergies: Lisinopril / Bupropion / Rosiglitazone Derivatives Attending:[**First Name3 (LF) 2736**] Chief Complaint: dyspnea Major Surgical or Invasive Procedure: none History of Present Illness: Mrs. [**Known firstname 2894**] [**Known lastname 2895**] is a very nice 62 year-old woman with significant past medical history of diabtes mellitus type 2, hypertension, hyperlipidemia, CAD s/p CABG who comes with three weeks of shortness of breath and dyspnea on excertion. Patient states that she is not very active at home given baseline shortness of breath, which is thought to be secondarely to her heart disease and COPD/Asthma, but she is able to do 1 flight of stairs with difficulty. However, during the last 3 weeks she has noted progressive SOB with less activity such as 10 steps. She denies any nausea, vomit, cough, chest pain, palpitations, wheezing associated with the SOB. She still uses either 1 or no pillows at night and can lie flat without difficulty. She weights herself daily and has been with diet to try to lose wieght. There have been no sick contacts and she denies any fever, chills, rigors, cough, rhinorrhea, arthralgias, muscle pains, diarrhea, dysuria, urinary frequency. She went to see her endocrinologist that follows her for her diabetes mellitus and was asked to come to our emergency room. Her VS at that time were: BP 167/71 mmHg, P 72 BPM, SpO2 O2 93% oN RA. . Per patient's report she had a stress test done in [**Month (only) **] last year, but could not walk for more than a couple of minutes. There was no imaging done. She had not had a cardiac cath since her CABG. . In the ER her initial VS were BP 163/61 mmHg, P63 BPM, RR 17, 94% on RA, T 98.4 F. She had an ECG that showed occasional PVCs with LVH by Sokolow-[**Doctor Last Name **] cirteria with TWI in I, II avL and V5-V6 as well as <1mm ST depression in I, II and V5-V6 without any dynamic changes. Patient was admitted for ROMI. On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Past Medical History: . CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: ~10 years ago. Anatomy unknown. -PERCUTANEOUS CORONARY INTERVENTIONS: None. -PACING/ICD: None. CAD PAST MEDICAL HISTORY: * Hypertension * Hyperlipidemia * Diabetes Mellitus Type 2 on insulin * H/o Left thyroid macro-follicular nodule s/p lobectomy in [**2133**] by Dr. [**Last Name (STitle) 2896**] Asthma/COPD GERD Colonic Adenoma CURRENT [**Last Name (un) **] Social History: She lives in [**Location 2268**] with her husband. History of smoking and quit in [**2136**] with 12.5 pack-years aproximately. Denies any current or past history of alcohol intake or illegal substance use. Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Mother died of chronic kidney disease secondarely to DM; father died of "old age". No family history of cancer. Physical Exam: VITAL SIGNS - Temp 96.1 F, BP 154/74 mmHg, HR 58 BPM, RR 16 X', O2-sat 98% RA. Glucose 106 GENERAL - well-appearing african-american woman in NAD, Oriented x3, comfortable, Mood, affect appropriate. HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK - supple, no thyromegaly, JVD 7 cm, no carotid bruits LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs), No c/c/e. No femoral bruits. SKIN - no rashes or lesions. No stasis dermatitis, ulcers, scars, or xanthomas. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**4-17**] throughout, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Pertinent Results: [**2148-1-2**] 07:38PM GLUCOSE-133* UREA N-27* CREAT-1.3* SODIUM-143 POTASSIUM-3.9 CHLORIDE-110* TOTAL CO2-23 ANION GAP-14 [**2148-1-2**] 07:38PM CK(CPK)-232* [**2148-1-2**] 07:38PM cTropnT-<0.01 [**2148-1-2**] 07:38PM CK-MB-4 proBNP-456* [**2148-1-2**] 07:38PM WBC-10.2 RBC-4.29 HGB-11.1* HCT-34.0* MCV-79* MCH-25.8* MCHC-32.6 RDW-15.5 [**2148-1-2**] 07:38PM NEUTS-68.7 LYMPHS-24.6 MONOS-4.3 EOS-1.5 BASOS-0.8 [**2148-1-2**] 07:38PM PLT COUNT-246 [**2148-1-5**] 03:39AM BLOOD WBC-11.0 RBC-4.52 Hgb-11.6* Hct-35.4* MCV-78* MCH-25.6* MCHC-32.6 RDW-15.4 Plt Ct-250 [**2148-1-5**] 03:39AM BLOOD Plt Ct-250 [**2148-1-5**] 03:39AM BLOOD Glucose-246* UreaN-20 Creat-1.6* Na-137 K-4.2 Cl-102 HCO3-28 AnGap-11 [**2148-1-5**] 03:39AM BLOOD CK(CPK)-191 [**2148-1-5**] 03:39AM BLOOD CK-MB-3 cTropnT-<0.01 [**2148-1-5**] 03:39AM BLOOD Calcium-9.0 Phos-3.5 Mg-1.8 [**2148-1-6**] 08:24AM BLOOD WBC-11.7* RBC-4.43 Hgb-11.4* Hct-35.4* MCV-80* MCH-25.7* MCHC-32.2 RDW-15.1 Plt Ct-238 [**2148-1-6**] 08:24AM BLOOD Glucose-193* UreaN-28* Creat-1.5* Na-137 K-4.8 Cl-102 HCO3-25 AnGap-15 [**2148-1-6**] 08:24AM BLOOD Calcium-9.7 Phos-3.4 Mg-2.3 [**2148-1-3**] 06:40AM BLOOD %HbA1c-9.3* . Echo: [**2148-1-4**] The left atrium is elongated. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with hypokinesis of the basal and mid-inferior walls, as well as basal inferoseptal and inferolateral segments (dominant RCA or LCx territory). The remaining segments contract normally (LVEF = 45%). No masses or thrombi are seen in the left ventricle. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. No clinically-significant valvular disease seen. . [**2148-1-3**]- cardiac perfusion IMPRESSION: 1. Fixed, medium sized, moderate reduction in photon counts involving the PDA territory. 2. Normal left ventricular cavity size. Hypokinesis of the mid and basal inferior wall and the basal inferoseptum with preserved systolic function. . [**2148-1-3**] - stress This is a 62 year old IDDM woman s/p CABG, htn, COPD who was referred for exercise stress with nuclear imaging following serial negative cardiac enzymes to evaluate symptoms of dyspnea on exertion. The patient completed 6.75 minutes of a modified [**Doctor First Name **] protocol and reached a peak MET capacity of 4.8 which represents a fair functional capacity for her age. The test was terminated due to fatigue. There were no complaints of chest, neck, back, or arm pain. Compared to baseline ECG with prominent voltage consistent with LVH and associated repolarization changes, there were no significant ST segment changes appreciated. The rhythm was sinus throughout the study with multifocal PVCs and two ventricular couplets. Blood pressure response to exercise was appropriate. The heart rate response was blunted in the setting of beta blockade therapy. IMPRESSION: No anginal symptoms or significant ST segment changes over baseline abnormalities at a fair functional capacity for age. Nuclear report sent separately. . [**2148-1-2**] PA AND LATERAL VIEWS OF THE CHEST: The patient is status post median sternotomy and CABG. The cardiac silhouette is mildly enlarged. The pulmonary vascularity is prominent, but there is no evidence of overt pulmonary edema. Linear opacities within both lung bases are compatible with subsegmental atelectasis. No pleural effusion, focal consolidation, or pneumothorax is seen. The osseous structures demonstrate no acute skeletal abnormalities. IMPRESSION: Bibasilar subsegmental atelectasis. Brief Hospital Course: Mrs. [**Known firstname 2894**] [**Known lastname 2895**] is a 62 year-old woman with significant past medical history of diabtes mellitus type 2, hypertension, hyperlipidemia, CAD s/p CABG who comes with three weeks of shortness of breath and dyspnea on exertion. . CAD: s/p CABG ([**2137**]). Patient presented with dyspnea over three weeks. She did not have EKG changes and she did not have elevation in her cardiac enzymes. Given her risk factors and her equivocal presentation, she underwent a nuclear stress test which showed a fixed defect in the PDA territory and hypokinesis of the mid and basal inferior wall and the basal inferoseptum with preserved systolic function. She underwent cardiac catheterization which showed a patent LIMA to LAD graft, patent SVG to OM1 and an occluded SVG to RCA. She had stenosis of the native RCA. An attempt was made to angioplasty the native RCA; however, this was complicated by dissection. The patient remained hemodynamically stable and completely asymptomatic during and after the attempted intervention, and a post-procedure ECG demonstrated no changes from baseline. The patient and her husband were apprised of the complication in detail, and appeared to understand that the vessel was not amenable to further intervention at this time, and that medical management was appropriate. She was admitted to the CCU overnight for monitoring and remained stable. She returned to the regular floor for medical optimization. She was discharged on aspirin, a betablocker, [**Last Name (un) **], and a statin. She was scheduled for repeat nuclear stress test as an outpatient with an eye toward enrollment in cardiac rehabilitation to be coordinated by her cardiologist. . #. SOB - Her dyspnea was likely an anginal equivalent for this patient or a manifestation of heart failure due to occlusion of her SVG-RCA graft. She also had a history of diastolic heart failure, although no current evidence of pulmonary edema. Her EF on this hospitalization was 45% due to regional dysfunction. She also endorsed weight gain over the last year and has a history of COPD, all of which could have contributed to her symptoms. She was encouraged to take her Spiriva consistently and weight loss is encouraged. Her presentation and hospital course was discussed with her PCP with whom she will have close outpatient follow up. She was without dyspnea on exertion at the time of discharge, and was able to ambulate maintaining her oxygen saturation in the high 90s on room air. She reported feeling markedly improved in regards to her shortness of breath as compared to her baseline presentation. . #HTN: Prior to admission she had presented to her endocrinologist's office with systolic blood pressures in the 180s. Her atenolol was discontinued at that time and she was started on Coreg 25mg twice a day. She was bradycardic in the 50s on admission, and her Coreg as reduced to 12.5mg twice a day. She was discharged on this dose. Her blood pressure should continue to be monitored as an outpatient and she was encouraged to check home BP readings periodically to ensure optimal control. . #. Increased creatinine - Her Cr was 1.3 on admission. She received prehydration and treatment with mucomyst prior to catheterization. Her Cr increased to 1.6 post cath. Her lasix and avapro were temporarily held, and restarted as her creatinine improved. . # Diabetes: She had a history of diabetes mellitus managed with insulin. Her HBA1C on this admission was 9.3%. Tighter glycemic control was encouraged, with insulin dosing to be titrated as an outpatient, in conjunction with dietary discretion and exercise. She was counseled on the adverse cardiovascular and general health consequences of suboptimal glycemic control. Medications on Admission: Avapro 300 mg PO Daily Vytorin 10/40 mg PO Daily Lantus 30 am 50 PM Novolog 30 u with meals Almodipine 10 mg PO Daily Vitamin D (cholecalciferol) 1,000 mg PO Daily Furosemide 40 mg PO Daily Carvedilol 25 mg PO BID Omeprazole 20 mg PO BID Spiriva with HandiHaler 18 mcg IH Daily Aspirin 325 mg PO Daily Discharge Medications: 1. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. Lantus 100 unit/mL Cartridge Sig: Thirty (30) units Subcutaneous in the mornings. 8. Lantus 100 unit/mL Cartridge Sig: Fifty (50) units Subcutaneous at bedtime. 9. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 10. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary Dyspnea on exertion. . Secondary Obesity. Coronary Artery Disease status post CABG Hypertension Hyperlipidemia Discharge Condition: stable, baseline ambulatory status (fully ambulatory) alert and oriented to person, place and time Discharge Instructions: You were admitted to the hospital because you were having worsening shortness of breath. You had a cardiac catheterization which showed that you had had a heart attack. During the procedure, one of the heart blood vessels was dissected. You went to the intensive care unit. You did well and returned to the regular floor. Some of your symptoms are also likely due to your COPD from past smoking. Please take your spiriva consistently. . The following changes were made to your medications. . We DECREASED carvedilol to: carvedilol 12.5 mg twice a day. . We STARTED: Atorvastatin 80mg daily . We STOPPED Ezetimibe/Vytorin: No other changes were made to your medications . Continue the following medications: -Avapro 300mg po daily -Home dose lantus and insulin -amlodipine 10mg daily -Vitamin D 1000mg daily -Lasix 40mg po daily -omeprazole 20mg daily -Spiriva 18mcg inhaled daily -Aspirin 325mg daily Followup Instructions: Appointment #1 MD: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Specialty: PCP [**Name Initial (PRE) 2897**]/ Time: [**Last Name (LF) 766**], [**1-8**] at 11:20am Location: [**Location (un) 2274**]-[**Location (un) 2898**], [**University/College 2899**], [**Location (un) **],[**Numeric Identifier 2900**] Phone number: [**Telephone/Fax (1) 2115**] . Appointment #2 Please call [**Telephone/Fax (1) 62**] and make an appointment to follow up with Dr. [**Last Name (STitle) **] in 4 weeks. . We will schedule you to have a stress imaging test as an outpatient to aide in cardiac rehab. Please have our stress test and then discuss the results and cardiac rehab with Dr. [**Last Name (STitle) **] at your follow up appointment.

414,496,585,403,272,278,250,530

{'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Mrs. [**Known firstname 2894**] [**Known lastname 2895**] is a very nice 62 year-old woman with significant past medical history of diabtes mellitus type 2, hypertension, hyperlipidemia, CAD s/p CABG who comes with three weeks of shortness of breath and dyspnea on excertion. Patient states that she is not very active at home given baseline shortness of breath, which is thought to be secondarely to her heart disease and COPD/Asthma, but she is able to do 1 flight of stairs with difficulty. However, during the last 3 weeks she has noted progressive SOB with less activity such as 10 steps. She denies any nausea, vomit, cough, chest pain, palpitations, wheezing associated with the SOB. She still uses either 1 or no pillows at night and can lie flat without difficulty. She weights herself daily and has been with diet to try to lose wieght. There have been no sick contacts and she denies any fever, chills, rigors, cough, rhinorrhea, arthralgias, muscle pains, diarrhea, dysuria, urinary frequency. She went to see her endocrinologist that follows her for her diabetes mellitus and was asked to come to our emergency room. Her VS at that time were: BP 167/71 mmHg, P 72 BPM, SpO2 O2 93% oN RA. . Per patient's report she had a stress test done in [**Month (only) **] last year, but could not walk for more than a couple of minutes. There was no imaging done. She had not had a cardiac cath since her CABG. . In the ER her initial VS were BP 163/61 mmHg, P63 BPM, RR 17, 94% on RA, T 98.4 F. She had an ECG that showed occasional PVCs with LVH by Sokolow-[**Doctor Last Name **] cirteria with TWI in I, II avL and V5-V6 as well as <1mm ST depression in I, II and V5-V6 without any dynamic changes. Patient was admitted for ROMI. On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: . CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: ~10 years ago. Anatomy unknown. -PERCUTANEOUS CORONARY INTERVENTIONS: None. -PACING/ICD: None. CAD PAST MEDICAL HISTORY: * Hypertension * Hyperlipidemia * Diabetes Mellitus Type 2 on insulin * H/o Left thyroid macro-follicular nodule s/p lobectomy in [**2133**] by Dr. [**Last Name (STitle) 2896**] Asthma/COPD GERD Colonic Adenoma CURRENT [**Last Name (un) **] MEDICATION ON ADMISSION: Avapro 300 mg PO Daily Vytorin 10/40 mg PO Daily Lantus 30 am 50 PM Novolog 30 u with meals Almodipine 10 mg PO Daily Vitamin D (cholecalciferol) 1,000 mg PO Daily Furosemide 40 mg PO Daily Carvedilol 25 mg PO BID Omeprazole 20 mg PO BID Spiriva with HandiHaler 18 mcg IH Daily Aspirin 325 mg PO Daily ALLERGIES: Lisinopril / Bupropion / Rosiglitazone Derivatives PHYSICAL EXAM: VITAL SIGNS - Temp 96.1 F, BP 154/74 mmHg, HR 58 BPM, RR 16 X', O2-sat 98% RA. Glucose 106 GENERAL - well-appearing african-american woman in NAD, Oriented x3, comfortable, Mood, affect appropriate. HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK - supple, no thyromegaly, JVD 7 cm, no carotid bruits LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs), No c/c/e. No femoral bruits. SKIN - no rashes or lesions. No stasis dermatitis, ulcers, scars, or xanthomas. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**4-17**] throughout, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Mother died of chronic kidney disease secondarely to DM; father died of "old age". No family history of cancer. SOCIAL HISTORY: She lives in [**Location 2268**] with her husband. History of smoking and quit in [**2136**] with 12.5 pack-years aproximately. Denies any current or past history of alcohol intake or illegal substance use. ### Response: {'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 58 year-old female with a past medical history of type 1 diabetes mellitus, hypertension, hypercholesterolemia, end stage renal disease, coronary artery disease status post coronary artery bypass graft who presented from an outside hospital with hypotension likely secondary to sepsis. She was recently admitted at [**Hospital1 69**] from [**1-5**] to [**1-21**] when she had a coronary artery bypass graft done for three vessel disease with normal EF. Her postoperative course was complicated by respiratory failure requiring a tracheostomy, atrial fibrillation, renal failure, requiring hemodialysis and an embolic cerebrovascular accident diagnosed on the CT of the head as a right MCA inferior division stroke. The patient had a G tube placed and was discharged to [**Hospital3 7665**] [**Hospital3 417**] and as an outpatient she had been treated for an Enterobacter line infection with Vancomycin and Cefepime. Cultures seemed to have been negative. On the 29th the patient had fevers and hypotension. She was transferred from [**Hospital3 417**] to [**Hospital3 **]. A right femoral line was placed and cultures were done. The patient had ID consulted and they recommended discontinuing the dialysis line as they suspected that was the source of her sepsis and elevated white blood cell count. The patient was started on neo-synephrine for her hypotension and transferred to [**Hospital1 69**]. MEDICAL HISTORY: 1. Type 1 diabetes mellitus. 2. Hypertension. 3. Hypercholesterolemia. 4. End stage renal disease. 5. Transient ischemic attack eleven years ago. 6. C section. 7. History of AV fistula. 8. Coronary artery disease status post coronary artery bypass graft [**2119-1-2**]. 9. Cerebrovascular accident [**2119-1-6**]. 10. Tracheostomy [**2119-1-14**]. 11. G tube placed on [**2119-1-18**]. 12. Atrial fibrillation postop. 13. Legally blind. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: She does not smoke, drink or use drugs. She lives at [**Hospital3 **].

Other specified septicemias,Infection and inflammatory reaction due to other vascular device, implant, and graft,Septic shock,Disruption of internal operation (surgical) wound,Acute kidney failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease

Septicemia NEC,React-oth vasc dev/graft,Septic shock,Disrup internal op wound,Acute kidney failure NOS,Atrial fibrillation,Acute & chronc resp fail,CHF NOS,Hyp kid NOS w cr kid V

Admission Date: [**2119-1-31**] Discharge Date: [**2091-4-2**] Date of Birth: [**2059-12-22**] Sex: F Service: MEDICAL ICU HISTORY OF PRESENT ILLNESS: This is a 58 year-old female with a past medical history of type 1 diabetes mellitus, hypertension, hypercholesterolemia, end stage renal disease, coronary artery disease status post coronary artery bypass graft who presented from an outside hospital with hypotension likely secondary to sepsis. She was recently admitted at [**Hospital1 69**] from [**1-5**] to [**1-21**] when she had a coronary artery bypass graft done for three vessel disease with normal EF. Her postoperative course was complicated by respiratory failure requiring a tracheostomy, atrial fibrillation, renal failure, requiring hemodialysis and an embolic cerebrovascular accident diagnosed on the CT of the head as a right MCA inferior division stroke. The patient had a G tube placed and was discharged to [**Hospital3 7665**] [**Hospital3 417**] and as an outpatient she had been treated for an Enterobacter line infection with Vancomycin and Cefepime. Cultures seemed to have been negative. On the 29th the patient had fevers and hypotension. She was transferred from [**Hospital3 417**] to [**Hospital3 **]. A right femoral line was placed and cultures were done. The patient had ID consulted and they recommended discontinuing the dialysis line as they suspected that was the source of her sepsis and elevated white blood cell count. The patient was started on neo-synephrine for her hypotension and transferred to [**Hospital1 69**]. PAST MEDICAL HISTORY: 1. Type 1 diabetes mellitus. 2. Hypertension. 3. Hypercholesterolemia. 4. End stage renal disease. 5. Transient ischemic attack eleven years ago. 6. C section. 7. History of AV fistula. 8. Coronary artery disease status post coronary artery bypass graft [**2119-1-2**]. 9. Cerebrovascular accident [**2119-1-6**]. 10. Tracheostomy [**2119-1-14**]. 11. G tube placed on [**2119-1-18**]. 12. Atrial fibrillation postop. 13. Legally blind. MEDICATIONS AT HOME: 1. Plavix 75 mg q.d. 2. Colace 100 mg b.i.d. 3. Vancomycin 500 q.d. 4. Vitamin B complex. 5. Prevacid 30 q day. 6. Keppra 500 b.i.d. 7. Albuterol and Atrovent nebs prn. 8. Amiodarone 200 q.d. 9. Aspirin 325 q.d. 10. Cefepime 1 gram q.d. 11. Heparin subq. 12. Reglan 10 mg q.d. 13. Sliding scale insulin. 14. K-phos. ALLERGIES: No known drug allergies. TUBE FEEDS: She was getting nephro feeds at 40 cc an hour. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: She does not smoke, drink or use drugs. She lives at [**Hospital3 **]. PHYSICAL EXAMINATION: Vital signs on admission her temperature was 101. Blood pressure 120/40. Heart rate 85. Respiratory rate 14. She was 99% on room air. Her vent settings, she was on assist control 500 by 12 with an FIO2 of 40% and a PEEP of 5. In general, she was a pleasant female lying in bed. HEENT her sclera were anicteric. Her left eye was nonreactive. Her right eye had surgical cataract removal. Cardiovascular regular rate and rhythm. Normal S1 and S2. No murmurs, rubs or gallops. Lungs were clear to auscultation bilaterally. She had suturing staples intact. Her wound was dry. Abdomen was soft, nontender, nondistended. Bowel sounds are present. Extremities she had a right subclavian tunnel catheter and the left femoral catheter. Neurological she was sedated. She did not withdraw to pain. She did have doll's eye present. LABORATORIES ON ADMISSION: BUN and creatinine of 59 and 3.8 respectively. White blood cell count 23 with 78% polys, 4% lymphocytes, 10 bands. Liver function tests were within normal limits. Urinalysis was negative. Electrocardiogram was sinus at 80 beats per minute with a left bundle branch block and a normal axis. HOSPITAL COURSE: The patient was admitted to the Medical Intensive Care Unit Service. 1. Sepsis: The source was initially felt to be a possible line infection. She was pancultured. It appeared that the source of her sepsis was an organism called actinobactor baummanni. She was placed on Ceptaz, Vancomycin, Flagyl initially once the organisms was speciated. She completed a fourteen day course of Unasyn. 2. Mental status: It appeared that her mental status waxed and waned throughout her admission. The patient did receive an LP and a repeat head CT, which were both negative. The Neurology Service was consulted and they felt that an electroencephalogram should be performed. The electroencephalogram showed no evidence of focal seizure activity. She was continued on her Keppra for her history of seizure disorder. Otherwise no changes were made. 3. Respiratory failure: She was continued on her ventilator settings throughout hospital admission. She was weaned to trach collar at the time of discharge. She intermittently needed to resume pressure support ventilation. However, on the Friday prior to discharge she did have what is likely an aspiration event. She was kept on assist control for three days and then transitioned back to trach collar, she tolerated well. 4. Diabetes mellitus: She was continued on sliding scale insulin for some period of time. She was on an insulin drip. Daily insulin requirements were converted to Glargine and sliding scale insulin. The patient's blood sugars were well controlled at the time of discharge. 5. Renal failure: The patient continued hemodialysis per her normal routine throughout her admission. A new tunneled left subclavian catheter was placed. 6. Coronary artery disease: The patient has a history of coronary artery disease. She was continued on her aspirin and Plavix. 7. History of atrial fibrillation: She was continued on her Amiodarone. 8. Fluids, electrolytes and nutrition: She was maintained on her tube feeds. The day prior to discharge the concentration of protein was increased in her tube feeds. 9. Surgical: During the [**Hospital 228**] hospital course the patient's sternotomy wound began to open. The patient was taken to the Operating Room for surgical debridement of her sternotomy wounds. The patient tolerated this procedure well. She had four JP drains in. These were followed by plastic surgery. The JP drains were discontinued when they put out less then 30 cc per day respectively. She will follow up with Plastic Surgery as an outpatient. 10. Prophylaxis: The patient had a left PICC line placed for intravenous antibiotics, which will be discontinued prior to discharge to rehab. The patient remained full code throughout her admission and communication was with her niece who is her health care proxy. DISCHARGE TO: The patient was discharged to an extended care facility. DISCHARGE INSTRUCTIONS: She is to follow up with her primary care physician in the next three to four weeks and follow up with surgery as directed. FINAL DIAGNOSES: 1. Septic shock. 2. Respiratory failure acute and chronic. 3. Chronic renal failure. 4. Coronary artery disease status post coronary artery bypass graft. 5. History of atrial fibrillation. 6. Coronary artery bypass graft wound dehiscence. 7. Type 1 diabetes mellitus with retinopathy nephropathy. 8. Hypertension. 9. Hyperlipidemia. 10. History of transient ischemic attack. 11. History of seizure disorder. 12. Aspiration. MAJOR SURGICAL AND INVASIVE PROCEDURES: She had the wound debridements and she had tunnel catheter placement for hemodialysis. She had a left PICC line placed. DISCHARGE CONDITION: She was stable on trach collar intermittently needing pressure support ventilation at night. DISCHARGE MEDICATIONS: Discharge medications will be dictated at the time of discharge. At this time it will be, 1. Plavix 75 mg po q.d. 2. Amiodarone 200 po q.d. 3. Colace and Senna. 4. Aspirin 325 q.d. 5. Vitamin B complex. 6. Keppra 500 mg po b.i.d. 7. Zinc sulfate 320 mg po q.d. 8. Vitamin C 500 mg po q.d. 9. Reglan 5 mg intravenously q 12. 10. Protonix 40 mg intravenously q.d. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 4561**] Dictated By:[**Name8 (MD) 8736**] MEDQUIST36 D: [**2119-2-20**] 01:17 T: [**2119-2-20**] 07:35 JOB#: [**Job Number 31936**] Admission Date: [**2119-1-31**] Discharge Date: [**2119-2-24**] Date of Birth: [**2059-12-22**] Sex: F Service: CARDIOTHORACIC SURGERY Attending Physicians: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**First Name8 (NamePattern2) **] [**Last Name (Titles) 412**] [**Last Name (Prefixes) **], MD ADDENDUM FOR [**2-20**] TO [**2119-2-24**]: The plan on [**2-20**] was that the patient would get a bed at [**Hospital1 **] for ventilatory failure, a respiratory bed, when the bed was available. The bed was not available as planned on [**2-20**], and so the patient remained in the MICU with trach collars overnight. Continuing consults were obtained, and follow-up through the nutrition team, as well as the [**Last Name (un) **] team for maintenance of tube feeds, and recommendations for both her Lantus and sliding scale insulin coverage. The patient was seen again by case management. The patient was a little bit lethargic and responded only really when spoken to. Case management helped the family with new referrals. The patient was seen by the renal attending on [**2-21**] also. There was a note from the renal attending on [**2-21**] describing the patient's grave prognosis and minimal responsiveness. The patient was seen continually by physical therapy and occupational therapy for evaluation. On [**2-21**], the patient had completed dialysis the day prior, had been on trach collar overnight, had a blood pressure in the range of 110-125 systolic/30-50 diastolic, with a temperature of 98.4, sinus rhythm in the 80s, with an FIO2 of 50% on the vent with the trach collar. She was somewhat somnolent. Her heart was regular rate and rhythm with S1 and S2 sounds, in sinus rhythm. She had her PICC line and her tunneled catheter in place for hemodialysis. White count 10.1, hematocrit 33.1, K 3.7, BUN 38, creatinine 2.4, PT 12.2, INR 1.0. The patient continued on antibiotic therapy. Her mental status did wax and wane at that time. The patient continued on antiseizure medication and continued with the trach collar as tolerated. Supportive care was given. The patient remained in the MICU under the care of pulmonary and critical care medicine with a planned hemodialysis schedule for Monday, Wednesday, Friday. The patient was out-of-bed to the chair that day and continued to receive PT and OT. The patient was followed also by plastic surgery for the flap that had been done. On [**2-22**], the patient had no events overnight, answers questions yes or no with a squeeze of the hands and was somewhat somnolent. BUN rose to 63 with a creatinine of 3.4. White count was stable at 9.5. The patient generally received supportive care over the next couple of days, awaiting the rehab bed, as well as getting her hemodialysis on the schedule indicated. Please refer to the renal attending note. The patient continued to be followed closely by case management. Plastics monitored her wound and flap, as well as the JP drain that was in place. The patient was evaluated for Passy-Muir valve. The speech pathology team recommended an ENT consult prior to Passy-Muir valve and determined that she was not a candidate for Passy-Muir at that time. JP output continued to be slow but [**Last Name (LF) 4374**], [**First Name3 (LF) **] the catheter was not placed at that time. Renal attending noted a desire for another neurologic consult at that time and a defined plan for the patient's care prior to going out to rehab. On postoperative day #18, the patient's vital signs were stable. The staples were removed from the flap wound. JP remained in place draining some serosanguineous fluid with the plan to leave the JP drain in place until the patient was ready to leave if drainage had decreased. The patient had some free water for electrolyte correction on [**2-24**]. Creatinine was 3.3 on [**2-24**], white count 9.8, hematocrit 34.1. The patient did have a little bit of worsening mental status on the 23. The patient, on exam, had minimal movement of the right hand but slightly better than the left hand. She blinks her eyes episodically. There was no neurologic progress being made at this time. Dr. [**Last Name (STitle) **] was the renal attending who consulted who again expressed desired to have a plan made about what is the endpoint in terms of her function and her continuing renal support. The patient was seen again on [**2-24**] by case management, and a bed became available at [**Hospital1 **]. FINAL DIAGNOSES ON DISCHARGE (Listed in the prior DC summary dated [**2119-2-20**] but will be repeated here for completeness): 1. Septic shock. 2. Respiratory failure, acute and chronic. 3. Chronic renal failure. 4. Status post coronary artery bypass grafting with coronary artery disease. 5. Atrial fibrillation. 6. Coronary artery bypass graft wound dehiscence. 7. Type 1 diabetes mellitus with retinopathy and nephropathy. 8. Hypertension. 9. Hyperlipidemia. 10.History of transient ischemic attack. 11.History of seizure disorder. 12.Aspiration. DISCHARGE MEDICATIONS: Listed in the discharge summary of [**2-20**]; please refer to this DC summary. DISCHARGE DISPOSITION: [**Hospital1 **] for ventilatory bed on [**2119-2-24**]. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Last Name (NamePattern1) 76**] MEDQUIST36 D: [**2119-6-13**] 11:18 T: [**2119-6-13**] 11:20 JOB#: [**Job Number 31937**]

038,996,785,998,584,427,518,428,403

{'Other specified septicemias,Infection and inflammatory reaction due to other vascular device, implant, and graft,Septic shock,Disruption of internal operation (surgical) wound,Acute kidney failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is a 58 year-old female with a past medical history of type 1 diabetes mellitus, hypertension, hypercholesterolemia, end stage renal disease, coronary artery disease status post coronary artery bypass graft who presented from an outside hospital with hypotension likely secondary to sepsis. She was recently admitted at [**Hospital1 69**] from [**1-5**] to [**1-21**] when she had a coronary artery bypass graft done for three vessel disease with normal EF. Her postoperative course was complicated by respiratory failure requiring a tracheostomy, atrial fibrillation, renal failure, requiring hemodialysis and an embolic cerebrovascular accident diagnosed on the CT of the head as a right MCA inferior division stroke. The patient had a G tube placed and was discharged to [**Hospital3 7665**] [**Hospital3 417**] and as an outpatient she had been treated for an Enterobacter line infection with Vancomycin and Cefepime. Cultures seemed to have been negative. On the 29th the patient had fevers and hypotension. She was transferred from [**Hospital3 417**] to [**Hospital3 **]. A right femoral line was placed and cultures were done. The patient had ID consulted and they recommended discontinuing the dialysis line as they suspected that was the source of her sepsis and elevated white blood cell count. The patient was started on neo-synephrine for her hypotension and transferred to [**Hospital1 69**]. MEDICAL HISTORY: 1. Type 1 diabetes mellitus. 2. Hypertension. 3. Hypercholesterolemia. 4. End stage renal disease. 5. Transient ischemic attack eleven years ago. 6. C section. 7. History of AV fistula. 8. Coronary artery disease status post coronary artery bypass graft [**2119-1-2**]. 9. Cerebrovascular accident [**2119-1-6**]. 10. Tracheostomy [**2119-1-14**]. 11. G tube placed on [**2119-1-18**]. 12. Atrial fibrillation postop. 13. Legally blind. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: She does not smoke, drink or use drugs. She lives at [**Hospital3 **]. ### Response: {'Other specified septicemias,Infection and inflammatory reaction due to other vascular device, implant, and graft,Septic shock,Disruption of internal operation (surgical) wound,Acute kidney failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease'}

CHIEF COMPLAINT: Shortness of breath and right sided weakness. PRESENT ILLNESS: The patient is a 48 year old male with a history of hepatitis B, Child's A cirrhosis and hepatocellular carcinoma who had been followed and treated by Dr. [**First Name (STitle) **] in [**Hospital **] Clinic. He presented with right arm and right leg weakness, dyspnea, hemoptysis and several hours of pleuritic chest pain. In route to the Emergency Department, he had witnessed tonoclonic seizures and was stabilized at [**Hospital3 **] and transferred to [**Hospital1 346**]. The patient was loaded on Dilantin in the Emergency Department and transferred to the Medical Intensive Care Unit. There he was found to have a pulmonary embolus and some hemorrhage around new brain metastases. An IVC filter was placed to protect against new pulmonary emboli but no deep vein thromboses were found in the lower extremities. The patient also received Decadron for brain metastases and was transferred to the [**Hospital Ward Name 516**] for radiation treatment. Currently, the patient felt that his shortness of breath and chest pain are improving. The weakness on his right side is subjectively worse. Otherwise, the patient had been diagnosed with hepatitis and liver cancer in [**2139**], after routine screening. He has no ethanol history. He has a mother with hepatitis B. MEDICAL HISTORY: 1. Hepatitis B and Child's A cirrhosis. 2. Portal hypertension. 3. Hepatocellular carcinoma with known lung metastases. MEDICATION ON ADMISSION: 1. Celebrex 200 mg p.o. once daily. 2. Cholestyramine once daily. 3. Epivir 100 mg p.o. once daily. 4. Propranolol 20 mg p.o. twice a day. ALLERGIES: Tylenol and Aspirin which both lead to a rash. PHYSICAL EXAM: FAMILY HISTORY: The patient's mother has hepatitis B as well as his maternal uncle who also died of liver cancer. SOCIAL HISTORY: The patient is married and lives in [**Hospital1 392**] with his family. He denies any alcohol use. He moved to the United States in the [**2117**].

Other pulmonary embolism and infarction,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Intracerebral hemorrhage,Portal hypertension

Pulm embol/infarct NEC,Sec mal neo brain/spine,Mal neo liver, primary,Secondary malig neo lung,Convulsions NEC,Hpt B chrn wo cm wo dlta,Cirrhosis of liver NOS,Intracerebral hemorrhage,Portal hypertension

Admission Date: [**2141-2-19**] Discharge Date: [**2141-2-25**] Date of Birth: [**2092-12-14**] Sex: M Service: CHIEF COMPLAINT: Shortness of breath and right sided weakness. HISTORY OF PRESENT ILLNESS: The patient is a 48 year old male with a history of hepatitis B, Child's A cirrhosis and hepatocellular carcinoma who had been followed and treated by Dr. [**First Name (STitle) **] in [**Hospital **] Clinic. He presented with right arm and right leg weakness, dyspnea, hemoptysis and several hours of pleuritic chest pain. In route to the Emergency Department, he had witnessed tonoclonic seizures and was stabilized at [**Hospital3 **] and transferred to [**Hospital1 346**]. The patient was loaded on Dilantin in the Emergency Department and transferred to the Medical Intensive Care Unit. There he was found to have a pulmonary embolus and some hemorrhage around new brain metastases. An IVC filter was placed to protect against new pulmonary emboli but no deep vein thromboses were found in the lower extremities. The patient also received Decadron for brain metastases and was transferred to the [**Hospital Ward Name 516**] for radiation treatment. Currently, the patient felt that his shortness of breath and chest pain are improving. The weakness on his right side is subjectively worse. Otherwise, the patient had been diagnosed with hepatitis and liver cancer in [**2139**], after routine screening. He has no ethanol history. He has a mother with hepatitis B. On review of systems, the patient has no hemoptysis or bright red blood per rectum. No nausea or vomiting. He does complain of sleep disturbance and confusion over the past week prior to admission. PAST MEDICAL HISTORY: 1. Hepatitis B and Child's A cirrhosis. 2. Portal hypertension. 3. Hepatocellular carcinoma with known lung metastases. MEDICATIONS ON ADMISSION: 1. Celebrex 200 mg p.o. once daily. 2. Cholestyramine once daily. 3. Epivir 100 mg p.o. once daily. 4. Propranolol 20 mg p.o. twice a day. ALLERGIES: Tylenol and Aspirin which both lead to a rash. FAMILY HISTORY: The patient's mother has hepatitis B as well as his maternal uncle who also died of liver cancer. SOCIAL HISTORY: The patient is married and lives in [**Hospital1 392**] with his family. He denies any alcohol use. He moved to the United States in the [**2117**]. PHYSICAL EXAMINATION: On admission, in general, the patient is well appearing pleasant male in no apparent distress. Head, eyes, ears, nose and throat examination - positive scleral icterus, moist mucous membranes. Extraocular movements are intact. Cardiac - regular rate and rhythm, no murmurs, rubs or gallops. Pulmonary - Bilaterally clear to auscultation, decreased breath sounds at the bases. The abdomen revealed positive bowel sounds, soft, nontender, nondistended, no hepatosplenomegaly, no ascites, a scar in the abdomen from previous liver surgery. Extremities - no cyanosis, clubbing or edema, good pulses. Neurologically, cranial nerves III through XII are intact. Mild asterixis. Right are the weakest muscles on the patient's neurologic examination which are 3 and otherwise his triceps are 4-, biceps 4+, and the remainder of the examination is [**4-10**] except for the right quadriceps muscles which are also [**3-11**]. LABORATORY DATA: On admission, white blood cell count 9.4, hemoglobin 13.5, hematocrit 37.1 down from 41.7 and platelet count 83,000. Prothrombin time was 14.2, INR 1.3. Chem7 showed sodium 138, potassium 3.9, chloride 105, bicarbonate 23, blood urea nitrogen 12, creatinine 0.9, and glucose 189. Magnetic resonance scan of the head showed left parietal occipital hemorrhagic metastatic lesions and a left frontoparietal enhancing metastatic focus with mild blood products and surrounding edema in the left frontotemporal region. There was mild mass effect in the left lateral ventricle without midline shift. There were no other metastatic foci seen. CTA of the chest had also been performed on admission which showed multiple segmental and subsegmental left sided pulmonary emboli. There were nodular lung parenchymal and mediastinal masses consistent with the patient's known metastatic disease. There was occlusion of the left lower lobe bronchus with associated atelectasis and superimposed infectious process could not be excluded. Given the above, the patient was managed on the [**Hospital Ward Name 516**]. He was seen by Dr. [**First Name (STitle) **] and by the radiation oncology service for treatment of his brain metastases. During his stay, hematology/oncology wise, for his pulmonary emboli, the patient was managed supportively. He remained approximately 99% oxygen saturation in room air. He was not anticoagulated given his propensity for coagulopathy with his liver disease. Otherwise in terms of his brain metastases, the patient received radiation treatment daily during his stay. He was also seen by physical therapy and occupational therapy to improve his function given his right sided deficits. In terms of his gastrointestinal issues, the patient had mild encephalopathy and was treated with Lactulose which was titrated to approximately three bowel movements per day. For question of esophageal varices, the patient was treated with Propranolol. He was continued on Protonix. He was also given a low protein diet to minimize any further exacerbation of his encephalopathy. He was also given Vitamin K to improve his coagulopathy and he was discharged on [**2141-2-26**], in stable condition. DISCHARGE DIAGNOSES: 1. Hepatitis B cirrhosis. 2. Hepatocellular carcinoma. 3. Pulmonary emboli. 4. Metastatic hemorrhagic brain lesions. He was instructed to follow-up with Dr. [**First Name (STitle) **] in one to two weeks. He was also instructed to follow-up for radiation treatment on Monday, [**2141-2-27**], at 11:00 a.m. in the [**Hospital Ward Name 12573**] basement of [**Hospital Ward Name 516**] where further appointments would be set. MEDICATIONS ON DISCHARGE: 1. Epivir 100 mg p.o. once daily. 2. Vitamin K 5 mg p.o. once daily. 3. Dilantin 100 mg p.o. three times a day. 4. Protonix 40 mg p.o. once daily. 5. Ambien 5 mg p.o. q.h.s. 6. Colace 100 mg p.o. twice a day. 7. Thorazine 25 mg p.o. three times a day. 8. Lactulose 30 ml p.o. three times a day. 9. Decadron 6 mg p.o. q6hours. 10. Propranolol 20 mg p.o. twice a day. [**First Name11 (Name Pattern1) 396**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 9758**] Dictated By:[**Name8 (MD) 10249**] MEDQUIST36 D: [**2141-2-26**] 11:36 T: [**2141-2-26**] 13:11 JOB#: [**Job Number 24191**]

415,198,155,197,780,070,571,431,572

{'Other pulmonary embolism and infarction,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Intracerebral hemorrhage,Portal hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Shortness of breath and right sided weakness. PRESENT ILLNESS: The patient is a 48 year old male with a history of hepatitis B, Child's A cirrhosis and hepatocellular carcinoma who had been followed and treated by Dr. [**First Name (STitle) **] in [**Hospital **] Clinic. He presented with right arm and right leg weakness, dyspnea, hemoptysis and several hours of pleuritic chest pain. In route to the Emergency Department, he had witnessed tonoclonic seizures and was stabilized at [**Hospital3 **] and transferred to [**Hospital1 346**]. The patient was loaded on Dilantin in the Emergency Department and transferred to the Medical Intensive Care Unit. There he was found to have a pulmonary embolus and some hemorrhage around new brain metastases. An IVC filter was placed to protect against new pulmonary emboli but no deep vein thromboses were found in the lower extremities. The patient also received Decadron for brain metastases and was transferred to the [**Hospital Ward Name 516**] for radiation treatment. Currently, the patient felt that his shortness of breath and chest pain are improving. The weakness on his right side is subjectively worse. Otherwise, the patient had been diagnosed with hepatitis and liver cancer in [**2139**], after routine screening. He has no ethanol history. He has a mother with hepatitis B. MEDICAL HISTORY: 1. Hepatitis B and Child's A cirrhosis. 2. Portal hypertension. 3. Hepatocellular carcinoma with known lung metastases. MEDICATION ON ADMISSION: 1. Celebrex 200 mg p.o. once daily. 2. Cholestyramine once daily. 3. Epivir 100 mg p.o. once daily. 4. Propranolol 20 mg p.o. twice a day. ALLERGIES: Tylenol and Aspirin which both lead to a rash. PHYSICAL EXAM: FAMILY HISTORY: The patient's mother has hepatitis B as well as his maternal uncle who also died of liver cancer. SOCIAL HISTORY: The patient is married and lives in [**Hospital1 392**] with his family. He denies any alcohol use. He moved to the United States in the [**2117**]. ### Response: {'Other pulmonary embolism and infarction,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Intracerebral hemorrhage,Portal hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 74 year old gentleman with type 2 diabetes mellitus, hypertension and a positive tobacco history who presented to the Emergency Department for acute onset of chest pain that awoke him out of bed early morning, nine out of ten substernal chest pain, no radiation, no diaphoresis. Positive nausea and vomiting times two; no shortness of breath. He never has had chest pain like this prior. No fever or chills, no cough. MEDICAL HISTORY: 1. Type 2 diabetes melitis with last hemoglobin A1C of 5.2; history of increased fingersticks secondary to dietary indiscretion. 2. Metastatic prostate cancer status post radiation therapy with radiation proctitis with resistance to androgen therapy. 3. Hypertension. 4. Gout. 5. Osteoarthritis. 6. HCV positive with low viral load, increased liver function tests at baseline. 7. History of RPR positive with treponemal antibody positive ([**2098-5-1**]). 8. Orbital cellulitis ([**2100-1-1**]). 9. Borderline hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: He has an allergy to Niferex which causes anaphylaxis and an allergy to ACE inhibitors which causes angioedema. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a positive tobacco history of [**12-2**] pack a day times 40 years; continues to smoke. Former alcohol use, former intravenous drug use. The patient lives alone and has three children.

Dissection of aorta, thoracic,Methicillin susceptible Staphylococcus aureus septicemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Malignant neoplasm of prostate

Dsct of thoracic aorta,Meth susc Staph aur sept,React-oth vasc dev/graft,Hypertension NOS,DMII wo cmp nt st uncntr,Malign neopl prostate

Admission Date: [**2100-9-22**] Discharge Date: [**2100-10-1**] Date of Birth: [**2026-2-26**] Sex: M Service: MICU-ORANG HISTORY OF PRESENT ILLNESS: This is a 74 year old gentleman with type 2 diabetes mellitus, hypertension and a positive tobacco history who presented to the Emergency Department for acute onset of chest pain that awoke him out of bed early morning, nine out of ten substernal chest pain, no radiation, no diaphoresis. Positive nausea and vomiting times two; no shortness of breath. He never has had chest pain like this prior. No fever or chills, no cough. REVIEW OF SYSTEMS: Review of systems reveals two months of increasing fatigue, decreased exercise tolerance. No abdominal pain, no change in bowel movements. In the Emergency Department, the patient had a temperature of 95.6 F.; heart rate of 60; blood pressure of 160/110; respiratory rate of 16, saturating 100% O2 on two liters nasal cannula, in moderate distress with several episodes of vomiting. EKG showed new T wave inversion in II, III and AVF with no ST elevation or depression. The patient was given Nitroglycerin, Lopressor, aspirin, heparin, morphine with decrease in the chest pain to five out of ten. CK enzymes were 74, troponin less than 0.3. Cardiology was consulted for question of ischemia. Prior to Cardiology consultation in the Emergency Department, the patient then developed change in his characterization of pain to the epigastric area. CT scan was done which showed a Type B aortic dissection originating at the left subclavian to the level of the diaphragm. At that point, the heparin was discontinued. CT Surgery was consulted and it was felt that there was no indication for surgical intervention, recommended medical management only. Cardiology consultation was in agreement. The patient was started on heart rate and blood pressure control with Nipride and Esmolol. The patient lost intravenous access prior to initiation of these intravenous drips. Before the central access was obtained, his heart rate increased to the hundreds and his systolic blood pressure into the 210s. A right femoral central line and a right radial arterial line were placed without complication. The patient at that point resumed on his intravenous blood pressure medications with a decrease in his systolic blood pressure to 120s and heart rate to the 70s. At that point, the patient was transferred to the floor during which he was lying more comfortably and states that chest pain had decreased. Positive nausea and complaint of increased thirst. PAST MEDICAL HISTORY: 1. Type 2 diabetes melitis with last hemoglobin A1C of 5.2; history of increased fingersticks secondary to dietary indiscretion. 2. Metastatic prostate cancer status post radiation therapy with radiation proctitis with resistance to androgen therapy. 3. Hypertension. 4. Gout. 5. Osteoarthritis. 6. HCV positive with low viral load, increased liver function tests at baseline. 7. History of RPR positive with treponemal antibody positive ([**2098-5-1**]). 8. Orbital cellulitis ([**2100-1-1**]). 9. Borderline hypercholesterolemia. Primary care physician is [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. MEDICATIONS: 1. Glyburide 2.5 mg twice a day. 2. Hydrocortisone 20 mg q. a.m. and 10 mg q. p.m. 3. Hytrin 5 mg twice a day. 4. Indomethacin 25 mg p.r.n. 5. Ketoconazole 400 mg twice a day. 6. Leuprolide 22.5 mg every ten weeks. 7. Zoledronic acid 4 mg every ten weeks. ALLERGIES: He has an allergy to Niferex which causes anaphylaxis and an allergy to ACE inhibitors which causes angioedema. SOCIAL HISTORY: The patient has a positive tobacco history of [**12-2**] pack a day times 40 years; continues to smoke. Former alcohol use, former intravenous drug use. The patient lives alone and has three children. PHYSICAL EXAMINATION: Upon presentation to the Medical Intensive Care Unit, his examination revealed he was afebrile; heart rate 84; blood pressure 143/80; respiratory rate 27; oxygen saturation 92% on room air. On general examination, this is an elderly male who looks uncomfortable but is in no acute distress. Head and Neck examination: Pupils are minimally constrictive, but equal. Mucous membranes were dry. No jugular venous distention. Neck is supple. Carotids are two plus with no bruits. Chest is clear to auscultation. Cardiac examination is regular rate, normal S1, S2. Abdomen is obese, soft, nontender, positive bowel sounds. Extremities with no lower extremity edema. Distal pulses two plus, radial pulses two plus bilaterally. Neurologic examination is alert and oriented; motor strength five out of five bilaterally. Sensation intact bilaterally. LABORATORY: His labs on examination were white blood cell count of 5.2 with a differential of 52, neutrophils 40, lymphocytes 7, 9 monos, and 1 eosinophil. Hematocrit 35.5, platelets 337, INR is 1.1. Sodium 135, potassium 3.2, chloride 101, bicarbonate 23, BUN 22, creatinine 1.2. Glucose is 405. Calcium is 8.5 with free calcium of 1.04. Albumin is 3.4. The PSA is 2.6. ALT is 61, AST 73, alkaline phosphatase 121, amylase is 88, total bilirubin 1.1, lipase 39, lactate 1.8. Repeat CK was 31 with troponin of 0.4. EKG shows T wave inversions in II, III and AVF with normal sinus rhythm at 60. CT scan of the abdomen shows: 1. [**Location (un) 11916**] type B aortic dissection beginning just distal to the left subclavian artery takeoff extending to the diaphragmatic hiatus. Extra-luminal contrast within a mural hematoma associated with dissection at the level of the aortic arch. 2. Prominent iliac vessels, 1.5 centimeters. 3. Emphysematous changes in the lungs. 4. Scattered mediastinal nodes. 5. Sclerotic areas throughout the skeleton. Chest x-ray shows stable compared with prior in [**2098-5-31**]. New minimal left basilar atelectasis. Abdominal ultrasound with fatty infiltration of the liver, hyper dense focus in the gallbladder wall with no stones. HOSPITAL COURSE BY ORGAN SYSTEMS: 1. CARDIOVASCULAR: The patient was medically managed for his aortic dissection with blood pressure and heart rate control. The goal was a systolic blood pressure between 120 and 130 and heart rate between 60 to 70. On transfer to the Medical Intensive Care Unit, the patient's Esmolol drip was changed to Labetalol for dual blood pressure and heart rate control with titration and the patient was continued on Nitroprusside drip. On the third hospital day, both the Nitroprusside and Labetalol drips were turned off secondary to low systolic blood pressure and heart rate. At that point, the patient was started on a p.o. anti-hypertensive regimen starting with p.o. Labetalol at 200 mg p.o. twice a day. Cardiology was re-consulted to follow-up with request for recommendations of blood pressure control. At that point, Amlodipine was started at 5 mg q. day. Hytrin was also started at 5 mg twice a day given the patient's history of benign prostatic hypertrophy as well as anti-hypertensive effect. The patient's Labetalol was increased to 300 mg twice a day. The Nipride drip had to be restarted secondary to increase in the patient's systolic blood pressure to the 170s despite his oral regimen. The Labetalol was discontinued and the patient was started on Metoprolol, initially at 25 mg p.o. three times a day. His Amlodipine was increased to 10 mg p.o. q. day. The patient developed pain secondary to bladder irrigation and his systolic blood pressure would rise during his spastic pain episodes. The Metoprolol was increased to 75 mg three times a day and the patient was given one dose of 5 mg of Metoprolol when his systolic blood pressure reached the 170s. Given that the patient remained on Nipride, there was a push to wean secondary to fear for development of cyanide toxicity. The Lopressor was at that point increased to 100 mg twice a day. The patient was given Hydrochlorothiazide 15 mg q. day. The patient also had Minoxidil at 10 mg twice a day added. On the above medications, the patient had adequate blood pressure and heart rate control, however, his systolic blood pressure then began to fall; the patient was given repeated fluid boluses with minimal improvement. His anti-hypertensive medications at that point were withheld and his blood pressure began to rise but still remained less than one systolic blood pressure of 130. At this point, evaluation for change in his blood pressure was undertaken and the patient was found to have Staphylococcus aureus sepsis, explaining the hypotension. When the patient's blood pressure began to rise with clinical improvement of his sepsis, he was restarted on low dose Metoprolol and adjusted accordingly for elevation in his heart rate and systolic blood pressure. The patient was increased to 100 mg p.o. twice a day; Amlodipine was restarted at 5 mg p.o. q. day; Hytrin was started at 5 mg p.o. twice a day. Further blood pressure control was curtailed secondary to the patient choosing to leave the hospital against medical advice in order to attend to personal affairs. When the patient left, his systolic blood pressure was within goal range, between 120 to 130 and his heart rate was less than 70; however, it is not known HOSPITAL COURSE:w his blood pressure will change as he continues to improve from his sepsis and as he begins to have increased activity. During the [**Hospital 228**] hospital course, he was monitored closely for evidence of worsening aortic dissection. He had a repeat CT scan during his hospital course secondary to decreased urine output, which showed no change in the aortic dissection since presentation. The case was discussed with Cardiothoracic Surgery who recommended that the patient follow-up with CT scan in one month in order to evaluate. The patient was monitored on Telemetry through his hospital course. The patient developed sinus arrhythmia, during which he was asymptomatic. Repeated electrocardiograms showed no ST wave changes. The patient then continued to have normal sinus rhythm with occasional PACs. 2. INFECTIOUS DISEASE: During the [**Hospital 228**] hospital course, he was found to have a fever, at which point he was pan cultured with chest x-ray. Urinalysis showed increased white blood cells and many bacteria, but also squamous epithelial cells. Culture was negative for growth. The patient was unable to produce sputum for culture. Chest x-ray showed new bibasilar bilateral increased opacities, left greater than right with pleural effusions. Differential diagnosis was atelectasis versus infiltrate. At this point, the patient was started empirically on Levaquin. His blood cultures then came back with four out of four bottles of Gram positive cocci. The patient, at that point, was started on Vancomycin. His right radial arterial line and right femoral lines were both pulled secondary to erythematous appearance and likely source of bacterial infection. Sensitivities on the blood cultures came back with Methicillin sensitive Staphylococcus aureus. The patient was taken off of the Vancomycin and then started on Oxacillin intravenously. He received two doses of intravenous Oxacillin prior to leaving the hospital, after which he was given a prescription for Dicloxacillin. One set of surveillance blood cultures were able to be drawn which were no growth as of the last hospital day. Discussion with Infectious Disease regarding whether the patient should follow-up with echocardiogram: Given that the source of infection was likely line and it was removed, they did not feel that an echocardiogram was required. Also, they recommended that given that the patient has a fibrin clot with the aortic dissection, it would be prudent to do four weeks of p.o. antibiotic therapy versus two weeks. 3. RENAL: The patient had decreasing urine output with very dark urine. This was thought to be secondary to hypovolemia, but there was concern for renal artery ischemia secondary to presence of aortic dissection, decreasing renal clearance secondary to intravenous contrast dye insult. The patient was given fluid boluses with minimal increase in his urine output. At that point, the patient was reevaluated via CT scan for ischemia to the renal artery which was negative. The patient was given pre-hydration and post-hydration fluid given the second dye load. The patient's urine output improved, but then the patient developed frankly bloody urine with clots. This was thought to be possibly be due trauma via the Foley, which was also causing the patient pain. The Foley was removed, but then the patient had minimal urine output. At that point a three way Foley was placed with flush. The patient was started on Ditropan and morphine for pain. Urology was consulted who recommended that a 20 French Foley be placed with continuous bladder irrigation, titrating to clear. This caused considerable pain to the patient and the irrigation was discontinued with the occasional flushes p.r.n. The patient, at that point, had decreasing clots. He had evidence of bladder spasm with episodic pain for which he was given morphine. The Ditropan was increased in dose. His bladder spasm symptoms resolved and his hematuria improved, but did not resolve. At the time of discharge, the patient had a condom catheter, without any evidence of urinary retention symptoms. The patient was continued on his Ketoconazole 400 mg twice a day for his prostate cancer therapy. The patient was also given one dose of Leuprolide 2.5 mg given that it was the time for this dose. The Zedronic acid was held, however, given his decreased urine output. 4. ENDOCRINE: The patient had elevated blood sugars at the time of admission. He was placed on an insulin drip with titration to keep his blood sugars between 80 to 120. He was weaned off the insulin drip and started on NPH at 35 units in the morning and 14 units at bedtime with regular insulin sliding scale adjustment according to fingersticks. His NPH was withheld secondary to bouts of hypoglycemia during his sepsis because of somnolence and decreased p.o. However, as the patient began to take in full p.o., his standing insulin doses were resumed. Given that the patient left early, he was not able to be transitioned to an oral diabetic [**Doctor Last Name 360**], or taught how to administer insulin. Therefore, he was instructed just to continue his outpatient dose of Glyburide 2.5 mg twice a day. The patient has a history of Ketoconazole induced borderline Addison's Disease. He is on a standing hydrocortisone of 20 in the morning and 10 in the evening. During his sepsis, his doses were doubled to hydrocortisone of 40 and 20, which was maintained for three days, at which point the patient was then returned to his usual standing doses. 4. GASTROINTESTINAL: The patient has baseline elevated liver function tests with fatty liver and history of HCV. He was maintained on a bowel regimen during his hospital course secondary to his narcotics to avoid constipation. 5. PULMONARY: The patient had tobacco history with evidence of emphysematous changes. He did not require supplemental oxygen. Given the chest x-ray findings which were felt to be likely secondary to atelectasis, given that the crackles on his lung examination cleared with the coughing, the patient was started on incentive spirometry. 6. NEUROLOGICAL: The patient had a change in mental status during his sepsis. It was felt that his increased somnolence was likely secondary to his infection as well as morphine administration secondary to pain. The morphine was discontinued and the patient was given Tylenol only p.r.n. which he did not require. The patient had an episode of agitation for which he was started on Zyprexa. This was discontinued whenever patient returned to his baseline. 7. FLUIDS, ELECTROLYTES AND NUTRITION: The patient had his electrolytes repleted p.r.n. He had consistently low magnesium levels for which he was started on magnesium oxide standing at 800 mg p.o. three times a day. 8. PROPHYLAXIS: The patient was maintained on Protonix and Pneumo boots throughout his hospital course. DISPOSITION: The patient stated that he needed to leave the hospital secondary to issues at home which he needed to take care of. It was explained at length to the patient and to his son that his blood pressure was not under adequate control yet and that he was still recovering from sepsis. The patient understood that he was taking a risk with his health, but refused to stay, stating that he needed to attend to these personal matters at home. DISCHARGE INSTRUCTIONS: 1. He was instructed to return to the Emergency Department immediately for symptoms of chest pain or fever. 2. The patient was scheduled for episodic follow-up visit at the [**Hospital 191**] Clinic with Dr. [**Last Name (STitle) **], who had the next available appointment. DISCHARGE MEDICATIONS: He was given prescriptions for the following medications: 1. Metoprolol 100 mg p.o. twice a day. 2. Dicloxacillin 500 mg p.o. q. six times one month. 3. Protonix 40 mg p.o. q. day. 4. Magnesium oxide 800 mg p.o. three times a day. 5. Amlodipine 10 mg p.o. q. day. 6. He was instructed to continue his Glyburide at 2.5 mg p.o. twice a day. 7. Hydrocortisone 20 mg p.o. q. a.m., 10 mg p.o. q. p.m. 8. Hytrin 5 mg twice a day. 9. Ketoconazole 400 mg twice a day. DISCHARGE DIAGNOSES: 1. Type B aortic dissection. 2. Hypertension. 3. Methicillin sensitive Staphylococcus aureus sepsis. 4. Diabetes mellitus. 5. Hematuria. 6. Metastatic prostate cancer. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 5587**] Dictated By:[**Last Name (NamePattern1) 9296**] MEDQUIST36 D: [**2100-10-2**] 16:00 T: [**2100-10-2**] 16:26 JOB#: [**Job Number 14897**]

441,038,996,401,250,185

{'Dissection of aorta, thoracic,Methicillin susceptible Staphylococcus aureus septicemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Malignant neoplasm of prostate'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is a 74 year old gentleman with type 2 diabetes mellitus, hypertension and a positive tobacco history who presented to the Emergency Department for acute onset of chest pain that awoke him out of bed early morning, nine out of ten substernal chest pain, no radiation, no diaphoresis. Positive nausea and vomiting times two; no shortness of breath. He never has had chest pain like this prior. No fever or chills, no cough. MEDICAL HISTORY: 1. Type 2 diabetes melitis with last hemoglobin A1C of 5.2; history of increased fingersticks secondary to dietary indiscretion. 2. Metastatic prostate cancer status post radiation therapy with radiation proctitis with resistance to androgen therapy. 3. Hypertension. 4. Gout. 5. Osteoarthritis. 6. HCV positive with low viral load, increased liver function tests at baseline. 7. History of RPR positive with treponemal antibody positive ([**2098-5-1**]). 8. Orbital cellulitis ([**2100-1-1**]). 9. Borderline hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: He has an allergy to Niferex which causes anaphylaxis and an allergy to ACE inhibitors which causes angioedema. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a positive tobacco history of [**12-2**] pack a day times 40 years; continues to smoke. Former alcohol use, former intravenous drug use. The patient lives alone and has three children. ### Response: {'Dissection of aorta, thoracic,Methicillin susceptible Staphylococcus aureus septicemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Malignant neoplasm of prostate'}

CHIEF COMPLAINT: Weakness PRESENT ILLNESS: 64M history of alcohol abuse, hypothyroidism presenting from home with a 5 day history of weakness. Patient reports he had a mechanical fall about 3 days ago. He states he was in the bathroom and lost his balance hitting his right side. He denies head strike or loss of consciousness. He also denies preceding dizziness or chest pain. He denies sz activity, loss of bowel or bladder control. Since the fall he has noticed pain in his R knee and hip. He however denies any cough, chest pain, abdominal pain, loose stools or bloody stools. He does note "losing his breath with ambulation" and occasional LE edema over the past week. He additionally reports a poor appetite in addition to an unintentional 50 lb wt loss over the past year. He denies travel of recent medication changes. Given on going weakness and difficulty with ambulation EMS was called. He was found on the porch cold with a blood pressure of 70/palp. MEDICAL HISTORY: # ETOH abuse - denies history of blackout, withdrawal seizure, DTs - history of DUI, attended mandatory AA - currently reports drinking [**2-6**] to 1 pint of gin 2 times per week # M-W tear with UGIB [**8-/2146**] # hypothyroidism # h/o acute pancreatitis requiring hospitalization [**9-/2145**] # fatty liver # peripheral neuropathy # macrocytic anemia # gout # HTN # impaired vision secondary to a battery acid splash in his eyes MEDICATION ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Ferrous Sulfate 325 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Thiamine 100 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Levothyroxine Sodium 50 mcg PO DAILY ALLERGIES: Heparin Analogues PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T: BP: 92/56 P:66 R: 18 O2:100% RA CVP 6 General: Alert, oriented, no acute distress, thin/ cachetic male FAMILY HISTORY: The patient has a sister who has diabetes. The patient's father died at 94. The patient's mother died at 84. She had diabetes and hypertension. The patient's maternal grandmother died at age [**Age over 90 **]. SOCIAL HISTORY: Prior notes from [**2145**] indicate heavy drinking, up to half a gallon of gin every couple of days. Currently lives with wife and daughter. [**Name (NI) 1139**] use consists of about 14-15 cigarettes per day.

Unspecified disorder of autonomic nervous system,Pneumonia, organism unspecified,Metabolic encephalopathy,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Glucocorticoid deficiency,Other protein-calorie malnutrition,Body Mass Index less than 19, adult,Acidosis,Acute kidney failure, unspecified,Unspecified pleural effusion,Other complications due to other internal prosthetic device, implant, and graft,Other ascites,Neoplasm of unspecified nature of digestive system,Loss of weight,Pain in limb,Unspecified fall,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Personal history of pneumonia (recurrent),Unspecified acquired hypothyroidism,Dysphagia, oropharyngeal phase,Hypoxemia,Other hemochromatosis,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified deficiency anemia,Alcoholic fatty liver,Unspecified hereditary and idiopathic peripheral neuropathy,Gout, unspecified,Unspecified essential hypertension,Other specified visual disturbances,Late effects of other accidents

Autonomic nerve dis NEC,Pneumonia, organism NOS,Metabolic encephalopathy,Septicemia NOS,Severe sepsis,Acute respiratry failure,Septic shock,Glucocorticoid deficient,Protein-cal malnutr NEC,BMI less than 19,adult,Acidosis,Acute kidney failure NOS,Pleural effusion NOS,Comp-int prost devic NEC,Ascites NEC,Digestive neoplasm NOS,Abnormal loss of weight,Pain in limb,Fall NOS,Alcoh dep NEC/NOS-contin,Tobacco use disorder,Prsnl hx recur pneumonia,Hypothyroidism NOS,Dysphagia, oropharyngeal,Hypoxemia,Hemochromatosis NEC,Abn react-procedure NEC,Deficiency anemia NOS,Alcoholic fatty liver,Idio periph neurpthy NOS,Gout NOS,Hypertension NOS,Visual disturbances NEC,Late eff accident NEC

Admission Date: [**2147-12-1**] Discharge Date: [**2147-12-16**] Date of Birth: [**2083-10-7**] Sex: M Service: CARDIOTHORACIC Allergies: Heparin Analogues Attending:[**First Name3 (LF) 31264**] Chief Complaint: Weakness Major Surgical or Invasive Procedure: None. History of Present Illness: 64M history of alcohol abuse, hypothyroidism presenting from home with a 5 day history of weakness. Patient reports he had a mechanical fall about 3 days ago. He states he was in the bathroom and lost his balance hitting his right side. He denies head strike or loss of consciousness. He also denies preceding dizziness or chest pain. He denies sz activity, loss of bowel or bladder control. Since the fall he has noticed pain in his R knee and hip. He however denies any cough, chest pain, abdominal pain, loose stools or bloody stools. He does note "losing his breath with ambulation" and occasional LE edema over the past week. He additionally reports a poor appetite in addition to an unintentional 50 lb wt loss over the past year. He denies travel of recent medication changes. Given on going weakness and difficulty with ambulation EMS was called. He was found on the porch cold with a blood pressure of 70/palp. In the ED, initial VS were: 97 78 73/49 16 100% RA. Exam was notable for dry skin. There was no evidence of trauma. Rectal exam notable for guaiac negative stool. Xrays were done as patient noted knee and hip pain and were negative for fracture. Labs were notable for a lactate of 5.6, HCT of 25.3 (from 34 in [**12-17**] though consistent with prior), WBC 4.5, Cr of 1.8 (1.3 in [**12-17**]), ALT/AST 31/75. Serum tox was negative. CXR demonstrated no acute process. UA was unremarkable. EKG was notable for diffuse low voltage. The patient was given in total 3L NS. Pressures remained low and he was started on levophed which was titrated up to 0.15. He was additionally given a multivitamin, thiamine and folate. Vitals on transfer were 68 103/64 16 100% On arrival to the MICU, patient is alert and oriented x 3. He notes pain in R knee and hip but it otherwise symptom free. Past Medical History: # ETOH abuse - denies history of blackout, withdrawal seizure, DTs - history of DUI, attended mandatory AA - currently reports drinking [**2-6**] to 1 pint of gin 2 times per week # M-W tear with UGIB [**8-/2146**] # hypothyroidism # h/o acute pancreatitis requiring hospitalization [**9-/2145**] # fatty liver # peripheral neuropathy # macrocytic anemia # gout # HTN # impaired vision secondary to a battery acid splash in his eyes # Cyst removal from the back about 40 years ago. Social History: Prior notes from [**2145**] indicate heavy drinking, up to half a gallon of gin every couple of days. Currently lives with wife and daughter. [**Name (NI) 1139**] use consists of about 14-15 cigarettes per day. Family History: The patient has a sister who has diabetes. The patient's father died at 94. The patient's mother died at 84. She had diabetes and hypertension. The patient's maternal grandmother died at age [**Age over 90 **]. Physical Exam: ADMISSION PHYSICAL EXAM: Vitals: T: BP: 92/56 P:66 R: 18 O2:100% RA CVP 6 General: Alert, oriented, no acute distress, thin/ cachetic male HEENT: Sclera anicteric, dry moucous membranes, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally Abdomen: soft, non-tender, non-distended, bowel sounds present GU: no foley Ext: cool, dry skin over bilateral feet, 1+ pulses, no clubbing, cyanosis or edema, R knee with effusion, no eryhtema no warmth Neuro: CNII-XII intact, 4/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, finger-to-nose intact DISCHARGE PHYSICAL EXAM: Pertinent Results: ADMISSION LABS: [**2147-12-1**] 04:12PM PT-13.4* PTT-44.9* INR(PT)-1.2* [**2147-12-1**] 04:12PM PLT SMR-LOW PLT COUNT-131* [**2147-12-1**] 04:12PM HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-NORMAL MACROCYT-3+ MICROCYT-NORMAL POLYCHROM-OCCASIONAL TARGET-1+ BURR-OCCASIONAL ELLIPTOCY-1+ [**2147-12-1**] 04:12PM NEUTS-66 BANDS-0 LYMPHS-19 MONOS-4 EOS-11* BASOS-0 ATYPS-0 METAS-0 MYELOS-0 NUC RBCS-1* [**2147-12-1**] 04:12PM WBC-4.5 RBC-2.13*# HGB-8.0*# HCT-25.3*# MCV-119*# MCH-37.7*# MCHC-31.7 RDW-14.9 [**2147-12-1**] 04:12PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2147-12-1**] 04:12PM FREE T4-0.84* [**2147-12-1**] 04:12PM TSH-11* [**2147-12-1**] 04:12PM VIT B12-GREATER TH FOLATE-17.6 [**2147-12-1**] 04:12PM ALBUMIN-2.3* CALCIUM-8.2* PHOSPHATE-4.9* MAGNESIUM-1.5* [**2147-12-1**] 04:12PM cTropnT-0.08* [**2147-12-1**] 04:12PM LIPASE-10 [**2147-12-1**] 04:12PM ALT(SGPT)-31 AST(SGOT)-75* CK(CPK)-118 ALK PHOS-242* TOT BILI-0.9 [**2147-12-1**] 04:12PM estGFR-Using this [**2147-12-1**] 04:12PM GLUCOSE-100 UREA N-16 CREAT-1.8* SODIUM-140 POTASSIUM-4.7 CHLORIDE-98 TOTAL CO2-26 ANION GAP-21* [**2147-12-1**] 04:17PM LACTATE-5.6* [**2147-12-12**] CT abdomen and pelvis with contrast IMPRESSION: 1. Increased size of pleural effusions, ascites and diffuse anasarca. 2. New dilation of the distal pancreatic duct in the tail (new since [**2146**]), with stable atrophy involving the distal pancreas. Small amount of fluid adjacent to the body of the pancreas, which was seen in [**2147-11-6**]. Findings may be related to acute on chronic pancreatitis, however exclusion of an underlying neoplasm is recommended. An EUS can be performed for further characterization as at this time MRCP seems impractical. 3. Enhancing nodular area within the head of the pancreas measuring 8 mm is unchanged from [**2146-9-5**], could be a neuroendocrine tumor. This can be assessed at the time of EUS. 4. Slightly thickened and edematous duodenum and jejunum may be from duodenitis/jejunitis versus third spacing. 5. Gallstones. 6. Heterogeneous enhancement of the kidneys suggest underlying medical renal disease. [**2147-12-12**] EGD Ulcers with overlying eschar in the first, second, and third part of the duodenum Normal mucosa in the antrum (biopsy) Erythema in the gastroesophageal junction and lower third of the esophagus compatible with esophagitis Otherwise normal EGD to third part of the duodenum [**2147-12-13**] Video/barium swallow 1. Unchanged mild narrowing of the distal esophagus. Otherwise, normal caliber esophagus. 2. Ineffective primary peristaltic contraction followed by tertiary contractions. [**2147-12-14**] CXR (portable) FINDINGS: As compared to the previous radiograph, the bilateral pleural effusion have substantially increased in extent and severity. Effusions are now more extensive on the left than on the right. Mild pulmonary edema is present. Areas of atelectasis are seen at both lung bases. Normal size of the cardiac silhouette. Unchanged appearance of the right PICC line Brief Hospital Course: 64 yo male with hx of ETOH, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tears and fatty liver p/w weakness at home with associated poor PO intake initially admitted to the MICU with hypotension requiring pressor support. He improved and was transferred to the floor for sometime before decompensating again immediately post-thoracentesis. He returned to the MICU and was reintubated. He was dependent on three pressors and persistently hypoxemic and acidemic despite ventilatory support, showing signs of multi-organ system failure. Care was withdrawn per the family's wishes and patient expired on [**12-16**]. # Hypotension/Shock- Patient noted to have hypotension of unclear etiology which has failed to improve with the administration of IVF and initially requiring pressor support on admission. There is clearly a component of volume depletion as the patient is visibly dry on exam. No clear infectious source to suggest a septic picture (normal WBC, nml CXR, nml UA, effusion on exam but exam not c/w a septic joint). The patient does have a history of hypothyroidism but reports compliance with levothyroxine therapy. No hx of bleeding and HCT is stable from previously documented baseline. EKG findings is concerning for cardiac etiology namely effusion with possible tamponade however reassuringly there is no evidence of JVD or cardiomegaly on CXR. PE is on ddx given history of dyspnea but this is less likely. Bedside echo was without significant effusion. The patient was aggressively fluid resuscitated during his ICU course, with a total net positive of almost 18L, and weaned off of pressors but despite this he continued to have low SBPs in the 80-90 range with low measured CVPs. Adrenal insufficiency was entertained as a diagnosis, however his cortisol was wnl and there was no mention of atrophic adrenal glands on his CT scan, and on a trial of hydrocortisone his BPs were minimally responsive, if at all. Hypothyroid contributing to his picture is a possibility, however his TSH is minimally elevated and he has been stable on his dose of thyroid replacement for quite some time. The leading diagnoses for this patient at the time of transfer to the floor are autonomic dysfunction vs possible adrenal insuffiency. He was empirically started on antibiotics on admission, were continued for a total 8 days course. On [**2147-12-14**], patient found to have T <[**Age over 90 **]F, short of breath and hypotension in the low 100s. CXR revealed worsening bilateral pleural effusions. Blood and urine cultures were sent and patient emperically started on vanc/zosyn. Despite bearhugger and IVF, patient continued to be hypotensive (in the 80s/50s) and short of breath. A left thoracentesis was attempted, but patient blood pressure dropped to the 70s. Procedure was aborted and he was sent to the ICU. Patient's blood pressures remained low despite support with levophed, phenylephrine, and vasopressin. He was persistently acidemic despite maximal ventilatory setting. He was given stress dose steroids, broadened to ESBL and anti-fungal coverage and still continued to remain pressor dependent. He was showing signs of multisystem organ failure including worsening hypoxemia and kidney failure. Further diagnostic procedures were deferred due to patient instability. After discussion with the family about his poor prognosis, patient was terminally extubated and pressor support was withdrawn and he expired shortly thereafter. Family was present at the bedside and agreed to an autopsy. # Weakness/Malnutrition - Likely related to poor PO intake and generalized deconditioning. Wt loss is certainly concerning for possible malignancy, immunsuppression or TB given findings on CT chest. HIV negative. A nutrition consult was placed for input into the best method/route of providing nutrition in this patient. Patient refused NGT and he was started on TPN on [**2147-12-9**] and patient tolerated it well. GI was also consulted given his diarrhea, with recommendations for a hemochromatosis workup including DNA testing, MRI liver, AFP, vitamin K levels. A PPD was placed and read negative on [**2147-12-8**], quantiferon levels were sent and were indeterminate (patient did not mount a response to positive control), and sputum cultures were sent for AFB x3 which were all negative. Concern for possible immunosupression: HIV negative, HIV viral load and T cell subsets were sent which were negative. #) Duodenal ulcers: EGD showed significant ulcers in the duodenum which may explain his difficulty with po intake. He was started on high dose IV pantoprazole. H. Pylori was negative. CT abdomen showed a hypoattenuating mass at the head of the pancreas, which was suspcious for possible gastrinoma. However, gastrin level was sent and returned normal. Unclear if mass is malignancy (pancreatic or lymphoma) vs. CMV infection vs. pseudocyst secondary to alcohol use. #) Hypothyroidism: diagnosed in [**2146**], but etiology is unclear as his antibodies were negative and a CT chest revealed a normal thyroid. Elevated TSH and free T4 of 0.84 on [**12-1**] suggests noncompliance or need for higher dose of levothyroxine. Switched to IV for concern for low intestinal absorption due to diarrhea and thickened colonic mucosa per CT. Hypothyroidism likely contributing to the weakness. Endocrine was consulted and adjusted levothyroxine dose as needed based on thyroid function tests. #) RASH: The patient exhibited a scaly, peeling rash over most of his extremities and trunk. Per derm consult unlikely to be specific vitamin deficiency syndrome, most likely xerosis and age-related changes. No corkscrew hairs which herald scurvy. Zinc level low, vitamin C pending. He receieved repletion with vitamin C, MVI and thiamine during his ICU course, as well as Aquaphor lotion for his xerosis. Throughout his hospitalization, rash significantly improved. #) THROMBOCYTOPENIA: Allergic to heparin products, not receiving them here, but central line was coated in heparin. Also possibly secondary to bone marrow suppression from inflammation vs TTP. Seems disproportionate from other cell lines. H/O was consulted who recommended BM biopsy, however patient declined the bone marrow biopsy. Thrombocytopenia likely a result of alcohol induced bone marrow suppression with contribution from malnutrition. Also possible cirrhosis given presence of ascites. #) Macrocytic anemia: Downtrended throughout his hospital course, suspect significant hemodilution. Did receieve intermittent transfusions. No evidence of active bleeding, although meets criteria for transfusion with hemoglobin of 7.0. B12 and folate were supplemented. Likely secondary to alcohol. No evidence of active bleeding and folate and vitB12 are normal. Elevated ferritin with high transferrin saturations concerning for hemochromatosis. In addition, macrocytic anemia with thrombocytopenia can be a result of MDS/Myeloma/POEMS syndrome. Peripheral smear only shows many target cells, possibly from underlying alcoholic liver disease. Patient has refused bone marrow biopsy. UPEP/SPEP are negative. Normal kappa/lambda ratio, negative hemochromatosis mutation analysis. # ETOH abuse- Pt still actively drinking. No hx of withdrawal szs or DTs. Tox screen negative on admission. He was monitored on a CIWA without any administration of BZDs. Repletion with thiamine, folate, MVI as above. Unclear if patient has cirrhosis. Medications on Admission: The Preadmission Medication list is accurate and complete. 1. Ferrous Sulfate 325 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Thiamine 100 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Levothyroxine Sodium 50 mcg PO DAILY Discharge Medications: Patient expired Discharge Disposition: Expired Discharge Diagnosis: Patient expired Discharge Condition: Patient expired Discharge Instructions: Patient expired Followup Instructions: Patient expired

337,486,348,038,995,518,785,255,263,V850,276,584,511,996,789,239,783,729,E888,303,305,V126,244,787,799,275,E879,281,571,356,274,401,368,E929

{'Unspecified disorder of autonomic nervous system,Pneumonia, organism unspecified,Metabolic encephalopathy,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Glucocorticoid deficiency,Other protein-calorie malnutrition,Body Mass Index less than 19, adult,Acidosis,Acute kidney failure, unspecified,Unspecified pleural effusion,Other complications due to other internal prosthetic device, implant, and graft,Other ascites,Neoplasm of unspecified nature of digestive system,Loss of weight,Pain in limb,Unspecified fall,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Personal history of pneumonia (recurrent),Unspecified acquired hypothyroidism,Dysphagia, oropharyngeal phase,Hypoxemia,Other hemochromatosis,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified deficiency anemia,Alcoholic fatty liver,Unspecified hereditary and idiopathic peripheral neuropathy,Gout, unspecified,Unspecified essential hypertension,Other specified visual disturbances,Late effects of other accidents'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Weakness PRESENT ILLNESS: 64M history of alcohol abuse, hypothyroidism presenting from home with a 5 day history of weakness. Patient reports he had a mechanical fall about 3 days ago. He states he was in the bathroom and lost his balance hitting his right side. He denies head strike or loss of consciousness. He also denies preceding dizziness or chest pain. He denies sz activity, loss of bowel or bladder control. Since the fall he has noticed pain in his R knee and hip. He however denies any cough, chest pain, abdominal pain, loose stools or bloody stools. He does note "losing his breath with ambulation" and occasional LE edema over the past week. He additionally reports a poor appetite in addition to an unintentional 50 lb wt loss over the past year. He denies travel of recent medication changes. Given on going weakness and difficulty with ambulation EMS was called. He was found on the porch cold with a blood pressure of 70/palp. MEDICAL HISTORY: # ETOH abuse - denies history of blackout, withdrawal seizure, DTs - history of DUI, attended mandatory AA - currently reports drinking [**2-6**] to 1 pint of gin 2 times per week # M-W tear with UGIB [**8-/2146**] # hypothyroidism # h/o acute pancreatitis requiring hospitalization [**9-/2145**] # fatty liver # peripheral neuropathy # macrocytic anemia # gout # HTN # impaired vision secondary to a battery acid splash in his eyes MEDICATION ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Ferrous Sulfate 325 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Thiamine 100 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Levothyroxine Sodium 50 mcg PO DAILY ALLERGIES: Heparin Analogues PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T: BP: 92/56 P:66 R: 18 O2:100% RA CVP 6 General: Alert, oriented, no acute distress, thin/ cachetic male FAMILY HISTORY: The patient has a sister who has diabetes. The patient's father died at 94. The patient's mother died at 84. She had diabetes and hypertension. The patient's maternal grandmother died at age [**Age over 90 **]. SOCIAL HISTORY: Prior notes from [**2145**] indicate heavy drinking, up to half a gallon of gin every couple of days. Currently lives with wife and daughter. [**Name (NI) 1139**] use consists of about 14-15 cigarettes per day. ### Response: {'Unspecified disorder of autonomic nervous system,Pneumonia, organism unspecified,Metabolic encephalopathy,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Glucocorticoid deficiency,Other protein-calorie malnutrition,Body Mass Index less than 19, adult,Acidosis,Acute kidney failure, unspecified,Unspecified pleural effusion,Other complications due to other internal prosthetic device, implant, and graft,Other ascites,Neoplasm of unspecified nature of digestive system,Loss of weight,Pain in limb,Unspecified fall,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Personal history of pneumonia (recurrent),Unspecified acquired hypothyroidism,Dysphagia, oropharyngeal phase,Hypoxemia,Other hemochromatosis,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified deficiency anemia,Alcoholic fatty liver,Unspecified hereditary and idiopathic peripheral neuropathy,Gout, unspecified,Unspecified essential hypertension,Other specified visual disturbances,Late effects of other accidents'}

CHIEF COMPLAINT: Ascending and descending aortic aneurysm PRESENT ILLNESS: Mrs. [**Known lastname **] is a 63-year-old female with a long-standing history of hypertension. During a recent ER evaluation, she underwent a chest CT scan that was notable for a very large aneurysm and dilatation of the ascending and descending thoracic aorta. The ascending aorta measured upwards of 5.2 x 4.8 cm while the descending aorta measured 7 x 2 x 7.0 cm. The aorta tapered to a more normal caliber at the levels of renal arteries. CT was also significant for a large amount of mural thrombus in the descending thoracic aorta. There was no evidence of contrast extravasation or rupture. The CT scan was also significant for coronary artery calcifications and left adrenal adenoma. On the day of admission, she was seen at the cardiac surgical clinic. During her visit, she was very hypertensive with blood pressures in the 160's mmHg systolic over 100's mmHg diastolic. Given the dimensions of her aneurysm and uncontrolled hypertension, it was decided to admit her for blood pressure management along with further preoperative evaluation and urgent surgical intervention. MEDICAL HISTORY: Ascending and Descending Thoracic Aortic Aneursym coronary artery disease Hypertension History of mitral valve prolapse History of Rheumatic Fever diabetes mellitus MEDICATION ON ADMISSION: ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day HYDROCHLOROTHIAZIDE 12.5 mg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth twice a day ALLERGIES: Penicillins / Ciprofloxacin / Wellbutrin PHYSICAL EXAM: awake and alert lungs- clear cor- RSR at 88. BP 130/84 bilat abdomen- benign extremeties- warm, good pulses, no edema wounds- clean and dry. No erythema. Stable sternum. FAMILY HISTORY: Father with coronary disease before age 55 SOCIAL HISTORY: Current smoker, 1ppd for last 16 years. Admits to infrequent ETOH, no history of abuse. R Retired, lives with her husband.

Dissection of aorta, thoracoabdominal,Unspecified pleural effusion,Urinary tract infection, site not specified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysphagia, unspecified,Depressive disorder, not elsewhere classified,Benign neoplasm of adrenal gland,Atherosclerosis of aorta,Nontoxic uninodular goiter,Cardiomegaly,Tobacco use disorder,Mitral valve disorders,Stricture of artery

Dsct of thoracoabd aorta,Pleural effusion NOS,Urin tract infection NOS,Hypertension NOS,Crnry athrscl natve vssl,Drug dermatitis NOS,Adv eff antibiotics NEC,DMII wo cmp nt st uncntr,Dysphagia NOS,Depressive disorder NEC,Benign neoplasm adrenal,Aortic atherosclerosis,Nontox uninodular goiter,Cardiomegaly,Tobacco use disorder,Mitral valve disorder,Stricture of artery

Admission Date: [**2143-10-21**] Discharge Date: [**2143-11-6**] Date of Birth: [**2079-12-4**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / Ciprofloxacin / Wellbutrin Attending:[**First Name3 (LF) 165**] Chief Complaint: Ascending and descending aortic aneurysm Major Surgical or Invasive Procedure: [**2143-10-30**] Replacement of Ascending Aorta and Total Arch, Four Vessel Coronary Artery Bypass Grafting(LIMA to LAD, SVG to Diag, SVG to OM, SVG to RCA) Left heart catheterization and coronary angiography History of Present Illness: Mrs. [**Known lastname **] is a 63-year-old female with a long-standing history of hypertension. During a recent ER evaluation, she underwent a chest CT scan that was notable for a very large aneurysm and dilatation of the ascending and descending thoracic aorta. The ascending aorta measured upwards of 5.2 x 4.8 cm while the descending aorta measured 7 x 2 x 7.0 cm. The aorta tapered to a more normal caliber at the levels of renal arteries. CT was also significant for a large amount of mural thrombus in the descending thoracic aorta. There was no evidence of contrast extravasation or rupture. The CT scan was also significant for coronary artery calcifications and left adrenal adenoma. On the day of admission, she was seen at the cardiac surgical clinic. During her visit, she was very hypertensive with blood pressures in the 160's mmHg systolic over 100's mmHg diastolic. Given the dimensions of her aneurysm and uncontrolled hypertension, it was decided to admit her for blood pressure management along with further preoperative evaluation and urgent surgical intervention. Past Medical History: Ascending and Descending Thoracic Aortic Aneursym coronary artery disease Hypertension History of mitral valve prolapse History of Rheumatic Fever diabetes mellitus Social History: Current smoker, 1ppd for last 16 years. Admits to infrequent ETOH, no history of abuse. R Retired, lives with her husband. Family History: Father with coronary disease before age 55 Physical Exam: awake and alert lungs- clear cor- RSR at 88. BP 130/84 bilat abdomen- benign extremeties- warm, good pulses, no edema wounds- clean and dry. No erythema. Stable sternum. Pertinent Results: [**2143-10-21**] Chest CTA: CT ANGIOGRAM: Not significant change in the previously described massive aneurysmal dilatation of the entire ascending and descending thoracic aorta, including the arch. There is mild compression of the main right and left pulmonary arteries by the large descending aortic aneurysm. Large amount of mural thrombus is associated with the descending aortic aneurysm. There is no evidence of contrast extravasation or rupture. Intimal wall calcifications identified throughout the aorta. The abdominal aorta measures 36 cm in diameter at the level of take off of celiac artery. Atherosclerotic calcifications seen throughout the aorta. The origins of celiac, SMA, renals (single bilaterally), and [**Female First Name (un) 899**] are patent. Iliac arteries are widely patent. 3D measurements are as follows: aortic root: 34 x 30 mm, ascending aorta: 51 x 47 mm, aortic arch: 61 x 48 mm descending aorta (maximum): 85 x 72 mm, lower descending aorta: 37 x 34 mm CT CHEST, ABDOMEN AND PELVIS WITHOUT AND WITH CONTRAST: A 8 x 5 mm hypodense nodule is seen in the right thyroid lobe. Diffusecoronary artery calcifications are again seen. There is no pleural effusion. Minimal atelectasis is seen at the left base. Low-attenuation nodule again seen in the left adrenal gland, most consistent with adrenal adenoma. Liver, spleen, pancreas, adrenal, kidneys, uterus and urinary bladder are unremarkable. [**2143-10-21**] Transthoracic ECHO: The left atrium is elongated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic arch is markedly dilated. The descending thoracic aorta is markedly dilated with extrinsic compression of the left atrial free wall The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is an anterior space which most likely represents a fat pad. [**2143-11-4**] 05:40AM BLOOD WBC-5.5 RBC-3.03* Hgb-9.3* Hct-26.3* MCV-87 MCH-30.6 MCHC-35.3* RDW-14.8 Plt Ct-223 [**2143-11-3**] 06:57AM BLOOD Glucose-115* UreaN-15 Creat-0.6 Na-138 K-4.1 Cl-99 HCO3-31 AnGap-12 [**2143-11-4**] 05:40AM BLOOD UreaN-16 Creat-0.6 K-3.5 Brief Hospital Course: Mrs. [**Known lastname **] was admitted and underwent preoperative evaluation which included cardiac catheterization, echocardiogram and chest CT angiogram. Cardiac catheterization was done to reveal significant disease . Atenolol was switched to Labetolol while she intermittently required IV Hydralazine to maintain systolic blood pressures in the 120mmHg range. Her preoperative workup was notable for a positive urinalysis for which she was empirically started on Ciprofloxacin. Unfortunately, she went on to develop a drug rash which delayed surgery for several days. The dermatology service was consulted, and she was eventually cleared for surgery. On [**10-30**], Dr. [**First Name (STitle) **] performed replacement of her total arch and ascending aorta(elephant trunk), along with four vessel coronary artery bypass grafting. For surgical details, please see seperate dictated operative note. She weaned from bypass with neosynephrine and propofol. Following the operation, she was brought to the CVICU for invasive monitoring. Within 24 hours, she awoke neurologically intact, weaned from pressor and was extubated without incident. She was subsequently transferred to the floor for further recovery. Her BP was controlled with high dose beta blockade and ACE inhibitors. She was diuresed to preop weight and mobilized. Due to tacycardia despite metoprolol an echo was done, which revealed no pericardial effusion and preserved LV function. A speech and swallowing evaluation was done due to continued complaints of odynophagia and dysphagia to liquids. She was found to have aspiration with use of a straw and told to avoid these. Should her problems persist for more than a couple more weeks, ENT evaluation will be undertaken. With BP controlled and her strength returning, she was deemed ready for discharge which she was anxious for. Medications, instructions and follow-up were discussed with her prior to release. Medications on Admission: ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day HYDROCHLOROTHIAZIDE 12.5 mg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth twice a day Discharge Medications: 1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed. 4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. Disp:*50 Tablet(s)* Refills:*0* 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*50 Tablet(s)* Refills:*0* 8. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). Disp:*135 Tablet(s)* Refills:*2* 9. Menthol-Cetylpyridinium 3 mg Lozenge Sig: One (1) Lozenge Mucous membrane PRN (as needed). 10. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 11. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*60 Capsule(s)* Refills:*2* 12. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily). Disp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: Ascending and Descending Aortic Aneurysm Coronary Artery Disease Hypertension Mitral Valve Prolapse History of Rheumatic fever Elevated Hemoglobin A1C Drug Rash(secondary to Ciprofloxacin) Preoperative Urinary Tract Infection Discharge Condition: Good Discharge Instructions: 1)No driving for one month AND until off narcotics 2)No lotions, creams, or powders on any surgical incisions 3)No lifting greater than 10 pounds for 10 weeks 4)Shower daily ,no swimming or baths 5)Call for fever greater than 100.5, redness of, or drainage from incisions 6)Report weight gain of more than 3 pounds a day or 5 pound a week 7)Take all medications as prescribed Followup Instructions: Dr. [**First Name (STitle) **] in [**4-27**] weeks ([**Telephone/Fax (1) 170**]) Dr. [**First Name (STitle) **] in [**2-24**] weeks Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**] in [**2-24**] weeks ([**Telephone/Fax (1) 1989**]) Please call for appointments [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2143-11-6**]

441,511,599,401,414,693,E930,250,787,311,227,440,241,429,305,424,447

{'Dissection of aorta, thoracoabdominal,Unspecified pleural effusion,Urinary tract infection, site not specified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysphagia, unspecified,Depressive disorder, not elsewhere classified,Benign neoplasm of adrenal gland,Atherosclerosis of aorta,Nontoxic uninodular goiter,Cardiomegaly,Tobacco use disorder,Mitral valve disorders,Stricture of artery'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Ascending and descending aortic aneurysm PRESENT ILLNESS: Mrs. [**Known lastname **] is a 63-year-old female with a long-standing history of hypertension. During a recent ER evaluation, she underwent a chest CT scan that was notable for a very large aneurysm and dilatation of the ascending and descending thoracic aorta. The ascending aorta measured upwards of 5.2 x 4.8 cm while the descending aorta measured 7 x 2 x 7.0 cm. The aorta tapered to a more normal caliber at the levels of renal arteries. CT was also significant for a large amount of mural thrombus in the descending thoracic aorta. There was no evidence of contrast extravasation or rupture. The CT scan was also significant for coronary artery calcifications and left adrenal adenoma. On the day of admission, she was seen at the cardiac surgical clinic. During her visit, she was very hypertensive with blood pressures in the 160's mmHg systolic over 100's mmHg diastolic. Given the dimensions of her aneurysm and uncontrolled hypertension, it was decided to admit her for blood pressure management along with further preoperative evaluation and urgent surgical intervention. MEDICAL HISTORY: Ascending and Descending Thoracic Aortic Aneursym coronary artery disease Hypertension History of mitral valve prolapse History of Rheumatic Fever diabetes mellitus MEDICATION ON ADMISSION: ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day HYDROCHLOROTHIAZIDE 12.5 mg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth twice a day ALLERGIES: Penicillins / Ciprofloxacin / Wellbutrin PHYSICAL EXAM: awake and alert lungs- clear cor- RSR at 88. BP 130/84 bilat abdomen- benign extremeties- warm, good pulses, no edema wounds- clean and dry. No erythema. Stable sternum. FAMILY HISTORY: Father with coronary disease before age 55 SOCIAL HISTORY: Current smoker, 1ppd for last 16 years. Admits to infrequent ETOH, no history of abuse. R Retired, lives with her husband. ### Response: {'Dissection of aorta, thoracoabdominal,Unspecified pleural effusion,Urinary tract infection, site not specified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysphagia, unspecified,Depressive disorder, not elsewhere classified,Benign neoplasm of adrenal gland,Atherosclerosis of aorta,Nontoxic uninodular goiter,Cardiomegaly,Tobacco use disorder,Mitral valve disorders,Stricture of artery'}

CHIEF COMPLAINT: chest pain radiating to back PRESENT ILLNESS: 77yo man w/history of HTN that has had several episodes of chest pain radiating to back and lasting several hours over past week. Called PCP whom referred him to emergency department MEDICAL HISTORY: HTN, Atrial tachyarrhythmias s/p ablation-PPM, CRI, GERD, BPH, Depression, Hypothyroid, Gout, h/o PE, rt shoulder replacement MEDICATION ON ADMISSION: Sotolol 120" Synthroid 75' Norvasc 5' Buproprion 75' Albuterol-prn Nabumetone 750" ASA 81' Allopurinol 300' Doxazosin 8' Ultram 50-prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: anxious Neuro: A&O, nonfocal Pulm: CTA bilat CV: RRR no murmur Abdm soft, NT/ND/+BS Ext: warm, well perfused. palpable pulses FAMILY HISTORY: noncontributory SOCIAL HISTORY: Retired engineer,lives w/partner. Denies [**Name2 (NI) 11324**]. 1 drink ETOH/day

Dissection of aorta, thoracoabdominal,Embolism and thrombosis of thoracic aorta,Other chest pain,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Gout, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Personal history of colonic polyps

Dsct of thoracoabd aorta,Thoracic aortic embolism,Chest pain NEC,Hypertension NOS,Renal & ureteral dis NOS,BPH w/o urinary obs/LUTS,Gout NOS,Hypothyroidism NOS,Status cardiac pacemaker,Prsnl hst colonic polyps

Admission Date: [**2107-8-2**] Discharge Date: [**2107-8-2**] Date of Birth: [**2030-1-18**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1267**] Chief Complaint: chest pain radiating to back Major Surgical or Invasive Procedure: none History of Present Illness: 77yo man w/history of HTN that has had several episodes of chest pain radiating to back and lasting several hours over past week. Called PCP whom referred him to emergency department Past Medical History: HTN, Atrial tachyarrhythmias s/p ablation-PPM, CRI, GERD, BPH, Depression, Hypothyroid, Gout, h/o PE, rt shoulder replacement Social History: Retired engineer,lives w/partner. Denies [**Name2 (NI) 11324**]. 1 drink ETOH/day Family History: noncontributory Physical Exam: Gen: anxious Neuro: A&O, nonfocal Pulm: CTA bilat CV: RRR no murmur Abdm soft, NT/ND/+BS Ext: warm, well perfused. palpable pulses Pertinent Results: [**2107-8-2**] 05:38AM GLUCOSE-108* UREA N-21* CREAT-1.2 SODIUM-142 POTASSIUM-2.9* CHLORIDE-104 TOTAL CO2-28 ANION GAP-13 [**2107-8-2**] 05:38AM ALT(SGPT)-26 AST(SGOT)-17 ALK PHOS-54 AMYLASE-71 TOT BILI-0.3 [**2107-8-2**] 05:38AM LIPASE-29 [**2107-8-2**] 05:38AM ALBUMIN-3.2* MAGNESIUM-2.0 [**2107-8-2**] 05:38AM WBC-9.6 RBC-3.57* HGB-12.3* HCT-34.3* MCV-96 MCH-34.4* MCHC-35.8* RDW-14.1 [**2107-8-2**] 05:38AM PLT COUNT-113* [**2107-8-2**] 05:38AM PT-11.0 PTT-23.7 INR(PT)-0.9 [**2107-8-1**] 07:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG RADIOLOGY Preliminary Report CTA CHEST W&W/O C&RECONS, NON-CORONARY [**2107-8-2**] 2:04 PM CTA CHEST W&W/O C&RECONS, NON-; CT PELVIS W&W/O C Reason: Evaluation of thoracic aorta. MMS ReconstructionATTN: Mr [**Name13 (STitle) **] Contrast: OPTIRAY [**Hospital 93**] MEDICAL CONDITION: 77 year old man with chest pain radiating to back REASON FOR THIS EXAMINATION: Evaluation of thoracic aorta. MMS ReconstructionATTN: Mr [**First Name (Titles) 102180**] [**Last Name (Titles) 104390**]S for IV CONTRAST: None. INDICATION: 77-year-old man with chest pain radiating to the back. COMPARISON: [**2107-8-1**]. TECHNIQUE: Continuous axial images of the chest were obtained without IV contrast. Following the administration of IV Optiray contrast images of the chest, abdomen and pelvis were obtained with multiplanar images also reformatted. CTA CHEST: Again seen is intramural hematoma involving the descending aorta and focal penetrating ulcer not significantly changed in appearance compared to the prior study. Mild aneurysmal dilatation of the descending aorta is unchanged, measuring 4.7 x 4.0 cm (series 3, image 20). There are small bilateral pleural effusions. There are no enlarged pelvic or inguinal lymph nodes. Calcifications are seen within the left anterior descending coronary artery. Lung windows reveal no pulmonary nodules or focal consolidations. There is a filling defect in a subsegmental right lower lobe pulmonary artery not confirmed on multiplanar reformatted images possibly representing mixing artifact. CT ABDOMEN WITH IV CONTRAST: The liver, gallbladder, spleen, adrenal glands, pancreas are unremarkable. Kidneys are atrophic with small hypodensities likely representing cysts but not fully characterized. Scattered retroperitoneal nodes do not meet CT criteria for enlargement. There is no free air or free fluid in the abdomen. CT PELVIS WITH IV CONTRAST: Rectum, sigmoid colon and bladder are unremarkable. There is hypertrophy of the medial segment of the prostate gland. No enlarged pelvic or inguinal lymph nodes. There are degenerative changes of the shoulder joint and a right humeral prosthesis. There are moderate degenerative changes of the lower lumbar spine. IMPRESSION: 1. Stable appearance of intramural hematoma and focal penetrating ulcer involving the proximal descending thoracic aorta with mild aneurysmal dilatation. 2. Small pleural effusions. DR. [**First Name (STitle) **] [**Doctor Last Name **] RADIOLOGY Final Report CTU (ABD/PEL) W/CONTRAST [**2107-8-1**] 7:35 PM CTA CHEST W&W/O C&RECONS, NON-; CTU (ABD/PEL) W/CONTRAST Reason: eval dissection Field of view: 40 Contrast: OPTIRAY [**Hospital 93**] MEDICAL CONDITION: 77 year old man with chest pain radiating to back REASON FOR THIS EXAMINATION: eval dissection CONTRAINDICATIONS for IV CONTRAST: None. HISTORY: 73-year-old man with chest pain radiating to the back. Evaluate for dissection. Comparison is made to prior CT examination dated [**2106-11-26**]. CT OF THE CHEST/ABDOMEN/PELVIS TECHNIQUE: MDCT acquired axial images were obtained through the chest, abdomen, and pelvis with intravenous contrast only. Coronal and sagittal reformations were evaluated. CT OF THE CHEST WITH INTRAVENOUS CONTRAST: There is no evidence of acute aortic dissection. There has been interval progression of ulcerating plaque within the descending aorta and amount of mural thrombus. Additionally, there is mild aneurysmal dilatation measuring approximately 4.1 x 4.5 cm (3:22). No pathologically enlarged lymph nodes are identified. Artifact from left-sided central venous catheter and pacemaker leads is noted along with mild coronary artery calcification. The airways are patent to the subsegmental level. There is bilateral dependent atelectasis and a minimal left-sided pleural effusion, new since prior examination. The lungs are otherwise clear. CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: The liver, gallbladder, spleen, stomach, intra-abdominal bowel, pancreas, and adrenal glands appear unremarkable. Both kidneys appear slightly atrophic with bilateral hypoattenuating lesions, too small to definitively characterize but likely representing simple cyst. No free air or free fluid is noted within the abdominal cavity. No pathologically enlarged lymph nodes are present. CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: There is hypertrophy of the median lobe of the prostate with intrapelvic bowel and urinary bladder appearing unremarkable. No free fluid is noted within the pelvic cavity. No pathologically enlarged lymph nodes are identified. BONE WINDOWS: No malignant-appearing osseous lesions are identified. There are severe multilevel degenerative changes involving the thoracic and lumbar spine. IMPRESSION: 1. Marked progression to mural thrombus and a focal aortic ulceration involving the proximal descending thoracic aorta with mild aneurysmal dilatation as noted above. No focal dissection identified. 2. New minimal left-sided left pleural effusion. 3. Bilateral renal hypoattenuating lesions. Too small to definitively characterize but likely representing simple cyst. 4. Enlarged prostate The study and the report were reviewed by the staff radiologist. DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7832**] Approved: TUE [**2107-8-2**] 4:55 PM Brief Hospital Course: Mr [**Known lastname 9904**] was admitted to the CSRU for blood pressure control via the emergency room. He was initially controlled w/Nicardipine infusion, this was transitioned to and increased oral calcium channel blocker dose and the addition of an ACE inhibitor to his existing oral regime. He was seen by CT surgery as well as vascular surgery during this admission. He had CTA torso w/reconstruction and it was decided he would benefit from endovascular stenting. The patient also had an echocardiogram and carotid ultrasound. He was scheduled to return on Friday [**8-5**] for endovascular stenting w/Dr [**Last Name (STitle) 914**]. He is also scheduled to return on [**8-4**] for a neck CTA prior to surgery. Medications on Admission: Sotolol 120" Synthroid 75' Norvasc 5' Buproprion 75' Albuterol-prn Nabumetone 750" ASA 81' Allopurinol 300' Doxazosin 8' Ultram 50-prn Discharge Medications: 1. Sotalol 80 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 2. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Bupropion 75 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 5. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Doxazosin 4 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*10 Tablet(s)* Refills:*0* 9. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Ulcerated descending Aorta plaque w/aortic thrombus PMH: HTN, CRI, BPH, Atrial tachyarrththymias s/p ablation/PPM, GERD, Depression, Hypothyroid, h/o PE '[**02**], gout, Rt shoulder replacement Discharge Condition: good Discharge Instructions: Take all medications as prescribed. Return to emergency department for any further symptoms of chest/back pain. Return to Radiology department([**Hospital Unit Name **]) on Thursday [**8-4**] @ 3:30P for scheduled neck CTA. Return to preop anesthesia area Friday [**8-5**] for endovascular stenting Followup Instructions: neck CTA [**8-4**] 3:30P [**Hospital Unit Name **] Preop holding area [**8-5**] 6A Clinical center Completed by:[**2107-8-2**]

441,444,786,401,593,600,274,244,V450,V127

{'Dissection of aorta, thoracoabdominal,Embolism and thrombosis of thoracic aorta,Other chest pain,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Gout, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Personal history of colonic polyps'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: chest pain radiating to back PRESENT ILLNESS: 77yo man w/history of HTN that has had several episodes of chest pain radiating to back and lasting several hours over past week. Called PCP whom referred him to emergency department MEDICAL HISTORY: HTN, Atrial tachyarrhythmias s/p ablation-PPM, CRI, GERD, BPH, Depression, Hypothyroid, Gout, h/o PE, rt shoulder replacement MEDICATION ON ADMISSION: Sotolol 120" Synthroid 75' Norvasc 5' Buproprion 75' Albuterol-prn Nabumetone 750" ASA 81' Allopurinol 300' Doxazosin 8' Ultram 50-prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: anxious Neuro: A&O, nonfocal Pulm: CTA bilat CV: RRR no murmur Abdm soft, NT/ND/+BS Ext: warm, well perfused. palpable pulses FAMILY HISTORY: noncontributory SOCIAL HISTORY: Retired engineer,lives w/partner. Denies [**Name2 (NI) 11324**]. 1 drink ETOH/day ### Response: {'Dissection of aorta, thoracoabdominal,Embolism and thrombosis of thoracic aorta,Other chest pain,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Gout, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Personal history of colonic polyps'}

CHIEF COMPLAINT: Ruptured abdominal aortic aneurysm PRESENT ILLNESS: HPI: Pt is 80 y/o M with h/o CAD, PVD, bilateral carotid endarterectomies within past year who presents with ~10cm, leaking infrarenal AAA. Pt had an acute onset of abdominal pain radiating to the back today and presented to OSH where subsequent CT scan revealed the AAA. No fevers or chills. Currently, no chest pain, shortness of breath, lightheadedness or dizziness. MEDICAL HISTORY: PMH: CABG in [**2-/2117**] with an LIMA to LAD and vein graft to the first diagonal, obtuse marginal, and right coronary arteries Carotid stenosis s/p bilateral carotid endarterectomies COPD hyperlipidemia hypertension mild congestive heart failure anxiety rotator cuff tear sleep apnea MEDICATION ON ADMISSION: Meds: Aspirin 81',Zocor 80',Plavix 75',albuterol inhaler,Spiriva ALLERGIES: Percocet PHYSICAL EXAM: PE: T 97 P 56 BP 132/74 R 18 SaO2 95% Gen: nad Heent: an-icteric Lungs: clear Heart: RRR Abd: mild periumbilical abd pain, soft, nondistended, nonrigid Extrem: palpable femoral/popliteal/DP/PT pulses bilaterally FAMILY HISTORY: SH: No ETOH or smoking. He is a remote smoker. SOCIAL HISTORY: FH: non-contributory

Abdominal aneurysm, ruptured,Diastolic heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Acute posthemorrhagic anemia,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Atherosclerosis of renal artery,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Knee joint replacement

Rupt abd aortic aneurysm,Diastolc hrt failure NOS,Comp-oth vasc dev/graft,Ac posthemorrhag anemia,Pleural effusion NOS,Pulmonary collapse,Chr airway obstruct NEC,Chronic kidney dis NOS,Renal artery atheroscler,Iliac artery aneurysm,Hypertension NOS,Crnry athrscl natve vssl,Obstructive sleep apnea,Joint replaced knee

Admission Date: [**2127-10-8**] Discharge Date: [**2127-10-21**] Date of Birth: [**2046-10-11**] Sex: M Service: SURGERY Allergies: Percocet Attending:[**First Name3 (LF) 1234**] Chief Complaint: Ruptured abdominal aortic aneurysm Major Surgical or Invasive Procedure: [**2127-10-8**]: Endovascular aortic aneurysm repair. [**2127-10-16**]: Abdominal aortogram. Balloon angioplasty of proximal extension cuff of endograft(aorta) and left CIA and EIA. History of Present Illness: HPI: Pt is 80 y/o M with h/o CAD, PVD, bilateral carotid endarterectomies within past year who presents with ~10cm, leaking infrarenal AAA. Pt had an acute onset of abdominal pain radiating to the back today and presented to OSH where subsequent CT scan revealed the AAA. No fevers or chills. Currently, no chest pain, shortness of breath, lightheadedness or dizziness. Past Medical History: PMH: CABG in [**2-/2117**] with an LIMA to LAD and vein graft to the first diagonal, obtuse marginal, and right coronary arteries Carotid stenosis s/p bilateral carotid endarterectomies COPD hyperlipidemia hypertension mild congestive heart failure anxiety rotator cuff tear sleep apnea Social History: FH: non-contributory Family History: SH: No ETOH or smoking. He is a remote smoker. Physical Exam: PE: T 97 P 56 BP 132/74 R 18 SaO2 95% Gen: nad Heent: an-icteric Lungs: clear Heart: RRR Abd: mild periumbilical abd pain, soft, nondistended, nonrigid Extrem: palpable femoral/popliteal/DP/PT pulses bilaterally Pertinent Results: [**2127-10-21**] 06:30AM BLOO WBC-10.1 RBC-3.59* Hgb-10.7* Hct-32.8* MCV-91 MCH-29.9 MCHC-32.7 RDW-14.5 Plt Ct-529* [**2127-10-21**] 06:30AM BLOOD PT-13.8* PTT-32.0 INR(PT)-1.2* [**2127-10-21**] 06:30AM BLOOD Glucose-113* UreaN-14 Creat-1.3* Na-140 K-3.9 Cl-101 HCO3-28 AnGap-15 [**2127-10-21**] 06:30AM BLOOD Calcium-8.4 Phos-2.6* Mg-1.8 CT ANGIOGRAM: The patient is status post placement of endovascular stent. There is no sign of migration of the stent compared to prior study, with its proximal margin just at the origin of the SMA and extending distally with the longer limb extending into the left common/external iliac artery junction while the shorter right limb terminates at the right common iliac artery. Again seen the endoleak in the aneurysmatic sac, in similar amount as in prior study. In the late venous phase, there is phasing out of the contrast enhancement. On today's study, the impression is that the endoleak originates from the area of overlapping stent- grafts (endoleak type 3). Both renal arteries arise at or just below the top of the endovascular stent, with a very stenotic origin of right renal artery. The left common iliac artery aneurysm is unchanged in size (13 mm), with the endovascular limb feeding the left external iliac artery and the excluded enhancing portion is feeding the left internal iliac artery. Again seen thedifference in enhancement between the right internal iliac artery and the left internal iliac artery (which is fed by the excluded portion of the left common iliac artery). IMPRESSION: Compared to prior study performed in [**2127-10-14**], again seen is the endoleak in the aneurysmatic sac. On today's examination, the impression is of a Type 3 endoleak. All the other previously described findings are unchanged compared to prior study, as follows: 1. Left iliac artery aneurysm. Difference in contrast enhancement of left and right internal iliac arteries. 2. Hypodensities seen in spleen that could represent infarct; an ultrasound examination is recommended for further evaluation. 3. Simple cyst in left hepatic lobe. 4. Bilateral pleural effusion with adjacent atelectasis. 5. Incidental left lower lobe lung nodule. A dedicated chest CT scan is recommended for further evaluation of other nodules. 6. Atrophic right kidney with delayed nephrogram and no excretory phase could be secondary to a significant stenosi at the origin of the right renal artery. Brief Hospital Course: [**10-8**]: Ruptured abdominal aortic aneurysm. Pt urgently taked to the OR for EVAR. PROCEDURE: Endovascular aortic aneurysm repair. Introduction of catheter into the aorta. Bilateral femoral artery exposure M-50 Zenith bifurcated modular graft placed Right limb graft placed with extension. Left femoral graft placed with extension. He tolerated the procedure well. No complications. Intubated. Precautions taken for hx of renal failure, Bicarb drip. Transfered to the CVICU in stable condition post operative [**10-9**]: CVIU intubated and sedated. Making good urine. Had bump in creat to 1.6. Lines remain in. [**10-10**]: CVICU. Extubated. PO pain meds. Drop in HCT to 26. Making good urine. Creat bump to 2.2. kept NPO. HCT followed. Transfused 2 units PRBC. [**10-11**]: Transfered to the VICU. Nitro for HTN. Creat improved to 1.9. Diet advanced. PT consult. HCT stable after PRBC. Making good urine. OOB. [**10-12**] - [**10-13**]: stable / ambulating / delined. Foley DC making urine. IS support. [**10-14**]: Creat stable at 1.5. Mucomyst PO and IV bicarb given in preperation for CTA. recieves CTA. Endoleak seen. HCT stable. EKG DC'd. Nitro weaned with PO HTN medications. Made floor status. [**10-15**] - [**10-16**]: Creat normalizes. HCT stable. Preperation for Angiogram: Again given Mucmyst and bicarb protocol. Making good urnine. [**10-16**]: goes for angio under general: OPERATION PERFORMED: 1. Exposure of left common femoral artery and primary repair 2. Introduction of catheter into aorta. 3. Abdominal aortogram. 4. Balloon angioplasty of proximal extension cuff of endograft(aorta) and left CIA and EIA Extubated in the OR. Sent to the PACU for recovery. IOnce recovered from the PACU sent back to the VICU for recovery. [**10-17**]: Delined. heplocked. Making good urine. Creat stable at 1.6. OOB to chair. foley left in. Diet advanced. Drop in HCT to 23 post op Transfused 2 units PRBC. Needs nitro for HTN: Cardiology consult for persistant HTN; PO medications adjsted. HTN adjusts. [**10-18**] - [**10-20**]: Foley DC'd. Making good urine. Creat remains stable. Normotensive with adjustment of pain meds. Ambulating with PT. Had to be given lasix for fluid overlaod secondary to CHF Systolic chronic stable. Creat stable at 1.5. Mucomyst PO and IV bicarb given in preperation for CTA. recieves CTA. Endoleak seen, much improved. [**10-21**]: recieves PMIBI for future open AAA repair. Pt deciding wether or not to have an open procedure. He is being DC'd today understanding the risk of rupture. His creatinine is stable. Normotensive on PO medications. Making good urine. HCT stable. VNA to check HCT and BP at home. Medications on Admission: Meds: Aspirin 81',Zocor 80',Plavix 75',albuterol inhaler,Spiriva Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 4. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 6. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 9. Albuterol 90 mcg/Actuation Aerosol Sig: Four (4) Puff Inhalation Q6H (every 6 hours). 10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 11. Simethicone 80 mg Tablet, Chewable Sig: 0.50 - 1.0 Tablet, Chewable PO three times a day as needed. 12. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). Disp:*30 qs* Refills:*2* Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: Abdominal aortic aneurysm; persistent type I endoleak I had a long talk with patient and family. he is pending completion operative repair. he knows going home even for a few days subjects him to potential risk of rupture and death. he accepts those risks Discharge Condition: Improved Discharge Instructions: Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. * Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your skin, or the whites of your eyes become yellow. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. * Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * Continue to ambulate several times per day. * No heavy ([**11-5**] lbs) until your follow up appointment. Followup Instructions: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2128-2-2**] 10:40 Call Dr [**Last Name (STitle) 8888**] [**Name (STitle) 42274**] at [**Telephone/Fax (1) 1241**]. To discuss further surgery. Completed by:[**2127-10-21**]

441,428,996,285,511,518,496,585,440,442,401,414,327,V436

{'Abdominal aneurysm, ruptured,Diastolic heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Acute posthemorrhagic anemia,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Atherosclerosis of renal artery,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Knee joint replacement'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Ruptured abdominal aortic aneurysm PRESENT ILLNESS: HPI: Pt is 80 y/o M with h/o CAD, PVD, bilateral carotid endarterectomies within past year who presents with ~10cm, leaking infrarenal AAA. Pt had an acute onset of abdominal pain radiating to the back today and presented to OSH where subsequent CT scan revealed the AAA. No fevers or chills. Currently, no chest pain, shortness of breath, lightheadedness or dizziness. MEDICAL HISTORY: PMH: CABG in [**2-/2117**] with an LIMA to LAD and vein graft to the first diagonal, obtuse marginal, and right coronary arteries Carotid stenosis s/p bilateral carotid endarterectomies COPD hyperlipidemia hypertension mild congestive heart failure anxiety rotator cuff tear sleep apnea MEDICATION ON ADMISSION: Meds: Aspirin 81',Zocor 80',Plavix 75',albuterol inhaler,Spiriva ALLERGIES: Percocet PHYSICAL EXAM: PE: T 97 P 56 BP 132/74 R 18 SaO2 95% Gen: nad Heent: an-icteric Lungs: clear Heart: RRR Abd: mild periumbilical abd pain, soft, nondistended, nonrigid Extrem: palpable femoral/popliteal/DP/PT pulses bilaterally FAMILY HISTORY: SH: No ETOH or smoking. He is a remote smoker. SOCIAL HISTORY: FH: non-contributory ### Response: {'Abdominal aneurysm, ruptured,Diastolic heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Acute posthemorrhagic anemia,Unspecified pleural effusion,Pulmonary collapse,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Atherosclerosis of renal artery,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Knee joint replacement'}

CHIEF COMPLAINT: alcoholic intoxication and heroin abuse PRESENT ILLNESS: Mr. [**Known lastname 24927**] is a 38 yo M with PMH of polysubstance abuse who presents with acute alcoholic intoxication and heroin abuse. He was found around [**Location (un) **] station and brought to [**Hospital1 18**]. On arrival to [**Hospital1 18**], he reported also snorting heroin. In the ED, VS: T 99 BP 98/73 HR 102 RR17 99%RA. He was initially alert and awake, then became somnolent with RR of 6 and O2 sat of 70%. He received naloxone with immediate awakening. RR normalized and O2sat was normal. After several hours in [**Name (NI) **], pt became increasingly agitated and received multiple doses of valium for elevated CIWA scale, receiving total of 50mg PO. Pt has frequent visits to [**Hospital1 18**]. Was recently admitted to MICU Green on [**2182-10-5**]. At that time, seen by psychiatry who left recommendation regarding administration of benzos as patient frequently is administered high doses of benzodiazepines for drug seeking behavior. MEDICAL HISTORY: Per Discharge Summary ([**2182-6-18**]) Poly Substance Abuse: Benzo/Opiates/IVDU 2. Ethanol Abuse: hx of DTs and withdrawal seizures, intubated in the past. 3. Hepatitis C 4. Hepatitis B 5. Compartment Syndrom RLE, [**2171**] 6. OCD and Anxiety 7. Depression with hx of suicidal ideations 8. Sever Peripheral Neuropathy MEDICATION ON ADMISSION: Per Discharge Summary ([**2182-6-18**]), Unknown Compliance 1. Folic Acid 1mg Daily 2. Thiamine 100mg Daily 3. MVT One tab Daily 4. Ferrous Sulfate 325mg One Tab Daily 5. Oxcarbazepine 300mg one tablet [**Hospital1 **] 6. Gabapentin 200mg PO Q8H 7. Prozac 40mg Once Daily ALLERGIES: Penicillins PHYSICAL EXAM: VS: T 96 HR 86 BP 128/79 02sat 97% RR 12 GEN: Disheveled, appears older than stated age HEENT: EOMI, PERRL NECK: Supple CHEST: CTABL CV: RRR, S1S2, no m/r/g ABD:Soft, NT, ND EXT: No c/c/e Skin: Pruritic papular rash on trunk, groin, ankles bilaterally FAMILY HISTORY: Father with depression, OCD and alcoholism. Mother died of DM complications SOCIAL HISTORY: From previous DC summary. States he does not speak to any family members, never married, no children. Homeless, states he does not like shelters because he gets "nervous around all the people."

Alcohol withdrawal,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Opioid abuse, unspecified,Obsessive-compulsive disorders,Cerebral degeneration, unspecified,Lack of housing,Scabies,Alcoholic polyneuropathy

Alcohol withdrawal,Hpt B chrn wo cm wo dlta,Opioid abuse-unspec,Obsessive-compulsive dis,Cereb degeneration NOS,Lack of housing,Scabies,Alcoholic polyneuropathy

Admission Date: [**2182-10-10**] Discharge Date: [**2182-10-11**] Date of Birth: [**2144-9-28**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 338**] Chief Complaint: alcoholic intoxication and heroin abuse Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname 24927**] is a 38 yo M with PMH of polysubstance abuse who presents with acute alcoholic intoxication and heroin abuse. He was found around [**Location (un) **] station and brought to [**Hospital1 18**]. On arrival to [**Hospital1 18**], he reported also snorting heroin. In the ED, VS: T 99 BP 98/73 HR 102 RR17 99%RA. He was initially alert and awake, then became somnolent with RR of 6 and O2 sat of 70%. He received naloxone with immediate awakening. RR normalized and O2sat was normal. After several hours in [**Name (NI) **], pt became increasingly agitated and received multiple doses of valium for elevated CIWA scale, receiving total of 50mg PO. Pt has frequent visits to [**Hospital1 18**]. Was recently admitted to MICU Green on [**2182-10-5**]. At that time, seen by psychiatry who left recommendation regarding administration of benzos as patient frequently is administered high doses of benzodiazepines for drug seeking behavior. Past Medical History: Per Discharge Summary ([**2182-6-18**]) Poly Substance Abuse: Benzo/Opiates/IVDU 2. Ethanol Abuse: hx of DTs and withdrawal seizures, intubated in the past. 3. Hepatitis C 4. Hepatitis B 5. Compartment Syndrom RLE, [**2171**] 6. OCD and Anxiety 7. Depression with hx of suicidal ideations 8. Sever Peripheral Neuropathy Social History: From previous DC summary. States he does not speak to any family members, never married, no children. Homeless, states he does not like shelters because he gets "nervous around all the people." Family History: Father with depression, OCD and alcoholism. Mother died of DM complications Physical Exam: VS: T 96 HR 86 BP 128/79 02sat 97% RR 12 GEN: Disheveled, appears older than stated age HEENT: EOMI, PERRL NECK: Supple CHEST: CTABL CV: RRR, S1S2, no m/r/g ABD:Soft, NT, ND EXT: No c/c/e Skin: Pruritic papular rash on trunk, groin, ankles bilaterally NEURO: speech slurred, unsteady gait, CN ii-xii intact; able to answer questions appropriately . Pertinent Results: [**2182-10-10**] 03:10PM GLUCOSE-83 UREA N-12 CREAT-0.8 SODIUM-143 POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-26 ANION GAP-16 [**2182-10-10**] 03:10PM estGFR-Using this [**2182-10-10**] 03:10PM CALCIUM-9.0 PHOSPHATE-3.1 MAGNESIUM-1.8 [**2182-10-10**] 03:10PM ASA-NEG ETHANOL-244* ACETMNPHN-NEG bnzodzpn-POS barbitrt-NEG tricyclic-NEG [**2182-10-10**] 03:10PM WBC-5.1# RBC-4.36* HGB-12.5* HCT-37.7* MCV-87 MCH-28.6 MCHC-33.0 RDW-16.5* [**2182-10-10**] 03:10PM NEUTS-33.2* BANDS-0 LYMPHS-58.8* MONOS-5.5 EOS-1.6 BASOS-0.9 [**2182-10-10**] 03:10PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2182-10-10**] 03:10PM PLT COUNT-239 Brief Hospital Course: A/P: 38 yo M with PMH of ETOH abuse/withdrawal and multiple hospitalizations presented with acute intoxication and heroin use requiring naloxone in ED. . ETOH intoxication: ETOH level 244. Speech somewhat slurred on exam. Pt admits to drinking rum and Listerine. Received Valium 50mg total in ED for CIWA >10. Had 5mg x 3 of Valium in the MICU. Given thiamine, folate, MVI. Social work was contact[**Name (NI) **] and paperwork for a section 35 was started. Pt left AMA before paperwork could be completed (will take several days). Will need to continue paperwork if pt returns in near future. Scabies: Pt was treated with permethrin cream and Ivermectin x 1. Pt left AMA before further care was done for pt. Medications on Admission: Per Discharge Summary ([**2182-6-18**]), Unknown Compliance 1. Folic Acid 1mg Daily 2. Thiamine 100mg Daily 3. MVT One tab Daily 4. Ferrous Sulfate 325mg One Tab Daily 5. Oxcarbazepine 300mg one tablet [**Hospital1 **] 6. Gabapentin 200mg PO Q8H 7. Prozac 40mg Once Daily Discharge Medications: left AMA Discharge Disposition: Home Discharge Diagnosis: left AMA Discharge Condition: left AMA Discharge Instructions: left AMA Followup Instructions: left AMA Completed by:[**2182-10-11**]

291,070,305,300,331,V600,133,357

{'Alcohol withdrawal,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Opioid abuse, unspecified,Obsessive-compulsive disorders,Cerebral degeneration, unspecified,Lack of housing,Scabies,Alcoholic polyneuropathy'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: alcoholic intoxication and heroin abuse PRESENT ILLNESS: Mr. [**Known lastname 24927**] is a 38 yo M with PMH of polysubstance abuse who presents with acute alcoholic intoxication and heroin abuse. He was found around [**Location (un) **] station and brought to [**Hospital1 18**]. On arrival to [**Hospital1 18**], he reported also snorting heroin. In the ED, VS: T 99 BP 98/73 HR 102 RR17 99%RA. He was initially alert and awake, then became somnolent with RR of 6 and O2 sat of 70%. He received naloxone with immediate awakening. RR normalized and O2sat was normal. After several hours in [**Name (NI) **], pt became increasingly agitated and received multiple doses of valium for elevated CIWA scale, receiving total of 50mg PO. Pt has frequent visits to [**Hospital1 18**]. Was recently admitted to MICU Green on [**2182-10-5**]. At that time, seen by psychiatry who left recommendation regarding administration of benzos as patient frequently is administered high doses of benzodiazepines for drug seeking behavior. MEDICAL HISTORY: Per Discharge Summary ([**2182-6-18**]) Poly Substance Abuse: Benzo/Opiates/IVDU 2. Ethanol Abuse: hx of DTs and withdrawal seizures, intubated in the past. 3. Hepatitis C 4. Hepatitis B 5. Compartment Syndrom RLE, [**2171**] 6. OCD and Anxiety 7. Depression with hx of suicidal ideations 8. Sever Peripheral Neuropathy MEDICATION ON ADMISSION: Per Discharge Summary ([**2182-6-18**]), Unknown Compliance 1. Folic Acid 1mg Daily 2. Thiamine 100mg Daily 3. MVT One tab Daily 4. Ferrous Sulfate 325mg One Tab Daily 5. Oxcarbazepine 300mg one tablet [**Hospital1 **] 6. Gabapentin 200mg PO Q8H 7. Prozac 40mg Once Daily ALLERGIES: Penicillins PHYSICAL EXAM: VS: T 96 HR 86 BP 128/79 02sat 97% RR 12 GEN: Disheveled, appears older than stated age HEENT: EOMI, PERRL NECK: Supple CHEST: CTABL CV: RRR, S1S2, no m/r/g ABD:Soft, NT, ND EXT: No c/c/e Skin: Pruritic papular rash on trunk, groin, ankles bilaterally FAMILY HISTORY: Father with depression, OCD and alcoholism. Mother died of DM complications SOCIAL HISTORY: From previous DC summary. States he does not speak to any family members, never married, no children. Homeless, states he does not like shelters because he gets "nervous around all the people." ### Response: {'Alcohol withdrawal,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Opioid abuse, unspecified,Obsessive-compulsive disorders,Cerebral degeneration, unspecified,Lack of housing,Scabies,Alcoholic polyneuropathy'}

CHIEF COMPLAINT: Chest Pain/Shortness of Breath PRESENT ILLNESS: 75 y/o male with new onset chest pain and shortness of breath x 1 week with exertion. Both Relieved at rest. Pt. went to emergency room and was found to have elevated cardiac enzymes and diagnosed with NSTEMI. She was eventually brought for a cardiac catheterization on this day which revealed 80% LMCA, 100% mRCA with LAD collaterals to PDA, and an EF of 60%. A Intra-aortic balloon pump was inserted and pt was referred for bypass surgery. MEDICAL HISTORY: Hypertension Hyperlipidemia Colon polyps s/p polypectomy MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], MVI, Triamterene/HCTZ ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 81 155/91 18 95%RA General: NAD w/ IABP HEENT: EOMI/PERRL, NC/AT Neck: Supple, -JVD, -Bruit Pulm: CTAB -w/r/r Cor: RRR, +S1S2, 2/6 SEM Abd: Soft, NT/ND, protuberent Neuro: MAE, non-focal, A&O x 3 FAMILY HISTORY: Mother died at the age 65 from an MI/CAD SOCIAL HISTORY: Quit smoking 20 yrs ago after 1ppd x 30yrs Pt admits to 3 shots of vodka a day

Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Crnry athrscl natve vssl,Subendo infarct, initial,Ac posthemorrhag anemia,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2146-10-26**] Discharge Date: [**2146-11-1**] Date of Birth: [**2071-9-23**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest Pain/Shortness of Breath Major Surgical or Invasive Procedure: [**2146-10-27**] Coronary Artery Bypass Graft x 3 (LIMA->LAD, SVG->PDA, OM) History of Present Illness: 75 y/o male with new onset chest pain and shortness of breath x 1 week with exertion. Both Relieved at rest. Pt. went to emergency room and was found to have elevated cardiac enzymes and diagnosed with NSTEMI. She was eventually brought for a cardiac catheterization on this day which revealed 80% LMCA, 100% mRCA with LAD collaterals to PDA, and an EF of 60%. A Intra-aortic balloon pump was inserted and pt was referred for bypass surgery. Past Medical History: Hypertension Hyperlipidemia Colon polyps s/p polypectomy Social History: Quit smoking 20 yrs ago after 1ppd x 30yrs Pt admits to 3 shots of vodka a day Family History: Mother died at the age 65 from an MI/CAD Physical Exam: VS: 81 155/91 18 95%RA General: NAD w/ IABP HEENT: EOMI/PERRL, NC/AT Neck: Supple, -JVD, -Bruit Pulm: CTAB -w/r/r Cor: RRR, +S1S2, 2/6 SEM Abd: Soft, NT/ND, protuberent Neuro: MAE, non-focal, A&O x 3 Pertinent Results: [**2146-10-31**] 06:15AM BLOOD WBC-9.0 RBC-3.13*# Hgb-10.5* Hct-29.5* MCV-94 MCH-33.5* MCHC-35.6* RDW-16.1* Plt Ct-108* [**2146-10-30**] 11:15AM BLOOD PT-12.7 PTT-22.1 INR(PT)-1.1 [**2146-10-31**] 06:15AM BLOOD Glucose-91 UreaN-22* Creat-1.1 Na-138 K-3.9 Cl-102 HCO3-27 AnGap-13 [**2146-10-26**] 10:22PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG Brief Hospital Course: Following cardiac cath with IABP placement, pt was pre-operatively prepared for coronary bypass surgery in the usual fashion. On hospital day two pt was brought to the operating room where he underwent coronary artery bypass surgery x 3. Please see operavtive report for details. Pt was transferred to the CSRU in stable condition on Neosynephrine and Propofol. Later on op day pt was weaned from mechanical ventilation and propofol and extubated. He was neurologically intact. He was weaned off of inotropic support and was hemodynamically stable. Also on this day the IABP was weaned off and removed. Diuretics and b-blockers were started per protocol and pt was transferred to the telemetry floor. He had a drop in hematocrit and required 2 blood transfusions on post-op day three. He responded well with a hemotocrit greater than 29. Chest tubes and epicardial pacing wires were removed by post-op day four. Pt. was improving well but had difficulties with ambulation and reaching level five status. He was therefore discharged to a rehabiliation facility on post-op day 5 for further physical therapy. He is being discharged on 1 week of lasix, and will need to be reevaluated at its completion to see if he needs to restart his home diuretic regimen. Medications on Admission: [**Last Name (LF) **], [**First Name3 (LF) **], MVI, Triamterene/HCTZ Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 1 weeks. 10. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 7 days. Discharge Disposition: Extended Care Facility: [**Hospital1 599**] of [**Location (un) 55**] Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3 Hypertension Hyperlipidemia Colon polyps s/p polypectomy Discharge Condition: Good Discharge Instructions: Shower, wash incisions with soap and water and pat dry. No lotions, creams or powders. Call with fever, redness or drainage from incisions, or weight gain more than 2 pounds in one day or five in one week. No driving for 1 month. No lifting more than 10 pounds for 2 months. Please call the office with problems/questions. [**Telephone/Fax (1) 170**] Followup Instructions: Dr. [**First Name (STitle) 4702**] 2 weeks Dr. [**Last Name (STitle) **] 4 weeks [**Telephone/Fax (1) 170**] Local cardiologist 2 weeks Completed by:[**2146-11-1**]

414,410,285,401,272

{'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest Pain/Shortness of Breath PRESENT ILLNESS: 75 y/o male with new onset chest pain and shortness of breath x 1 week with exertion. Both Relieved at rest. Pt. went to emergency room and was found to have elevated cardiac enzymes and diagnosed with NSTEMI. She was eventually brought for a cardiac catheterization on this day which revealed 80% LMCA, 100% mRCA with LAD collaterals to PDA, and an EF of 60%. A Intra-aortic balloon pump was inserted and pt was referred for bypass surgery. MEDICAL HISTORY: Hypertension Hyperlipidemia Colon polyps s/p polypectomy MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], MVI, Triamterene/HCTZ ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 81 155/91 18 95%RA General: NAD w/ IABP HEENT: EOMI/PERRL, NC/AT Neck: Supple, -JVD, -Bruit Pulm: CTAB -w/r/r Cor: RRR, +S1S2, 2/6 SEM Abd: Soft, NT/ND, protuberent Neuro: MAE, non-focal, A&O x 3 FAMILY HISTORY: Mother died at the age 65 from an MI/CAD SOCIAL HISTORY: Quit smoking 20 yrs ago after 1ppd x 30yrs Pt admits to 3 shots of vodka a day ### Response: {'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: s/p fall on coumadin PRESENT ILLNESS: Patient is an 85 yo male with complex PMH significant for cerebrovascular accident x 2 on home coumadin who presents to [**Hospital1 18**] s/p mechanical fall from standind. He was working in his front yard when he tripped over a garden hose and fell to the pavement, striking his abdomen, right hand and his head. No loss of consciousness. Denies antecedent chest pain/dyspnea/lightheadedness, but noted increased SOB after fall. He was brought by EMS to [**Hospital6 5016**] where he was hemodynamically stable with GCS of 15 and complaining of mild L abdominal pain. A limited trauma workup was notable for CT scans demonstrating R orbital floor fracture, maxillary sinus opacification, free fluid collection around spleen. The patient was given Vitamin K and transferred to [**Hospital1 18**] via [**Location (un) **]. MEDICAL HISTORY: Colon Cancer s/p resection x 2 CVAx2 hypothyroidism s/p appendectomy Inguinal hernia repair Ventral hernia repair Idiopathic Thrombocytopenic Purpura MEDICATION ON ADMISSION: Coumadin Levoxyl Calcitriol Folate Terazosin Prednisone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 74 120/80 16 100% 2LNC NAD, A+Ox3 Ecchymoses over R orbit, EOMI, PERRL RRR CTA B, trachea midline Abdomen Soft, mildly distended, ,mildly tender Reducible incisional hernia, Bilaterally reducible inguinal hernias Extremities WWP no edema Sensation x 4, MAE x 4 spontaneously R wrist in splint, NV intact FAMILY HISTORY: Noncontributory SOCIAL HISTORY: 15+ pack year tobacco, quit 50 years ago Heavy EtOH, abstinent x 2 years No IVDU Former Dye factory worker Retired Lives in [**Location 7661**] with wife and daughter

Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Acute kidney failure, unspecified,Atrial fibrillation,Closed fracture of orbital floor (blow-out),Closed Colles' fracture,Fall from other slipping, tripping, or stumbling,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of large intestine

Cl skul base fx w/o coma,Spleen injury NOS-closed,Acute kidney failure NOS,Atrial fibrillation,Fx orbital floor-closed,Colles' fracture-closed,Fall from slipping NEC,Hypothyroidism NOS,Long-term use anticoagul,Hx of colonic malignancy

Admission Date: [**2164-9-5**] Discharge Date: [**2164-9-14**] Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1481**] Chief Complaint: s/p fall on coumadin Major Surgical or Invasive Procedure: None History of Present Illness: Patient is an 85 yo male with complex PMH significant for cerebrovascular accident x 2 on home coumadin who presents to [**Hospital1 18**] s/p mechanical fall from standind. He was working in his front yard when he tripped over a garden hose and fell to the pavement, striking his abdomen, right hand and his head. No loss of consciousness. Denies antecedent chest pain/dyspnea/lightheadedness, but noted increased SOB after fall. He was brought by EMS to [**Hospital6 5016**] where he was hemodynamically stable with GCS of 15 and complaining of mild L abdominal pain. A limited trauma workup was notable for CT scans demonstrating R orbital floor fracture, maxillary sinus opacification, free fluid collection around spleen. The patient was given Vitamin K and transferred to [**Hospital1 18**] via [**Location (un) **]. Past Medical History: Colon Cancer s/p resection x 2 CVAx2 hypothyroidism s/p appendectomy Inguinal hernia repair Ventral hernia repair Idiopathic Thrombocytopenic Purpura Social History: 15+ pack year tobacco, quit 50 years ago Heavy EtOH, abstinent x 2 years No IVDU Former Dye factory worker Retired Lives in [**Location 7661**] with wife and daughter Family History: Noncontributory Physical Exam: 74 120/80 16 100% 2LNC NAD, A+Ox3 Ecchymoses over R orbit, EOMI, PERRL RRR CTA B, trachea midline Abdomen Soft, mildly distended, ,mildly tender Reducible incisional hernia, Bilaterally reducible inguinal hernias Extremities WWP no edema Sensation x 4, MAE x 4 spontaneously R wrist in splint, NV intact Pertinent Results: [**2164-9-5**] 03:15PM FIBRINOGE-310 [**2164-9-5**] 03:15PM PT-22.4* PTT-27.8 INR(PT)-3.3 [**2164-9-5**] 03:15PM PLT SMR-VERY LOW PLT COUNT-59* LPLT-3+ [**2164-9-5**] 03:15PM WBC-11.3* RBC-2.72* HGB-7.7* HCT-23.0* MCV-85 MCH-28.4 MCHC-33.5 RDW-14.2 [**2164-9-5**] 03:15PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2164-9-5**] 03:15PM AMYLASE-75 [**2164-9-5**] 03:15PM UREA N-50* CREAT-2.9* [**2164-9-5**] 03:23PM GLUCOSE-193* LACTATE-2.9* NA+-142 K+-5.1 CL--115* TCO2-20* [**2164-9-5**] 03:23PM GLUCOSE-193* LACTATE-2.9* NA+-142 K+-5.1 CL--115* TCO2-20* [**2164-9-5**] 03:43PM URINE RBC-[**12-30**]* WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-0 [**2164-9-5**] 03:43PM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-TR KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2164-9-5**] 03:43PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.013 [**2164-9-5**] 03:43PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2164-9-5**] 03:43PM URINE GR HOLD-HOLD [**2164-9-5**] 03:43PM URINE HOURS-RANDOM [**2164-9-5**] 03:43PM URINE HOURS-RANDOM [**2164-9-5**] 06:28PM PLT COUNT-77* [**2164-9-5**] 06:28PM HCT-18.8* [**2164-9-5**] 08:59PM PT-16.1* PTT-20.5* INR(PT)-1.7 XR RIGHT WRIST- Comminuted fracture distal radius with probable intra-articular extension. CT HEAD - negative at outside hospital CT FACIAL - Right inferior orbital wall blow-out fracture with herniation of fat into the maxillary sinus . No evidence of herniation of the inferior rectus muscle. Nondisplaced fracture of the lateral wall of the right maxillary sinus. Probable small right lamina papyrecea fracture also. CT CSPINE - Degenerative change within the cervical spine. No evidence of fracture or malalignment. CT ABD/PELVIS -Heterogeneously attenuating collection, which extends from surrounding the spleen in the left upper quadrant through the mid abdomen and down into the left inguinal canal consistent with a large intra-abdominal hematoma. No other significant abnormality identified. An underlying mass cannot be excluded and a followup study is recommended to assess for resolution. [**2164-9-5**] 08:59PM CALCIUM-8.2* PHOSPHATE-3.7 MAGNESIUM-1.8 [**2164-9-5**] 08:59PM CK-MB-3 cTropnT-0.04* [**2164-9-5**] 08:59PM CK(CPK)-105 Brief Hospital Course: Patient was admitted to the trauma ICU for further monitoring of his hematocrit, which trended downward over the inital days of his stay. His hematocrit stabilized with transfusion of several units of pRBC over the course of several days. On HD#5 he was transferred to the floor with stable hematocrits. On HD#5, the patient was noted to be in atrial fibrillation, which was rate controlled. Previously in his hospital stay, he had been in regular sinus rhythm. The patient, his family, and his primary care doctor [**First Name (Titles) **] [**Name (NI) 653**], and none corroborated a history of Afib, so it was presumed to be of new onset. Cardiology was consulted, and reccomended rate control with lopressor, which was performed. Anticoagulation, although indicated for this diagnosis, was held due to the patient's splenic laceration. The patient will follow the question of whether to be on coumadin with his primary care provider as an outpatient. Coumadin was held, and he was not discharged on coumadin. The patient also experienced a slight bump in his BUN and Cr on HD#7, which appeared to be prerenal in origin. The patient has only one kidney, and has a baseline chronic renal failure (Cr~3.0), and this increased acutely to 3.5. The patient was volume rescusitated and his renal function was improving. On discharge, he was almost back to his intake creatinine. Orthopedics was consulted regarding the R wrist fracture, and after evaluation, declined urgent/emergent operative repair. Place patient in wrist splint and reccomended outpatient follow up once medical condition was stabilized. Plastic surgery was consulted regarding the facial bone fractures, and advised delayed operative management until the patient became symptomatic, or elective repair as outpatient. The ophthomology service also saw the patient and, as he was aymptomatic from his orbital floor fractures, reccomended that the patient follow up in Eye Clinic in 2 weeks for repeat eye exam. Medications on Admission: Coumadin Levoxyl Calcitriol Folate Terazosin Prednisone Discharge Medications: 1. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Levothyroxine Sodium 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*30 Capsule(s)* Refills:*2* 5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 7. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 8. Terazosin 1 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). Disp:*30 Capsule(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: 1. splenic laceration 2. COmminuted radial head fracture (right) 3. Right inferior orbital wall blow-out fracture 4. Left maxillary sinus fracture 5. New onset Atrial fibrillation 6. Acute on chronic renal failure (resolving) 7. Idiopathic Thrombpocytopenic purpura 8. Hypothyroidism Discharge Condition: Stable. Discharge Instructions: It is very important that you continue to maintain as much liquid intake as you can, especially with drinks which are not plain water. This will help to protect your kidney. You must speak with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 9533**] your coumadin medication. It was stopped because of the bleeding you had in your abdomen. Take care not to cause any further trauma to your left side for at least 6 months, because you are at an elevated risk of having your spleen bleed again over this time. Call or come back to the emergency department if you have any of the following: fevers, chills, mental status changes, chest pain, increasing shortness of breath, abdominal pain, lightheadedness or any other symptom which Followup Instructions: 1. Follow up with Trauma clinic in 2 weeks. Call 1-[**Telephone/Fax (1) 2359**] for appointment. 2. Follow up with Dr. [**Last Name (STitle) **] (orthopedics) for wrist fractures in 1 week. Call ([**Telephone/Fax (1) 8746**] for an appointment. 3. Follow up with plastic surgery clinic in 2 weeks regarding your facial bone fractures. Call ([**Telephone/Fax (1) 23144**] for an appointment. 4. Follow up with your primary care provider regarding your [**Name9 (PRE) 64409**] atrial fibrillation and anticoagulation in 1 week. Call his office for an appointment. 5. Follow up with [**Hospital **] clinic in 1 week. Call ([**Telephone/Fax (1) 7572**] for an appointment.

801,865,584,427,802,813,E885,244,V586,V100

{"Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Acute kidney failure, unspecified,Atrial fibrillation,Closed fracture of orbital floor (blow-out),Closed Colles' fracture,Fall from other slipping, tripping, or stumbling,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of large intestine"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: s/p fall on coumadin PRESENT ILLNESS: Patient is an 85 yo male with complex PMH significant for cerebrovascular accident x 2 on home coumadin who presents to [**Hospital1 18**] s/p mechanical fall from standind. He was working in his front yard when he tripped over a garden hose and fell to the pavement, striking his abdomen, right hand and his head. No loss of consciousness. Denies antecedent chest pain/dyspnea/lightheadedness, but noted increased SOB after fall. He was brought by EMS to [**Hospital6 5016**] where he was hemodynamically stable with GCS of 15 and complaining of mild L abdominal pain. A limited trauma workup was notable for CT scans demonstrating R orbital floor fracture, maxillary sinus opacification, free fluid collection around spleen. The patient was given Vitamin K and transferred to [**Hospital1 18**] via [**Location (un) **]. MEDICAL HISTORY: Colon Cancer s/p resection x 2 CVAx2 hypothyroidism s/p appendectomy Inguinal hernia repair Ventral hernia repair Idiopathic Thrombocytopenic Purpura MEDICATION ON ADMISSION: Coumadin Levoxyl Calcitriol Folate Terazosin Prednisone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 74 120/80 16 100% 2LNC NAD, A+Ox3 Ecchymoses over R orbit, EOMI, PERRL RRR CTA B, trachea midline Abdomen Soft, mildly distended, ,mildly tender Reducible incisional hernia, Bilaterally reducible inguinal hernias Extremities WWP no edema Sensation x 4, MAE x 4 spontaneously R wrist in splint, NV intact FAMILY HISTORY: Noncontributory SOCIAL HISTORY: 15+ pack year tobacco, quit 50 years ago Heavy EtOH, abstinent x 2 years No IVDU Former Dye factory worker Retired Lives in [**Location 7661**] with wife and daughter ### Response: {"Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Acute kidney failure, unspecified,Atrial fibrillation,Closed fracture of orbital floor (blow-out),Closed Colles' fracture,Fall from other slipping, tripping, or stumbling,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of large intestine"}

CHIEF COMPLAINT: Bicycle accident, back pain, respiratory distress PRESENT ILLNESS: 26 M s/p dirt bike accident at unknown speed. Was found combative, moving all extremeties, and apneic. He was intubated and med-flighted to [**Hospital1 18**]. Pt was found to have sever mid-back pain and T7 and T8 fractures. Also found to have collapsed RUL. MEDICAL HISTORY: Asthma MEDICATION ON ADMISSION: Albuterol MDI, Advair ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon Discharge: VS: NAD, AAOX3 RRR, S1S2 CTAB SOFT, NON-TENDER, NON-DISTENDED BACK - TTP at mid-thoracic spine. mild edema. no ecchymosses. EXT - no C/C/E FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at home w/ others. Denies ETOH or drug abuse Employment status: Employed. Pt self-employed as landscaper.

Traumatic hemothorax without mention of open wound into thorax,Concussion, with loss of consciousness of 30 minutes or less,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Nontraffic accident involving other off-road motor vehicle injuring driver of motor vehicle other than motorcycle,Acute pain due to trauma,Pain in joint, shoulder region,Asthma, unspecified type, unspecified

Traum hemothorax-closed,Concus-brief coma <31 mn,Food/vomit pneumonitis,Fx dorsal vertebra-close,Ac posthemorrhag anemia,Oth off-road mv acc-driv,Acute pain due to trauma,Joint pain-shlder,Asthma NOS

Admission Date: [**2146-3-26**] Discharge Date: [**2146-4-1**] Date of Birth: [**2119-12-22**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1556**] Chief Complaint: Bicycle accident, back pain, respiratory distress Major Surgical or Invasive Procedure: None History of Present Illness: 26 M s/p dirt bike accident at unknown speed. Was found combative, moving all extremeties, and apneic. He was intubated and med-flighted to [**Hospital1 18**]. Pt was found to have sever mid-back pain and T7 and T8 fractures. Also found to have collapsed RUL. Past Medical History: Asthma Social History: Lives at home w/ others. Denies ETOH or drug abuse Employment status: Employed. Pt self-employed as landscaper. Family History: Non-contributory Physical Exam: Upon Discharge: VS: NAD, AAOX3 RRR, S1S2 CTAB SOFT, NON-TENDER, NON-DISTENDED BACK - TTP at mid-thoracic spine. mild edema. no ecchymosses. EXT - no C/C/E Pertinent Results: [**2146-3-26**] 07:00PM BLOOD WBC-30.2* RBC-5.02 Hgb-15.0 Hct-42.7 MCV-85 MCH-29.9 MCHC-35.1* RDW-13.6 Plt Ct-295 [**2146-3-27**] 04:29AM BLOOD WBC-17.0* RBC-4.16* Hgb-13.2* Hct-35.8* MCV-86 MCH-31.7 MCHC-36.8* RDW-13.5 Plt Ct-255 [**2146-3-28**] 02:11AM BLOOD WBC-11.9* RBC-4.00* Hgb-12.6* Hct-34.2* MCV-86 MCH-31.6 MCHC-36.9* RDW-13.3 Plt Ct-249 [**2146-3-29**] 01:57AM BLOOD WBC-15.9* RBC-3.78* Hgb-12.0* Hct-32.7* MCV-87 MCH-31.7 MCHC-36.6* RDW-13.8 Plt Ct-249 [**2146-3-30**] 02:03AM BLOOD WBC-13.3* RBC-3.80* Hgb-11.9* Hct-32.7* MCV-86 MCH-31.3 MCHC-36.4* RDW-13.9 Plt Ct-208 [**2146-3-31**] 01:25AM BLOOD WBC-15.3* RBC-3.99* Hgb-12.0* Hct-34.5* MCV-87 MCH-30.2 MCHC-34.9 RDW-13.8 Plt Ct-239 [**2146-4-1**] 06:30AM BLOOD WBC-12.0* RBC-4.66 Hgb-13.7* Hct-40.5 MCV-87 MCH-29.3 MCHC-33.7 RDW-13.5 Plt Ct-263 [**2146-4-1**] 06:30AM BLOOD Neuts-72.3* Lymphs-18.3 Monos-4.9 Eos-4.3* Baso-0.1 [**2146-3-26**] 07:00PM BLOOD PT-12.4 PTT-24.7 INR(PT)-1.0 [**2146-3-27**] 04:29AM BLOOD PT-12.8 PTT-28.8 INR(PT)-1.1 [**2146-3-28**] 04:30AM BLOOD PT-12.2 PTT-25.9 INR(PT)-1.0 [**2146-3-26**] 10:49PM BLOOD Glucose-96 UreaN-16 Creat-0.8 Na-139 K-4.8 Cl-107 HCO3-22 AnGap-15 [**2146-3-27**] 04:29AM BLOOD Glucose-112* UreaN-14 Creat-0.7 Na-138 K-4.5 Cl-105 HCO3-24 AnGap-14 [**2146-3-28**] 02:11AM BLOOD Glucose-155* UreaN-10 Creat-0.7 Na-141 K-4.3 Cl-103 HCO3-29 AnGap-13 [**2146-3-29**] 01:57AM BLOOD Glucose-100 UreaN-15 Creat-0.8 Na-140 K-3.9 Cl-103 HCO3-29 AnGap-12 [**2146-3-30**] 02:03AM BLOOD Glucose-90 UreaN-11 Creat-0.6 Na-139 K-3.7 Cl-96 HCO3-33* AnGap-14 [**2146-3-31**] 01:25AM BLOOD Glucose-104 UreaN-10 Creat-0.6 Na-137 K-4.1 Cl-95* HCO3-29 AnGap-17 [**2146-3-27**] 04:29AM BLOOD CK(CPK)-491* [**2146-3-27**] 02:28PM BLOOD CK(CPK)-809* [**2146-3-28**] 02:11AM BLOOD CK(CPK)-729* [**2146-3-26**] 10:49PM BLOOD Calcium-8.2* Phos-4.5 Mg-1.8 [**2146-3-27**] 04:29AM BLOOD Calcium-8.3* Phos-3.7 Mg-2.0 [**2146-3-28**] 02:11AM BLOOD Calcium-8.6 Phos-2.9 Mg-2.3 [**2146-3-29**] 01:57AM BLOOD Calcium-8.4 Phos-3.5 Mg-2.4 [**2146-3-30**] 02:03AM BLOOD Calcium-8.2* Phos-4.1 Mg-1.9 [**2146-3-31**] 01:25AM BLOOD Calcium-8.6 Phos-3.3 Mg-2.2 [**2146-3-26**] 07:19PM BLOOD Glucose-154* Lactate-1.7 Na-143 K-3.9 Cl-107 calHCO3-19* [**2146-3-27**] 05:02AM BLOOD Lactate-2.1* [**2146-3-27**] 09:11AM BLOOD Glucose-155* Lactate-1.7 [**2146-3-27**] 08:03PM BLOOD Glucose-169* [**2146-3-26**] 11:00PM BLOOD freeCa-1.17 [**2146-3-28**] 08:32AM BLOOD freeCa-1.16 CT Torso [**3-26**]: 1. Comminuted fracture of T7 vertebra and superior endplate of T8. Minimal loss of vertebral body height and minimal T7 fracture retropulsion. MRI may be obtained to further assess for spinal cord injury. 2. Right upper lobe consolidation, left upper and lower lobe segmental consolidation which may be related to aspiration. 3. ET and NG tubes in appropriate position. CT C-spine [**3-26**]: 1. No evidence of acute fracture or abnormal alignment in the cervical spine. 2. Right upper lobe collapse better demonstrated on CT torso. CT Head [**3-26**]: No acute intracranial hemorrhage, edema or mass. Paranasal sinus disease as described above. CXR [**3-27**]: The monitoring and support devices are in unchanged position. The right upper lobe atelectasis is also unchanged. The preexisting left upper lobe opacity has partially cleared, there is now no evidence of left apical fluid; however, a large discoid atelectasis is seen at the level of the left hilus. There is evidence of increasing intravascular fluid. The size of the cardiac silhouette is unchanged. Right Shoulder Xrays [**3-27**]: No fracture is detected about the right shoulder. Some support tubing overlies the scapula. The AC joint is congruent on these nonstress views. The glenohumeral joint is grossly unremarkable. CXR [**3-31**]: Progressive clearing of pulmonary opacifications. T-spine Xrays [**4-1**]: Brief Hospital Course: Pt was [**Last Name (un) **]-flighted in from the scene of the accident and admitted to the TSICU. A neurosurgery consult was obtained for his thoracic spine fractures, which were deemed non-operable and stable. He was fitted for a TLSO brace for the fractures and was wearing it prior to discharge. The patient remained in the TSICU intubated and sedated until [**2146-3-30**]. After extubating, the patient passed a bedside swallow evaluation and began tolerating a reguar diet. RUL Collapse/PNA: The patient was found also to have a RUL collapse on his CT Torso. He was also noted to have a PNA on CXR and was treated with ceftriaxone and flagyl for suspected aspiration. Pain: His pain was difficult to control. Adequate analgesia was well controlled, but with very high doses of IV and then PO pain medications. His foley catheter was removed prior to discharge. He was evaluated by physical therapy and deemed safe for discharge home. The patient was discharged in stable condition with a TLSO brace on [**2146-4-1**] Medications on Admission: Albuterol MDI, Advair Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. Disp:*60 Tablet(s)* Refills:*0* 2. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for heartburn. 5. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed. 6. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly Transdermal QTUES (every Tuesday). Disp:*3 Patch Weekly(s)* Refills:*0* 7. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*0* 8. OxyContin 15 mg Tablet Sustained Release 12 hr Sig: Three (3) Tablet Sustained Release 12 hr PO twice a day. Disp:*90 Tablet Sustained Release 12 hr(s)* Refills:*0* 9. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 10. Compazine 5 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as needed for nausea. Disp:*20 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: 1. T7 and T8 vertebral body fractures 2. Collapse of RUL of lung 3. Pneumonia Discharge Condition: Stable. TLSO in place. Discharge Instructions: You must wear your TLSO brace at all times when out of bed, or sitting up in bed. You may remove the brace when lying flat in bed only. Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. Other: *Avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *Avoid driving or operating heavy machinery while taking pain medications. * Please resume all regular home medications and take any new meds as ordered. * Continue to ambulate several times per day Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 739**] in 4 weeks. Call his office at ([**Telephone/Fax (1) 88**] to make an appointment. Make sure to tell his office you will need AP and lateral thoracic spine xrays the day of your appointment. Call ([**Telephone/Fax (1) 2537**] during business hours if you have any concerns. Completed by:[**2146-4-1**]

860,850,507,805,285,E821,338,719,493

{'Traumatic hemothorax without mention of open wound into thorax,Concussion, with loss of consciousness of 30 minutes or less,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Nontraffic accident involving other off-road motor vehicle injuring driver of motor vehicle other than motorcycle,Acute pain due to trauma,Pain in joint, shoulder region,Asthma, unspecified type, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Bicycle accident, back pain, respiratory distress PRESENT ILLNESS: 26 M s/p dirt bike accident at unknown speed. Was found combative, moving all extremeties, and apneic. He was intubated and med-flighted to [**Hospital1 18**]. Pt was found to have sever mid-back pain and T7 and T8 fractures. Also found to have collapsed RUL. MEDICAL HISTORY: Asthma MEDICATION ON ADMISSION: Albuterol MDI, Advair ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon Discharge: VS: NAD, AAOX3 RRR, S1S2 CTAB SOFT, NON-TENDER, NON-DISTENDED BACK - TTP at mid-thoracic spine. mild edema. no ecchymosses. EXT - no C/C/E FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at home w/ others. Denies ETOH or drug abuse Employment status: Employed. Pt self-employed as landscaper. ### Response: {'Traumatic hemothorax without mention of open wound into thorax,Concussion, with loss of consciousness of 30 minutes or less,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Nontraffic accident involving other off-road motor vehicle injuring driver of motor vehicle other than motorcycle,Acute pain due to trauma,Pain in joint, shoulder region,Asthma, unspecified type, unspecified'}

CHIEF COMPLAINT: Chest discomfort PRESENT ILLNESS: 74 year old female with known aortic valve stenosis whoe developed chest pain recently with exertion. Follow-up echocardiogram revealed progression of her aortic stenosis with now higher gradients and a smaller aortic valve area. She was referred for cardiac cath which showed one vessel coronary artery disease. Given the progression of her aortic stenosis and new finding of coronary artery disease, she is being admitted today for pretesting/heparin with plans for AVR/CABG in AM. MEDICAL HISTORY: Aortic stenosis Myocardial Infarction [**2187**] Coronary Artery Disease Coronary PTCA/Stent [**2180**] Permanent atrial fibrillation Diabetes Mellitus Hypertension Hyperlipidemia CVA [**2187**] - Continues with mild word finding difficulty Non-hodgkin's lymphoma s/p Oral and Abdominal radiation + Chemo Tachybrady syndrome Myelodysplastic syndrome Anemia (heme positive stools with endoscopy done at [**Hospital3 **] which showed gastritis but no active bleeding) Prolapsed bladder Urinary incontinence Vertebral compression fracture PVD Spinal stenosis Past Surgical History: Pacemaker insertion - [**6-23**] Dr. [**Last Name (STitle) 23246**] Laparotomy with resection of abdominal tumor [**2185**] Cholecystectomy (open) [**2167**] Hysterectomy Incisional hernia repair Hemorrhoidectomy Appendectomy Bilateral greater saphenous vein stripping/ligation Repair of prolapsed bladder which failed Bilateral femoral artery vs. Iliac stents Back surgery for Spinal stenosis MEDICATION ON ADMISSION: Coumadin followed by Dr. [**Last Name (STitle) 3497**] Lisinopril 20mg qd Labetalol 200mg qd Simvastatin 20mg qd HCTZ 25mg qd or prn given lower extremity edema Procrit q4wks Folic acid 0.4mg QD Metformin 1000mg twice daily Aspirin 81mg daily Calcium with Vitamin D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: Resp:12 O2 sat:98% RA Temp 97.7 B/P Right: Left:131/84 Height:5'3" Weight:172# FAMILY HISTORY: Father died of MI at age 65 and Mother died at age 82 of stroke SOCIAL HISTORY: Occupation: Retired. Worked in admitting at [**Hospital **] Hospital Last Dental Exam: Last year Lives with: Husband in [**Name2 (NI) 2624**] Race: Caucasian Tobacco: Never ETOH: Rarely if ever has a drink

Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Aortic valve disorders,Old myocardial infarction,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, aphasia,Myelodysplastic syndrome, unspecified

Crnry athrscl natve vssl,Ac kidny fail, tubr necr,Urin tract infection NOS,Oth lymp unsp xtrndl org,Aortic valve disorder,Old myocardial infarct,Atrial fibrillation,Long-term use anticoagul,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Status cardiac pacemaker,Periph vascular dis NOS,Late eff CV dis-aphasia,Myelodysplastic synd NOS

Admission Date: [**2190-9-2**] Discharge Date: [**2190-9-9**] Date of Birth: [**2116-7-3**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest discomfort Major Surgical or Invasive Procedure: [**2190-9-3**] - AVR(25 [**Company 1543**] Mosaic Tissue)/Coronary artery bypass grafting to one vessel (Left internal mammary->Left anterior descending artery). History of Present Illness: 74 year old female with known aortic valve stenosis whoe developed chest pain recently with exertion. Follow-up echocardiogram revealed progression of her aortic stenosis with now higher gradients and a smaller aortic valve area. She was referred for cardiac cath which showed one vessel coronary artery disease. Given the progression of her aortic stenosis and new finding of coronary artery disease, she is being admitted today for pretesting/heparin with plans for AVR/CABG in AM. Past Medical History: Aortic stenosis Myocardial Infarction [**2187**] Coronary Artery Disease Coronary PTCA/Stent [**2180**] Permanent atrial fibrillation Diabetes Mellitus Hypertension Hyperlipidemia CVA [**2187**] - Continues with mild word finding difficulty Non-hodgkin's lymphoma s/p Oral and Abdominal radiation + Chemo Tachybrady syndrome Myelodysplastic syndrome Anemia (heme positive stools with endoscopy done at [**Hospital3 **] which showed gastritis but no active bleeding) Prolapsed bladder Urinary incontinence Vertebral compression fracture PVD Spinal stenosis Past Surgical History: Pacemaker insertion - [**6-23**] Dr. [**Last Name (STitle) 23246**] Laparotomy with resection of abdominal tumor [**2185**] Cholecystectomy (open) [**2167**] Hysterectomy Incisional hernia repair Hemorrhoidectomy Appendectomy Bilateral greater saphenous vein stripping/ligation Repair of prolapsed bladder which failed Bilateral femoral artery vs. Iliac stents Back surgery for Spinal stenosis Social History: Occupation: Retired. Worked in admitting at [**Hospital **] Hospital Last Dental Exam: Last year Lives with: Husband in [**Name2 (NI) 2624**] Race: Caucasian Tobacco: Never ETOH: Rarely if ever has a drink Family History: Father died of MI at age 65 and Mother died at age 82 of stroke Physical Exam: Pulse: Resp:12 O2 sat:98% RA Temp 97.7 B/P Right: Left:131/84 Height:5'3" Weight:172# General:AAox3 in NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur IV/VI SEM at LLSB Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities:1+ LE edema B/L with superficial veins B/L None [] Neuro: Grossly intact Pulses: Femoral Right:2+ Left:2+ DP Right:1+ Left:1+ PT [**Name (NI) 167**]:1+ Left:1+ Radial Right:2+ Left:2+ Carotid Bruit Right:murmur Left:murmur Pertinent Results: [**2190-9-2**] 06:52PM URINE RBC-0 WBC->50 BACTERIA-MANY YEAST-NONE EPI-0-2 [**2190-9-2**] 05:32PM GLUCOSE-169* UREA N-44* CREAT-1.5* SODIUM-142 POTASSIUM-5.1 CHLORIDE-107 TOTAL CO2-24 ANION GAP-16 [**2190-9-2**] 05:32PM ALT(SGPT)-17 AST(SGOT)-18 ALK PHOS-60 AMYLASE-40 TOT BILI-0.6 [**2190-9-2**] 05:32PM LIPASE-39 [**2190-9-2**] 05:32PM ALBUMIN-4.6 CALCIUM-9.1 PHOSPHATE-3.3 MAGNESIUM-1.6 [**2190-9-2**] 05:32PM %HbA1c-6.5* [**2190-9-2**] 05:32PM WBC-4.9 RBC-3.60* HGB-9.9* HCT-31.7* MCV-88 MCH-27.3 MCHC-31.1 RDW-17.6* [**2190-9-2**] 05:32PM PLT COUNT-158 [**2190-9-2**] 05:32PM PT-14.9* PTT-24.4 INR(PT)-1.3* [**2190-9-7**] 06:30AM BLOOD WBC-7.3 RBC-3.35* Hgb-9.5* Hct-29.2* MCV-87 MCH-28.2 MCHC-32.4 RDW-17.2* Plt Ct-126* [**2190-9-9**] 06:03AM BLOOD PT-22.1* INR(PT)-2.1* [**2190-9-9**] 06:03AM BLOOD UreaN-42* Creat-1.3* K-4.5 [**2190-9-7**] 06:30AM BLOOD Glucose-77 UreaN-44* Creat-1.6* Na-135 K-4.2 Cl-104 HCO3-23 AnGap-12 /24/09 Carotid Ultrasound There is less than 40% stenosis within the internal carotid arteries bilaterally. [**2190-9-3**] ECHO PRE BYPASS The left atrium is dilated. No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. The left atrial appendage emptying velocity is depressed (<0.2m/s). No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with moderate hypokinesis of the distal anterior, anterolateral, anteroseptal, apical and mid septal walls. Overall left ventricular systolic function is mildly depressed (LVEF= 45-50 %). The right ventricular cavity is dilated with borderline normal free wall function. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are severely thickened/deformed. There is critical aortic valve stenosis (valve area = 0.5 cm2). No aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is a trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST BYPASS The patient is v paced. Right ventricular systolic function remains low normal. The left ventricle displays a septal "bounce" consistent with ventricular pacing. There is some distal anteroseptal dyskinesis they may also be due to ventricular pacing. The distal anterior and anterolateral walls display improved function relative to the pre bypass study. The overall ejection fraction is in the 50% range. There is a bioprosthesis located in the aortic position. It is well seated. The ;eaflets are only poorly seen. The maximum pressure gradient through the valve is 12 mmHg with a mean pressure of 7 mmHg and an area calculated to be 1.7 cm2. No aortic regurgiation is seen. The thoracic aorta appears intact. No other changes from the pre-bypass study. Radiology Report CHEST (PA & LAT) Study Date of [**2190-9-7**] 2:06 PM Final Report TYPE OF EXAMINATION: Chest PA and lateral. INDICATION: Female patient status post aortic valve replacement and bypass surgery, evaluate for interval change. FINDINGS: Patient's condition did not permit examination in standard view therefore changed to AP and lateral view in sitting semi-upright position. Comparison is made with the next preceding AP single chest view of [**9-5**], [**2189**]. Previously described permanent pacer with single intracavitary electrode terminating in right ventricle unchanged. The same holds for the metallic components of a [**Company 80889**] aortic valve prosthesis. Right internal jugular vein approach central venous line in unchanged position and no pneumothorax has developed. The lateral view demonstrates some mild degree of bilateral pleural effusions in the posterior pleural sinuses. No new parenchymal abnormalities besides the previously described plate atelectasis on the bases. IMPRESSION: No significant interval change. DR. [**First Name (STitle) **] [**Initials (NamePattern5) 3250**] [**Last Name (NamePattern5) 3251**] Approved: TUE [**2190-9-7**] 5:50 PM Brief Hospital Course: Ms. [**Known lastname 7435**] was admitted to the [**Hospital1 18**] on [**2190-9-2**] for surgical management of her aortic stenosis and coronary artery disease. Heparin was started as she had been off of her coumadin for several days. She was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed less then 40% stenosis bilaterally. On [**2190-9-3**], Ms. [**Known lastname 7435**] was taken to the opertaing room where she underwent cornary artery bypass grafting to one vessel with and aortic valve replacment. Please see operative note for details. Postoperatively she was taken to the intensive care unit for monitoring. Over the next 24 hours, she awoke neurologically intact and was extubated. She developed non-oliguria acute tubular nephrosis post operatively and creatinine peaked at 2.2. All diuretics were discontinued and her creatinine had decreased to 1.6 (which was her baseline) at the time of discharge. Chest tubes and pacing wires were removed per cardiac surgery protocol. Coumadin was restarted at home dose for atrial fibrillation and her INR was monitored. Dr [**Name (NI) 80890**] office was contact[**Name (NI) **] and will be following her INR levels on discharge from rehab. Results are to be called into [**Telephone/Fax (1) 77064**] She was discharged to rehabilitation at [**Location (un) 931**] House inWalpole on on post operative day 6 in stable condition. Medications on Admission: Coumadin followed by Dr. [**Last Name (STitle) 3497**] Lisinopril 20mg qd Labetalol 200mg qd Simvastatin 20mg qd HCTZ 25mg qd or prn given lower extremity edema Procrit q4wks Folic acid 0.4mg QD Metformin 1000mg twice daily Aspirin 81mg daily Calcium with Vitamin D Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Warfarin 5 mg Tablet Sig: as directed below Tablet PO once a day: 5mg on sat/sun 7.5mg on mon-fri. 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever/pain. 6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 9. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 13. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**] Discharge Diagnosis: CAD/AS s/p CABG/AVR Aortic stenosis Myocardial Infarction [**2187**] Coronary Artery Disease Coronary PTCA/Stent [**2180**] Permanent atrial fibrillation Diabetes Mellitus Hypertension Hyperlipidemia CVA [**2187**] - Continues with mild word finding difficulty Non-hodgkin's lymphoma s/p Oral and Abdominal radiation + Chemo Tachybrady syndrome Myelodysplastic syndrome Anemia (heme + stools. endoscopy @ [**Hospital3 **]-gastritis no active bleeding) Prolapsed bladder Urinary incontinence Vertebral compression fracture PVD Spinal stenosis Discharge Condition: Stable Discharge Instructions: 1) Monitor wounds for signs of infection. These inlcude redness, drainage or increased pain. Report all wound issues to your surgeon at ([**Telephone/Fax (1) 1504**]. 2) Report any fever greater then 100.5. 3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) Shower daily and was incision with soap and water. No lotions, creams or powders to incision for 6 weeks. 5) No driving for 1 month. 6) No lifting more then 10 pounds for 10 weeks from date of surgery. 7) Call with any questions or concers. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**] Please follow-up with Dr. [**Last Name (STitle) 3497**] in [**1-12**] weeks. Please follow-up with Dr. [**Last Name (STitle) 32496**] in [**1-12**] weeks. [**Telephone/Fax (1) 42946**] Call all providers for appointments. Completed by:[**2190-9-9**]

414,584,599,202,424,412,427,V586,250,272,401,V450,443,438,238

{'Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Aortic valve disorders,Old myocardial infarction,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, aphasia,Myelodysplastic syndrome, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest discomfort PRESENT ILLNESS: 74 year old female with known aortic valve stenosis whoe developed chest pain recently with exertion. Follow-up echocardiogram revealed progression of her aortic stenosis with now higher gradients and a smaller aortic valve area. She was referred for cardiac cath which showed one vessel coronary artery disease. Given the progression of her aortic stenosis and new finding of coronary artery disease, she is being admitted today for pretesting/heparin with plans for AVR/CABG in AM. MEDICAL HISTORY: Aortic stenosis Myocardial Infarction [**2187**] Coronary Artery Disease Coronary PTCA/Stent [**2180**] Permanent atrial fibrillation Diabetes Mellitus Hypertension Hyperlipidemia CVA [**2187**] - Continues with mild word finding difficulty Non-hodgkin's lymphoma s/p Oral and Abdominal radiation + Chemo Tachybrady syndrome Myelodysplastic syndrome Anemia (heme positive stools with endoscopy done at [**Hospital3 **] which showed gastritis but no active bleeding) Prolapsed bladder Urinary incontinence Vertebral compression fracture PVD Spinal stenosis Past Surgical History: Pacemaker insertion - [**6-23**] Dr. [**Last Name (STitle) 23246**] Laparotomy with resection of abdominal tumor [**2185**] Cholecystectomy (open) [**2167**] Hysterectomy Incisional hernia repair Hemorrhoidectomy Appendectomy Bilateral greater saphenous vein stripping/ligation Repair of prolapsed bladder which failed Bilateral femoral artery vs. Iliac stents Back surgery for Spinal stenosis MEDICATION ON ADMISSION: Coumadin followed by Dr. [**Last Name (STitle) 3497**] Lisinopril 20mg qd Labetalol 200mg qd Simvastatin 20mg qd HCTZ 25mg qd or prn given lower extremity edema Procrit q4wks Folic acid 0.4mg QD Metformin 1000mg twice daily Aspirin 81mg daily Calcium with Vitamin D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: Resp:12 O2 sat:98% RA Temp 97.7 B/P Right: Left:131/84 Height:5'3" Weight:172# FAMILY HISTORY: Father died of MI at age 65 and Mother died at age 82 of stroke SOCIAL HISTORY: Occupation: Retired. Worked in admitting at [**Hospital **] Hospital Last Dental Exam: Last year Lives with: Husband in [**Name2 (NI) 2624**] Race: Caucasian Tobacco: Never ETOH: Rarely if ever has a drink ### Response: {'Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Aortic valve disorders,Old myocardial infarction,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac pacemaker in situ,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, aphasia,Myelodysplastic syndrome, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 67-year-old female who was walking her dog two days prior to admission, fell when her dog pulled her. She denies any loss of consciousness. She had a laceration to her left eyebrow. She went to [**Hospital3 1196**]. Her laceration was sutured and the patient did not stay for further work up, including CT scan. The morning of admission while shopping, the patient developed slurred speech and had a grand malignancy seizure. She was taken to [**Hospital3 13313**] and had another seizure in the Emergency Department. She received 8 mg of Ativan and Dilantin load was fair. CT was performed and she was transferred to [**Hospital6 649**] for further management. MEDICAL HISTORY: 1. Hypertension MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Atrial fibrillation,Unspecified essential hypertension,Hypopotassemia

Subdural hem w/o coma,Convulsions NEC,Atrial fibrillation,Hypertension NOS,Hypopotassemia

Admission Date: [**2187-7-11**] Discharge Date: [**2187-7-17**] Date of Birth: [**2121-2-25**] Sex: F Service: HISTORY OF PRESENT ILLNESS: The patient is a 67-year-old female who was walking her dog two days prior to admission, fell when her dog pulled her. She denies any loss of consciousness. She had a laceration to her left eyebrow. She went to [**Hospital3 1196**]. Her laceration was sutured and the patient did not stay for further work up, including CT scan. The morning of admission while shopping, the patient developed slurred speech and had a grand malignancy seizure. She was taken to [**Hospital3 13313**] and had another seizure in the Emergency Department. She received 8 mg of Ativan and Dilantin load was fair. CT was performed and she was transferred to [**Hospital6 649**] for further management. PAST MEDICAL HISTORY: 1. Hypertension MEDICATIONS: 1. Norvasc ALLERGIES: No known drug allergies. PHYSICAL EXAM ON ADMISSION: VITAL SIGNS: Temperature 101.6??????, blood pressure 130/88, heart rate 96, respiratory rate 16, O2 saturation 100% on 4 liters. GENERAL: ACS was 13 out of 15, medication induced with slurred speech. Hard collar was applied. HEAD, EARS, EYES, NOSE AND THROAT: There is ecchymosis around the left eye and a small laceration with sutures noted. Tympanic membranes clear. Oropharynx mucous membranes moist, no obvious lesions. NECK: No tenderness, palpation along the cervical spine. No stepoff or deformity. CHEST: No injury over the bony thorax, no tenderness to palpation. LUNGS: Clear to auscultation bilaterally. HEART: Regular, S1, S2 without murmurs noted. ABDOMEN: Soft, nontender, nondistended, no masses. PELVIS: Stable, nontender. RECTAL: Normal tone, guaiac negative. EXTREMITIES: Moving all four extremities, no obvious injuries, full distal pulses. NEUROLOGIC: GSC eyes 3, voice 5, motor 6, 13 to 14. The patient was still sedated, awake, alert and oriented x2, slurred speech, but coherent and not dysphasic or aphasic. Grip strength 5/5 bilaterally, moves all 4 extremities, good strength. Sensation intact to light touch throughout. Able to follow commands. ADMISSION LABS: White blood cell count 9.9, hematocrit 36.2, platelets 247. PT 12.0, INR 1.0, PTT 25.6. SMA-7: Sodium 131, potassium 6.0, the repeat is 3.4, chloride 96, bicarbonate 23, BUN 8, creatinine 0.7, glucose 140. Toxicology screen negative. RADIOLOGY ON ADMISSION: Cross table lateral C-spine with degenerative changes, but no acute process. Chest x-ray was negative for any acute cardiopulmonary disease or injury. CT of the head revealed left frontoparietal subdural hematoma, small without midline shift or mass effect. CT of the abdomen and pelvis negative for any intraabdominal injury. HOSPITAL COURSE: The patient was admitted to the Surgical Intensive Care Unit for frequent neurological assessment. She was started on Dilantin after receiving her Dilantin load at the previous hospital. Neurosurgery was consulted. Plan from neurosurgery was to load Dilantin to therapeutic levels of 10 to 15 and follow up with Dr. [**Last Name (STitle) 1132**] with repeat CT scan in two weeks after discharge. On hospital day #4, the patient was noted to be in atrial fibrillation. She had CKs, MBs and troponins sent at that time. First CPK 2682 with an MB of 4. Troponin of 2.5. Second CK 3357 with an MB of 3, troponin of 1.7. Third CK was 1223 with an MB of 8. Cardiology was consulted. The patient was transferred to the floor on hospital day #4 on telemetry. The patient was placed on Lopressor. Anticoagulation with Coumadin was precluded by the subdural hematoma. The patient was completely asymptomatic at this time. No chest pain, chest tightness, palpitation. No shortness of breath, dyspnea, no nausea. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 11889**] Dictated By:[**Last Name (NamePattern1) 9333**] MEDQUIST36 D: [**2187-7-16**] 10:31 T: [**2187-7-16**] 11:52 JOB#: [**Job Number 108387**] Admission Date: [**2187-7-11**] Discharge Date: [**2187-7-17**] Date of Birth: [**2121-2-25**] Sex: F Service: HISTORY OF PRESENT ILLNESS: The patient is a 67-year-old female who was walking her dog two days prior to admission and fell when her dog pulled her. She denies any loss of consciousness. She sustained a laceration to the left eyebrow. She went to [**Hospital6 4620**] where the laceration was sutured. She left prior to any further care including a CT scan. The morning of admission while shopping the patient developed slurred speech and had a grand mal seizure. She was taken to [**Hospital 2725**] Hospital and had another seizure. In the Emergency Room she received 8 mg of Ativan and Dilantin load. CT was performed and patient was transferred to the [**Hospital1 69**] for further treatment. PAST MEDICAL HISTORY: Hypertension and renal surgery for reflux as a child. MEDICATIONS: Norvasc. ALLERGIES: No known drug allergies. PHYSICAL EXAMINATION: Vital signs on admission, temperature 101.6 rectally, blood pressure 130/88, heart rate 96, respiratory rate 16, O2 saturation 100% on four liters nasal cannula. The patient was a well developed, elderly female. GCS was 13 on admission in the Emergency Room. HEENT: She was noted to have an ecchymosis over her left eye, temporal area. She had a small laceration that was sutured closed. TM's were clear. OP, mucus membranes moist, no obvious injury. Neck, no tenderness to palpation along the C spine, no step-off or deformity. C collar was applied. Chest x-ray, no injury or tenderness to palpation over the bony thorax. Lungs were clear to auscultation bilaterally. Heart was regular. S1 and S2 without murmur appreciated. Abdomen soft, nontender, non distended, no masses noted. Pelvis stable, nontender. Extremities warm, well perfused, palpable distal pulses, no obvious injuries. Rectal exam, normal tone, guaiac negative. Neurologically patient's GCS was E3, V5, M6, 13-14, 14 at best. The patient was sedated, still some slurred speech. She was awake, alert and oriented times two. She did not have any dysphagia. Her speech was slurred but coherent. Gross strength was [**3-31**] bilaterally. She had good strength of upper and lower extremities, spontaneous movement of all four extremities. She was able to follow simple commands. Incision was intact to light touch throughout. LABORATORY DATA: On admission white blood cell count 9.9, hematocrit 36.2, platelet count 247,000, PT 12.0, INR 1.0, PTT 25.6, sodium 131, potassium 6.3, repeat was 3.4, chloride 96, CO2 23, BUN 8, creatinine 0.7, glucose 140, tox screen was negative. Imaging on admission, cross table lateral C spine, noted degenerative changes but no acute fracture or dislocation. Chest x-ray was negative for no acute cardiopulmonary process. CT head showed a small left frontoparietal subdural hematoma without midline shift or mass effect. CT of the abdomen and pelvis was negative for any intraabdominal trauma or pathology. HOSPITAL COURSE: The patient was admitted to the surgical Intensive Care Unit for frequent neurological assessment. Neurosurgery was consulted. She was continued on Dilantin. On hospital day #4 she was noted to be in new onset atrial fibrillation. Cardiology was consulted and CPKs were obtained. The first was 1223 with an MB of 8. The second was 2682 with MB of 4 and troponin of 2.5. The third was 3357 with MB of 3 and troponin of 1.7. She was noted to have two minor nonspecific EKG changes that were not consistent with acute infarct. The patient was started on Lopressor, anticoagulation is precluded by her subdural hematoma. The patient remained asymptomatic throughout this event. She denied any chest pain, chest tightness, palpitations, no shortness of breath or dyspnea on exertion, no lightheaded or dizziness, no nausea and no diaphoresis. The patient was transferred to the floor on hospital day #4 in stable condition. She spontaneously converted to normal sinus rhythm, remained in normal sinus rhythm on telemetry until day of discharge. Cardiology felt that the slightly elevated troponin were consistent with a troponin leak from a mild subendocardial ischemia but no acute infarct. Physical therapy has evaluated the patient and does not feel that she is steady enough in order to do well on her own at home. She is being screened to go to an acute rehabilitation center. She is stable from a medical standpoint to do this. DISCHARGE MEDICATIONS: Dilantin 200 mg po bid, Metoprolol 25 mg po bid. FOLLOW-UP: Patient to follow-up with Dr. [**Last Name (STitle) **] for neurosurgery in 10 days, [**Telephone/Fax (1) 2992**]. She is to have a CT scan of her head prior to that appointment. The patient is to follow-up with her primary care provider and the cardiologist of her choice for outpatient echocardiogram and stress test per the recommendations of our cardiology consult here. If not, she can follow-up with Dr. [**Last Name (STitle) 911**] for cardiology if she is unable to obtain a cardiologist. She should be seen two weeks after discharge. The patient is stable and ready for discharge to an acute rehabilitation facility. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 11889**] Dictated By:[**Last Name (NamePattern1) 9333**] MEDQUIST36 D: [**2187-7-16**] 10:44 T: [**2187-7-16**] 12:02 JOB#: [**Job Number 102616**]

852,780,427,401,276

{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Atrial fibrillation,Unspecified essential hypertension,Hypopotassemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 67-year-old female who was walking her dog two days prior to admission, fell when her dog pulled her. She denies any loss of consciousness. She had a laceration to her left eyebrow. She went to [**Hospital3 1196**]. Her laceration was sutured and the patient did not stay for further work up, including CT scan. The morning of admission while shopping, the patient developed slurred speech and had a grand malignancy seizure. She was taken to [**Hospital3 13313**] and had another seizure in the Emergency Department. She received 8 mg of Ativan and Dilantin load was fair. CT was performed and she was transferred to [**Hospital6 649**] for further management. MEDICAL HISTORY: 1. Hypertension MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Atrial fibrillation,Unspecified essential hypertension,Hypopotassemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 32-year-old woman with no significant past medical history, although with previous tobacco use and who is seven months postpartum, who presented to her outpatient clinic on [**2-29**] with dyspnea on exertion which has been progressive over five months, epigastric pain, and fatigue. MEDICAL HISTORY: No significant past medical history. MEDICATION ON ADMISSION: The patient was not on any medications at home. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Cardiogenic shock,Other primary cardiomyopathies,Cocaine abuse, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Pneumonia, organism unspecified

Peripartum card-postpart,CHF NOS,Cardiogenic shock,Prim cardiomyopathy NEC,Cocaine abuse-unspec,Parox ventric tachycard,Urin tract infection NOS,Comp-oth cardiac device,Pneumonia, organism NOS

Admission Date: [**2132-2-29**] Discharge Date: [**2132-3-16**] Date of Birth: [**2099-12-6**] Sex: F Service: CCU NOTE: This is an interim Discharge Summary through [**2132-3-16**]. HISTORY OF PRESENT ILLNESS: The patient is a 32-year-old woman with no significant past medical history, although with previous tobacco use and who is seven months postpartum, who presented to her outpatient clinic on [**2-29**] with dyspnea on exertion which has been progressive over five months, epigastric pain, and fatigue. The patient was sent for a chest x-ray as an outpatient which showed an enlarged, and she was sent to the Emergency Department at an outside hospital where an echocardiogram showed a dilated left ventricle, severe global hypokinesis, and an estimated ejection fraction of 15%, as well as 2+ mitral valve regurgitation. The patient was transferred to [**Hospital1 188**] for further management and was initially admitted to the C-MED Service. The patient was diuresed approximately 2 liters on the Medicine floor but was transferred to the Coronary Care Unit on [**3-1**] after becoming tachycardic, dizzy, with a weak pulse, and hypotensive (requiring a dopamine drip). Upon transfer to the Coronary Care Unit, the patient reported shortness of breath at rest as well as overall fatigue. The patient denied chest pain or palpitations. The patient also reported lightheadedness as well as visual blackouts which had resolved by the time she had arrived to the Coronary Care Unit. PAST MEDICAL HISTORY: No significant past medical history. MEDICATIONS ON ADMISSION: The patient was not on any medications at home. ALLERGIES: No known drug allergies. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination on admission was notable for the patient being afebrile with tachycardia to the 110s. The patient was saturating in the high 90s on 2 liters nasal cannula. Physical examination was notable for bibasilar crackles. First heart sounds and second heart sounds. An audible loud third heart sound. Displaced point of maximal impulse. PERTINENT LABORATORY VALUES ON PRESENTATION: Diagnostics on transfer included a normal complete blood count with a hematocrit of 40. Chemistries were normal with a creatinine of 0.8. Creatine kinase was 46. PERTINENT RADIOLOGY/IMAGING: A chest x-ray showed mild congestive heart failure with cardiomegaly. An electrocardiogram revealed a normal sinus rhythm with a rate of approximately 140. Normal axis and normal intervals. Also with likely left atrial dilatation. Approximately 1-mm to 2-mm anterior ST elevations as well as V4 to V6 T wave inversions which may be related to repolarization changes. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: The patient is a 33-year-old woman with no significant past medical history with dilated cardiomyopathy and congestive heart failure. She is seven months postpartum. 1. PUMP/CARDIOMYOPATHY ISSUES: Etiology was most likely postpartum and less likely viral; although the patient did have a upper respiratory tract infection a few months prior to admission. A workup for the patient's cardiomyopathy included thyroid studies which showed a moderately elevated thyroid-stimulating hormone but a normal free T4. Erythrocyte sedimentation rate was normal. Iron studies were normal. Lyme was negative. Antinuclear antibody was negative. Serum protein electrophoresis was normal. Negative human immunodeficiency virus test. A cardiac magnetic resonance imaging on [**3-12**] did not show evidence of congenital coronary abnormalities. The patient was diuresed while on the C-MED Service; however, she became hypotensive (requiring dopamine). The patient was started on digoxin on [**2-29**]; however, this discontinued on [**3-2**] after the patient had complete heart block on electrocardiogram. The patient's ins-and-outs were followed very closely, and she was in fact very negative with good urine output. A Swan-Ganz catheter was placed and showed fairly low filling pressures, and the patient was bolused with intravenous fluids as needed. The patient was tried on trials of an ACE inhibitor and beta blocker which were started at very low doses, and then stopped, and then restarted several times due to hypotension. By [**3-15**], the patient had been restarted on her captopril 6.25 mg by mouth three times per day with plans to restart her Coreg soon at a low dose. 2. HEMODYNAMIC ISSUES: In terms of hemodynamics, the patient was initially on dopamine upon transfer to the Coronary Care Unit but was switched to dobutamine for anatropic support with good results. The patient's central venous pressure was initially consistently in the 3 to 4 range which was thought to be too low for her, and she was given intravenous fluids for this. The patient was kept net even in terms of ins-and-outs. Dobutamine was titrated off within two days, and the patient tolerated increased captopril and a beta blocker on [**3-5**]. However, the patient had systolic blood pressures in the 60s on [**3-6**] with a wedge pressure of 17. The patient was started on dopamine once again, and her ACE inhibitor and beta blocker were held. Dopamine was continued for two to three days and was slowly weaned off as her blood pressure tolerated. Due to hypotension in the Electrophysiology Laboratory, the patient was placed on dobutamine and epinephrine in the Electrophysiology Laboratory. These were weaned off within two days, and the patient was restarted on her ACE inhibitor. The incoming intern will dictate the remainder of the details regarding her congestive heart failure management. 3. RHYTHM: The patient with occasional palpitations and with telemetry and electrocardiogram showing some intermittent atrioventricular disassociation as well as complete heart block on [**3-2**]. The patient also had short runs of nonsustained ventricular tachycardia as well as supraventricular tachycardia up to a heart rate in the 160s. The patient did have 40 beats of nonsustained ventricular tachycardia with hypotension with a mean arterial pressure in the 40s on [**3-9**]. Electrophysiology was consulted, and after discussion with the patient and her family and Coronary Care Unit team, the decision was made to pursue implantable cardioverter-defibrillator placement. The patient underwent this procedure on [**3-13**], and had a 41-joule implantable cardioverter-defibrillator placed, including a coil in the back that was needed per the electrophysiology studies. A chest x-ray status post procedure showed good placement. Implantable cardioverter-defibrillator was thought to be indicated due to the patient's multiple runs of nonsustained ventricular tachycardia as well as her frequent ectopy and also due to the patient's poor ejection fraction; although, it was not due to ischemic causes. 4. CHEST PAIN ISSUES: The patient had a short episode of positional chest pain shortly after admission which resolved within two to three days. This was likely pericarditis because it was positional and improved dramatically with Toradol and then Percocet. The patient's cardiac enzymes were stable. A V/Q scan showed low probability for pulmonary embolism. Her amylase and lipase were also within normal limits. 5. NEUROLOGIC ISSUES: The patient with occasional visual changes that were thought to be due to hypotension. The patient had a transient episode of left facial numbness and subtle left-sided weakness, for which she underwent a head computerized axial tomography which was negative. The Neurology Service was consulted and felt that the episode was likely consistent with a migraine as the patient has a remote history of migraine headaches. The patient had no further episodes through [**3-16**]. 6. ENDOCRINE ISSUES: The patient had a thyroid-stimulating hormone of 9.8 and a free T4 of 1.4. The Endocrinology Service was consulted, and the patient was started on Levoxyl 25 mcg by mouth once per day. The patient was not thought to be clinically hypothyroid. Plans to recheck thyroid studies as an outpatient after the patient's acute illness has been stabilized. 7. ANTICOAGULATION ISSUES: The patient was started and maintained on a heparin drip throughout her hospitalization due to her poor ejection fraction. 8. PSYCHIATRIC ISSUES: The Psychiatry Service was consulted for the patient as she was expressing discouragement. The Psychiatry Service believed that the patient was undergoing an adjustment disorder and recommended Ativan as needed. 9. FLUIDS/ELECTROLYTES/NUTRITION ISSUES: The patient was on a cardiac diet, and her electrolytes were repleted as needed. 10. PROPHYLAXIS ISSUES: The patient was on a heparin drip for a low ejection fraction as well as a proton pump inhibitor throughout her hospitalization. 11. ACCESS ISSUES: The patient had a right internal jugular central line that was placed and then removed and then re-placed again. The patient also with an arterial line for close blood pressure monitoring. NOTE: The remainder of the [**Hospital 228**] hospital course and discharge to be dictated by the incoming intern. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15176**], M.D. [**MD Number(1) 15177**] Dictated By:[**Name8 (MD) 6906**] MEDQUIST36 D: [**2132-3-22**] 11:47 T: [**2132-3-22**] 11:56 JOB#: [**Job Number 21999**] Name: [**Known lastname **], [**Known firstname **] Unit No: [**Numeric Identifier 3667**] Admission Date: [**2132-2-29**] Discharge Date: [**2132-3-27**] Date of Birth: [**2099-12-6**] Sex: F Service: CCU ADDENDUM: This is a discharge summary from [**2132-3-17**] to [**2132-3-27**]. Please see prior discharge summary from date [**2132-3-16**] for further details. HOSPITAL COURSE: The patient is a 33-year-old woman with no significant past medical history who was admitted for dilated cardiomyopathy and congestive heart failure likely from postpartum state. 1. PUMP/CARDIOMYOPATHY: The patient from [**2132-3-17**] to [**2132-3-27**] was started on Captopril at a dose of 6.25 mg and was initially started on a t.i.d. basis but could not tolerate it and was switched to a b.i.d. basis. The patient was also started on a low-dose beta blocker in the form of carvedilol and was given a dose of 1.5 mg twice a day. Over the course of ten days, the patient slowly began to tolerate more doses of her medications. Upon discharge, she was tolerating b.i.d. doses of both medications. The patient's medication was occasionally held due to low blood pressure. The patient was also started on digoxin on [**2132-3-23**] and was loaded with 0.25 mg for inotropy. The goal digoxin level for the patient will likely be between 1.5 and 2.0 nanograms for inotropic effect. The patient will be discharged to the [**Hospital 3668**] for evaluation for cardiac transplant given her minimal improvement during the past several months. The patient had her workup for her cardiac transplant done including PFTs and several viral studies which were negative. Her PFTs showed an FVC of 83% predicted, FEV1 of 94% predicted, FEV1 to FVC ratio 114% predicted, DLC 88% predicted, and a DLCO of 83 to 89% predicted. 2. RHYTHM: The patient had an ICD revision on [**2132-3-21**] due to malfunctioning leads. The patient had a 41 joule implantable cardioverter defibrillator placed on [**2132-3-21**]. The procedure was without complications. This was placed given her significant cardiomyopathy as potential for arrhythmia. The patient was also started on low-dose Lasix given her recurrent ascites and pulmonary edema. She was started on 10 mg p.o. q.d. of Lasix which helped remove excess fluid from her cardiomyopathy. The patient also developed a hematoma at the original ICD site and anticoagulation was held until the hematoma improved. After the replacement procedure on [**2132-3-21**], the Electrophysiology Service recommended anticoagulation be held for ten additional days until [**2132-3-31**]. At that point, anticoagulation can resume for her risk of thrombus given her low ejection fraction. 3. INFECTIOUS DISEASE: The patient was noted to have a right lower lobe effusion with a possible infiltrate and was given a seven day course of levofloxacin for questionable pneumonia. She finished the course on [**2132-3-23**]. The patient's chest x-ray resolved over a period of a week and she had improvement in her lung volumes and decrease in her pleural effusions bilaterally. 4. ENDOCRINE: The patient was noted to be slightly hypothyroid and was started on low-dose Levoxyl 25 micrograms and needs to have an outpatient TSH level rechecked in approximately two to three weeks. The patient's TSH level was 9.8 and free T4 was 1.4. 5. HEMATOLOGY: The patient was noted to be iron-deficient with an iron level of 50 and a ferritin of 89. She was given approximately [**1-18**] units of red blood cells during her hospital stay and started on low-dose oral iron 325 q.d. Her hematocrit remained stable, greater than 30 for the remainder of the hospital stay after receiving blood products. 6. GASTROINTESTINAL: The patient had occasional constipation and intermittent abdominal pain. The abdominal pain was thought most likely secondary to both a small amount of ascites and gas pain. Serial KUBs were done which were all negative for signs of obstruction. She was given an aggressive bowel regimen which helped improve her symptoms and also put on p.o. Lasix which also helped to improve her symptoms. The patient had poor p.o. intake most of her hospital stay felt secondary to poor appetite. She was given Boost supplements which she occasionally tolerated. She was also given simethicone for her gas pain. DISPOSITION: The patient was seen by physical therapy and was walked and exercised on a regular basis once she was on the hospital floor and tolerated many of the exercising and was able to walk greater than 100 feet and a flight of stairs. The patient was to be transferred to the [**Hospital 3668**] for further evaluation for cardiac transplant on [**2132-3-27**]. DISCHARGE STATUS: Stable, able to tolerate some exercise with no chest pain, no rest shortness of breath. DISCHARGE DIAGNOSIS: Dilated cardiomyopathy secondary to postpartum state. DISCHARGE MEDICATIONS: 1. Protonix 40 q.d. 2. Levothyroxine 25 micrograms q.d. 3. Docusate 100 mg b.i.d. 4. Multivitamin one tablet q.d. 5. Ferrous sulfate 325 q.d. 6. Captopril 6.25 b.i.d. 7. Carvedilol 1.5 b.i.d. 8. Furosemide 10 q.d. 9. Miconazole nitrate 2% cream applied vaginally at bedtime. 10. Digoxin 0.25 mg, 250 micrograms, one p.o. q.d. 11. Simethicone 40-80 mg p.o. q.i.d. [**First Name8 (NamePattern2) 77**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 715**] Dictated By:[**Last Name (NamePattern1) 3669**] MEDQUIST36 D: [**2132-3-27**] 10:34 T: [**2132-3-27**] 11:01 JOB#: [**Job Number 3670**] cc:[**Hospital 3671**]

674,428,785,425,305,427,599,996,486

{'Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Cardiogenic shock,Other primary cardiomyopathies,Cocaine abuse, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Pneumonia, organism unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 32-year-old woman with no significant past medical history, although with previous tobacco use and who is seven months postpartum, who presented to her outpatient clinic on [**2-29**] with dyspnea on exertion which has been progressive over five months, epigastric pain, and fatigue. MEDICAL HISTORY: No significant past medical history. MEDICATION ON ADMISSION: The patient was not on any medications at home. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Cardiogenic shock,Other primary cardiomyopathies,Cocaine abuse, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Pneumonia, organism unspecified'}

CHIEF COMPLAINT: s/p fall PRESENT ILLNESS: The patient is a gentleman who sustained a fall from a roof and was seen at an outside hospital where he was found to have an intertrochanteric fracture in addition to a femoral shaft fracture. He has been transferred to our care and is undergoing trauma work up. MEDICAL HISTORY: HTN MEDICATION ON ADMISSION: atenolol 25mg po daily zyrtec prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon discharge: AVSS NAD A+O CTA b/l RRR S/NT/ND+BS spine: incisions c/d/i LLE: incision c/d/i +[**Last Name (un) 938**]/FHL/AT SILT brisk cap refill FAMILY HISTORY: NC SOCIAL HISTORY: spanish speaking

Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of intertrochanteric section of neck of femur,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Secondary hypercoagulable state,Paralytic ileus,Unspecified pleural effusion,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Closed fracture of shaft of femur,Retention of urine, unspecified,Accidental fall from ladder,Other disorders of neurohypophysis,Unspecified essential hypertension,Hiccough,Unspecified disorder of male genital organs

Fx dorsal vertebra-close,Intertrochanteric fx-cl,Brain lacer NEC w/o coma,Convulsions NEC,Sec hypercoagulable st,Paralytic ileus,Pleural effusion NOS,Urin tract infection NOS,Ac posthemorrhag anemia,Fx femur shaft-closed,Retention urine NOS,Fall from ladder,Neurohypophysis dis NEC,Hypertension NOS,Hiccough,Male genital dis NOS

Admission Date: [**2120-6-12**] Discharge Date: [**2120-7-1**] Date of Birth: [**2064-4-27**] Sex: M Service: ORTHOPAEDICS Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 11415**] Chief Complaint: s/p fall Major Surgical or Invasive Procedure: [**2120-6-12**]: Insertion tibial traction pin left proximal tibia. [**2120-6-13**]: Left gamma nail [**2120-6-19**]: Total vertebrectomy at T12, Fusion T11-L1, Anterior cage placement at T12, Segmental instrumentation from T11-L1, Autograft [**2120-6-20**]: Posterior T9-L2 fusion, Multiple thoracic and lumbar laminotomies, Segmental instrumentation T9-L2, Autograft, Epidural catheter placement. [**2120-6-24**]: IVC filter placement History of Present Illness: The patient is a gentleman who sustained a fall from a roof and was seen at an outside hospital where he was found to have an intertrochanteric fracture in addition to a femoral shaft fracture. He has been transferred to our care and is undergoing trauma work up. Past Medical History: HTN Social History: spanish speaking Family History: NC Physical Exam: Upon discharge: AVSS NAD A+O CTA b/l RRR S/NT/ND+BS spine: incisions c/d/i LLE: incision c/d/i +[**Last Name (un) 938**]/FHL/AT SILT brisk cap refill Pertinent Results: [**2120-6-12**] 11:17PM TYPE-ART TEMP-37.2 TIDAL VOL-500 PEEP-5 O2-50 PO2-169* PCO2-54* PH-7.30* TOTAL CO2-28 BASE XS-0 -ASSIST/CON INTUBATED-INTUBATED [**2120-6-12**] 11:17PM LACTATE-3.1* [**2120-6-12**] 11:17PM O2 SAT-98 [**2120-6-12**] 03:12PM GLUCOSE-265* LACTATE-2.7* NA+-142 K+-4.7 CL--101 TCO2-28 [**2120-6-12**] 03:00PM UREA N-11 CREAT-1.2 [**2120-6-12**] 03:00PM AMYLASE-38 [**2120-6-12**] 03:00PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2120-6-12**] 03:00PM WBC-18.3* RBC-5.11 HGB-15.3 HCT-44.0 MCV-86 MCH-30.0 MCHC-34.8 RDW-12.7 [**2120-6-12**] 03:00PM PLT COUNT-237 [**2120-6-12**] 03:00PM PT-12.3 PTT-20.6* INR(PT)-1.1 [**2120-6-12**] 03:00PM FIBRINOGE-286 PELVIS WITH JUDET VIEWS [**2120-6-12**] 7:40 PM PELVIS WITH JUDET VIEWS Reason: evaluate for fx [**Hospital 93**] MEDICAL CONDITION: 56 M s/p fall from 15 feet REASON FOR THIS EXAMINATION: evaluate for fx EXAM ORDER: Pelvis. HISTORY: Status post fall. PELVIS: Three views including Judet views show mildly displaced left intertrochanteric fracture. No other fracture is seen. Mild osteoarthritic changes are seen in both hips. The sacroiliac joints are unremarkable. The symphysis pubis appears normal. IMPRESSION: Left intertrochanteric fracture. FOOT AP,LAT & OBL LEFT [**2120-6-12**] 7:40 PM FEMUR (AP & LAT) LEFT; TIB/FIB (AP & LAT) LEFT Reason: evaluate for fx [**Hospital 93**] MEDICAL CONDITION: 56 year old man s/p fall REASON FOR THIS EXAMINATION: evaluate for fx EXAM ORDER: Femur and tibia and fibula. HISTORY: Status post fall. LEFT FEMUR: AP and lateral views show minimally displaced left intertrochanteric fracture. There is also comminuted and displaced distal femoral shaft fracture. The distal fragment shows one shaft-width posterior displacement with 1 cm overriding. The left tibia and fibula are intact. The external fixator hardware partially obscures the tibia and fibula. A note is made of a linear ossific density at the posterior aspect of the lateral malleolus, which may represent avulsion injury. Additional ankle views can be obtained for further evaluation. [**Hospital 93**] MEDICAL CONDITION: 56 year old man with fall from height REASON FOR THIS EXAMINATION: r/o fx CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: 56-year-old man status post fall, from height. T-spine CT without contrast with multiplanar reformation. No comparison. FINDINGS: There is extensively communicated burst fracture of the T12 vertebral body, with a large retropulsion fragment in the spinal canal, compressing the spinal cord with marked narrowing of the spinal channel. There is comminuted fracture of the spinous process and lamina of T12. The fracture lines of the T12 vertibral body extends to both superior and inferior endplates. No definite fracture is identified at the other levels. There is calcification of ligamentum flavum. In the visualized portion of the lung bases, note is made of bilateral pleural effusion with atelectasis. IMPRESSION: 1. Burst fracture of T12 with large retropulsion fragment narrowing spinal canal and compressing spinal cord at the level. Comminuted fracture of the spinous process and lamina of T12. 2. Bilateral pleural effusion and atelectasis. Brief Hospital Course: The patient was admitted to the trauma service on [**2120-6-12**]. A tibial traction pin was placed in his left tibia in the emergency room to stabilize his fracture. He was taken to the operating room on [**2120-6-13**] for a left gamma nail. He tolerated the procedure well. He remained intubated and was taken to the recovery room in stable condition. Once anesthesia was comfortable with his respiratory status he was extubated. While in the PACU he was noted by anesthesia and nursing to have seizure like behavior. Neurology was consulted and he was given a loading dose of dilantin. A repeat head CT and an EEG were done, both of which were essentially normal. The patient was transferred to the floor stable. He was transfused PRBC's for post operative anemia. On [**2120-6-19**] he was taken to the operating room with Dr. [**Last Name (STitle) 363**] for anterior fusion. He returned to the operating room on [**2120-6-20**] with Dr. [**Last Name (STitle) 363**] for posterior fusion. He experienced some distention post-operatively and an NG tube was placed with minimal relief of distention. Repeated KUBs were negative fr obstruction. His subsequent hospital course was complicated by a eft pleural effusion with chest tube placement, s/p removal on [**6-22**]. A CXR will need to be repeated within the next week to monitor resolution of the effusion. The pt was also diagnosed with a UTI and for which he was treated with Ciprofloxacin for 7 days. He also was found to have urinary retention and was started on Tamsulosin. A voiding trial should be attempted. He then experience an episode of CP but trop was negative and no EKG were present. Medical management was pursued of the CP and Metoprolol and Aspirin were started as well as Lisinopril for better BP control. Lisinopril and Metorpolol were titrated as tolerated. The pt'c course was also complicated by hyponatremia. Urine and serum osm were consistent with SIADH. This was attributed to posttraumatic SIADH with hyponatremia, but further w/u needs to be pursued if the problem [**Name (NI) 68118**]. The pt was fluid restricted and serum sodium slowly improved. Fluid restriction needs to be continued and normalization of sodium. The pt was followed for his seizure disorder by neurology. Dilantin is being tapered off as the seizures were thought to be posttraumatic only. The pt's fluid overloaded was attributed to poor nutrition and hyponatremia. The pt's nutrition improved as his clinical status improved and the pt was autodiuresing. The pt's anemia postoperative remained stable. DVT prophylaxis was not given, due to high risk of bleeding. The pt had an IVC filter placed postoperatively for prevention of PE. Pain was adequately managed on current regimen. Pt was maintained on sliding scale for hyperglycemia. Medications on Admission: atenolol 25mg po daily zyrtec prn Discharge Disposition: Extended Care Facility: St [**Hospital **] Healthcare Center - [**Hospital1 189**] Discharge Diagnosis: L intertrochanteric fracture L distal femur fracture T12 burst fracture Seizure Discharge Condition: Stable Discharge Instructions: Please keep incisions clean and dry. Dry sterile dressings daily as needed. If you notice any increased pain, swelling, drainage, temperature >101.4, shortness of breathe, or room. Take all medications as prescribed. Please follow up as below. Call with any questions. Physical Therapy: PWB on LLE, otherwise WBAT Treatments Frequency: Dry sterile dressing daily as needed . Site: MIDLINE LUMBAR & RIGHT OF LUMBAR (INFERIOR) Description: INCISIONAL WOUND INTACT WITH STERI-STRIPS, NO DRAINAGE OR SX OF INFECTION Care: COVER WITH DSD, CHANGE DAILY OR PRN.KEEP CLEAN AND DRY. . Site: LEFT TRUNK Description: INCISIONAL WOUND INTACT WITH STERI-STRIPS, NO DRAINAGE OR SX OF INFECTION Care: COVER WITH DSD, CHANGE DAILY OR PRN.KEEP CLEAN AND DRY. . Physical therapy as per instructions Continued titration of BP meds for optimal control Dilantin titration as instructed Continue fluid restriction for hyponatremia Followup Instructions: Please follow up with your PCP two weeks after discharge from the rehab center. . Please follow up with Dr. [**Last Name (STitle) 1005**] in 2 weeks. Call [**Telephone/Fax (1) **] for an appointment. . Please follow up with Dr. [**Last Name (STitle) 363**] in 2 weeks. Call [**Telephone/Fax (1) **] for an appointment. . Please follow up with Dr. [**First Name (STitle) **] in [**1-1**] months. Call [**Telephone/Fax (1) 541**] for an appointment. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**]

805,820,851,780,289,560,511,599,285,821,788,E881,253,401,786,608

{'Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of intertrochanteric section of neck of femur,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Secondary hypercoagulable state,Paralytic ileus,Unspecified pleural effusion,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Closed fracture of shaft of femur,Retention of urine, unspecified,Accidental fall from ladder,Other disorders of neurohypophysis,Unspecified essential hypertension,Hiccough,Unspecified disorder of male genital organs'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: s/p fall PRESENT ILLNESS: The patient is a gentleman who sustained a fall from a roof and was seen at an outside hospital where he was found to have an intertrochanteric fracture in addition to a femoral shaft fracture. He has been transferred to our care and is undergoing trauma work up. MEDICAL HISTORY: HTN MEDICATION ON ADMISSION: atenolol 25mg po daily zyrtec prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon discharge: AVSS NAD A+O CTA b/l RRR S/NT/ND+BS spine: incisions c/d/i LLE: incision c/d/i +[**Last Name (un) 938**]/FHL/AT SILT brisk cap refill FAMILY HISTORY: NC SOCIAL HISTORY: spanish speaking ### Response: {'Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of intertrochanteric section of neck of femur,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Other convulsions,Secondary hypercoagulable state,Paralytic ileus,Unspecified pleural effusion,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Closed fracture of shaft of femur,Retention of urine, unspecified,Accidental fall from ladder,Other disorders of neurohypophysis,Unspecified essential hypertension,Hiccough,Unspecified disorder of male genital organs'}

CHIEF COMPLAINT: ventral hernia PRESENT ILLNESS: 47F s/p lap-assisted total proctocolectomy w/end ileostomy [**2133-4-29**], complicated by wound infection and pelvic abscess, now with incisional hernia and pain. Her initial hospital course was uncomplicated, but Ms. [**Known lastname 28315**] was re-admitted [**2133-5-29**] with purulent vaginal drainage and wound drainage. She was discharged to rehab [**2133-6-4**] with a VAC dressing to her surgical wound and a pigtail drain in her abscess. She had one post-discharge follow-up visit on [**2133-6-22**], at which time her midline wound was healing well with the VAC and her pigtail drain was removed. She failed to make/keep her follow-up appointments after that visit, and has not been seen in clinic since that time. Since her last visit, she has developed a large hernia in her surgical incision. Her sister, who is her healthcare proxy, called the office one day PTA, stating that [**Known firstname **] is in terrible pain from her hernia and that it needs to be repaired. Ms. [**Known lastname 28315**] presented to clinic [**2133-12-2**] for admission. She states that the pain has been developing over the past 2 months, and has worsened over the past 2 weeks. She also states that the pain is impairing her breathing, and that she only feels ok when she is lying down. She also complains of passing gas from her vagina over the past few months. She saw her doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) 1474**] and had a CT scan performed, and was told that she may have a fistula. She has also had several UTI's in the past few months. She has been afebrile. She denies nausea, vomiting, change in ostomy output, chest pain, cough, SOB, hematemesis, melena, muscle weakness. MEDICAL HISTORY: Past Medical History: Crohn's disease Malrotation of the colon Gastroesophageal Reflux Asthma Irritable Bowel Syndrome Gastroparesis Osteoporosis Anxiety and/or Depression Endometriosis MEDICATION ON ADMISSION: albuterol inh prn, advair diskus [**Hospital1 **], vitamin C 500 [**Hospital1 **], vistaril 25 prn, prilosec 20', KCl 30', vitamin D [**Numeric Identifier 1871**] qMonth, clonazepam 1", ferrous sulfate 350', calcium 600''' ALLERGIES: Paxil / Fosamax / Erythromycin Estolate / Adhesive Bandage PHYSICAL EXAM: VITALS: T 98.4, HR 73, BP 97/62, RR 16, O2 99% RA GEN: alert and oriented x3, NAD CV: RRR, no murmur LUNGS: CTA bilaterally, good respiratory effort ABD: large hernia at midline incision, edges of defect not well-defined, protrudes from abdomen when sitting, approx 15x15cm; ileostomy in RLQ w/pink, healthy stoma; otherwise soft, obese, NT, ND, +BS EXTR: warm, well-perfused, 2+ pulses FAMILY HISTORY: Question of a sister with [**Name (NI) 4522**] colitis, otherwise NC. SOCIAL HISTORY: She works fulltime at [**Hospital 1474**] Hospital food services. Does not smoke cigarettes or drink alcohol. Sister is her health care proxy.

Other colostomy and enterostomy complication,Regional enteritis of small intestine with large intestine,Anomalies of intestinal fixation,Urinary tract infection, site not specified,Pulmonary collapse,Bacteremia,Tachycardia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,First degree atrioventricular block,Mitral valve disorders,Esophageal reflux,Irritable bowel syndrome,Dysthymic disorder,Localized adiposity,Incisional hernia without mention of obstruction or gangrene,Asthma, unspecified type, unspecified,Gastroparesis,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Calculus of kidney,Body Mass Index 36.0-36.9, adult,Iron deficiency anemia, unspecified

Colstmy/enteros comp NEC,Reg enterit sm/lg intest,Intestinal fixation anom,Urin tract infection NOS,Pulmonary collapse,Bacteremia,Tachycardia NOS,Other streptococcus,Atrial fibrillation,Atriovent block-1st degr,Mitral valve disorder,Esophageal reflux,Irritable bowel syndrome,Dysthymic disorder,Localized adiposity,Incisional hernia,Asthma NOS,Gastroparesis,Cholelithiasis NOS,Calculus of kidney,BMI 36.0-36.9,adult,Iron defic anemia NOS

Admission Date: [**2133-12-2**] Discharge Date: [**2133-12-22**] Date of Birth: [**2086-11-26**] Sex: F Service: SURGERY Allergies: Paxil / Fosamax / Erythromycin Estolate / Adhesive Bandage Attending:[**First Name3 (LF) 3376**] Chief Complaint: ventral hernia Major Surgical or Invasive Procedure: Exploratory laparotomy Lysis of adhesions Re-siting of ileostomy Component separation Closure of hernia History of Present Illness: 47F s/p lap-assisted total proctocolectomy w/end ileostomy [**2133-4-29**], complicated by wound infection and pelvic abscess, now with incisional hernia and pain. Her initial hospital course was uncomplicated, but Ms. [**Known lastname 28315**] was re-admitted [**2133-5-29**] with purulent vaginal drainage and wound drainage. She was discharged to rehab [**2133-6-4**] with a VAC dressing to her surgical wound and a pigtail drain in her abscess. She had one post-discharge follow-up visit on [**2133-6-22**], at which time her midline wound was healing well with the VAC and her pigtail drain was removed. She failed to make/keep her follow-up appointments after that visit, and has not been seen in clinic since that time. Since her last visit, she has developed a large hernia in her surgical incision. Her sister, who is her healthcare proxy, called the office one day PTA, stating that [**Known firstname **] is in terrible pain from her hernia and that it needs to be repaired. Ms. [**Known lastname 28315**] presented to clinic [**2133-12-2**] for admission. She states that the pain has been developing over the past 2 months, and has worsened over the past 2 weeks. She also states that the pain is impairing her breathing, and that she only feels ok when she is lying down. She also complains of passing gas from her vagina over the past few months. She saw her doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) 1474**] and had a CT scan performed, and was told that she may have a fistula. She has also had several UTI's in the past few months. She has been afebrile. She denies nausea, vomiting, change in ostomy output, chest pain, cough, SOB, hematemesis, melena, muscle weakness. Past Medical History: Past Medical History: Crohn's disease Malrotation of the colon Gastroesophageal Reflux Asthma Irritable Bowel Syndrome Gastroparesis Osteoporosis Anxiety and/or Depression Endometriosis Past Surgical History: hysterectomy, appendectomy, total proctocolectomy w/end ileostomy Social History: She works fulltime at [**Hospital 1474**] Hospital food services. Does not smoke cigarettes or drink alcohol. Sister is her health care proxy. Family History: Question of a sister with [**Name (NI) 4522**] colitis, otherwise NC. Physical Exam: VITALS: T 98.4, HR 73, BP 97/62, RR 16, O2 99% RA GEN: alert and oriented x3, NAD CV: RRR, no murmur LUNGS: CTA bilaterally, good respiratory effort ABD: large hernia at midline incision, edges of defect not well-defined, protrudes from abdomen when sitting, approx 15x15cm; ileostomy in RLQ w/pink, healthy stoma; otherwise soft, obese, NT, ND, +BS EXTR: warm, well-perfused, 2+ pulses Pertinent Results: Admission Labs: WBC-7.8 RBC-4.50 Hgb-12.5 Hct-36.0 Plt Ct-247 Glucose-85 UreaN-15 Creat-0.5 Na-142 K-3.6 Cl-108 HCO3-24 AnGap-14 Albumin-4.0 Calcium-9.3 Phos-4.2 Iron-68 Urine culture [**12-2**]: ESCHERICHIA COLI AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- 128 R TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- =>16 R CT abd/pelvis [**2133-12-2**]: 1. Diastasis of the anterior abdominal wall containing non-obstructed, non-dilated loops of bowel. There is a small amount of free fluid within the dependent portion. 2. Non-obstructed appearance to an end ileostomy. 3. Status post proctocolectomy with trace fluid at the surgical site. At the site of prior drain in the low pelvis there is no residual fluid collection. Cystogram [**2133-12-4**]: No evidence of leak or fistula with adequate distention of the urinary bladder. BLOOD CULTURE [**2133-12-14**]: Source: Line-picc. STAPHYLOCOCCUS, COAGULASE NEGATIVE. ISOLATED FROM ONE SET ONLY. SENSITIVITIES PERFORMED ON REQUEST.. VIRIDANS STREPTOCOCCI. ISOLATED FROM ONE SET ONLY. Urine culture [**2133-12-14**]: Negative Blood culture [**2133-12-15**]: Negative Brief Hospital Course: Ms. [**Known lastname 28315**] was admitted to the colorectal surgery service on [**2133-12-2**] for evaluation and management of her large incisional hernia. She was seen by plastic surgery for assistance with closure of her large abdominal wall defect. She was taken to the OR on [**2133-12-11**], where she had an exploratory laparotomy, lysis of adhesions, re-siting of her end ileostomy, and closure of her hernia with the assistance of Dr. [**First Name (STitle) **] of the plastic surgery service. She tolerated the procedure well and returned to the floor post-operatively. Neuro: The patient received a dilaudid PCA with good effect and adequate pain control. When tolerating oral intake, the patient was transitioned to oral pain medications. CV: On [**12-15**], Ms. [**Known lastname 28315**] developed atrial fibrillation. Troponins were negative. She was initially rate controlled with diltiazem. However, the atrial fibrillation continued and cardiology was consulted for recommendation of management. On [**12-16**] she was started on metoprolol and titrated up to 37.5 TID, aspirin 325 QD, and had a trans thoracic echocardiogram which revealed: "Normal global and regional biventricular systolic function. No clinically-significant valvular disease seen. Left atrial enlargement." She remained tachycardic and was started on diltiazem 30mg every 6 hours. This did not sufficiently control her rate and she was transferred to the [**Hospital Ward Name 332**] ICU on [**12-18**] for diltiazem drip. She converted to NSR on [**12-19**] and was transferred back to the floor on [**12-20**]. Cardiology recommended a PO regimen of 180mg diltiazem extended release QD and 325mg aspirin QD. She remained asymptomatic, but she had sinus tachycardia to 140s on [**12-21**], likely realted to post-op deconditioning as her pain was controlled, she was well-hydrated, and she had no signs of infection or pulmonary embolism. Her diltiazem was increased to 360 QD. Pulmonary: Ms. [**Known lastname 28315**] was treated with incentive spirometry and encouraged to have good pulmonary toilet during this admission. Her asthma was managed with Fluticasone-Salmeterol Diskus (250/50) 1 INH IH [**Hospital1 **] and albuterol inhaler prn. GI/GU/FEN: Ms. [**Known lastname 28315**] was made NPO for scans, procedures, and operations. After the surgical ventral hernia repair on [**12-11**], she was initially NPO, then experienced nausea and vomiting and an NG tube was placed and remained until [**12-16**]. On [**12-17**] she tolerated clears, then full liquids on [**12-18**]. She was advanced to a regular diet on [**12-19**]. She tolerated this diet and was supplemented with Ensure. Her electrolytes were monitored and repleted as needed. ID: A urine culture on admission revealed E.coli sensitive to cephalosporins. She was treated with ceftazadine for 14 days. Ms. [**Known lastname 28315**] [**Last Name (Titles) 28316**] a fever to 102.3 on POD 3, for which blood and urine cultures and chest/abdominal x-rays were obtained. The radiology studies were normal. Her urine culture was negative, blood cultures revealed Strep viridans and coagulase negative staphylococcus. She was treated with IV vancomycin and her PICC line was replaced. Endocrine: The patient's blood sugar was monitored throughout this stay; insulin dosing was adjusted accordingly. Hematology: The patient's complete blood count was examined routinely; She was transfused 1 unit packed RBCs for a heamtocrit of 24.6 on [**12-15**]. Prophylaxis: The patient received subcutaneous heparin during this stay, and was encouraged to get up and ambulate as early as possible. At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. Medications on Admission: albuterol inh prn, advair diskus [**Hospital1 **], vitamin C 500 [**Hospital1 **], vistaril 25 prn, prilosec 20', KCl 30', vitamin D [**Numeric Identifier 1871**] qMonth, clonazepam 1", ferrous sulfate 350', calcium 600''' Discharge Disposition: Extended Care Facility: [**Hospital **] Rehabilitation and Nursing Center - [**Location (un) 701**] Discharge Diagnosis: Ventral hernia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the hospital for surgical managment of your ventral hernia. You had a hernia repair with mesh and re-siting of your ostomy, which you tolerated well. You have tolerated a regular diet, passed gas, your pain is well controlled with pain medications by mouth and you are now ready to be discharged to rehab. It is important that you monitor your bowel function closely. It is not required that you have a bowel movement prior to returning home, however it is important that you have a bowel movement in the next 2-3 days. Please call the office if you do not have a bowel movement. Please monitor yourself for the following abdominal symptoms: nausea, vomiting, increased abdominal distension, increased abdominal pain, frequent loose stools, or inability to tolerate food or liquids. If you develop any of these symtpoms, please call the office or go to the emergency room if severe. It is expected that your first bowel movmement after surgery will be loose and it may have a small amount of blood. Feel free to call the office if there is an alarming amount of blood. Eat small frequent meals and keep yourself well hydrated. The pain medication we have given you causes constipation. Continue taking colace and senna while you are on the narcotics (oxycodone). You may add miralax or milk of magnesia if you are still constipated. If you have diarrhea or loose stools, you may remove the medications one at a time until your stools are soft and formed. You have an incision on your abdomen that is closed with dermabond (skin glue). The drains will stay until you follow-up with Dr. [**First Name (STitle) **]. Please keep the abdominal binder on at all times. This will fall off on its own. You may shower, please do not rub the incision dry, pat dry with a towel. Please watch for signs and symptoms of infection near the incision such as: increased redness, increased pain, white/green/yellow/thick/malodorous drainage, or increased swelling at the incision thin or if you develop a fever. You may cover the area with a dry gauze dressing if it becomes irritated from your clothing. You will be given a small amount of oxycodone for pain. Please take this medication directly as prescribed and do not drink alcohol or drive a car while taking this medication. You may also take tylenol as written, do not drink alcohol while taking this medication and do not take more than 4000mg of Tylenol daily. Please walk frequently at home. No heavy lifting greater than 6 pounds or heavy excersise for at least 3-4 weeks after surgery. You have 2 drains in your abdomen. Please empty the bulbs daily and as needed, and record the amount and character of the fluid. Please bring your log to your follow-up appointments. Please look at the drain sites once a day and monitor for redness or drainage. Please keep you abdominal binder on at all times. If the drains drain over 100cc in a day or begin to drain frank blood please call the office for advice or go to the emergency room if the bleeding is severe. Good luck with your recovery! Followup Instructions: A follow up appointment has been made for you with Dr. [**First Name (STitle) **], Plastic Surgeon, at 2:45 pm on [**12-31**] at his office. Please call [**Telephone/Fax (1) 1416**] for any questions pertaining to this appointment or if you will be unable to keep it. You also have a follow-up appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], Cardiologist [**Hospital1 18**] [**Location (un) **]; on Monday [**12-28**] @ 15:30. Address: 15 [**Name (NI) **] Brothers [**Name (NI) **], [**Name (NI) **]; [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], [**Numeric Identifier 28317**]; [**Telephone/Fax (1) 8725**]; (F)[**Telephone/Fax (1) 8719**] You have an appointment with Dr. [**Last Name (STitle) **] and the WOUND/OSTOMY NURSE Date/Time:[**2133-12-31**] 12:30 Phone:[**Telephone/Fax (1) 13760**]

569,555,751,599,518,790,785,041,427,426,424,530,564,300,278,553,493,536,574,592,V853,280

{'Other colostomy and enterostomy complication,Regional enteritis of small intestine with large intestine,Anomalies of intestinal fixation,Urinary tract infection, site not specified,Pulmonary collapse,Bacteremia,Tachycardia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,First degree atrioventricular block,Mitral valve disorders,Esophageal reflux,Irritable bowel syndrome,Dysthymic disorder,Localized adiposity,Incisional hernia without mention of obstruction or gangrene,Asthma, unspecified type, unspecified,Gastroparesis,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Calculus of kidney,Body Mass Index 36.0-36.9, adult,Iron deficiency anemia, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: ventral hernia PRESENT ILLNESS: 47F s/p lap-assisted total proctocolectomy w/end ileostomy [**2133-4-29**], complicated by wound infection and pelvic abscess, now with incisional hernia and pain. Her initial hospital course was uncomplicated, but Ms. [**Known lastname 28315**] was re-admitted [**2133-5-29**] with purulent vaginal drainage and wound drainage. She was discharged to rehab [**2133-6-4**] with a VAC dressing to her surgical wound and a pigtail drain in her abscess. She had one post-discharge follow-up visit on [**2133-6-22**], at which time her midline wound was healing well with the VAC and her pigtail drain was removed. She failed to make/keep her follow-up appointments after that visit, and has not been seen in clinic since that time. Since her last visit, she has developed a large hernia in her surgical incision. Her sister, who is her healthcare proxy, called the office one day PTA, stating that [**Known firstname **] is in terrible pain from her hernia and that it needs to be repaired. Ms. [**Known lastname 28315**] presented to clinic [**2133-12-2**] for admission. She states that the pain has been developing over the past 2 months, and has worsened over the past 2 weeks. She also states that the pain is impairing her breathing, and that she only feels ok when she is lying down. She also complains of passing gas from her vagina over the past few months. She saw her doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) 1474**] and had a CT scan performed, and was told that she may have a fistula. She has also had several UTI's in the past few months. She has been afebrile. She denies nausea, vomiting, change in ostomy output, chest pain, cough, SOB, hematemesis, melena, muscle weakness. MEDICAL HISTORY: Past Medical History: Crohn's disease Malrotation of the colon Gastroesophageal Reflux Asthma Irritable Bowel Syndrome Gastroparesis Osteoporosis Anxiety and/or Depression Endometriosis MEDICATION ON ADMISSION: albuterol inh prn, advair diskus [**Hospital1 **], vitamin C 500 [**Hospital1 **], vistaril 25 prn, prilosec 20', KCl 30', vitamin D [**Numeric Identifier 1871**] qMonth, clonazepam 1", ferrous sulfate 350', calcium 600''' ALLERGIES: Paxil / Fosamax / Erythromycin Estolate / Adhesive Bandage PHYSICAL EXAM: VITALS: T 98.4, HR 73, BP 97/62, RR 16, O2 99% RA GEN: alert and oriented x3, NAD CV: RRR, no murmur LUNGS: CTA bilaterally, good respiratory effort ABD: large hernia at midline incision, edges of defect not well-defined, protrudes from abdomen when sitting, approx 15x15cm; ileostomy in RLQ w/pink, healthy stoma; otherwise soft, obese, NT, ND, +BS EXTR: warm, well-perfused, 2+ pulses FAMILY HISTORY: Question of a sister with [**Name (NI) 4522**] colitis, otherwise NC. SOCIAL HISTORY: She works fulltime at [**Hospital 1474**] Hospital food services. Does not smoke cigarettes or drink alcohol. Sister is her health care proxy. ### Response: {'Other colostomy and enterostomy complication,Regional enteritis of small intestine with large intestine,Anomalies of intestinal fixation,Urinary tract infection, site not specified,Pulmonary collapse,Bacteremia,Tachycardia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,First degree atrioventricular block,Mitral valve disorders,Esophageal reflux,Irritable bowel syndrome,Dysthymic disorder,Localized adiposity,Incisional hernia without mention of obstruction or gangrene,Asthma, unspecified type, unspecified,Gastroparesis,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Calculus of kidney,Body Mass Index 36.0-36.9, adult,Iron deficiency anemia, unspecified'}

CHIEF COMPLAINT: Recent Cerebellar Infarct PRESENT ILLNESS: Ms. [**Known lastname **] is a 48 year old female with a known patent foramen ovale with right to left shunting. In [**10/2174**], She sustained a stroke and subsequently placed on coumadin. She is admitted today for transition of coumadin to heparin and a patent foramen ovale closure. MEDICAL HISTORY: Stroke Migraine Eye surgery Attention Deficit Disorder MEDICATION ON ADMISSION: Coumadin ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: 99.1 59 Sinus 122/76 100% Room Air saturation GEN: No acute distress NECK: Supple, no JVD HEART: RRR, no murmur LUNG: Clear ABD: SOft, nontender, nondistended, normal bowel sounds. EXT: No edema FAMILY HISTORY: Father with MI and stroke SOCIAL HISTORY: Married. Lives with husband in [**Name (NI) 1439**], MA. Denies alcohol or smoking history.

Ostium secundum type atrial septal defect,Iatrogenic pneumothorax

Secundum atrial sept def,Iatrogenic pneumothorax

Admission Date: [**2175-3-5**] Discharge Date: [**2175-3-12**] Date of Birth: [**2126-5-9**] Sex: F Service: CARDIOTHORACIC Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 1283**] Chief Complaint: Recent Cerebellar Infarct Major Surgical or Invasive Procedure: [**2175-3-7**] Minimally Invasive ASD Repair History of Present Illness: Ms. [**Known lastname **] is a 48 year old female with a known patent foramen ovale with right to left shunting. In [**10/2174**], She sustained a stroke and subsequently placed on coumadin. She is admitted today for transition of coumadin to heparin and a patent foramen ovale closure. Past Medical History: Stroke Migraine Eye surgery Attention Deficit Disorder Social History: Married. Lives with husband in [**Name (NI) 1439**], MA. Denies alcohol or smoking history. Family History: Father with MI and stroke Physical Exam: 99.1 59 Sinus 122/76 100% Room Air saturation GEN: No acute distress NECK: Supple, no JVD HEART: RRR, no murmur LUNG: Clear ABD: SOft, nontender, nondistended, normal bowel sounds. EXT: No edema Pertinent Results: [**2175-3-9**] 06:15AM BLOOD WBC-5.8 RBC-3.01* Hgb-9.4* Hct-27.8* MCV-93 MCH-31.3 MCHC-33.8 RDW-12.7 Plt Ct-148* [**2175-3-9**] 06:15AM BLOOD Plt Ct-148* [**2175-3-10**] 06:15AM BLOOD UreaN-10 Creat-0.6 K-4.1 Chest X-ray [**2175-3-11**] The right-sided chest tube has been removed. A small right apical pneumothorax remains, unchanged. There is extensive subcutaneous emphysema as well as some gas within the anterior soft tissues of the breast. These findings are also unchanged. Small amount of pneumomediastinum is also unchanged Brief Hospital Course: Mrs. [**Known lastname **] was admitted to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] Medical Center on [**2175-3-5**] for surgical management of her patent foramen ovale. As she had been holding her coumadin, heparin was started for anticoagulation. On [**2175-3-7**], Mrs. [**Known lastname **] was taken to the operating room where she underwent a minimally invasive atrial septal defect closure. Postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. On postoperative day one, Mrs. [**Known lastname **] awoke neurologically intact and was extubated. She was then transferred to the step down unit for further recovery. She was gently diuresed towards her preoperative weight. A right sided pigtail catheter was placed for a right pneumothorax. Unfortunately this failed to re-expand her lung and her pigtail was changed to a chest tube over a wire. Aspirin (325 mg) was started for anticoagulation per the neurology service given her past stroke. He chest tube was removed on postoperative day five without complication. Mrs. [**Known lastname **] continued to make steady progress and was discharged to her home on postoperative day five. She will follow-up with Dr. [**Last Name (Prefixes) **], her cardiologist and her primary care physician as an outpatient. Medications on Admission: Coumadin Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* 3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 4. Hydromorphone HCl 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H () as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*1* 6. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q12H (every 12 hours) as needed. 8. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift 9. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift 10. Magnesium Sulfate 2 gm / 100 ml D5W IV ONCE Duration: 1 Doses Discharge Disposition: Home With Service Facility: [**Location (un) **] vna Discharge Diagnosis: s/p Minimally Invasive ASD repair Discharge Condition: good Discharge Instructions: No lifting > 10 lbs for 6-8 weeks. No driving for 4 weeks. Call if you have fevers/ chills, redness/ drainage from wound. [**Last Name (NamePattern4) 2138**]p Instructions: Dr. [**Last Name (Prefixes) **] 4 weeks. Please call [**Telephone/Fax (1) 1504**] for an appointment Completed by:[**2175-4-11**]

745,512

{'Ostium secundum type atrial septal defect,Iatrogenic pneumothorax'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Recent Cerebellar Infarct PRESENT ILLNESS: Ms. [**Known lastname **] is a 48 year old female with a known patent foramen ovale with right to left shunting. In [**10/2174**], She sustained a stroke and subsequently placed on coumadin. She is admitted today for transition of coumadin to heparin and a patent foramen ovale closure. MEDICAL HISTORY: Stroke Migraine Eye surgery Attention Deficit Disorder MEDICATION ON ADMISSION: Coumadin ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: 99.1 59 Sinus 122/76 100% Room Air saturation GEN: No acute distress NECK: Supple, no JVD HEART: RRR, no murmur LUNG: Clear ABD: SOft, nontender, nondistended, normal bowel sounds. EXT: No edema FAMILY HISTORY: Father with MI and stroke SOCIAL HISTORY: Married. Lives with husband in [**Name (NI) 1439**], MA. Denies alcohol or smoking history. ### Response: {'Ostium secundum type atrial septal defect,Iatrogenic pneumothorax'}

CHIEF COMPLAINT: Overdose, unresponsiveness PRESENT ILLNESS: 37 yo M with no significant PMH presented with progressive altered mental status in the setting of intentional multi-drug and alcohol ingestion, intubated for airway protection. . The patient was reportedly involved in a domestic violence dispute with his wife. The wife called the police due to his violent behavior towards her. Initially police were unable to find the patient. Subsequently he was reportedly found in a car with empty alcohol containers and numerous empty pill bottles. Reportedly, the empty bottles reviewed by the [**Hospital3 44023**] staff included 4 bottles of acyclovir, percocet, flexeril, citalopram and ciprofloxacin. The patient was taken by police to [**Hospital **] Hospital because of altered mental status described as alert and oriented but 'not making sense'. He was able to walk to the ambulance in the field. On presentation to triage at [**Hospital1 **], the patient was speaking but incoherent. Presentation vitals at [**Hospital3 1280**] 97.6 90 121/74 20 97% 3L. He was noted to have equal and responsive pupils. Quickly the patient became obtunded and unresponsive. He was noted to have no gag reflex and to have no response to noxious salts. The patient received narcan 2mg without any response. He was intubated for airway protection. He had normal vital signs throughout his ICU stay, with max heartrate of 101 otherwise 50-80 and mild relative bp decline from sbp 120 to 90's after intubation. Head CT was negative. Tox screen was remarkable for an EtOH level of 240, otherwise negative urine tox and negative tylenol level. The patient was transferred for further management due to no available ICU beds at [**Hospital **] Hospital. While in the ED at [**Hospital3 1280**], the patient received vecuronium, ativan and narcan. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE 96.5 51 106/65 100% AC Vt 600, RR 20, PEEP 5, FiO2 60% Gen: Intubated and sedated. HEENT: PERRL approximately 2-3mm bilaterally. CV: RRR. Normal S1 and S2. No M/R/G. Pulm: CTA bilaterally. Abd: Soft, nontender, nondistended. Ext: No edema. Neuro: Sedated. Spontaneously moved all extremities in response to OG tube placement. Reflexes 1+ patellar bilaterally. No clonus. FAMILY HISTORY: Uncle and ?grandfather suicide SOCIAL HISTORY: Patient lives with wife and three children. He works occasionally in construction. He reports to drink approx. 8 beers a day and cocaine use. Per police report, he physically assulted his wife on the night of ingestion and she has taken out a restraining order on him. He also posted bail recently on other charges.

Poisoning by antiviral drugs,Toxic encephalopathy,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by skeletal muscle relaxants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Other and unspecified alcohol dependence, unspecified

Poisoning-antiviral drug,Toxic encephalopathy,Pois-arom analgesics NEC,Pois-skelet muscle relax,Poison-drug/medicin NEC,Alcoh dep NEC/NOS-unspec

Admission Date: [**2149-9-10**] Discharge Date: [**2149-9-12**] Date of Birth: [**2112-9-6**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2167**] Chief Complaint: Overdose, unresponsiveness Major Surgical or Invasive Procedure: Intubated at [**Hospital **] Hospital [**2149-9-9**] for airway protection. Extubated at [**Hospital1 18**] [**2149-9-10**]. History of Present Illness: 37 yo M with no significant PMH presented with progressive altered mental status in the setting of intentional multi-drug and alcohol ingestion, intubated for airway protection. . The patient was reportedly involved in a domestic violence dispute with his wife. The wife called the police due to his violent behavior towards her. Initially police were unable to find the patient. Subsequently he was reportedly found in a car with empty alcohol containers and numerous empty pill bottles. Reportedly, the empty bottles reviewed by the [**Hospital3 44023**] staff included 4 bottles of acyclovir, percocet, flexeril, citalopram and ciprofloxacin. The patient was taken by police to [**Hospital **] Hospital because of altered mental status described as alert and oriented but 'not making sense'. He was able to walk to the ambulance in the field. On presentation to triage at [**Hospital1 **], the patient was speaking but incoherent. Presentation vitals at [**Hospital3 1280**] 97.6 90 121/74 20 97% 3L. He was noted to have equal and responsive pupils. Quickly the patient became obtunded and unresponsive. He was noted to have no gag reflex and to have no response to noxious salts. The patient received narcan 2mg without any response. He was intubated for airway protection. He had normal vital signs throughout his ICU stay, with max heartrate of 101 otherwise 50-80 and mild relative bp decline from sbp 120 to 90's after intubation. Head CT was negative. Tox screen was remarkable for an EtOH level of 240, otherwise negative urine tox and negative tylenol level. The patient was transferred for further management due to no available ICU beds at [**Hospital **] Hospital. While in the ED at [**Hospital3 1280**], the patient received vecuronium, ativan and narcan. Past Medical History: unknown Social History: Patient lives with wife and three children. He works occasionally in construction. He reports to drink approx. 8 beers a day and cocaine use. Per police report, he physically assulted his wife on the night of ingestion and she has taken out a restraining order on him. He also posted bail recently on other charges. Family History: Uncle and ?grandfather suicide Physical Exam: PE 96.5 51 106/65 100% AC Vt 600, RR 20, PEEP 5, FiO2 60% Gen: Intubated and sedated. HEENT: PERRL approximately 2-3mm bilaterally. CV: RRR. Normal S1 and S2. No M/R/G. Pulm: CTA bilaterally. Abd: Soft, nontender, nondistended. Ext: No edema. Neuro: Sedated. Spontaneously moved all extremities in response to OG tube placement. Reflexes 1+ patellar bilaterally. No clonus. Pertinent Results: [**2149-9-10**] 08:50PM GLUCOSE-89 UREA N-9 CREAT-1.1 SODIUM-143 POTASSIUM-4.4 CHLORIDE-112* TOTAL CO2-24 ANION GAP-11 [**2149-9-10**] 08:50PM ALT(SGPT)-16 AST(SGOT)-17 ALK PHOS-37* [**2149-9-10**] 08:50PM CALCIUM-8.4 PHOSPHATE-3.7# MAGNESIUM-1.9 [**2149-9-10**] 08:50PM WBC-6.1 RBC-3.76* HGB-11.6* HCT-32.1* MCV-86 MCH-30.9 MCHC-36.1* RDW-13.4 [**2149-9-10**] 08:50PM PLT COUNT-153 [**2149-9-10**] 05:29AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-POS [**2149-9-10**] 05:16AM CK-MB-3 cTropnT-<0.01 [**2149-9-10**] 05:16AM TOT PROT-6.5 ALBUMIN-4.3 GLOBULIN-2.2 CALCIUM-8.5 PHOSPHATE-3.3 MAGNESIUM-2.1 [**2149-9-10**] 05:16AM OSMOLAL-329* [**2149-9-10**] 05:16AM ASA-NEG ETHANOL-175* ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG . CXR: FINDINGS: There has been interval removal of an ET tube. There is no evidence of pneumothorax. There is no consolidation or effusion. Increased retrocardiac opacities likely due to atelectasis. The osseous structures are grossly unremarkable. IMPRESSION: Retrocardiac opacity likely represents atelectasis. The study and the report were reviewed by the staff radiologist. . EKG [**9-11**]: Sinus rhythm Modest inferior in lead V2 - may be in part positional/normal variant Since previous tracing of [**2149-9-10**], sinus bradycardia absentand the prolonged Q-Tc interval is now upper limits of normal Brief Hospital Course: Pt. arrived to the ICU intubated and sedated. His labs were notable for high alcohol level and osmolal gap. Toxicology was consulted and recommended serial EKGs to evaluate for QTc prolongation as a complication of quinolone overdose. Patient had serial EKGs and increased QTc that peaked at 490 and was down to 430 by ICU day 2. QRS was never >100. On ICU day 2 the patient was awake, alert and successfully extubated. He remained hemodynamically stable and was seen by psychiatry and social work. He denied suicidal or homicidal ideations. He was put on CIWA scale but did not have any signs of EToH withdrawl. He was given multivitamin, thiamine, and folate and did not show any signs of withdrawal. He had a CIWA scale but did not require any diazepam. He was evaluated by psychiatry and social work. He was transferred to the floor, and subsequently discharged home. The [**Location (un) 47**] police was contact to notify them of his discahrge. Medications on Admission: None Discharge Medications: None Discharge Disposition: Home Discharge Diagnosis: 1. Drug overdose (acyclovir, Percocet, Flexeril, Citalopram, and ciprofloxacin) 2. Substance use 3. QT prolongation 4. Altered mental status 5. Respiratory depression requiring intubation Discharge Condition: Stable Discharge Instructions: You were admitted with a drug overdose. Followup Instructions: Please follow up with your primary care doctor in the next [**1-22**] weeks.

961,349,965,975,E950,303

{'Poisoning by antiviral drugs,Toxic encephalopathy,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by skeletal muscle relaxants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Other and unspecified alcohol dependence, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Overdose, unresponsiveness PRESENT ILLNESS: 37 yo M with no significant PMH presented with progressive altered mental status in the setting of intentional multi-drug and alcohol ingestion, intubated for airway protection. . The patient was reportedly involved in a domestic violence dispute with his wife. The wife called the police due to his violent behavior towards her. Initially police were unable to find the patient. Subsequently he was reportedly found in a car with empty alcohol containers and numerous empty pill bottles. Reportedly, the empty bottles reviewed by the [**Hospital3 44023**] staff included 4 bottles of acyclovir, percocet, flexeril, citalopram and ciprofloxacin. The patient was taken by police to [**Hospital **] Hospital because of altered mental status described as alert and oriented but 'not making sense'. He was able to walk to the ambulance in the field. On presentation to triage at [**Hospital1 **], the patient was speaking but incoherent. Presentation vitals at [**Hospital3 1280**] 97.6 90 121/74 20 97% 3L. He was noted to have equal and responsive pupils. Quickly the patient became obtunded and unresponsive. He was noted to have no gag reflex and to have no response to noxious salts. The patient received narcan 2mg without any response. He was intubated for airway protection. He had normal vital signs throughout his ICU stay, with max heartrate of 101 otherwise 50-80 and mild relative bp decline from sbp 120 to 90's after intubation. Head CT was negative. Tox screen was remarkable for an EtOH level of 240, otherwise negative urine tox and negative tylenol level. The patient was transferred for further management due to no available ICU beds at [**Hospital **] Hospital. While in the ED at [**Hospital3 1280**], the patient received vecuronium, ativan and narcan. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE 96.5 51 106/65 100% AC Vt 600, RR 20, PEEP 5, FiO2 60% Gen: Intubated and sedated. HEENT: PERRL approximately 2-3mm bilaterally. CV: RRR. Normal S1 and S2. No M/R/G. Pulm: CTA bilaterally. Abd: Soft, nontender, nondistended. Ext: No edema. Neuro: Sedated. Spontaneously moved all extremities in response to OG tube placement. Reflexes 1+ patellar bilaterally. No clonus. FAMILY HISTORY: Uncle and ?grandfather suicide SOCIAL HISTORY: Patient lives with wife and three children. He works occasionally in construction. He reports to drink approx. 8 beers a day and cocaine use. Per police report, he physically assulted his wife on the night of ingestion and she has taken out a restraining order on him. He also posted bail recently on other charges. ### Response: {'Poisoning by antiviral drugs,Toxic encephalopathy,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by skeletal muscle relaxants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Other and unspecified alcohol dependence, unspecified'}

CHIEF COMPLAINT: AICD firing. PRESENT ILLNESS: MEDICAL HISTORY: Dilated cardiomyopathy with an EF of 20 percent. MEDICATION ON ADMISSION: 1. Lisinopril 5 q.d. 2. Aspirin 325 q.d. 3. Plavix 75 q.d. 4. Lasix 40 q.d. 5. Digoxin 0.125 q.d. 6. Lipitor 20 q.d. 7. Atrovent. 8. Toprol XL 25 q.d. 9. Dofetilide 500 mg p.o. b.i.d. 10. Coumadin. 11. Protonix 40. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Paroxysmal ventricular tachycardia,Electrolyte and fluid disorders not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia

Parox ventric tachycard,Electrolyt/fluid dis NEC,CHF NOS,Chr airway obstruct NEC,Adv eff card rhyth regul,Crnry athrscl natve vssl,Pure hypercholesterolem

Admission Date: [**2198-6-19**] Discharge Date: [**2198-6-23**] Date of Birth: [**2142-2-13**] Sex: M Service: CME CHIEF COMPLAINT: AICD firing. The patient is a 56-year-old male with coronary disease, cardiomyopathy with EF of 20 percent, 3 plus MR, Afib status post cardioversion, and COPD, who presents with AICD firing. The patient was in his usual state of health until this afternoon when he felt a little woozy on his way to the dishwasher. He sat down and at that time his AICD fired for a total of nine shocks from the time he was at home to the time he presented to the Emergency Room. He also noted [**6-4**] substernal chest discomfort 30 minutes before the first AICD firing with associated nausea. No radiating chest pain, no diaphoresis. Currently, the patient was chest pain free. The patient denies any history of recent PND, orthopnea, or lower extremity swelling. In the Emergency Room, he was noted to be in V-tach and was shocked again by his AICD three more times. He was eventually started on a lidocaine drip. MEDICATIONS ON ADMISSION: 1. Lisinopril 5 q.d. 2. Aspirin 325 q.d. 3. Plavix 75 q.d. 4. Lasix 40 q.d. 5. Digoxin 0.125 q.d. 6. Lipitor 20 q.d. 7. Atrovent. 8. Toprol XL 25 q.d. 9. Dofetilide 500 mg p.o. b.i.d. 10. Coumadin. 11. Protonix 40. PAST MEDICAL HISTORY: Dilated cardiomyopathy with an EF of 20 percent. Coronary artery disease with stent to LAD in [**12-28**]. COPD. Afib. Status post pacemaker and AICD implantation in [**12-28**]. Dyslipidemia. On exam, the patient was sitting in bed, anxious, and in no acute distress. His vital signs are stable. His jugular venous pressure was approximately 10 cm. His lungs were clear except for fine crackles of his left base. His heart had regular, rate, and rhythm. An EKG on the day of admission at 14:47 showed polymorphic VT. After the shock by his defibrillator, his subsequent EKG showed normal sinus at 88 with normal axis and intervals, inferior Q waves, and poor R-wave progression. SIGNIFICANT LABORATORY DATA: His INR was 2.8. His potassium was 3.3, which is repleted in the Emergency Room and his magnesium was 1.7. First set of cardiac enzymes were negative. HOSPITAL COURSE: Patient presented with ventricular tachycardia and multiple shocks from his AICD. The patient had three sets of cardiac enzymes, which were checked and he ruled out for MI. It was felt by the EP team that the most likely etiology of his ventricular tachycardia was due to the dofetilide in combination with hypomagnesemia and hypokalemia. His dofetilide was stopped and the patient was started on amiodarone. His digoxin was also D/C'd. His lidocaine drip was eventually weaned off. Of note, the patient did have a small troponin leak with flat CK's and MB's, and this was thought to be due to the shocks themselves and not from ischemia. His Toprol XL was increased to 37.5 q.d. He was continued on 5 of lisinopril and also started on Aldactone 25 for potassium-sparing effect. Of note, the patient had no further episodes of AICD firing while in the hospital. He did have short runs of NSVT, the longest of which was five beats. The patient also had a very difficult time coping with the number of shocks he received. The patient does have a history of anxiety disorder for which he sees Dr. [**Last Name (STitle) **], his psychiatrist. The patient during his hospital stay was very concerned about events leading to his hospitalization and repeatedly expressed feelings of anxiety. He also stated at times he wished that he did not have the defibrillator in, and would rather have it out. It was explained to the patient numerous times that the defibrillator saved his life and that if it had not been in, he would have died. The Psychiatry consult was obtained while in-house, and they recommended starting Klonopin 1 mg p.o. b.i.d. The patient will also follow up with his outpatient psychiatrist as well. DISCHARGE DIAGNOSES: Ventricular tachycardia secondary to dofetilide toxicity and electrolyte abnormalities. Congestive heart failure. AICD firing. Anxiety. Depression. FOLLOW-UP PLANS: The patient has several follow-up appointments including with his primary care doctor, Dr. [**Last Name (STitle) **]. He also has an appointment for an outpatient set of pulmonary function tests given the fact that he will be on amiodarone. He also has a followup with both the Heart Failure Clinic and Pacemaker Clinics. He also has a followup with his outpatient psychiatrist, Dr. [**Last Name (STitle) **]. DISCHARGE MEDICATIONS: 1. Lisinopril 5 mg p.o. q.d. 2. Aspirin 325 mg q.d. 3. Plavix 75 q.d. 4. Lipitor 20 q.d. 5. Atrovent inhaler. 6. Protonix 40 q.d. 7. Aldactone 25 q.d. 8. Lasix 40 mg q.d. 9. Amiodarone 200 mg p.o. t.i.d. 10. Toprol XL 37.5 mg p.o. q.d. 11. Klonopin 1 mg p.o. b.i.d. 12. Coumadin 2.5 mg p.o. q.h.s. He was instructed to followup with the Heart Failure Clinic on [**6-26**] to get his Coumadin levels checked. 13. Magnesium oxide 400 mg p.o. q.d. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 13600**] Dictated By:[**Doctor Last Name 10457**] MEDQUIST36 D: [**2198-6-25**] 16:35:19 T: [**2198-6-26**] 11:07:11 Job#: [**Job Number **]

427,276,428,496,E942,414,272

{'Paroxysmal ventricular tachycardia,Electrolyte and fluid disorders not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: AICD firing. PRESENT ILLNESS: MEDICAL HISTORY: Dilated cardiomyopathy with an EF of 20 percent. MEDICATION ON ADMISSION: 1. Lisinopril 5 q.d. 2. Aspirin 325 q.d. 3. Plavix 75 q.d. 4. Lasix 40 q.d. 5. Digoxin 0.125 q.d. 6. Lipitor 20 q.d. 7. Atrovent. 8. Toprol XL 25 q.d. 9. Dofetilide 500 mg p.o. b.i.d. 10. Coumadin. 11. Protonix 40. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Paroxysmal ventricular tachycardia,Electrolyte and fluid disorders not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Hematemesis. PRESENT ILLNESS: The patient is an 87-year-old female with a history of peptic ulcer disease, status post Billroth II procedure 35 years ago with history of GI bleed at the anastomotic site in [**Month (only) 547**] of this year. At that time the patient was diagnosed with H. pylori and completed H. pylori therapy earlier this past month. She presented to [**Hospital1 69**] on the 25th after awakening with nausea, vomiting, bright red blood and dark diarrhea. In the Emergency Room the patient was hypotensive at 84/50. She was orthostatic and NG lavage was performed. She was admitted to the MICU. MEDICAL HISTORY: Significant for type 2 diabetes with retinopathy, glaucoma, hypotension, GI bleed in [**2155-4-19**] with an ulcer at her anastomotic site and diagnosis of H. pylori at that time, Billroth II 35 years ago, CVA with multiple subcortical infarcts. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives with her elderly sister, no tobacco or alcohol.

Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Helicobacter pylori [H. pylori],Personal history of other diseases of circulatory system

Chr stomach ulc w hem,Chr blood loss anemia,DMI keto nt st uncntrld,Hypertension NOS,Helicobacter pylori,Hx-circulatory dis NEC

Admission Date: [**2156-9-11**] Discharge Date: [**2156-9-14**] Service: CHIEF COMPLAINT: Hematemesis. HISTORY OF PRESENT ILLNESS: The patient is an 87-year-old female with a history of peptic ulcer disease, status post Billroth II procedure 35 years ago with history of GI bleed at the anastomotic site in [**Month (only) 547**] of this year. At that time the patient was diagnosed with H. pylori and completed H. pylori therapy earlier this past month. She presented to [**Hospital1 69**] on the 25th after awakening with nausea, vomiting, bright red blood and dark diarrhea. In the Emergency Room the patient was hypotensive at 84/50. She was orthostatic and NG lavage was performed. She was admitted to the MICU. PAST MEDICAL HISTORY: Significant for type 2 diabetes with retinopathy, glaucoma, hypotension, GI bleed in [**2155-4-19**] with an ulcer at her anastomotic site and diagnosis of H. pylori at that time, Billroth II 35 years ago, CVA with multiple subcortical infarcts. ALLERGIES: No known drug allergies. MEDICATIONS: At home include Lasix 10 mg q d, Glyburide 10 mg [**Hospital1 **], Prilosec 40 mg q d, Cozaar 100 mg q d, Metformin 500 mg q d, Plavix 75 mg q d. SOCIAL HISTORY: The patient lives with her elderly sister, no tobacco or alcohol. PHYSICAL EXAMINATION: On admission temperature 98.1, heart rate 58, blood pressure 117/37, respirations 16, satting 100% on room air. Pleasant, elderly woman in no acute distress. HEENT: Normocephalic, atraumatic. Extraocular movements intact, moist mucus membranes. Cardiovascular, regular rate and rhythm with a 1/6 systolic flow murmur. Chest is clear to auscultation bilaterally. Abdomen soft, nontender, non distended, positive bowel sounds. Extremities, no clubbing, cyanosis, trace edema. LABORATORY DATA: On admission, hematocrit was 15.4, platelet count 152,000, white count 7.4, PT 12.4, PTT 26.2. Electrolytes, sodium 137, potassium 5.3, chloride 98, CO2 21, BUN 53, creatinine 1.4 and glucose 582. HOSPITAL COURSE: The patient came in. She had an NG lavage that did not clear with one liter of fluid. It was guaiac positive. She received 8 units of insulin and a total of 4 units of packed red blood cells. Her Plavix was discontinued. She had an endoscopy that showed two areas of ulceration at the anastomosis site where she had cautery and Epinephrine to stop the bleeding. She was started on Protonix IV and initially kept npo. Her blood glucoses were treated with insulin and normalized. She was hydrated aggressively. Her initial hematocrit that was 15.4 went to 40.2 after the four units of blood and remained stable throughout her hospital course. She had no further evidence of upper GI bleeding. During her hospital stay she did continue to have some maroon stools although her hematocrit remained stable and was 42 on her day of discharge. The patient's diet was advanced and she tolerated this without any difficulty. Her antihypertensives were restarted as well as her diabetic medication. Her care was discussed and followed by the GI team. Per their recommendation her Plavix should not be restarted due to her very high risk of rebleeding at the anastomotic site. They also recommend that she has her hematocrit checked frequently following her discharge, and it should be checked every other day for her first week of discharge. If it remains stable, it can be checked less frequently but should be followed. She will need a repeat endoscopy by Dr. [**Last Name (STitle) **] in two weeks. DISCHARGE MEDICATIONS: Cozaar 100 mg q d, Metformin 500 mg q d, Protonix 40 mg po bid, Glyburide 10 mg [**Hospital1 **] and Lasix 10 mg q d. DISCHARGE STATUS: Patient will be discharged to rehab facility. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSIS: 1. Upper GI bleed. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 93264**], M.D. [**MD Number(1) 93265**] Dictated By:[**Name8 (MD) 2069**] MEDQUIST36 D: [**2156-9-14**] 14:38 T: [**2156-9-14**] 14:56 JOB#: [**Job Number 93266**]

531,280,250,401,041,V125

{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Helicobacter pylori [H. pylori],Personal history of other diseases of circulatory system'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Hematemesis. PRESENT ILLNESS: The patient is an 87-year-old female with a history of peptic ulcer disease, status post Billroth II procedure 35 years ago with history of GI bleed at the anastomotic site in [**Month (only) 547**] of this year. At that time the patient was diagnosed with H. pylori and completed H. pylori therapy earlier this past month. She presented to [**Hospital1 69**] on the 25th after awakening with nausea, vomiting, bright red blood and dark diarrhea. In the Emergency Room the patient was hypotensive at 84/50. She was orthostatic and NG lavage was performed. She was admitted to the MICU. MEDICAL HISTORY: Significant for type 2 diabetes with retinopathy, glaucoma, hypotension, GI bleed in [**2155-4-19**] with an ulcer at her anastomotic site and diagnosis of H. pylori at that time, Billroth II 35 years ago, CVA with multiple subcortical infarcts. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives with her elderly sister, no tobacco or alcohol. ### Response: {'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Helicobacter pylori [H. pylori],Personal history of other diseases of circulatory system'}

CHIEF COMPLAINT: Here for elective alcohol septal ablation. PRESENT ILLNESS: Ms. [**Known lastname 111649**] is a 79-year-old female with a history of heart failure secondary to hypertrophic obstructive cardiomyopathy who presents to the CCU following an alcohol ablation of her septum. The patient has had the diagnosis of septal hypertrophy with outflow obstruction, and cardiac catheterization in [**2144-10-3**] showed mild diagonal disease, severe mitral regurgitation, diastolic dysfunction, severe left ventricular outflow tract gradient of 100-110 mmHg. The patient has had over the last few months worsening dyspnea on exertion, fatigue with chores, and decreased exercise tolerance. She has been followed in the Advanced Heart Failure Clinic by both Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] as well as Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. She denied any chest pain. She was referred by Dr. [**Last Name (STitle) **] for alcohol ablation, which occurred on [**2145-11-17**]. Subsequently, she was transferred to the CCU team. MEDICAL HISTORY: Significant for hypertrophic cardiomyopathy, chronic DDD pacer for complete heart block placed in [**2140-4-2**], history of endocarditis in [**2140-4-2**], and inguinal node biopsy that was notably benign. MEDICATION ON ADMISSION: 1. Aspirin 325 mg q.d. 2. Verapamil 180 mg q.d. 3. Toprol XL 100 mg q.d. 4. Fosamax 70 mg q. week. 5. Wellbutrin 100 mg b.i.d. 6. Amiloride 5 mg q.d. 7. Nexium. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Her father had CAD (versus HOCM) and her brother has CAD (versus HOCM). SOCIAL HISTORY: She lives alone at home. She has two daughters who are involved in her care; one lives in [**State 4565**]. She is a nonsmoker and does not drink alcohol.

Congestive heart failure, unspecified,Mitral valve disorders,Old myocardial infarction,Cardiac pacemaker in situ

CHF NOS,Mitral valve disorder,Old myocardial infarct,Status cardiac pacemaker

Admission Date: [**2145-11-17**] Discharge Date: [**2145-11-19**] Service: CCU/MED CHIEF COMPLAINT: Here for elective alcohol septal ablation. HISTORY OF THE PRESENT ILLNESS: Ms. [**Known lastname 111649**] is a 79-year-old female with a history of heart failure secondary to hypertrophic obstructive cardiomyopathy who presents to the CCU following an alcohol ablation of her septum. The patient has had the diagnosis of septal hypertrophy with outflow obstruction, and cardiac catheterization in [**2144-10-3**] showed mild diagonal disease, severe mitral regurgitation, diastolic dysfunction, severe left ventricular outflow tract gradient of 100-110 mmHg. The patient has had over the last few months worsening dyspnea on exertion, fatigue with chores, and decreased exercise tolerance. She has been followed in the Advanced Heart Failure Clinic by both Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] as well as Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. She denied any chest pain. She was referred by Dr. [**Last Name (STitle) **] for alcohol ablation, which occurred on [**2145-11-17**]. Subsequently, she was transferred to the CCU team. In the Cath Lab, alcohol ablation was successfully performed, with a reduction of her peak left ventricular outflow tract gradient to 10-15 mmHg (from 100-110 mmHg). There was also a limited LCA injection which showed a normal large LCA. Following her catheterization, she was transferred to the CCU where she presented essentially denying any chest pain, shortness of breath. She had no fever, chills, no urinary symptoms, no vomiting, and no other complaints with the exception of feeling tired. PAST MEDICAL HISTORY: Significant for hypertrophic cardiomyopathy, chronic DDD pacer for complete heart block placed in [**2140-4-2**], history of endocarditis in [**2140-4-2**], and inguinal node biopsy that was notably benign. FAMILY HISTORY: Her father had CAD (versus HOCM) and her brother has CAD (versus HOCM). CARDIAC RISK FACTORS: Include hypertension, hyperlipidemia. SOCIAL HISTORY: She lives alone at home. She has two daughters who are involved in her care; one lives in [**State 4565**]. She is a nonsmoker and does not drink alcohol. ALLERGIES: The patient has no known drug allergies. MEDICATIONS ON ADMISSION: 1. Aspirin 325 mg q.d. 2. Verapamil 180 mg q.d. 3. Toprol XL 100 mg q.d. 4. Fosamax 70 mg q. week. 5. Wellbutrin 100 mg b.i.d. 6. Amiloride 5 mg q.d. 7. Nexium. PHYSICAL EXAMINATION ON ADMISSION: Her heart rate was 64, blood pressure 94/43. She was saturating 100% on 2 liters nasal cannula. In general, she was pleasant and slightly fatigued but in no apparent distress. Her eyes were anicteric. Her oropharynx was clear without exudates. She had a cardiac examination that was significant for regular rate and rhythm, S1, S2, and a III/VI systolic ejection murmur at the left upper sternal border consistent with hypertrophic cardiomyopathy. Her lung examination was clear to auscultation bilaterally without wheezes. Her abdomen was soft, nontender, nondistended, with no organomegaly. Her extremities had palpable pedal pulses bilaterally. Her right groin site was without ecchymosis, nontender, and without bruits. Neurologically, she was alert and oriented times three. Her cranial nerve examination was grossly intact and the remainder of her neurological examination was nonfocal. LABORATORY STUDIES ON ADMISSION: Her white blood cell count was 5.8, hematocrit 38.3, platelets 199,000. Her INR was 1.1. Her sodium was 137, potassium 5.0, BUN 29, creatinine 1.2, glucose 92. IMAGING ON ADMISSION: On [**2145-11-17**], she had a transthoracic echocardiogram status post ethanol ablation. It demonstrated hyperenhancement of the basal septum. Her left systolic function was excellent with an ejection fraction of greater than 65%. She was also noted to have mild to moderate mitral regurgitation. This was in comparison to her preablation echocardiogram which again demonstrated and EF of greater than 65% and left ventricular outflow tract peak of 36-40. Her EKG postablation on admission to the CCU demonstrated DDD pacing at 87 beats per minute with a left bundle branch block (this is an old finding). HOSPITAL COURSE: 1. CARDIAC: Ischemia; the patient received an ethanol ablation which is consistent with a deliberately induced myocardial infarction. She had peak creatinine kinases of 868, peak MB 122, peak index 14.1. She had no ensuing chest pain following her ablation. She was maintained on aspirin at 325 mg q.d. PUMP: Her postablation echocardiogram demonstrated an EF of greater than 65%. She was maintained on her anticontractile agents of Toprol XL at 100 mg q.h.s. and her verapamil SR was slowly tapered from 180 mg to 120 mg q.a.m. upon discharge. RHYTHM: The patient is chronically DDD paced. She had some episodes of her native AV conduction demonstrated on telemetry throughout her postablation course. Upon discharge, she remained DDD paced with no further issues. 2. NEUROLOGY: Sedation was withheld postablation. The patient was alert and oriented times three and had no further issues in this regard. Overall, the patient did well postprocedure, ambulated well on postprocedure day number two, and was discharged home with no further issues. MEDICATIONS UPON DISCHARGE: 1. Toprol XL 100 mg p.o. q.h.s. 2. Verapamil SR 120 mg p.o. q.a.m. 3. Amiloride 5 mg p.o. q.d. 4. Bupropion 100 mg b.i.d. 5. Alendronate 70 mg q. week. 6. Aspirin 325 mg q.d. Of note, the patient received a flu shot prior to discharge. FOLLOW-UP: The patient will follow-up in three months with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] appointment of which has already been scheduled. Prior to this visit, she will receive a repeat transthoracic echocardiogram which has already been scheduled. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSIS: Hypertrophic cardiomyopathy, status post alcohol septal ablation. [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D. [**MD Number(1) 422**] Dictated By:[**Name8 (MD) 17844**] MEDQUIST36 D: [**2145-11-23**] 15:27 T: [**2145-11-26**] 06:54 JOB#: [**Job Number **]

428,424,412,V450

{'Congestive heart failure, unspecified,Mitral valve disorders,Old myocardial infarction,Cardiac pacemaker in situ'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Here for elective alcohol septal ablation. PRESENT ILLNESS: Ms. [**Known lastname 111649**] is a 79-year-old female with a history of heart failure secondary to hypertrophic obstructive cardiomyopathy who presents to the CCU following an alcohol ablation of her septum. The patient has had the diagnosis of septal hypertrophy with outflow obstruction, and cardiac catheterization in [**2144-10-3**] showed mild diagonal disease, severe mitral regurgitation, diastolic dysfunction, severe left ventricular outflow tract gradient of 100-110 mmHg. The patient has had over the last few months worsening dyspnea on exertion, fatigue with chores, and decreased exercise tolerance. She has been followed in the Advanced Heart Failure Clinic by both Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] as well as Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. She denied any chest pain. She was referred by Dr. [**Last Name (STitle) **] for alcohol ablation, which occurred on [**2145-11-17**]. Subsequently, she was transferred to the CCU team. MEDICAL HISTORY: Significant for hypertrophic cardiomyopathy, chronic DDD pacer for complete heart block placed in [**2140-4-2**], history of endocarditis in [**2140-4-2**], and inguinal node biopsy that was notably benign. MEDICATION ON ADMISSION: 1. Aspirin 325 mg q.d. 2. Verapamil 180 mg q.d. 3. Toprol XL 100 mg q.d. 4. Fosamax 70 mg q. week. 5. Wellbutrin 100 mg b.i.d. 6. Amiloride 5 mg q.d. 7. Nexium. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Her father had CAD (versus HOCM) and her brother has CAD (versus HOCM). SOCIAL HISTORY: She lives alone at home. She has two daughters who are involved in her care; one lives in [**State 4565**]. She is a nonsmoker and does not drink alcohol. ### Response: {'Congestive heart failure, unspecified,Mitral valve disorders,Old myocardial infarction,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: UTI PRESENT ILLNESS: 78M POD20/13 from left lat segementectomy followed by exploratory laparotomy and washout with subsequent bile leakage in mediastinum s/p drainage. He was assessed as being stable for discharge with two drains and maintained himself at home, until the past day, at which time the patient noted to his family that he had absolutely no appetite for food. His family noted that his PO intake decreased to nothing, while he has continued to have liquid bowel movements 5-6x/day. Additional symptoms have included fevers to 102F, continued dysuria, diaphoresis, and pallor. The patient was evaluated recently in the outpatient surgery clinic, but it appears that these symptoms have been greatly increasing since yesterday. Additionally, the patient's abdominal drains have largely decreased in drainage, but there is concern expressed by the patient's family that the output is, in fact, increasing. As such, the patient is being directly admitted to the hepatobiliary surgery service for further evaluation. We find him on the floor to be listless and not interested in po intake, mildly tachycardic, and feeling poorly. MEDICAL HISTORY: Hypothyroidism Osteoporosis Presumed secondary hyperparathyroidism Partial gastrectomy with presumed consequent B12 deficiency . Past Surgical History Billroth II gastrectomy Complete gastrectomy w/ feeding jejunostomy [**2105-9-18**] c/b SBO at jejunostomy site, re-siting of feeding jejunostomy [**2105-9-22**] MEDICATION ON ADMISSION: FOSAMAX - 70MG Tablet - ONE BY MOUTH Q WEEK LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once a day VITAMIN D - [**Numeric Identifier 1871**] UNIT Capsule - ONE BY MOUTH Q WEEK ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital signs 96.5 105 137/80 16 99RA General: A+O x 3, NAD, notably listless and with malaise Card: RRR, no M/R/G Lungs: CTA bilaterally, no coughs or wheezes on exam with deep inspiration Abd: Soft, non-tender, non distended, no masses, open incision with fibrinopurulent superficial exudate, drain sites mildly erythematous but otherwise clean, dry, intact with bile-tinged sero-sanguinous output Extr: no peripheral edema noted FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives with wife, retired. [**Name2 (NI) 108414**] Greek primarily, some English. Son in area, daughter lives in CA>

Urinary tract infection, site not specified,Secondary hyperparathyroidism (of renal origin),Secondary malignant neoplasm of lung,Malnutrition of moderate degree,Other B-complex deficiencies,Other specified disorders of biliary tract,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hypotension, unspecified,Personal history of malignant neoplasm of stomach,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance,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

Urin tract infection NOS,Sec hyperparathyrd-renal,Secondary malig neo lung,Malnutrition mod degree,B-complex defic NEC,Dis of biliary tract NEC,Hypothyroidism NOS,Osteoporosis NOS,Hypotension NOS,Hx of gastric malignancy,Infc mcrg drgrst mult,Abn react-anastom/graft

Admission Date: [**2107-2-17**] Discharge Date: [**2107-2-25**] Date of Birth: [**2028-6-30**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 695**] Chief Complaint: UTI Major Surgical or Invasive Procedure: none History of Present Illness: 78M POD20/13 from left lat segementectomy followed by exploratory laparotomy and washout with subsequent bile leakage in mediastinum s/p drainage. He was assessed as being stable for discharge with two drains and maintained himself at home, until the past day, at which time the patient noted to his family that he had absolutely no appetite for food. His family noted that his PO intake decreased to nothing, while he has continued to have liquid bowel movements 5-6x/day. Additional symptoms have included fevers to 102F, continued dysuria, diaphoresis, and pallor. The patient was evaluated recently in the outpatient surgery clinic, but it appears that these symptoms have been greatly increasing since yesterday. Additionally, the patient's abdominal drains have largely decreased in drainage, but there is concern expressed by the patient's family that the output is, in fact, increasing. As such, the patient is being directly admitted to the hepatobiliary surgery service for further evaluation. We find him on the floor to be listless and not interested in po intake, mildly tachycardic, and feeling poorly. Past Medical History: Hypothyroidism Osteoporosis Presumed secondary hyperparathyroidism Partial gastrectomy with presumed consequent B12 deficiency . Past Surgical History Billroth II gastrectomy Complete gastrectomy w/ feeding jejunostomy [**2105-9-18**] c/b SBO at jejunostomy site, re-siting of feeding jejunostomy [**2105-9-22**] Social History: Lives with wife, retired. [**Name2 (NI) 108414**] Greek primarily, some English. Son in area, daughter lives in CA> Family History: Noncontributory Physical Exam: Vital signs 96.5 105 137/80 16 99RA General: A+O x 3, NAD, notably listless and with malaise Card: RRR, no M/R/G Lungs: CTA bilaterally, no coughs or wheezes on exam with deep inspiration Abd: Soft, non-tender, non distended, no masses, open incision with fibrinopurulent superficial exudate, drain sites mildly erythematous but otherwise clean, dry, intact with bile-tinged sero-sanguinous output Extr: no peripheral edema noted LABS/Studies: just arrived, still pending Pertinent Results: [**2107-2-22**] 05:40AM BLOOD WBC-5.9 RBC-3.64* Hgb-10.5* Hct-31.8* MCV-87 MCH-28.9 MCHC-33.2 RDW-16.1* Plt Ct-363 [**2107-2-19**] 05:37AM BLOOD PT-13.7* PTT-24.5 INR(PT)-1.2* [**2107-2-25**] 05:45AM BLOOD Glucose-81 UreaN-21* Creat-0.9 Na-141 K-5.1 Cl-104 HCO3-31 AnGap-11 [**2107-2-21**] 06:13AM BLOOD ALT-12 AST-15 AlkPhos-40 TotBili-0.2 [**2107-2-23**] 05:48AM BLOOD Calcium-8.2* Phos-3.6 Mg-2.4 [**2107-2-17**] 4:43 pm URINE Source: CVS. **FINAL REPORT [**2107-2-24**]** URINE CULTURE (Final [**2107-2-24**]): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. CEFPODOXIME Susceptibility testing requested by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Numeric Identifier 108415**] [**2107-2-21**] AT 1800. Cefpodoxime = INTERMEDIATE, sensitivity testing performed by [**First Name8 (NamePattern2) 3077**] [**Last Name (NamePattern1) 3060**]. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- =>64 R CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S PIPERACILLIN/TAZO----- =>128 R TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- =>16 R [**2107-2-19**] 11:04 am BILE **FINAL REPORT [**2107-2-24**]** GRAM STAIN (Final [**2107-2-19**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2107-2-24**]): ESCHERICHIA COLI. RARE GROWTH. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Numeric Identifier 108416**]) REQUESTED SENSITIVITIES TO CEFPODOXIME [**2107-2-23**]. CEFPODOXIME = SENSITIVE BY [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ <=2 S AMPICILLIN/SULBACTAM-- <=2 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S ANAEROBIC CULTURE (Final [**2107-2-23**]): NO ANAEROBES ISOLATED. Brief Hospital Course: Given the patient's recent slight increase in drain output, recent discharge with drains for fluid collection, and the above symptoms, a CT scan was done to evaluate for fluid collection. CT demonstrated smaller abdominal collections and left lower lung consolidation. He was cultured for complaints of dysuria. On hospital day 2, he became tachypneic and hypotensive requiring fluid boluses and transfer to the SICU for management. He also spiked a temperature and was found to have a positive UA. IV Zosyn and linezolid were started given past h/o E.coli and VRE. Blood cultures remained negative. Urine cultured out for multi-drug resistant E. coli. IV antibiotics were tailored to Ceftriaxone per ID recommendations. He improved and was transferred out of the SICU. He received a total of 7 days of ceftriaxone for UTI. The plan was to cover for 5 days with ceftriaxone. Sensitivities were run on Cefpodoxime in the event that an oral antibiotic was needed. Cefpodoxime had intermediate sensitivity. The decision was made to stop antibiotics after the seven day course. UA and culture were done. UA was negative. Urine culture was pending at time of discharge. Nutrition status was monitored with KCAL done. Caloric intake average 1500-1900 Kcal. The decision was made to defer placement of a feeding tube. Megace was started on the day of discharge. Vital signs remained stable. Perihepatic drains remained to gravity drainage with the subhepatic #3 averaging 90-8cc/day. The perihepatic drain output averaged 20-58cc/day. Both drains appeared cloudy/green. The abdominal incision was dressed with a normal saline damp to dry 4x4 [**Hospital1 **]. The wound was healing nicely and appeared clean with granulation tissue. PT declared him safe for discharge home without services. He was ambulating independently. VNA services were arranged. Medications on Admission: FOSAMAX - 70MG Tablet - ONE BY MOUTH Q WEEK LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once a day VITAMIN D - [**Numeric Identifier 1871**] UNIT Capsule - ONE BY MOUTH Q WEEK Medications - OTC ACETAMINOPHEN - (Prescribed by Other Provider) - 325 mg Tablet - [**12-11**] Tablet(s) by mouth Q6hr as needed for pain CALCIUM CARBONATE-VIT D3-MIN [CALTRATE PLUS] - Tablet - 1 Tablet(s) by mouth up to tid CYANOCOBALAMIN [VITAMIN B-12] - (OTC) - 1,000 mcg Tablet - 2 Tablet(s) by mouth once a day FERROUS SULFATE - (Prescribed by Other Provider) - 325 mg (65 mg Iron) Tablet - 1 Tablet(s) by mouth once a day Do not take in combination with thyroid pill LOPERAMIDE [IMODIUM A-D] - (Prescribed by Other Provider) - 2 mg Tablet - 1 Tablet(s) by mouth q2h as needed for diarrhea --------------- --------------- --------------- --------------- Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 2. Ergocalciferol (Vitamin D2) 50,000 unit Capsule Sig: One (1) Capsule PO 1X/WEEK (SA). 3. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 5. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week. 6. Vitamin B-12 1,000 mcg Tablet Sig: Two (2) Tablet PO once a day. 7. Calcium 600 with Vitamin D3 600 mg(1,500mg) -400 unit Capsule Sig: One (1) Capsule PO twice a day. 8. Megestrol 40 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Multidrug resistant E.coli UTI Malnutrition, moderate perihepatic collections Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - Independent Discharge Instructions: Please call Dr.[**Name (NI) 1369**] office [**Telephone/Fax (1) 673**] if you experience any of the warning signs listed below Visiting Nurse Services will be arranged to do the abdominal wound dressing Continue to empty and record Drain outputs Followup Instructions: [**First Name4 (NamePattern1) 698**] [**Last Name (NamePattern1) 699**] RN coordinator for Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 17195**] Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2107-3-2**] 1:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2107-3-14**] 1:30 Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 3150**] Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2107-3-14**] 1:30 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**] Completed by:[**2107-2-25**]

599,588,197,263,266,576,244,733,458,V100,V099,E878

{'Urinary tract infection, site not specified,Secondary hyperparathyroidism (of renal origin),Secondary malignant neoplasm of lung,Malnutrition of moderate degree,Other B-complex deficiencies,Other specified disorders of biliary tract,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hypotension, unspecified,Personal history of malignant neoplasm of stomach,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance,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'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: UTI PRESENT ILLNESS: 78M POD20/13 from left lat segementectomy followed by exploratory laparotomy and washout with subsequent bile leakage in mediastinum s/p drainage. He was assessed as being stable for discharge with two drains and maintained himself at home, until the past day, at which time the patient noted to his family that he had absolutely no appetite for food. His family noted that his PO intake decreased to nothing, while he has continued to have liquid bowel movements 5-6x/day. Additional symptoms have included fevers to 102F, continued dysuria, diaphoresis, and pallor. The patient was evaluated recently in the outpatient surgery clinic, but it appears that these symptoms have been greatly increasing since yesterday. Additionally, the patient's abdominal drains have largely decreased in drainage, but there is concern expressed by the patient's family that the output is, in fact, increasing. As such, the patient is being directly admitted to the hepatobiliary surgery service for further evaluation. We find him on the floor to be listless and not interested in po intake, mildly tachycardic, and feeling poorly. MEDICAL HISTORY: Hypothyroidism Osteoporosis Presumed secondary hyperparathyroidism Partial gastrectomy with presumed consequent B12 deficiency . Past Surgical History Billroth II gastrectomy Complete gastrectomy w/ feeding jejunostomy [**2105-9-18**] c/b SBO at jejunostomy site, re-siting of feeding jejunostomy [**2105-9-22**] MEDICATION ON ADMISSION: FOSAMAX - 70MG Tablet - ONE BY MOUTH Q WEEK LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once a day VITAMIN D - [**Numeric Identifier 1871**] UNIT Capsule - ONE BY MOUTH Q WEEK ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital signs 96.5 105 137/80 16 99RA General: A+O x 3, NAD, notably listless and with malaise Card: RRR, no M/R/G Lungs: CTA bilaterally, no coughs or wheezes on exam with deep inspiration Abd: Soft, non-tender, non distended, no masses, open incision with fibrinopurulent superficial exudate, drain sites mildly erythematous but otherwise clean, dry, intact with bile-tinged sero-sanguinous output Extr: no peripheral edema noted FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives with wife, retired. [**Name2 (NI) 108414**] Greek primarily, some English. Son in area, daughter lives in CA> ### Response: {'Urinary tract infection, site not specified,Secondary hyperparathyroidism (of renal origin),Secondary malignant neoplasm of lung,Malnutrition of moderate degree,Other B-complex deficiencies,Other specified disorders of biliary tract,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hypotension, unspecified,Personal history of malignant neoplasm of stomach,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance,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'}

CHIEF COMPLAINT: Bilateral MSSA empyemas Port Infection Bacteremia PRESENT ILLNESS: This is a 51 year-old Female with a stage IV breast cancer with mets to liver who was admitted to ACS on [**2122-7-13**] with a port line infection which was subsequently removed on [**2122-7-13**]. Initial blood cultures grew MSSA and Enterococcus and she was started on Vancomycin. She was then transferred to the medicine service on [**2122-7-20**] for bacteremia management and progressive dyspnea. She received a TEE on [**2122-7-21**] that was negative for vegetations. Chest imaging revealed bilateral loculated pleural effusions prompting left VATS and chest tube placement on [**2122-7-21**] with the pleural fluid growing MSSA. Her shortness of breath progressed and she required up to 4L NC. She had a CTA on [**2122-7-23**] that did not reveal central or lobar PE, but segmental/subsegmental PE could not be ruled out. She was briefly started on heparin, but this was discontinued due to persistent right sided empyema as leading cause of hypoxia. Her antibiotic coverage was broadened to Vancomycin and Zosyn the night of [**2122-7-23**]. Blood cultures negative since [**2122-7-17**], left sided pleural fluid growing MSSA. MEDICAL HISTORY: - Stage IV breast ca: Dx [**2115**], Tx'd with L breast partial mastectomy, radiation, chemotherapy. Mets to liver and LN's in [**2119**], s/p several chemotherapies since. CT scan in [**1-/2122**] showing liver met doubling in size. Currently on Faslodex (Fulvestrant) ONCOLOGY HISTORY: [**11-13**]: Self-palp left breast mass. +IDC, G III, ER+/PR+/HEr2neu neg. Left lump'y and LND (Soybel). 4.2cm, +LVI, [**6-21**]+lymph nodes. [**12-13**] - [**4-14**] Six cycles of Taxotere, Adriamycin and Cytoxan [**7-14**] XRT [**7-14**] - [**6-15**] Tamoxifen [**6-15**] - [**8-17**] Arimidex [**8-17**] ?liver mass on CT- biopsy +poorly diff carcinoma consistent w/breast primary. ER+/Her2neu neg. Bone scan-uptake thoracic spine, sternomanubrial joint. Subsequent chest and thoracic MRI's, no mets. Started on Xeloda. MRI after 3 cycles w/progression in liver. [**1-17**] - [**3-18**] Tamoxifen. Progression in liver and portocaval lymphadenopathy [**4-18**] Taxol and Avastin started. During 3rd cycle, portacath wound dehisced. Port removed. Avastin on hold pending healing and placement of new portacath. PICC line for Taxol. [**8-18**] Abd MRI:Decreased size of the hepatic mass and decreased portacaval soft tissue and decreased paraaortic adenopathy with no new lesions identified. CA27.29 down from 199 to 62. [**2120-10-4**] Right portacath wound healed. Left portacath placed. [**2120-11-20**] Tumor marker with some fluctuation and MRI w/stable liver lesions, slightly larger portocaval lymphadenopathy. [**2121-2-28**] Tumor marker slightly higher w/stable scans. Avastin restarted. [**9-19**] Progression on abd MRI [**2121-9-24**] Started Gemzar 800mg/m2 - after two doses, anasarca increased, patient felt poorly with nausea, fatigue, aching. Progression confirmed on CT chest/abd/pelvis but no source of edema identified. Normal echocardiogram. Gemzar d/c. [**10-19**] Started on weekly Navelbine. Did not tolerate. [**2121-11-19**] Started weekly Carboplatin [**2-20**] CT with progression of liver mets [**2122-2-25**], [**2122-3-18**] and [**2122-4-8**] Ixempra 40mg/m2 IV q 21 days [**2122-4-22**] CT C/A/P: Hepatobiliary: Hepatic metastases in segment 5 and 6 have further increased in size measuring 7 x 9.6 cm (2-49), previously 7.5 x 5.5 cm. Lymph nodes: Abdominal and retroperitoneal lymph nodes have remained stable or increased in size. For example,celiac lymph nodes measures 3.2 x 2.6 cm, previously 1.7 x 1.3cm. Porta hepatis lymph node is stable at 3.3 x 2 cm. Retrocaval node is stable at 2.2 x 0.9 cm. Left periaortic lymph node measures 2.9 x 1.8 cm, previously 2.4 x 1.5 cm. [**2122-5-6**] #1 Faslodex 500mg IM . Other Past Medical History: - HTN - Neuropathy - Anxiety - Cellulitis - R IJ port placement and removal for infection 3.5 yrs ago, L IJ port placement 3 yrs ago MEDICATION ON ADMISSION: Ondansetron HCl 4 mg Oral Tablet take 1 to 2 tablets Diphenhydramine HCl 50 mg Oral Capsule 1 by mouth up to 3xday Prednisone 10 mg Oral Tablet take 6-6-5-5-4-4-3-3-2-2-1- 1-([**1-11**])-([**1-11**]) tablets daily on consecutive days. take in the morning with food Fulvestrant (FASLODEX) 125 mg/2.5 Intramuscular Syringe 500mg im ALLERGIES: Codeine / Nafcillin PHYSICAL EXAM: Admission: PHYSICAL EXAM: VS - Temp 97.6F, BP 100/60, HR 98, R 24, O2-sat 98% 4L GENERAL - pleasant obese woman in NAD, comfortable, appropriate FAMILY HISTORY: Father - stroke, MI and Mother - h/o stroke. No family history of cancer. SOCIAL HISTORY: Husband passed away in MVC 13 yrs ago. Grew up in [**Hospital1 3494**], 2 siblings, lives in [**Location 3786**], has worked for insurance company for 22 yrs. Lives at home with son [**Name (NI) 4049**] 17 [**Name2 (NI) **]. Has 2 siblings. Weekend EtOH [**5-15**] drinks/wk

Empyema without mention of fistula,Acute glomerulonephritis with other specified pathological lesion in kidney,Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Severe sepsis,Other and unspecified infection due to central venous catheter,Malignant neoplasm of liver, secondary,Malignant pleural effusion,Mechanical complication of other vascular device, implant, and graft,Cellulitis and abscess of trunk,Other fluid overload,Malignant neoplasm of breast (female), unspecified,Anemia in neoplastic disease,Unspecified essential hypertension,Penicillins causing adverse effects in therapeutic use,Other disorders of plasma protein metabolism,Constipation, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other stomatitis and mucositis (ulcerative),Dermatitis due to drugs and medicines taken internally,Other opiates and related narcotics causing adverse effects in therapeutic use

Empyema w/o fistula,Acute nephritis NEC,Meth susc Staph aur sept,Septic shock,Severe sepsis,Oth/uns inf-cen ven cath,Second malig neo liver,Malignant pleural effusn,Malfunc vasc device/graf,Cellulitis of trunk,Fluid overload NEC,Malign neopl breast NOS,Anemia in neoplastic dis,Hypertension NOS,Adv eff penicillins,Dis plas protein met NEC,Constipation NOS,Abn react-procedure NEC,Stomatits & mucosits NEC,Drug dermatitis NOS,Adv eff opiates

Admission Date: [**2122-7-13**] Discharge Date: [**2122-8-4**] Date of Birth: [**2070-12-11**] Sex: F Service: MEDICINE Allergies: Codeine / Nafcillin Attending:[**First Name3 (LF) 759**] Chief Complaint: Bilateral MSSA empyemas Port Infection Bacteremia Major Surgical or Invasive Procedure: 1. [**2122-7-24**]: Right video-assisted thoracoscopic surgery total pulmonary decortication. [**2122-7-21**]: Left video-assisted thoracoscopic surgical decortication. [**2122-7-13**]: Excision of infected Infuse-a-Port, with debridement of overlying tissue and abscess cavity. History of Present Illness: This is a 51 year-old Female with a stage IV breast cancer with mets to liver who was admitted to ACS on [**2122-7-13**] with a port line infection which was subsequently removed on [**2122-7-13**]. Initial blood cultures grew MSSA and Enterococcus and she was started on Vancomycin. She was then transferred to the medicine service on [**2122-7-20**] for bacteremia management and progressive dyspnea. She received a TEE on [**2122-7-21**] that was negative for vegetations. Chest imaging revealed bilateral loculated pleural effusions prompting left VATS and chest tube placement on [**2122-7-21**] with the pleural fluid growing MSSA. Her shortness of breath progressed and she required up to 4L NC. She had a CTA on [**2122-7-23**] that did not reveal central or lobar PE, but segmental/subsegmental PE could not be ruled out. She was briefly started on heparin, but this was discontinued due to persistent right sided empyema as leading cause of hypoxia. Her antibiotic coverage was broadened to Vancomycin and Zosyn the night of [**2122-7-23**]. Blood cultures negative since [**2122-7-17**], left sided pleural fluid growing MSSA. Past Medical History: - Stage IV breast ca: Dx [**2115**], Tx'd with L breast partial mastectomy, radiation, chemotherapy. Mets to liver and LN's in [**2119**], s/p several chemotherapies since. CT scan in [**1-/2122**] showing liver met doubling in size. Currently on Faslodex (Fulvestrant) ONCOLOGY HISTORY: [**11-13**]: Self-palp left breast mass. +IDC, G III, ER+/PR+/HEr2neu neg. Left lump'y and LND (Soybel). 4.2cm, +LVI, [**6-21**]+lymph nodes. [**12-13**] - [**4-14**] Six cycles of Taxotere, Adriamycin and Cytoxan [**7-14**] XRT [**7-14**] - [**6-15**] Tamoxifen [**6-15**] - [**8-17**] Arimidex [**8-17**] ?liver mass on CT- biopsy +poorly diff carcinoma consistent w/breast primary. ER+/Her2neu neg. Bone scan-uptake thoracic spine, sternomanubrial joint. Subsequent chest and thoracic MRI's, no mets. Started on Xeloda. MRI after 3 cycles w/progression in liver. [**1-17**] - [**3-18**] Tamoxifen. Progression in liver and portocaval lymphadenopathy [**4-18**] Taxol and Avastin started. During 3rd cycle, portacath wound dehisced. Port removed. Avastin on hold pending healing and placement of new portacath. PICC line for Taxol. [**8-18**] Abd MRI:Decreased size of the hepatic mass and decreased portacaval soft tissue and decreased paraaortic adenopathy with no new lesions identified. CA27.29 down from 199 to 62. [**2120-10-4**] Right portacath wound healed. Left portacath placed. [**2120-11-20**] Tumor marker with some fluctuation and MRI w/stable liver lesions, slightly larger portocaval lymphadenopathy. [**2121-2-28**] Tumor marker slightly higher w/stable scans. Avastin restarted. [**9-19**] Progression on abd MRI [**2121-9-24**] Started Gemzar 800mg/m2 - after two doses, anasarca increased, patient felt poorly with nausea, fatigue, aching. Progression confirmed on CT chest/abd/pelvis but no source of edema identified. Normal echocardiogram. Gemzar d/c. [**10-19**] Started on weekly Navelbine. Did not tolerate. [**2121-11-19**] Started weekly Carboplatin [**2-20**] CT with progression of liver mets [**2122-2-25**], [**2122-3-18**] and [**2122-4-8**] Ixempra 40mg/m2 IV q 21 days [**2122-4-22**] CT C/A/P: Hepatobiliary: Hepatic metastases in segment 5 and 6 have further increased in size measuring 7 x 9.6 cm (2-49), previously 7.5 x 5.5 cm. Lymph nodes: Abdominal and retroperitoneal lymph nodes have remained stable or increased in size. For example,celiac lymph nodes measures 3.2 x 2.6 cm, previously 1.7 x 1.3cm. Porta hepatis lymph node is stable at 3.3 x 2 cm. Retrocaval node is stable at 2.2 x 0.9 cm. Left periaortic lymph node measures 2.9 x 1.8 cm, previously 2.4 x 1.5 cm. [**2122-5-6**] #1 Faslodex 500mg IM . Other Past Medical History: - HTN - Neuropathy - Anxiety - Cellulitis - R IJ port placement and removal for infection 3.5 yrs ago, L IJ port placement 3 yrs ago Social History: Husband passed away in MVC 13 yrs ago. Grew up in [**Hospital1 3494**], 2 siblings, lives in [**Location 3786**], has worked for insurance company for 22 yrs. Lives at home with son [**Name (NI) 4049**] 17 [**Name2 (NI) **]. Has 2 siblings. Weekend EtOH [**5-15**] drinks/wk Family History: Father - stroke, MI and Mother - h/o stroke. No family history of cancer. Physical Exam: Admission: PHYSICAL EXAM: VS - Temp 97.6F, BP 100/60, HR 98, R 24, O2-sat 98% 4L GENERAL - pleasant obese woman in NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear NECK - supple, no thyromegaly, no carotid bruits LUNGS - breath sounds inaudible in lower lung fields bilaterally, distant at midfield, and mildly coarse breath sounds in the upper lung fields bilaterally. resp unlabored but shallow, no accessory muscle use HEART - PMI non-displaced, RRR, no MRG, 3/6 systolic ejection murmur ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - 1+ edema in upper and lower extremity bilaterally, 2+ peripheral pulses (radials, DPs) SKIN - fresh dressing at wound site, no induration LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**5-14**] throughout, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait Discharge: PHYSICAL EXAM (upon transfer): VITALS: Tmax 99.8 Tcurrent 98.1 HR 100 130/64 RR 20 96% RA GENERAL - obese woman with anasarca to 4 extremities, NAD without labored breathing HEENT - PERRLA, EOMI, MMM, OP clear NECK - supple, cannot appreciate JVD CHEST - Lung fields clear to auscultation, with scattered crackles CVS - RRR, 3/6 systolic ejection murmur at RUSB ABDOMEN - NABS, soft/ND, non tender EXTR - Edema/anasarca to all 4 extremities, worse to upper extremities, PICC line in R arm flushing well without pain orerythema LYMPH - no cervical, axillary, or inguinal LAD NEURO - CNs II-XII grossly intact Pertinent Results: see attached. Brief Hospital Course: This is a 51 year-old Female with a stage IV breast cancer with mets to liver who was admitted to ACS on [**2122-7-13**] with a port line infection which was subsequently removed on [**2122-7-13**]. Initial blood cultures grew MSSA and Enterococcus and she was started on Vancomycin. She was then transferred to the medicine service on [**2122-7-20**] for bacteremia management and progressive dyspnea. She received a TEE on [**2122-7-21**] that was negative for vegetations. Chest imaging revealed bilateral loculated pleural effusions prompting left VATS and chest tube placement on [**2122-7-21**] with the pleural fluid growing MSSA. Her shortness of breath progressed and she required up to 4L NC. She had a CTA on [**2122-7-23**] that did not reveal central or lobar PE, but segmental/subsegmental PE could not be ruled out. She was briefly started on heparin, but this was discontinued due to persistent right sided empyema as leading cause of hypoxia. Her antibiotic coverage was broadened to Vancomycin and Zosyn the night of [**2122-7-23**]. Blood cultures negative since [**2122-7-17**], left sided pleural fluid growing MSSA. . She subsequently had right sided VATS with chest tube placement on [**2122-7-24**]. The pleural fluid demonstrated frank purulence. During the procedure the patient required Levophed support and in the PACU, SBP remained in 80's, MAPs 60's despite 2L LR. Phenylephrine gtt was started, which was switched to Levophed gtt. She received IV dilaudid for pain control. . Upon evaluation in the PACU, she was lethargic, awaking to voice, but with poor attention and not answering questions coherently, intermittently moaning in pain. Respirations were unlabored and an ABG obtained prior to transfer was 7.38/42/164. She was transfered to the MICU with 5 chest tubes in place and requiring pressor support. The patient continued IV antibiotic treatment with vancomycin. . The patient was transferred back to the medicine floor on [**7-27**] from the MICU. The patient was briefly transitioned to Nafcillin on [**7-31**]; however, subsequent blood work revealed [**Last Name (un) **] and likely AIN, with Cr plateauing at 1.9, up from her baseline of 1.1-1.4. This prompted the patient's return to Vancomycin. In brief, the summary of the patient's active issues at discharge: 51F with metastatic stage IV breast CA admitted to ACS for port-line infection with subsequent removal of line, found to have MSSA/Enterococcal bacteremia, and development of B/L empyemas s/p multiple chest tubes who required MICU admission for hypotension, previously on pressors. . # Fluid balance - The patient's hypotension resolved shortly before transfer to the floor on [**2122-7-27**]. Her BP has been stable on the medicine floor, with SBPs ranging from 120s to 140s. During the patient's stay in the hospital, she became gradually more edematous, with upper and lower extremity anasarca. Pt's Albumin was noted to be at 2. Pt developed [**Last Name (un) **] with CR 1.9 after lasix diuresis and nafcillin induction on [**8-31**]. Eos in urine on [**7-31**], since resolved, prompted concern for AIN. The patient has been transitioned back to Vancomycin, and her renal function has been stable. The patient will be discharged to [**Hospital1 **] on Vancomycin. Per our renal consult, we started the patient on [**Hospital1 **] albumin (25g IV) chased one hour after with 10mg lasix. This promoted successful diuresis, and the patient has been stable on this regimen. # BILATERAL EMPYEMAS, CHEST TUBES, DYSPNEA - Pt was noted to have increasing dyspnea, and bilateral pleural effusions were noted on [**2122-7-19**]. CT confirmed the presence of loculated pleural effusions. Pt is s/p bilateral VATS on the left side [**2122-7-21**] and the right side on [**2122-7-24**]. Pt received b/l drainage and pleural biopsy. 2 chest tubes were placed on the left side [**2122-7-21**] amd 3 were placed on the right side [**2122-7-24**]. The last chest tube was successfully removed on [**2122-7-29**], and subsequent CXR has shown no return of effusions with notmal lung spaces. Cultures from empyemas were positive for MSSA. Pt's dyspnea resolved s/p VATS. *Atypical epithelial cells recovered from VATS suspicious for malignancy. - Thoracic surgery recs - F/u as outpatient, appointment made for [**2122-8-13**]. Pt's pain has been effectively controlled with Dilaudid PO 4 mg Q4H PRN; oxycodone 20 mg PO BID. Pt has been relatively pain free with only ocasional need for the Dilaudid. . # Port infection - PT was admitted for a port infection on [**2122-7-13**] to acute care surgery. She had her port removed, with the area debrided. Wet to dry dressings have been applied to the surgical site, with marked improvement of the wound. There has been no return of purulence since surgery, and her penrose drain was removed [**2122-7-15**]. The wound shows evidence of good granulation tissue. Cultures from the infected port grew MSSA. # ANEMIA - evidence of downward trending hematocrit is likely due to worsening chronic disease. Pt has been consistently guaiac negative, and a hemolytic work-up was negative for hemolysis. At time of discharge, Pt's hematocrit is at 25. Since returning from the ICU, pt has received 2 units of blood on [**7-31**], with hematocrit stable at 25 since. # METASTATIC BREAST CANCER - faslodex 500mg IM was given to the patient on [**2122-8-3**]. Her next dose is due on [**2122-8-31**]. Atypical epithelial cells suspicious for malignancy were present in tissue taken from pleural empyema. B/L empyemas may have had a malignant component. . # CONSTIPATION - Pt initially constipated, but has been stable on current bowel regimen of docusate, miralax, bisacodyl, and senna. # ANXIETY - Pt has complained of anxiety, but has been stable on Lorazepam 1 mg PO Q8hrs for anxiety. . # FEN: Regular diet with supplementation of carnation instant breakfast in between meals for added nutrition. # PPX: HSQ, SCDs # ACCESS: PICC (changed [**7-28**]) # CODE: FULL # DISPO: to [**Hospital1 **] Medications on Admission: Ondansetron HCl 4 mg Oral Tablet take 1 to 2 tablets Diphenhydramine HCl 50 mg Oral Capsule 1 by mouth up to 3xday Prednisone 10 mg Oral Tablet take 6-6-5-5-4-4-3-3-2-2-1- 1-([**1-11**])-([**1-11**]) tablets daily on consecutive days. take in the morning with food Fulvestrant (FASLODEX) 125 mg/2.5 Intramuscular Syringe 500mg im Acyclovir 400 mg Oral Tablet TAKE 1 TABLET TWICE A DAY Oxycodone 5 mg Oral Tablet TAKE 1 TABLET EVERY 6 TO 8 HOURS Gabapentin 100 mg Oral Capsule take 1 to 3 CAPSULES THREE TIMES DAILY Lorazepam 1 mg Oral Tablet take 1 tablet at bedtime as needed Propranolol 10 mg Oral Tablet Take 2 TABLETs q am and 1 tablet q pm Prochlorperazine Maleate 10 mg Oral Tablet TAKE 1 TABLET EVERY 8 hours AS NEEDED FOR nausea Lactulose 10 gram/15 mL Oral Solution TAKE 30 mL every 6hrs as need for constipation Hydrochlorothiazide 50 mg Oral Tablet take 1 tablet daily Bilateral lymphedema sleeves with gloves, Dx code 174.9 Discharge Medications: 1. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day) as needed for glaucoma. 2. gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 3. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 4. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheeze. 5. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itchiness. 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 8. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily) as needed for constipation. 9. lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 10. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. hydromorphone 2 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 12. guaifenesin 600 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO BID (2 times a day) as needed for difficulty coughing. 13. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 14. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). 15. oxycodone 20 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO Q12H (every 12 hours). 16. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 17. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 18. fulvestrant 250 mg/5 mL Syringe Sig: Two (2) Intramuscular ONCE ON [**2122-8-31**] for 1 months: GIVE ON [**2122-8-31**] (last dose given [**2122-8-3**]). 19. ondansetron HCl (PF) 4 mg/2 mL Solution Sig: One (1) Injection Q8H (every 8 hours) as needed for nausea. 20. Outpatient Lab Work [**2122-8-5**]: CBC, Chem 7, Vanco Trough 7/28.[**2122**]: CBC, Chem 7, Vanco trough 21. albumin, human 25 % 25 % Parenteral Solution Sig: Twenty Five (25) g Intravenous [**Hospital1 **] (2 times a day): Please take this one hour before receiving furosemide. 22. furosemide 10 mg/mL Solution Sig: Ten (10) mg Injection [**Hospital1 **] (2 times a day): Please take this 10mg furosemide IV twice daily. Please take one hour after receiving albumin. 23. vancomycin 1,000 mg Recon Soln Sig: One (1) Intravenous Q 24H (Every 24 Hours): Please adjust dose according to vancomycin trough. Pt's trough should have a blood level between 15 and 20. Pt will need to be on vancomycin through [**2122-8-21**]. 24. Outpatient Lab Work Once a week Labs: CBC with diff, chem 7, BUN/Cr, Vanco trough. Fax results to: Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] from infectious disease [**Telephone/Fax (1) 1419**] Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Bilateral MSSA empyemas Port site infection MSSA bacteremia and sepsis Anemia Acute Kidney Insuficiency Acute Interstitial Nephritis from nafcillin Hypoalbuminemia with anasarca 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: Dear Ms. [**Known lastname 89606**], It was a pleasure being able to participate in your medical care at [**Hospital1 69**]. You were treated here for a port line infection and bilateral empyemas (lung infections). We wish you well in your continued recovery at [**Hospital3 **]. Activity -Shower daily. Wash chest incisions with mild soap and water, rinse pat dry -No tub bathing swimming or hot tubs until incision healed. -No lotion or creme applied to incisions -No lifting greater than [**10-24**] pounds. Your wounds from the port infection on the upper-left side of your chest must have clean dressing changes once daily (apply 4x4 to infected area and cover with clean gauze and skin tape. Change every day.) We have made numerous changes to your medications during your stay with us. Please take the following medications as described: Post-Discharge Medications: Albumin: Please take 25g IV twice daily. (this will be titrated base on renal function and fluid state) Furosemide: Please take 10mg IV twice daily, one hour after receiving albumin. (this will be titrated base on renal function and fluid state) Timolol maleate 0.5 % Drops: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day) as needed for glaucoma. gabapentin 300 mg Capsule: One (1) Capsule PO HS (at bedtime). ipratropium bromide 0.02 % Solution: One (1) Inhalation Q6H (every 6 hours) albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization: One (1) Inhalation Q6H (every 6 hours) as needed for wheeze. camphor-menthol 0.5-0.5 % Lotion: One (1) Appl Topical QID (4 times a day) as needed for itchiness. senna 8.6 mg Tablet: One (1) Tablet PO BID (2 times a day) as needed for constipation Bisacodyl 5 mg Tablet, Delayed Release: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. polyethylene glycol 3350 17 gram/dose Powde: One (1) PO DAILY (Daily) as needed for constipation. lorazepam 1 mg Tablet: One (1) Tablet PO TID (3 times a day). ranitidine HCl 150 mg Tablet: One (1) Tablet PO BID (2 times a day). hydromorphone 2 mg Tablet: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain guaifenesin 600 mg Tablet Extended Release: One (1) Tablet Extended Release PO BID (2 times a day) as needed for difficulty coughing. docusate sodium 100 mg Capsule: One (1) Capsule PO BID (2 times a day) miconazole nitrate 2 % Powder: One (1) Appl Topical [**Hospital1 **] (2 times a day). oxycodone 20 mg Tablet Extended Release 12 hr: One (1) Tablet Extended Release 12 hr PO Q12H (every 12 hours). acetaminophen 500 mg Tablet: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. heparin (porcine) 5,000 unit/mL Solution: One (1) Injection TID (3 times a day). fulvestrant 250 mg/5 mL Syringe: Two (2) Intramuscular one time per month. ondansetron HCl (PF) 4 mg/2 mL Solution: One (1) Injection Q8H (every 8 hours) as needed for nausea. Vancomycin 1000 mg IV Q 24H (every 24 hours). Please adjust the dose according to the vancomycin trough, which should be between 15 and 20. Pt will need vancomycin until [**2122-8-21**]. Followup Instructions: Provider: [**Name10 (NameIs) 1532**] [**Name11 (NameIs) 1533**], MD Phone:[**0-0-**] [**2122-8-13**] 4:00 on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**] of [**Hospital1 69**]. Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your appointment Please see Dr. [**Last Name (STitle) 84995**] at 11:30am on [**2122-8-12**]. The address is [**Location (un) **], [**Location (un) 86**]. [**Telephone/Fax (1) 65559**] Completed by:[**2122-8-4**]

510,580,038,785,995,999,197,511,996,682,276,174,285,401,E930,273,564,E879,528,693,E935

{'Empyema without mention of fistula,Acute glomerulonephritis with other specified pathological lesion in kidney,Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Severe sepsis,Other and unspecified infection due to central venous catheter,Malignant neoplasm of liver, secondary,Malignant pleural effusion,Mechanical complication of other vascular device, implant, and graft,Cellulitis and abscess of trunk,Other fluid overload,Malignant neoplasm of breast (female), unspecified,Anemia in neoplastic disease,Unspecified essential hypertension,Penicillins causing adverse effects in therapeutic use,Other disorders of plasma protein metabolism,Constipation, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other stomatitis and mucositis (ulcerative),Dermatitis due to drugs and medicines taken internally,Other opiates and related narcotics causing adverse effects in therapeutic use'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Bilateral MSSA empyemas Port Infection Bacteremia PRESENT ILLNESS: This is a 51 year-old Female with a stage IV breast cancer with mets to liver who was admitted to ACS on [**2122-7-13**] with a port line infection which was subsequently removed on [**2122-7-13**]. Initial blood cultures grew MSSA and Enterococcus and she was started on Vancomycin. She was then transferred to the medicine service on [**2122-7-20**] for bacteremia management and progressive dyspnea. She received a TEE on [**2122-7-21**] that was negative for vegetations. Chest imaging revealed bilateral loculated pleural effusions prompting left VATS and chest tube placement on [**2122-7-21**] with the pleural fluid growing MSSA. Her shortness of breath progressed and she required up to 4L NC. She had a CTA on [**2122-7-23**] that did not reveal central or lobar PE, but segmental/subsegmental PE could not be ruled out. She was briefly started on heparin, but this was discontinued due to persistent right sided empyema as leading cause of hypoxia. Her antibiotic coverage was broadened to Vancomycin and Zosyn the night of [**2122-7-23**]. Blood cultures negative since [**2122-7-17**], left sided pleural fluid growing MSSA. MEDICAL HISTORY: - Stage IV breast ca: Dx [**2115**], Tx'd with L breast partial mastectomy, radiation, chemotherapy. Mets to liver and LN's in [**2119**], s/p several chemotherapies since. CT scan in [**1-/2122**] showing liver met doubling in size. Currently on Faslodex (Fulvestrant) ONCOLOGY HISTORY: [**11-13**]: Self-palp left breast mass. +IDC, G III, ER+/PR+/HEr2neu neg. Left lump'y and LND (Soybel). 4.2cm, +LVI, [**6-21**]+lymph nodes. [**12-13**] - [**4-14**] Six cycles of Taxotere, Adriamycin and Cytoxan [**7-14**] XRT [**7-14**] - [**6-15**] Tamoxifen [**6-15**] - [**8-17**] Arimidex [**8-17**] ?liver mass on CT- biopsy +poorly diff carcinoma consistent w/breast primary. ER+/Her2neu neg. Bone scan-uptake thoracic spine, sternomanubrial joint. Subsequent chest and thoracic MRI's, no mets. Started on Xeloda. MRI after 3 cycles w/progression in liver. [**1-17**] - [**3-18**] Tamoxifen. Progression in liver and portocaval lymphadenopathy [**4-18**] Taxol and Avastin started. During 3rd cycle, portacath wound dehisced. Port removed. Avastin on hold pending healing and placement of new portacath. PICC line for Taxol. [**8-18**] Abd MRI:Decreased size of the hepatic mass and decreased portacaval soft tissue and decreased paraaortic adenopathy with no new lesions identified. CA27.29 down from 199 to 62. [**2120-10-4**] Right portacath wound healed. Left portacath placed. [**2120-11-20**] Tumor marker with some fluctuation and MRI w/stable liver lesions, slightly larger portocaval lymphadenopathy. [**2121-2-28**] Tumor marker slightly higher w/stable scans. Avastin restarted. [**9-19**] Progression on abd MRI [**2121-9-24**] Started Gemzar 800mg/m2 - after two doses, anasarca increased, patient felt poorly with nausea, fatigue, aching. Progression confirmed on CT chest/abd/pelvis but no source of edema identified. Normal echocardiogram. Gemzar d/c. [**10-19**] Started on weekly Navelbine. Did not tolerate. [**2121-11-19**] Started weekly Carboplatin [**2-20**] CT with progression of liver mets [**2122-2-25**], [**2122-3-18**] and [**2122-4-8**] Ixempra 40mg/m2 IV q 21 days [**2122-4-22**] CT C/A/P: Hepatobiliary: Hepatic metastases in segment 5 and 6 have further increased in size measuring 7 x 9.6 cm (2-49), previously 7.5 x 5.5 cm. Lymph nodes: Abdominal and retroperitoneal lymph nodes have remained stable or increased in size. For example,celiac lymph nodes measures 3.2 x 2.6 cm, previously 1.7 x 1.3cm. Porta hepatis lymph node is stable at 3.3 x 2 cm. Retrocaval node is stable at 2.2 x 0.9 cm. Left periaortic lymph node measures 2.9 x 1.8 cm, previously 2.4 x 1.5 cm. [**2122-5-6**] #1 Faslodex 500mg IM . Other Past Medical History: - HTN - Neuropathy - Anxiety - Cellulitis - R IJ port placement and removal for infection 3.5 yrs ago, L IJ port placement 3 yrs ago MEDICATION ON ADMISSION: Ondansetron HCl 4 mg Oral Tablet take 1 to 2 tablets Diphenhydramine HCl 50 mg Oral Capsule 1 by mouth up to 3xday Prednisone 10 mg Oral Tablet take 6-6-5-5-4-4-3-3-2-2-1- 1-([**1-11**])-([**1-11**]) tablets daily on consecutive days. take in the morning with food Fulvestrant (FASLODEX) 125 mg/2.5 Intramuscular Syringe 500mg im ALLERGIES: Codeine / Nafcillin PHYSICAL EXAM: Admission: PHYSICAL EXAM: VS - Temp 97.6F, BP 100/60, HR 98, R 24, O2-sat 98% 4L GENERAL - pleasant obese woman in NAD, comfortable, appropriate FAMILY HISTORY: Father - stroke, MI and Mother - h/o stroke. No family history of cancer. SOCIAL HISTORY: Husband passed away in MVC 13 yrs ago. Grew up in [**Hospital1 3494**], 2 siblings, lives in [**Location 3786**], has worked for insurance company for 22 yrs. Lives at home with son [**Name (NI) 4049**] 17 [**Name2 (NI) **]. Has 2 siblings. Weekend EtOH [**5-15**] drinks/wk ### Response: {'Empyema without mention of fistula,Acute glomerulonephritis with other specified pathological lesion in kidney,Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Severe sepsis,Other and unspecified infection due to central venous catheter,Malignant neoplasm of liver, secondary,Malignant pleural effusion,Mechanical complication of other vascular device, implant, and graft,Cellulitis and abscess of trunk,Other fluid overload,Malignant neoplasm of breast (female), unspecified,Anemia in neoplastic disease,Unspecified essential hypertension,Penicillins causing adverse effects in therapeutic use,Other disorders of plasma protein metabolism,Constipation, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other stomatitis and mucositis (ulcerative),Dermatitis due to drugs and medicines taken internally,Other opiates and related narcotics causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Tylenol overdose PRESENT ILLNESS: 24 year-old female with past medical history of depression and anxiety transferred from [**Hospital1 18**] [**Location (un) 620**] after tylenol overdose. The patient states that she was drinking alcohol the night prior to admission and took an accidental overdose of tylenol PM (extra-strength tylenol and benadryl). The patient was found by the police. A 50-count pill bottle of tylenol PM was found with only 20 pills remaining. The receipt for the tylenol was found and was time-stamped 9:47 pm. Per OSH records, the patient's tylenol level at 1:45 am (approximately 4 hours post ingestion) was 209.4, at 6:50 am 199.7, and at 2:49 pm 143.3, all of which are in the range of probable hepatic toxicity per the Rumack-[**Doctor First Name **] nomogram. Per OSH records, the patient was loaded with NAC 7500 mg IV (150 mg/kg) at 1:30 am. Records show that the patient was started on NAC gtt at 17.5 mg/kg/hr at 10:30 am, approximately 12 hours after the initial ingestion. The patient was likely on NAC gtt in the interim but this is unclear. The patient was infused from 10:30 am to 2:45 pm, at which time the infusion was halted due an erythematous rash over the chest. Notes state the patient was restarted on NAC gtt at 5:00 pm, but the patient was not on this medication on transfer at 7:30 pm. The patient also received at least 2L NS in addition to electrolyte repletion. . Of note, the patient denied SI, but a nurse overheard the patient telling her mother that this was a suicide attempt and she wished she were dead. . MEDICAL HISTORY: Anxiety Depression MEDICATION ON ADMISSION: none ALLERGIES: Erythromycin Base / Bactrim / Amoxicillin / Iodine PHYSICAL EXAM: VS: 100.0 99 118/71 22 100%RA GEN: Well-appearing young woman in NAD HEENT: Sclera anicteric, CN II-XII intact, OP clear without lesions NECK: Supple, no LAD HEART: RRR, no MRG LUNGS: CTAB ABD: Hypoactive bowel sounds, soft, NTND, no HSM EXT: No c/c/e RECTAL: Guaiac positive per OSH records SKIN: No rashes NEURO: AAOx3, no asterixis FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Patient is currently between jobs. Per her mother, she recently restarted a physically abusive relationship with her ex-boyfriend. The patient drinks 15 alcoholic drinks per week. The patient denies tobacco or IVDU.

Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Hepatitis, unspecified,Acquired coagulation factor deficiency,Dysthymic disorder,Poisoning by antiallergic and antiemetic drugs,Alcohol abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted

Pois-arom analgesics NEC,Acidosis,Hepatitis NOS,Acq coagul factor defic,Dysthymic disorder,Pois-antiallrg/antiemet,Alcohol abuse-unspec,Undeterm pois-analgesics

Admission Date: [**2119-10-3**] Discharge Date: [**2119-10-5**] Date of Birth: [**2095-1-22**] Sex: F Service: MEDICINE Allergies: Erythromycin Base / Bactrim / Amoxicillin / Iodine Attending:[**First Name3 (LF) 3556**] Chief Complaint: Tylenol overdose Major Surgical or Invasive Procedure: none History of Present Illness: 24 year-old female with past medical history of depression and anxiety transferred from [**Hospital1 18**] [**Location (un) 620**] after tylenol overdose. The patient states that she was drinking alcohol the night prior to admission and took an accidental overdose of tylenol PM (extra-strength tylenol and benadryl). The patient was found by the police. A 50-count pill bottle of tylenol PM was found with only 20 pills remaining. The receipt for the tylenol was found and was time-stamped 9:47 pm. Per OSH records, the patient's tylenol level at 1:45 am (approximately 4 hours post ingestion) was 209.4, at 6:50 am 199.7, and at 2:49 pm 143.3, all of which are in the range of probable hepatic toxicity per the Rumack-[**Doctor First Name **] nomogram. Per OSH records, the patient was loaded with NAC 7500 mg IV (150 mg/kg) at 1:30 am. Records show that the patient was started on NAC gtt at 17.5 mg/kg/hr at 10:30 am, approximately 12 hours after the initial ingestion. The patient was likely on NAC gtt in the interim but this is unclear. The patient was infused from 10:30 am to 2:45 pm, at which time the infusion was halted due an erythematous rash over the chest. Notes state the patient was restarted on NAC gtt at 5:00 pm, but the patient was not on this medication on transfer at 7:30 pm. The patient also received at least 2L NS in addition to electrolyte repletion. . Of note, the patient denied SI, but a nurse overheard the patient telling her mother that this was a suicide attempt and she wished she were dead. . Past Medical History: Anxiety Depression Social History: Patient is currently between jobs. Per her mother, she recently restarted a physically abusive relationship with her ex-boyfriend. The patient drinks 15 alcoholic drinks per week. The patient denies tobacco or IVDU. Family History: Noncontributory Physical Exam: VS: 100.0 99 118/71 22 100%RA GEN: Well-appearing young woman in NAD HEENT: Sclera anicteric, CN II-XII intact, OP clear without lesions NECK: Supple, no LAD HEART: RRR, no MRG LUNGS: CTAB ABD: Hypoactive bowel sounds, soft, NTND, no HSM EXT: No c/c/e RECTAL: Guaiac positive per OSH records SKIN: No rashes NEURO: AAOx3, no asterixis Pertinent Results: [**2119-10-3**] 07:46PM TYPE-[**Last Name (un) **] PH-7.43 COMMENTS-GREEN TOP [**2119-10-3**] 07:46PM freeCa-1.03* [**2119-10-3**] 07:42PM GLUCOSE-186* UREA N-4* CREAT-0.8 SODIUM-132* POTASSIUM-3.3 CHLORIDE-101 TOTAL CO2-14* ANION GAP-20 [**2119-10-3**] 07:42PM estGFR-Using this [**2119-10-3**] 07:42PM ALT(SGPT)-15 AST(SGOT)-28 LD(LDH)-222 ALK PHOS-48 AMYLASE-87 TOT BILI-0.9 [**2119-10-3**] 07:42PM LIPASE-63* [**2119-10-3**] 07:42PM ALBUMIN-4.3 CALCIUM-8.0* PHOSPHATE-1.8* MAGNESIUM-2.8* [**2119-10-3**] 07:42PM ACETMNPHN-45.4* [**2119-10-3**] 07:42PM WBC-9.2 RBC-4.11* HGB-13.6 HCT-38.1 MCV-93 MCH-33.0* MCHC-35.7* RDW-12.3 [**2119-10-3**] 07:42PM PLT COUNT-256 [**2119-10-3**] 07:42PM PT-15.5* PTT-30.5 INR(PT)-1.4* LIVER OR GALLBLADDER US (SINGL Reason: PLEASE EVAL FOR DISEASE/DAMAGE TYLENOL INGESTION 15GM [**Hospital 93**] MEDICAL CONDITION: 24 year old woman with recent 15gm tylenol ingestion REASON FOR THIS EXAMINATION: please evaluate for liver disease / damage INDICATION: 24-year-old woman with recent 15 gram of Tylenol ingestion. LIVER AND GALLBLADDER ULTRASOUND: Comparison is made with the prior CT study dated [**2118-2-9**]. The liver is mildly diffusely echogenic, without focal liver lesion or intrahepatic ductal dilatation. CBD measures 2 mm. Gallbladder is unremarkable. There is no ascites. Portal flow is normal. IMPRESSION: Mild diffusely echogenic liver, without intrahepatic ductal dilatation, focal lesion or ascites. The mild increased echogenicity of the liver may represent fatty inflitration; however, in this young patient with Tylenol overdose, etiologies such as drug- induced hepatitis or NASH cannot be excluded on this study. Brief Hospital Course: Patient took approximately 15 gm tylenol (30 x 500 mg) and her tylenol levels have consistently been in the range of probable hepatic toxicity. Per OSH records, the patient was loaded with NAC 7500 mg IV (150 mg/kg) at 1:30 am. Records show that the patient was started on NAC gtt at 17.5 mg/kg/hr at 10:30 am, approximately 12 hours after the initial ingestion. The patient was likely on NAC gtt in the interim but this is unclear. The patient was infused from 10:30 am to 2:45 pm, at which time the infusion was halted due an erythematous rash over the chest. Per toxicology, this reaction is due to histamine release and should not preclude further infusion. - On [**10-3**] she was Reloaded with NAC at 7500 mg over 60 minutes (150 mg/kg), then give 2500 mg over 4 hours (50 mg/kg), then 5000 mg over 16 hours (100 mg/kg)--> Continue 100mg/hour today. At [**Hospital1 18**], she completed a NAC course; her INR, LFTs, ph and lactate returned to [**Location 213**]. She was judged by the hepatology service to no longer be at risk for hepatotoxicity, and the NAC infusion was stopped. Pt was seen by psychiatry while in house. Pt had 1:1 sitter while in the hospital to monitor for suicidal thoughts/attempts. Psychiatry felt she has some generalized anxiety NOS and could not rule out major depressive disorder. However, the psychiatry consultation judged that she would be safe to discharge home, and that this she was not at risk for further suicide attempts. She received Ativan 1mg prn and is scheduled to follow up in outpatient psychiatry and psychotherapy beginning the day after discharge, [**2119-10-6**]. These discharge instructions were reviewed carefully with the patient. Medications on Admission: none Discharge Medications: none Discharge Disposition: Home Discharge Diagnosis: Tylenol overdose Discharge Condition: stable Discharge Instructions: You came into the hospital having taken an overdose of tylenol with benadryl. We treated you with N-acetylcystein and watched your liver function to make sure that you didn't have any liver failure. If you have any abdominal pain, nausea or vomiting, please come back to the hospital. In addition, if you feel suicidal, please report back to the ED. Followup Instructions: Please follow up with [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 51485**] in [**Location (un) **] tomorrow [**10-6**] at 12pm. Her phone number is [**Telephone/Fax (1) 51486**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]

965,276,573,286,300,963,305,E980

{'Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Hepatitis, unspecified,Acquired coagulation factor deficiency,Dysthymic disorder,Poisoning by antiallergic and antiemetic drugs,Alcohol abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Tylenol overdose PRESENT ILLNESS: 24 year-old female with past medical history of depression and anxiety transferred from [**Hospital1 18**] [**Location (un) 620**] after tylenol overdose. The patient states that she was drinking alcohol the night prior to admission and took an accidental overdose of tylenol PM (extra-strength tylenol and benadryl). The patient was found by the police. A 50-count pill bottle of tylenol PM was found with only 20 pills remaining. The receipt for the tylenol was found and was time-stamped 9:47 pm. Per OSH records, the patient's tylenol level at 1:45 am (approximately 4 hours post ingestion) was 209.4, at 6:50 am 199.7, and at 2:49 pm 143.3, all of which are in the range of probable hepatic toxicity per the Rumack-[**Doctor First Name **] nomogram. Per OSH records, the patient was loaded with NAC 7500 mg IV (150 mg/kg) at 1:30 am. Records show that the patient was started on NAC gtt at 17.5 mg/kg/hr at 10:30 am, approximately 12 hours after the initial ingestion. The patient was likely on NAC gtt in the interim but this is unclear. The patient was infused from 10:30 am to 2:45 pm, at which time the infusion was halted due an erythematous rash over the chest. Notes state the patient was restarted on NAC gtt at 5:00 pm, but the patient was not on this medication on transfer at 7:30 pm. The patient also received at least 2L NS in addition to electrolyte repletion. . Of note, the patient denied SI, but a nurse overheard the patient telling her mother that this was a suicide attempt and she wished she were dead. . MEDICAL HISTORY: Anxiety Depression MEDICATION ON ADMISSION: none ALLERGIES: Erythromycin Base / Bactrim / Amoxicillin / Iodine PHYSICAL EXAM: VS: 100.0 99 118/71 22 100%RA GEN: Well-appearing young woman in NAD HEENT: Sclera anicteric, CN II-XII intact, OP clear without lesions NECK: Supple, no LAD HEART: RRR, no MRG LUNGS: CTAB ABD: Hypoactive bowel sounds, soft, NTND, no HSM EXT: No c/c/e RECTAL: Guaiac positive per OSH records SKIN: No rashes NEURO: AAOx3, no asterixis FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Patient is currently between jobs. Per her mother, she recently restarted a physically abusive relationship with her ex-boyfriend. The patient drinks 15 alcoholic drinks per week. The patient denies tobacco or IVDU. ### Response: {'Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Hepatitis, unspecified,Acquired coagulation factor deficiency,Dysthymic disorder,Poisoning by antiallergic and antiemetic drugs,Alcohol abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted'}

CHIEF COMPLAINT: GI Bleed PRESENT ILLNESS: HMED ATTENDING ADMISSION NOTE . ADMIT DATE: [**2156-4-26**] ADMIT TIME: 2345 . PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) 1575**] [**Name Initial (NameIs) **]. Address: [**Doctor Last Name 32771**], [**Location (un) **],[**Numeric Identifier 17464**] Phone: [**Telephone/Fax (1) 8340**] Fax: [**Telephone/Fax (1) 8341**] . Cardiology: Dr. [**First Name4 (NamePattern1) 2855**] [**Last Name (NamePattern1) 32772**] Address: [**Location (un) **] [**Apartment Address(1) 32773**]. [**Location (un) 936**] Phone: [**Telephone/Fax (1) 14967**] . 69 yo M with CAD s/p CABG complicated be restenosis requiring multiple stents, mechanical aortic valve on coumadin, recurrent GI bleeding and IDDM who is transferred from [**Hospital3 **] for advanced endoscopy for management of active upper GI bleed. . Patient was admitted to [**Hospital6 33**] approximately one week ago with melena and hematocrit of 22, found to have a NSTEMI (medical management per cardiology, restarted on plavix - d/c'ed in [**2154**] given recurrent gi bleeds, 1 month after BMS placed). Upper endoscopy was unrevealing except for mild gastritis. Colonoscopy last done one year ago which was unremarkable except for benign polyps. Patient was transfused 4 units of pRBCs, hematorcrit increased to 27 and discharged three days ago. Of note, he required diuresis for decompensated CHF. Was seen in the ED on [**4-21**] for chest pain, no EKG changes, resolved with nitro, discharged home. . Patient was re-admitted to [**Hospital3 **] today ([**2156-4-26**]) with recurrent melena. Last night he had two black/tarry stools. He also endorsed some mild chest pain. His hematocrit on admission was 26.2. Patient transfused 1 unit of packed cells. He ruled out for ACS by three sets of negative cardiac enzymes and non-ischemic EKG. Patient underwent a CT angiogram which revealed 3 small bowel foci of hemorrhage likely in the proximal ileum. Given the location of the bleeding decision made by gastroenterologist to transfer to [**Hospital1 18**] for single balloon enteroscopy. Patient has been continued on plavix given his significant cardiac comorbidities. He has been bridged with a heparin gtt for a subtherapeutic INR of 1.9. . Of note, patient had recurrent GI bleeding at site of anastamosis from sigmoid colectomy in [**2154**], requiring multiple transfusions. Was on asa/plavix/coumadin with recent BMS placed in diagonal. ASA stopped and plavix discontinued 1 month after BMS placement given recurrent bleeding. He had no further bleeding issues until this past week. . Currently patient has no complaints. Denies any current chest pain, sob, lightheadedness or dizziness. No nausea, vomiting or abdominal pain. Reports one episode of black stool prior to transfer. . ROS as per HPI, 10 pt ROS otherwise negative. MEDICAL HISTORY: -CAD s/p CABG 2v [**2135**], restenosis requiring multiple stents, [**2151**] DES for RCA stenosis, [**2152**] NSTEMI medically managed, [**2154**] BMS diagonal -St. [**Male First Name (un) 923**] aortic valve replacement [**2135**] -IDDM -COPD -Diverticulitis s/p sigmoid colectomy complicated by unstable angina, s/p cardiac cath and BMS to diagonal, then developed recurrent bleeding on asa/plavix/coumadin therefore plavix d/c'ed after 1 month -HTN -Hypothyroidism -CHF -Anxiety -S/p knee replacement [**2152**] complicated NSTEMI and CHF exacerbation -Hernia repair MEDICATION ON ADMISSION: Medications on Transfer: Vicodin 5/500 q6h prn Ativan 2mg po TID prn Morphine 2mg iv prn NTG 0.4 q5 mins prn Protonix gtt Atenolol 25mg po bid Plavix 75mg daily Ferrous sulfate 325mg [**Hospital1 **] Gabapentin 600mg QID Humalog sliding scale Synthroid 50mcg daily Kdur ? dose daily Simvastatin 20mg daily Heparin gtt Imdur ER 60mg [**Hospital1 **] Lasix 40mg daily Lantus 10 units qam Lisinopril 20mg daily . Outpatient Medications Lantus 20 units qam Metformin 850mg [**Hospital1 **] Glyburide 10mg [**Hospital1 **] Atenolol 25mg [**Hospital1 **] Plavix 75mg daily Tylenol prn vicodin 1 tablet q6h prn Ativan 2mg tid prn NTG prn Lasix 40mg daily Gabapentin 600mg qid Isosorbide mononitrate 60mg daily Levoxyl 50mcg daily Lisinopril 20mg daily Simvastatin 20mg daily Coumadin 5mg all days except 2.5mg on M or F Omeprazole 40mg daily KCl 20 meq daily Ferrous sulfate 325mg [**Hospital1 **] ALLERGIES: Niacin / aspirin / Codeine PHYSICAL EXAM: ON ADMISSION: VS: 97.9 138/79 56 20 96%RA Appearance: alert, NAD, obese Eyes: eomi, perrl, anicteric ENT: OP clear s lesions, mmd, no JVD, neck supple Cv: +s1, s2 mechanical aortic click, no peripheral edema, 2+ dp/pt bilaterally Pulm: clear bilaterally, diminished at bases Abd: soft, obese, midline scar, nt, nd, +bs Msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing Neuro: cn 2-12 grossly intact, no focal deficits Skin: no rashes Psych: appropriate, pleasant Heme: no cervical [**Doctor First Name **] FAMILY HISTORY: + CAD and DM, no hx of gi bleeds SOCIAL HISTORY: Lives with wife, [**Name (NI) 32774**] and grandson in [**Name (NI) 32775**], MA. Retired heavy lift mechanic. + tobacco, 1 ppd x 55 yrs. No etoh or illicits.

Blood in stool,Coronary atherosclerosis of autologous vein bypass graft,Chronic diastolic heart failure,Acute posthemorrhagic anemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Benign essential hypertension,Thrombocytopenia, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other specified cardiac dysrhythmias,Leukocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified,Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small),Knee joint replacement,Percutaneous transluminal coronary angioplasty status,Personal history of colonic polyps,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Subendocardial infarction, subsequent episode of care,Other and unspecified angina pectoris

Blood in stool,Crn ath atlg vn bps grft,Chr diastolic hrt fail,Ac posthemorrhag anemia,DMII neuro nt st uncntrl,Neuropathy in diabetes,Benign hypertension,Thrombocytopenia NOS,Dvrtclo colon w/o hmrhg,Cardiac dysrhythmias NEC,Leukocytopenia NOS,Chr airway obstruct NEC,Anxiety state NOS,Esophageal reflux,Hypothyroidism NOS,Heart valve replac NEC,Long-term use anticoagul,Acquire absnce intestine,Joint replaced knee,Status-post ptca,Prsnl hst colonic polyps,Adv eff sedat/hypnot NEC,Adv eff blood agent NEC,Adv eff salicylates,Subendo infarct, subseq,Angina pectoris NEC/NOS

Admission Date: [**2156-4-26**] Discharge Date: [**2156-5-1**] Date of Birth: [**2086-12-6**] Sex: M Service: MEDICINE Allergies: Niacin / aspirin / Codeine Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: GI Bleed Major Surgical or Invasive Procedure: enteroscopy [**2156-4-29**] and [**2156-4-30**] History of Present Illness: HMED ATTENDING ADMISSION NOTE . ADMIT DATE: [**2156-4-26**] ADMIT TIME: 2345 . PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) 1575**] [**Name Initial (NameIs) **]. Address: [**Doctor Last Name 32771**], [**Location (un) **],[**Numeric Identifier 17464**] Phone: [**Telephone/Fax (1) 8340**] Fax: [**Telephone/Fax (1) 8341**] . Cardiology: Dr. [**First Name4 (NamePattern1) 2855**] [**Last Name (NamePattern1) 32772**] Address: [**Location (un) **] [**Apartment Address(1) 32773**]. [**Location (un) 936**] Phone: [**Telephone/Fax (1) 14967**] . 69 yo M with CAD s/p CABG complicated be restenosis requiring multiple stents, mechanical aortic valve on coumadin, recurrent GI bleeding and IDDM who is transferred from [**Hospital3 **] for advanced endoscopy for management of active upper GI bleed. . Patient was admitted to [**Hospital6 33**] approximately one week ago with melena and hematocrit of 22, found to have a NSTEMI (medical management per cardiology, restarted on plavix - d/c'ed in [**2154**] given recurrent gi bleeds, 1 month after BMS placed). Upper endoscopy was unrevealing except for mild gastritis. Colonoscopy last done one year ago which was unremarkable except for benign polyps. Patient was transfused 4 units of pRBCs, hematorcrit increased to 27 and discharged three days ago. Of note, he required diuresis for decompensated CHF. Was seen in the ED on [**4-21**] for chest pain, no EKG changes, resolved with nitro, discharged home. . Patient was re-admitted to [**Hospital3 **] today ([**2156-4-26**]) with recurrent melena. Last night he had two black/tarry stools. He also endorsed some mild chest pain. His hematocrit on admission was 26.2. Patient transfused 1 unit of packed cells. He ruled out for ACS by three sets of negative cardiac enzymes and non-ischemic EKG. Patient underwent a CT angiogram which revealed 3 small bowel foci of hemorrhage likely in the proximal ileum. Given the location of the bleeding decision made by gastroenterologist to transfer to [**Hospital1 18**] for single balloon enteroscopy. Patient has been continued on plavix given his significant cardiac comorbidities. He has been bridged with a heparin gtt for a subtherapeutic INR of 1.9. . Of note, patient had recurrent GI bleeding at site of anastamosis from sigmoid colectomy in [**2154**], requiring multiple transfusions. Was on asa/plavix/coumadin with recent BMS placed in diagonal. ASA stopped and plavix discontinued 1 month after BMS placement given recurrent bleeding. He had no further bleeding issues until this past week. . Currently patient has no complaints. Denies any current chest pain, sob, lightheadedness or dizziness. No nausea, vomiting or abdominal pain. Reports one episode of black stool prior to transfer. . ROS as per HPI, 10 pt ROS otherwise negative. Past Medical History: -CAD s/p CABG 2v [**2135**], restenosis requiring multiple stents, [**2151**] DES for RCA stenosis, [**2152**] NSTEMI medically managed, [**2154**] BMS diagonal -St. [**Male First Name (un) 923**] aortic valve replacement [**2135**] -IDDM -COPD -Diverticulitis s/p sigmoid colectomy complicated by unstable angina, s/p cardiac cath and BMS to diagonal, then developed recurrent bleeding on asa/plavix/coumadin therefore plavix d/c'ed after 1 month -HTN -Hypothyroidism -CHF -Anxiety -S/p knee replacement [**2152**] complicated NSTEMI and CHF exacerbation -Hernia repair Social History: Lives with wife, [**Name (NI) 32774**] and grandson in [**Name (NI) 32775**], MA. Retired heavy lift mechanic. + tobacco, 1 ppd x 55 yrs. No etoh or illicits. Family History: + CAD and DM, no hx of gi bleeds Physical Exam: ON ADMISSION: VS: 97.9 138/79 56 20 96%RA Appearance: alert, NAD, obese Eyes: eomi, perrl, anicteric ENT: OP clear s lesions, mmd, no JVD, neck supple Cv: +s1, s2 mechanical aortic click, no peripheral edema, 2+ dp/pt bilaterally Pulm: clear bilaterally, diminished at bases Abd: soft, obese, midline scar, nt, nd, +bs Msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing Neuro: cn 2-12 grossly intact, no focal deficits Skin: no rashes Psych: appropriate, pleasant Heme: no cervical [**Doctor First Name **] Pertinent Results: [**Hospital6 33**] labs: . [**2156-4-26**] . 6.3> [**10-20**] <148 . 138 100 18 ------------< 161 3.2 28 1.0 . LFTs wnl . [**Hospital6 33**] Images: . [**2156-4-26**] CT angio a/p: three small foci of hemorrhage, located in proximal ileum with extravasation of intraluminal intravenous contrast may be due to angiodysplasia, no evidence for underlying mucosal masses; colonic diverticulosis without diverticulitis, mild splenomegaly . [**2156-5-1**]: WBC 3.1 HCT 24.6 PLT 95 [**2156-4-30**] HCT 25.7 PLT 105 [**2156-4-28**] 05:05AM BLOOD WBC-3.6* RBC-3.02* Hgb-10.1* Hct-29.2* MCV-97 MCH-33.6* MCHC-34.7 RDW-17.8* Plt Ct-129* [**2156-4-27**] 09:04PM BLOOD Hct-29.9* [**2156-4-27**] 03:16PM BLOOD Hct-30.9* [**2156-4-27**] 09:00AM BLOOD Hct-28.5* [**2156-4-27**] 05:15AM BLOOD WBC-3.7* RBC-2.72* Hgb-9.5* Hct-26.8* MCV-99* MCH-34.8* MCHC-35.3* RDW-17.2* Plt Ct-134* [**2156-4-27**] 12:40AM BLOOD WBC-4.0# RBC-2.84*# Hgb-9.5*# Hct-27.7* MCV-98# MCH-33.4*# MCHC-34.3 RDW-17.1* Plt Ct-134* [**2156-4-27**] 12:40AM BLOOD Neuts-55 Bands-0 Lymphs-35 Monos-8 Eos-2 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2156-4-27**] 12:40AM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-2+ Macrocy-2+ Microcy-NORMAL Polychr-NORMAL Ovalocy-1+ Pencil-OCCASIONAL Ellipto-OCCASIONAL [**2156-5-1**]: INR 1.7 [**2156-4-28**] 06:40PM BLOOD PT-19.7* PTT-75.3* INR(PT)-1.9* [**2156-4-28**] 05:05AM BLOOD Plt Ct-129* [**2156-4-28**] 05:05AM BLOOD PT-19.2* PTT-109.9* INR(PT)-1.8* [**2156-4-28**] 02:48AM BLOOD PT-19.0* PTT-112.8* INR(PT)-1.8* [**2156-4-27**] 08:55PM BLOOD PT-18.9* PTT-56.0* INR(PT)-1.8* [**2156-4-27**] 01:00PM BLOOD PT-20.7* PTT-42.6* INR(PT)-2.0* [**2156-4-27**] 05:15AM BLOOD Plt Ct-134* [**2156-4-27**] 05:15AM BLOOD PT-22.3* PTT-150* INR(PT)-2.1* [**2156-4-27**] 12:40AM BLOOD Plt Smr-LOW Plt Ct-134* [**2156-4-27**] 12:40AM BLOOD PT-23.0* PTT-45.1* INR(PT)-2.2* RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2156-5-1**] 02:22 glu131* urea N9 cr0.9 na140 k3.5 cl108 hco3 24 AG12 [**2156-4-28**] 05:05AM BLOOD Glucose-85 UreaN-13 Creat-1.1 Na-141 K-3.9 Cl-105 HCO3-25 AnGap-15 [**2156-4-27**] 05:15AM BLOOD Glucose-95 UreaN-11 Creat-0.9 Na-142 K-3.4 Cl-104 HCO3-26 AnGap-15 [**2156-4-27**] 12:40AM BLOOD Glucose-80 UreaN-12 Creat-1.0 Na-143 K-3.7 Cl-105 HCO3-28 AnGap-14 [**2156-4-27**] 12:40AM BLOOD Lipase-29 [**2156-5-1**] ca8.0* mg2.4* phos1.8 [**2156-4-28**] 05:05AM BLOOD Calcium-8.4 Phos-3.2 Mg-2.3 [**2156-4-27**] 05:15AM BLOOD Calcium-8.4 Phos-3.0 Mg-2.4 [**2156-4-27**] 12:40AM BLOOD Calcium-8.5 Phos-3.1 Mg-1.0* . [**4-28**] ECHO: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. The ascending aorta is mildly dilated. The aortic arch is mildly dilated. A mechanical aortic valve prosthesis is present. The transaortic gradient is higher than expected for this type of prosthesis. Trace aortic regurgitation is seen. [Normal for this prosthesis.] The mitral valve leaflets are mildly thickened. A mitral valve annuloplasty ring is present. The gradient across the mitral valve is slightly increased (mean = 3-4 mmHg) resulting in trivial/minimal mitral stenosis. No mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Well seated mechanical aortic valve but with increased gradient. Well seated mitral annuloplasty ring with trivial mitral stenosis. Mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. Pulmonary artery hypertension. Dilated thoracic aorta. Compared with the report of the prior study (images unavailable for review) of [**2144-12-25**], the aortic valve gradient is increased and minimal mitral stenosis is now identified. If clinically indicated, a TEE may be better able to define the cause of the increased gradient across the aortic valve. . [**2156-4-30**] small bowel enteroscopy report: (from above) Healthy surgical anastomosis at left colon corresponding to the previous colectomy. Moderate to severe diverticulosis in the entire colon. The terminal ileum was entered and the scope was advanced to the proximal/mid ileum. A few tiny red spots were seen. But there was no active bleeding. No AVM or mass lesions were seen. Otherwise normal small bowel enteroscopy to third part of the duodenum. . [**2156-4-29**] small bowel enteroscopy report: (from below) The examined proximal ileum was normal. No active bleeding or AVM or mass was seen. Impression: Normal esophagus; A tiny nonbleeding erosion seen at the antrum; Mild and pathy erythema seen at duodenal bulb; Normal jejunum. No active bleeding or AVM or mass seen. Itattooed for marking; Normal proximal ileum. No active bleeding or AVM or mass seen. Otherwise normal small bowel enteroscopy to distal jejunum/proximal ileum. Brief Hospital Course: REASON FOR ICU ADMISSION: Pt is a 69 y.o male with h.o CAD s/p CABG complicated by restenosis requiring multiple stents and recent NSTEMI, mechanical aortic valve on coumadin, recurrent GI bleeds and IDDM who was transferred from OSH with melena and CTA showing active bleeding in proximal ileum. . #upper GI bleed/acute blood loss/anemia-CTA per OSH report showed active bleeding in the proximal ileum. Pt with recent EGD with non-bleeding gastritis. Last colonoscopy 1 yr ago with polyps. UGIB in the setting of restarting plavix 1 week ago for NSTEMI. PT also on couamdin for mechanical valve, and started on heparin ggt as coumadin was held in setting of procedure. Hct remained stable. Pt was placed on a protonix gtt. Plavix was continued up until transfer to [**Hospital1 18**], then restarted. Discussed anticoagulation with patient's cardiologist Dr. [**Last Name (STitle) 32772**] who felt as though pt should be on heparin gtt as long as deemed safe from GI procedure prospective. Would prefer to restart ASAP after any procedure. In addition, outpt cardiologist felt as though pt should be on plavix unless there is presence of hemodynamically significant GI bleeding. He agreed that pt does not tolerate dual anti-platelet therapy (per pt, ASA caused bleeding). Enteroscopy was performed at [**Hospital1 18**] [**2156-4-29**] which showed no evidence of bleeding via approach from above. Small bowel enteroscopy/colonoscopy was performed [**2156-4-30**] which was similarly unremarkable. Pt was restarted on warfarin and heparin gtt. Pt went home [**2156-5-1**] on lovenox as bridge, with INR checks planned for [**2156-5-3**] and [**2156-5-5**]. . #CORONARY ARTERY DISEASE: s/p CABG and PCI x2, severe CAD with chronic angina medically managed. Recent NSTEMI with decision to restart plavix after being held x2 years due to recurrent GI bleeds. At [**Hospital1 18**] plavix was held initially as GI team was uncomfortable doing procedure on plavix as interventions for bleeding (ex. clipping, cauterization could lead to more bleeding while on plavix). In addition, it was felt that at the time plavix effects would still be in his system as there was no complete washout period. As above, discussed case with pt's outpatient cardiologist who felt that pt would need to remain on plavix unless life hemodynamically significant GI bleeding. Pt was continued on imdur, statin, beta blocker held, see bradycardia below. He was ruled out for MI at OSH prior to transfer. He was monitored on tele. Without events. . # MECHANICAL AORTIC VALVE: placed at St. [**Male First Name (un) 1525**]. Patient's goal INR 3.5 for mechanical valve. Was switched to heparin which was stopped 6 hours prior to procedures. Given significant risk of thrombosis, heparin was restarted after procedures, despite patient's known GI bleed. HCT was monitored closely and remained stable. Heparin gtt was changed to lovenox on discharge, see above. . # Bradycardia: Patient noted to be bradycardic after procedure. Thought to be related to sedation for procedure. Improved as the patient woke up from sedation. Still, HR remained in the 50-60 range throughout hospitalization. Initially home beta blocker was held. Pt was monitored on telemetry without events. He was asymptomatic. Home atenolol restarted on discharge. . #DIABETES MELLITUS - type 2, with complications, peripheral neuropathy. Placed on conservative insulin regimen while NPO. Pt resumed meformin and glyburide upon discharge. Continued gabapentin for neuropathy. . #HYPERTENSION - benign; initially held beta blocker in setting of bradycardia. Continued imdur. Held lisinopril while NPO. On the morning of discharge his blood pressure was elevated in the 170s systolic. We then restarted his home medications (atenolol, lisinopril) which we had been holding and felt these would be adequate for blood pressure control. . #DIASTOLIC HEART FAILURE - chronic, but with recent acute exacerbation. Lasix was held while pt was NPO, and also was given with 1u pRBCs. . #hypothyroidism-continued synthroid . #HL-continued simvastatin . #GERD-on PPI ggt for c/f GI bleed as above, transitioned to PO PPI on discharge . #leukopenia/thrombocytopenia-unclear etiology. Could be due to acute process. Thrombocytopenia could be consumptive. PLT count was monitored closely and remained stable. . Pt was maintained as FULL CODE throughout the course of this hospitalization. . TRANSITIONAL ISSUES: anticoagulation: pt sent home on warfarin (subtherapeutic after holding for procedures) and lovenox. He will need INR checked Monday [**2156-5-3**] and Wednesday [**2156-5-5**] likely to DC lovenox [**2156-5-5**] as ideally he would have a 48 hour therapeutic overlap. Pt was instructed to follow up with PCP regarding this issue. Medications on Admission: Medications on Transfer: Vicodin 5/500 q6h prn Ativan 2mg po TID prn Morphine 2mg iv prn NTG 0.4 q5 mins prn Protonix gtt Atenolol 25mg po bid Plavix 75mg daily Ferrous sulfate 325mg [**Hospital1 **] Gabapentin 600mg QID Humalog sliding scale Synthroid 50mcg daily Kdur ? dose daily Simvastatin 20mg daily Heparin gtt Imdur ER 60mg [**Hospital1 **] Lasix 40mg daily Lantus 10 units qam Lisinopril 20mg daily . Outpatient Medications Lantus 20 units qam Metformin 850mg [**Hospital1 **] Glyburide 10mg [**Hospital1 **] Atenolol 25mg [**Hospital1 **] Plavix 75mg daily Tylenol prn vicodin 1 tablet q6h prn Ativan 2mg tid prn NTG prn Lasix 40mg daily Gabapentin 600mg qid Isosorbide mononitrate 60mg daily Levoxyl 50mcg daily Lisinopril 20mg daily Simvastatin 20mg daily Coumadin 5mg all days except 2.5mg on M or F Omeprazole 40mg daily KCl 20 meq daily Ferrous sulfate 325mg [**Hospital1 **] Discharge Medications: 1. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous once a day for 5 days: Continue until INR is therepeutic. . Disp:*5 syringes* Refills:*2* 2. lorazepam 1 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for anxiety. 3. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4 times a day). 4. insulin glargine 100 unit/mL Solution Sig: Twenty (20) Units Subcutaneous once a day. 5. metformin 850 mg Tablet Sig: One (1) Tablet PO twice a day. 6. atenolol 25 mg Tablet Sig: One (1) Tablet PO twice a day. 7. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day. 8. glyburide 5 mg Tablet Sig: Two (2) Tablet PO twice a day. 9. Vicodin 5-500 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain. 10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 11. isosorbide mononitrate 60 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 12. Levoxyl 50 mcg Tablet Sig: One (1) Tablet PO once a day. 13. lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. 14. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 15. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 16. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO once a day. 17. ferrous sulfate 325 mg (65 mg iron) Capsule, Extended Release Sig: One (1) Capsule, Extended Release PO twice a day. Capsule, Extended Release(s) 18. Outpatient Lab Work please have INR drawn [**2156-5-3**] and [**2156-5-5**] Discharge Disposition: Home Discharge Diagnosis: Acute blood loss anemia from gastrointestinal bleeding CAD s/p stenting and mechanical aortic valve Recent NSTEMI HTN Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 32776**], You were admitted for further evaluation of gastrointestinal bleeding. For this, you had endoscopic procedures both from above and below the level of the stomach, both which were unrevealing for a source of bleeding. This likely occurred in the presence of multiple blood thinners, causing leaking of a vessel which stopped once we held your blood thinners. We discussed the risks and benefits of being on blood thinners. Given your cardiac history, including stents and mechanical heart valves, it is necessary that your remain on warfarin and an antiplatelet [**Doctor Last Name 360**] (such as aspirin or clopidogrel AKA Plavix), to prevent a stroke and a heart attack respectively. You will be discharged on warfarin at your usual home dose as well as clopidogrel (Plavix). Please note to follow up with your cardiologest within the week to assure you are on the most appropriate therapy for your cardiac health. As you know, your INR was below goal prior to discharge (goal 2.5-3.5), since we held your warfarin in the hospital so you could have procedures. You will be going home on enoxaparin (AKA Lovenox)injections to keep your blood thin while your INR becomes therepeutic. Medication changes: Please START taking Clopidogrel (AKA Plavix) 75mg po qday Please START taking Enoxaparin subcutaneous injections until your INR is therepeutic Please continue taking the rest of your medications as prescribed. . It has been a pleasure taking care of you Mr. [**Known lastname 32776**]! Followup Instructions: Please arrange follow up with your primary care doctor and your cardiologist within 1 week of discharge. You will need to have your INR on Monday [**2156-5-3**] and Wednesday [**2156-5-5**]. Speak to your primary care physician but you should stop lovenox on Wednesday [**2156-5-5**] if Dr. [**Last Name (STitle) 26652**] approves. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

578,414,428,285,250,357,401,287,562,427,288,496,300,530,244,V433,V586,V457,V436,V458,V127,E937,E934,E935,410,413

{'Blood in stool,Coronary atherosclerosis of autologous vein bypass graft,Chronic diastolic heart failure,Acute posthemorrhagic anemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Benign essential hypertension,Thrombocytopenia, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other specified cardiac dysrhythmias,Leukocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified,Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small),Knee joint replacement,Percutaneous transluminal coronary angioplasty status,Personal history of colonic polyps,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Subendocardial infarction, subsequent episode of care,Other and unspecified angina pectoris'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: GI Bleed PRESENT ILLNESS: HMED ATTENDING ADMISSION NOTE . ADMIT DATE: [**2156-4-26**] ADMIT TIME: 2345 . PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) 1575**] [**Name Initial (NameIs) **]. Address: [**Doctor Last Name 32771**], [**Location (un) **],[**Numeric Identifier 17464**] Phone: [**Telephone/Fax (1) 8340**] Fax: [**Telephone/Fax (1) 8341**] . Cardiology: Dr. [**First Name4 (NamePattern1) 2855**] [**Last Name (NamePattern1) 32772**] Address: [**Location (un) **] [**Apartment Address(1) 32773**]. [**Location (un) 936**] Phone: [**Telephone/Fax (1) 14967**] . 69 yo M with CAD s/p CABG complicated be restenosis requiring multiple stents, mechanical aortic valve on coumadin, recurrent GI bleeding and IDDM who is transferred from [**Hospital3 **] for advanced endoscopy for management of active upper GI bleed. . Patient was admitted to [**Hospital6 33**] approximately one week ago with melena and hematocrit of 22, found to have a NSTEMI (medical management per cardiology, restarted on plavix - d/c'ed in [**2154**] given recurrent gi bleeds, 1 month after BMS placed). Upper endoscopy was unrevealing except for mild gastritis. Colonoscopy last done one year ago which was unremarkable except for benign polyps. Patient was transfused 4 units of pRBCs, hematorcrit increased to 27 and discharged three days ago. Of note, he required diuresis for decompensated CHF. Was seen in the ED on [**4-21**] for chest pain, no EKG changes, resolved with nitro, discharged home. . Patient was re-admitted to [**Hospital3 **] today ([**2156-4-26**]) with recurrent melena. Last night he had two black/tarry stools. He also endorsed some mild chest pain. His hematocrit on admission was 26.2. Patient transfused 1 unit of packed cells. He ruled out for ACS by three sets of negative cardiac enzymes and non-ischemic EKG. Patient underwent a CT angiogram which revealed 3 small bowel foci of hemorrhage likely in the proximal ileum. Given the location of the bleeding decision made by gastroenterologist to transfer to [**Hospital1 18**] for single balloon enteroscopy. Patient has been continued on plavix given his significant cardiac comorbidities. He has been bridged with a heparin gtt for a subtherapeutic INR of 1.9. . Of note, patient had recurrent GI bleeding at site of anastamosis from sigmoid colectomy in [**2154**], requiring multiple transfusions. Was on asa/plavix/coumadin with recent BMS placed in diagonal. ASA stopped and plavix discontinued 1 month after BMS placement given recurrent bleeding. He had no further bleeding issues until this past week. . Currently patient has no complaints. Denies any current chest pain, sob, lightheadedness or dizziness. No nausea, vomiting or abdominal pain. Reports one episode of black stool prior to transfer. . ROS as per HPI, 10 pt ROS otherwise negative. MEDICAL HISTORY: -CAD s/p CABG 2v [**2135**], restenosis requiring multiple stents, [**2151**] DES for RCA stenosis, [**2152**] NSTEMI medically managed, [**2154**] BMS diagonal -St. [**Male First Name (un) 923**] aortic valve replacement [**2135**] -IDDM -COPD -Diverticulitis s/p sigmoid colectomy complicated by unstable angina, s/p cardiac cath and BMS to diagonal, then developed recurrent bleeding on asa/plavix/coumadin therefore plavix d/c'ed after 1 month -HTN -Hypothyroidism -CHF -Anxiety -S/p knee replacement [**2152**] complicated NSTEMI and CHF exacerbation -Hernia repair MEDICATION ON ADMISSION: Medications on Transfer: Vicodin 5/500 q6h prn Ativan 2mg po TID prn Morphine 2mg iv prn NTG 0.4 q5 mins prn Protonix gtt Atenolol 25mg po bid Plavix 75mg daily Ferrous sulfate 325mg [**Hospital1 **] Gabapentin 600mg QID Humalog sliding scale Synthroid 50mcg daily Kdur ? dose daily Simvastatin 20mg daily Heparin gtt Imdur ER 60mg [**Hospital1 **] Lasix 40mg daily Lantus 10 units qam Lisinopril 20mg daily . Outpatient Medications Lantus 20 units qam Metformin 850mg [**Hospital1 **] Glyburide 10mg [**Hospital1 **] Atenolol 25mg [**Hospital1 **] Plavix 75mg daily Tylenol prn vicodin 1 tablet q6h prn Ativan 2mg tid prn NTG prn Lasix 40mg daily Gabapentin 600mg qid Isosorbide mononitrate 60mg daily Levoxyl 50mcg daily Lisinopril 20mg daily Simvastatin 20mg daily Coumadin 5mg all days except 2.5mg on M or F Omeprazole 40mg daily KCl 20 meq daily Ferrous sulfate 325mg [**Hospital1 **] ALLERGIES: Niacin / aspirin / Codeine PHYSICAL EXAM: ON ADMISSION: VS: 97.9 138/79 56 20 96%RA Appearance: alert, NAD, obese Eyes: eomi, perrl, anicteric ENT: OP clear s lesions, mmd, no JVD, neck supple Cv: +s1, s2 mechanical aortic click, no peripheral edema, 2+ dp/pt bilaterally Pulm: clear bilaterally, diminished at bases Abd: soft, obese, midline scar, nt, nd, +bs Msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing Neuro: cn 2-12 grossly intact, no focal deficits Skin: no rashes Psych: appropriate, pleasant Heme: no cervical [**Doctor First Name **] FAMILY HISTORY: + CAD and DM, no hx of gi bleeds SOCIAL HISTORY: Lives with wife, [**Name (NI) 32774**] and grandson in [**Name (NI) 32775**], MA. Retired heavy lift mechanic. + tobacco, 1 ppd x 55 yrs. No etoh or illicits. ### Response: {'Blood in stool,Coronary atherosclerosis of autologous vein bypass graft,Chronic diastolic heart failure,Acute posthemorrhagic anemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Benign essential hypertension,Thrombocytopenia, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other specified cardiac dysrhythmias,Leukocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified,Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small),Knee joint replacement,Percutaneous transluminal coronary angioplasty status,Personal history of colonic polyps,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Subendocardial infarction, subsequent episode of care,Other and unspecified angina pectoris'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 42 yr old male with history of Factor XII defiency, total occlusion RPL with DES in [**2191**] who presented to OSH with chest pain, found to have NSTEMI, tranferred to [**Hospital1 18**] for intervention. . Patient reports that he has been experiencing chest pain for the past 2 months, but despite repeated attempts to seek medical care, was never diagnosed. Starting 2 days prior to admission, pain became more severe, [**10-20**], located substernally, radiating to the left should and jaw, associated with nausea, and diaphoresis. Patient took tylenol with no improvement. . He presented to [**Hospital1 1474**] earlier today with NQWMI earlier today with troponin of 14. EKG showed TWI and Q waves in III and aVF without ST changes. CK-MB 76 and trop 13.65. He received Aspirin 325mg po, SLNG 0.4mg X3, and Zofran 4mg IV X3. He was given 600mg Plavix and ASA 325mg in the cath lab. Nitrolgycerin was started at 20mcg IV/minute. He received 2500 units IV heparin periprocedurally. PTT was >130 prior to receiving heparin. Cardiac catheterization via right radial artery showed late in stent thrombosis but no other acute disease. He requested transfer to [**Hospital1 18**] for further intervention. . On arrival at the [**Hospital1 18**], his vital signs were 72 127/68 15 99%RA. Catheterization performed radially showed PLV state stent thrombosis. Pt underwent unsuccessful aspiration thrombectomy and angiojet without PTCA. He was continued on integrellin but IV heparin was discontinued given abnormally elevated PTT. He was given 40mg of protamine for reversal and sent to the CCU. Hematology was consulted for assitance for monitoring anticoagulation. Prior to transfer to the CCU he developed chest pain and nitro gtt was reinitiated at 3mcg/minute. . On the floor he continued to complain of chest pain, left shoulder and jaw pain, and back pain. . On review of systems, he denies a history of difficulty with epistaxis, gingival bleeding, bruising. He has had wisdom teeth pulled over the past 2 weeks without evidence of excessive bleeding or transfusion requirement. He denies BRBPR. Denied any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. No fevers or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension . [**Male First Name (un) **] disease, factor XII deficiency, head injury in past, hypertension 2. CARDIAC HISTORY: CAD s/P MI [**2191**] - PERCUTANEOUS CORONARY INTERVENTIONS: Taxus (DES) x 2 to PLV 3. OTHER PAST MEDICAL HISTORY: Abd infection treated with antibiotics Obesity Pancreatitis (attributed to triglyceridemia) Traumatic Brain Injury as a child Prolonged PTT, with normal PT and TT. Evaluated by Heme-Onc in [**2191**], thought to be consistent with factor XII deficiency with no clinical sequelae. MEDICATION ON ADMISSION: - Aspirin 325 mg daily - Simvastatin 80 mg qd - Metoprolol 25 mg [**Hospital1 **] - tylenol prn for chest pain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: Obese gentleman, oriented x3 HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink NECK: Supple with JVP of 6 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: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NT/ND. obese.. EXTREMITIES: No c/c/e. No femoral bruits. Right TR band site without hematoma. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: There is a family history of premature coronary artery disease or sudden death (brother had an MI at age 39 and had stent placed.) SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. Patient is currently unemployed but works as an Internet writer. He lives with his parents in [**Last Name (un) 33487**].

Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congenital deficiency of other clotting factors,Chronic pancreatitis,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Personal history of traumatic brain injury

Subendo infarct, initial,Comp-oth cardiac device,Cong def clot factor NEC,Chronic pancreatitis,Status-post ptca,Abn react-cardiac cath,Accident in place NEC,Fever NOS,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hx traumatc brain injury

Admission Date: [**2194-1-13**] Discharge Date: [**2194-1-16**] Date of Birth: [**2151-11-17**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 425**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: Cardiac catheterization with anjiojet to PL branch of the right coronary artery History of Present Illness: 42 yr old male with history of Factor XII defiency, total occlusion RPL with DES in [**2191**] who presented to OSH with chest pain, found to have NSTEMI, tranferred to [**Hospital1 18**] for intervention. . Patient reports that he has been experiencing chest pain for the past 2 months, but despite repeated attempts to seek medical care, was never diagnosed. Starting 2 days prior to admission, pain became more severe, [**10-20**], located substernally, radiating to the left should and jaw, associated with nausea, and diaphoresis. Patient took tylenol with no improvement. . He presented to [**Hospital1 1474**] earlier today with NQWMI earlier today with troponin of 14. EKG showed TWI and Q waves in III and aVF without ST changes. CK-MB 76 and trop 13.65. He received Aspirin 325mg po, SLNG 0.4mg X3, and Zofran 4mg IV X3. He was given 600mg Plavix and ASA 325mg in the cath lab. Nitrolgycerin was started at 20mcg IV/minute. He received 2500 units IV heparin periprocedurally. PTT was >130 prior to receiving heparin. Cardiac catheterization via right radial artery showed late in stent thrombosis but no other acute disease. He requested transfer to [**Hospital1 18**] for further intervention. . On arrival at the [**Hospital1 18**], his vital signs were 72 127/68 15 99%RA. Catheterization performed radially showed PLV state stent thrombosis. Pt underwent unsuccessful aspiration thrombectomy and angiojet without PTCA. He was continued on integrellin but IV heparin was discontinued given abnormally elevated PTT. He was given 40mg of protamine for reversal and sent to the CCU. Hematology was consulted for assitance for monitoring anticoagulation. Prior to transfer to the CCU he developed chest pain and nitro gtt was reinitiated at 3mcg/minute. . On the floor he continued to complain of chest pain, left shoulder and jaw pain, and back pain. . On review of systems, he denies a history of difficulty with epistaxis, gingival bleeding, bruising. He has had wisdom teeth pulled over the past 2 weeks without evidence of excessive bleeding or transfusion requirement. He denies BRBPR. Denied any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. No fevers or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. Past Medical History: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension . [**Male First Name (un) **] disease, factor XII deficiency, head injury in past, hypertension 2. CARDIAC HISTORY: CAD s/P MI [**2191**] - PERCUTANEOUS CORONARY INTERVENTIONS: Taxus (DES) x 2 to PLV 3. OTHER PAST MEDICAL HISTORY: Abd infection treated with antibiotics Obesity Pancreatitis (attributed to triglyceridemia) Traumatic Brain Injury as a child Prolonged PTT, with normal PT and TT. Evaluated by Heme-Onc in [**2191**], thought to be consistent with factor XII deficiency with no clinical sequelae. Social History: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. Patient is currently unemployed but works as an Internet writer. He lives with his parents in [**Last Name (un) 33487**]. Family History: There is a family history of premature coronary artery disease or sudden death (brother had an MI at age 39 and had stent placed.) Physical Exam: GENERAL: Obese gentleman, oriented x3 HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink NECK: Supple with JVP of 6 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: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NT/ND. obese.. EXTREMITIES: No c/c/e. No femoral bruits. Right TR band site without hematoma. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Pertinent Results: [**2194-1-16**] 02:50AM BLOOD WBC-6.3 RBC-4.35* Hgb-13.6* Hct-38.1* MCV-88 MCH-31.3 MCHC-35.7* RDW-14.3 Plt Ct-162 [**2194-1-13**] 08:03PM BLOOD Neuts-82.9* Lymphs-12.8* Monos-4.0 Eos-0.3 Baso-0 [**2194-1-16**] 02:50AM BLOOD Plt Ct-162 [**2194-1-15**] 05:45PM BLOOD LMWH-0.53 [**2194-1-14**] 08:04AM BLOOD Heparin-0.20* [**2194-1-16**] 02:50AM BLOOD Glucose-108* UreaN-6 Creat-0.7 Na-143 K-3.7 Cl-110* HCO3-21* AnGap-16 [**2194-1-15**] 03:29AM BLOOD CK(CPK)-150 [**2194-1-14**] 03:43AM BLOOD CK(CPK)-280 [**2194-1-15**] 03:29AM BLOOD CK-MB-10 MB Indx-6.7* cTropnT-1.26* [**2194-1-14**] 08:04AM BLOOD CK-MB-19* [**2194-1-14**] 03:43AM BLOOD CK-MB-20* MB Indx-7.1* cTropnT-1.20* [**2194-1-16**] 02:50AM BLOOD Calcium-8.9 Phos-2.7 Mg-2.2 [**2194-1-14**] 08:04AM BLOOD Triglyc-379* HDL-38 CHOL/HD-5.3 LDLcalc-89 LDLmeas-124 [**2194-1-15**] 11:19AM BLOOD APOLIPOPROTEIN A (LITTLE A)-PND . Cardiac Catheterization [**2194-1-13**]: FINAL DIAGNOSIS: 1. Severe coronary artery disease: see above comments section 2. ASA 325 mg daily indefinitely 3. Continue to hold clopidogrel therapy 4. Integrilin (eptifibatide) for 18 hours 5. Heparin for a goal PTT 50-80 for 48 HRS and then potential relook angiography if persistent symptoms 6. R 6Fr radial artery sheath removed and TR band applied without complications . ECHO [**2194-1-14**]: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with inferior/inferolateral hypokinesis. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The left ventricular inflow pattern suggests impaired relaxation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. Compared with the report of the prior study (images unavailable for review) of [**2191-11-21**], left ventricular systolic function is probably similar or slightly more impaired (inferolateral hypokinesis noted in the current study). . ECG [**2194-1-14**]: Sinus rhythm. Inferior wall myocardial infarction. Early R wave progression. Consider posterior involvement. Minor ST-T wave abnormalities. Compared to the previous tracing there is less artifact. . CXR [**2194-1-14**]: IMPRESSION: AP chest compared to [**2191-11-20**]: Lungs are fully expanded and clear. There is no pleural abnormality. Heart size is normal. Mediastinal widening to the left of midline extending from the aortic knob which is partially obscured to the thoracic inlet is unchanged since [**2191-11-12**], therefore unlikely due to malignancy or other active process. It could be a large fat collection or vascular anomaly, particularly left-sided SVC. I do not think this warrants additional imaging investigation. Brief Hospital Course: 42 yr old male with history of Factor XII deficiency, total occlusion RCA PL with DES in [**2191**], presents with chest pain, found to have NSTEMI with thrombosis in the RCA PL. . # CAD: NSTEMI on admission with elevated cardiac enzymes. Catheterization showed large thrmobus burden inthe distal RCA at the distal bifurcation into the PDA/PL origin. Patient kept on nitroglycerin gtt and IV morphine. Thrombectomy was attempted by aspiration and angiojet, but the PL brance remained totally occluded. Decision was made to medically manage. Patient kept on aspirin, started plavix 75 mg qd, coumadin 5 mg qd which was bridged with lovenox. Metoprolol dose was increased to 25 mg [**Hospital1 **] to decrease cardiac work. Daily EKG showed no progression of NSTEMI. Cardiac enzymes peaked and then trended down. . # Fever: One episode of fever during the hospitalization. Workup included UA and CXR which were both negative. No diarrhea to suggest C. diff. Urine culture negative. Blood culture no growth to date on discharge and should be followed. . # Factor XII deficiency: Patient is known to have this rare disorder which was diagnosed by hematology/oncology in [**2191**] when DES was placed. This condition is clinically not associated with increased rate of bleeding despite the elevated PRR (>150 for patient at baseline) but is associated with arterial and venous thrombosis per literature. Hematologist/oncology service was consulted and decision was made to start patient on lovenox rather than On Lovenox rather than heparin gtt for CAD, due to the difficulty for titration of heparin gtt given elevated PTT. Patient was started on coumadin for anticoagulation prior to discharge. . # Drop in hematocrit: Hematocrit dropped from 38 -> 33.5 after hospital day 1. No active signs of bleeding, and recovered spontaneous to 38 prior to discharge. . # HLD: Elevated triglycerides and cholesterol despite being on statin at home. Fenofibrate was started and should be continued after discharge. . To be followed by primary care doctor: - Blood cultures Medications on Admission: - Aspirin 325 mg daily - Simvastatin 80 mg qd - Metoprolol 25 mg [**Hospital1 **] - tylenol prn for chest pain Discharge Medications: 1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for CAD: s/p PLV late stent thrombosis. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 4. fenofibrate micronized 48 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*2* 7. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. Disp:*30 Tablet(s)* Refills:*2* 8. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for chest pain. Disp:*20 Tablet(s)* Refills:*0* 9. enoxaparin 150 mg/mL Syringe Sig: One (1) syringe Subcutaneous Q12H (every 12 hours). Disp:*8 syringe* Refills:*2* 10. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Non ST Elevation Myocardial Infarction Factor 7 Deficiency Hypertension Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You had a heart attack that was caused by a blockage in your stent in your right coronary artery branch. We were unable to remove the clot or drill through it. But we gave you on medicines to prevent the stent from more clotting. It is extremely important that you continue to take these medicines every day unless Dr. [**Last Name (STitle) **] tells you to stop them. You continued to have chest pain after the procedure that we do not think is because of your heart. We want you to take Prilosec every day to see if this helps the chest pain and you can take Tramadol, a pain medicine, at home for the chest pain as well if it helps. Please follow up with the providers listed below. . We made the following changes to your medicines: 1. Start taking Prilosec twice daily 2. Continue to take aspirin daily to prevent blood clots and another heart attack. You need to take an aspirin every day for the rest of your life. 3. Start taking Plavix (clopidogrel) every day to prevent the stent from developing a clot again. Do not stop taking Plavix or miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] unless Dr. [**Last Name (STitle) **] tells you it is OK. 4. Start taking coumadin to prevent further blood clots. You need to take this medicine every day in the evening at the dose that your nurse practitioner tells you to. The dose may be different according to your blood levels. You will need to have your coumadin level (INR) checked on Monday [**1-20**] at your NP [**Doctor First Name 80131**] office. 5. Lovenox is a short acting blood thinner that you inject twice daily. You will need to take this injection until the coumadin level is therapeutic. [**First Name8 (NamePattern2) 72619**] [**Last Name (NamePattern1) **], NP, will tell you when you can stop taking this medicine. 6. Start Fenofibrate to lower your triglycerides, a type of fat in your blood 7. Start Lisinopril to lower your blood pressure and help your heart work better. 8. Start Tramadol to use if you have chest pain. Please only take every 6 hours. 9. Continue to take the Simvastatin and metoprolol as before. Followup Instructions: Primary Care: [**First Name8 (NamePattern2) 72619**] [**Last Name (NamePattern1) **], NP Signature Heathcare Phone: ([**Hospital1 80132**], [**Hospital1 1474**] Monday [**2194-1-20**] at 10 am Please confirm this appt on Friday. . Cardiology: [**Name6 (MD) **] [**Name8 (MD) **], MD Phone: ([**Telephone/Fax (1) 80133**] [**2-6**] at 10:15am Completed by:[**2194-1-16**]

410,996,286,577,V458,E879,E849,780,414,272,V155

{'Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congenital deficiency of other clotting factors,Chronic pancreatitis,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Personal history of traumatic brain injury'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 42 yr old male with history of Factor XII defiency, total occlusion RPL with DES in [**2191**] who presented to OSH with chest pain, found to have NSTEMI, tranferred to [**Hospital1 18**] for intervention. . Patient reports that he has been experiencing chest pain for the past 2 months, but despite repeated attempts to seek medical care, was never diagnosed. Starting 2 days prior to admission, pain became more severe, [**10-20**], located substernally, radiating to the left should and jaw, associated with nausea, and diaphoresis. Patient took tylenol with no improvement. . He presented to [**Hospital1 1474**] earlier today with NQWMI earlier today with troponin of 14. EKG showed TWI and Q waves in III and aVF without ST changes. CK-MB 76 and trop 13.65. He received Aspirin 325mg po, SLNG 0.4mg X3, and Zofran 4mg IV X3. He was given 600mg Plavix and ASA 325mg in the cath lab. Nitrolgycerin was started at 20mcg IV/minute. He received 2500 units IV heparin periprocedurally. PTT was >130 prior to receiving heparin. Cardiac catheterization via right radial artery showed late in stent thrombosis but no other acute disease. He requested transfer to [**Hospital1 18**] for further intervention. . On arrival at the [**Hospital1 18**], his vital signs were 72 127/68 15 99%RA. Catheterization performed radially showed PLV state stent thrombosis. Pt underwent unsuccessful aspiration thrombectomy and angiojet without PTCA. He was continued on integrellin but IV heparin was discontinued given abnormally elevated PTT. He was given 40mg of protamine for reversal and sent to the CCU. Hematology was consulted for assitance for monitoring anticoagulation. Prior to transfer to the CCU he developed chest pain and nitro gtt was reinitiated at 3mcg/minute. . On the floor he continued to complain of chest pain, left shoulder and jaw pain, and back pain. . On review of systems, he denies a history of difficulty with epistaxis, gingival bleeding, bruising. He has had wisdom teeth pulled over the past 2 weeks without evidence of excessive bleeding or transfusion requirement. He denies BRBPR. Denied any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. No fevers or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension . [**Male First Name (un) **] disease, factor XII deficiency, head injury in past, hypertension 2. CARDIAC HISTORY: CAD s/P MI [**2191**] - PERCUTANEOUS CORONARY INTERVENTIONS: Taxus (DES) x 2 to PLV 3. OTHER PAST MEDICAL HISTORY: Abd infection treated with antibiotics Obesity Pancreatitis (attributed to triglyceridemia) Traumatic Brain Injury as a child Prolonged PTT, with normal PT and TT. Evaluated by Heme-Onc in [**2191**], thought to be consistent with factor XII deficiency with no clinical sequelae. MEDICATION ON ADMISSION: - Aspirin 325 mg daily - Simvastatin 80 mg qd - Metoprolol 25 mg [**Hospital1 **] - tylenol prn for chest pain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: Obese gentleman, oriented x3 HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink NECK: Supple with JVP of 6 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: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NT/ND. obese.. EXTREMITIES: No c/c/e. No femoral bruits. Right TR band site without hematoma. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: There is a family history of premature coronary artery disease or sudden death (brother had an MI at age 39 and had stent placed.) SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. Patient is currently unemployed but works as an Internet writer. He lives with his parents in [**Last Name (un) 33487**]. ### Response: {'Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congenital deficiency of other clotting factors,Chronic pancreatitis,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Personal history of traumatic brain injury'}

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: HPI: Pt is a [**Age over 90 **]yoW with pmh sig for CVA, seizures, recent UTI who was found to have slurred speech and later on to be non responsive at rehab. Pt was seen by her son-in law at rehab at 9am and he noted that she seemed confused. Shortly thereafter, according to RN at rehab, she was found asleep in bed only awakening briefly to sternal rub. No seizure activity was noted. Of note, she was hospitalized one week prior with seizures in the setting of a UTI and her seizures in teh past manefest as staring followed by [**Doctor Last Name 555**] paralysis. No fever or chills had been noted at rehab, no cough or diarrhea. Per daughter, pt was "almost back to baseline" and walked 50 yards in her walker the night before. . At the [**Hospital1 **] [**Name (NI) 620**] [**Name (NI) **] pt intubated for airway protection, CT head without bleed or other acute findings, cxr with possible pneumonia, given Vancomycin, Levofloxacin, and Flagyl. Hypotensive briefly in the setting of starting Versed, responding to fluid bolus, femoral line placed under sterile conditions. MEDICAL HISTORY: AF - not on anticoagulation, recently d/c'd digoxin in setting of SSS SSS CVA Seizures with [**Doctor Last Name 555**] Paralysis - documented by EEG MEDICATION ON ADMISSION: Keppra 500 [**Hospital1 **] Dilantin 200 qam, 100 qpm Namenda Fiber ASA 81 qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen- elderly female in no acute distress, sitting in bed Vitals- 99.8, 118/80, 88, 22, 97% 3L HEENT- MMM, JVP ~10 cm CV- irregulary irregular, no murmurs noted Pulm-inspiratory wheeze right middle to low lung fields, sparse crackles. Abdom-soft, non tender, non distended. + BS Extr-1+ edema Neuro- Alert, not oriented, unable to perform neuro exam. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with daughter, no smoking/alcohol/tobacco. As per daughter, was able to perform all [**Name (NI) 5669**], knitting and dressing herseld daily, with some bouts of confusion throughout the day.

Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Other convulsions,Atrial fibrillation,Anemia, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Other specified paralytic syndrome

Acute respiratry failure,Food/vomit pneumonitis,CHF NOS,Convulsions NEC,Atrial fibrillation,Anemia NOS,Mental disor NEC oth dis,Oth spcf paralytic synd

Admission Date: [**2140-3-1**] Discharge Date: [**2140-3-10**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 783**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: none History of Present Illness: HPI: Pt is a [**Age over 90 **]yoW with pmh sig for CVA, seizures, recent UTI who was found to have slurred speech and later on to be non responsive at rehab. Pt was seen by her son-in law at rehab at 9am and he noted that she seemed confused. Shortly thereafter, according to RN at rehab, she was found asleep in bed only awakening briefly to sternal rub. No seizure activity was noted. Of note, she was hospitalized one week prior with seizures in the setting of a UTI and her seizures in teh past manefest as staring followed by [**Doctor Last Name 555**] paralysis. No fever or chills had been noted at rehab, no cough or diarrhea. Per daughter, pt was "almost back to baseline" and walked 50 yards in her walker the night before. . At the [**Hospital1 **] [**Name (NI) 620**] [**Name (NI) **] pt intubated for airway protection, CT head without bleed or other acute findings, cxr with possible pneumonia, given Vancomycin, Levofloxacin, and Flagyl. Hypotensive briefly in the setting of starting Versed, responding to fluid bolus, femoral line placed under sterile conditions. Past Medical History: AF - not on anticoagulation, recently d/c'd digoxin in setting of SSS SSS CVA Seizures with [**Doctor Last Name 555**] Paralysis - documented by EEG Social History: Lives with daughter, no smoking/alcohol/tobacco. As per daughter, was able to perform all [**Name (NI) 5669**], knitting and dressing herseld daily, with some bouts of confusion throughout the day. Family History: Non-contributory Physical Exam: Gen- elderly female in no acute distress, sitting in bed Vitals- 99.8, 118/80, 88, 22, 97% 3L HEENT- MMM, JVP ~10 cm CV- irregulary irregular, no murmurs noted Pulm-inspiratory wheeze right middle to low lung fields, sparse crackles. Abdom-soft, non tender, non distended. + BS Extr-1+ edema Neuro- Alert, not oriented, unable to perform neuro exam. Pertinent Results: [**2140-3-1**] 08:54PM PLT COUNT-236 [**2140-3-1**] 08:54PM WBC-12.2* RBC-3.62* HGB-11.4* HCT-35.0* MCV-97 MCH-31.5 MCHC-32.7 RDW-14.1 [**2140-3-1**] 08:54PM DIGOXIN-<0.2* [**2140-3-1**] 08:54PM CALCIUM-7.5* PHOSPHATE-3.2 MAGNESIUM-2.1 [**2140-3-1**] 08:54PM LD(LDH)-216 CK(CPK)-42 [**2140-3-1**] 08:54PM estGFR-Using this [**2140-3-1**] 08:54PM GLUCOSE-107* UREA N-18 CREAT-0.8 SODIUM-136 POTASSIUM-5.0 CHLORIDE-107 TOTAL CO2-21* ANION GAP-13 [**2140-3-1**] 09:25PM LACTATE-2.2* [**2140-3-1**] 09:57PM LACTATE-2.2* [**2140-3-1**] 09:57PM LACTATE-2.2* . CHEST (PORTABLE AP) [**2140-3-1**] 10:25 PM Pneumonic infiltrate in left mid lung zone, suspicion for pleural effusion on the left side. ETT too close to carina and withdrawal by a few centimeters is recommended. This film is first seen and interpreted at 1:15 p.m. on [**3-3**]. Thus no telephone message was sent to recommend adjustment of ETT position. . [**2140-3-2**] EEG This is an abnormal EEG due to the left temporal sharp waves and theta slowing, as well as the slow background rhythm. The first abnormality indicates left temporal cortical hypersynchrony (possibly related to epilepsy), while the second abnormality suggests left temporal subcortical dysfunction. The third abnormality suggests a mild encephalopathy, which may be seen with infections, toxic metabolic abnormalities, medication effect or neurodegenerative disorders. . CT HEAD W/O CONTRAST [**2140-3-4**] 7:39 PM No prior for comparison. The study is limited by motion despite several attempts at acquisition. Within the limits of the study, no hydrocephalus, shift of normally midline structures or large intra- or extra-axial hemorrhage is identified. No definite major vascular territorial infarct is identified. Diffuse hypodensities seen in both corona radiata and centrum semiovale indicating chronic microvascular disease. Imaged paranasal sinuses and mastoid air cells appear clear. Middle ear cavities are aerated. No fractures identified. IMPRESSION: No acute intracranial hemorrhage or mass effect on this somewhat limited study. . CHEST (PORTABLE AP) [**2140-3-4**] 2:41 PM FINDINGS: Collapse consolidation within the left lower lobe is again seen. Bilateral pleural effusions are now present and I suspect that the degree of failure has occurred. IMPRESSION: Collapse consolidation left lower lobe. Small bilateral effusions suggesting some failure. . [**2140-3-7**] TTE The left atrium is mildly dilated. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). The estimated right atrial pressure is 5-10 mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. Right ventricular chamber size and free wall motion are normal. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is an anterior space which most likely represents a fat pad. IMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mild mitral regurgitation with mildly thickened leaflets. . MICRO [**2140-3-3**] Influenza A/B by DFA -(NEGATIVE) [**2140-3-2**] URINE URINE CULTURE- NO GROWTH [**2140-3-2**] BLOOD CULTURE AEROBIC BOTTLE-PENDING; ANAEROBIC BOTTLE-PENDING [**2140-3-1**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL <10 PMNs and <10 epithelial cells/100X field. NO MICROORGANISMS SEEN. QUALITY OF SPECIMEN CANNOT BE ASSESSED. RESPIRATORY CULTURE (Final [**2140-3-5**]): RARE GROWTH OROPHARYNGEAL FLORA. [**2140-3-1**] BLOOD CULTURE AEROBIC BOTTLE-PENDING; ANAEROBIC BOTTLE-PENDING . Brief Hospital Course: [**Age over 90 **] y/o F with a history of AFib, CVA, and seizures, from rehab with recent UTI and seizures, who had an acute event od AMS and slurred speach leading to intubation for altered mental status and transient hypotension requiring pressors. . In the MICU became persistently hypotensive, started on levophed. Question of sedation vs sepsis. CXR with questionable pneumonia, started on vanc/levo/flagyl. Vanc stopped with no growth on cultures. The next morning pt was extubated [**3-2**], improved BP, and was successfully taken off pressors. Course complicated only by delerium and AF with rate 120s. Patient started on low dose Beta blocker, given concern for hypotension. Tachy Brady syndrome in the past with digoxin hence its discontinuation. EEG [**3-2**] abnormal EEG due to the left temporal sharp waves and theta slowing, as well as the slow background rhythm, concerning for epilepsy, and evidence of encephalopathy. In discussion with neurology, no active seizing. Patient on dilantin and Keppra. . #AMS: Question whether related to seizure-post ictal state, which is the likely etiology of presenting symptoms. Head CT at OSH was reportedly negative. Infection, Afib with hypotension, or symptomatic bradycardia may have been the inciting incident. EEG abnormal but with no active seizure activity as per neurology. Infection likely lowered seizure threshold. Pt was treated with vanc/levo/flagyl then levo/flgayl [**3-6**] day 6. Rate control Afib with low dose beta blocker with caution for bradycardia and hypotension. Re-imaged with CT head w/o contrast to rule out bleed given daughter stated pt acute change in mental status when called out from the MICU. Chronic macrovascular change with no evidence of bleed. Low dose haldol and [**11-16**] sitter. [**3-5**], alert and oriented with waxing and [**Doctor Last Name 688**] periods. Appears delirium superimposed on baseline dementia, waxing and [**Doctor Last Name 688**] periods. . #Left lower lobe pneumonia. [**Month (only) 116**] have been transiently septic given hypothermia, hypotension, and tachycardia. Most likely source pneumonic process as consolidation present. But also considered sedation related to intubation, leading to hypotension. Heart failure. Levofloxacin, Flagyl for pneumonia. CXR with infiltrate in left mid lung zone on 17th, reconfirmed on [**3-4**] in addition to evidence of overload. Continued abx, f/u sputum cx, blood cx, UA/UC, with no growth to date. Ruled out flu. No luekocutyosis, fever, or hypotension at the time of discharge. Nebulizer treatments as needed for wheezing. . #Seizure: Has seizure history post CVA from Afib. Rapid recovery, which is uncharacteristic for her seizures. EEG with evidence of epilepsy and encephalopathy. Likely infection lowering seizure threshold. Cont PO dilantin and keppra, seizure precautions. No evidence of seizure while in house. As per Neuro, not acutely seizing and stable on keppra and Dilantin regimen. . #Atrial Fibrillation/Sick Sinus Syndrome: Tachycardic and in Afib. Improved with PO metoprolol in the MICU. Increased to 37.5 TID as HR increased to 120's, but patient became hypotensive and was therefore returned to original dose. No anti-coagulation because had been stopped by outpatient PCP. [**Name10 (NameIs) **] been on dig in the past but stopped because of sick sinus syndrome. . #CHF: Fluid overload on [**3-4**] CXR. Net positive as fluid given during hypotension, in MICU. Considered fluid overload likely result of tachycardia, left sided failure, with proBNP 5389. Dig also likely benefit to heart failure, but unable to tolerate. Patient gently diuresed. O2 sat stable on 2L NC at transfer. Sparse crackles right base.ECHO with mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. LVEF>55%. Mild mitral regurgitation with mildly thickened leaflets. . #h/o CVA: Stable, no evidence of new stroke. CT head [**3-4**] with no evidence of acute bleed. Restarted ASA. Not on anticoaguation given fall risk will discuss with PCP. . #Anemia: Stable Hct . #Code: DNR/DNI Medications on Admission: Keppra 500 [**Hospital1 **] Dilantin 200 qam, 100 qpm Namenda Fiber ASA 81 qd Discharge Medications: 1. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule PO QAM (once a day (in the morning)). 2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO QPM (once a day (in the evening)). 3. Levetiracetam 250 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: [**3-24**] MLs PO Q6H (every 6 hours) as needed for cough. 6. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day). 7. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 9. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 3 days. 10. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 3 days. 11. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q4H (every 4 hours) as needed for cough. Discharge Disposition: Extended Care Facility: [**Hospital1 **] Senior Healthcare - [**Location (un) 1887**] Discharge Diagnosis: Primary: ?seizure altered mental status hypotension LLL Pneumonia CHF . Secondary: AF - not on anticoagulation, recently d/c'd digoxin in setting of tach brady CVA Seizures with [**Doctor Last Name 555**] Paralysis - documented by EEG Discharge Condition: Stable for transfer Discharge Instructions: You were admitted with slurred speech and a change in mental status. You developed hypotension and were also treatet for a pneumonia. You are being discharged to [**Hospital 599**] Nursing home in [**Location (un) 1887**]. Please take all medications as prescribed here, including antiseizure and heart control medications -Please follow up with Neurology regarding further management of possible seizures. Followup Instructions: Please call [**Telephone/Fax (1) 8927**]. PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 892**] [**Last Name (NamePattern1) **] for follow up appointment, once discharged from the hospital. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

518,507,428,780,427,285,294,344

{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Other convulsions,Atrial fibrillation,Anemia, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Other specified paralytic syndrome'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: HPI: Pt is a [**Age over 90 **]yoW with pmh sig for CVA, seizures, recent UTI who was found to have slurred speech and later on to be non responsive at rehab. Pt was seen by her son-in law at rehab at 9am and he noted that she seemed confused. Shortly thereafter, according to RN at rehab, she was found asleep in bed only awakening briefly to sternal rub. No seizure activity was noted. Of note, she was hospitalized one week prior with seizures in the setting of a UTI and her seizures in teh past manefest as staring followed by [**Doctor Last Name 555**] paralysis. No fever or chills had been noted at rehab, no cough or diarrhea. Per daughter, pt was "almost back to baseline" and walked 50 yards in her walker the night before. . At the [**Hospital1 **] [**Name (NI) 620**] [**Name (NI) **] pt intubated for airway protection, CT head without bleed or other acute findings, cxr with possible pneumonia, given Vancomycin, Levofloxacin, and Flagyl. Hypotensive briefly in the setting of starting Versed, responding to fluid bolus, femoral line placed under sterile conditions. MEDICAL HISTORY: AF - not on anticoagulation, recently d/c'd digoxin in setting of SSS SSS CVA Seizures with [**Doctor Last Name 555**] Paralysis - documented by EEG MEDICATION ON ADMISSION: Keppra 500 [**Hospital1 **] Dilantin 200 qam, 100 qpm Namenda Fiber ASA 81 qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen- elderly female in no acute distress, sitting in bed Vitals- 99.8, 118/80, 88, 22, 97% 3L HEENT- MMM, JVP ~10 cm CV- irregulary irregular, no murmurs noted Pulm-inspiratory wheeze right middle to low lung fields, sparse crackles. Abdom-soft, non tender, non distended. + BS Extr-1+ edema Neuro- Alert, not oriented, unable to perform neuro exam. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with daughter, no smoking/alcohol/tobacco. As per daughter, was able to perform all [**Name (NI) 5669**], knitting and dressing herseld daily, with some bouts of confusion throughout the day. ### Response: {'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Other convulsions,Atrial fibrillation,Anemia, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Other specified paralytic syndrome'}

CHIEF COMPLAINT: Hit head on bathroom door PRESENT ILLNESS: 77y F with afib/flutter on warfarin and h/o post-rheumatic valvular disease (MS/MR [**First Name (Titles) **] [**Last Name (Titles) **] s/p bioprosthetic MVR and TV repair in [**2141**] with symptomatic improvement, on MTP and dig) is transferred here from [**Hospital6 **] after she was found on MEDICAL HISTORY: -afib/flutter on warfarin ppx -MS/MR s/p [**2141**] bioprosthetic valve replacement -TR s/p [**2141**] (same op) TVRepair -HTN/HL -osteopenia, on bisphosphonate (Actonel) s/p 1x traumatic hip fracture after a fall in the rain within the last several years -s/p cataract repairs R 2wk ago, L 1mos ago MEDICATION ON ADMISSION: aspirin 81mg daily warfarin 2mg M-Sa / 3mg Sun metoprolol 50mg [**Hospital1 **] digoxin 0.125mg daily atorvastatin 80mg daily Actonel ALLERGIES: Heparin Agents / Codeine PHYSICAL EXAM: T: afeb 96 125/85 17 100% RA FAMILY HISTORY: Non contributory SOCIAL HISTORY: Lives independently at home with husband.

Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Other accident caused by striking against or being struck accidentally by objects or persons,Long-term (current) use of anticoagulants,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Subarachnoid hem-no coma,Atrial flutter,Obj w-w/o sub fall NEC,Long-term use anticoagul,Heart valve transplant,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2145-7-14**] Discharge Date: [**2145-7-15**] Date of Birth: [**2067-9-6**] Sex: F Service: NEUROSURGERY Allergies: Heparin Agents / Codeine Attending:[**First Name3 (LF) 3227**] Chief Complaint: Hit head on bathroom door Major Surgical or Invasive Procedure: None History of Present Illness: 77y F with afib/flutter on warfarin and h/o post-rheumatic valvular disease (MS/MR [**First Name (Titles) **] [**Last Name (Titles) **] s/p bioprosthetic MVR and TV repair in [**2141**] with symptomatic improvement, on MTP and dig) is transferred here from [**Hospital6 **] after she was found on NCHCT to have a small right frontal SAH. She was in her USOH on morning of admission when she awoke to use the bathroom, half-asleep. Her husband was already in the bathroom, so she turned around to return to the bedroom, and hit her head on the door. Not bothersome to patient, no pain per patient, no LOC, but on returning to bed, her husband noticed profuse bleeding from her forehead. When the bleeding did not stop over the subsequent hour or so, she agreed to be taken to the [**Name (NI) **] (son drove her to [**Hospital1 **] in [**Hospital1 8**]). At OSH, their w/u and Tx was signficant for: NCHCT revealed a small right-frontal subarachnoid hemorrhage. 2. INR was therapeutic Her forehead lac was sutured. Denies neurologic symptoms this morning or ever before. Denies pain. Apparently normal neurologic exam there, and definitively normal MS/neurologic exam on arrival to our ED at [**Hospital1 18**]. Past Medical History: -afib/flutter on warfarin ppx -MS/MR s/p [**2141**] bioprosthetic valve replacement -TR s/p [**2141**] (same op) TVRepair -HTN/HL -osteopenia, on bisphosphonate (Actonel) s/p 1x traumatic hip fracture after a fall in the rain within the last several years -s/p cataract repairs R 2wk ago, L 1mos ago Social History: Lives independently at home with husband. Family History: Non contributory Physical Exam: T: afeb 96 125/85 17 100% RA Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 3-->2 EOMs full no nystagmus. Neck: Supple. No bruits. Lungs: CTA bilaterally. Non-labored. Cardiac: Irregular. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Mild ankle edema L>R with some distal bruising L>R c/w chronic warfarin use and h/o TR. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**2-4**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Calculation intact and quick for age. DOW backwards without difficulty. No impairment of attention. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 3 to 2mm bilaterally. Visual fields are full. III, IV, VI: Extraocular movements full bilaterally without nystagmus. No saccadic intrusions. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**4-7**] throughout. No pronator drift. Sensation: Grossly intact and equal bilaterally to light touch. Reflexes: B T Br Pa Ac Right 2 2 2 1 1 Left 2 2 2 1 1 Toes mute bilaterally. Coordination: No dysmetria or tremor with finger-nose-finger testing on either side. HKS normal. Normal rapid alternating movements (no dysdiadochokinesia). Upon discharge her exam remained stable. Pertinent Results: [**2145-7-15**] 03:50AM BLOOD WBC-8.9 RBC-3.29* Hgb-9.3* Hct-28.1* MCV-85 MCH-28.2 MCHC-33.1 RDW-14.6 Plt Ct-183 [**2145-7-15**] 03:50AM BLOOD Neuts-64.4 Lymphs-24.6 Monos-7.4 Eos-3.1 Baso-0.5 [**2145-7-15**] 03:50AM BLOOD Plt Ct-183 [**2145-7-15**] 03:50AM BLOOD Glucose-93 UreaN-14 Creat-0.8 Na-139 K-5.0 Cl-109* HCO3-24 AnGap-11 [**2145-7-15**] 03:50AM BLOOD Calcium-8.0* Phos-3.1 Mg-2.0 Head CT [**2145-7-14**]: IMPRESSION: No significant change in right frontal lobe subarachnoid hemorrhage. Tiny underlying cortical contusion may be present, unchanged. No new hemorrhage identified. Brief Hospital Course: Ms [**Known lastname 87532**] was admitted to the ICU for close neurological observation. Her Coumadin was held but her coagulopathy was not reversed given her mitral valve replacement. She was followed with 2 head CTs when compared with the outside CT, no change in R medial frontal lobe hemorrhage was noted. She remained neurologically intact through her hospital stay. She tolerated a regular diet and worked with PT who decided she was safe to be discharged. An echocardiogram was performed as an inpatient but the formal interpreation was not available at the time of discharge. We have contact[**Name (NI) **] the cardiologist to follow up with the results. Based on discussion with the cardiologist, the patient will resume Coumadin on [**2145-7-16**] at 2 mg daily Mon-Sun. She was discharged home on [**2145-7-15**] Medications on Admission: aspirin 81mg daily warfarin 2mg M-Sa / 3mg Sun metoprolol 50mg [**Hospital1 **] digoxin 0.125mg daily atorvastatin 80mg daily Actonel Discharge Medications: 1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for afib/flutter, chf/valvular disease, htn. 3. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever/pain. 5. Fioricet 50-325-40 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for headache. Disp:*30 Tablet(s)* Refills:*0* 6. Coumadin 2 mg Tablet Sig: One (1) Tablet PO once a day: Mon-Sun. Discharge Disposition: Home Discharge Diagnosis: Traumatic Right SAH Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. ?????? You may resume your coumadin [**2145-7-16**] but you will take Coumadin 2mg Daily Mon-Sun. You will need to follow-up with your cardiologist regarding your INRs. Followup Instructions: ??????Please call ([**Telephone/Fax (1) 9403**] to schedule an appointment with Dr. [**First Name (STitle) **] to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. Completed by:[**2145-7-15**]

852,427,E917,V586,V422,401,272

{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Other accident caused by striking against or being struck accidentally by objects or persons,Long-term (current) use of anticoagulants,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Hit head on bathroom door PRESENT ILLNESS: 77y F with afib/flutter on warfarin and h/o post-rheumatic valvular disease (MS/MR [**First Name (Titles) **] [**Last Name (Titles) **] s/p bioprosthetic MVR and TV repair in [**2141**] with symptomatic improvement, on MTP and dig) is transferred here from [**Hospital6 **] after she was found on MEDICAL HISTORY: -afib/flutter on warfarin ppx -MS/MR s/p [**2141**] bioprosthetic valve replacement -TR s/p [**2141**] (same op) TVRepair -HTN/HL -osteopenia, on bisphosphonate (Actonel) s/p 1x traumatic hip fracture after a fall in the rain within the last several years -s/p cataract repairs R 2wk ago, L 1mos ago MEDICATION ON ADMISSION: aspirin 81mg daily warfarin 2mg M-Sa / 3mg Sun metoprolol 50mg [**Hospital1 **] digoxin 0.125mg daily atorvastatin 80mg daily Actonel ALLERGIES: Heparin Agents / Codeine PHYSICAL EXAM: T: afeb 96 125/85 17 100% RA FAMILY HISTORY: Non contributory SOCIAL HISTORY: Lives independently at home with husband. ### Response: {'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Other accident caused by striking against or being struck accidentally by objects or persons,Long-term (current) use of anticoagulants,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: respiratory failure PRESENT ILLNESS: 75 yo lady with hx of severe COPD on home O2, non operable NSCL CA with nodule in LUL dx in [**2184**], s/p XRT, throid nodule, s/p flex bronch today with radioactive seed implantation by Dr. [**Last Name (STitle) **]. Procedure performed w/out complications and patient sent home. CXR prior to procedure showed spiculated mass in the left upper lung field retracting the left hilum with volume loss in the LUL area and post procedure there was no evidence of pneumothorax. There was no evidence of any pulmonary vascular congestion or any other pulmonary parenchymal densities. Patient now returns with increasing SOB. Patient apparently returned home after procedure which was tolerated well, some hemoptysis post procedure. Patient then "just didn't look well" as per family, developed increasing SOB and brought to ED by daughter. Family denies any other precipitating factors, has been well previously, unable to elicit any other history from family. . In ED, patient with O2 sat of 95% on NRB, RR 35 therefore patient intubated. No ABG done at that time. Tmax 99.8, SBP initially stable at 110s, then decreased to 50s post intubation and after receiving sedation. Lactate was 6.0, patient received 4 L of NS but did not respond therefore started on Dopamine and Levophed. Also started on Vancomycin and Unasyn to cover oral flora s/p bronch as well as post obstructive PNA given hx of lung CA. CTA of chest was negative for PE but showed LLL consolidation suggestive of atelectasis with stable LUL mass but new opacities suggestive of aspiration vs. post obstructive PNA. Right IJ central line was placed in the ED and the sepsis protocol was initiated. Patient transfered to ICU sedated and intubated on Levophed gtt at 0.18 mcg/kg/min. Upon arrival, VS were T 98 HR 101 BP 102/60 O2 sat 100% AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/52/329 MEDICAL HISTORY: 1. NSCL CA: non operable, no hx of chemotherapy as per family, s/p XRT, s/p radioactive seed implantation, initial bronch in [**2181**] was negative for malignancy, diagnosed in [**2184**] after mass identified on CXR, PET positive nodule, also positive thyroid nodule 2. Severe COPD/Emphysema requiring intermittent home O2, last PFTs showing obstructive defect (FEV1/FVC 34) 3. HTN 4. Anxiety MEDICATION ON ADMISSION: - Albuterol 2 puffs qid - Atrovent 2 puffs qid - Advair 500/50 one puff twice a day - Lisinopril -*has been on prednisone in past (last documented here in 03) - ?Ativan ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 98 HR 101 BP 102/60 O2 sat 100% Vent: AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/ 52/329 Gen: Intubated and sedated, non responsive to voice/pain, Skin: very pale, dry, cold extremities Neck: supple, unable to assess JVP, R IJ, L EJ in place HEENT: PERRL, pupils constricted 2 mm b/l, anicteric, dry mmm CVS: nl S1 S2, regular, distant heart sounds, no m/r/g appreciated Lungs: diffuse high pitch wheezing throughout, poor air entry Abd: obese, firm, no hepatosplenomegaly, BS+ Ext: cold to touch, pulses faint 1+ b/l, no rashes, no c/c/e Neuro: intubated and sedated, non responsive, PERRL FAMILY HISTORY: positive for cardiac disease and emphysema but denies any diabetes or cancers SOCIAL HISTORY: She smoked one pack per day for 50 years and stopped smoking over 10 years ago, denies ETOH, OTC meds, she lives alone in a senior home x many years, widow, usually functional with ADLs, has five children alive and well, active in her care.

Unspecified septicemia,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Klebsiella pneumoniae,Malignant neoplasm of upper lobe, bronchus or lung,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Severe sepsis,Other specified forms of chronic ischemic heart disease

Septicemia NOS,Septic shock,Acute respiratry failure,Food/vomit pneumonitis,Obs chr bronc w(ac) exac,K. pneumoniae pneumonia,Mal neo upper lobe lung,Acidosis,React-oth vasc dev/graft,Hypertension NOS,Severe sepsis,Chr ischemic hrt dis NEC

Admission Date: [**2187-7-31**] Discharge Date: [**2187-8-17**] Date of Birth: [**2112-6-10**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: respiratory failure Major Surgical or Invasive Procedure: R IJ Central Line placement Intubation Tracheostomy and PEG tube placement. History of Present Illness: 75 yo lady with hx of severe COPD on home O2, non operable NSCL CA with nodule in LUL dx in [**2184**], s/p XRT, throid nodule, s/p flex bronch today with radioactive seed implantation by Dr. [**Last Name (STitle) **]. Procedure performed w/out complications and patient sent home. CXR prior to procedure showed spiculated mass in the left upper lung field retracting the left hilum with volume loss in the LUL area and post procedure there was no evidence of pneumothorax. There was no evidence of any pulmonary vascular congestion or any other pulmonary parenchymal densities. Patient now returns with increasing SOB. Patient apparently returned home after procedure which was tolerated well, some hemoptysis post procedure. Patient then "just didn't look well" as per family, developed increasing SOB and brought to ED by daughter. Family denies any other precipitating factors, has been well previously, unable to elicit any other history from family. . In ED, patient with O2 sat of 95% on NRB, RR 35 therefore patient intubated. No ABG done at that time. Tmax 99.8, SBP initially stable at 110s, then decreased to 50s post intubation and after receiving sedation. Lactate was 6.0, patient received 4 L of NS but did not respond therefore started on Dopamine and Levophed. Also started on Vancomycin and Unasyn to cover oral flora s/p bronch as well as post obstructive PNA given hx of lung CA. CTA of chest was negative for PE but showed LLL consolidation suggestive of atelectasis with stable LUL mass but new opacities suggestive of aspiration vs. post obstructive PNA. Right IJ central line was placed in the ED and the sepsis protocol was initiated. Patient transfered to ICU sedated and intubated on Levophed gtt at 0.18 mcg/kg/min. Upon arrival, VS were T 98 HR 101 BP 102/60 O2 sat 100% AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/52/329 Past Medical History: 1. NSCL CA: non operable, no hx of chemotherapy as per family, s/p XRT, s/p radioactive seed implantation, initial bronch in [**2181**] was negative for malignancy, diagnosed in [**2184**] after mass identified on CXR, PET positive nodule, also positive thyroid nodule 2. Severe COPD/Emphysema requiring intermittent home O2, last PFTs showing obstructive defect (FEV1/FVC 34) 3. HTN 4. Anxiety Social History: She smoked one pack per day for 50 years and stopped smoking over 10 years ago, denies ETOH, OTC meds, she lives alone in a senior home x many years, widow, usually functional with ADLs, has five children alive and well, active in her care. Family History: positive for cardiac disease and emphysema but denies any diabetes or cancers Physical Exam: VS: T 98 HR 101 BP 102/60 O2 sat 100% Vent: AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/ 52/329 Gen: Intubated and sedated, non responsive to voice/pain, Skin: very pale, dry, cold extremities Neck: supple, unable to assess JVP, R IJ, L EJ in place HEENT: PERRL, pupils constricted 2 mm b/l, anicteric, dry mmm CVS: nl S1 S2, regular, distant heart sounds, no m/r/g appreciated Lungs: diffuse high pitch wheezing throughout, poor air entry Abd: obese, firm, no hepatosplenomegaly, BS+ Ext: cold to touch, pulses faint 1+ b/l, no rashes, no c/c/e Neuro: intubated and sedated, non responsive, PERRL Pertinent Results: On Admission: [**2187-7-31**] 03:40PM ALBUMIN-4.7 CALCIUM-9.2 PHOSPHATE-8.6* MAGNESIUM-2.1 [**2187-7-31**] 03:40PM ALT(SGPT)-71* AST(SGOT)-77* ALK PHOS-74 AMYLASE-104* TOT BILI-0.3 [**2187-7-31**] 03:40PM GLUCOSE-371* UREA N-15 CREAT-1.0 SODIUM-142 POTASSIUM-4.6 CHLORIDE-103 TOTAL CO2-22 ANION GAP-22* [**2187-7-31**] 03:53PM LACTATE-6.0* [**2187-7-31**] 05:10PM PT-13.7* PTT-21.7* INR(PT)-1.3 [**2187-7-31**] 05:10PM PLT SMR-NORMAL PLT COUNT-274 [**2187-7-31**] 05:10PM HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL [**2187-7-31**] 05:10PM NEUTS-70 BANDS-17* LYMPHS-12* MONOS-1* EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2187-7-31**] 05:10PM WBC-20.8*# RBC-4.07* HGB-12.5 HCT-39.4 MCV-97 MCH-30.7 MCHC-31.7 RDW-13.6 [**2187-7-31**] 09:00PM URINE RBC-35* WBC-3 BACTERIA-NONE YEAST-NONE EPI-<1 [**2187-7-31**] 09:00PM URINE BLOOD-LGE NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-MOD UROBILNGN-NEG PH-5.0 LEUK-SM [**2187-7-31**] 09:00PM URINE COLOR-Amber APPEAR-SlCldy SP [**Last Name (un) 155**]-1.015 [**2187-7-31**] 09:10PM freeCa-1.11* [**2187-7-31**] 09:54PM CORTISOL-120.3* [**2187-7-31**] 10:10PM CORTISOL-110.2* [**2187-7-31**] 10:39PM LACTATE-2.2* [**2187-7-31**] 10:39PM TYPE-ART TEMP-36.9 RATES-/16 TIDAL VOL-500 O2-40 PO2-82* PCO2-43 PH-7.19* TOTAL CO2-17* BASE XS--11 -ASSIST/CON INTUBATED-INTUBATED [**2187-7-31**] 10:41PM CORTISOL-97.1* . Imaging: CTA: 1. No evidence of pulmonary embolism. 2. Interval development of a left lower lobe consolidation. This could represent atelectasis. Patchy opacities are also visualized in the left lower lobe, which could represent aspiration pneumonia. 3. Stable appearance of left upper lobe mass. 4. Interval placement of metallic objects within the mass and in the adjacent areas. . CXR [**2187-7-31**]: Findings consistent within inoperable lung cancer in left upper lobe. No evidence of pneumothorax following bronchoscopy. . Repeat CXR post line placement: Satisfactory placement of right internal jugular central venous catheter. Slightly increase interstitial densities at the lung bases, raising the possibility of CHF superimposed on COPD changes. . PET CT [**2187-7-2**]: Interval worsening in the region of a left upper lobe linear scar (post XRT): on [**2185-1-21**] soft tissue mass measured at 1.2 x 3.6cm with peak SUV 10.1, today 4 x 2.5cm & peak SUV 14.6. There is interval worsening posteriorly with increased FDG-avidity and sclerosis of the posterior ribs. These are consistent with tumor recurrence. 2) Focal area of FDG avidity in the right middle zone (peak SUV 2.1 below our cutoff of 2.5) that may represent infection. 3) FDG-avidity in paratracheal region near right lower pole of thyroid (peak SUV 15.1) Brief Hospital Course: Ms. [**Known lastname **] is a 75 yo lady w/ severe COPD, non operable lung CA s/p bronch with gold seed placement admitted with respiratory failure and septic shock. . # Respiratory Failure: Patient intubated for worsening SOB, increased work of breathing. CTA done in ED was negative for PE. Respiratory failure likely secondary to aspiration PNA vs. post obstructive PNA s/p bronch with gold seed placement, new opacities on CTA in LLL. Also with elevated WBC count with left shift. Diffusely wheezy on exam, likely [**12-20**] to severe underlying COPD. Also question of LLL segmental bronchus obstruction from clot post procedure given history of hemoptysis and LLL atelectasis on CTA. Patient treated with Unasyn for gram negative and anaerobic coverage and Vancomycin since patient has been in/out of hospital, instrumented, lives in retirement home, to complete a 14 day course of each. The patient was also treated with steroids for COPD exacerbation with hydrocortisone and then Solu-Medrol with inhaled steroids. She was also treated with Albuterol/Atrovent MDI through the ET tube with improvement in her wheezing. Due to her severe COPD she required Albuterol Q2 hrs and Atrovent Q 6 hrs, 8-10 puffs each. Blood cultures and urine culture were negative. Sputum showed both gram positive cocci and gram positive rods. After initial fluid resuscitation, patient was diuresed, initially slowly due to borderline low BP, then more aggressively. CXR does not show any evidence of fluid overload. but shows the stable LUL mass with severe underlying COPD. Patient has remained on ventilator throughout admission. She has been weaned several times to pressure support of [**3-22**] and even 0/5 but then becomes hypertensive, tachycardic, with increased secretions and dropping O2 sats. Difficulty with extubation likely [**12-20**] severe underlying COPD and lung CA with element of increased anxiety initially. Patient is off baseline sedation, anxiety well controlled with Seroquel and small doses of Ativan since patient was taking Ativan at home for anxiety (?). Patient also developed some blood tinged sputum, either secondary to new process vs. underlying malignancy. CXR showed questionable new LUL infiltrate on top of mass in that area, now resolved on CXR. Her sputum grew out klebsiella and stenotrophomonas that were both sensitive to Bactrim. She was started on a 14 day course of bactrim. She had a tracheostomy placed given the anticipated prolonged weaning process. . # Septic Shock: Patient initially met criteria with elevated WBC, tachypnea with hypotension despite fluid resuscitation. Central line placed was performed in the ED. Empiric antibiotic coverage for post-obstructive PNA initiated with Unasyn and Vancomycin given recent bronchoscopy and high risk for mixed flora/anaerobes. Patient received a total of 5 units of NS in the ED with continued fluid resuscitation in the ICU as per the sepsis protocol. CVP was maintain between [**6-29**], MAP >65 and SvO2 >70 with continuous monitoring. Levophed drip was started to meet the above criteria which was weaned after stabilization of her BP after approximately 48 hrs. IV fluid boluses were continued with Lactated Ringers due to rising lactic acidosis. Patient had a cortisol stim test which showed abnormal and paradoxical results but was ultimately started on steroids due to severe COPD. The patient was adequately fluid resuscitated and weaned off pressors. She later became hypertensive and was diuresed due to the large amount of fluids she initially received for resuscitation. She remained stable in terms of her likely pulmonary infection with her limitations being her dependence on the ventilator due to COPD and underlying lung CA. . # Metabolic Acidosis - Initially the patient had an anion gap of 17 with of ABG 7.15/52/329, lactate elevated to 6.0 ->2.2 after aggressive IVF. Likely secondary to the underlying pulmonary infection. Monitoring was continued with daily chemistries, lactic acid measurement and ABGs with subsequent resolution and normalization of her lab values. . # CE elevation: TnT highest at 0.26 with new TWI on telemetry/EKG. Likely due to demand ischemia given severe hypotension with septic shock. TWI subsequently resolved on repeat EKG. Patient also had enzymes drawn with repeat EKG during episodes of anxiety, all negative. Patient was monitor on tele for new events throughout. She was treated with ASA. Beta blockers avoided given severe COPD. . # Hypertension- Patient with episodes of tachycardia and hypertension thought to be anxiety attacks with response to Ativan/Seroquel. On [**8-10**] patient developed sustained hypertension after another episode of anxiety with SBP >230. Patient had been off all antihypertensives until this point due to initial sepsis with hypotension. Patient had been taking an ACE inhibitor at home, which was restarted, Captopril 6.25 mg titrated as necessary for elevated BP. On [**8-16**], she has another episode of tachycardia to 110s and hypertension to 220s systolic in the setting of hypoxia secondary to being on a spontaneous breathing trial PS 0/5 for 45 minutes. She blood pressure and heart rate improved with light sedation with propofol. . # Drop in Hct: Patient with a drop in Hct from 26 to 23 then 22 on [**8-9**], requiring 1 unit of pRBCs with an increase in Hct to 27. Etiology unclear, possibly secondary in increased blood tinged sputum, also with one episode of hematuria. Patient was followed clinically for any signs of bleeding. She received another unit of red cells on [**8-15**] for a hematocrit of 24.4. # Hyperglycemia. Patient does not have a known diagnosis of DM but did have glucose of >300 on admission, either secondary to a stress response vs. underlying DM. Patient has been monitored with regular finger sticks and coverage with regular insulin drip then sliding scale with good control. Her glucose was further elevated once steroids were started. As her steroids were tapered, her glucose levels were not longer elevated and she no longer required insulin. # Anxiety: Patient has been anxious throughout admission, on benzos at home. Patient was having episodes of anxiety with hypertension, tachycardia, agitation with weaning of sedation/ventilation. She responds well to low doses of Ativan, since patient thought to be taking this at home, and nighttime dose of Seroquel. . # FEN - Patient started on tube feeds. Electrolytes were monitored and repleted as necessary. IV fluid resuscitation initially, subsequently bolused as needed with LR, then not requiring fluids with OG feeds. Once the PEG was placed, she was continued on tube feeds via the PEG tube. . # Prophylaxis: Bowel regimen, Heparin SC + pneuma boots given history of CA, PPI, FS with insulin, ASA . # Comm: [**Name (NI) **] [**Name (NI) **] [**Name (NI) **] (Home) [**Telephone/Fax (1) 9233**] (Cell) [**Telephone/Fax (1) 9234**]. . # Access: She had initially had a right IJ, which was removed on [**8-15**] once she had a right PICC placed. . # Code: FULL . # Dispo: She was discharged to [**Hospital1 **] for vent weaning. Medications on Admission: - Albuterol 2 puffs qid - Atrovent 2 puffs qid - Advair 500/50 one puff twice a day - Lisinopril -*has been on prednisone in past (last documented here in 03) - ?Ativan Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection Q8H (every 8 hours). 3. Docusate Sodium 150 mg/15 mL Liquid Sig: 100 mg PO BID (2 times a day). 4. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY (Daily). 5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Ten (10) Puff Inhalation Q6H (every 6 hours). 7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 8. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 9. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed. 10. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours) as needed. 11. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 12. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). 13. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 14. Ibuprofen 100 mg/5 mL Suspension Sig: [**12-22**] PO Q8H (every 8 hours) as needed. 15. Albuterol 90 mcg/Actuation Aerosol Sig: Eight (8) Puff Inhalation Q4H (every 4 hours). 16. Lorazepam 2 mg/mL Syringe Sig: 0.5-1 mg Injection Q4H (every 4 hours) as needed for anxiety. 17. Methylprednisolone Sodium Succ 1,000 mg/8 mL Recon Soln Sig: 10 mg Recon Solns Injection Q24H (every 24 hours) for 1 days: Last dose to be given on [**2187-8-18**]. 18. Trimethoprim-Sulfamethoxazole 80-400 mg/5 mL Solution Sig: 400 mg Intravenous Q8H (every 8 hours) for 9 days. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Sepsis from pneumonia Non-small cell lung cancer COPD Hypertension Anxiety Discharge Condition: Stable. Currently on Pressure support ventilation 15/8 with ability to maintain prolonged time on [**8-25**]. She is able to tolerate spontaneous breathing trials for short periods. Discharge Instructions: Please take all medications as prescribed. Continue the weaning process from mechanical ventilation. Followup Instructions: Please follow-up with your primary care physician upon discharge from rehab. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2187-8-17**]

038,785,518,507,491,482,162,276,996,401,995,414

{'Unspecified septicemia,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Klebsiella pneumoniae,Malignant neoplasm of upper lobe, bronchus or lung,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Severe sepsis,Other specified forms of chronic ischemic heart disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: respiratory failure PRESENT ILLNESS: 75 yo lady with hx of severe COPD on home O2, non operable NSCL CA with nodule in LUL dx in [**2184**], s/p XRT, throid nodule, s/p flex bronch today with radioactive seed implantation by Dr. [**Last Name (STitle) **]. Procedure performed w/out complications and patient sent home. CXR prior to procedure showed spiculated mass in the left upper lung field retracting the left hilum with volume loss in the LUL area and post procedure there was no evidence of pneumothorax. There was no evidence of any pulmonary vascular congestion or any other pulmonary parenchymal densities. Patient now returns with increasing SOB. Patient apparently returned home after procedure which was tolerated well, some hemoptysis post procedure. Patient then "just didn't look well" as per family, developed increasing SOB and brought to ED by daughter. Family denies any other precipitating factors, has been well previously, unable to elicit any other history from family. . In ED, patient with O2 sat of 95% on NRB, RR 35 therefore patient intubated. No ABG done at that time. Tmax 99.8, SBP initially stable at 110s, then decreased to 50s post intubation and after receiving sedation. Lactate was 6.0, patient received 4 L of NS but did not respond therefore started on Dopamine and Levophed. Also started on Vancomycin and Unasyn to cover oral flora s/p bronch as well as post obstructive PNA given hx of lung CA. CTA of chest was negative for PE but showed LLL consolidation suggestive of atelectasis with stable LUL mass but new opacities suggestive of aspiration vs. post obstructive PNA. Right IJ central line was placed in the ED and the sepsis protocol was initiated. Patient transfered to ICU sedated and intubated on Levophed gtt at 0.18 mcg/kg/min. Upon arrival, VS were T 98 HR 101 BP 102/60 O2 sat 100% AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/52/329 MEDICAL HISTORY: 1. NSCL CA: non operable, no hx of chemotherapy as per family, s/p XRT, s/p radioactive seed implantation, initial bronch in [**2181**] was negative for malignancy, diagnosed in [**2184**] after mass identified on CXR, PET positive nodule, also positive thyroid nodule 2. Severe COPD/Emphysema requiring intermittent home O2, last PFTs showing obstructive defect (FEV1/FVC 34) 3. HTN 4. Anxiety MEDICATION ON ADMISSION: - Albuterol 2 puffs qid - Atrovent 2 puffs qid - Advair 500/50 one puff twice a day - Lisinopril -*has been on prednisone in past (last documented here in 03) - ?Ativan ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 98 HR 101 BP 102/60 O2 sat 100% Vent: AC 500 x 18 FiO2 100, Peep 5, ABG 7.15/ 52/329 Gen: Intubated and sedated, non responsive to voice/pain, Skin: very pale, dry, cold extremities Neck: supple, unable to assess JVP, R IJ, L EJ in place HEENT: PERRL, pupils constricted 2 mm b/l, anicteric, dry mmm CVS: nl S1 S2, regular, distant heart sounds, no m/r/g appreciated Lungs: diffuse high pitch wheezing throughout, poor air entry Abd: obese, firm, no hepatosplenomegaly, BS+ Ext: cold to touch, pulses faint 1+ b/l, no rashes, no c/c/e Neuro: intubated and sedated, non responsive, PERRL FAMILY HISTORY: positive for cardiac disease and emphysema but denies any diabetes or cancers SOCIAL HISTORY: She smoked one pack per day for 50 years and stopped smoking over 10 years ago, denies ETOH, OTC meds, she lives alone in a senior home x many years, widow, usually functional with ADLs, has five children alive and well, active in her care. ### Response: {'Unspecified septicemia,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia due to Klebsiella pneumoniae,Malignant neoplasm of upper lobe, bronchus or lung,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified essential hypertension,Severe sepsis,Other specified forms of chronic ischemic heart disease'}

CHIEF COMPLAINT: PRESENT ILLNESS: A 77-year-old man with no known CAD, a history of hyperlipidemia, tobacco use, and a family history of CAD. He was admitted to the hospital with chest pain that was nonradiating, but was associated with bilateral arm numbness. After getting out of bed the patient's chest pain persisted and he called 9-1-1. In the Emergency Room the patient was treated with sublingual nitroglycerin and aspirin. He had relief from his symptoms and he was admitted to rule out MI and for cardiac catheterization. MEDICAL HISTORY: Significant for hypercholesterolemia, anxiety, depression, hypothyroidism, GERD, vertigo, cancer of the mouth and chronic hip pain. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Widowed, lives alone, lives a sedentary lifestyle. Sixty year history of tobacco use, currently smokes seven to ten cigarettes per day. No alcohol or drug use.

Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified acquired hypothyroidism

Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Esophageal reflux,Hypothyroidism NOS

Admission Date: [**2194-1-30**] Discharge Date: [**2194-2-7**] Date of Birth: [**2117-1-10**] Sex: M Service: CSU Mr. [**Known lastname 22226**] is a postoperative admission, admitted directly to the Operating Room for coronary artery bypass grafting. He was seen in preadmission testing at the end of [**2193-12-25**]. At that time he had been admitted for cardiac catheterization. HISTORY OF PRESENT ILLNESS: A 77-year-old man with no known CAD, a history of hyperlipidemia, tobacco use, and a family history of CAD. He was admitted to the hospital with chest pain that was nonradiating, but was associated with bilateral arm numbness. After getting out of bed the patient's chest pain persisted and he called 9-1-1. In the Emergency Room the patient was treated with sublingual nitroglycerin and aspirin. He had relief from his symptoms and he was admitted to rule out MI and for cardiac catheterization. PAST MEDICAL HISTORY: Significant for hypercholesterolemia, anxiety, depression, hypothyroidism, GERD, vertigo, cancer of the mouth and chronic hip pain. PAST SURGICAL HISTORY: Significant for hallux surgery. SOCIAL HISTORY: Widowed, lives alone, lives a sedentary lifestyle. Sixty year history of tobacco use, currently smokes seven to ten cigarettes per day. No alcohol or drug use. PHYSICAL EXAMINATION: Vital signs showed temperature 97.2, heart rate 63, blood pressure 120/50, respiratory rate 18, O2 sat 96 percent on two liters. In general pleasant, appears younger than stated age, alert and oriented x3. HEENT showed pupils equally round and reactive to light, extraocular movements intact. Tympanic membranes clear. Mucous membranes moist. Neck was supple with no lymphadenopathy or thyromegaly. Pulmonary was clear to auscultation bilaterally. Cardiovascular showed regular rate and rhythm. Normal S1 and S2, no murmurs, rubs or gallops. Abdomen was soft, nontender, nondistended with normoactive bowel sounds. Extremities were warm and well perfused with no clubbing, cyanosis or edema. LABORATORY DATA: White count 9.2, hematocrit 40, platelets 204,000. PT 12.9, PTT 28.1, INR 1.1, troponin less than 0.01. Glucose 198, BUN 17, creatinine 0.7, sodium 140, potassium 4.0, chloride 101, CO2 28. EKG showed sinus rhythm at 71 beats per minute with borderline ST depressions in V5 through V6. Chest x-ray showed no pulmonary infiltrates. A stress MIBI had no ischemic EKG changes, reversible perfusion defect involving the apex as well as the basilar portion of the inferior wall, and an EF of 40 percent. TEE showed an EF of 55 percent with mild AR as well as mild MR. Cardiac cath showed three vessel disease with 100 percent LAD, 80 percent circumflex, and 60 percent RCA. PREOPERATIVE MEDS: Levothyroxine 50 mcg every day, atenolol 25 mg every day, atorvastatin 40 mg every day, aspirin 325 every day, fluoxetine 20 mg every day, Valium 5 mg q. eight hours p.r.n., Pepcid 20 mg every day. As stated previously, the patient was a direct admission to the Operating Room. Please see the OR report for full details. In summary the patient had a CABG x3 with a LIMA to the LAD, saphenous vein graft to OM and saphenous vein graft to PDA. His bypass time was 65 minutes with a crossclamp time of 40 minutes. He tolerated the operation well and was transferred from the Operating Room to the Cardiothoracic Intensive Care Unit. At the time of transfer the patient was in sinus rhythm at 74 beats per minute with a mean arterial pressure of 82 and a CVP of 6. He had Neo-Synephrine at 0.75 mcg per kilogram per minute and propofol at 10 mcg per kilogram per minute. The patient did well in the immediate postoperative period. His anesthesia was reversed. He was weaned from the ventilator and successfully extubated. He remained hemodynamically stable throughout the operative day, requiring only Neo-Synephrine to maintain an adequate blood pressure. On postoperative day one attempts to wean the patient's Neo- Synephrine were unsuccessful, therefore, he remained in the ICU. He was, however, at that time transferred to the coronary care unit, as there was a need for a bed in the Cardiac Recovery Unit. He stayed in the Coronary Care Unit for two additional days, being weaned from his Neo- Synephrine. During that time the patient was noted to have atrial fibrillation for which he was started on amiodarone. By postoperative day four the patient had weaned from all drips and he was transferred to the floor for continuing postoperative care and cardiac rehabilitation. Over the next several days the patient had an uneventful postoperative course. He did have periods of intermittent atrial fibrillation, therefore, was begun on heparin as well as Coumadin. His activity level was increased with the assistance of the nursing staff and Physical Therapy. On postoperative day seven it was decided the patient would be stable and ready to be transferred to rehabilitation on the following morning. At the time of this dictation the patient's physical exam is as follows; vital signs show temperature 99, heart rate 88 sinus rhythm, blood pressure 122/56, respiratory rate 28, O2 sat 98 percent on three liters. Weight preoperatively was 79 kg, at discharge 68.5 kg. Laboratory data shows white count 16.2, hematocrit 31.2, platelets 287,000. PT 13.6, INR 1.2. Sodium 142, potassium 4.2, chloride 105, CO2 31, BUN 15, creatinine 0.8, glucose 167. Neuro shows alert and oriented x3. Moves all extremities. Follows commands. Nonfocal exam. Pulmonary is clear to auscultation bilaterally. Cardiac shows regular rate rhythm, S1 and S2 with no murmur. Sternum is stable. Incision with Steri-Strips, open to air without erythema or drainage. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well perfused with no edema. Right saphenous vein graft harvest site incision with Steri-Strips, clean and dry. Patient's condition at the time of transfer is good. DISCHARGE DIAGNOSES: 1. Coronary artery disease, status post coronary artery bypass grafting times three with left internal mammary artery to the left anterior descending, saphenous vein graft to the obtuse marginal, and saphenous vein graft to the posterior descending coronary artery. 2. Hypertension. 3. Hyperlipidemia. 4. Diabetes mellitus Type 2, diet controlled. 5. Anxiety. 6. Gastroesophageal reflux disease. 7. Hypothyroidism. 8. Osteoarthritis. 9. Bilateral hernia repair. The patient is to follow-up with Dr. [**Last Name (STitle) 70**] in six weeks, follow-up with Dr. [**Last Name (STitle) 1007**] in three to four weeks, and follow- up with Dr. [**Last Name (STitle) 696**] in three to four weeks. DISCHARGE MEDICATIONS: 1. Potassium chloride 20 mEq every day times 10 days. 2. Colace 100 mg b.i.d. 3. Atorvastatin 80 mg every day. 4. Fluoxetine 20 mg every day. 5. Levothyroxine 50 mcg every day, 6. Flomax 0.4 mg at bedtime. 7. Prilosec 40 mg every day. 8. Aspirin 81 mg enteric coated every day. 9. Amiodarone 400 mg b.i.d. times one week, then 400 mg every day times one week, then 200 mg every day times one month. 10. Metoprolol 50 mg b.i.d. 11. Lasix 20 mg every day times 10 days. 12. Warfarin, dose to be adjusted to maintain an INR 2 to 2.5. The patient received 2 mg on [**2194-2-4**] and [**2194-2-5**], and 4 mg [**2194-2-6**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**] Dictated By:[**Last Name (NamePattern4) 1718**] MEDQUIST36 D: [**2194-2-6**] 15:45:28 T: [**2194-2-7**] 14:25:28 Job#: [**Job Number 22227**]

414,413,997,427,401,272,250,530,244

{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified acquired hypothyroidism'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: A 77-year-old man with no known CAD, a history of hyperlipidemia, tobacco use, and a family history of CAD. He was admitted to the hospital with chest pain that was nonradiating, but was associated with bilateral arm numbness. After getting out of bed the patient's chest pain persisted and he called 9-1-1. In the Emergency Room the patient was treated with sublingual nitroglycerin and aspirin. He had relief from his symptoms and he was admitted to rule out MI and for cardiac catheterization. MEDICAL HISTORY: Significant for hypercholesterolemia, anxiety, depression, hypothyroidism, GERD, vertigo, cancer of the mouth and chronic hip pain. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Widowed, lives alone, lives a sedentary lifestyle. Sixty year history of tobacco use, currently smokes seven to ten cigarettes per day. No alcohol or drug use. ### Response: {'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified acquired hypothyroidism'}

CHIEF COMPLAINT: Found unresponsive. PRESENT ILLNESS: This is an 83-year-old woman with a past medical history of dementia, hypertension, hypercholesterolemia, and diabetes, who was found unresponsive in bed by her husband at around 10:30 p.m. on the evening of admission, which was [**2192-3-2**]. The husband stated that she was doing well all day, but around 9 p.m., he went into the kitchen to have cereal and she did not join him in the kitchen. He went back to check on her, and she was on the bed moving only very slightly and wound not arouse. She did vomit once there. MEDICAL HISTORY: 1. Dementia during which her husband has been taking care of her for the last month including everything around the house like cleaning, cooking, bills, and shopping. She apparently still dresses herself and knows other family members. 2. Hypertension. 3. Hypercholesterolemia. 4. Diabetes. 5. History of breast cancer in [**2184**] status post lumpectomy and XRT. 6. Peripheral vascular disease status post right leg bypass. 7. Osteoarthritis. 8. Glaucoma. 9. TIAs of unclear etiology and characteristics. 10. Uterine fibroids. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She lives with her husband in [**Name (NI) **]. Her daughter and her son-in-law live in [**State 2748**].

Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Acute and chronic respiratory failure,Obstructive hydrocephalus,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of larynx

Intracerebral hemorrhage,Food/vomit pneumonitis,Acute & chronc resp fail,Obstructiv hydrocephalus,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Edema of larynx

Admission Date: [**2192-3-2**] Discharge Date: [**2192-3-15**] Service: Neurology CHIEF COMPLAINT: Found unresponsive. HISTORY OF PRESENT ILLNESS: This is an 83-year-old woman with a past medical history of dementia, hypertension, hypercholesterolemia, and diabetes, who was found unresponsive in bed by her husband at around 10:30 p.m. on the evening of admission, which was [**2192-3-2**]. The husband stated that she was doing well all day, but around 9 p.m., he went into the kitchen to have cereal and she did not join him in the kitchen. He went back to check on her, and she was on the bed moving only very slightly and wound not arouse. She did vomit once there. A nurse, who lives in the building, came and checked on her, and then decided to call EMS. Her blood pressure was noted by EMS to be over 200 systolic and they thought they saw some jerking of her right arm. Upon arrival to the [**Hospital1 18**] ED, she was still unresponsive and was noted to have some jerking of the right arm as well as the head. There was urinary incontinence at the time as well. She was given a total of 3 mg of Ativan and then intubated for decreased level of consciousness. She was then admitted to the Neuro ICU. On head CT, she did have a right thalamic hemorrhage with extension into the lateral ventricles as well as the third and fourth ventricles. There was some hydrocephalus as well as a 5 mm midline shift. PAST MEDICAL HISTORY: 1. Dementia during which her husband has been taking care of her for the last month including everything around the house like cleaning, cooking, bills, and shopping. She apparently still dresses herself and knows other family members. 2. Hypertension. 3. Hypercholesterolemia. 4. Diabetes. 5. History of breast cancer in [**2184**] status post lumpectomy and XRT. 6. Peripheral vascular disease status post right leg bypass. 7. Osteoarthritis. 8. Glaucoma. 9. TIAs of unclear etiology and characteristics. 10. Uterine fibroids. ALLERGIES: No known drug allergies. MEDICATIONS UPON ADMISSION: 1. Metoprolol 50 mg p.o. q.d. 2. Glyburide 2.5 mg p.o. q.d. 3. Nolvadex 10 mg p.o. b.i.d. 4. Lipitor 20 mg p.o. q.d. 5. Zestril 20 mg p.o. q.d. 6. Aspirin 81 mg p.o. q.d. 7. Tylenol prn. 8. Aleve prn. 9. Multivitamins. 10. Tums. 11. Fosamax. 12. Aricept. 13. Timolol eyedrops. SOCIAL HISTORY: She lives with her husband in [**Name (NI) **]. Her daughter and her son-in-law live in [**State 2748**]. PHYSICAL EXAM UPON PRESENTATION: Temperature was 99.8, blood pressure was 238/45. Her heart rate was 119 and regular. Her respiratory rate. Her respiratory rate was 19, and her O2 saturation was 100% prior to intubation on room air. In general, she was intubated and sedated having just received Versed. Her HEENT exam revealed moist mucous membranes with clear oropharynx. There was no scleral icterus. Her neck was supple. There were no carotid bruits appreciated. Lungs were clear bilaterally to auscultation. Heart was regular rate and rhythm with a normal S1, S2. Abdomen is soft, nontender, and nondistended. Extremities were warm and showed no edema. On neurologic examination, her mental status: She was intubated and sedated. Did not follow commands and did not open her eyes to stimulation. Cranial nerves: Pupils are equal, round, and reactive to light. The corneals were present bilaterally. There is a positive gag. There was a grimace with pain that made the face appear symmetric. Motor examination: Her left upper extremity was flaccid and not moving. Rest of the extremities had normal tone. The lower extremities appeared to be moving spontaneously bilaterally. The reflexes: Decreased in the left upper extremity initially with the rest of the extremity appearing slightly brisk, although symmetric in the lower extremities. There were no Achilles reflexes. The left toe was upgoing and the right toe was mute. Sensation: She withdrew to pain in all four extremities except for the left upper extremity. LABORATORIES UPON ADMISSION: White count was 13.6, hematocrit was 35, and platelets were 286. Her coag studies were normal. Her Chem-7 revealed a sodium of 145, glucose of 238, and bicarb of 30, otherwise was unremarkable. Cardiac enzymes were negative upon admission. HOSPITAL COURSE BY PROBLEMS: 1. Thalamic hemorrhage: The patient's level of consciousness remained fairly depressed for the first week of her hospital course, but towards the end of the first week, she started to open her eyes and although she did not follow commands, she appeared to keep her eyes open for a good deal of time. The prognosis of the patient's hemorrhage was discussed with the family in that the thalamic region controlled the level of consciousness, however, if she did regain some consciousness, she might be left only with a left-sided hemiparesis. Neurosurgery evaluated the patient in the Emergency Room upon admission, and they felt that extraventricular [**State 19843**] might be helpful in her management. One was placed with not much CSF draining and there appeared on the CAT scan to be ample room for any potential hydrocephalus to be a problem. This [**Name2 (NI) 19843**] was D/C'd on [**3-3**], and CSF cultures withdrawn from the [**Month (only) 19843**] prior to removal were negative for any infection. She also did receive some doses of Ancef prophylactically for the [**Month (only) 19843**] presence. We also explained, however, that because she had a premorbid dementia, that recovery might be less significant, that it might be otherwise suspected. Because of the level of consciousness, she remained intubated and the family decided for a trial of extubation and to see if she would be successfully extubated. On [**3-10**], she was extubated and given steroids prior to extubation to prevent laryngeal edema, but she began to have stridor, and a few hours later, the family requested that she be reintubated and this was done. Thereafter, her level of consciousness remained about the same with her eyes being open, but not following commands. The tone has increased in the left upper and lower extremities and appeared to be less responsive to stimuli than the right. The left toe remains upgoing. With regards to the right arm shaking, this was not thought to be a seizure, but she was given Dilantin prophylactically in the Emergency Room until it could be straightened out. The movement was irregular, it was coarse, and it appeared more like a tremor, but was fairly stimulus sensitive. Dilantin level was therapeutic for about three days, and it was discontinued. An EEG done during the movement revealed no electrographic seizures during this. 2. Ventilator dependence: The patient's original reason for intubation was depressed level of consciousness. The presumed etiology behind her inability to wean successfully on [**3-10**] was perhaps due to laryngeal edema. She, as mentioned, remained intubated and plans were made for tracheostomy and percutaneous endoscopic gastrostomy tube placement. She received both of these on [**2192-3-13**] without any event. Currently she was weaned off of the ventilator to just a trach mask at 40% FIO2 and has been oxygenating well. Recent chest x-ray showed some atelectasis versus consolidation in the left lower lobe, which has been present throughout the hospital course, but this does not appear to be getting worse. 3. Fever: The patient did have fevers during her first week of hospital course. These were initially treated with levofloxacin for presumed aspiration and vancomycin was later added in the case of a nosocomially acquired MRSA infection. No specific MRSA organism was ever identified and cultures from the CSF as I mentioned were negative. There were a couple of sputum samples showing gram-positive cocci in pairs, and on [**3-10**], the report on the Gram stain gram-negative rods and gram-positive rods 2+ and 3+, but the respiratory culture shows only sparse growth of oropharyngeal flora. Nevertheless, her levofloxacin was continued for a total of 11 days given the recent tracheostomy and PEG tube placement. She has been afebrile now for three days, and will not require any further antibiotic treatment at this point. In addition, it should be noted that she did have Clostridium difficile sent, which was negative as well. She did have a central line that was discontinued, and that was sent for culture, and that is also negative for organisms. Urine cultures remained negative throughout the hospital course. Communication with family: The family was updated on her prognosis and throughout the hospital course, the daughters and sons of the patient helped the husband make decisions regarding her care. Therefore, the plan is to send her to a facility that accepts tracheostomy tube care. At this time that facility is pending. They did state their wishes that if she were to ever be dependent on the ventilator, they would like to withdraw care. Code status at this point is do not resuscitate and do not intubate. DISCHARGE DIAGNOSES: 1. Right thalamic hemorrhage. 2. Pneumonia. 3. Dementia. 4. Hypertension. 5. Hypercholesterolemia. 6. History of breast cancer. 7. Diabetes. 8. Peripheral vascular disease. 9. Osteoarthritis. 10. Glaucoma. 11. Transient ischemic attacks. 12. Uterine fibroids. DISCHARGE MEDICATIONS: 1. Bisacodyl 10 mg p.o. q.d. prn constipation. 2. Tylenol 325-650 mg/elixir per G tube prn fever or pain. 3. Lisinopril 20 mg p.o. q.d., hold for blood pressure less than 100. 4. Metoprolol 150 mg p.o. t.i.d. for blood pressure control, and please hold for systolic blood pressure less than 100 and a heart rate less than 60. 5. Lansoprazole 30 mg per G tube q.d. 6. Heparin 5000 units subq b.i.d. 7. Glyburide 2.5 mg per G tube q.d. Of note, patient's Fosamax, Aricept, and Lipitor were held during this hospital admission, but there does not appear to be any contraindication to restarting these after she gets to the rehab facility. DISCHARGE CONDITION: Fair. DISCHARGE DISPOSITION: To skilled nursing facility. [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**], M.D. [**MD Number(1) 4269**] Dictated By:[**Name8 (MD) 4064**] MEDQUIST36 D: [**2192-3-14**] 12:00 T: [**2192-3-14**] 12:27 JOB#: [**Job Number 109741**]

431,507,518,331,401,272,250,478

{'Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Acute and chronic respiratory failure,Obstructive hydrocephalus,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of larynx'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Found unresponsive. PRESENT ILLNESS: This is an 83-year-old woman with a past medical history of dementia, hypertension, hypercholesterolemia, and diabetes, who was found unresponsive in bed by her husband at around 10:30 p.m. on the evening of admission, which was [**2192-3-2**]. The husband stated that she was doing well all day, but around 9 p.m., he went into the kitchen to have cereal and she did not join him in the kitchen. He went back to check on her, and she was on the bed moving only very slightly and wound not arouse. She did vomit once there. MEDICAL HISTORY: 1. Dementia during which her husband has been taking care of her for the last month including everything around the house like cleaning, cooking, bills, and shopping. She apparently still dresses herself and knows other family members. 2. Hypertension. 3. Hypercholesterolemia. 4. Diabetes. 5. History of breast cancer in [**2184**] status post lumpectomy and XRT. 6. Peripheral vascular disease status post right leg bypass. 7. Osteoarthritis. 8. Glaucoma. 9. TIAs of unclear etiology and characteristics. 10. Uterine fibroids. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She lives with her husband in [**Name (NI) **]. Her daughter and her son-in-law live in [**State 2748**]. ### Response: {'Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Acute and chronic respiratory failure,Obstructive hydrocephalus,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of larynx'}

CHIEF COMPLAINT: Delirium, hypoxia PRESENT ILLNESS: Ms. [**Known lastname 97368**] is a 75 yo female with COPD on 2L of home oxygen, with recently diagnosed PE on coumadin (INR 1.9 today), who presents to the ER from [**Hospital1 **] with acute respiratory failure as well as confusion, agitation and tremors. Her respiratory status had acutely declined. An ABG on the morning of admission on 3L O2 was 7.42/51/24 (O2 sat was 42% at that time). The pt was placed on 35% O2 by venti mask and her ABG improved to 7.45/43/74 with O2 sats of 95%. Her son states she has been confused for 4 days, confirmed by [**Hospital1 **]. She had been given ativan on day PTA for agitation (<2mg) and [**Hospital1 **] was concerned that her MS changes could be due to medication. Of note, haldol and morphine had been discontinued 2 days PTA. . She was admitted to [**Hospital1 18**] from [**Date range (2) 97369**] for left ankle fracture (medial malleolus, tibia and fibula) after a fall at home and underwent an ORIF on [**2180-12-8**]. During her hospital stay, she was intermittently delirious for a few days and her delirium at that time had been attributed to morphine use and possible ETOH withdrawal. She was also more hypoxic during that hospitalization, from a baseline of high 80s on room air to 70s on room air. She was also tachycardic at that time, so a CTA had been done and demonstrated multiple subsegmental pumonary emboli. She was treated with heparin and then d/c'd to rehab ([**Hospital1 **]) on [**2180-12-11**] on lovenox and coumadin. . Additionally, during her previous hospitalization, she was treated for a COPD flare with IV -> PO steroids, along with her baseline inhalers. Her HTN was harder to control, requiring increasing her lisinopril and adding metoprolol. She also required 2units of pRBC for a drop in Hct (is anemic at baseline). The new medications she was started on included metoprolol, haldol, protonix, warfarin, tramadol, thiamine and folate. She was not taking folic acid and thiamine at rehab. . In ED, she was placed on a nonrebreather. An ABG was 7.45/45/426. She had an abnormal UA and was started on levofloxacin for a UTI. She was also transfused 2 units of pRBC for an HCT of 22.5 (Hct on d/c [**2180-12-11**] was 30). She was admitted to the ICU for closer monitoring. MEDICAL HISTORY: # COPD - on 2L home O2 (pulmonologist Dr. [**Last Name (STitle) 23427**] at [**Hospital1 112**]) # PE - mutliple subsegmental PEs dx [**12-8**], therapeutic on coumadin # HTN - started ACE-i [**3-7**], started BB [**12-8**] # Anxiety - on imipramine # Fibrocystic breast dz # Polycystic ovarian syndrome # h/o syncope 3 years ago (negative w/u) # Left knee cyst # Osteoporosis # Complete gastric outlet obstruction in [**6-6**] # Babinski and clonus on RLE during [**12-8**] hospitalization # Anemia - chronic, has been on Fe, B12 for years # UTIs # Declining cognitive function over past year MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H as needed. 2. Albuterol Sulfate 0.083 % Solution Sig: One (1) newb Inhalation Q2H as needed for shortness of breath or wheezing. 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q6H 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 5. Enoxaparin 60 mg/0.6mL Syringe Sig: Sixty (60) mg Subcutaneous Q12H: continue until patient has been therapeutic on coumadin (INR [**1-5**]) for 48 hours. 6. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY 8. Haloperidol 1 mg Tablet Sig: 1-2 mg PO TID (3 times a day) as ALLERGIES: Penicillins PHYSICAL EXAM: PE: wt 65.3kg, 98.4, 81, 163/86, 27, 97%on 10l 50% cool neb White elderly female in mild respiratory distress. Perrl. Neck supple. Flat JVP. Distant heart sounds Poor air flow, expiratory wheezes Soft, nt, nd Left lower extremity with ecchymoses and edema compared to right. Air cast in place. Awake, oriented to person only, confused. Asking to go home. Trying to get out of bed. guaiac negative in ED Foley in place from rehab. FAMILY HISTORY: Mother c anxiety d/o, fa was alcoholic. Sister and 2 children all in psychiatric tx (details unknown). SOCIAL HISTORY: Widow. Lived alone until last admission, now has been at Rehab. Using bivalve cast at rehab. 120 pack year smoking history (quit [**2145**]). Extensive etoh use.

Obstructive chronic bronchitis with (acute) exacerbation,Cardiac arrest,Urinary tract infection, site not specified,Other pulmonary insufficiency, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Other pulmonary embolism and infarction,Aftercare for healing traumatic fracture of lower leg,Anxiety state, unspecified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Iron deficiency anemia, unspecified,Long-term (current) use of steroids

Obs chr bronc w(ac) exac,Cardiac arrest,Urin tract infection NOS,Other pulmonary insuff,Food/vomit pneumonitis,Pulm embol/infarct NEC,Aftrcre traum fx low leg,Anxiety state NOS,Delirium d/t other cond,Hypertension NOS,Iron defic anemia NOS,Long-term use steroids

Admission Date: [**2180-12-16**] Discharge Date: [**2180-12-25**] Date of Birth: [**2105-9-2**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 898**] Chief Complaint: Delirium, hypoxia Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Known lastname 97368**] is a 75 yo female with COPD on 2L of home oxygen, with recently diagnosed PE on coumadin (INR 1.9 today), who presents to the ER from [**Hospital1 **] with acute respiratory failure as well as confusion, agitation and tremors. Her respiratory status had acutely declined. An ABG on the morning of admission on 3L O2 was 7.42/51/24 (O2 sat was 42% at that time). The pt was placed on 35% O2 by venti mask and her ABG improved to 7.45/43/74 with O2 sats of 95%. Her son states she has been confused for 4 days, confirmed by [**Hospital1 **]. She had been given ativan on day PTA for agitation (<2mg) and [**Hospital1 **] was concerned that her MS changes could be due to medication. Of note, haldol and morphine had been discontinued 2 days PTA. . She was admitted to [**Hospital1 18**] from [**Date range (2) 97369**] for left ankle fracture (medial malleolus, tibia and fibula) after a fall at home and underwent an ORIF on [**2180-12-8**]. During her hospital stay, she was intermittently delirious for a few days and her delirium at that time had been attributed to morphine use and possible ETOH withdrawal. She was also more hypoxic during that hospitalization, from a baseline of high 80s on room air to 70s on room air. She was also tachycardic at that time, so a CTA had been done and demonstrated multiple subsegmental pumonary emboli. She was treated with heparin and then d/c'd to rehab ([**Hospital1 **]) on [**2180-12-11**] on lovenox and coumadin. . Additionally, during her previous hospitalization, she was treated for a COPD flare with IV -> PO steroids, along with her baseline inhalers. Her HTN was harder to control, requiring increasing her lisinopril and adding metoprolol. She also required 2units of pRBC for a drop in Hct (is anemic at baseline). The new medications she was started on included metoprolol, haldol, protonix, warfarin, tramadol, thiamine and folate. She was not taking folic acid and thiamine at rehab. . In ED, she was placed on a nonrebreather. An ABG was 7.45/45/426. She had an abnormal UA and was started on levofloxacin for a UTI. She was also transfused 2 units of pRBC for an HCT of 22.5 (Hct on d/c [**2180-12-11**] was 30). She was admitted to the ICU for closer monitoring. Past Medical History: # COPD - on 2L home O2 (pulmonologist Dr. [**Last Name (STitle) 23427**] at [**Hospital1 112**]) # PE - mutliple subsegmental PEs dx [**12-8**], therapeutic on coumadin # HTN - started ACE-i [**3-7**], started BB [**12-8**] # Anxiety - on imipramine # Fibrocystic breast dz # Polycystic ovarian syndrome # h/o syncope 3 years ago (negative w/u) # Left knee cyst # Osteoporosis # Complete gastric outlet obstruction in [**6-6**] # Babinski and clonus on RLE during [**12-8**] hospitalization # Anemia - chronic, has been on Fe, B12 for years # UTIs # Declining cognitive function over past year Social History: Widow. Lived alone until last admission, now has been at Rehab. Using bivalve cast at rehab. 120 pack year smoking history (quit [**2145**]). Extensive etoh use. Family History: Mother c anxiety d/o, fa was alcoholic. Sister and 2 children all in psychiatric tx (details unknown). Physical Exam: PE: wt 65.3kg, 98.4, 81, 163/86, 27, 97%on 10l 50% cool neb White elderly female in mild respiratory distress. Perrl. Neck supple. Flat JVP. Distant heart sounds Poor air flow, expiratory wheezes Soft, nt, nd Left lower extremity with ecchymoses and edema compared to right. Air cast in place. Awake, oriented to person only, confused. Asking to go home. Trying to get out of bed. guaiac negative in ED Foley in place from rehab. Pertinent Results: Labs on admission: WBC 17.8, Hgb 7.6, Hct 22.5, Plt 547 (diff: 95% PMNs, 2.6% L, 1.7% M) PT 16.4, PTT 35.6, INR 1.9 Na 138, K 5.2, Cl 101, HCO3 29, BUN 19, Cr 0.8, Glu 108 ALT 23, AST 23, AP 73, amylase 51, TB 0.5, CPK 280, MB 4, TropT <0.01 albumin 3.3, Ca 8.4, phos 4.5, mg 2.1 abg: 7.45/45/426, lactate 0.8 U/A: 1.015, trace leuk, large blood, >50 RBCs, [**10-22**] WBC, few bacteria, 0-2 epi Fe 52, hapto <20, ferritin 333, TRF 192, TIBC 250 B12 275, folate >20 . Pertinent labs during her hospitalization: Cardiac enzymes negative x3 on [**2180-12-23**] Retic 2.6 TSH 2.8 . Micro: [**2180-12-16**]: URINE CULTURE (Final [**2180-12-18**]): KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ KLEBSIELLA PNEUMONIAE | AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S GENTAMICIN------------ <=1 S IMIPENEM-------------- <=1 S LEVOFLOXACIN----------<=0.25 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- 64 I PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S . [**2180-12-16**]: blood cx x2 negative . [**2180-12-17**]: URINE CULTURE (Final [**2180-12-18**]): GRAM POSITIVE BACTERIA. ~3000/ML. SUGGESTING STAPHYLOCOCCI. GRAM POSITIVE BACTERIA. ~1000/ML. SECOND MORPHOLOGY SUGGESTING STAPHYLOCOCCI. . [**2180-12-17**]: blood cx x2 negative [**2180-12-23**]: urine cx <10,000 orgs/ml [**2180-12-24**]: stool cx neg for Cdiff [**2180-12-24**]: urine cx negative [**2180-12-24**]: blood cx x2 negative . Imaging: [**2180-12-16**] CXR - The heart is enlarged, but there is no definite pulmonary edema. There are emphysematous changes of the lungs. Small calcified granuloma is again demonstrated in the right upper lobe. Allowing for limitations of this study, there are no gross areas of consolidations or there is evidence for presence of pneumonia. . [**2180-12-16**] CTA - 1. The previously noted tiny nonocclusive possible pulmonary emboli within the subsegmental branches of the left lung are not as well visualized. There has been no interval extension of these, or new occlusive pulmonary emboli. 2. Tiny nodules noted within the right upper and lower lobes which are again seen. In the absence of a known primary malignancy, followup evaluation should be obtained in six months' time. . [**2180-12-16**] CT abd/pelvis - 1. No retroperitoneal hemorrhage is seen. 2. Hypodensities within the kidneys are seen, which likely represent cysts, and are better characterized on the prior exam. 3. There is an 8-mm nodule within the right lower lobe. In the absence of a known malignancy, followup evaluation should be obtained in six months' time to evaluate for interval change. . [**2180-12-16**] CT head - There is no intracranial hemorrhage or mass effect. Ventricles are symmetric, and there is no shift of normally midline structures. The [**Doctor Last Name 352**]-white matter differentiation is preserved. There is decreased attenuation in the periventricular white matter, consistent with chronic small vessel ischemic infarct. Soft tissue and osseous structures are stable in appearance. . [**2180-12-21**] L ankle XR - Status post ORIF of bimalleolar fracture with some callus healing. . [**2180-12-21**] LLE U/S - No evidence of left lower extremity deep vein thrombosis. . [**2180-12-22**] CXR - Unchanged mild cardiomegaly. A small calcified granuloma is again seen in the right upper lobe. There is no pneumothorax. There is no evidence of pleural effusion. There are no areas of consolidations. Ther is no evidence of pneumonia. . [**2180-12-24**] CXR - The cardiac silhouette and mediastinum is unchanged. There of calcifications of the thoracic aorta. A calcified granuloma is seen within the right mid lung zone. There is no evidence for focal infiltrates. Calcifications are seen at the right base as well. There is no signs of pulmonary edema. No interval change since the previous study. No definite evidence for acute cardiopulmonary process. Brief Hospital Course: 75yo F w/ COPD, recent DVTs/PEs now on anticoagulation, and recent L ORIF for ankle fx, comes in with delirium and hypoxic respiratory distress likely due to a UTI and COPD exacerbation/anemia respectively. . # COPD - On admission, Ms. [**Known lastname 97368**] was started on IV steroids for hypoxia/COPD flare. Once her respiratory status appeared stable, she was switched to PO prednisone and placed on a two week taper to be completed as an outpatient. She was continued on her nebulizers (albuterol and ipratroprium RTC). She was given combivent inhalers to be used prn for SOB with exertion as well as her flovent inhaler [**Hospital1 **]. When she became acutely agitated, or with any type of activity, she frequently dropped her O2 sats to the low 80s/high 70s. She was continued on oxygen via nasal canula with a stable O2 requirement at rest. . # ANEMIA - Ms. [**Known lastname 97368**] had a chronic anemia, for which she has been on iron and B12 in the past. On admission, however, her Hct was 22.5, which was down from her discharge Hct of 30 a week prior. Labs on admission were suspicious for hemolysis (low haptoglobin and high LDH), but a full workup could not be done because the patient was given a transfusion in the ER. Her coumadin was held on admission and she was put on a heparin gtt (for nonocclusive bilateral PEs found during her last admission). Her stools were guaiac negative and she had no overt signs of bleeding. She was noted to have a large ecchymosis on the posterior aspect of her L leg, likely from her anticoagulation and compression from her cast. An U/S of her LLE was negative for hematoma. After receiving 2u pRBC, her Hct bumped to 30.9, but then trended back down to 24.2. She was given an additional 1u pRBC and orthopedics was consulted to see if it was possible that she was losing blood into her leg. Orthopedics did not feel that she had an active bleed into her leg. Heme-Onc was consulted to see if she could be hemolyzing after her transfusions, but the patient refused to speak to the attending hematologist. It was felt that hemolysis was unlikely based on her labwork, but that she should have a GI workup to r/o an occult malignancy (which she adamantly refused). Per heme's recommendations, she was started on B12 injections and PO tablets. She was transfused up to a Hct of 31 during the final 24 hours before she coded. . # DELIRIUM/AGITATION - Her delirium on admission was likely multifactorial, with UTI, medication changes, and hypoxia being the main components. We treated her UTI with levofloxacin originally, then switched to Bactrim once sensitivities were known. Her hypoxia improved with treatment of her COPD. We attempted to control her pain with non-narcotic medications like tylenol and tramadol, but she did require some prn doses of oxycodone for L foot and hip pain. She was given oxycodone and ativan for L thigh pain, and that made her intermittently delirious. The team then decided not to give any narcotics to her as she seemed very sensitive to them. She was given IV haldol when she was agitated. However, she continued to remain agitated and began to have episodes where she would become acutely tachypneic and breathe very shallowly through her mouth, hyperventilating. Her sat's would drop to the mid 70's. Talking with the patient to help her relax and reassuring her seemed to work best during these episodes, and her O2 sats would improve back to the mid 90's with no other intervention. Psych was consulted and suggested that she not receive any benzodiazepines but to place her on standing Haldol four times daily. Her response to haldol was mixed. Her mental status continued to fluctuate between alertness, somnolence, and agitation, but overall it was felt that she was more alert and awake with fewer episodes of acute agitation while taking haldol. Her ECGs did not show any QTc prolongation with the haldol. . # UTI - Her urine culture from admission grew Klebsiella, which was virtually pansensitive. She was started on levaquin originally, then was switched to Bactrim once sensitivities were known. She was later switched back to Levaquin and then to clindamycin as the orthopedics team wanted to insure coverage of any possible skin flora that might be involving her L ankle incision. . # HTN - Her antihypertensives were held on admission due to her mental status changes and concern for infection. Once her mental status cleared, she was restarted on lisinopril. She was not restarted on a beta-blocker as it was felt that it could be worsening her COPD symptoms. . # PULMONARY EMBOLI - CT scan during her last admission found multiple bilateral nonocclusive PEs, which were still visualized on repeat imaging during this hospitalization. On admission, her coumadin was held ([**1-4**] her Hct of 22.5) and she was put on a heparin gtt for anticoagulation. She was restarted on coumadin 5mg PO QHS with a lovenox bridge until her INR was therapeutic (goal [**1-5**]). . # h/o ETOH USE: Ms. [**Known lastname 97368**] had a h/o of heavy EtOH use, but since she came from rehab, it was not felt necessary to place her on a CIWA scale for withdrawal. She was given thiamine, folate and MVI daily. . # L BIMALLEOLAR FRACTURE: Orthopedics were consulted as Ms. [**Known lastname 97368**] had extensive ecchymosis and swelling in her LLE. They removed her cast and gave her a bigger bivalve cast to accomodate her swelling. U/S was performed and was negative for DVT and for gross hematoma formation. An XR was also performed and showed early signs of healing. She was advised to remain non-weight bearing on that foot. PT was made aware of that recommendation. They also recommended changing her antibiotic to clindamycin, in case of a mild infection at the incision site of her L ankle fracture. . # PPX: She was given a PPI for ? GI bleed. She was on an insulin sliding scale while in the ICU for tight glycemic control, but it was discontinued once she was transferred out to the floor. She was given an aggressive bowel regimen to prevent constipation. For anticoagulation, she was originally started on a heparin gtt and was then switched to lovenox as a bridge to therapeutic INR (goal [**1-5**]) on coumadin. She was also put on fall precautions given her recent ankle fracture and cast. . # FEN: She was given a regular, cardiac, heart healthy diet. No IVF were needed. Her electrolytes were checked daily and repleted prn. . # CODE - At 0348 on [**2180-12-25**], Ms. [**Known lastname 97368**] was found to be in respiratory arrest. The nurse described her as cyanotic and pulseless. A code blue was called and CPR was initiated. She was intubated by anesthesia who found a large amount of emesis in her pharynx and trachea. She was given atropine and epinephrine x2 without any effect. Central access was obtained through femoral vein. Another two rounds of epinephrine and atropine were given with establishment of a wide complex rhythm. Bicarbonate (1 amp) x2 given x2, along with IVF (NS) wide open. At that time, breath sounds were felt to be decreased on the left side. Intubation had been confirmed by direct visualization. Needle thoracentesis decompression was attempted x2 without success. At 4:12am, after being unable to establish a pulse or a viable rhtyhm, the code was called. Immediate cause of death was cardiopulmonary arrest, felt to be due to hypoxia. Ms. [**Known lastname 97370**] family was contact[**Name (NI) **] and declined an autopsy. Medications on Admission: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H as needed. 2. Albuterol Sulfate 0.083 % Solution Sig: One (1) newb Inhalation Q2H as needed for shortness of breath or wheezing. 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q6H 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 5. Enoxaparin 60 mg/0.6mL Syringe Sig: Sixty (60) mg Subcutaneous Q12H: continue until patient has been therapeutic on coumadin (INR [**1-5**]) for 48 hours. 6. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY 8. Haloperidol 1 mg Tablet Sig: 1-2 mg PO TID (3 times a day) as needed for severe agitation or confusion. 9. Imipramine HCl 25 mg Tablet Sig: Four (4) Tablet PO BID 10. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H 11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY 12. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID 13. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain: Please hold if sedated. 14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H 15. Prednisone 20 mg day 6 of taper 16. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY 17. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 18. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. Discharge Medications: Not applicable Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Cardiopulmonary arrest Discharge Condition: Expired Discharge Instructions: Not applicable Followup Instructions: Not applicable

491,427,599,518,507,415,V541,300,293,401,280,V586

{'Obstructive chronic bronchitis with (acute) exacerbation,Cardiac arrest,Urinary tract infection, site not specified,Other pulmonary insufficiency, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Other pulmonary embolism and infarction,Aftercare for healing traumatic fracture of lower leg,Anxiety state, unspecified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Iron deficiency anemia, unspecified,Long-term (current) use of steroids'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Delirium, hypoxia PRESENT ILLNESS: Ms. [**Known lastname 97368**] is a 75 yo female with COPD on 2L of home oxygen, with recently diagnosed PE on coumadin (INR 1.9 today), who presents to the ER from [**Hospital1 **] with acute respiratory failure as well as confusion, agitation and tremors. Her respiratory status had acutely declined. An ABG on the morning of admission on 3L O2 was 7.42/51/24 (O2 sat was 42% at that time). The pt was placed on 35% O2 by venti mask and her ABG improved to 7.45/43/74 with O2 sats of 95%. Her son states she has been confused for 4 days, confirmed by [**Hospital1 **]. She had been given ativan on day PTA for agitation (<2mg) and [**Hospital1 **] was concerned that her MS changes could be due to medication. Of note, haldol and morphine had been discontinued 2 days PTA. . She was admitted to [**Hospital1 18**] from [**Date range (2) 97369**] for left ankle fracture (medial malleolus, tibia and fibula) after a fall at home and underwent an ORIF on [**2180-12-8**]. During her hospital stay, she was intermittently delirious for a few days and her delirium at that time had been attributed to morphine use and possible ETOH withdrawal. She was also more hypoxic during that hospitalization, from a baseline of high 80s on room air to 70s on room air. She was also tachycardic at that time, so a CTA had been done and demonstrated multiple subsegmental pumonary emboli. She was treated with heparin and then d/c'd to rehab ([**Hospital1 **]) on [**2180-12-11**] on lovenox and coumadin. . Additionally, during her previous hospitalization, she was treated for a COPD flare with IV -> PO steroids, along with her baseline inhalers. Her HTN was harder to control, requiring increasing her lisinopril and adding metoprolol. She also required 2units of pRBC for a drop in Hct (is anemic at baseline). The new medications she was started on included metoprolol, haldol, protonix, warfarin, tramadol, thiamine and folate. She was not taking folic acid and thiamine at rehab. . In ED, she was placed on a nonrebreather. An ABG was 7.45/45/426. She had an abnormal UA and was started on levofloxacin for a UTI. She was also transfused 2 units of pRBC for an HCT of 22.5 (Hct on d/c [**2180-12-11**] was 30). She was admitted to the ICU for closer monitoring. MEDICAL HISTORY: # COPD - on 2L home O2 (pulmonologist Dr. [**Last Name (STitle) 23427**] at [**Hospital1 112**]) # PE - mutliple subsegmental PEs dx [**12-8**], therapeutic on coumadin # HTN - started ACE-i [**3-7**], started BB [**12-8**] # Anxiety - on imipramine # Fibrocystic breast dz # Polycystic ovarian syndrome # h/o syncope 3 years ago (negative w/u) # Left knee cyst # Osteoporosis # Complete gastric outlet obstruction in [**6-6**] # Babinski and clonus on RLE during [**12-8**] hospitalization # Anemia - chronic, has been on Fe, B12 for years # UTIs # Declining cognitive function over past year MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H as needed. 2. Albuterol Sulfate 0.083 % Solution Sig: One (1) newb Inhalation Q2H as needed for shortness of breath or wheezing. 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q6H 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 5. Enoxaparin 60 mg/0.6mL Syringe Sig: Sixty (60) mg Subcutaneous Q12H: continue until patient has been therapeutic on coumadin (INR [**1-5**]) for 48 hours. 6. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY 8. Haloperidol 1 mg Tablet Sig: 1-2 mg PO TID (3 times a day) as ALLERGIES: Penicillins PHYSICAL EXAM: PE: wt 65.3kg, 98.4, 81, 163/86, 27, 97%on 10l 50% cool neb White elderly female in mild respiratory distress. Perrl. Neck supple. Flat JVP. Distant heart sounds Poor air flow, expiratory wheezes Soft, nt, nd Left lower extremity with ecchymoses and edema compared to right. Air cast in place. Awake, oriented to person only, confused. Asking to go home. Trying to get out of bed. guaiac negative in ED Foley in place from rehab. FAMILY HISTORY: Mother c anxiety d/o, fa was alcoholic. Sister and 2 children all in psychiatric tx (details unknown). SOCIAL HISTORY: Widow. Lived alone until last admission, now has been at Rehab. Using bivalve cast at rehab. 120 pack year smoking history (quit [**2145**]). Extensive etoh use. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Cardiac arrest,Urinary tract infection, site not specified,Other pulmonary insufficiency, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Other pulmonary embolism and infarction,Aftercare for healing traumatic fracture of lower leg,Anxiety state, unspecified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Iron deficiency anemia, unspecified,Long-term (current) use of steroids'}

CHIEF COMPLAINT: fall PRESENT ILLNESS: HPI: 55 y/o male with PMH significant for seizures thought to be dueto perinatal hypoxia, mild mental retardation, and probable sleep apnea presents to ED following fall. His seizures began at age 5 and were characterized as generalized tonic clonic with associated urinary incontinence and occasional falls. He had poor seizure control throughout his childhood. He was started on tegretol at around age 30, after which he was seizure free until [**2178-7-13**]. It is unclear what triggered seizure recurrence at that time, but since then the seizures became progressively more frequent. Previous MRI showed a small left frontal lesion c/w prior trauma or cavernous angioma. Initially, he had presented to the ED with fall secondary to seizure and his tegretol was increased; after another seizure within that month,he was started on neurontin as well, which was increased to 900mg daily. Over the course of the next 6 months, the tegretol was increased from 1200mg daily (his dose over the 20 years seizure-free) to 2200mg daily. He continued to have seizures and was started on keppra, which was titrated up to 3500mg daily. Tegretol was then decreased for concern that it could be exacerbating his seizures. In [**2180-4-11**] he was admitted for LTM and medication adjustment. He was found on EEG to have "frequent bursts of generalized spike and slow wave discharges, predominant in the bilateral frontal and parasagittal regions, suggestive of a primary generalized epilepsy." Today the patient was attending a Red Sox game when he fell backwards, striking his head. Seizure activity was witnessed by a bystander, and he was transferred to [**Hospital1 18**] ED for evaluation. MEDICAL HISTORY: Seizures as above. Has been on phenobarbital and tegretol in the past and possibly other meds per his father. MEDICATION ON ADMISSION: Medications - Prescription CARBAMAZEPINE [TEGRETOL] - 200 mg Tablet - 1 Tablet(s) by mouth 8/d No substitute; brand name medically necessary - No Substitution LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth 8/day ZONISAMIDE [ZONEGRAN] - 100 mg Capsule - 1 Capsule(s) by mouth 6/d - No Substitution ALLERGIES: Dilantin PHYSICAL EXAM: Gen:NAD. HEENT:MMM. Sclera clear. OP clear CV: RRR, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally Ext:No cyanosis/edema FAMILY HISTORY: No seizures in the family. SOCIAL HISTORY: Lives alone. Works as courier for law firm. His father is involved in his medical care. He denies EtOH and tobacco use.

Closed fracture of base of skull with cerebral laceration and contusion, unspecified state of consciousness,Cerebral edema,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Mild intellectual disabilities,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),History of fall,Pain in joint, shoulder region,Other specified cardiac dysrhythmias

Cl skl base fx/cereb lac,Cerebral edema,Fall NOS,Epilep NOS w/o intr epil,Mild intellect disabilty,Obstructive sleep apnea,BPH w/o urinary obs/LUTS,Personal history of fall,Joint pain-shlder,Cardiac dysrhythmias NEC

Admission Date: [**2181-5-19**] Discharge Date: [**2181-5-27**] Date of Birth: [**2126-2-24**] Sex: M Service: NEUROLOGY Allergies: Dilantin Attending:[**First Name3 (LF) 11344**] Chief Complaint: fall Major Surgical or Invasive Procedure: none History of Present Illness: HPI: 55 y/o male with PMH significant for seizures thought to be dueto perinatal hypoxia, mild mental retardation, and probable sleep apnea presents to ED following fall. His seizures began at age 5 and were characterized as generalized tonic clonic with associated urinary incontinence and occasional falls. He had poor seizure control throughout his childhood. He was started on tegretol at around age 30, after which he was seizure free until [**2178-7-13**]. It is unclear what triggered seizure recurrence at that time, but since then the seizures became progressively more frequent. Previous MRI showed a small left frontal lesion c/w prior trauma or cavernous angioma. Initially, he had presented to the ED with fall secondary to seizure and his tegretol was increased; after another seizure within that month,he was started on neurontin as well, which was increased to 900mg daily. Over the course of the next 6 months, the tegretol was increased from 1200mg daily (his dose over the 20 years seizure-free) to 2200mg daily. He continued to have seizures and was started on keppra, which was titrated up to 3500mg daily. Tegretol was then decreased for concern that it could be exacerbating his seizures. In [**2180-4-11**] he was admitted for LTM and medication adjustment. He was found on EEG to have "frequent bursts of generalized spike and slow wave discharges, predominant in the bilateral frontal and parasagittal regions, suggestive of a primary generalized epilepsy." Today the patient was attending a Red Sox game when he fell backwards, striking his head. Seizure activity was witnessed by a bystander, and he was transferred to [**Hospital1 18**] ED for evaluation. Past Medical History: Seizures as above. Has been on phenobarbital and tegretol in the past and possibly other meds per his father. Social History: Lives alone. Works as courier for law firm. His father is involved in his medical care. He denies EtOH and tobacco use. Family History: No seizures in the family. Physical Exam: Gen:NAD. HEENT:MMM. Sclera clear. OP clear CV: RRR, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally Ext:No cyanosis/edema Neurologic examination: Mental status: Awake and alert, cooperative with exam, easily distactable Orientation: Oriented to person, place, not date. Perseverates constantly. Attention: DOWF, not backwards, inattentive. Language: Minimally fluent with moderate comprehension. Naming decreased. Moderate dysarthria. Repeats 3 words only. Follows simple commands, but not always. Unaware of new deficits. Cranial Nerves: I: not tested II: Pupils equally round and reactive to light, 4 to 3 mm bilaterally. Visual fields are full to finger movement. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric, although poor cooperation. VIII: Hearing intact grossly IX, X: Palatal elevation symmetrical [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations, intact movements Motor: Normal bulk and tone bilaterally No tremor No obvious strength asymmetry, but he won't cooperate with formal exam. Sensation: Intact to light touch grossly. Reflexes: B T Br Pa Ankle Right 2 3 2 2 2 Left 2 3 2 2 2 Toes were mute bilaterally Coordination: Normal on finger-nose-finger, won't do other tests Gait:Not tested Pertinent Results: CT head [**5-19**]: IMPRESSION: 1. Unchanged appearance of bifrontal hemorrhagic contusion, left greater than right. 2. Unchanged small subdural hematomas overlying the convexities bilaterally, but slightly increased subdural blood now seen along the tentorium. 3. Unchanged diffuse cerebral edema, but unchanged ventricular size. 4. Unchanged non-displaced occipital bone fracture. [**5-21**]: Head CT: IMPRESSION: 1. Evolution of bilateral frontotemporal hemorrhagic contusions. 2. No change in small foci of subarachnoid hemorrhage of bilateral frontal and parietal lobes. 3. Nondisplaced occipital fracture redemonstrated CT torso: IMPRESSION: 1. Minimal areas of ground-glass opacity in the upper lobes bilaterally, which may represent tiny areas of contusion. 2. No other evidence for acute injury in the chest, abdomen, or pelvis. Left shoulder: Three views of the left shoulder do not include axillary projection. This exam is normal without fracture, dislocation, diminution in the acromio-humeral soft tissues, or joint space narrowing. Right shoulder: Bony fragment at the AC joint could represent small fracture of the acromion, but may also represent degenerative change. On re-review by radiology, it was felt to chronic in nature, not acute. [**2181-5-19**] 03:00PM BLOOD WBC-8.8 RBC-4.61 Hgb-14.3 Hct-42.6 MCV-92 MCH-31.0 MCHC-33.6 RDW-13.6 Plt Ct-337 [**2181-5-19**] 03:00PM BLOOD PT-12.8 PTT-21.2* INR(PT)-1.1 [**2181-5-19**] 03:00PM BLOOD Glucose-123* UreaN-19 Creat-1.1 Na-142 K-4.4 Cl-109* HCO3-24 AnGap-13 [**2181-5-19**] 03:00PM BLOOD Calcium-9.1 Phos-3.5 Mg-2.2 [**2181-5-19**] 03:00PM BLOOD ASA-NEG Ethanol-NEG Carbamz-12.7* Acetmnp-5.3 Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2181-5-20**] 02:51AM BLOOD Carbamz-8.1 [**2181-5-24**] 06:33AM BLOOD Carbamz-6.2 Brief Hospital Course: Mr. [**Known lastname 10675**] was admitted after a seizure and a fall. He has fairly large bilateral frontal contusions which were stable on most recent CT head on [**5-21**]. There was no other trauma found on torso CT. He is complaining of bilateral shoulder pain, but there is no fracture on X-ray, and this is likely musculoskeletal in nature. From a trauma standpoint, he is stable, but needs a follow-up visit with neurosurgery in 4 weeks, with a head CT that day. His injury has left him fairly frontally limited, with frequent perseveration and he is not always oriented to place/date. He follows commands most of the time, but not always. We expect this will continue to improve over time. He is sleepy, but easily arouses to voice. His C-spine was cleared by CT and MRI and his collar was removed. He'll need a 4 week f/u with neurosurgery as in d/c paperwork. From a seizure standpoint, his home anticonvulsants were continued at their typical doses. He was monitored on EEG telemetry and wasn't found to have subclinical or clinical seizures. He does have an abnormal EEG, but this he has had at baseline. He may need his antiepileptics changed in the future and should f/u with his neurologist at the [**Hospital1 **], Dr. [**Last Name (STitle) 2442**]. He was bradycardic in the 50s (and at times high 40s) during his stay. His BP was low normal throughout and he wasn't symptomatic from this at all. The telemetry was reviewed by cardiology who felt it was consistent with sinus bradycardia and did not need additional inpatient work-up. He's had outpt Holter already in the past. Tegretol can cause bradycardia, but his levels are on the low side and this is not felt ot be contributing to his current HR issues. He can f/u as an outpt with cardiology after d/c from rehab if this bradycardia continues and they may consider options such as implantable monitor if needed. Overall though, his known seizure disorder is to blame for his episodes. Medications on Admission: Medications - Prescription CARBAMAZEPINE [TEGRETOL] - 200 mg Tablet - 1 Tablet(s) by mouth 8/d No substitute; brand name medically necessary - No Substitution LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth 8/day ZONISAMIDE [ZONEGRAN] - 100 mg Capsule - 1 Capsule(s) by mouth 6/d - No Substitution Medications - OTC CALCIUM CITRATE-VITAMIN D3 [CITRACAL + D] - 315 mg-200 unit Tablet - 2 Tablet(s) by mouth [**Hospital1 **] with meals --------------- --------------- --------------- --------------- All: dilantin -> rash Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 3. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg PO BID (2 times a day). 4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml Injection TID (3 times a day). 5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed. 7. Levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO BID (2 times a day): BRAND NAME ONLY. 8. Carbamazepine 200 mg Tablet Sig: Two (2) Tablet PO QID (4 times a day): BRAND NAME ONLY. 9. Zonisamide 100 mg Capsule Sig: Six (6) Capsule PO HS (at bedtime): BRAND NAME ONLY. 10. Ondansetron 4 mg IV Q8H:PRN 11. Citracal + D 315-200 mg-unit Tablet Sig: Two (2) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Traumatic brain injury cervical stenosis Seizure Disorder Discharge Condition: neurologically stable. Fairly perseverative and oriented to self and occasionally place. No obvious gross motor deficits, but will not perform full exam. Complains of bilateral shoulder pain, but X-rays are normal. Discharge Instructions: Please call your PCP or return to the ED if you have any new seizures, vision changes, dizziness, or falls. Followup Instructions: PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.[**First Name (STitle) **] TO BE SEEN IN 4 WEEKS. YOU WILL NEED A CAT SCAN OF THE BRAIN WITH OR WITHOUT CONTRAST, Please tell the secretary this when you call to schedule. --- Pls see your PCP after discharge from rehab. --- You need to follow-up with your seizure doctor, Dr. [**Last Name (STitle) 2442**] at [**Telephone/Fax (1) 5563**] after you are discharged from rehab. Name: [**Known lastname 10151**],[**Known firstname 2892**] Unit No: [**Numeric Identifier 10152**] Admission Date: [**2181-5-19**] Discharge Date: [**2181-5-27**] Date of Birth: [**2126-2-24**] Sex: M Service: NEUROLOGY Allergies: Dilantin Attending:[**First Name3 (LF) 3824**] Addendum: Note: Pt would benefit greatly by a helmet for when he is up and walking around given his frequent falls. This was not able to be arranged here, but if possible at rehab he should have a helmet fitted and ordered. Discharge Disposition: Extended Care Facility: [**Hospital6 41**] - [**Location (un) 42**] [**Name6 (MD) **] [**Last Name (NamePattern4) 3826**] MD [**MD Number(1) 3827**] Completed by:[**2181-5-26**]

801,348,E888,345,317,327,600,V158,719,427

{'Closed fracture of base of skull with cerebral laceration and contusion, unspecified state of consciousness,Cerebral edema,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Mild intellectual disabilities,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),History of fall,Pain in joint, shoulder region,Other specified cardiac dysrhythmias'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: fall PRESENT ILLNESS: HPI: 55 y/o male with PMH significant for seizures thought to be dueto perinatal hypoxia, mild mental retardation, and probable sleep apnea presents to ED following fall. His seizures began at age 5 and were characterized as generalized tonic clonic with associated urinary incontinence and occasional falls. He had poor seizure control throughout his childhood. He was started on tegretol at around age 30, after which he was seizure free until [**2178-7-13**]. It is unclear what triggered seizure recurrence at that time, but since then the seizures became progressively more frequent. Previous MRI showed a small left frontal lesion c/w prior trauma or cavernous angioma. Initially, he had presented to the ED with fall secondary to seizure and his tegretol was increased; after another seizure within that month,he was started on neurontin as well, which was increased to 900mg daily. Over the course of the next 6 months, the tegretol was increased from 1200mg daily (his dose over the 20 years seizure-free) to 2200mg daily. He continued to have seizures and was started on keppra, which was titrated up to 3500mg daily. Tegretol was then decreased for concern that it could be exacerbating his seizures. In [**2180-4-11**] he was admitted for LTM and medication adjustment. He was found on EEG to have "frequent bursts of generalized spike and slow wave discharges, predominant in the bilateral frontal and parasagittal regions, suggestive of a primary generalized epilepsy." Today the patient was attending a Red Sox game when he fell backwards, striking his head. Seizure activity was witnessed by a bystander, and he was transferred to [**Hospital1 18**] ED for evaluation. MEDICAL HISTORY: Seizures as above. Has been on phenobarbital and tegretol in the past and possibly other meds per his father. MEDICATION ON ADMISSION: Medications - Prescription CARBAMAZEPINE [TEGRETOL] - 200 mg Tablet - 1 Tablet(s) by mouth 8/d No substitute; brand name medically necessary - No Substitution LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth 8/day ZONISAMIDE [ZONEGRAN] - 100 mg Capsule - 1 Capsule(s) by mouth 6/d - No Substitution ALLERGIES: Dilantin PHYSICAL EXAM: Gen:NAD. HEENT:MMM. Sclera clear. OP clear CV: RRR, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally Ext:No cyanosis/edema FAMILY HISTORY: No seizures in the family. SOCIAL HISTORY: Lives alone. Works as courier for law firm. His father is involved in his medical care. He denies EtOH and tobacco use. ### Response: {'Closed fracture of base of skull with cerebral laceration and contusion, unspecified state of consciousness,Cerebral edema,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Mild intellectual disabilities,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),History of fall,Pain in joint, shoulder region,Other specified cardiac dysrhythmias'}

CHIEF COMPLAINT: GIB PRESENT ILLNESS: [**Age over 90 **] y.o. female with multiple medical problems, most pertinent for a history of diverticulosis and diverticulitis, transferred from [**Hospital3 7571**]Hospital with for further management of a GIB. Patient was admitted to [**Hospital3 7571**]Hospital on [**6-22**] with BRBPR and a Hct of 23, for which she received 4 units of PRBCs. Her Hct increased to 30 with this intervention and she remained stable for the remainder of [**6-22**] and [**6-23**]. During this time, GI and surgery were consulted and plans from both perspectives were supportive care/conservative management, particularly as she was not felt to be a surgical candidate and the patient refused. On [**6-24**], patient's Hct was noted to drop to 23 and she began to have continuous BRBPR. She remained normotensive and was not tachycardic despite these intermittent GI bleeds. She received one unit of PRBCS and an RBC scan was performed, which reportedly showed bleeding at the splenic flexure. Patient received an additional unit of PRBCs while in route to [**Hospital1 18**] for further management. MEDICAL HISTORY: CAD s/p PCI Hypertension Anemia History of urinary retention and recurrent UTIs Hypothyroidism Depression GERD Osteoporosis Glaucoma TAH and bladder lift Ataxia ([**1-31**] peripheral neuropathy) Nephrolithiasis History of C. diff colitis CCY Atrial fibrillation MEDICATION ON ADMISSION: Timolol gtt QD Levothyroxine 100 mcg PO QD Amiodarone 100 mg PO QD Aspirin 81 mg PO QD Celexa 20 mg PO QD MVI PO QD Omeprazole 20 mg PO QD Preservision 2 capsules PO QD Vitamin D 50,000 TU PO Qmonth (on the 28th) Vitamin B12 injection Qmonth (on the 16th) Brimonidine 0.2% gtt [**Hospital1 **] Calcium Carbonate 500 mg PO BID Senna 2 tabs PO BID Natural Balance Tear Drops 1 drop R eye QID Sodium Chloride 5% solution 1 drop L eye QID Desipramine 10 mg PO QHS [**Doctor First Name **] 180 mg PO QHS ALLERGIES: Levofloxacin PHYSICAL EXAM: VS: T - 97.6, BP - 133/67, HR - 70, RR - 18, O2 - 96% RA GEN: Awake, alert, well-related, NAD HEENT: NC/AT; PERRLA, EOMI, conjuctival pallor; OP clear, dry mucous membranes CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, inspiratory crackles at left base ABD: soft, NT, ND, + BS, no HSM Rectal: Maroon-colored, guaiac positive stool EXT: warm, dry, +2 distal pulses BL FAMILY HISTORY: NC SOCIAL HISTORY: Denies history of tobacco, alcohol or illicit drug use

Hemorrhage of gastrointestinal tract, unspecified,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of colon,Constipation, unspecified,Unspecified essential hypertension,Atrial fibrillation,Esophageal reflux,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Percutaneous transluminal coronary angioplasty status

Gastrointest hemorr NOS,Hyposmolality,Ac posthemorrhag anemia,Dvrtclo colon w/o hmrhg,Benign neoplasm lg bowel,Constipation NOS,Hypertension NOS,Atrial fibrillation,Esophageal reflux,Osteoporosis NOS,Hypothyroidism NOS,Status-post ptca

Admission Date: [**2156-6-24**] Discharge Date: [**2156-7-1**] Service: MEDICINE Allergies: Levofloxacin Attending:[**First Name3 (LF) 603**] Chief Complaint: GIB Major Surgical or Invasive Procedure: Colonoscopy History of Present Illness: [**Age over 90 **] y.o. female with multiple medical problems, most pertinent for a history of diverticulosis and diverticulitis, transferred from [**Hospital3 7571**]Hospital with for further management of a GIB. Patient was admitted to [**Hospital3 7571**]Hospital on [**6-22**] with BRBPR and a Hct of 23, for which she received 4 units of PRBCs. Her Hct increased to 30 with this intervention and she remained stable for the remainder of [**6-22**] and [**6-23**]. During this time, GI and surgery were consulted and plans from both perspectives were supportive care/conservative management, particularly as she was not felt to be a surgical candidate and the patient refused. On [**6-24**], patient's Hct was noted to drop to 23 and she began to have continuous BRBPR. She remained normotensive and was not tachycardic despite these intermittent GI bleeds. She received one unit of PRBCS and an RBC scan was performed, which reportedly showed bleeding at the splenic flexure. Patient received an additional unit of PRBCs while in route to [**Hospital1 18**] for further management. Past Medical History: CAD s/p PCI Hypertension Anemia History of urinary retention and recurrent UTIs Hypothyroidism Depression GERD Osteoporosis Glaucoma TAH and bladder lift Ataxia ([**1-31**] peripheral neuropathy) Nephrolithiasis History of C. diff colitis CCY Atrial fibrillation Social History: Denies history of tobacco, alcohol or illicit drug use Family History: NC Physical Exam: VS: T - 97.6, BP - 133/67, HR - 70, RR - 18, O2 - 96% RA GEN: Awake, alert, well-related, NAD HEENT: NC/AT; PERRLA, EOMI, conjuctival pallor; OP clear, dry mucous membranes CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, inspiratory crackles at left base ABD: soft, NT, ND, + BS, no HSM Rectal: Maroon-colored, guaiac positive stool EXT: warm, dry, +2 distal pulses BL Pertinent Results: EKG: Sinus at rate of 60 with prolonged PR, borderline QRS, nl QT, LAD, poor R wave progression, TWF in V1, V2, V3, no STE, no STD; Unchanged from prior . Brief Hospital Course: [**Age over 90 **] y.o. female with multiple medical problems, transferred from OSH with persistent GIB. . # GIB: Pt was initially admitted to the ICU for serial hct monitoring and pending colonoscopy by GI. Colonoscopy was performed which revealed 2 polyps and diverticulosis with old blood, but no active bleeding was visualized. Patient remained hemodynamically stable (with respect to heart rate and blood pressure) despite several episodes of rebleed. Tagged RBC scan was performed twice in the setting of active rebleed, however they failed to reveal a clear source of bleed. Her hct was monitored serially and she was transfused supportively with a total of 5 units of pRBCs. Her last episode of BRBPR was on [**2156-6-28**]. She will need daily CBC and if hematocrit drops below 25 or she has BRBPR she should be evaluated immediately and transfused. She would need interventional radiology assessment for possible embolization procedure. . # Leukocytosis: She presented with a leukocytosis of 17K with only mild neutrophil predominance of 80%. It was thought to be most likely from GI bleed/stress response as she had no history of fever and no localizing signs/symptoms of infection. UA was negative, CXR did not reveal any infiltrate. Urine culture was negative. . # CAD: She had no chest pain and EKG was without ischemic changes even in setting of her anemia and acute blood loss. Cardiac enzymes were cycled on presentation, which were negative. TTE on [**6-25**] showed preserved EF, mild LVH, and mild pulm htn (27mmHg). Her aspirin was held in the setting of GI bleed, this was restarted at 81mg daily upon discharge. She was not on beta blocker, statin, nor ACEI on presentation. Fasting lipids were checked, which were within normal limits. . # Urinary Retention: Patient was transferred without foley and Urology was consulted for foley placement due to difficulty identifying the urethral meatus. . # Hypothyroidism: She was continued on her outpatient synthroid dose of 100mcg daily. . # Atrial fibrillation: She remained in NSR on amiodarone. Her CHADS2 score was 2, with <3% yearly risk of stroke due to emboli from A fib. She was not anticoagulated in the setting of bleeding diathesis during her hospital stay, however, anticoagulation should be considered as an outpatient, she was discharged on 81mg of aspirin daily. . # Depression: She was continued on outpatient antidepressants. . # GERD: Continued on PPI. . # Glaucoma: Continued outpatient timolol and brimonidine eye drops. . # Osteoporosis: Continue calcium carbonate and she received her weekly vitamin D on [**2156-6-26**]. . # CODE: DNR/DNI confirmed with patient on arrival. Medications on Admission: Timolol gtt QD Levothyroxine 100 mcg PO QD Amiodarone 100 mg PO QD Aspirin 81 mg PO QD Celexa 20 mg PO QD MVI PO QD Omeprazole 20 mg PO QD Preservision 2 capsules PO QD Vitamin D 50,000 TU PO Qmonth (on the 28th) Vitamin B12 injection Qmonth (on the 16th) Brimonidine 0.2% gtt [**Hospital1 **] Calcium Carbonate 500 mg PO BID Senna 2 tabs PO BID Natural Balance Tear Drops 1 drop R eye QID Sodium Chloride 5% solution 1 drop L eye QID Desipramine 10 mg PO QHS [**Doctor First Name **] 180 mg PO QHS Discharge Medications: 1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 4. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic DAILY (Daily). 5. Amiodarone 200 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 8. Desipramine 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 9. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-31**] Drops Ophthalmic PRN (as needed). 10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. 12. Multi-Vitamin W/Minerals Capsule Sig: One (1) Capsule PO once a day. 13. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO Monthly on the 28th. 14. Natural Balance 0.4 % Drops Sig: One (1) Ophthalmic four times a day: to Right eye. 15. Sodium Chloride 5 % 5 % Parenteral Solution Sig: One (1) Intravenous four times a day: to Left eye. 16. [**Doctor First Name **] 180 mg Tablet Sig: One (1) Tablet PO at bedtime. 17. Xalatan 0.005 % Drops Sig: One (1) Ophthalmic at bedtime: to BOTH eyes. 18. Milk of Magnesia 400 mg/5 mL Suspension Sig: 30 cc PO once a day as needed for constipation. 19. Maalox 200-200-20 mg/5 mL Suspension Sig: 30 cc PO every four (4) hours as needed for indigestion. 20. Acetaminophen 650 mg Suppository Sig: One (1) Rectal every 4-6 hours as needed for fever/ pain with nausea. 21. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every [**4-4**] hours as needed for fever or pain. 22. Vitamin B12-Vitamin B1 100-1 mg/mL Solution Sig: 1 cc Intramuscular monthly on 16th. 23. PreserVision 226-200-5 mg-unit-mg Capsule Sig: Two (2) Capsule PO once a day. 24. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 25. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 26. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Discharge Disposition: Extended Care Facility: [**Location (un) 25576**] Discharge Diagnosis: Primary: GI bleeding Secondary: CAD s/p PCI Hypertension Anemia History of urinary retention and recurrent UTIs Hypothyroidism Depression GERD Osteoporosis Glaucoma TAH and bladder lift Ataxia ([**1-31**] peripheral neuropathy) Nephrolithiasis History of C. diff colitis CCY Atrial fibrillation Discharge Condition: fair, with stable Hct (~29-30), and stable vital signs. Discharge Instructions: You were transferred to [**Hospital1 69**] for further management of your gastrointestinal bleeding. Studies we performed failed to identify the source of bleeding. Because you deemed not to be a candidate for surgery, and because you did not want a surgery, you were treated supportively with fluids and blood transfusions. Your blood pressure and heart rate remained stable even with episodes of bleeding, and your last episode of bleeding was on [**2156-6-28**]. . If you experience bleeding again, have chest pain, shortness of breath, fatigue, or ANY other worrisome symptoms, please contact your primary care physician or go to the emergency room. Followup Instructions: Please call your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 1159**], at [**Telephone/Fax (1) 20587**] to make a follow-up appointment for sometime in the next 1-2 weeks.

578,276,285,562,211,564,401,427,530,733,244,V458

{'Hemorrhage of gastrointestinal tract, unspecified,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of colon,Constipation, unspecified,Unspecified essential hypertension,Atrial fibrillation,Esophageal reflux,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Percutaneous transluminal coronary angioplasty status'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: GIB PRESENT ILLNESS: [**Age over 90 **] y.o. female with multiple medical problems, most pertinent for a history of diverticulosis and diverticulitis, transferred from [**Hospital3 7571**]Hospital with for further management of a GIB. Patient was admitted to [**Hospital3 7571**]Hospital on [**6-22**] with BRBPR and a Hct of 23, for which she received 4 units of PRBCs. Her Hct increased to 30 with this intervention and she remained stable for the remainder of [**6-22**] and [**6-23**]. During this time, GI and surgery were consulted and plans from both perspectives were supportive care/conservative management, particularly as she was not felt to be a surgical candidate and the patient refused. On [**6-24**], patient's Hct was noted to drop to 23 and she began to have continuous BRBPR. She remained normotensive and was not tachycardic despite these intermittent GI bleeds. She received one unit of PRBCS and an RBC scan was performed, which reportedly showed bleeding at the splenic flexure. Patient received an additional unit of PRBCs while in route to [**Hospital1 18**] for further management. MEDICAL HISTORY: CAD s/p PCI Hypertension Anemia History of urinary retention and recurrent UTIs Hypothyroidism Depression GERD Osteoporosis Glaucoma TAH and bladder lift Ataxia ([**1-31**] peripheral neuropathy) Nephrolithiasis History of C. diff colitis CCY Atrial fibrillation MEDICATION ON ADMISSION: Timolol gtt QD Levothyroxine 100 mcg PO QD Amiodarone 100 mg PO QD Aspirin 81 mg PO QD Celexa 20 mg PO QD MVI PO QD Omeprazole 20 mg PO QD Preservision 2 capsules PO QD Vitamin D 50,000 TU PO Qmonth (on the 28th) Vitamin B12 injection Qmonth (on the 16th) Brimonidine 0.2% gtt [**Hospital1 **] Calcium Carbonate 500 mg PO BID Senna 2 tabs PO BID Natural Balance Tear Drops 1 drop R eye QID Sodium Chloride 5% solution 1 drop L eye QID Desipramine 10 mg PO QHS [**Doctor First Name **] 180 mg PO QHS ALLERGIES: Levofloxacin PHYSICAL EXAM: VS: T - 97.6, BP - 133/67, HR - 70, RR - 18, O2 - 96% RA GEN: Awake, alert, well-related, NAD HEENT: NC/AT; PERRLA, EOMI, conjuctival pallor; OP clear, dry mucous membranes CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, inspiratory crackles at left base ABD: soft, NT, ND, + BS, no HSM Rectal: Maroon-colored, guaiac positive stool EXT: warm, dry, +2 distal pulses BL FAMILY HISTORY: NC SOCIAL HISTORY: Denies history of tobacco, alcohol or illicit drug use ### Response: {'Hemorrhage of gastrointestinal tract, unspecified,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of colon,Constipation, unspecified,Unspecified essential hypertension,Atrial fibrillation,Esophageal reflux,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Percutaneous transluminal coronary angioplasty status'}

CHIEF COMPLAINT: back pain and fevers PRESENT ILLNESS: 53 yo F with HTN who presents to the ED with back pain and fever. She has had the back pain for the past 5 days. She began to feel SOB approx 4 days ago. Two days ago she presented to the clinic with this back pain; it was thought to be due to muscle spasm though she did not recall any particular injury. She was advised to take ibuprofen, valium and hydromorphone for pain and was given a PT consult. Her SOB was not discussed. Yesterday her SOB continued to worsen and she developed a fever to 101.3 and decided to come to the ED. Her back pain is located on the right side in the mid back. It radiates to her right shoulder and to her right anterior abdomen. Patients states that her abdominal pain resembles the chronic pain she has from her fibroids which tend to flare around her menses. Pain is currently [**5-15**] (10=worst) . In the ED, her vital signs were T 99.5 BP 113/69 HR 101 RR 20 O2sats 87-89% RA. She had a CTA done which wa neg for PE, but showed a RLL PNA and mild pulm edema. In the ED she was given Levoflox, Vanco and Ceftriaxone and she was placed on 6L NC, RR 30, sat 90 - 95%. Transferred to ICU b/c high O2 requirement, hypoxia and tachypnea. MEDICAL HISTORY: HTN hypokalemia anemia - Fe deficiency anemia. in past on Fe replacement. Fibroid uterus Cesearean section hx of Group B strep left knee septic arthritis, [**2189**] MEDICATION ON ADMISSION: atenolol 100mg po daily hydrochlorothiazide 12.5 mg po daily lisinopril 40 mg po daily nifedipine 90 mg po daily diazepam 5 mg PO QHS hydromorphone 2 mg PO 1-2 times daily as needed for pain ibuprofen 800 mg PO TID x 5 days. ALLERGIES: Tetracycline / Robitussin / Flexeril PHYSICAL EXAM: Vitals: T 101.6, HR 103, BP 130/73, RR 29, O2 Sat 89% 6L NC. General: Patients SOB with talking, lying in bed appears to be in pain. HEENT: NCAT, sclera white. PERRLA, EOMI. oropharynx with moist mucosa and no erythema. Neck: no LAD Lungs: bilat crackles at bases. Right worse than left. On right the crackles extend higher to mid lung zones. CV: RRR, s1 & s2 nl, no m/r/g, 2+ radial and DP pulses Abd: obese, +bs, tender to palpation on right side. neg [**Doctor Last Name **], no rebound or guarding, no HSM. Ext: no cyanosis, clubbing or edema Neuro: a&o x3, MAE, CN grossly intact. reports walking without difficulty. Back: tender to palpation on right side mid back in area of RLL. no rashes/lesions. FAMILY HISTORY: Most of the family members with hypertension. She had a brother and a grandmother who had astroke. Mother had a heart attack at an old age. Twin children who were born prematurely. Daughter is healthy but her son has developmental delays. Brother with DM2. SOCIAL HISTORY: Ms. [**Known lastname **] works as a school nurse. She was divorced 10 years ago. She lives with her daughter. [**Name (NI) **] daughter has a son with severe disability who lives in a group home 5 days a week. Denies smoking, alcohol, or drugs. She is not sexually active. Not in a relationship currently.

Streptococcal septicemia,Pneumonia, organism unspecified,Sepsis,Unspecified essential hypertension

Streptococcal septicemia,Pneumonia, organism NOS,Sepsis,Hypertension NOS

Admission Date: [**2192-6-23**] Discharge Date: [**2192-6-29**] Date of Birth: [**2139-2-5**] Sex: F Service: MEDICINE Allergies: Tetracycline / Robitussin / Flexeril Attending:[**First Name3 (LF) 2009**] Chief Complaint: back pain and fevers Major Surgical or Invasive Procedure: None History of Present Illness: 53 yo F with HTN who presents to the ED with back pain and fever. She has had the back pain for the past 5 days. She began to feel SOB approx 4 days ago. Two days ago she presented to the clinic with this back pain; it was thought to be due to muscle spasm though she did not recall any particular injury. She was advised to take ibuprofen, valium and hydromorphone for pain and was given a PT consult. Her SOB was not discussed. Yesterday her SOB continued to worsen and she developed a fever to 101.3 and decided to come to the ED. Her back pain is located on the right side in the mid back. It radiates to her right shoulder and to her right anterior abdomen. Patients states that her abdominal pain resembles the chronic pain she has from her fibroids which tend to flare around her menses. Pain is currently [**5-15**] (10=worst) . In the ED, her vital signs were T 99.5 BP 113/69 HR 101 RR 20 O2sats 87-89% RA. She had a CTA done which wa neg for PE, but showed a RLL PNA and mild pulm edema. In the ED she was given Levoflox, Vanco and Ceftriaxone and she was placed on 6L NC, RR 30, sat 90 - 95%. Transferred to ICU b/c high O2 requirement, hypoxia and tachypnea. Past Medical History: HTN hypokalemia anemia - Fe deficiency anemia. in past on Fe replacement. Fibroid uterus Cesearean section hx of Group B strep left knee septic arthritis, [**2189**] Social History: Ms. [**Known lastname **] works as a school nurse. She was divorced 10 years ago. She lives with her daughter. [**Name (NI) **] daughter has a son with severe disability who lives in a group home 5 days a week. Denies smoking, alcohol, or drugs. She is not sexually active. Not in a relationship currently. Family History: Most of the family members with hypertension. She had a brother and a grandmother who had astroke. Mother had a heart attack at an old age. Twin children who were born prematurely. Daughter is healthy but her son has developmental delays. Brother with DM2. Physical Exam: Vitals: T 101.6, HR 103, BP 130/73, RR 29, O2 Sat 89% 6L NC. General: Patients SOB with talking, lying in bed appears to be in pain. HEENT: NCAT, sclera white. PERRLA, EOMI. oropharynx with moist mucosa and no erythema. Neck: no LAD Lungs: bilat crackles at bases. Right worse than left. On right the crackles extend higher to mid lung zones. CV: RRR, s1 & s2 nl, no m/r/g, 2+ radial and DP pulses Abd: obese, +bs, tender to palpation on right side. neg [**Doctor Last Name **], no rebound or guarding, no HSM. Ext: no cyanosis, clubbing or edema Neuro: a&o x3, MAE, CN grossly intact. reports walking without difficulty. Back: tender to palpation on right side mid back in area of RLL. no rashes/lesions. Pertinent Results: WBC 10.9 Hgb 10.3 Hct 33.2 Plts 296 Diff: N:87.2 Band:0 L:9.7 M:2.5 E:0.5 Bas:0.1 134 | 95 | 10 ---------------< 195 2.8 | 28 | 0.9 lactate 1.4 CK: 210 MB: 4 Trop <0.01 Ca: 9.9 Mg: 1.9 P: 2.8 PT: 13.4 PTT: 28.5 INR: 1.1 . U/A Color Straw Appear Clear SpecGr 1.019 OTW neg [**2192-6-23**] Admission CXR: (prelim) some fluffy opacities in the R base and along the right heart border. both right and left CP angles are blunted. . [**2192-6-23**] CTA Chest: (prelim) No PE or dissection. Patchy multifocal airspace opacity, worse in RLL, most consistent with infection. Mild pulmonary edema. Spinal MRI: Cervical 1. Mild central canal stenosis at C3 through C6 secondary to disc-osteophyte complexes and ligamentum flavum infolding. 2. Diffuse signal abnormality within the bone marrow may reflect anemia or infiltrative marrow process. Thoracic MRI No evidence of nerve root or cauda equina compression. Microbiology Blood cultures:Date 6 Specimen Tests Ordered By [**2192-6-27**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2192-6-26**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2192-6-25**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2192-6-24**] BLOOD CULTURE Blood Culture, Routine-FINAL {BETA STREPTOCOCCUS GROUP B}; Anaerobic Bottle Gram Stain-FINAL; Aerobic Bottle Gram Stain-FINAL INPATIENT [**2192-6-23**] URINE URINE CULTURE-FINAL INPATIENT [**2192-6-23**] BLOOD CULTURE Blood Culture, Routine-FINAL {BETA STREPTOCOCCUS GROUP B}; Aerobic Bottle Gram Stain-FINAL; Anaerobic Bottle Gram Stain- [**2192-6-23**] BLOOD CULTURE Blood Culture, Routine-FINAL {BETA STREPTOCOCCUS GROUP B}; Anaerobic Bottle Gram Stain-FINAL; Aerobic Bottle Gram Stain-FINAL ECHO Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. No significant valvular pathology seen. No ASD/PFO seen. Brief Hospital Course: #Group B strep bacteremia. She was admitted with back pain and tachypnea, with high O2 requirement. On hospital day 2, she was found to have Group B Streptococcus growing in her blood, pan sensitive. She was started on penicillin given pansensitivity. She was seen by ID, and was evaluated for source of the bacteremia, with a spinal MRI, abdominal pelvic CT which showed no abscesses or evidence of osteomyelitis. In addition, she had a TTE which showed no evidence of endocarditis. An HIV test and IgG levels were recommended by ID, but she refused. No clear source of the bacteremia was identified. She will receive a total of 2 weeks of penicillin with home IV therapy. She will discuss HIV and immunoglobulin testing with her PCP. #SIRS: The patient was admitted with severe hypoxia. A chest xray was unremarkable, and chest CT showed no evidence for PE, but a possible infiltrate. She was admitted to the ICU with concern re: her tachypnea and high oxygen requirement. She was initially started on levofloxacin, vancomycin and ceftriaxone. She improved with treatment of her pain, and this likely reflected a systemic inflammatory response to her bacteremia. # Back pain: The patient had a MRI of her spine to evaluate for the cause of the pain. This showed intermittent cervical disk bulges, but no evidence of other significant pathology. It also showed diffuse marrow enhancement, likely due to anemia or other mild bone marrow suppressing process. Her back pain was thought to be musculoskeletal in nature. She had PT and was ambulating well without significant difficulty. # Hypertension: Her blood pressure remained in good control on her home regimen. # Anemia: She was anemic on admission and persistently. She had no evidence of blood loss. Anemia studies are pending. She also had the diffuse vertebral body enhancement seen on the spinal CT which may need to be further evaluated if she remains anemic, or has any other symptoms of malignancy. Medications on Admission: atenolol 100mg po daily hydrochlorothiazide 12.5 mg po daily lisinopril 40 mg po daily nifedipine 90 mg po daily diazepam 5 mg PO QHS hydromorphone 2 mg PO 1-2 times daily as needed for pain ibuprofen 800 mg PO TID x 5 days. Discharge Medications: 1. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO QPM (once a day (in the evening)). 2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO QPM (once a day (in the evening)). 3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 4. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO DAILY (Daily). 5. Penicillin G Pot in Dextrose 3,000,000 unit/50 mL Piggyback Sig: 4 million units Intravenous Q4H (every 4 hours) for 10 days. Disp:*9 day supply* Refills:*0* 7. Dilaudid 2 mg Tablet Sig: One (1) Tablet q4 Hours as needed for Back pain, disp #60. 8. Hydrochlorothiazide 12.5 mg Tablet Sig: One (1) Tablet PO once a day. 9. Saline Flush 0.9 % Syringe Sig: Five (5) ml Injection SASH and prn for 9 days. Disp:*9 days supply* Refills:*0* 10. Heparin Flush 10 unit/mL Kit Sig: 100 u/ml [**2-8**] ml Intravenous SASH and prn for 9 days days. Disp:*9 days supply* Refills:*0* Discharge Disposition: Home With Service Facility: Critical Care Systems Discharge Diagnosis: Pneumonia Discharge Condition: Good Discharge Instructions: You were admitted with a blood stream infection with Group B streptococcus. Return to the ER in the event of worsening symptoms, fevers, chills, worse back pain, cough, trouble breathing. Followup Instructions: You should consider HIV and immunoglobulin testing. Provider: [**Name10 (NameIs) **] [**Name8 (MD) 9501**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2192-8-13**] 11:00 [**Hospital **] Clinic follow up:

038,486,995,401

{'Streptococcal septicemia,Pneumonia, organism unspecified,Sepsis,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: back pain and fevers PRESENT ILLNESS: 53 yo F with HTN who presents to the ED with back pain and fever. She has had the back pain for the past 5 days. She began to feel SOB approx 4 days ago. Two days ago she presented to the clinic with this back pain; it was thought to be due to muscle spasm though she did not recall any particular injury. She was advised to take ibuprofen, valium and hydromorphone for pain and was given a PT consult. Her SOB was not discussed. Yesterday her SOB continued to worsen and she developed a fever to 101.3 and decided to come to the ED. Her back pain is located on the right side in the mid back. It radiates to her right shoulder and to her right anterior abdomen. Patients states that her abdominal pain resembles the chronic pain she has from her fibroids which tend to flare around her menses. Pain is currently [**5-15**] (10=worst) . In the ED, her vital signs were T 99.5 BP 113/69 HR 101 RR 20 O2sats 87-89% RA. She had a CTA done which wa neg for PE, but showed a RLL PNA and mild pulm edema. In the ED she was given Levoflox, Vanco and Ceftriaxone and she was placed on 6L NC, RR 30, sat 90 - 95%. Transferred to ICU b/c high O2 requirement, hypoxia and tachypnea. MEDICAL HISTORY: HTN hypokalemia anemia - Fe deficiency anemia. in past on Fe replacement. Fibroid uterus Cesearean section hx of Group B strep left knee septic arthritis, [**2189**] MEDICATION ON ADMISSION: atenolol 100mg po daily hydrochlorothiazide 12.5 mg po daily lisinopril 40 mg po daily nifedipine 90 mg po daily diazepam 5 mg PO QHS hydromorphone 2 mg PO 1-2 times daily as needed for pain ibuprofen 800 mg PO TID x 5 days. ALLERGIES: Tetracycline / Robitussin / Flexeril PHYSICAL EXAM: Vitals: T 101.6, HR 103, BP 130/73, RR 29, O2 Sat 89% 6L NC. General: Patients SOB with talking, lying in bed appears to be in pain. HEENT: NCAT, sclera white. PERRLA, EOMI. oropharynx with moist mucosa and no erythema. Neck: no LAD Lungs: bilat crackles at bases. Right worse than left. On right the crackles extend higher to mid lung zones. CV: RRR, s1 & s2 nl, no m/r/g, 2+ radial and DP pulses Abd: obese, +bs, tender to palpation on right side. neg [**Doctor Last Name **], no rebound or guarding, no HSM. Ext: no cyanosis, clubbing or edema Neuro: a&o x3, MAE, CN grossly intact. reports walking without difficulty. Back: tender to palpation on right side mid back in area of RLL. no rashes/lesions. FAMILY HISTORY: Most of the family members with hypertension. She had a brother and a grandmother who had astroke. Mother had a heart attack at an old age. Twin children who were born prematurely. Daughter is healthy but her son has developmental delays. Brother with DM2. SOCIAL HISTORY: Ms. [**Known lastname **] works as a school nurse. She was divorced 10 years ago. She lives with her daughter. [**Name (NI) **] daughter has a son with severe disability who lives in a group home 5 days a week. Denies smoking, alcohol, or drugs. She is not sexually active. Not in a relationship currently. ### Response: {'Streptococcal septicemia,Pneumonia, organism unspecified,Sepsis,Unspecified essential hypertension'}

CHIEF COMPLAINT: Bright red blood per rectum. PRESENT ILLNESS: This 86 year old female with a history of inflammatory bowel disease with a recent flare, status post an admission to [**Hospital6 2018**] in [**2147-2-26**], presents again with recurrent bright red blood per rectum and an acute anemia with an 8 point hematocrit drop and hypotension. In [**2147-1-26**], the patient was admitted to [**Hospital6 1708**] for bleeding and colitis. At that time she had a flexible sigmoidoscopy which demonstrated mucosal ulceration and friability to 70 cm, and her stool cultures at that time were positive for Clostridium difficile. She was discharged to rehabilitation but returned to [**Hospital6 2018**] for admission from [**2-28**], to [**2147-3-13**], for bright red blood per rectum and fatigue times one week. At that time, she was Clostridium difficile negative and a flexible sigmoidoscopy demonstrated friability, granulation and ulceration in the rectum and sigmoid colon consistent with colitis. She was treated with intravenous steroids and discharged to rehabilitation on intravenous Solu-Medrol. For this admission she returned with similar complaints of bright red blood per rectum with multiple stools per day and general malaise. She denied abdominal pain, nausea and vomiting but had a near syncopal event when getting out of bed five days prior to admission. She states that she also had subjective fevers. MEDICAL HISTORY: Inflammatory bowel disease, type unspecified diagnosed in [**2130**]; Clostridium difficile in [**2147-1-26**]; aortic stenosis diagnosed as moderate to severe at [**Hospital6 1708**] in [**2147-1-26**] with a valve area of 0.8 to 0.9, however, repeat echocardiogram at [**Hospital6 256**] showed only mild atrial fibrillation, history of biliary sepsis secondary to common bile duct stone, now status post endoscopic retrograde cholangiopancreatography on sphincterotomy in [**2146-11-26**], history of diverticulosis with colonic resection, history of breast cancer status post lumpectomy and radiation, abdominal aortic aneurysm repaired in [**2142**], hyperthyroidism, migraines, gastroesophageal reflux disease, hypercholesterolemia, chronic anemia, chronic renal insufficiency with a baseline creatinine of 1.2, hypertension, status post cholecystectomy, status post right total hip replacement, history of bowel and bladder incontinence. MEDICATION ON ADMISSION: Prednisone 35 mg a day, Fluconazole, Atorvastatin, Lansoprazole, calcium carbonate 500 mg b.i.d., Nystatin Swish and Swallow 5 mg q.i.d., Meclizine 25 mg p.o. q. 6 hours prn, insulin, sliding scale, subcutaneous heparin, Vancomycin 250 mg p.o. q.i.d. ALLERGIES: Tylenol causing nausea. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is a former smoker, quit smoking 30 years ago. The patient rarely drinks alcohol and is only a social drinker. The patient's code status is full code. Her health care proxy is her son, [**Name (NI) **] [**Name (NI) **], telephone #[**Telephone/Fax (1) 111138**].

Other ulcerative colitis,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to other vascular device, implant, and graft,Hyperpotassemia,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm

Other ulcerative colitis,Gastrointest hemorr NOS,Ac posthemorrhag anemia,Aortic valve disorder,Hyp kid NOS w cr kid V,Comp-oth vasc dev/graft,Hyperpotassemia,Thyrotox NOS no crisis

Admission Date: [**2147-4-5**] Discharge Date: [**2147-4-13**] Service: Medicine CHIEF COMPLAINT: Bright red blood per rectum. HISTORY OF PRESENT ILLNESS: This 86 year old female with a history of inflammatory bowel disease with a recent flare, status post an admission to [**Hospital6 2018**] in [**2147-2-26**], presents again with recurrent bright red blood per rectum and an acute anemia with an 8 point hematocrit drop and hypotension. In [**2147-1-26**], the patient was admitted to [**Hospital6 1708**] for bleeding and colitis. At that time she had a flexible sigmoidoscopy which demonstrated mucosal ulceration and friability to 70 cm, and her stool cultures at that time were positive for Clostridium difficile. She was discharged to rehabilitation but returned to [**Hospital6 2018**] for admission from [**2-28**], to [**2147-3-13**], for bright red blood per rectum and fatigue times one week. At that time, she was Clostridium difficile negative and a flexible sigmoidoscopy demonstrated friability, granulation and ulceration in the rectum and sigmoid colon consistent with colitis. She was treated with intravenous steroids and discharged to rehabilitation on intravenous Solu-Medrol. For this admission she returned with similar complaints of bright red blood per rectum with multiple stools per day and general malaise. She denied abdominal pain, nausea and vomiting but had a near syncopal event when getting out of bed five days prior to admission. She states that she also had subjective fevers. PAST MEDICAL HISTORY: Inflammatory bowel disease, type unspecified diagnosed in [**2130**]; Clostridium difficile in [**2147-1-26**]; aortic stenosis diagnosed as moderate to severe at [**Hospital6 1708**] in [**2147-1-26**] with a valve area of 0.8 to 0.9, however, repeat echocardiogram at [**Hospital6 256**] showed only mild atrial fibrillation, history of biliary sepsis secondary to common bile duct stone, now status post endoscopic retrograde cholangiopancreatography on sphincterotomy in [**2146-11-26**], history of diverticulosis with colonic resection, history of breast cancer status post lumpectomy and radiation, abdominal aortic aneurysm repaired in [**2142**], hyperthyroidism, migraines, gastroesophageal reflux disease, hypercholesterolemia, chronic anemia, chronic renal insufficiency with a baseline creatinine of 1.2, hypertension, status post cholecystectomy, status post right total hip replacement, history of bowel and bladder incontinence. ALLERGIES: Tylenol causing nausea. MEDICATIONS ON ADMISSION: Prednisone 35 mg a day, Fluconazole, Atorvastatin, Lansoprazole, calcium carbonate 500 mg b.i.d., Nystatin Swish and Swallow 5 mg q.i.d., Meclizine 25 mg p.o. q. 6 hours prn, insulin, sliding scale, subcutaneous heparin, Vancomycin 250 mg p.o. q.i.d. SOCIAL HISTORY: The patient is a former smoker, quit smoking 30 years ago. The patient rarely drinks alcohol and is only a social drinker. The patient's code status is full code. Her health care proxy is her son, [**Name (NI) **] [**Name (NI) **], telephone #[**Telephone/Fax (1) 111138**]. LABORATORY DATA: On admission white blood cell count 5.5, hematocrit 25.1, platelets 252, sodium 134, potassium 5.9, chloride 103, bicarbonate 24, BUN 48, creatinine 1.4, ALT 11, AST 9, alkaline phosphatase 72, LDH 113, total bilirubin 0.1, albumin 2.0. Chest x-ray showed clear lungs that are stable, elevation of the right hemidiaphragm. Abdominal computerized tomography scan showed pancolic wall thickening, most likely within the transverse colon but overall decreased in appearance in the prior study, no evidence of abscess, pneumobilia and hypodense cysts within the tail of the pancreas. Electrocardiogram showed normal sinus rhythm, borderline left axis deviation, slow R wave progression. HOSPITAL COURSE: 1. Bright red blood per rectum/acute anemia - On presentation the patient's hematocrit had dropped from a baseline of 30 to 22, the patient was hypertensive and required aggressive fluid resuscitation and blood transfusion. The patient's bright red blood per rectum was felt to be secondary to a flare of her inflammatory bowel disease or to recurrent Clostridium difficile colitis. She was initially treated with bowel rest, intravenous steroids and oral Vancomycin, however, once two stool samples had returned as Clostridium difficile negative her Vancomycin was stopped and the focus of treatment was placed on her flare of inflammatory bowel disease. The patient was placed on maximum medical management of her inflammatory bowel disease which included Solu-Medrol drip, bowel rest with total parenteral nutrition, Rowasa, and Hydrocortisone enemas, Mesalamine, both p.o. and p.r. Unfortunately, the patient's inflammatory bowel disease flare did not respond to maximum medical management. She continued to have six or more bloody bowel movements per day. The patient was seen in consultation by the Surgical Service as her inflammatory bowel disease had not responded to medical management and it was felt that definitive therapy would require surgical intervention. She was seen and evaluated by the Surgery Team and was transferred to the Surgical Service on [**2147-4-13**] for a colectomy. 2. Aortic stenosis - There was some question as to the severity of the patient's aortic valve disease as an echocardiogram at [**Hospital6 1708**] in [**2147**] showed severe aortic stenosis with a valve area of 0.8 to 0.9 cm squared. The patient was seen by Cardiology during this admission and a repeat echocardiogram was ordered. The repeat echocardiogram showed a normal left ventricular ejection fraction of greater than 55% with only mild aortic valve stenosis. The echocardiogram was reviewed by the attending cardiologist and it was confirmed that the patient's aortic valve disease was mild. 3. Bradycardia - During this admission, the patient was noted to have sinus bradycardia with heartrates in the 40s and 50s. The patient's PR interval and QTC remained within normal limits. It was felt by the cardiology consult there was no acute indication for pacemaker placement. In addition perioperative beta blockers were held given the patient's significant bradycardia. Throughout the course of her admission, the patient remained hemodynamically stable despite her bradycardia with the exception of the initial 24 hours during which he had acute anemia with hypotension. 4. Oral thrush - The patient was admitted on Nystatin Swish and Swallow for oral thrush. This was changed during her Intensive Care Unit admission to oral Clotrimazole, however, upon examination it appeared that the patient had a cluster of approximately six to eight acthous ulcers at the tip of her tongue. There was no evidence of active Candidal infection. It was recommended that the patient's oral antifungal [**Doctor Last Name 360**] be discontinued. 5. Diabetes mellitus - The patient was placed on a regular insulin sliding scale. In addition, the patient had insulin placed in her total parenteral nutrition. 6. Fluids, electrolytes and nutrition - The patient was placed on bowel rest for optimal medical management of her inflammatory bowel disease. Therefore, she required PICC line placement and initiation of total parenteral nutrition. The remainder of the hospital course will be covered by the covering surgical intern. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 2506**] Dictated By:[**Last Name (NamePattern1) 9609**] MEDQUIST36 D: [**2147-4-13**] 20:37 T: [**2147-4-13**] 21:28 JOB#: [**Job Number 111139**] Admission Date: [**2147-2-28**] Discharge Date: [**2147-4-24**] Service: PURPLE SURGERY HISTORY OF PRESENT ILLNESS: The patient was admitted originally under Dr. [**Last Name (STitle) 111140**] for bright red blood per rectum. This note continues following the patient's operative procedure on [**2147-4-13**]. On that date, the patient was taken to the Operating Room for a subtotal colectomy with ileostomy placement. There was also lysis of adhesions and repair of incisional hernia was done at the same time. The procedure was performed by Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **] and assisted by Dr. [**First Name8 (NamePattern2) 3825**] [**Last Name (NamePattern1) 3826**]. There were no complications during this procedure. The patient tolerated the procedure very well. Following a brief stay in the PACU, the patient was transferred to the floor. For a complete description of the operation, please see the operative note date [**2147-4-13**]. Postoperatively the patient did very well. He remained intubated on the first night postoperatively but was able to be extubated on postoperative day #1 without any difficulty. After the patient was transferred to the floor, she was seen by Occupational Therapy who recommended a brief stay in rehabilitation prior to being discharged to home. While on the floor, the patient did very well. She was placed on TPN while she was NPO status. Her steroids were placed on a taper, initially starting off at Hydrocortisone 50 mg t.i.d. The patient had a delayed return of her bowel function following her ileostomy. Because of this, the patient remained NPO for a relatively prolonged period of time. The patient did regain her bowel function on postoperative day #8, and at that point, she was placed on a clear liquid diet, which she tolerated without any difficulty. The patient's diet was advanced as tolerated until she was able to be discharged on a regular diet. From a cardiovascular standpoint, the Cardiology Team was requested to see the patient due to intermittent periods of tachycardia. The patient had a known history of being bradycardiac and was originally not to be given any beta-blockers due to this. The Cardiology Team felt that her intermittent supraventricular tachycardia was likely triggered by her acute illness and recent surgery and that this was improved as the patient's clinical condition did so as well. The patient was not placed on any beta-blockers or any cardiac medications at this time. The patient's postoperative course was complicated by a deep venous thrombosis located in her right arm. The clot was present from the right axillary and right brachial vein, as assessed by ultrasound. The patient was placed on intravenous Lovenox and Coumadin to get her to a therapeutic level. The PICC line, in her right arm, was removed following two days of anticoagulation therapy. The patient will be discharged to rehabilitation on Lovenox and Coumadin. DISCHARGE STATUS: The patient will be discharged to an acute rehabilitation facility. There she will undergo physical therapy conditioning, as well as continuation of her anticoagulation. CONDITION ON DISCHARGE: The patient will be discharged in good condition. She is afebrile, tolerating a regular diet without difficulty. She is able to be up and out of bed to chair without any difficulty. FOLLOW-UP: The patient was instructed to follow-up with Dr. [**Last Name (STitle) **] in [**1-27**] weeks. The patient was asked to please call to make this appointment. DISCHARGE DIAGNOSIS: 1. Status post subtotal colectomy with ileostomy. 2. Deep venous thrombosis. 3. IVD. 4. Critical aortic stenosis. 5. Diverticulitis. 6. Status post biliary sepsis. 7. Anemia. 8. Chronic renal insufficiency. 9. Gastroesophageal reflux disease. DISCHARGE MEDICATIONS: Prednisone 15 mg p.o. q.d. x 6 days, Prednisone 10 mg p.o. q.d. x 7 days following completion of 15 mg per day course, Prednisone 5 mg p.o. q.d. x 7 days following completion of 10 mg course, Lasix 20 mg 1 tab p.o. q.d. x 7 days, Dilaudid 2 mg [**1-27**] tab p.o. q.4-6 hours p.r.n. pain, Lovenox 60 mg subcue b.i.d. until therapeutic on Coumadin, Coumadin adjusted daily dosing to maintain an INR of 2.0-2.5. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 6066**] Dictated By:[**Name8 (MD) 846**] MEDQUIST36 D: [**2147-4-24**] 09:47 T: [**2147-4-24**] 09:55 JOB#: [**Job Number 111141**]

556,578,285,424,403,996,276,242

{'Other ulcerative colitis,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to other vascular device, implant, and graft,Hyperpotassemia,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Bright red blood per rectum. PRESENT ILLNESS: This 86 year old female with a history of inflammatory bowel disease with a recent flare, status post an admission to [**Hospital6 2018**] in [**2147-2-26**], presents again with recurrent bright red blood per rectum and an acute anemia with an 8 point hematocrit drop and hypotension. In [**2147-1-26**], the patient was admitted to [**Hospital6 1708**] for bleeding and colitis. At that time she had a flexible sigmoidoscopy which demonstrated mucosal ulceration and friability to 70 cm, and her stool cultures at that time were positive for Clostridium difficile. She was discharged to rehabilitation but returned to [**Hospital6 2018**] for admission from [**2-28**], to [**2147-3-13**], for bright red blood per rectum and fatigue times one week. At that time, she was Clostridium difficile negative and a flexible sigmoidoscopy demonstrated friability, granulation and ulceration in the rectum and sigmoid colon consistent with colitis. She was treated with intravenous steroids and discharged to rehabilitation on intravenous Solu-Medrol. For this admission she returned with similar complaints of bright red blood per rectum with multiple stools per day and general malaise. She denied abdominal pain, nausea and vomiting but had a near syncopal event when getting out of bed five days prior to admission. She states that she also had subjective fevers. MEDICAL HISTORY: Inflammatory bowel disease, type unspecified diagnosed in [**2130**]; Clostridium difficile in [**2147-1-26**]; aortic stenosis diagnosed as moderate to severe at [**Hospital6 1708**] in [**2147-1-26**] with a valve area of 0.8 to 0.9, however, repeat echocardiogram at [**Hospital6 256**] showed only mild atrial fibrillation, history of biliary sepsis secondary to common bile duct stone, now status post endoscopic retrograde cholangiopancreatography on sphincterotomy in [**2146-11-26**], history of diverticulosis with colonic resection, history of breast cancer status post lumpectomy and radiation, abdominal aortic aneurysm repaired in [**2142**], hyperthyroidism, migraines, gastroesophageal reflux disease, hypercholesterolemia, chronic anemia, chronic renal insufficiency with a baseline creatinine of 1.2, hypertension, status post cholecystectomy, status post right total hip replacement, history of bowel and bladder incontinence. MEDICATION ON ADMISSION: Prednisone 35 mg a day, Fluconazole, Atorvastatin, Lansoprazole, calcium carbonate 500 mg b.i.d., Nystatin Swish and Swallow 5 mg q.i.d., Meclizine 25 mg p.o. q. 6 hours prn, insulin, sliding scale, subcutaneous heparin, Vancomycin 250 mg p.o. q.i.d. ALLERGIES: Tylenol causing nausea. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is a former smoker, quit smoking 30 years ago. The patient rarely drinks alcohol and is only a social drinker. The patient's code status is full code. Her health care proxy is her son, [**Name (NI) **] [**Name (NI) **], telephone #[**Telephone/Fax (1) 111138**]. ### Response: {'Other ulcerative colitis,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to other vascular device, implant, and graft,Hyperpotassemia,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm'}

CHIEF COMPLAINT: Upper GI bleed. PRESENT ILLNESS: This is a 54-year-old gentleman with a history of hepatitis C, cirrhosis, and known varices, status post recent banding of his varices who presents with hematemesis. The patient was noted at his group home to be vomiting blood. EMS was called at that time. In the field, EMS noted that the patient's blood pressure was 40/palpable. The patient was transferred emergently to [**Hospital6 256**] where he received approximately 8 units of packed red blood cells, 4 units of fresh frozen plasma, and 5-6 liters of normal saline. Nasogastric lavage revealed bright red blood that did not clear with 1 liter. At that time, the patient was intubated for airway protection. MEDICAL HISTORY: 1. Hepatitis C. 2. Cirrhosis, Child's A. 3. Varices. 4. Hypertension. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient currently lives in a group home. Positive history of IV drug abuse and alcohol.

Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Hematemesis,Other shock without mention of trauma,Acute respiratory failure,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft

Cirrhosis of liver NOS,Bleed esoph var oth dis,Hematemesis,Shock w/o trauma NEC,Acute respiratry failure,Ac posthemorrhag anemia,React-oth vasc dev/graft

Admission Date: [**2122-10-25**] Discharge Date: [**2122-11-5**] Date of Birth: [**2068-9-13**] Sex: M Service: [**Hospital1 **] CHIEF COMPLAINT: Upper GI bleed. HISTORY OF THE PRESENT ILLNESS: This is a 54-year-old gentleman with a history of hepatitis C, cirrhosis, and known varices, status post recent banding of his varices who presents with hematemesis. The patient was noted at his group home to be vomiting blood. EMS was called at that time. In the field, EMS noted that the patient's blood pressure was 40/palpable. The patient was transferred emergently to [**Hospital6 256**] where he received approximately 8 units of packed red blood cells, 4 units of fresh frozen plasma, and 5-6 liters of normal saline. Nasogastric lavage revealed bright red blood that did not clear with 1 liter. At that time, the patient was intubated for airway protection. The patient was started on IV Octreotide and IV ciprofloxacin 240 mg q. 12 hours. The patient was admitted to the Medical Intensive Care Unit for further care. PAST MEDICAL HISTORY: 1. Hepatitis C. 2. Cirrhosis, Child's A. 3. Varices. 4. Hypertension. ALLERGIES: The patient has no known drug allergies. ADMISSION MEDICATIONS: 1. Protonix. 2. Inderal. SOCIAL HISTORY: The patient currently lives in a group home. Positive history of IV drug abuse and alcohol. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Afebrile, heart rate 100, blood pressure 127/61, respiratory rate 12, saturating 98%. General: Intubated and paralyzed, assist control. HEENT: Blood coming out of nares. Active bleeding out of mouth, NG tube placed. [**Last Name (un) **] tube placed via OG. Heart: Tachycardiac. Normal S1 and S2. Lungs: Bilateral breath sounds anteriorly and laterally. Abdomen: Distended, positive bowel sounds, tympanic. Extremities: No clubbing, cyanosis or edema. LABORATORY/RADIOLOGIC DATA: On admission, sodium 138, potassium 4.0, chloride 106, bicarbonate 25, BUN 13, creatinine 1.5, glucose 154. White blood cell count 6.6, hematocrit 28.3, platelets 133,000. INR 1.2. Fibrinogen 123, amylase 92. ABGs on admission 7.33/41/467. Chest x-ray on admission: Low lung volumes. ET tube in place, approximately 3 cm above the carina. Perihilar haziness. HOSPITAL COURSE: During the ICU course, the patient received 23 units of packed red blood cells, 12 units of FFP, and 3 of cryo. He underwent [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] procedure on [**2122-10-26**] with placement of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] tube. This resulted in 1 liter of bloody output. The patient had no further variceal bleeding since [**2122-10-26**]. He did have positive blood cultures on [**2122-10-26**] and [**2122-10-27**] resulting in initiation of penicillin for gram-positive alpha Streptococcus. The patient was extubated on [**2122-11-1**] and did well on room air with oxygen saturation in the high 90s. He did have some mental status changes in the Intensive Care Unit which were thought to be due to sedation with Fentanyl and possible hepatic encephalopathy. These quickly resolved after the patient was weaned off the Fentanyl drip. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], M.D. [**MD Number(2) 22654**] Dictated By:[**Name8 (MD) 315**] MEDQUIST36 D: [**2122-11-5**] 03:24 T: [**2122-11-5**] 17:45 JOB#: [**Job Number 50904**] Name: [**Known lastname 9477**],[**Known firstname **] Unit No: [**Numeric Identifier 9478**] Admission Date: [**2122-10-25**] Discharge Date: [**2122-11-10**] Date of Birth: [**2068-9-13**] Sex: M Service: ADDENDUM: SUMMARY OF HOSPITAL COURSE: Since transfer from the Medical Intensive Care Unit to the floor team on [**2122-11-2**], patient has done well. Issues have included: 1. Status post variceal GI bleed: Patient has been stable since his transfer to the floor. His hematocrit has remained stable and has continued to be checked periodically. He has had no more bleeding. Propranolol has been continued to lower his hepatic hypertension. 2. Infectious disease: Patient has continued on penicillin-G for treatment of gram-positive alpha Strep isolated on blood cultures from [**10-26**] and [**10-27**]. He will continue on these antibiotics through [**2122-11-12**] to complete a greater than two week course. We continued to await identification of the organism from the state laboratory. The patient is not receiving treatment for a past sputum culture and methicillin-sensitive Staphylococcus aureus. He has continued to be afebrile, asymptomatic, and having normal white blood cell count. 2. Cirrhosis: Patient has not been encephalopathic since his transfer to the floor. He has continued to have a clear mental status. He is continued on lactulose with a goal of three stools per day. 3. Transaminitis status post TIPS procedure: LFTs have been monitored periodically in this patient since his TIPS procedure. Although he has had mild elevations with the LFTs, overall they were within acceptable limits. Most importantly, his total bilirubin and INR have not been elevated. On last check on [**2122-11-7**], values included ALT of 66, AST 93, LD 261, alkaline phosphatase 59, total bilirubin 1.4. 4. Left eye cloudiness: The patient noted left eye cloudiness approximately five days after being transferred to the floor. However, he reported it had been noticeable since his discharge from the Medical Intensive Care Unit, that he had simply failed to mention it. It has been then improving since that time with Artificial Tears. I will have the patient follow up outpatient Ophthalmology. 5. Fluids, electrolytes, and nutrition: Patient has been continued on a low sodium house diet. He has been tolerating this well. Electrolytes have been replaced as needed. 6. Rehabilitation: Patient was seen by both Physical Therapy and Occupational Therapy. He has made great strides during his stay on the floor. He has been discharged by both Physical and Occupational therapy. He is successfully ambulating around the unit without difficulty. CONDITION ON DISCHARGE: Stable. DISPOSITION: The patient will be discharged to [**Hospital 1238**] Hospital for completion of his IV penicillin. DISCHARGE DIAGNOSES: 1. Esophageal varices with bleeding. 2. Cirrhosis. 3. Hepatitis B without hepatic carcinoma. 4. Hypertension. 5. Mental status changes now resolved. 6. Bacteremia. DISCHARGE MEDICATIONS: 1. Combivent 1-2 puffs inhaled q.4h. prn. 2. Spironolactone 50 mg p.o. q.d. 3. Lactulose 30 mL q.8h. prn for a goal of three stools per day. 4. Propanolol 80 mg p.o. t.i.d. 5. Famotidine 20 mg p.o. b.i.d. 6. Multivitamin tablets one cap p.o. q.d. 7. Zinc sulfate 220 mg p.o. q.d. 8. Ascorbic acid 500 mg one tablet p.o. b.i.d. 9. Artificial Tears prn. 10. Penicillin-G 4 mU IV q.4h. to complete a two week course through [**2122-11-12**]. FOLLOW-UP INSTRUCTIONS: Patient will follow up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 9479**] in [**Location (un) 4887**]. He will schedule this appointment at his convenience once he is discharged from rehabilitation. Instructions will be made to have Dr. [**Last Name (STitle) 9479**] facilitate the patient and seen at outpatient ophthalmologist once the patient has obtained insurance. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4098**], M.D. [**MD Number(2) 5314**] Dictated By:[**Name8 (MD) 9480**] D: [**2122-11-10**] 09:19 T: [**2122-11-10**] 09:18 JOB#: [**Job Number 9481**] Name: [**Known lastname 9477**],[**Known firstname **] Unit No: [**Numeric Identifier 9478**] Admission Date: [**2122-10-25**] Discharge Date: [**2122-11-10**] Date of Birth: [**2068-9-13**] Sex: M Service: ADDENDUM: SUMMARY OF HOSPITAL COURSE: Since transfer from the Medical Intensive Care Unit to the floor team on [**2122-11-2**], patient has done well. Issues have included: 1. Status post variceal GI bleed: Patient has been stable since his transfer to the floor. His hematocrit has remained stable and has continued to be checked periodically. He has had no more bleeding. Propranolol has been continued to lower his portal hypertension. 2. Infectious disease: Patient has continued on penicillin-G for treatment of gram-positive alpha Strep isolated on blood cultures from [**10-26**] and [**10-27**]. He will continue on these antibiotics through [**2122-11-12**] to complete a greater than two week course. We continued to await identification of the organism from the state laboratory. The patient is not receiving treatment for a past sputum culture and methicillin-sensitive Staphylococcus aureus. He has continued to be afebrile, asymptomatic, and having normal white blood cell count. 2. Cirrhosis: Patient has not been encephalopathic since his transfer to the floor. He has continued to have a clear mental status. He is continued on lactulose with a goal of three stools per day. 3. Transaminitis status post TIPS procedure: LFTs have been monitored periodically in this patient since his TIPS procedure. Although he has had mild elevations with the LFTs, overall they were within acceptable limits. Most importantly, his total bilirubin and INR have not been elevated. On last check on [**2122-11-7**], values included ALT of 66, AST 93, LD 261, alkaline phosphatase 59, total bilirubin 1.4. 4. Left eye cloudiness: The patient noted left eye cloudiness approximately five days after being transferred to the floor. However, he reported it had been noticeable since his discharge from the Medical Intensive Care Unit, that he had simply failed to mention it. It has been then improving since that time with Artificial Tears. I will have the patient follow up outpatient Ophthalmology. 5. Fluids, electrolytes, and nutrition: Patient has been continued on a low sodium house diet. He has been tolerating this well. Electrolytes have been replaced as needed. 6. Rehabilitation: Patient was seen by both Physical Therapy and Occupational Therapy. He has made great strides during his stay on the floor. He has been discharged by both Physical and Occupational therapy. He is successfully ambulating around the unit without difficulty. CONDITION ON DISCHARGE: Stable. DISPOSITION: The patient will be discharged to [**Hospital 1238**] Hospital for completion of his IV penicillin. DISCHARGE DIAGNOSES: 1. Esophageal varices with bleeding. 2. Cirrhosis. 3. Hepatitis B without hepatic carcinoma. 4. Hypertension. 5. Mental status changes now resolved. 6. Bacteremia. DISCHARGE MEDICATIONS: 1. Combivent 1-2 puffs inhaled q.4h. prn. 2. Spironolactone 50 mg p.o. q.d. 3. Lactulose 30 mL q.8h. prn for a goal of three stools per day. 4. Propanolol 80 mg p.o. t.i.d. 5. Famotidine 20 mg p.o. b.i.d. 6. Multivitamin tablets one cap p.o. q.d. 7. Zinc sulfate 220 mg p.o. q.d. 8. Ascorbic acid 500 mg one tablet p.o. b.i.d. 9. Artificial Tears prn. 10. Penicillin-G 4 mU IV q.4h. to complete a two week course through [**2122-11-12**]. FOLLOW-UP INSTRUCTIONS: Patient will follow up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 9479**] in [**Location (un) 4887**]. He will schedule this appointment at his convenience once he is discharged from rehabilitation. Instructions will be made to have Dr. [**Last Name (STitle) 9479**] facilitate the patient and seen at outpatient ophthalmologist once the patient has obtained insurance. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4098**], M.D. [**MD Number(2) 5314**] Dictated By:[**Name8 (MD) 9480**] D: [**2122-11-10**] 09:19 T: [**2122-11-10**] 09:18 JOB#: [**Job Number 9481**]

571,456,578,785,518,285,996

{'Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Hematemesis,Other shock without mention of trauma,Acute respiratory failure,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Upper GI bleed. PRESENT ILLNESS: This is a 54-year-old gentleman with a history of hepatitis C, cirrhosis, and known varices, status post recent banding of his varices who presents with hematemesis. The patient was noted at his group home to be vomiting blood. EMS was called at that time. In the field, EMS noted that the patient's blood pressure was 40/palpable. The patient was transferred emergently to [**Hospital6 256**] where he received approximately 8 units of packed red blood cells, 4 units of fresh frozen plasma, and 5-6 liters of normal saline. Nasogastric lavage revealed bright red blood that did not clear with 1 liter. At that time, the patient was intubated for airway protection. MEDICAL HISTORY: 1. Hepatitis C. 2. Cirrhosis, Child's A. 3. Varices. 4. Hypertension. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient currently lives in a group home. Positive history of IV drug abuse and alcohol. ### Response: {'Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Hematemesis,Other shock without mention of trauma,Acute respiratory failure,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 88 year old Portuguese speaking female found in respiratory distress at her nursing home. EMS was called and vital signs at that time were a heart rate of 112, blood pressure of 140/80; respiratory rate of 40 and she was 71% on room air. Rales were noted bilaterally. This patient is normally on two liters of home oxygen. She was given Nitroglycerin, 80 mg of Lasix and morphine and nebulizers during transport; the patient was unresponsive. The patient, in the Emergency Department, BiPAP ventilation was started. The patient's systolic blood pressure dropped to the 70s. Dopamine was started and titrated up to 7.5. Blood pressure was stabilized at systolic blood pressure of 110 and Dopamine was weaned off later during the day. The patient was also given Levofloxacin 500 mg times one for possible pneumonia, and Ceftriaxone 1 gram. Per report at nursing home, at 04:30 p.m. the previous day, the patient had an episode of chest pain and was given Ativan, Nitroglycerin and percocet. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease on home O2 of two liters. 2. Diabetes mellitus type 2, insulin dependent. 3. Hypertension. 4. Chronic renal failure with a baseline creatinine of 1.0. 5. Peptic ulcer disease. 6. Coronary artery disease status post coronary artery bypass graft and myocardial infarction in [**2121**]. 7. Left bundle branch block. 8. Atrial fibrillation. 9. History of pulmonary embolism in [**2128**], on Coumadin. 10. Positive PPD. 11. Costochondritis. 12. History of supraventricular tachycardia. 13. Congestive heart failure, ejection fraction subnormal, two plus mitral regurgitation. 14. Transient ischemic attack. 15. Hyperlipidemia. 16. "DO NOT RESUSCITATE" and "DO NOT INTUBATE" code status. 17. History of falls. 18. Right wrist fracture in [**2131-6-12**]. MEDICATION ON ADMISSION: 1. Enteric coated aspirin 325 mg q. day. 2. Diltiazem 120 q. day. 3. Isosorbide MN 120 q. day. 4. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q. day. 5. Paxil 10 mg q. day. 6. Protonix 40 mg q. day. 7. Lisinopril 40 mg q. day. 8. Atenolol 100 mg q. day. 9. Colace 100 mg twice a day. 10. Flovent 110 micrograms, two puffs q. four to six hours p.r.n. 11. Lasix 40 mg twice a day. 12. Atrovent MDI two puffs four times a day. 13. Senna one tablet q. h.s. 14. Lipitor 10 mg q. day. 15. Ativan 0.5 mg three times a day p.r.n. 16. Klonopin 0.5 mg q. h.s. p.r.n. 17. NPH 8 units q. a.m. 18. Coumadin 5.5 mg q. day. 19. Insulin sliding scale. 20. Ground, two grams of sodium. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Nursing home resident. No history of tobacco, no history of alcohol.

Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other left bundle branch block,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction

Pneumonia, organism NOS,Obs chr bronc w(ac) exac,CHF NOS,Atrial fibrillation,Acute & chronc resp fail,Mitral valve disorder,Hyp kid NOS w cr kid V,Left bb block NEC,Peptic ulcer NOS

Admission Date: [**2131-8-21**] Discharge Date: [**2131-8-22**] Service: MICU HISTORY OF PRESENT ILLNESS: This is an 88 year old Portuguese speaking female found in respiratory distress at her nursing home. EMS was called and vital signs at that time were a heart rate of 112, blood pressure of 140/80; respiratory rate of 40 and she was 71% on room air. Rales were noted bilaterally. This patient is normally on two liters of home oxygen. She was given Nitroglycerin, 80 mg of Lasix and morphine and nebulizers during transport; the patient was unresponsive. The patient, in the Emergency Department, BiPAP ventilation was started. The patient's systolic blood pressure dropped to the 70s. Dopamine was started and titrated up to 7.5. Blood pressure was stabilized at systolic blood pressure of 110 and Dopamine was weaned off later during the day. The patient was also given Levofloxacin 500 mg times one for possible pneumonia, and Ceftriaxone 1 gram. Per report at nursing home, at 04:30 p.m. the previous day, the patient had an episode of chest pain and was given Ativan, Nitroglycerin and percocet. On oxygen at 01:00 p.m., her O2 saturations were fine. She was without any complaints. At 03:00 a.m., she desaturated to the 70s. No chest pain at that time. The patient was communicating when she left the nursing home. At the time of evaluation, this was unresponsive. She grimaced only to pain. The family was unavailable and a message was left for them. Urine output was 400 cc in the Emergency Room. PAST MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease on home O2 of two liters. 2. Diabetes mellitus type 2, insulin dependent. 3. Hypertension. 4. Chronic renal failure with a baseline creatinine of 1.0. 5. Peptic ulcer disease. 6. Coronary artery disease status post coronary artery bypass graft and myocardial infarction in [**2121**]. 7. Left bundle branch block. 8. Atrial fibrillation. 9. History of pulmonary embolism in [**2128**], on Coumadin. 10. Positive PPD. 11. Costochondritis. 12. History of supraventricular tachycardia. 13. Congestive heart failure, ejection fraction subnormal, two plus mitral regurgitation. 14. Transient ischemic attack. 15. Hyperlipidemia. 16. "DO NOT RESUSCITATE" and "DO NOT INTUBATE" code status. 17. History of falls. 18. Right wrist fracture in [**2131-6-12**]. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Enteric coated aspirin 325 mg q. day. 2. Diltiazem 120 q. day. 3. Isosorbide MN 120 q. day. 4. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q. day. 5. Paxil 10 mg q. day. 6. Protonix 40 mg q. day. 7. Lisinopril 40 mg q. day. 8. Atenolol 100 mg q. day. 9. Colace 100 mg twice a day. 10. Flovent 110 micrograms, two puffs q. four to six hours p.r.n. 11. Lasix 40 mg twice a day. 12. Atrovent MDI two puffs four times a day. 13. Senna one tablet q. h.s. 14. Lipitor 10 mg q. day. 15. Ativan 0.5 mg three times a day p.r.n. 16. Klonopin 0.5 mg q. h.s. p.r.n. 17. NPH 8 units q. a.m. 18. Coumadin 5.5 mg q. day. 19. Insulin sliding scale. 20. Ground, two grams of sodium. SOCIAL HISTORY: Nursing home resident. No history of tobacco, no history of alcohol. PHYSICAL EXAMINATION: Temperature was 100.8 F.; heart rate was 75; blood pressure 99/47; respiratory rate of 19 and 99% on pressure support, Bi-PAP mask [**9-16**], FIO2 0.6, total volume around 350. In general, unmasked, ventilation grimaces to pain, right wrist in cast, moderately obese. HEENT: pupils equally round and reactive to light bilaterally. Mucous membranes were moist. Unable to assess jugular venous pressure. Chest with diffuse expiratory wheezes. Minimal crackles at bases bilaterally. Cardiovascular is regular rate and rhythm, grade I/VI systolic ejection murmur heard best at the left lower sternal border. Abdomen with positive bowel sounds, nontender, plus hepatomegaly. No splenomegaly. Extremities warm, no dorsalis pedis bilaterally. No edema. Right wrist in cast. Neurologic: Moves all limbs, grimaces to pain. LABORATORY: On admission, arterial blood gas 7.14, CO2 128; O2 127 on Bi-PAP. White blood cell count of 7.7, hematocrit 30.7, platelets 225. Chemistries were sodium of 145, potassium 4.0, chloride 105, bicarbonate 35, BUN 26, creatinine 1.3, glucose 176. CK is 16. MB not done. Troponin less than 0.01. PT 26.1, [**Month/Day (1) 263**] 4.5, PTT 39.0. Chest x-ray with pleural thickening in the left, no change from previous examination. Small bilateral effusions, right heart border scarred. EKG with sinus rate, 112, left bundle branch block, old. SUMMARY OF HOSPITAL COURSE: This is an 88 year old woman with chronic obstructive pulmonary disease, congestive heart failure and coronary artery disease status post myocardial infarction and coronary artery bypass graft who had episodes of chest pain [**8-20**], at 04:30 p.m. which resolved with sublingual Nitroglycerin, percocet and ativan. The patient was stable until 3 a.m. the morning of [**8-21**], when she developed shortness of breath and desaturated to 70% on room air. Initially, she was in congestive heart failure and diuresed and dropped blood pressure transiently and required dopamine in the Emergency Room. Now, on admission to the Medical Intensive Care Unit she had diffuse wheezes, question of pneumonia on chest x-ray. There was a left shift and a low grade temperature. Concern at the time of the admission to the Medical Intensive Care Unit for an infectious process causing respiratory failure in the setting of a patient with chronic obstructive pulmonary disease. Given chest pain yesterday and reported congestive heart failure earlier, she also ruled out for myocardial infarction. HOSPITAL COURSE BY PROBLEM: 1. RESPIRATORY FAILURE: Most likely secondary to pneumonia, but chronic obstructive pulmonary disease and congestive heart failure likely contributing. The patient was started on Levofloxacin, Ceftriaxone and Flagyl to treat for nursing home acquired pneumonia and possible aspiration. Blood cultures, sputum cultures were sent. Arterial blood gas was repeated and it was 7.21 pH, pCO2 of 108 and a pO2 of 91. She was continued on Bi-PAP and weaned to nasal cannula during the course of her hospital stay and within the first 12 hours, desaturated on nasal cannula 4 liters to the low 80s, and was switched to a Venturi Mask at 40%. The family was [**Month (only) 653**] regarding the aggressiveness of care. The family re-iterated to the staff that the patient is a "DO NOT RESUSCITATE" and "DO NOT INTUBATE" and the family wished not to have any shock electrocardioversion, or pressors used. We continued nebs for chronic obstructive pulmonary disease component. 2. CARDIOVASCULAR SYSTEM: The patient has known coronary artery disease with episode of chest pain one day prior to admission and was reported to be in congestive heart failure overnight. One set of cardiac enzymes were drawn before the family was [**Name (NI) 653**]. They wished not to have any labs drawn on the patient. Her first set of cardiac enzymes were unremarkable with a troponin less than 0.01. We continued her aspirin p.r. The patient was unable to take p.o. medications and so the Lipitor was held as well as the beta blocker and ACE inhibitor. 3. DIABETES MELLITUS TYPE 2: The patient was continued on her regular regimen of NPH and insulin sliding scale, however, she took no p.o. during her course of stay here, so she did not require her NPH. 4. HEMATOLOGIC: The patient has a history of pulmonary embolism on Coumadin. [**Name (NI) 263**] at the time of admission was super therapeutic. Coumadin was held, however, subsequent labs to check hematocrit and [**Name (NI) 263**] were not drawn. 6. GASTROINTESTINAL/HEPATOMEGALY: Possibly related to congestive heart failure episode. The patient was monitored during the course of her stay. 7. CHRONIC RENAL FAILURE: The creatinine has slightly risen from baseline. Her Levofloxacin was dosed renally and will continue, however, labs were not drawn during the course of her stay, so her creatinine was not followed. 8. NEUROLOGIC: The patient was admitted unresponsive and grimacing only to pain. Had intermittent periods of time where she would ask for ice chips or water, but for the most part was unresponsive. 9. FLUIDS, ELECTROLYTES AND NUTRITION: The patient was NPO during the course of her stay here, unable to take p.o. medications. A family meeting was held twice with the patient's daughters as well as her granddaughter who is her health care proxy. It was re-iterated several times to the medical team that the family did not want extraordinary measures for their mother which included no resuscitation, no intubation, no pressors, no cardioversion, or defibrillation. CONDITION AT DISCHARGE: Stable. DISCHARGE STATUS: Poor. DISCHARGE DIAGNOSES: 1. Nursing home acquired pneumonia. DISCHARGE MEDICATIONS: 1. Aspirin 300 p.r. 2. Atrovent nebulizer treatments. 3. Albuterol nebulizer treatments. 4. Levofloxacin 500 mg q. day. 5. Ceftriaxone one gram q. day. 6. Flagyl 500 mg twice a day. 7. Ativan 0.5 mg three times a day p.r.n. 8. Insulin sliding scale. DISCHARGE INSTRUCTIONS: 1. The patient does not require Medical Intensive Care Unit level of care at this time and the family does not want additional intervention to be done, so she will be transferred either to the floor for further care or back to her nursing home facility where she can receive antibiotics to treat her pneumonia. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3795**] Dictated By:[**Last Name (NamePattern1) 2706**] MEDQUIST36 D: [**2131-8-22**] 13:19 T: [**2131-8-22**] 15:44 JOB#: [**Job Number 11681**]

486,491,428,427,518,424,403,426,533

{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other left bundle branch block,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is an 88 year old Portuguese speaking female found in respiratory distress at her nursing home. EMS was called and vital signs at that time were a heart rate of 112, blood pressure of 140/80; respiratory rate of 40 and she was 71% on room air. Rales were noted bilaterally. This patient is normally on two liters of home oxygen. She was given Nitroglycerin, 80 mg of Lasix and morphine and nebulizers during transport; the patient was unresponsive. The patient, in the Emergency Department, BiPAP ventilation was started. The patient's systolic blood pressure dropped to the 70s. Dopamine was started and titrated up to 7.5. Blood pressure was stabilized at systolic blood pressure of 110 and Dopamine was weaned off later during the day. The patient was also given Levofloxacin 500 mg times one for possible pneumonia, and Ceftriaxone 1 gram. Per report at nursing home, at 04:30 p.m. the previous day, the patient had an episode of chest pain and was given Ativan, Nitroglycerin and percocet. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease on home O2 of two liters. 2. Diabetes mellitus type 2, insulin dependent. 3. Hypertension. 4. Chronic renal failure with a baseline creatinine of 1.0. 5. Peptic ulcer disease. 6. Coronary artery disease status post coronary artery bypass graft and myocardial infarction in [**2121**]. 7. Left bundle branch block. 8. Atrial fibrillation. 9. History of pulmonary embolism in [**2128**], on Coumadin. 10. Positive PPD. 11. Costochondritis. 12. History of supraventricular tachycardia. 13. Congestive heart failure, ejection fraction subnormal, two plus mitral regurgitation. 14. Transient ischemic attack. 15. Hyperlipidemia. 16. "DO NOT RESUSCITATE" and "DO NOT INTUBATE" code status. 17. History of falls. 18. Right wrist fracture in [**2131-6-12**]. MEDICATION ON ADMISSION: 1. Enteric coated aspirin 325 mg q. day. 2. Diltiazem 120 q. day. 3. Isosorbide MN 120 q. day. 4. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q. day. 5. Paxil 10 mg q. day. 6. Protonix 40 mg q. day. 7. Lisinopril 40 mg q. day. 8. Atenolol 100 mg q. day. 9. Colace 100 mg twice a day. 10. Flovent 110 micrograms, two puffs q. four to six hours p.r.n. 11. Lasix 40 mg twice a day. 12. Atrovent MDI two puffs four times a day. 13. Senna one tablet q. h.s. 14. Lipitor 10 mg q. day. 15. Ativan 0.5 mg three times a day p.r.n. 16. Klonopin 0.5 mg q. h.s. p.r.n. 17. NPH 8 units q. a.m. 18. Coumadin 5.5 mg q. day. 19. Insulin sliding scale. 20. Ground, two grams of sodium. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Nursing home resident. No history of tobacco, no history of alcohol. ### Response: {'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute and chronic respiratory failure,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other left bundle branch block,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 48-year-old gentleman with a prior myocardial infarction in [**2114**], who presented to an outside hospital on [**2123-8-7**] with crushing substernal chest pain similar to the pain that he had experienced in [**2114**]. He was transferred to [**Hospital1 346**], where an electrocardiogram was performed which revealed depressed T waves in leads II, III and aVF as well as J point elevations in leads V1 through V3. His first set of cardiac enzymes was 668 for the CK and 73 for the CK MB; troponin I was not done. The second set of enzymes was 1056 for the CK, 102 for the CK MB and greater than 50 for the troponin I. MEDICAL HISTORY: MEDICATION ON ADMISSION: Lopressor 15 mg p.o. q.d. Lipitor 10 mg p.o. q.d. Enteric coated aspirin 325 mg p.o. q.d. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Old myocardial infarction

Subendo infarct, initial,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Old myocardial infarct

Admission Date: [**2123-8-7**] Discharge Date: [**2123-8-16**] Date of Birth: [**2075-8-25**] Sex: M Service: CT [**Doctor First Name 147**] HISTORY OF PRESENT ILLNESS: This is a 48-year-old gentleman with a prior myocardial infarction in [**2114**], who presented to an outside hospital on [**2123-8-7**] with crushing substernal chest pain similar to the pain that he had experienced in [**2114**]. He was transferred to [**Hospital1 346**], where an electrocardiogram was performed which revealed depressed T waves in leads II, III and aVF as well as J point elevations in leads V1 through V3. His first set of cardiac enzymes was 668 for the CK and 73 for the CK MB; troponin I was not done. The second set of enzymes was 1056 for the CK, 102 for the CK MB and greater than 50 for the troponin I. The patient therefore ruled in for a myocardial infarction and was started on heparin drip, Lopressor drip, integrelin drip and nitroglycerin drip, as well as being given Captopril and aspirin. He was subsequently admitted to the hospital. MEDICATIONS ON ADMISSION: Lopressor 15 mg p.o. q.d. Lipitor 10 mg p.o. q.d. Enteric coated aspirin 325 mg p.o. q.d. HOSPITAL COURSE: On [**2123-8-7**], the patient was admitted to the hospital for management of his acute myocardial infarction. He was pain free overnight and throughout hospital day #2 he was stable. On hospital day #3, he had a second episode of substernal chest pain. There were no electrocardiogram changes compared to his admission electrocardiogram and no change in therapy was made. On hospital day #4, [**2123-8-10**], the patient underwent a cardiac catheterization that revealed a 90% occlusion of the left anterior descending artery, a 100% occlusion of the left circumflex coronary artery, a 100% occlusion of the right coronary artery and an ejection fraction of approximately 45%. On hospital day #5, the patient remained stable and pain free. On hospital day #6, the patient underwent an uncomplicated four vessel coronary artery bypass graft surgery. He tolerated the procedure well; however, he remained intubated and on Diltiazem and nitroglycerin drips upon transfer to the cardiac surgery recovery unit. On hospital day #7, the patient was noted to have a pericardial rub on examination and the cardiology service was consulted. A diagnosis of pericarditis was made. The patient was extubated on postoperative day #1 uneventfully. He remained stable overnight and was transferred to the floor on postoperative day #2. On postoperative day #3, the patient was noted to have remained afebrile with stable vital signs and at his preoperative weight. His chest tubes were noted to put out 220 cc and 555 cc respectively. The chest tube with the lower output was subsequently removed without incident. By postoperative day #4, the patient continued to do well. He was weaned off of his supplemental oxygen and the last chest tube, which had only put out 20 cc overnight, was removed in the morning. His pacing wires were also removed on the day of discharge without incident. DISPOSITION: The patient was subsequently discharged to home in stable condition with instructions to follow up with Dr. [**First Name (STitle) 10102**] in one week as well as his primary care physician in one to two weeks. DISCHARGE DIAGNOSES: Acute myocardial infarction, status post coronary artery bypass grafting times four. DISCHARGE MEDICATIONS: Lasix 20 mg p.o. b.i.d. times one week. Potassium chloride 20 mEq p.o. b.i.d. times one week. Colace 100 mg p.o. b.i.d. Zantac 150 mg p.o. b.i.d. Enteric coated aspirin 81 mg p.o. q.d. Cardizem XR 180 mg p.o. q.d. Lopressor 75 mg p.o. b.i.d. Combivent metered dose inhaler four puffs inhaled q.i.d. Ibuprofen 400 to 600 mg p.o. every six hours p.r.n. Percocet 5/325 mg one to two tablets p.o. every three to four hours p.r.n. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 13625**] Dictated By:[**Last Name (NamePattern1) 3801**] MEDQUIST36 D: [**2123-8-16**] 10:47 T: [**2123-8-18**] 10:04 JOB#: [**Job Number 19190**]

410,414,272,412

{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Old myocardial infarction'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is a 48-year-old gentleman with a prior myocardial infarction in [**2114**], who presented to an outside hospital on [**2123-8-7**] with crushing substernal chest pain similar to the pain that he had experienced in [**2114**]. He was transferred to [**Hospital1 346**], where an electrocardiogram was performed which revealed depressed T waves in leads II, III and aVF as well as J point elevations in leads V1 through V3. His first set of cardiac enzymes was 668 for the CK and 73 for the CK MB; troponin I was not done. The second set of enzymes was 1056 for the CK, 102 for the CK MB and greater than 50 for the troponin I. MEDICAL HISTORY: MEDICATION ON ADMISSION: Lopressor 15 mg p.o. q.d. Lipitor 10 mg p.o. q.d. Enteric coated aspirin 325 mg p.o. q.d. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Old myocardial infarction'}

CHIEF COMPLAINT: Lower GI bleed. PRESENT ILLNESS: The patient is an 88-year-old male known to our hospital who was transferred here with a history of a lower GI bleed from an outside hospital. He was admitted there for five days in work-up for this lower GI bleed and both endoscopies from above and colonoscopy failed to reveal the source of the bleed, so he was transferred to our hospital. At that hospital, he received four units of blood. MEDICAL HISTORY: MEDICATION ON ADMISSION: Benicar 20 mg once a day, pravastatin 10 mg once a day, paroxetine 20 mg once a day, levothyroxine 50 mcg once a day, propranolol 40 mg once a day, metoprolol 25 mg once a day, Flomax 0.4 mg once a day, aspirin 81 mg once a day. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Rupture of artery,Atherosclerosis of native arteries of the extremities with gangrene,Diverticulosis of colon (without mention of hemorrhage),Peritoneal adhesions (postoperative) (postinfection),Coronary atherosclerosis of native coronary artery,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of large intestine,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,Hypotension, unspecified

Hemorrhage complic proc,Acute kidney failure NOS,React-oth vasc dev/graft,Intestinal fistula,Rupture of artery,Ath ext ntv art gngrene,Dvrtclo colon w/o hmrhg,Peritoneal adhesions,Crnry athrscl natve vssl,Alzheimer's disease,Dementia w/o behav dist,Hypertension NOS,Hypothyroidism NOS,Esophageal reflux,Diaphragmatic hernia,Status-post ptca,Hx-ven thrombosis/embols,Hx of colonic malignancy,Abn react-anastom/graft,Hypotension NOS

Admission Date: [**2116-9-27**] Discharge Date: [**2116-10-2**] Service: [**Last Name (un) **] ADMITTING DIAGNOSES: 1. Lower gastrointestinal bleed. 2. Diverticular disease. 3. Gastroesophageal reflux. 4. Hypothyroidism. 5. History of pulmonary embolus. 6. Hypertension. 7. Coronary artery disease. PAST SURGICAL HISTORY: 1. Percutaneous coronary intervention. 2. Abdominal aortic aneurysm repair in [**2101**]. 3. Colon cancer status post resection in [**2114**]. 4. Bilateral inguinal hernia repairs. MEDICATIONS ON ADMISSION: Benicar 20 mg once a day, pravastatin 10 mg once a day, paroxetine 20 mg once a day, levothyroxine 50 mcg once a day, propranolol 40 mg once a day, metoprolol 25 mg once a day, Flomax 0.4 mg once a day, aspirin 81 mg once a day. CHIEF COMPLAINT: Lower GI bleed. HISTORY OF PRESENT ILLNESS: The patient is an 88-year-old male known to our hospital who was transferred here with a history of a lower GI bleed from an outside hospital. He was admitted there for five days in work-up for this lower GI bleed and both endoscopies from above and colonoscopy failed to reveal the source of the bleed, so he was transferred to our hospital. At that hospital, he received four units of blood. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: 98.5, heart rate of 61, blood pressure 141/67, respiratory rate 18 and saturation 97 on room air. In general, he was in no acute distress, alert and oriented x3. HEENT: Normocephalic, atraumatic, injected sclerae, dry mucous membranes. Cardiovascular: He had a regular rate and rhythm with no orthostatic signs. Pulmonary: Chest was clear to auscultation bilaterally. Abdomen was soft. There is a midline incision noted. He was nontender and nondistended. He had good bowel sounds. He had gross blood on rectal exam. Extremities: No clubbing, cyanosis or edema, and he had warm and well- perfused feet. BRIEF HOSPITAL COURSE: The patient was admitted on the [**9-27**] for treatment of his lower GI bleed. Initially, his hematocrit was 27.7 and this steadily declined to 25 over the ensuing day. On hospital day two, he had significant hematochezia and at that time he was transfused two units of blood and was immediately transferred to the [**Hospital Ward Name 517**] in anticipated of a tagged red cell scan and subsequent angiography to attempt embolization of the bleeding vessel. He underwent the tagged red cell scan but this study failed to show the source of the bleed. He was admitted to the surgical ICU for close monitoring after this negative test. On hospital day three, he again suffered colonic bleeding and was again taken for a tagged red cell scan to try to identify the source of the bleed. Again, this test was negative. On hospital day four, he had a 1300 cc hematochezia and also hypotension which prompted a third red cell scan to attempt to identify the source of the bleed. The gastroenterology team made preparations to perform an endoscopy and potential colonoscopy earlier, but as he had appeared to stabilize, these studies were post-poned. The third tagged red cell scan was negative and we brought the patient to the ICU for esophagogastroduodenoscopy. This test was also negative despite the fact that the patient was scoped all the way to the beginning of the jejunum. Thereafter, a CT scan of the abdomen and pelvis were ordered to ensure that the patient did not have an aortoenteric fistula. The patient did have a history of a distant AAA repair back in the [**2098**]. This study also proved negative and was considered to be a normal study. On hospital day five, the patient again had a massive bleed and at this point it was decided, due to two negative EGDs at the outside hospital, one negative EGD here, and a negative colonoscopy at the outside hospital, a negative CT scan here, three negative tagged red cells scans, to directly take the patient to the operating room for a planned total abdominal colectomy which was potentially the only procedure that could save his life. During the 4 day admission to [**Hospital1 18**], he had recieved at least 12 units of transfusion. Initially the patient's family had declined surgery but agreed to proceed if a straightforward outcome could be assured. The patient was taken to the operating room on [**2116-10-1**]. Please refer to the operative note for details of this operation. He appeared to have a fistula from an infected distal aorto-iliac graft to common iliac anastamosis to the appendix, requiring division of his graft. An appendectomy was performed. There was insufficient inflow to the left femoral artery to perform a femoral-to-femoral bypass graft. After discussion with his family, it was elected to not perform an axillo-bifemoral bypass graft. After the patient was returned to the ICU from the operating room, he had threatened limb ischemia bilaterally. The family and staff discussed at length the options and the prognosis for Mr. [**Known lastname 770**], and it was decided to make him comfort measures only. He was extubated in the early afternoon on the [**10-2**] and expired shortly thereafter with his family present. The family declined autopsy. The medical examiner was notified of the death and declined the case. DISCHARGE DIAGNOSES: 1. Lower gastrointestinal bleed. 2. Diverticular disease. 3. Gastroesophageal reflux. 4. Hypothyroidism. 5. History of pulmonary embolus. 6. Hypertension. 7. Coronary artery disease. 8. Iliac-appendiceal fistula. 9. Peripheral vascular disease. 10.Threatened limb ischemia. DISPOSITION: Expired. [**First Name11 (Name Pattern1) 518**] [**Last Name (NamePattern4) **], [**MD Number(1) 17554**] Dictated By:[**Doctor Last Name 9032**] MEDQUIST36 D: [**2116-10-2**] 17:23:33 T: [**2116-10-2**] 19:42:48 Job#: [**Job Number 22300**]

998,584,996,569,447,440,562,568,414,331,294,401,244,530,553,V458,V125,V100,E878,458

{"Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Rupture of artery,Atherosclerosis of native arteries of the extremities with gangrene,Diverticulosis of colon (without mention of hemorrhage),Peritoneal adhesions (postoperative) (postinfection),Coronary atherosclerosis of native coronary artery,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of large intestine,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,Hypotension, unspecified"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Lower GI bleed. PRESENT ILLNESS: The patient is an 88-year-old male known to our hospital who was transferred here with a history of a lower GI bleed from an outside hospital. He was admitted there for five days in work-up for this lower GI bleed and both endoscopies from above and colonoscopy failed to reveal the source of the bleed, so he was transferred to our hospital. At that hospital, he received four units of blood. MEDICAL HISTORY: MEDICATION ON ADMISSION: Benicar 20 mg once a day, pravastatin 10 mg once a day, paroxetine 20 mg once a day, levothyroxine 50 mcg once a day, propranolol 40 mg once a day, metoprolol 25 mg once a day, Flomax 0.4 mg once a day, aspirin 81 mg once a day. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {"Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Rupture of artery,Atherosclerosis of native arteries of the extremities with gangrene,Diverticulosis of colon (without mention of hemorrhage),Peritoneal adhesions (postoperative) (postinfection),Coronary atherosclerosis of native coronary artery,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism,Personal history of malignant neoplasm of large intestine,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,Hypotension, unspecified"}

CHIEF COMPLAINT: 28 y/o male with self inflicted gun shot wound to head. PRESENT ILLNESS: 28 year old male found by his father after patient shot himslef in the head with a .38 mm gun. Taken to [**Hospital **] hospital where he was intubated and then transferred to [**Hospital1 18**] ER MEDICAL HISTORY: Knee surgery MEDICATION ON ADMISSION: None ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: HR 1212, BP 92/p, RR 13, SpO2, 100% intubated HEENT: Pupils fixed and dilated, blood in oropharynx, wound to top of head Pulm: CTA b CV: tachycardic, RRR ABD: Soft, NT, ND, Rectal: no tone, guiac negative Pelvis: Stable EXT: palpable pulses, no LE injury FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Non-contirbutory

Cortex (cerebral) laceration with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Suicide and self-inflicted injury by handgun

Opn cortex lac-deep coma,Injury-handgun

Admission Date: [**2148-6-10**] Discharge Date: [**2148-6-11**] Date of Birth: [**2120-3-7**] Sex: M Service: SURGERY Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 2534**] Chief Complaint: 28 y/o male with self inflicted gun shot wound to head. Major Surgical or Invasive Procedure: None History of Present Illness: 28 year old male found by his father after patient shot himslef in the head with a .38 mm gun. Taken to [**Hospital **] hospital where he was intubated and then transferred to [**Hospital1 18**] ER Past Medical History: Knee surgery Social History: Non-contirbutory Family History: Non-contributory Physical Exam: Vitals: HR 1212, BP 92/p, RR 13, SpO2, 100% intubated HEENT: Pupils fixed and dilated, blood in oropharynx, wound to top of head Pulm: CTA b CV: tachycardic, RRR ABD: Soft, NT, ND, Rectal: no tone, guiac negative Pelvis: Stable EXT: palpable pulses, no LE injury Pertinent Results: [**2148-6-10**] 09:03PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2148-6-10**] 09:12PM WBC-25.4* RBC-2.64* HGB-7.9* HCT-21.9* MCV-83 MCH-30.0 MCHC-36.1* RDW-14.3 [**2148-6-10**] 09:12PM PO2-162* PCO2-46* PH-7.20* TOTAL CO2-19* BASE XS--9 COMMENTS-GREEN TOP [**2148-6-10**] 09:12PM GLUCOSE-252* LACTATE-3.4* NA+-141 K+-3.5 CL--119* [**2148-6-10**] 09:12PM PT-18.8* PTT-86.4* INR(PT)-1.8* CT HEAD W/O CONTRAST [**2148-6-11**] 12:28 AM NON-CONTRAST HEAD CT: There is extensive intracranial hemorrhage with blood identified within the lateral ventricles, third ventricle and fourth ventricle. Air layers in the nondependent aspect of the left frontal [**Doctor Last Name 534**]. Intraparenchymal hemorrhage is seen extending from the left thalamus cephalad toward the vertex following the bullet tract. There is subarchnoid blood near the exit wound in the vertex as well as a small parafalcine subdural hematoma. The sulci and basal cisterns are effaced, suggesting cerebral edema. There is approximately 4 mm of rightward shift of normally midline structures. There is transtentorial herniation. Extensive bony destruction is seen involving the skull base, particularly through the sella, and calvarium. The ethmoid and sphenoid sinuses are completely opacified with blood. IMPRESSION: Status post self inflicted gunshot wound to the head with extensive intraparenchymal and intraventricular hemorrhage There is evidence of cerebral edema with effacement of the sulci and basal cisterns with subsequent transtentorial herniation. Brief Hospital Course: Patient was transported to [**Hospital1 18**] from [**Hospital **] hospital intubated and on double pressors after a self inflicted gun shot wound to the head. On arrival pupils were fixed and dilated and patient was noted to have decorticate posturing. He was admitted from the ED to the TSICU where resuscitation continued with fluids and blood products. A neurosurgery consult was obtained and they recommended a STAT CT scan of the head which was obtained. The CT showed extensive intraparenchymal and intraventricular hemorrhage and transtentorial herniation. A family meeting was had with neurosurgery, and Dr. [**Last Name (STitle) **] and the decision was made by the family to make the patient comfort measures only. The [**Location (un) 511**] Organ Bank was contact[**Name (NI) **]. The patient expired on [**2148-6-11**] at 6:00 AM due to an immediate cause of respiratory failure and a chief cause of a gun shot wound to the head. The family was contact[**Name (NI) **] and the body was transported to the morgue. Medications on Admission: None Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Gun shot wound to the head, death Discharge Condition: Expired Discharge Instructions: None Followup Instructions: None

851,E955

{'Cortex (cerebral) laceration with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Suicide and self-inflicted injury by handgun'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: 28 y/o male with self inflicted gun shot wound to head. PRESENT ILLNESS: 28 year old male found by his father after patient shot himslef in the head with a .38 mm gun. Taken to [**Hospital **] hospital where he was intubated and then transferred to [**Hospital1 18**] ER MEDICAL HISTORY: Knee surgery MEDICATION ON ADMISSION: None ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: HR 1212, BP 92/p, RR 13, SpO2, 100% intubated HEENT: Pupils fixed and dilated, blood in oropharynx, wound to top of head Pulm: CTA b CV: tachycardic, RRR ABD: Soft, NT, ND, Rectal: no tone, guiac negative Pelvis: Stable EXT: palpable pulses, no LE injury FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Non-contirbutory ### Response: {'Cortex (cerebral) laceration with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Suicide and self-inflicted injury by handgun'}

CHIEF COMPLAINT: 1. Abdominal pain 2. Constipation PRESENT ILLNESS: Patient is a 89 years-old female with history of chronic constipation present with new [**7-29**] colicky LLQ pain. It woke her from sleep two nights ago. Her last BM was 2 days ago and was normal per patient report. She feels like she needs to defecate or pass flatus but can't. She has had no emesis. MEDICAL HISTORY: 1. Hypertension 2. Urge incontinence 3. Osteoporosis 4. Chronic constipation MEDICATION ON ADMISSION: 1. Motrin 200 mg PO prn pain 2. VESIcare 10 mg PO bid 3. Fosamax 70 mg weekly 4. GlycoLax PRN constipation 5. Lisinopril 10 mg PO qday 6. Tolterodone 1 mg PO BID ALLERGIES: Penicillins / Aspirin / Codeine PHYSICAL EXAM: On Admission: VS: T 98.3, HR 93, BP 136/76, RR 16, O2 Sat 99% RA A&Ox4, NAD RRR CTAB Abd - distended, firm, R subcostal scar, no hernias Rectal - tight sphincter, no blood Ext - 1+ edema FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Married. Denies tobacco, EtOH, illicit drugs.

Volvulus,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Pulmonary collapse,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified cardiac dysrhythmias,Anal fissure,Stenosis of rectum and anus,Malnutrition of moderate degree,Unspecified essential hypertension,Other constipation,Osteoporosis, unspecified,Urge incontinence,Esophageal reflux,Volume depletion, unspecified,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

Volvulus of intestine,Urin tract infection NOS,Delirium d/t other cond,Pulmonary collapse,Mth sus Stph aur els/NOS,Cardiac dysrhythmias NEC,Anal fissure,Rectal & anal stenosis,Malnutrition mod degree,Hypertension NOS,Constipation NEC,Osteoporosis NOS,Urge incontinence,Esophageal reflux,Volume depletion NOS,Abn react-anastom/graft

Admission Date: [**2177-4-6**] Discharge Date: [**2177-4-26**] Service: SURGERY Allergies: Penicillins / Aspirin / Codeine Attending:[**First Name3 (LF) 6346**] Chief Complaint: 1. Abdominal pain 2. Constipation Major Surgical or Invasive Procedure: [**2177-4-8**]: Exploratory laparotomy and sigmoid colectomy with colocolostomy. . [**2177-4-21**]: Botox injection to anal sphincter. History of Present Illness: Patient is a 89 years-old female with history of chronic constipation present with new [**7-29**] colicky LLQ pain. It woke her from sleep two nights ago. Her last BM was 2 days ago and was normal per patient report. She feels like she needs to defecate or pass flatus but can't. She has had no emesis. Past Medical History: 1. Hypertension 2. Urge incontinence 3. Osteoporosis 4. Chronic constipation Social History: Married. Denies tobacco, EtOH, illicit drugs. Family History: Non-contributory Physical Exam: On Admission: VS: T 98.3, HR 93, BP 136/76, RR 16, O2 Sat 99% RA A&Ox4, NAD RRR CTAB Abd - distended, firm, R subcostal scar, no hernias Rectal - tight sphincter, no blood Ext - 1+ edema On Discharge: Abdomen: soft, nondistended, low midabdominal incision open to air and clean/dry and intact Pertinent Results: On Admission: [**2177-4-6**] 04:15PM GLUCOSE-104* UREA N-27* CREAT-0.8 SODIUM-139 POTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-15 [**2177-4-6**] 04:15PM estGFR-Using this [**2177-4-6**] 04:15PM ALT(SGPT)-12 AST(SGOT)-28 ALK PHOS-54 TOT BILI-0.2 [**2177-4-6**] 04:15PM CALCIUM-9.8 PHOSPHATE-4.1 MAGNESIUM-2.1 [**2177-4-6**] 04:15PM WBC-10.7 RBC-4.38 HGB-11.9* HCT-36.3 MCV-83 MCH-27.1 MCHC-32.7 RDW-14.1 [**2177-4-6**] 04:15PM NEUTS-81.3* LYMPHS-13.0* MONOS-3.6 EOS-1.4 BASOS-0.7 [**2177-4-6**] 04:15PM PLT COUNT-274 [**2177-4-6**] 04:15PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.009 [**2177-4-6**] 04:15PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2177-4-9**] 07:50AM BLOOD WBC-12.8*# RBC-4.04* Hgb-11.3* Hct-33.4* MCV-83 MCH-27.9 MCHC-33.8 RDW-14.1 Plt Ct-219 [**2177-4-9**] 07:50AM BLOOD Plt Ct-219 [**2177-4-9**] 07:50AM BLOOD Glucose-87 UreaN-12 Creat-0.5 Na-141 K-4.2 Cl-105 HCO3-26 AnGap-14 . [**2177-4-6**] CT ABDOMEN W/CONTRAST: IMPRESSION: 1. Sigmoid volvulus. 2. Intra-hepatic and extra-hepatic biliary ductal dilatation with an apparent intraluminal lesion within the distal common bile duct, possibly a stone or mass. Clinical correlation with LFTs are recommended, and consider ERCP or MRCP for further evaluation once the patient is clinically stable. 3. Fibroid uterus. 4. Two adjacent 4-mm nodules in the right middle lobe, which are slightly larger than on the prior study. One year follow up CT chest is recommended for further evaluation. . [**2177-4-7**] CHEST X-RAY: IMPRESSION: No acute cardiopulmonary process. . [**2177-4-10**] 09:07AM BLOOD WBC-10.8 RBC-3.69* Hgb-10.3* Hct-30.4* MCV-82 MCH-27.8 MCHC-33.8 RDW-14.2 Plt Ct-206 . [**2177-4-12**] CHEST XRAY: No pulmonary edema, no evidence of infection. The extensive intestinal distention, seen on the pre-operative radiograph, has not decreased . [**2177-4-8**] Pathology Examination: Name Birthdate Age Sex Pathology # [**Hospital1 18**] [**Known lastname 33550**],[**Known firstname **] [**2087-10-30**] 89 Female [**Numeric Identifier 33551**] [**Numeric Identifier 33552**] Report to: DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) 2093**] Description by: DR. [**Last Name (STitle) **]. WENSON/dif SPECIMEN SUBMITTED: sigmoid. Procedure date Tissue received Report Date Diagnosed by [**2177-4-8**] [**2177-4-8**] [**2177-4-14**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 7001**]/ttl Previous biopsies: [**-7/3354**] GI BIOPSIES. (2 JARS) DIAGNOSIS: Sigmoid colon, segmental resection: 1. Colonic segment with focal, mild submucosal fibrosis, suggestive of prior injury; no active diverticular disease identified. 2. No intrinsic mucosal abnormalities otherwise recognized. 3. Regional lymph nodes with no diagnostic abnormalities recognized. . [**2177-4-15**] ABDOMEN X-RAY: IMPRESSION: 1. Markedly dilated loops of large bowel consistent with obstruction or ileus. 2. NG tube with side port at the level of GE junction and should be advanced to ensure side port positioning within the stomach. . [**2177-4-15**] CXR: IMPRESSION: 1. No definite evidence of pneumonia or aspiration pneumonitis. 2. Left PIC catheter with tip now at distal left brachiocephalic vein. Advancent by 3-4 cm is recommended. 3. Feeding tube with side port projecting above GE junction, unchanged. [**2177-4-18**] EKG: Sinus tachycardia. Leftward axis. Left bundle-branch block. Possible biatrial enlargment. Non-specific ST-T wave abnormalities. Compared to the previous tracing of [**2177-4-14**] evidence for left atrial abnormality is more suggestive. Otherwise, there is no diagnostic change. . [**2177-4-18**] ABD CT: IMPRESSION: 1. Multiple dilated loops of small and large bowel consistent with ileus, though the degree of distention of large bowel is not significantly different from multiple prior examinations dating back to [**2169**]. No evidence of ischemia. 2. New small bilateral pleural effusions. . MICROBIOLOGY: [**2177-4-14**] BLOOD CULTURE-FINAL: No GROWTH. [**2177-4-14**] SEROLOGY/BLOOD RAPID PLASMA REAGIN TEST-FINAL: NON-REACTIVE. [**2177-4-14**] BLOOD CULTURE-FINAL: NO GROWTH. [**2177-4-14**] URINE URINE CULTURE-FINAL {STAPHYLOCOCCUS, COAGULASE NEGATIVE, STAPHYLOCOCCUS, COAGULASE NEGATIVE}: **FINAL REPORT [**2177-4-18**]** URINE CULTURE (Final [**2177-4-18**]): STAPHYLOCOCCUS, COAGULASE NEGATIVE. >100,000 ORGANISMS/ML.. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. STAPHYLOCOCCUS, COAGULASE NEGATIVE. >100,000 ORGANISMS/ML.. SECOND MORPHOLOGY. COAG NEG STAPH does NOT require contact precautions, regardless of resistance Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPHYLOCOCCUS, COAGULASE NEGATIVE | STAPHYLOCOCCUS, COAGULASE NEGATIVE | | GENTAMICIN------------ <=0.5 S <=0.5 S LEVOFLOXACIN---------- 4 R 4 R NITROFURANTOIN-------- <=16 S <=16 S OXACILLIN------------- =>4 R 1 R TETRACYCLINE---------- <=1 S <=1 S VANCOMYCIN------------ <=0.5 S <=0.5 S . [**2177-4-7**] MRSA SCREEN-FINAL: NEGATIVE. Brief Hospital Course: The patient was admitted to the General Surgical Service for evaluation of the aforementioned problem. On [**2177-4-8**], the patient underwent exploratory laparotomy and sigmoid colectomy with colocolostomy, which went well without complication (reader referred to the Operative Note for details). After a brief, uneventful stay in the PACU, the patient arrived on the floor NPO, on IV fluids, with a foley catheter and Dilaudid PCA for pain control. The patient was hemodynamically stable. . Post-operative pain was initially well controlled with Dilaudid PCA, which was converted to oral pain medication (Tylenol and Oxycodone) when tolerating clear liquids. The patient was started on sips of clears on POD# 1. The foley catheter was discontinued at midnight of POD# 2. The patient subsequently voided without problem. [**Name (NI) **] was advanced to clear liquids on POD# 2, and tolerated well. She did not have bowel movement since operation, her abdomen became more distended on POD #4. Patient's diet was changed to NPO except meds. On [**2177-4-13**] she triggered for decreased urine output as well as nausea/vomiting and abdominal distention. This was managed with NG tube and IVF as well as metoclopramide. Foley catheter was placed. Urine output improved on [**4-14**], patient was given several fluid boluses and started on continues IVF @ 175 cc/hr. Same day, patient was evaluated by dietitian, and was started on TPN. Her IVF was adjusted to 125 cc/hr total (TPN + IVF). Urinalysis and urine cultures were sent, urinalysis showed elevated WBC. CBC test also revealed elevated WBC. Patient was started on Ciprofloxacin IV, Foley catheter was removed, urine culture revealed infection with staphylococcus organism, patient was continue on Cipro IV for 3 days total. Starting on [**2177-4-13**] the patient was noted to have alteration in mental status. Geriatric consult was called, their recommendations were followed. On [**4-15**] patient became more agitated, she tried to pull NGT and IV, became severely delirious. Patient received dose of Haldol with minimal effect, then physical restraints were utilized, When patient's condition improved, 1:1 sitter was used for observation. Same day, patient had several episodes of asymptomatic SVT, her Lopressor doses were increased to 10 mg q6h, patient returned to regular rate. NG tube was removed on POD#7, patient started to pass small amounts of liquid stool. Neurologically improving, Haldol dose was decreased to 0.25 mg qhs prn and she no longer rquired a sitter. On POD#8, she had negative cardiac enzymes from the SVT yesterday. On POD#9, she became more incontinent of urine, but her mental status improved markedly. On POD #10, she was comfortable, not in any pain and had one large and one small loose bowel movements. Had rectal tube placed with drainage of stool on POD#11. She continued to have small liqud to no stooling and was given a botox injection into the rectum via anoscopy. There was 300 mL of liquid stool drained. She was given a soap suds enema and had brown stool. She had no abdominal discomfort or any nausea, she was advanced to a clear liquid diet, which she tolerated well. She was given a regular, mechanical soft diet for dinner and tolerated a small amount of it on POD 17. . During this hospitalization, the patient was evaluated by Physical Therapy, they recommended discharge patient in Rehab to continue PT. Patient was adherent with respiratory toilet and incentive spirrometry, and actively participated in the plan of care. The patient received subcutaneous heparin and venodyne boots were used during this stay. The patient's blood sugar was monitored regularly throughout the stay; sliding scale insulin was administered when indicated. Labwork was routinely followed; electrolytes were repleted when indicated. . At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating with assistance, voiding without assistance, and pain was well controlled. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Medications on Admission: 1. Motrin 200 mg PO prn pain 2. VESIcare 10 mg PO bid 3. Fosamax 70 mg weekly 4. GlycoLax PRN constipation 5. Lisinopril 10 mg PO qday 6. Tolterodone 1 mg PO BID Discharge Medications: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for pain. 3. Vesicare 10 mg Tablet Sig: One (1) Tablet PO twice a day. 4. Tolterodine 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week. 8. 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. 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 10. Sodium Chloride 0.9 % 0.9 % Parenteral Solution Sig: [**5-8**] mL Intravenous twice a day: Please flush with 5-10 cc prior to TPN start and flush with 10-20 cc after TPN is finished, NaCl must be sterile. Disp:*500 mL* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: 1. Sigmoid volvulus. 2. Dilirium. 3. UTI. 4. Chronic anal fissure and hypertonic internal anal sphincter. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: General Discharge Instructions: Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than [**4-28**] lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips 7-10 days after surgery. Followup Instructions: 1. Please call [**Telephone/Fax (1) 133**] to arrange a follow up appointment with Dr. [**Last Name (STitle) 2472**] (PCP) in [**1-22**] weeks after discharge. . 2. Please call [**Telephone/Fax (1) 2998**] to arrange a follow up appointment with Dr. [**First Name (STitle) 2819**] (General Surgery) in [**1-22**] weeks after surgery. Completed by:[**2177-4-26**]

560,599,293,518,041,427,565,569,263,401,564,733,788,530,276,E878

{'Volvulus,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Pulmonary collapse,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified cardiac dysrhythmias,Anal fissure,Stenosis of rectum and anus,Malnutrition of moderate degree,Unspecified essential hypertension,Other constipation,Osteoporosis, unspecified,Urge incontinence,Esophageal reflux,Volume depletion, unspecified,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'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: 1. Abdominal pain 2. Constipation PRESENT ILLNESS: Patient is a 89 years-old female with history of chronic constipation present with new [**7-29**] colicky LLQ pain. It woke her from sleep two nights ago. Her last BM was 2 days ago and was normal per patient report. She feels like she needs to defecate or pass flatus but can't. She has had no emesis. MEDICAL HISTORY: 1. Hypertension 2. Urge incontinence 3. Osteoporosis 4. Chronic constipation MEDICATION ON ADMISSION: 1. Motrin 200 mg PO prn pain 2. VESIcare 10 mg PO bid 3. Fosamax 70 mg weekly 4. GlycoLax PRN constipation 5. Lisinopril 10 mg PO qday 6. Tolterodone 1 mg PO BID ALLERGIES: Penicillins / Aspirin / Codeine PHYSICAL EXAM: On Admission: VS: T 98.3, HR 93, BP 136/76, RR 16, O2 Sat 99% RA A&Ox4, NAD RRR CTAB Abd - distended, firm, R subcostal scar, no hernias Rectal - tight sphincter, no blood Ext - 1+ edema FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Married. Denies tobacco, EtOH, illicit drugs. ### Response: {'Volvulus,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Pulmonary collapse,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified cardiac dysrhythmias,Anal fissure,Stenosis of rectum and anus,Malnutrition of moderate degree,Unspecified essential hypertension,Other constipation,Osteoporosis, unspecified,Urge incontinence,Esophageal reflux,Volume depletion, unspecified,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'}

CHIEF COMPLAINT: Pedestrian vs. car + LOC PRESENT ILLNESS: Mr. [**Known lastname 16408**] is a 35 yo pedestrian who was struck by a car. GCS of 3 at scene. + LOC. + ETOH. He was transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: ^lipid MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On discharge: FAMILY HISTORY: non-contributory SOCIAL HISTORY: ETOH use

Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Closed fracture of mandible, symphysis of body,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Street and highway accidents,Alcohol abuse, continuous,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication

Brain lacer NEC-coma NOS,Food/vomit pneumonitis,Acute respiratry failure,Fx symphy mandib body-cl,Mv coll w pedest-pedest,Accid on street/highway,Alcohol abuse-continuous,Broken tooth-uncomplic

Admission Date: [**2191-11-24**] Discharge Date: [**2191-12-7**] Date of Birth: [**2155-12-17**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2534**] Chief Complaint: Pedestrian vs. car + LOC Major Surgical or Invasive Procedure: s/p IMF and tracheostomy History of Present Illness: Mr. [**Known lastname 16408**] is a 35 yo pedestrian who was struck by a car. GCS of 3 at scene. + LOC. + ETOH. He was transferred to [**Hospital1 18**] for further management. Past Medical History: ^lipid Social History: ETOH use Family History: non-contributory Physical Exam: On discharge: Patient is afebrile, VSS Gen: NAD, A+O x3, unable to fully verbalize secondary to fixation of mandible, sitting upright in chair HEENT: Lip laceration scabbed over, appears stable CV: RRR Resp: CTAB Abd: Soft, NT/ND Pertinent Results: Admit hct: 44.6 Discharge hct: 37.9 [**11-24**] CT head: Posterior parafalcine SDH with associated foci of subarachnoid and intraventricular hemorrhage. [**11-24**] CT sinus/[**Last Name (un) **]: Right subcondylar mandible fx, left parasymphyseal mandible fx, Minimally displaced L maxillary fx [**11-24**] CT c-spine: no fx seen, possible osteophyte fx [**11-24**] CT chest: Aspiration of all lung lobes [**11-24**] CT abd/pelvis: no injury [**11-30**] CT head: Slight interval evolution of previously seen subdural hematomas. No new hemorrhage. No evidence of communicating hydrocephalus. [**12-3**] CT Sinus/Max: No change as compared to before, stable hardware Brief Hospital Course: After being transferred to the ED at [**Hospital1 18**], the patient was emergently intubated given his GCS score. However following intubation, the patient vomitted and desaturated into the 70's. The ETT was promptly removed and the patient was suctioned. Reintubation was successful with saturations in the high 90's. The patient's injuries consist of a SDH, chin and lip lacerations, and pan-facial fractures. Neurosurgery, plastics, and OMFS were consulted. Neurosurgery requested repeat head CT's which showed stable SDH, thus the patient was non-operative. Plastics sutured the chin lacerations. After being scanned and deemed hemodynamically stable in the ED, the patient was transferred to the TSICU. His C-collar was discontinued given his negative scans. On [**11-26**] (HD 3), the patient underwent a tracheostomy such that OMFS could repair his pan-facial fractures the next day. On [**11-27**], the patient underwent IMF of his b/l mandibular fractures. A Dobloff was placed on [**11-29**] and he was started on TF. The patient was successfully extubated on [**11-29**] and maintained his saturations on trach mask at 40%. Multiple attempts by speech and swallow were made however the patient was too sedated to participate. On [**12-2**], the patient was transferred from the ICU to the floor. On the floor the patient was agitated and required restraints. Psychiatry was consulted for his agitation and the patient was given Haldol PRN. On the floor PT saw the patient and suggested rehab. In addition, the patient pulled out his dobloff. Attempts to replace the dobloff were unsuccessful. A repeat S/S trial was done, however the patient was too sedated to participate again. On [**12-3**] the patient fell out of his bed despite being on restraints and landed on the right side of his face. Dr. [**First Name (STitle) **] was called regarding this fall and a repeat CT Max/Sinus was performed to evaluate the extent of his injuries. His hardware was found to be intact and there were no new fractures. Because of this fall, a 1:1 sitter was initiated. His tracheostomy tube was downsized to a 8. It was capped and the patient did well from a respiratory standpoint. On [**12-4**], the trauma team saw the patient and decided he would be capable starting on full liquids, which the patient did well on. On [**12-5**], his 1:1 sitter was discontinued. On [**12-5**] his tracheostomy tube was discontinued. On [**12-7**] the patient will be discharged to rehab. Medications on Admission: Unknown Discharge Medications: 1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 4. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed. 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Pedestrian vs. car, +LOC, s/p IMF and tracheostomy Discharge Condition: Good Discharge Instructions: Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *Avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *Avoid driving or operating heavy machinery while taking pain medications. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. * Continue to ambulate several times per day. Followup Instructions: Follow up with Dr. [**Last Name (STitle) 2866**] in 5 days for removal of wires. Please call [**Telephone/Fax (1) 81467**] to make an appointment. Follow up with Neurosurgery in one month. Please call [**Telephone/Fax (1) 1669**] to make an appointment. Follow up in general trauma clinic in one week. Please call [**Telephone/Fax (1) 6429**] to make an appointment. Completed by:[**2191-12-7**]

851,507,518,802,E814,E849,305,873

{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Closed fracture of mandible, symphysis of body,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Street and highway accidents,Alcohol abuse, continuous,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Pedestrian vs. car + LOC PRESENT ILLNESS: Mr. [**Known lastname 16408**] is a 35 yo pedestrian who was struck by a car. GCS of 3 at scene. + LOC. + ETOH. He was transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: ^lipid MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On discharge: FAMILY HISTORY: non-contributory SOCIAL HISTORY: ETOH use ### Response: {'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Closed fracture of mandible, symphysis of body,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Street and highway accidents,Alcohol abuse, continuous,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication'}

CHIEF COMPLAINT: Fall, rhabdomyolysis, hypothermia PRESENT ILLNESS: Mrs. [**Known lastname **] is a 76 year old woman with a past medical history significant for hypertension found at the bottom of a flight of stairs now admitted found to have a L2 fracture and shoulder subluxation now admitted to the MICU for hypothermia and rhabdomyolysis. The patient was found down at her home today by Physical Therapy at the bottom of the basement stairs. She reports that she was walking down her stairs on Monday when she tripped and fell, and was unable to get up. She was oriented x3 per EMS and denied any pain. Of note, the last time she was in contact with family was 3 days prior to admission (Monday). . In the [**Hospital1 18**] ED, initial VS 32.3 (rectal) 52 111/65 14 100%RA. Labs notable for a CK 3387 and a WBC of 12.5. She had a negative CTH and CT cspine, with CT torso demonstrating a non-displaced fracture of the right transverse process of L2 vertebra and shoulder film demonstrating anterior medial subluxation. Neurosurgery and vascular surgery were consulted, and she was then admitted to the MICU for further management. . Currently, the patient states that she has some right shoulder pain, but otherwise denies any CP/SOB, f/c/s, n/v/d, abd pain, HA, palpitations, HA, hip pain. . ROS: As above, otherwise negative. Per discussion with brother, has had right shoulder pain x6 months, holding it against her chest. History of frequent falls. MEDICAL HISTORY: Rheumatic fever age 18 - per pt no valvular problems HTN R arm immobility x approx 2 years, gradual in onset, now has no use of R hand, extensive w/u without cause found, thought could be due to ? atypical ALS, + recent shoulder dislocation [**2-8**], relocated at ED, placed in sling and dc'ed home MEDICATION ON ADMISSION: Aspirin 81mg qd Diltiazem ER 240mg qd Atenolol 50mg qd Lisinopril 40mg qd ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: VS: 35.7 72 137/62 18 99%RA Gen: Frail elderly female, NAD with echymosses throughout. HEENT: Bilateral periorbital echymosses. Abrasion over bridge of nose. Poor dentition, but OP otherwise clear. Neck supple. CV: Nl S1+S2, no m/r/g Pulm: CTAB anteriorly Abd: S/NT/ND +bs Ext: Venous stasis signs, trace pitting edema bilaterally. Right arm cool to touch with increased edema. Palpabled right radial pulse, CR<2 seconds. Neuro: AOx3, CN II-XII intact. Skin: Bilateral periorbital bruising, bruising down entire back and buttocks, bilateral shoulders, right upper arm, left elbow, bilateral hips, bilateral knees, left shin, and toes. MSK: Right shoulder displaced anteriomedially. FAMILY HISTORY: Mother died 69 of CAD Father died 93 of old age Sister with brain aneurysm SOCIAL HISTORY: Lives alone. Retired worker in a candy factory - no exposures per pt [**Name (NI) 6934**] unaided. Per pt, independent in IDLs, does own shopping and cleaning. Tobacco - none. EtOH - social. Denies IV, illicit, or herbal drug use.

Closed fracture of lumbar vertebra without mention of spinal cord injury,Rhabdomyolysis,Closed dislocation of shoulder, unspecified,Anemia, unspecified,Hypothermia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension

Fx lumbar vertebra-close,Rhabdomyolysis,Disloc shoulder NOS-clos,Anemia NOS,Hypothermia,Fall on stair/step NEC,Hypertension NOS

Admission Date: [**2141-2-15**] Discharge Date: [**2141-2-18**] Date of Birth: [**2064-2-22**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Doctor First Name 2080**] Chief Complaint: Fall, rhabdomyolysis, hypothermia Major Surgical or Invasive Procedure: None. History of Present Illness: Mrs. [**Known lastname **] is a 76 year old woman with a past medical history significant for hypertension found at the bottom of a flight of stairs now admitted found to have a L2 fracture and shoulder subluxation now admitted to the MICU for hypothermia and rhabdomyolysis. The patient was found down at her home today by Physical Therapy at the bottom of the basement stairs. She reports that she was walking down her stairs on Monday when she tripped and fell, and was unable to get up. She was oriented x3 per EMS and denied any pain. Of note, the last time she was in contact with family was 3 days prior to admission (Monday). . In the [**Hospital1 18**] ED, initial VS 32.3 (rectal) 52 111/65 14 100%RA. Labs notable for a CK 3387 and a WBC of 12.5. She had a negative CTH and CT cspine, with CT torso demonstrating a non-displaced fracture of the right transverse process of L2 vertebra and shoulder film demonstrating anterior medial subluxation. Neurosurgery and vascular surgery were consulted, and she was then admitted to the MICU for further management. . Currently, the patient states that she has some right shoulder pain, but otherwise denies any CP/SOB, f/c/s, n/v/d, abd pain, HA, palpitations, HA, hip pain. . ROS: As above, otherwise negative. Per discussion with brother, has had right shoulder pain x6 months, holding it against her chest. History of frequent falls. Past Medical History: Rheumatic fever age 18 - per pt no valvular problems HTN R arm immobility x approx 2 years, gradual in onset, now has no use of R hand, extensive w/u without cause found, thought could be due to ? atypical ALS, + recent shoulder dislocation [**2-8**], relocated at ED, placed in sling and dc'ed home Social History: Lives alone. Retired worker in a candy factory - no exposures per pt [**Name (NI) 6934**] unaided. Per pt, independent in IDLs, does own shopping and cleaning. Tobacco - none. EtOH - social. Denies IV, illicit, or herbal drug use. Family History: Mother died 69 of CAD Father died 93 of old age Sister with brain aneurysm Physical Exam: VS: 35.7 72 137/62 18 99%RA Gen: Frail elderly female, NAD with echymosses throughout. HEENT: Bilateral periorbital echymosses. Abrasion over bridge of nose. Poor dentition, but OP otherwise clear. Neck supple. CV: Nl S1+S2, no m/r/g Pulm: CTAB anteriorly Abd: S/NT/ND +bs Ext: Venous stasis signs, trace pitting edema bilaterally. Right arm cool to touch with increased edema. Palpabled right radial pulse, CR<2 seconds. Neuro: AOx3, CN II-XII intact. Skin: Bilateral periorbital bruising, bruising down entire back and buttocks, bilateral shoulders, right upper arm, left elbow, bilateral hips, bilateral knees, left shin, and toes. MSK: Right shoulder displaced anteriomedially. Pertinent Results: Admission labs: [**2141-2-15**] 01:15PM BLOOD WBC-12.5* RBC-4.72 Hgb-14.1 Hct-41.6 MCV-88 MCH-29.8 MCHC-33.8 RDW-14.2 Plt Ct-272 [**2141-2-15**] 01:15PM BLOOD Neuts-69.7 Bands-0 Lymphs-26.8 Monos-2.9 Eos-0.1 Baso-0.6 [**2141-2-15**] 01:15PM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL [**2141-2-15**] 01:15PM BLOOD PT-13.2 PTT-28.6 INR(PT)-1.1 [**2141-2-15**] 01:15PM BLOOD Glucose-139* UreaN-41* Creat-0.7 Na-137 K-4.1 Cl-102 HCO3-24 AnGap-15 [**2141-2-15**] 01:15PM BLOOD Albumin-3.8 Calcium-9.1 Phos-3.3 Mg-2.4 . Other labs: [**2141-2-17**] 06:40AM BLOOD Ret Aut-1.7 [**2141-2-15**] 01:15PM BLOOD ALT-88* AST-108* CK(CPK)-3387* AlkPhos-62 TotBili-0.8 [**2141-2-15**] 09:35PM BLOOD CK(CPK)-1722* [**2141-2-16**] 04:08AM BLOOD CK(CPK)-1342* [**2141-2-17**] 06:40AM BLOOD LD(LDH)-536* CK(CPK)-673* TotBili-0.4 [**2141-2-15**] 01:15PM BLOOD Lipase-18 [**2141-2-15**] 01:15PM BLOOD cTropnT-<0.01 [**2141-2-15**] 09:35PM BLOOD CK-MB-46* MB Indx-2.7 cTropnT-<0.01 [**2141-2-16**] 04:08AM BLOOD CK-MB-30* MB Indx-2.2 cTropnT-<0.01 [**2141-2-16**] 04:08AM BLOOD calTIBC-198* Ferritn-287* TRF-152* [**2141-2-17**] 06:40AM BLOOD VitB12-535 Folate-8.7 Hapto-43 [**2141-2-15**] 01:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2141-2-15**] 01:22PM BLOOD Glucose-138* Lactate-1.5 Na-142 K-4.0 Cl-102 calHCO3-24 . Discharge labs: [**2141-2-18**] 07:00AM BLOOD WBC-5.5 RBC-3.07* Hgb-9.2* Hct-27.7* MCV-90 MCH-29.8 MCHC-33.1 RDW-14.1 Plt Ct-162 [**2141-2-18**] 07:00AM BLOOD Glucose-98 UreaN-18 Creat-0.5 Na-143 K-3.8 Cl-112* HCO3-24 AnGap-11 [**2141-2-18**] 07:00AM BLOOD Calcium-8.0* Phos-2.0* Mg-1.9 . . Urine: [**2141-2-15**] 07:13PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]->1.050* [**2141-2-15**] 07:13PM URINE Blood-SM Nitrite-NEG Protein-TR Glucose-NEG Ketone-40 Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG [**2141-2-15**] 07:13PM URINE RBC-3* WBC-2 Bacteri-FEW Yeast-NONE Epi-<1 [**2141-2-15**] 07:13PM URINE CastHy-1* [**2141-2-15**] 07:13PM URINE Mucous-RARE . . Microbiology: [**2141-2-17**] STOOL FECAL CULTURE-PENDING; CAMPYLOBACTER CULTURE-PENDING; CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-PENDING [**2141-2-16**] BLOOD CULTURE Blood Culture, Routine-PENDING [**2141-2-15**] BLOOD CULTURE Blood Culture, Routine-PENDING [**2141-2-15**] URINE URINE CULTURE- NEGATIVE [**2141-2-15**] MRSA SCREEN NEGATIVE [**2141-2-15**] BLOOD CULTURE Blood Culture, Routine-PENDING [**2141-2-15**] BLOOD CULTURE Blood Culture, Routine-PENDING . . Radiology: PELVIS (AP ONLY) Study Date of [**2141-2-15**] 1:15 PM FINDINGS: CHEST: Single supine AP portable view of the chest was obtained. Underlying trauma board partially obscures the view. Given this, the lung fields appear clear. No focal consolidation or evidence of pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is identified. PELVIS: Single AP portable view of the pelvis was obtained. Underlying trauma board partially obscures the view. Given this, no evidence of acute fracture or dislocation is seen. The pubic symphysis and sacroiliac joints are intact. The visualized aspect of the lower lumbar spine demonstrates degenerative change. Vascular calcifications are also noted. Mild osteoarthritic changes are noted at both hip joints. IMPRESSION: 1. No evidence of acute intrathoracic process given underlying trauma board. 2. No evidence of acute fracture or dislocation in the pelvis. . CHEST (PORTABLE AP) Study Date of [**2141-2-15**] 1:15 PM COMPARISON: None. FINDINGS: CHEST: Single supine AP portable view of the chest was obtained. Underlying trauma board partially obscures the view. Given this, the lung fields appear clear. No focal consolidation or evidence of pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is identified. PELVIS: Single AP portable view of the pelvis was obtained. Underlying trauma board partially obscures the view. Given this, no evidence of acute fracture or dislocation is seen. The pubic symphysis and sacroiliac joints are intact. The visualized aspect of the lower lumbar spine demonstrates degenerative change. Vascular calcifications are also noted. Mild osteoarthritic changes are noted at both hip joints. IMPRESSION: 1. No evidence of acute intrathoracic process given underlying trauma board. 2. No evidence of acute fracture or dislocation in the pelvis. . CT C-SPINE W/O CONTRAST Study Date of [**2141-2-15**] 2:13 PM INDINGS: No acute fractures are identified in the cervical spine. The cervical spine alignment and vertebral body heights are preserved. There is no prevertebral soft tissue swelling. There is mild anterolisthesis of C3 on C4. Minimal posterior osteophytes are seen at C5-C6 level, indenting the thecal sac, without significant spinal canal stenosis. The imaged portion of the thyroid gland is unremarkable. Minimal emphysema is seen in the imaged lung apices. IMPRESSION: No acute cervical spine fracture. . CT HEAD W/O CONTRAST Study Date of [**2141-2-15**] 2:13 PM INDINGS: There is no evidence of acute intracranial hemorrhage, edema, mass effect or large vascular territorial infarction. The ventricles and sulci are slightly prominent consistent with age-related parenchymal involution. The mastoid air cells and paranasal sinuses are clear. No fractures are identified. Soft tissue swelling is noted overlying the right temporal bone. Soft tissue swelling with underlying density is noted along the parietal bone and along the vertex, consistent with subgaleal hematoma. IMPRESSION: No acute intracranial process. Right-sided soft tissue swelling. Left-sided subgaleal hematoma. No acute fracture seen. . CT TORSO WITH CONTRAST Study Date of [**2141-2-15**] 2:14 PM FINDINGS: CT OF THE CHEST WITH INTRAVENOUS CONTRAST: The major airways are patent to subsegmental levels bilaterally. A 3-mm right upper lobe nodule (2:20), a 3-mm nodule within the left lower lobe (2:42), are seen in subpleural location, could represent atelectasis; however a followup is recommended as [**First Name8 (NamePattern2) **] [**Last Name (un) 8773**] criteria. There is mild emphysema in both lungs. Trace simple right pleural effusion is present. No pericardial effusion is seen. The thoracic aorta demonstrates atherosclerotic calcification, without evidence of acute traumatic injury or aneurysmal dilation. There is no mediastinal hemorrhage. No significant mediastinal, hilar or axillary lymphadenopathy is seen. Incidental note is made of coarse calcification in the right breast. CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: There is no acute traumatic injury in the liver, spleen, adrenal glands, pancreas and both kidneys. A tiny subcentimeter hypodensity in the left lobe of liver (2:56) is too small to characterize. Lobulated iso to hyperdense areas in the fundus of the gallbladder, may represent adenomyomatosis or impacted fundal stone. There is no evidence of acute cholecystitis. A subcentimeter hypodensity in the lower pole of the left kidney (2:66) is too small to characterize. The stomach, small and large bowel are normal in appearance, without evidence of acute traumatic injury. There is no intra-abdominal free fluid or air. No significant retroperitoneal or mesenteric lymphadenopathy is seen. Calcification is seen in the abdominal aorta and iliac arteries, without aneurysmal dilation or acute traumatic injury. CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The urinary bladder is moderately distended. A calcified uterine fibroid is present. A temperature probe is seen within the rectum. No significant pelvic free fluid or adenopathy seen. BONES AND SOFT TISSUES: There is a subtle nondisplaced fracture involving the transverse process of L2 vertebra, with suggestion of surrounding soft tissue edema. No other fractures are identified. Mild degenerative changes are seen in the thoracolumbar spine. IMPRESSION: 1. No acute traumatic injury identified in the chest. 2. Non-displaced fracture of the right transverse processes of L2 vertebra, of indeterminate age, but could represent an acute fracture. 3. Sub-4-mm pulmonary nodules in both lungs. Based on [**Last Name (un) 8773**] criteria, if the patient has history of smoking or other known risk factors for lung cancer, followup chest CT at 12 months is recommended, if the patient is a low-risk patient, no followup is needed. Findings added to radiology critical findings dashboard on [**2141-2-15**]. 4. Trace right pleural effusion. 5. Adenomyomatosis and possible impacted stones of the gallbladder fundus. If clinically indicated, right upper quadrant ultrasound can be obtained. . SHOULDER (AP, NEUTRAL & AXILLARY) TRAUMA RIGHT Study Date of [**2141-2-15**] 2:39 PM FINDINGS: Three views of the right shoulder were obtained. No true external rotation view was obtained and the Y view is also slightly suboptimal. No evidence of acute fracture is seen, but it is difficult to exclude dislocation. There is likely at least anterior medial subluxation of the humeral head in relation to the glenoid fossa. Right acromioclavicular joint is intact with degenerative change seen. The visualized aspect of the very upper lateral right lung is clear. IMPRESSION: 1. No evidence of acute fracture. 2. Suboptimal examination due to inability to appropriately position patient. Suggestion of anterior medial subluxation of the right humeral head in relation to the glenoid fossa, of indeterminate age. Recommend clinical correlation. Consider repeat imaging when appropriate and patient able to be appropriate position. . SHOULDER (AP, NEUTRAL & AXILLARY) TRAUMA RIGHT Study Date of [**2141-2-15**] 8:11 PM COMPARISON: [**2141-2-15**]. THREE VIEWS, RIGHT SHOULDER: On these three limited views of the shoulder there is a suggestion of anterior subluxation of the humeral head upon the glenoid fossa. Dedicated axillary views are recommended. There are moderate degenerative changes of the acromioclavicular joint. Visualized right hemithorax is clear. . GLENO-HUMERAL SHOULDER (W/O Y VIEW) RIGHT PORT Study Date of [**2141-2-15**] 9:10 PM COMPARISON: [**2141-2-15**]. SIX VIEWS, RIGHT SHOULDER: There is anterior subluxation of the humeral head upon the glenoid fossa. There is deformity of the humeral head laterally which could represent a [**Doctor Last Name **]-[**Doctor Last Name 3450**] deformity. There also may be a small osseous fragment inferior to the glenoid which could reflect Bankart injury. . . Cardiology: ECG Study Date of [**2141-2-15**] 5:25:06 PM Sinus rhythm. Baseline artifact. Normal tracing. No previous tracing available for comparison. TRACING #1 Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**] Intervals Axes Rate PR QRS QT/QTc P QRS T 66 156 76 452/462 86 75 72 . ECG Study Date of [**2141-2-16**] 7:57:44 AM Sinus rhythm. Normal tracing. Compared to the previous tracing of [**2141-2-15**] no diagnostic interim change. TRACING #2 Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**] Intervals Axes Rate PR QRS QT/QTc P QRS T 73 114 80 [**Telephone/Fax (2) 89456**] 61 Brief Hospital Course: 76-year-old woman with a past medical history significant for hypertension, previous rheumatic fever, chronic right arm weakness ? atypical ALS and frequent falls who presented after a mechanical fall down stairs and prolonged period on floor who was found to have a right transverse process L2 fracture and shoulder subluxation and had a brief MICU stay for hypothermia and rhabdomyolysis. There, she was stabilized and called out to the general medical floor the following day on [**2141-2-16**]. Patient was managed conservatively and improved and discharged to rehab on [**2141-2-18**]. Patient will likely require placement on discharge from rehab. . . # Fall/Pre-syncope: Per patient, fall was mechanical and has had many previous falls. She was unable to get up from floor and found by visiting PT. Given history of numerous falls, she will likely need placement in [**Hospital3 **] or other sheltered housing on discharge as she lives alone. Infectious work-up was negative. UA unremarkable, CXR was clear. ACS ruled out with serial cardiac biomarkers. She sustained possible acute right shoulder subluxation in addition to L2 transverse process fracture which were both managed conservatively. PT, OT and social work were consulted and she was discharged to rehab on [**2141-2-18**] and will likely need placement thereafter. . # Hypothermia: Body temperature was 32.3 C (rectal) on admission. The most likely etiology was felt to be environmental exposure given report of last contact being 3 days prior. She was treated with a warming blanket and fluid rescusitated, and body temperature normalized overnight. . # Rhabdomyolysis: CK on arrival was 3387 and was noted to trend down from that point with fluid rescusitation. Elevated CK was felt secondary to a prolonged period down following her fall. Creatinine was 0.7 on admission and remained stable following IVF. CK on discharge was 673. . # Likely acute on chronic right shoulder subluxation: Initial exam was concerning for anterior dislocation of right shoulder but XR showed right anterior subluxation of the humeral head upon the glenoid fossa. Per discussion with family, this may be a chronic or acute on chronic injury. Patient had recent shoulder dislocation [**2-8**] which was relocated at ED. She was evaluated by the vascular surgery team for concern over poor peripheral pulses in her right arm, but was felt to have adequate perfusion and good pulse was present. She was also evaluated by the orthopedic surgery team who recommended conservative with a right arm sling and follow-up in 4 weeks with appointment scheduled for [**2141-3-14**]. Pain control was initially with acetaminophen and morphine but quickly transitioned to tramadol on discharge. . # L2 FRACTURE: On CT Torso patient was found to have an undisplaced right L2 transverse process fracture. The patient was evaluated by the neurosurgery consult team, with recommendation for no limitation to activity and conservative management with pain control. Calcium and Vitamin D supplementation started at discharge. , # Anemia: Hct 41.6 on admission and fell to 27 after volume resuscitation. No evidence of bleeding. HD stable. Guaiac negative stools and latterly had iron studies, B12 and folate which were all normal and retics <3%. . R arm immobility: Patient could just move fingers of right hand and otherwise no significant movement in right UE. Per family this has been for approximately 2 years, gradual in onset, now has no use of R hand, extensive w/u without cause found, thought could be due to ? atypical ALS. In addition, had recent shoulder dislocation [**2-8**], relocated at ED. This remained at apparent baseline. . # HTN: Anti-hypertensives were initially held and slowly re-introduced initially with home atenolol and lisinopril. If persistent hypertension at rehab, can add diltiazem. . # Diarrhea: Patient developed frequent loose stools on [**2-17**]. Stools were sent for culture and c difficile toxin. . # Pulmonary nodule: Sub-4-mm pulmonary nodules in both lungs seen on CT-Thorax. Based on [**Last Name (un) 8773**] criteria, if the patient has history of smoking or other known risk factors for lung cancer, followup chest CT at 12 months is recommended, if the patient is a low-risk patient, no followup is needed per radiology. PCP to [**Name9 (PRE) 702**] as appropriate. Medications on Admission: Aspirin 81mg qd Diltiazem ER 240mg qd Atenolol 50mg qd Lisinopril 40mg qd Discharge Medications: 1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 2. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) dose Injection TID (3 times a day). 3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 4. tramadol 50 mg Tablet Sig: 0.5-1 Tablet PO Q6H (every 6 hours) as needed for pain. 5. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 8. Calcium 500 + D 500 mg(1,250mg) -400 unit Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Location (un) 582**] @ [**Hospital1 189**] Discharge Diagnosis: Mechanical fall in setting of frequent falls Likely acute on chronic right shoulder subluxation Undisplaced right transverse fracture of L2 Rhabdomyolysis Hypothermia Discharge Condition: Mental Status: Clear and coherent with likely chronic cognitive deficit Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: It was a pleasure taking care of you during your stay at the [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **]. You presented following a fall at home when you were unable to get up. You were found by PT and taken to the ED. There you had scans of your shoulder and hip in addition to a CT scan of your head, neck and body. The scans showed evidence of a possibly new worsening of a right shoulder injury in addition to a tiny fracture involving one of the vertebrae of your lower back. You were seen by vascular surgery who felt that blood supply to your shoulder was good. You were also seen by neurosurgery who felt that nothing needed to be done for your back injury and it will heal on its own. You were also seen by orthopaedics for your shoulder injury who recommended a sling and follow-up with them. You have an appointment on [**2141-3-14**] for review. You were discharged to rehab on [**2-17**] after assessment by PT. . Changes to medications: We HELD you diltiazem at present and can be restarted as necessary on discharge We STARTED tramdol 25-50mg as needed every 6 hours for pain We STARTED acetaminophen 650mg as needed every 6 hours for pain We STARTED laxatives We STARTED calcium and vitamin D Followup Instructions: Please make an appointment with your PCP on discharge. Department: ORTHOPEDICS When: TUESDAY [**2141-3-14**] at 10:20 AM With: ORTHO XRAY (SCC 2) [**Telephone/Fax (1) 1228**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: ORTHOPEDICS When: TUESDAY [**2141-3-14**] at 10:40 AM With: [**First Name11 (Name Pattern1) 2191**] [**Last Name (NamePattern4) 2192**], NP [**Telephone/Fax (1) 1228**] Building: [**Hospital6 29**] [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

805,728,831,285,991,E880,401

{'Closed fracture of lumbar vertebra without mention of spinal cord injury,Rhabdomyolysis,Closed dislocation of shoulder, unspecified,Anemia, unspecified,Hypothermia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Fall, rhabdomyolysis, hypothermia PRESENT ILLNESS: Mrs. [**Known lastname **] is a 76 year old woman with a past medical history significant for hypertension found at the bottom of a flight of stairs now admitted found to have a L2 fracture and shoulder subluxation now admitted to the MICU for hypothermia and rhabdomyolysis. The patient was found down at her home today by Physical Therapy at the bottom of the basement stairs. She reports that she was walking down her stairs on Monday when she tripped and fell, and was unable to get up. She was oriented x3 per EMS and denied any pain. Of note, the last time she was in contact with family was 3 days prior to admission (Monday). . In the [**Hospital1 18**] ED, initial VS 32.3 (rectal) 52 111/65 14 100%RA. Labs notable for a CK 3387 and a WBC of 12.5. She had a negative CTH and CT cspine, with CT torso demonstrating a non-displaced fracture of the right transverse process of L2 vertebra and shoulder film demonstrating anterior medial subluxation. Neurosurgery and vascular surgery were consulted, and she was then admitted to the MICU for further management. . Currently, the patient states that she has some right shoulder pain, but otherwise denies any CP/SOB, f/c/s, n/v/d, abd pain, HA, palpitations, HA, hip pain. . ROS: As above, otherwise negative. Per discussion with brother, has had right shoulder pain x6 months, holding it against her chest. History of frequent falls. MEDICAL HISTORY: Rheumatic fever age 18 - per pt no valvular problems HTN R arm immobility x approx 2 years, gradual in onset, now has no use of R hand, extensive w/u without cause found, thought could be due to ? atypical ALS, + recent shoulder dislocation [**2-8**], relocated at ED, placed in sling and dc'ed home MEDICATION ON ADMISSION: Aspirin 81mg qd Diltiazem ER 240mg qd Atenolol 50mg qd Lisinopril 40mg qd ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: VS: 35.7 72 137/62 18 99%RA Gen: Frail elderly female, NAD with echymosses throughout. HEENT: Bilateral periorbital echymosses. Abrasion over bridge of nose. Poor dentition, but OP otherwise clear. Neck supple. CV: Nl S1+S2, no m/r/g Pulm: CTAB anteriorly Abd: S/NT/ND +bs Ext: Venous stasis signs, trace pitting edema bilaterally. Right arm cool to touch with increased edema. Palpabled right radial pulse, CR<2 seconds. Neuro: AOx3, CN II-XII intact. Skin: Bilateral periorbital bruising, bruising down entire back and buttocks, bilateral shoulders, right upper arm, left elbow, bilateral hips, bilateral knees, left shin, and toes. MSK: Right shoulder displaced anteriomedially. FAMILY HISTORY: Mother died 69 of CAD Father died 93 of old age Sister with brain aneurysm SOCIAL HISTORY: Lives alone. Retired worker in a candy factory - no exposures per pt [**Name (NI) 6934**] unaided. Per pt, independent in IDLs, does own shopping and cleaning. Tobacco - none. EtOH - social. Denies IV, illicit, or herbal drug use. ### Response: {'Closed fracture of lumbar vertebra without mention of spinal cord injury,Rhabdomyolysis,Closed dislocation of shoulder, unspecified,Anemia, unspecified,Hypothermia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension'}

CHIEF COMPLAINT: Failed graft. PRESENT ILLNESS: This is a 69-year-old gentleman who underwent a left fem posterior tibial bypass graft with nonreversed saphenous vein in [**2154-12-20**], who underwent a graft surveillance on [**2155-4-16**], which demonstrated significant graft stenosis in the distal segment in the region of the distal anastomosis. The patient underwent an arteriogram today with hopes of interventional procedure. They were not able to intervene. The patient now is admitted for preoperative hydration and postoperative angio hydration for revision of his left fem PT bypass. MEDICAL HISTORY: Peripheral vascular disease, status post left fem PT in [**2154-12-20**], history of carotid artery stenosis status post right CEA in [**2153-3-20**], history of coronary artery disease and non Q wave MI in [**2149-10-20**], status post CABG x5 in [**2149-10-20**], history of systolic congestive heart failure with ejection fraction of 35% [**2153-1-20**], history of diabetes type 2 insulin-dependent with neuropathy and retinopathy, history of vitreous hemorrhage with vitrectomy. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is married, lives with his wife. [**Name (NI) **] has 35 tobacco years of smoking, has not smoked for greater than 20 years. Occasional alcohol intake.

Other complications due to other vascular device, implant, and graft,Diastolic heart failure, unspecified,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,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy

Comp-oth vasc dev/graft,Diastolc hrt failure NOS,Abn react-anastom/graft,Periph vascular dis NOS,Crnry athrscl natve vssl,DMII neuro nt st uncntrl,Neuropathy in diabetes,Diabetic retinopathy NOS

Admission Date: [**2155-4-28**] Discharge Date: [**2155-5-3**] Date of Birth: [**2085-6-21**] Sex: M Service: VSU CHIEF COMPLAINT: Failed graft. HISTORY OF PRESENT ILLNESS: This is a 69-year-old gentleman who underwent a left fem posterior tibial bypass graft with nonreversed saphenous vein in [**2154-12-20**], who underwent a graft surveillance on [**2155-4-16**], which demonstrated significant graft stenosis in the distal segment in the region of the distal anastomosis. The patient underwent an arteriogram today with hopes of interventional procedure. They were not able to intervene. The patient now is admitted for preoperative hydration and postoperative angio hydration for revision of his left fem PT bypass. ALLERGIES: No known drug allergies. MEDICATIONS: On admission include Toprol XL 25 mg daily, Lasix 40 mg in the a.m. and 20 mg in the p.m., Trental 400 mg 4 times daily, Lantus 36 units at bedtime, Humalog insulin sliding scale, folate 1 mg daily. PAST MEDICAL HISTORY: Peripheral vascular disease, status post left fem PT in [**2154-12-20**], history of carotid artery stenosis status post right CEA in [**2153-3-20**], history of coronary artery disease and non Q wave MI in [**2149-10-20**], status post CABG x5 in [**2149-10-20**], history of systolic congestive heart failure with ejection fraction of 35% [**2153-1-20**], history of diabetes type 2 insulin-dependent with neuropathy and retinopathy, history of vitreous hemorrhage with vitrectomy. SOCIAL HISTORY: The patient is married, lives with his wife. [**Name (NI) **] has 35 tobacco years of smoking, has not smoked for greater than 20 years. Occasional alcohol intake. PHYSICAL EXAMINATION: Vital signs 97.4, 64, 138/76, respirations 18, O2 saturation 99% in room air. General appearance: Alert, white male in no acute distress. Lungs are clear to auscultation. Heart: Regular rate and rhythm. Abdominal examination is unremarkable. Right groin is clean, dry and intact without hematoma. Pulse exam shows palpable femoral bilaterally. The popliteal is palpable. The DP and PT are dopplerable signals. On the left, the DP is dopplerable. There are 3 lateral plantar ulcerations without erythema or exudate. HOSPITAL COURSE: The patient underwent diagnostic arteriogram. He was without any event and was admitted for elective surgery. Labs: White count was 8.5, hematocrit 36.6. INR 1.1. BUN 20, creatinine 1.0. Urinalysis was negative. EKG was normal sinus rhythm without significant changes from previous EKG of [**2151-1-20**]. Chest x-ray was unremarkable. The patient's post-angio labs were without any changes. The patient underwent on [**4-29**], a patch angioplasty of the left common femoral DP graft with lesser saphenous vein jump graft from the left graft to DP distally. The patient tolerated the procedure well and was transferred to the PACU in stable condition. Postoperatively, he remained hemodynamically stable. Postoperative hematocrit was 32.5. The patient was placed on a heparin drip for goal PTT of 50 to 60. Heparin dosing was adjusted according to goal PTT from 50 to 60. The patient was transferred to the VICU for continued monitoring and care from the PACU. Postoperative day 1, he did require nitroglycerin for systolic hypertension which was weaned the following day. His hematocrit dropped to 28.7. BUN and creatinine remained stable at 14 and 0.8. PTT was 56.3 with an adjustment in his heparin with PTT 6 hours later of 75.4 and repeat PTT was continued and heparin was adjusted accordingly. The patient had palpable graft pulse at the calf and a palpable left radial pulse. The patient remained on bedrest. His fluids were HEP-locked. His nitroglycerin was weaned and he was continued on his home medications. He auto-diuresed and did not require Lasix. His diet was advanced. His Humalog sliding scale was adjusted secondary to hyperglycemia with improvement in his glycemic control. Postoperative day 2, blood pressure was under excellent control with systolic blood pressure 133, diastolic 65. He was afebrile. His heparin was discontinued. His Foley was discontinued. A line was discontinued. The patient was allowed up out of bed to the chair. He was to be nonweightbearing on the left foot secondary to site of incision. Ace wrap should be worn when ambulating from foot to knee on the left. Postoperative day 3, it was noted the patient had a troponin spike from 0.04 to 0.17. The patient denied any symptoms, was hemodynamically stable. An EKG was obtained and enzymes were continued to be cycled. The patient was allowed to ambulate. Decision regarding discharge will be made after evaluation of the elevated enzymes at that time. DISCHARGE INSTRUCTIONS: The patient may ambulate essential distances. He should wear an ace wrap from foot to knee on the left when ambulating. He should keep the left leg elevated when sitting in a chair. He may shower but no tub baths. He should call Dr.[**Name (NI) 1392**] office if he develops a fever greater than 101.5. if the leg wounds become red, swollen or drain. He should not drive until seen in follow- up. He should continue taking his stool softener while taking pain medications to prevent constipation. DISCHARGE MEDICATIONS: 1. Folic acid 1 mg daily. 2. Trental 400 mg 3 times daily. 3. Protonix 40 mg daily. 4. Colace 100 mg twice a day. 5. Acetaminophen 500 mg tablets, 2 q.4-6 hours p.r.n. for pain. 6. Hydromorphone 2 mg tablet, 1 q-2 hours p.r.n. for pain. 7. Aspirin 325 mg daily. 8. Plavix 75 mg daily. 9. Metoprolol 75 mg 3 times daily. 10. Lasix 20 mg q.p.m. and 40 mg q.a.m. 11. Amoxicillin/Clavulanate 500/125 mg tablets q.8 hours for a total of 7 days. 12. Insulin Glargine U-100 at 36 units at bedtime with a Humalog sliding scale. 13. Simvastatin 10 mg daily. The patient should also follow up with [**Last Name (un) **] for management of his diabetes. He can call for an appointment to the [**Hospital **] Clinic. DISCHARGE DIAGNOSES: 1. Left femoral posterior tibial graft stenosis. 2. History of peripheral vascular disease. 3. History of carotid stenoses, status post right carotid endarterectomy. 4. History of coronary artery disease, status post non Q wave myocardial infarction in [**2149-10-20**], status post coronary artery bypass graft x5 in [**2149-10-20**]. 5. History of congestive heart failure, systolic ejection fraction 35%. 6. History of type 2 diabetes mellitus, insulin dependent, with neuropathy and retinopathy. 7. History of vitreous hemorrhage, status post vitrectomy. MAJOR SURGICAL PROCEDURES: 1. Diagnostic arteriogram with left leg runoff via the right femoral access on [**2155-4-28**]. 2. Patch angioplasty of the left common femoral artery posterior tibial bypass with a jump graft from bypass to distal dorsalis pedis with saphenous vein on [**2155-4-29**]. FOLLOW UP: The patient should follow up with Dr. [**Last Name (STitle) 1391**] in 2 weeks time. He should also follow up with the [**Hospital **] Clinic. An addendum will be dictated regarding the patient's elevated troponin level. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2380**], [**MD Number(1) 2381**] Dictated By:[**Last Name (NamePattern1) 2382**] MEDQUIST36 D: [**2155-5-2**] 11:21:48 T: [**2155-5-2**] 12:24:16 Job#: [**Job Number 30308**] Name: [**Known lastname 5309**],[**Known firstname 651**] F Unit No: [**Numeric Identifier 5310**] Admission Date: [**2155-4-28**] Discharge Date: [**2155-5-8**] Date of Birth: [**2085-6-21**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 231**] Addendum: [**2155-5-2**] patient's troponin level increased from 0.04-0.17. patient asymptomatic EKG with st changes in lateral leads. cardology consulted.enzymes cycled x3 more draws and ECHO to assess LVF and wall motion were pending. [**2155-5-3**] patient seen by cardilogy . IV heparin began. [**2155-5-7**] underwent Pmibi . new changes with ef 23%.Patient asymptomatic. d/c home [**5-8**] to followup with his cardology. Discharge Disposition: Home With Service Facility: [**Hospital 197**] [**Name (NI) 198**] [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern1) 237**] MD [**MD Number(1) 238**] Completed by:[**2155-7-31**]

996,428,E878,443,414,250,357,362

{'Other complications due to other vascular device, implant, and graft,Diastolic heart failure, unspecified,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,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Failed graft. PRESENT ILLNESS: This is a 69-year-old gentleman who underwent a left fem posterior tibial bypass graft with nonreversed saphenous vein in [**2154-12-20**], who underwent a graft surveillance on [**2155-4-16**], which demonstrated significant graft stenosis in the distal segment in the region of the distal anastomosis. The patient underwent an arteriogram today with hopes of interventional procedure. They were not able to intervene. The patient now is admitted for preoperative hydration and postoperative angio hydration for revision of his left fem PT bypass. MEDICAL HISTORY: Peripheral vascular disease, status post left fem PT in [**2154-12-20**], history of carotid artery stenosis status post right CEA in [**2153-3-20**], history of coronary artery disease and non Q wave MI in [**2149-10-20**], status post CABG x5 in [**2149-10-20**], history of systolic congestive heart failure with ejection fraction of 35% [**2153-1-20**], history of diabetes type 2 insulin-dependent with neuropathy and retinopathy, history of vitreous hemorrhage with vitrectomy. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is married, lives with his wife. [**Name (NI) **] has 35 tobacco years of smoking, has not smoked for greater than 20 years. Occasional alcohol intake. ### Response: {'Other complications due to other vascular device, implant, and graft,Diastolic heart failure, unspecified,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,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy'}

CHIEF COMPLAINT: Purulent drainage at left craniotomy site PRESENT ILLNESS: HPI: The patient is a 57 year old right handed man with a history of Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**], arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] who presented with infected surgical wound s/p washout today, now with post-operative seizures. MEDICAL HISTORY: -Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**] -Arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] -Pulmonary empyema -Pneumothorax MEDICATION ON ADMISSION: Lamictal 200 mg/300 mg (brand name only) Ativan 1 mg qid (brand name only) Keppra 1875/2250 mg (brand name only) Pyridoxine 50 mg qAM Cuprimine 500 mg [**Hospital1 **] Calcium 1000 mg qAM ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: temp 99, bp 103/46, HR 84, RR 14, SaO2 100% on 2L Genl: Awake, sleepy, NAD HEENT: Sclerae anicteric, no conjunctival injection, oropharynx clear CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops Chest: CTA bilaterally anteriorly and laterally, no wheezes, rhonchi, rales Abd: +BS, soft, ND abdomen, diffusely tender to palpation FAMILY HISTORY: There is no family history of seizures. His older brother is a carrier for Wilson's disease. SOCIAL HISTORY: He lives alone with supervision and a housekeeper. His brother and sister-in-law live in the same town, and help him with cooking. His sister-in-law helps organize his medications.

Other postoperative infection,Acute osteomyelitis, other specified sites,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Epilepsy, unspecified, without mention of intractable epilepsy,Disorders of copper metabolism,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site

Other postop infection,Ac osteomyelitis NEC,Abn react-surg proc NEC,Epilep NOS w/o intr epil,Dis copper metabolism,Mth sus Stph aur els/NOS

Admission Date: [**2175-11-9**] Discharge Date: [**2175-11-15**] Date of Birth: [**2118-11-1**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2927**] Chief Complaint: Purulent drainage at left craniotomy site Major Surgical or Invasive Procedure: Exploration/Washout of Left craniotomy site History of Present Illness: HPI: The patient is a 57 year old right handed man with a history of Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**], arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] who presented with infected surgical wound s/p washout today, now with post-operative seizures. The patient is s/p surgical wound washout today for drainage from the incision site (see full details below). He came out of surgery at 7:30 pm. At 8:15 pm, he had a seizure with left gaze deviation and raising his left arm in the air lasting approximately 1 minute. There was no shaking of his arms or legs and no loss of bowel/bladder function. The seizure broke without needing Ativan. He received his PM AEDs at 8:20 pm (which is 20 minutes late, but his sister-in-law reports that he is no longer oversensitive to a slight delay in AED administration). Then at 8:30 pm, he rolled to the left side, tensed up his arms, and was unresponsive lasting for 4-5 minutes. Over the next 40 minutes he had approximately [**3-26**] more similar seizures (the third seizure was associated with a few seconds of bilateral arm shaking though), with only 1 minute lasting between each seizures. He received Ativan 1 mg IV at 8:50 pm and 8:55 pm, then Ativan 2 mg IV at 8:57 pm. Neurology was consulted and immediately came to the bedside at 9:10 pm, by which time the patient was no longer seizing. His sister-in-law reports that he has not missed any doses of medications pre- or post-operatively. His sister-in-law reports that he has had seizures since age 12 which are due to Wilson's disease. He has multiple seizure types including his eyes deviating to the left or right, occasionally turning his head or entire body to one side, he may sit straight up in bed with his arms out, occasionally he just stares straight ahead, he has had drop attacks, and he occasionally has shaking of his arms and legs. He can cluster these events. He has been intubated in the past for seizures (his sister-in-law thinks only once). Prior to having his recent Rickham catheter placement, his seizures were difficult to control and were occuring daily. He has had no further seizures since the Rickham catheter was removed by Neurosurgery on [**2175-9-30**] (see below). He has previously had depth electrode placement in 1/98 which EEG monitoring revealed that all of his seizures initiated from the left cingulate gyrus recording area, the more superficial contacts more involved than the deep contacts. [**Name (NI) **] is followed by Dr. [**Last Name (STitle) **] as an outpatient. He was most recently admitted to Neurology [**Date range (1) **]/09 with increase seizure frequency. EEG showed spikes and sharp discharges seen focally and independently in the right frontal and central areas much more than in the left central area, and only a few discharges seen in the left temporal region. EEG [**9-9**] showed 20 pushbutton events of turning to the left which had EEG correlate of a rhythmic sharp activity seen in the right frontal area. EEG [**9-10**] showed 19 pushbutton events for unresponsiveness and behavioral arrest correlated with sharp rhythmic activity seen in the right frontal area reflected of the central areas and the left frontal area lasting for up to 20-30 seconds. EEG on [**9-13**] showed 22 pushbutton activations for events for clinical seizures of either turning to the left or the right which were most of the time correlated with rhythmic sharp activity in the right fronto-temporal areas. He was initially started on rufinamide; however, the patient had multiple seizures after discontinuing EEG monitoring so the rufinadmide was discontinued. He was then started on Depakote again with continued seizures. MRI head was read as "stable left extraaxial fluid collection", but the team was concerned that his left frontal cyst had slightly enlarged and may have been causing pressure on his parenchyma. Neurosurgery was consulted and took him stereotactic cyst ventriculostomy and [**Last Name (un) **] catheter placement on [**2175-9-14**]. He did have increased seizures post-operatively, but this was thought to be due to missing his morning AEDs. He complained of vertical diplopia, which was thought to be a Depakote side effect. He was therefore tapered off Depakote, and discharged to rehab on Keppra, Lamictal, Ativan, and Depakote taper. He was readmitted to Neurosurgery [**Date range (1) 110890**] with purulent drainage and erythema at the surgical incision. He also had GTC seizures and was loaded with Dilantin (which was not continued), and Neurology was consulted that admission. He underwent wound wash out and Rickham catheter removal. Cultures grew MSSA, and he was discharged on a 14 day course of Ancef and Vancomycin. Past Medical History: -Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**] -Arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] -Pulmonary empyema -Pneumothorax Social History: He lives alone with supervision and a housekeeper. His brother and sister-in-law live in the same town, and help him with cooking. His sister-in-law helps organize his medications. Family History: There is no family history of seizures. His older brother is a carrier for Wilson's disease. Physical Exam: VS: temp 99, bp 103/46, HR 84, RR 14, SaO2 100% on 2L Genl: Awake, sleepy, NAD HEENT: Sclerae anicteric, no conjunctival injection, oropharynx clear CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops Chest: CTA bilaterally anteriorly and laterally, no wheezes, rhonchi, rales Abd: +BS, soft, ND abdomen, diffusely tender to palpation Neurologic examination: Mental status: Awake but sleepy, cooperative with exam, pleasant. Oriented to person, place (says [**Location (un) 86**], but does not name [**Hospital1 **]), says year is [**2175**] but the month is [**Month (only) **]. Inttentive, able to say DOW forwards but unable to say them backward. Normal repetition; naming intact (to thumb, pin). Has baseline speech impediment, speech is slowed. Cranial Nerves: Pupils equally round at 1.5 mm and minimally reactive to light bilaterally. Extraocular movements intact bilaterally without nystagmus. Facial movement symmetric. Palate elevation symmetric. Tongue midline, movements intact. Motor: Normal tone bilaterally in UE and LE. No observed myoclonus, asterixis, or tremor. Moves bilateral UE against gravity, but moves his right arm more briskly against gravity than the left (however, he is laying more on his left side, and his sister says this is baseline). [**Doctor First Name **] Tri [**Hospital1 **] WE FE FF IP H Q DF PF TE R 4 5 5 5 5 5 5 5 5 5 5 5 L 5- 5 5 5 5 5 5 5 5 5 5 5 Sensation: Intact light touch throughout. Reflexes: 3+ and symmetric in biceps, brachioradialis, triceps, knees. 1+ in left ankle and 0 in right ankle. Toes equivocal bilaterally. Coordination: Slowed but otherwise normal finger-nose-finger bilaterally. Has difficulty with FFM bilaterally as inattentive. Gait: Deferred Pertinent Results: CT Head [**2175-11-9**]: 1. No significant change in size of the small lentiform left frontal extra-axial collection, with stable hyperattenuating deep and superficial margins of uniform thickness. This corresponds to the uniformly enhancing rim on the most recent study, likely representing an organizing lining capsule. 2. New interval foci of air at the site of left frontal burr hole, likely from recent "wound wash-out" with persistent focal soft tissue thickening at the site of the burr hole. MRI head [**2175-11-10**]; lentiform 5.1cm (TRV) extra-axial fluid collection, L frontal region. uniformly thick enhancing rind, T1/FLAIR slightly hyperint contents. no def restricted diffusion. likely = post-procedure seroma w/complex contents, but no specific evid infxn (would have to aspirate, to be sure). no vasogenic edema/enhcmt/rest diff in subjct brain to suggest early cerebritis. post-op dural enhcmt, but no leptomening enhcmt. dural venous sinuses, incldg SSS, patent (on MP-RAGE). [**2175-11-10**] 01:24AM BLOOD WBC-6.9 RBC-3.88* Hgb-11.7* Hct-34.1* MCV-88 MCH-30.2 MCHC-34.4 RDW-14.1 Plt Ct-280 [**2175-11-11**] 06:40AM BLOOD ESR-50* [**2175-11-10**] 01:24AM BLOOD Glucose-101 UreaN-13 Creat-0.9 Na-142 K-4.0 Cl-107 HCO3-28 AnGap-11 [**2175-11-10**] 06:00AM BLOOD ALT-22 AST-23 LD(LDH)-148 AlkPhos-63 TotBili-0.5 [**2175-11-11**] 06:40AM BLOOD Calcium-8.3* Phos-2.7 Mg-2.1 [**2175-11-11**] 06:40AM BLOOD CRP-108.8* [**2175-11-11**] 06:40AM BLOOD Vanco-13.0 Brief Hospital Course: Mr. [**Known lastname 110891**] was seen in the [**Hospital 4695**] clinic by Dr. [**First Name (STitle) **]. He was then admitted to the Neurosurgery service for a wound exploration/wash out. He was taken to he recovery room and suffered [**3-26**] seizures witnessed by sister in law. He was seen by the Neurology service. They recommended a change from Ativan 1mg QID to 1mg Q4hrs. Post-op head CT was satisfactory. He remained afebrile. On [**2175-11-10**] ID was consulted. He was on Vancomycin/Ceftazidime and Cipro while awaiting final cultures. The patient was transferred to the neurology service after his post-operative seizures. He remained seizure free for the next 48-hours and resumed his home dose of ativan 1mg q6h as well as his keppra and lamictal. He was followed closely by the infectious disease team and his antibiotics were tailored after his wound cultures grew staph aureus that were resistant to oxacillin. He was continued on vancomycin and had a PICC line placed for long-term antibiotics. Due to concern of osteomyelitis of the skull, he will need at least six weeks of vancomycin. He will also require weekly CBC with differential, BUN, Creatine, and vanco trough (goal 15-20). Please fax these results to the [**Hospital **] clinic at [**Telephone/Fax (1) 432**]. He will follow up with the infectious disease clinic as well as neurosurgery and neurology clinics. Medications on Admission: Lamictal 200 mg/300 mg (brand name only) Ativan 1 mg qid (brand name only) Keppra 1875/2250 mg (brand name only) Pyridoxine 50 mg qAM Cuprimine 500 mg [**Hospital1 **] Calcium 1000 mg qAM Discharge Medications: 1. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO DAILY (Daily). 3. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO DAILY (Daily). 7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 8. Penicillamine 250 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. Lamotrigine 100 mg Tablet Sig: Three (3) Tablet PO QPM (once a day (in the evening)). *** name brand only *** 10. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO QAM (once a day (in the morning)). *** name brand only *** 11. Levetiracetam 750 mg Tablet Sig: Three (3) Tablet PO QHS (once a day (at bedtime)). *** name brand only *** 12. Levetiracetam 750 mg Tablet Sig: 2.5 Tablets PO QAM (once a day (in the morning)). *** name brand only *** 13. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). 14. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1) Intravenous Q 12H (Every 12 Hours): Will continue for 6-8 weeks. Draw weekly CBC, diff, BUN, Cr, and vanco trough (goal 15-20). Fax results to [**Telephone/Fax (1) 432**], attn Dr. [**Last Name (STitle) 13895**]. Discharge Disposition: Extended Care Facility: [**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**] Discharge Diagnosis: Wound infection Exacerbation of epilepsy Discharge Condition: A&Ox3, naming, repetition and comprehension intact. Mild L NLF. Normal bulk and tone. Full strength throughout. Sensation intact to light touch. Brisk reflexes but symmetric. Discharge Instructions: General Instructions ?????? Have a friend/family member check your incision daily for signs of infection. ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? You may wash your hair only after sutures and/or staples have been removed. ?????? You may shower before this time using a shower cap to cover your head. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ?????? continue taking your anti-seizure medicine. ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? Fever greater than or equal to 101?????? F. Please continue your medications as prescribed including your seizure medications and antibiotics. Followup Instructions: Follow-Up Appointment Instructions ??????Please return to the neurosurgery office in 14 days for removal of your sutures. ??????Please call ([**Telephone/Fax (1) 88**] if you have any questions about the following appointment: [**2175-12-12**] 03:15p [**Last Name (LF) **],[**First Name3 (LF) **] C. LM [**Hospital Unit Name **], [**Location (un) **] NEUROSURGERY WEST [**2175-12-12**] 02:45p XCT [**Apartment Address(1) 9394**] [**Hospital Ward Name **] CC CLINICAL CENTER, [**Location (un) **] RADIOLOGY Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 5285**] Date/Time:[**2175-12-7**] 11:00 (epilepsy) Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2175-12-12**] 2:45 You will need to continue vancomycin for 6-8 weeks. You will need weekly CBC, manual differential, BUN, Creatine, and vanco trough (goal level 15-20). Please fax these results to Dr. [**Last Name (STitle) 110892**] in the Infectious Disease clinic at [**Telephone/Fax (1) 432**]. Please call the infectious disease clinic for follow up. They can be reached at ([**Telephone/Fax (1) 4170**]. Name: [**Known lastname 18175**],[**Known firstname **] V. Unit No: [**Numeric Identifier 18176**] Admission Date: [**2175-11-9**] Discharge Date: [**2175-11-15**] Date of Birth: [**2118-11-1**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 13287**] Addendum: Patient to be discharged to rehabilitation facility [**11-15**]. He will continue ativan at 1 mg q4h with intention to resume home dose of 1 mg q6h on [**11-17**]. He will continue lamictal at 300 mg [**Hospital1 **] and increase to 350 mg [**Hospital1 **] in one week. Further adjustments may be considered upon follow-up with Dr. [**Last Name (STitle) **]. Discharge Disposition: Extended Care Facility: [**Location (un) 2332**] House Nursing & Rehabilitation Center - [**Location (un) 2333**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13288**] MD [**Doctor Last Name 13289**] Completed by:[**2175-11-15**] Name: [**Known lastname 18175**],[**Known firstname **] V. Unit No: [**Numeric Identifier 18176**] Admission Date: [**2175-11-9**] Discharge Date: [**2175-11-15**] Date of Birth: [**2118-11-1**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 186**] Addendum: On [**11-13**], the patient had three seizures in the hour prior to scheduled departure to [**Location (un) 2332**] House. He was given 1mg ativan x1 and his lamictal dose will be increased to 300 mg [**Hospital1 **]. He will be monitored overnight and disposition will be reassessed in the AM. Discharge Disposition: Extended Care Facility: [**Location (un) 2332**] House Nursing & Rehabilitation Center - [**Location (un) 2333**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 191**] MD [**MD Number(1) 192**] Completed by:[**2175-11-13**]

998,730,E878,345,275,041

{'Other postoperative infection,Acute osteomyelitis, other specified sites,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Epilepsy, unspecified, without mention of intractable epilepsy,Disorders of copper metabolism,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Purulent drainage at left craniotomy site PRESENT ILLNESS: HPI: The patient is a 57 year old right handed man with a history of Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**], arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] who presented with infected surgical wound s/p washout today, now with post-operative seizures. MEDICAL HISTORY: -Wilson's disease c/b seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy [**4-/2164**] -Arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy [**8-30**] with insertion of Rickham catheter c/b infection and Rickham catheter removal [**2175-9-30**] -Pulmonary empyema -Pneumothorax MEDICATION ON ADMISSION: Lamictal 200 mg/300 mg (brand name only) Ativan 1 mg qid (brand name only) Keppra 1875/2250 mg (brand name only) Pyridoxine 50 mg qAM Cuprimine 500 mg [**Hospital1 **] Calcium 1000 mg qAM ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: temp 99, bp 103/46, HR 84, RR 14, SaO2 100% on 2L Genl: Awake, sleepy, NAD HEENT: Sclerae anicteric, no conjunctival injection, oropharynx clear CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops Chest: CTA bilaterally anteriorly and laterally, no wheezes, rhonchi, rales Abd: +BS, soft, ND abdomen, diffusely tender to palpation FAMILY HISTORY: There is no family history of seizures. His older brother is a carrier for Wilson's disease. SOCIAL HISTORY: He lives alone with supervision and a housekeeper. His brother and sister-in-law live in the same town, and help him with cooking. His sister-in-law helps organize his medications. ### Response: {'Other postoperative infection,Acute osteomyelitis, other specified sites,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Epilepsy, unspecified, without mention of intractable epilepsy,Disorders of copper metabolism,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}

CHIEF COMPLAINT: dysphagia PRESENT ILLNESS: Mr. [**Known lastname 19219**] is a 63 year old male with a history of GERD and Barrett's esophagus for which he was undergoing surveillance endoscopy. He was found to have an adenocarcinoma within an esophageal nodule near the GE junction. He underwent EUS on [**4-21**] which noted a 1cm malignant appearing lesion at the GE junction without evidence of invasion beyond the mucosal layer. A single 0.7 x 0.8 cm lymph node was seen in the periesophageal region which was sampled via FNA. LN negative for malignancy. The patient underwent endoscopic mucosal resection on [**2107-5-12**] with pathology as low grade well to moderately differentiated adenocarcinoma, at least intramucosal, multifocally extending to specimen margins with concern for invasion, possibly into the muscularis mucosae. He presents to discuss the possibility of surgical resection. MEDICAL HISTORY: PAST MEDICAL HISTORY: COPD, HTN, HTN, depression, tobacco use, hypercholesterolemia, BPH, GERD MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. Fluoxetine 60 mg PO DAILY 2. Omeprazole 40 mg PO BID 3. Atenolol 25 mg PO DAILY 4. Atorvastatin 10 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Quetiapine extended-release 600 mg PO HS ALLERGIES: Codeine PHYSICAL EXAM: Vital Signs sheet entries for [**2107-5-26**]: BP: 117/73. Heart Rate: 78. Weight: 198.3. Height: 71.25. BMI: 27.5. Temperature: 97.5. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 98. FAMILY HISTORY: Mother: colon cancer Father Siblings: brother lung cancer Offspring Other: aunt bladder cancer SOCIAL HISTORY: Cigarettes: [ ] never [x} ex-smoker (quit 2 weeks ago) [ ] current

Malignant neoplasm of cardia,Infection of colostomy or enterostomy,Delirium due to conditions classified elsewhere,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Cellulitis and abscess of trunk,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use

Mal neo stomach cardia,Colosty/enterost infectn,Delirium d/t other cond,Barrett's esophagus,Chr airway obstruct NEC,Chrnc hpt C wo hpat coma,Cellulitis of trunk,Hypertension NOS,BPH w/o urinary obs/LUTS,History of tobacco use

Admission Date: [**2107-6-27**] Discharge Date: [**2107-7-6**] Date of Birth: [**2044-2-7**] Sex: M Service: CARDIOTHORACIC Allergies: Codeine Attending:[**First Name3 (LF) 4679**] Chief Complaint: dysphagia Major Surgical or Invasive Procedure: [**2107-6-27**] 1. Minimally-invasive esophagectomy with intrathoracic anastomosis. 2. Laparoscopic jejunostomy. 3. Buttressing of intrathoracic anastomosis with pericardial fat. 4. Esophagogastroduodenoscopy . History of Present Illness: Mr. [**Known lastname 19219**] is a 63 year old male with a history of GERD and Barrett's esophagus for which he was undergoing surveillance endoscopy. He was found to have an adenocarcinoma within an esophageal nodule near the GE junction. He underwent EUS on [**4-21**] which noted a 1cm malignant appearing lesion at the GE junction without evidence of invasion beyond the mucosal layer. A single 0.7 x 0.8 cm lymph node was seen in the periesophageal region which was sampled via FNA. LN negative for malignancy. The patient underwent endoscopic mucosal resection on [**2107-5-12**] with pathology as low grade well to moderately differentiated adenocarcinoma, at least intramucosal, multifocally extending to specimen margins with concern for invasion, possibly into the muscularis mucosae. He presents to discuss the possibility of surgical resection. Mr. [**Known lastname 19219**] explains that he had some mild heartburn in the past but has difficulty remembering exactly when he was first started on antacid medication. He reports having been followed with serial endoscopy for at least 3-5 years for what sounds like Barrett's esophagus likely found at the time of his initial GI workup in the past. The cancer was diagnosed on recent surveillance EGD. The patient complains of a 15 pound weight loss and significant anxiety which began upon learning his diagnosis. Otherwise he denies reflux, dysphagia, odynophagia, heartburn, nausea, shortness of breath, dyspnea on exertion, chest pain. Eating and drinking well. Denies heart disease, MI, has never needed oxygen therapy, never been hospitalized, never taken inhalers or steroids for his lungs. He has a heavy smoking history, having quit 2 weeks ago. Also a heavy drinking history, sober for last 20 years. The patient states that he hopes to have surgery as soon as possible. Past Medical History: PAST MEDICAL HISTORY: COPD, HTN, HTN, depression, tobacco use, hypercholesterolemia, BPH, GERD PAST SURGICAL HISTORY: None Social History: Cigarettes: [ ] never [x} ex-smoker (quit 2 weeks ago) [ ] current Pack-yrs: 40 pack years ETOH: [x ] No [ ] Yes drinks/day: prior heavy drinker, sober 19 yrs Exposure: [x] No [ ] Yes [ ] Radiation [ ] Asbestos [ ] Other: Occupation: retired truck driver Marital Status: [ ] Married [x] Single Lives: [ ] Alone [x} w/ family, accompanied today by supportive niece [**Name (NI) **] pertinent social history: does not exercise but states that he does a lot of walking, says does not get out of breath with 2 flights ________________________________________________________________ Family History: Mother: colon cancer Father Siblings: brother lung cancer Offspring Other: aunt bladder cancer Physical Exam: Vital Signs sheet entries for [**2107-5-26**]: BP: 117/73. Heart Rate: 78. Weight: 198.3. Height: 71.25. BMI: 27.5. Temperature: 97.5. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 98. GENERAL [x] All findings normal [ ] WN/WD [ ] NAD [ ] AAO [ ] abnormal findings: HEENT [x] All findings normal [ ] NC/AT [ ] EOMI [ ] PERRL/A [ ] Anicteric [ ] OP/NP mucosa normal [ ] Tongue midline [ ] Palate symmetric [ ] Neck supple/NT/without mass [ ] Trachea midline [ ] Thyroid nl size/contour [ ] Abnormal findings: RESPIRATORY [x] All findings normal [ ] CTA/P [ ] Excursion normal [ ] No fremitus [ ] No egophony [ ] No spine/CVAT [ ] Abnormal findings: CARDIOVASCULAR [x] All findings normal [ ] RRR [ ] No m/r/g [ ] No JVD [ ] PMI nl [ ] No edema [ ] Peripheral pulses nl [ ] No abd/carotid bruit [ ] Abnormal findings: GI [x] All findings normal [ ] Soft [ ] NT [ ] ND [ ] No mass/HSM [ ] No hernia [ ] Abnormal findings: GU [x] Deferred [ ] All findings normal [ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE [ ] Abnormal findings: NEURO [x] All findings normal [ ] Strength intact/symmetric [ ] Sensation intact/ symmetric [ ] Reflexes nl [ ] No facial asymmetry [ ] Cognition intact [ ] Cranial nerves intact [ ] Abnormal findings: MS [x] All findings normal [ ] No clubbing [ ] No cyanosis [ ] No edema [ ] Gait nl [ ] No tenderness [ ] Tone/align/ROM nl [ ] Palpation nl [ ] Nails nl [ ] Abnormal findings: LYMPH NODES [x] All findings normal [ ] Cervical nl [ ] Supraclavicular nl [ ] Axillary nl [ ] Inguinal nl [ ] Abnormal findings: SKIN [x] All findings normal [ ] No rashes/lesions/ulcers [ ] No induration/nodules/tightening [ ] Abnormal findings: PSYCHIATRIC [x] All findings normal [ ] Nl judgment/insight [ ] Nl memory [ ] Nl mood/affect [ ] Abnormal findings: Pertinent Results: [**2107-6-27**] 09:42AM GLUCOSE-180* LACTATE-1.1 NA+-138 K+-6.3* CL--107 [**2107-6-27**] 09:42AM HGB-13.8* calcHCT-41 [**2107-6-27**] 10:43AM GLUCOSE-170* LACTATE-1.6 NA+-139 K+-6.4* CL--108 [**2107-6-27**] 12:30PM GLUCOSE-190* UREA N-18 CREAT-0.9 SODIUM-139 POTASSIUM-4.8 CHLORIDE-110* TOTAL CO2-26 ANION GAP-8 [**2107-7-2**] Ba swallow : Status post esophagectomy with gastric pull-through, without evidence of holdup or leak at the neogastroesophageal junction [**2107-7-3**] CXR : The right-sided chest tube has been removed. Emphysematous changes in the lungs are again visualized. There is improved aeration in the left lower lung with decreased effusion; however, there continues to be some retrocardiac volume loss. Old rib fractures on the right are again seen Brief Hospital Course: Mr. [**Known lastname 19219**] was admitted to the hospital and taken to the Operating Room where he underwent a laparoscopic esophagectomy. He tolerated the procedure well and returned to the PACU in stable condition. He maintained stable hemodynamics and his pain was well controlled with a thoracic epidural catheter. His tube feedings were started via J tube on post op day #1 and he was eventually cycled over 18 hours. He was able to use his incentive spirometer effectively and his oxygen was gradually weaned off with room air saturations of 94%. His epidural was removed and he was treated with oxycodone for pain via the j tube. A barium swallow was done on post op day #6 which confirmed no anastomotic leak and he began a liquid diet which he tolerated well. Unfortunately his J tube site started to leak some purulent material and some erythema was noted around the tube. The J tube was removed on [**2107-7-4**] and his diet was advanced to soft solids along with Ensure supplements which he continued to tolerate well. The j tube site had a 1 cm area of cellulitis around the insertion site and was I&D'd at the bedside with placement of a wick. He was also placed on Keflex and the wound was monitored for another 24 hours. The area receded a bit and he continued to undergo [**Hospital1 **] dressing changes. He remained afebrile and his pain at the J tube site decreased. He was up and walking independently and continued to increase his oral intake with soft food and supplements. He was discharged to home on [**2107-7-6**] with VNA services and he will follow up with Dr. [**First Name (STitle) **] in 1 week. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. Fluoxetine 60 mg PO DAILY 2. Omeprazole 40 mg PO BID 3. Atenolol 25 mg PO DAILY 4. Atorvastatin 10 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Quetiapine extended-release 600 mg PO HS Discharge Medications: 1. Atenolol 25 mg PO DAILY 2. Fluoxetine 60 mg PO DAILY 3. Acetaminophen 650 mg PO Q6H pain do not exceed 4 tabs in 24 hours 4. Cephalexin 500 mg PO Q6H thru [**7-10**] RX *cephalexin 500 mg 1 Tablet(s) by mouth four times a day Disp #*20 Tablet Refills:*0 5. OxycoDONE (Immediate Release) 5-10 mg PO Q3H:PRN pain RX *oxycodone 5 mg [**1-10**] Tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 10 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Omeprazole 40 mg PO BID 10. Quetiapine extended-release 600 mg PO HS 11. Protein supplements Ensure 1 can TID disp 1 case Refill 3 months Dx esophageal cancer 12. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 Tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*2 Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Esophageal cancer J tube wound infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Call Dr[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience: -Fevers greater than 101 or chills -Increased shortness of breath, cough or chest pain -Nausea, vomiting -Increased abdominal pain -Incision develops increased drainage J tube site -Wick in place -Change dressing twice daily and as needed with the help of VNA -Call Dr. [**First Name (STitle) **] if the redness around the wound increases beyond the purple mark Pain -Oxycodone as needed -Take stool softners with narcotics Activity -Shower daily. Wash incision with mild soap & water, rinse, pat dry -No tub bathing, swimming or hot tub until incision healed -No driving while taking narcotics -No lifting greater than 10 pounds until seen -Walk 4-5 times a day for 10-15 minutes increase to a Goal of 30 minutes daily Diet: Soft solids as tolerated with protein supplements ( 4 cans a day) Eat small frequent meals. Sit up in chair for all meals and remain sitting for 30-45 minutes after meals Daily weights: keep a log bring with you to your appointment NO CARBONATED DRINKS Danger signs Fevers > 101 or chills Increased shortness of breath, cough or chest pain Incision develops drainage Nausea, vomiting (take anti-nausea medication) Increased abdominal pain Followup Instructions: Department: HEMATOLOGY/ONCOLOGY When: TUESDAY [**2107-7-12**] at 9:00 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD [**0-0-**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Please report 30 minutes prior to your appointment to the Radiology Department on the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical Center for a chest xray. Completed by:[**2107-7-6**]

151,569,293,530,496,070,682,401,600,V158

{"Malignant neoplasm of cardia,Infection of colostomy or enterostomy,Delirium due to conditions classified elsewhere,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Cellulitis and abscess of trunk,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: dysphagia PRESENT ILLNESS: Mr. [**Known lastname 19219**] is a 63 year old male with a history of GERD and Barrett's esophagus for which he was undergoing surveillance endoscopy. He was found to have an adenocarcinoma within an esophageal nodule near the GE junction. He underwent EUS on [**4-21**] which noted a 1cm malignant appearing lesion at the GE junction without evidence of invasion beyond the mucosal layer. A single 0.7 x 0.8 cm lymph node was seen in the periesophageal region which was sampled via FNA. LN negative for malignancy. The patient underwent endoscopic mucosal resection on [**2107-5-12**] with pathology as low grade well to moderately differentiated adenocarcinoma, at least intramucosal, multifocally extending to specimen margins with concern for invasion, possibly into the muscularis mucosae. He presents to discuss the possibility of surgical resection. MEDICAL HISTORY: PAST MEDICAL HISTORY: COPD, HTN, HTN, depression, tobacco use, hypercholesterolemia, BPH, GERD MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. Fluoxetine 60 mg PO DAILY 2. Omeprazole 40 mg PO BID 3. Atenolol 25 mg PO DAILY 4. Atorvastatin 10 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Quetiapine extended-release 600 mg PO HS ALLERGIES: Codeine PHYSICAL EXAM: Vital Signs sheet entries for [**2107-5-26**]: BP: 117/73. Heart Rate: 78. Weight: 198.3. Height: 71.25. BMI: 27.5. Temperature: 97.5. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 98. FAMILY HISTORY: Mother: colon cancer Father Siblings: brother lung cancer Offspring Other: aunt bladder cancer SOCIAL HISTORY: Cigarettes: [ ] never [x} ex-smoker (quit 2 weeks ago) [ ] current ### Response: {"Malignant neoplasm of cardia,Infection of colostomy or enterostomy,Delirium due to conditions classified elsewhere,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Cellulitis and abscess of trunk,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use"}

CHIEF COMPLAINT: Found unresponsive by friends. PRESENT ILLNESS: 41 year-old female with a PMHx significant for major depression and migraine headaches, transferred from Mt. [**Hospital 4257**] Hospital where she was brought after being found unresponsive by her friends. MEDICAL HISTORY: Major depression Migraine headaches Status post emergent colectomy in [**2143-5-9**] for cecal volvulus Recurrent ovarian cysts on ultrasound Status post nasal septoplasty Hemorrhoids status post hemorrhoidectomy MEDICATION ON ADMISSION: Symbalta 20 mg PO QD Dexadrine 10 mg PO QD Ambien HS PRN Vitamin B12 Vitamin B6 Alprazolam 0.5 mg PO PRN Dextroamphetamine 5 mg PO QD ALLERGIES: Penicillins / Sulfonamides PHYSICAL EXAM: Per MICU evaluation note: VITALS: T 99.2, BP 100-130/60-80, HR 50-115 VENT AC 550 X 12 (RR 16) 100% GEN: Thin female, intubated and sedated. HEENT: Pupils pinpoint 1mm, non reactive. Nares with blood bilaterally. ETT and OGT in place. RESP: CTA bilaterally. No wheezing or rhonchi. CV: RRR, normal S1, S2. No S3, S4. No murmur/rub. GI: BS normoactive. Abdomen soft. No HSM. No palpable mass. EXT: Thin, + ecchymoses on knees, elbows. No pedal edema. Warm. NEURO: Sedated. Withdraws to painful stimuli. Toes upgoing bilaterally. + rigidity. + corneal reflexes. INTEGUMENT: Dry skin. Ecchymoses over flanks bilaterally. FAMILY HISTORY: Father with anxiety. SOCIAL HISTORY: Per friends, patient is a lawyer and teaches [**Name (NI) 1017**] school. She is divorced. Her family lives in [**State 4260**]. No known history of tobacco or EtOH consumption.

Streptococcal meningitis,Acute respiratory failure,Acute pancreatitis,Mixed acid-base balance disorder,Intracerebral hemorrhage,Unspecified otitis media,Encounter for palliative care,Major depressive affective disorder, recurrent episode, unspecified,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally

Streptococcal meningitis,Acute respiratry failure,Acute pancreatitis,Mixed acid-base bal dis,Intracerebral hemorrhage,Otitis media NOS,Encountr palliative care,Recurr depr psychos-unsp,Anemia NOS,Drug dermatitis NOS

Admission Date: [**2144-12-2**] Discharge Date: [**2144-12-16**] Date of Birth: [**2103-3-23**] Sex: F Service: MEDICINE Allergies: Penicillins / Sulfonamides Attending:[**First Name3 (LF) 338**] Chief Complaint: Found unresponsive by friends. Major Surgical or Invasive Procedure: Endotracheal intubation Ventriculostomy Lumbar punctures History of Present Illness: 41 year-old female with a PMHx significant for major depression and migraine headaches, transferred from Mt. [**Hospital 4257**] Hospital where she was brought after being found unresponsive by her friends. Per report, Ms. [**Known lastname 4258**] was diagnosed with otitis media in the week prior to admission and treated with Z-pac and cortisporin ear drops. 2 days PTA, she complained of a severe headache, "possibly worst ever", accompanied by vomiting and fatigue. No one saw her in the following 2 days. On the day of admission, she was found unresponsive in her house on a couch, with "hoarse breathing". EMS were called and Ms. [**Known lastname 4258**] was taken to [**Hospital1 4259**], where she was electively intubated for airway protection. She was given fentanyl, Mannitol, NS X 1 liter, and etomidate. A tox screen at the OSH was positive for BDZ and opioids (on amphetamines and a sleeping pill at home, and possibly received opioids prior to intubation and tox screen). Her exam raised concern for increased ICP with extensor posturing and lack of corneal relexes. A CT head was remarkable for foci of parenchymal hemorrhage, and she was transferred to [**Hospital1 18**] for further evaluation and consideration for neurosurgery. Past Medical History: Major depression Migraine headaches Status post emergent colectomy in [**2143-5-9**] for cecal volvulus Recurrent ovarian cysts on ultrasound Status post nasal septoplasty Hemorrhoids status post hemorrhoidectomy Social History: Per friends, patient is a lawyer and teaches [**Name (NI) 1017**] school. She is divorced. Her family lives in [**State 4260**]. No known history of tobacco or EtOH consumption. Family History: Father with anxiety. Physical Exam: Per MICU evaluation note: VITALS: T 99.2, BP 100-130/60-80, HR 50-115 VENT AC 550 X 12 (RR 16) 100% GEN: Thin female, intubated and sedated. HEENT: Pupils pinpoint 1mm, non reactive. Nares with blood bilaterally. ETT and OGT in place. RESP: CTA bilaterally. No wheezing or rhonchi. CV: RRR, normal S1, S2. No S3, S4. No murmur/rub. GI: BS normoactive. Abdomen soft. No HSM. No palpable mass. EXT: Thin, + ecchymoses on knees, elbows. No pedal edema. Warm. NEURO: Sedated. Withdraws to painful stimuli. Toes upgoing bilaterally. + rigidity. + corneal reflexes. INTEGUMENT: Dry skin. Ecchymoses over flanks bilaterally. Pertinent Results: Relevant data on admission: CBC: WBC-21.3*# RBC-3.61* Hgb-11.3* Hct-30.7* MCV-85 MCH-31.3 MCHC-36.9* RDW-12.5 Plt Ct-236 (Neuts-93.4* Bands-0 Lymphs-3.5* Monos-2.8 Eos-0.3 Baso-0) Coagulation profile: PT-14.0* PTT-38.6* INR(PT)-1.2 Chemistry: Glucose-128* UreaN-18 Creat-0.7 Na-139 K-3.7 Cl-104 HCO3-21* AnGap-18 ALT-30 AST-76* LD(LDH)-237 CK(CPK)-1269* AlkPhos-89 Amylase-143* TotBili-0.7 Albumin-3.1* Calcium-8.1* Phos-2.5* Mg-2.3 UricAcd-3.2 Iron-8* Misc: ESR-72* [**2144-12-2**] 07:31PM BLOOD Acetone-NEG Osmolal-295 [**2144-12-2**] 07:31PM BLOOD Phenoba-<1.2* Phenyto-<0.6* Valproa-<3.0* [**2144-12-2**] 07:31PM BLOOD ASA-4 Ethanol-NEG Carbamz-<1.0* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2144-12-2**] 09:01PM BLOOD Lactate-1.9 [**2144-12-2**] CT HEAD: At least three punctate foci of parenchymal hemorrhage are identified, one within the left frontal subcortical white matter, the second within the right inferior temporal lobe, and the third in the high right posterior parietal lobe. There is no appreciable mass effect. There is no shift of the normally midline structures. Ventricles and sulci are normal in size and configuration. Basal cisterns remain patent. There is a large area of hypodensity in the right cerebellum. No abnormally enhancing lesions are identified following the administration of contrast. The osseous structures appear grossly normal. Note is made of fluid within the right mastoid air cells and middle ear, a finding concerning for mastoiditis in light of reports of patient right ear pain. No underlying abscess is identified on the post- contrast images. There is aerosolized fluid within the ethmoid air cells, likely relating to intubation. IMPRESSION 1. At least three tiny foci of parenchymal hemorrhage as above. 2. Findings consistent with mastoiditis in a patient with an elevated white blood cell count and ear pain. 3. No evidence of intracranial abscess. Brief Hospital Course: The patient's ICU course will be reviewed by problems. 1. Meningitis: The initial LP on [**12-2**] was remarkable for an opening pressure of 32, and CSF fluid with diplococci (later identified as Streptococcus pneumonia). Given her recent otitis media, ENT was consulted to rule out ongoing seeding +/- mastoiditis. A bedside myringotomy was performed on [**12-2**]. Subsequent imaging data and clinical examination ruled out mastoiditis. Neurology and neurosurgery were also consulted on admission. Ms. [**Known lastname 4258**] was empirically started on Ceftriaxone 2 gm IV BID, Vancomycin 1 gm IV BID and Acyclovir. She was also initially given Flagyl per ORL for anaerobic coverage. Antibiotherapy was subsequently tailored given pansensitive Strep pneumo (all subsequent CSF cultures sterile). Flagyl was D/C'd on [**12-4**], and Vanco and Acyclo were D/C'd on [**12-7**]. She was continued on CTX (query allergy to PCN) with the plan to complete a 14-day course. She was also started on IV decadron 10 mg Q 6H on admission, along with mannitol for management of high ICP. On [**12-3**] and [**12-4**], her clinical exam was suggestive of slow neurological decline. Imaging studies (CT head and MRI) were also consistent with increasing cerebral edema. Per neuro, daily LPs were performed, both diagnostic and therapeutic, with results as follows: [**12-3**]: OP 38, Closing pressure 23; [**12-4**] OP 25/ CP 17, removed 20cc; [**12-5**]: OP 25, CP 13, removed 25 cc. On [**12-6**], the patient was noted to have a new downward and adducted left eye, prompting a repeat CT head which showed stable punctate hemorrhages, increased white matter edema, mass effect on the lateral 3rd ventricle, extensive bilateral watershed infarcts, acute infarct in the left thalamus, and query uncal herniation. Neurosurgery was called and a ventriculostomy drain was placed at the bedside. Insertion was notable for a normal opening pressure, an ominous sign suggesting that the edema was of parenchymal origin. Her ICP remained low over the next 24 hours, and decision was made to remove the EVD. She was subsequently weaned off Mannitol and Dexamethasone. On [**12-7**], an EEG was performed to rule out seizure activity given new ocular bobbing on exam. Per neuro, the patient was also started on seizure prophylaxis with Dilantin. From [**12-7**] onward, serial neurological exams revealed no meaningful recovery. Her brainstem reflexes, however, were intact throughout. Serial CTs also revealed stable edema and hemorrhages. Per the family's wishes, given the lack of meaningful recovery despite adequate therapy, decision was made to withdraw care on [**2144-12-16**]. 2. Respiratory: Ms. [**Known lastname 4258**] was intubated at the OSH for airway protection. She was kept intubated until completion of the antibiotic course. Serial ABGs were consistent with respiratory alkalosis. She was extubated on [**2144-12-16**] per family's wishes, and expired shortly thereafter. 3. Elevated amylase and lipase: In the ICU, rising amylase and lipase were noted, the etiology of which was unclear. A RUQ U/S revealed mild edema without obstruction/gallstone. Our suspicion was low for acalculous cholecystitis. A medication list review could not identify a clear culprit. A literature review revealed possible pancreatic enzyme elevation in the setting of intracranial hemorrhage. Enzymes trended down with IVF, and NPO status. 4. Rash: A new rash was noted on [**12-9**], erythematous, with papules and comedones over the anterior chest, non-dermatomal, and expanding. Dermatology was consulted. The rash was consistent with steroid acne, which was not treated. 5. Communication: Her parents travelled here from [**State 4260**] on [**12-2**]. The family was kept abreast of developments. The plan was for continued aggressive care until completion of 14 days of antibiotherapy, and then reassessment of direction of care. Given the lack of meaningful recovery despite aggressive therapy, a family meeting was held on [**2144-12-15**] with Dr. [**Last Name (STitle) 4261**], neurology team, ICU team, and SW present. Per family's wishes, the decision was taken to withdraw care on [**2144-12-16**]. The NE Organ Bank was called at the family's request, and procedures were initiated for potential organ donation should the patient expire rapidly after extubation. The patient was extubated on [**2144-12-16**]. All medications were withdrawn and comfort measures were instituted. She past away on [**2144-12-16**] at night, >4 hours after extubation. Medications on Admission: Symbalta 20 mg PO QD Dexadrine 10 mg PO QD Ambien HS PRN Vitamin B12 Vitamin B6 Alprazolam 0.5 mg PO PRN Dextroamphetamine 5 mg PO QD Discharge Medications: Patient expired Discharge Disposition: Expired Discharge Diagnosis: Streptococcus pneumonia meningitis Intracerebral hemorrhages Cerebral edema Anemia Steroid acne Pancreatitis Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired Completed by:[**2145-1-28**]

320,518,577,276,431,382,V667,296,285,693

{'Streptococcal meningitis,Acute respiratory failure,Acute pancreatitis,Mixed acid-base balance disorder,Intracerebral hemorrhage,Unspecified otitis media,Encounter for palliative care,Major depressive affective disorder, recurrent episode, unspecified,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Found unresponsive by friends. PRESENT ILLNESS: 41 year-old female with a PMHx significant for major depression and migraine headaches, transferred from Mt. [**Hospital 4257**] Hospital where she was brought after being found unresponsive by her friends. MEDICAL HISTORY: Major depression Migraine headaches Status post emergent colectomy in [**2143-5-9**] for cecal volvulus Recurrent ovarian cysts on ultrasound Status post nasal septoplasty Hemorrhoids status post hemorrhoidectomy MEDICATION ON ADMISSION: Symbalta 20 mg PO QD Dexadrine 10 mg PO QD Ambien HS PRN Vitamin B12 Vitamin B6 Alprazolam 0.5 mg PO PRN Dextroamphetamine 5 mg PO QD ALLERGIES: Penicillins / Sulfonamides PHYSICAL EXAM: Per MICU evaluation note: VITALS: T 99.2, BP 100-130/60-80, HR 50-115 VENT AC 550 X 12 (RR 16) 100% GEN: Thin female, intubated and sedated. HEENT: Pupils pinpoint 1mm, non reactive. Nares with blood bilaterally. ETT and OGT in place. RESP: CTA bilaterally. No wheezing or rhonchi. CV: RRR, normal S1, S2. No S3, S4. No murmur/rub. GI: BS normoactive. Abdomen soft. No HSM. No palpable mass. EXT: Thin, + ecchymoses on knees, elbows. No pedal edema. Warm. NEURO: Sedated. Withdraws to painful stimuli. Toes upgoing bilaterally. + rigidity. + corneal reflexes. INTEGUMENT: Dry skin. Ecchymoses over flanks bilaterally. FAMILY HISTORY: Father with anxiety. SOCIAL HISTORY: Per friends, patient is a lawyer and teaches [**Name (NI) 1017**] school. She is divorced. Her family lives in [**State 4260**]. No known history of tobacco or EtOH consumption. ### Response: {'Streptococcal meningitis,Acute respiratory failure,Acute pancreatitis,Mixed acid-base balance disorder,Intracerebral hemorrhage,Unspecified otitis media,Encounter for palliative care,Major depressive affective disorder, recurrent episode, unspecified,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally'}

CHIEF COMPLAINT: change in mental status at home PRESENT ILLNESS: Pt is a 80m who was transfered from OSH after he was found to have a large acute right sided SDH with 10mm of midline shift. Pt was a MVA on Tuesday and was seen at [**Hospital 2725**] hospital with a negative workup. Tonight pt was found on the floor next to his chair at home and EMS was called.Pt had been complaining of some dizziness after his MVA and did have one episode of vomiting. Upon EMS arrival pt was reported to be awake and oriented to self only. He appeared drowsy but answered simple questions appropriately. Pt was taken to OSH where CT head ultimately found a subdural hematoma. Pt was then intubated for airway protection and to [**Hospital1 18**] for further care. MEDICAL HISTORY: Breast cancer, High cholesterol, GERD, peripheral neuropathy, Type II DM MEDICATION ON ADMISSION: Gemfibrozil 600 twice daily,Tamoxifen 20mg daily, Protonix 40mg daily, MVI 1 tab daily,Zolpedin 10mg qhs, Metformin unknown dose and spiriva unknown dose. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 97.4 BP: 121/67 HR:81 R 16 O2Sats 100% Intubated and sedated. HEENT: Pupils: 2.5-2.0 bilateral EOMs unable to evaluate FAMILY HISTORY: nc SOCIAL HISTORY: married, children

Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Aphasia,Closed Colles' fracture,Other convulsions,Unspecified accident,Personal history of malignant neoplasm of breast,Pure hypercholesterolemia,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Rash and other nonspecific skin eruption,Closed fracture of lunate [semilunar] bone of wrist,Other unspecified back disorders

Subdural hem w/o coma,Aphasia,Colles' fracture-closed,Convulsions NEC,Accident NOS,Hx of breast malignancy,Pure hypercholesterolem,Esophageal reflux,DMII wo cmp nt st uncntr,Idio periph neurpthy NOS,Nonspecif skin erupt NEC,Fx lunate, wrist-closed,Back disorder NOS

Admission Date: [**2150-7-23**] Discharge Date: [**2150-7-31**] Date of Birth: [**2069-12-20**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2724**] Chief Complaint: change in mental status at home Major Surgical or Invasive Procedure: none History of Present Illness: Pt is a 80m who was transfered from OSH after he was found to have a large acute right sided SDH with 10mm of midline shift. Pt was a MVA on Tuesday and was seen at [**Hospital 2725**] hospital with a negative workup. Tonight pt was found on the floor next to his chair at home and EMS was called.Pt had been complaining of some dizziness after his MVA and did have one episode of vomiting. Upon EMS arrival pt was reported to be awake and oriented to self only. He appeared drowsy but answered simple questions appropriately. Pt was taken to OSH where CT head ultimately found a subdural hematoma. Pt was then intubated for airway protection and to [**Hospital1 18**] for further care. Past Medical History: Breast cancer, High cholesterol, GERD, peripheral neuropathy, Type II DM Social History: married, children Family History: nc Physical Exam: T: 97.4 BP: 121/67 HR:81 R 16 O2Sats 100% Intubated and sedated. HEENT: Pupils: 2.5-2.0 bilateral EOMs unable to evaluate Neuro: Mental status: Intubated and sedated. Will follow simple commands in all four extremities appears to be moving symmetrically Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light,2.5 to 2.0 mm bilaterally. VII: Face appears symetric. VIII: Hearing intact to voice. Motor: Moving all extremities equally and symetrically. Sensation: Intact to light touch Pertinent Results: CT head shows large R sided acute SDH with maximal thickness 1.5cm and 7mm midline shift. Labs: Na 142 K 4.5 WBC 11.8 HCT 31.2 PLT 273 INR 1.2 PTT 20.4 Brief Hospital Course: Pt was admitted to the ICU for close monitoring. He was given a loading dose of fosphenytoin. He was following commands and was able to be extubated. Repeat CT should stable appearance. He continued to be monitored closely. It was noted that he was unable to speak on [**7-25**], but given that there were no other lateralizing symptoms or signs the decision was made that he would be monitored closely. His symptoms improved over the course of [**7-25**] and [**7-26**] and he was not taken to the OR. He continued to have word-finding difficulty, but he was able to respond to most questions with obvious comprehension. On [**7-26**] R wrist pain and swelling was noted and he was found to have a wrist fracture, which was casted by ortho. On [**7-27**] he developed an erythematous rash over his lower back and flank and he was transitioned from dilantin to keppra for seizure prophylaxis. His exam continued to improved. He complained of posterior neck pain on [**2150-7-29**] - CT of c-spine done which showed degenerative changes but no acute fracture. He was evaluated by PT/OT and felt suitable for rehab. Upon discharge he was alert and oriented x3, only very minimally word finding issues, full motors, no pronator drift following commands. Medications on Admission: Gemfibrozil 600 twice daily,Tamoxifen 20mg daily, Protonix 40mg daily, MVI 1 tab daily,Zolpedin 10mg qhs, Metformin unknown dose and spiriva unknown dose. Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Tamoxifen 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 8. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 9. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3 times a day). 10. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Menthol-Cetylpyridinium 3 mg Lozenge Sig: One (1) Lozenge Mucous membrane PRN (as needed) as needed for sore throat. 12. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for rash. 13. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 14. Levetiracetam 500 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 15. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 16. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours) as needed for pain. 17. Baclofen 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day) as needed for muscle spasm/stiffness. Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at [**Hospital6 1109**] - [**Location (un) 1110**] Discharge Diagnosis: Acute right subdural hematoma Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. until seen in follow up. ?????? You have been prescribed Dilantin (Phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. This can be drawn at your PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**]. Followup Instructions: ??????Please call ([**Telephone/Fax (1) 2726**] to schedule an appointment with Dr. [**Last Name (STitle) 548**] to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. Completed by:[**2150-7-31**]

852,784,813,780,E928,V103,272,530,250,356,782,814,724

{"Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Aphasia,Closed Colles' fracture,Other convulsions,Unspecified accident,Personal history of malignant neoplasm of breast,Pure hypercholesterolemia,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Rash and other nonspecific skin eruption,Closed fracture of lunate [semilunar] bone of wrist,Other unspecified back disorders"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: change in mental status at home PRESENT ILLNESS: Pt is a 80m who was transfered from OSH after he was found to have a large acute right sided SDH with 10mm of midline shift. Pt was a MVA on Tuesday and was seen at [**Hospital 2725**] hospital with a negative workup. Tonight pt was found on the floor next to his chair at home and EMS was called.Pt had been complaining of some dizziness after his MVA and did have one episode of vomiting. Upon EMS arrival pt was reported to be awake and oriented to self only. He appeared drowsy but answered simple questions appropriately. Pt was taken to OSH where CT head ultimately found a subdural hematoma. Pt was then intubated for airway protection and to [**Hospital1 18**] for further care. MEDICAL HISTORY: Breast cancer, High cholesterol, GERD, peripheral neuropathy, Type II DM MEDICATION ON ADMISSION: Gemfibrozil 600 twice daily,Tamoxifen 20mg daily, Protonix 40mg daily, MVI 1 tab daily,Zolpedin 10mg qhs, Metformin unknown dose and spiriva unknown dose. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 97.4 BP: 121/67 HR:81 R 16 O2Sats 100% Intubated and sedated. HEENT: Pupils: 2.5-2.0 bilateral EOMs unable to evaluate FAMILY HISTORY: nc SOCIAL HISTORY: married, children ### Response: {"Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Aphasia,Closed Colles' fracture,Other convulsions,Unspecified accident,Personal history of malignant neoplasm of breast,Pure hypercholesterolemia,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Rash and other nonspecific skin eruption,Closed fracture of lunate [semilunar] bone of wrist,Other unspecified back disorders"}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 27 year old female who presented with a left-sided headache for two weeks, also associated with left facial and tooth pain and with some amount of double vision. A CT scan done at the outside patient was transferred to [**Hospital1 188**] for further evaluation. MEDICAL HISTORY: 1. Not significant. MEDICATION ON ADMISSION: ALLERGIES: She had no drug allergies. PHYSICAL EXAMINATION: On examination, her pupils were equal, round and reactive. There was no lateral gaze past midline in the left eye. There was no nystagmus. There was Grade five muscle strength in all muscle groups. Sensation was grossly intact. Cranial nerves: She had a left sixth nerve palsy. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Cerebral aneurysm, nonruptured

Nonrupt cerebral aneurym

Admission Date: [**2102-2-7**] Discharge Date: [**2102-2-18**] Date of Birth: [**2074-6-17**] Sex: F HISTORY OF PRESENT ILLNESS: This is a 27 year old female who presented with a left-sided headache for two weeks, also associated with left facial and tooth pain and with some amount of double vision. A CT scan done at the outside patient was transferred to [**Hospital1 188**] for further evaluation. PAST MEDICAL HISTORY: 1. Not significant. ALLERGIES: She had no drug allergies. PHYSICAL EXAMINATION: On examination, her pupils were equal, round and reactive. There was no lateral gaze past midline in the left eye. There was no nystagmus. There was Grade five muscle strength in all muscle groups. Sensation was grossly intact. Cranial nerves: She had a left sixth nerve palsy. LABORATORY: CT scan was reviewed by the Neurosurgery chief resident and attending, and the diagnosis of aneurysm was made. HOSPITAL COURSE: The patient was admitted to the Neurosurgery Service and underwent an MRI which confirmed that there was a large aneurysm in the sella region. On the next day, the [**3-10**], she underwent a diagnostic angiogram. The angiogram revealed a 4 cm fusiform [**Doctor First Name 3098**] aneurysm. The patient was admitted to the Neurosurgical Intensive Care Unit overnight for observation. The following day, the [**2102-2-9**], the patient underwent GDC Coil embolization of the left internal carotid artery aneurysm. After test balloon occlusion of left internal carotid artery, permanent balloon occlusion of left internal carotid artery was performed. The procedure was uneventful and the patient tolerated the procedure well. She was transferred to the Surgical Intensive Care Unit for postoperative management. The patient was transferred to the Floor on the [**2-14**] and continued to do well on the Floor and was discharged to home in stable condition on the [**2102-2-18**]. She was instructed to follow-up with Dr. [**Last Name (STitle) 1132**] in a week. DISCHARGE DIAGNOSES: 1. Left cavernous internal carotid artery aneurysm, status post embolization and coiling. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Name8 (MD) 7075**] MEDQUIST36 D: [**2102-2-18**] 21:22 T: [**2102-2-20**] 12:16 JOB#: [**Job Number 20308**]

437

{'Cerebral aneurysm, nonruptured'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is a 27 year old female who presented with a left-sided headache for two weeks, also associated with left facial and tooth pain and with some amount of double vision. A CT scan done at the outside patient was transferred to [**Hospital1 188**] for further evaluation. MEDICAL HISTORY: 1. Not significant. MEDICATION ON ADMISSION: ALLERGIES: She had no drug allergies. PHYSICAL EXAMINATION: On examination, her pupils were equal, round and reactive. There was no lateral gaze past midline in the left eye. There was no nystagmus. There was Grade five muscle strength in all muscle groups. Sensation was grossly intact. Cranial nerves: She had a left sixth nerve palsy. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Cerebral aneurysm, nonruptured'}

CHIEF COMPLAINT: Nausea, vomiting, hyperglycemia PRESENT ILLNESS: Ms. [**Name13 (STitle) 6129**] is a 34 year old woman with DM type 1 and Hashimoto's thyroiditis who presented to the ED with nausea, vomiting, and hyperglycemia concerning for DKA. She took tramadol the night before admission for R shoulder pain and has been nauseous and vomiting since that time. She has been unable to take anything by mouth. Since then she has noted a high blood sugars over the past 24 hours. She uses an insulin pump and has been taking her insulin and bolusing frequently, but finger stick blood glucose remained in the high 300s to low 400s, so she became concerned that that she was in DKA. She has been in DKA a few times in the past and was worried that she would be unable to keep up with her fluid requirements given her nausea and vomiting, so she came into the ED. She attributes the nausea to the tramadol. She denies recent illness, fevers, diarrhea, [**Name13 (STitle) **], shortness of breath, chest pain, abdominal pain, rashes, dysuria, URI symptoms, or sick contacts. MEDICAL HISTORY: - Diabetes, type 1 (on insulin pump) - Hashimoto's thyroiditis MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Levothyroxine Sodium 75 mcg PO DAILY 2. Ibuprofen 800 mg PO Q8H:PRN pain 3. Sertraline 50 mg PO DAILY 4. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Target glucose: 80-180 ALLERGIES: tramadol PHYSICAL EXAM: Admission Physical Exam: Vitals: T 98.4 HR 103 BP 99/43 RR 20 O2 100% General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic ejection murmur loudest at the base, no rubs or gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. FAMILY HISTORY: Father died from adrenal failure, also had hypertension. Mother alive and healthy. No family history of diabetes or heart disease. SOCIAL HISTORY: Lives with husband, two children, and dog and works as a stay at home mom. She denies tobacco or illicit drugs. Endorses rare alcohol.

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Chronic lymphocytic thyroiditis,Long-term (current) use of insulin,Disorders of bursae and tendons in shoulder region, unspecified,Dehydration,Insulin pump status,Insomnia, unspecified

DMI ketoacd uncontrold,Chr lymphocyt thyroidit,Long-term use of insulin,Rotator cuff synd NOS,Dehydration,Insulin pump status,Insomnia NOS

Admission Date: [**2175-10-7**] Discharge Date: [**2175-10-9**] Date of Birth: [**2141-6-17**] Sex: F Service: MEDICINE Allergies: tramadol Attending:[**First Name3 (LF) 338**] Chief Complaint: Nausea, vomiting, hyperglycemia Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Name13 (STitle) 6129**] is a 34 year old woman with DM type 1 and Hashimoto's thyroiditis who presented to the ED with nausea, vomiting, and hyperglycemia concerning for DKA. She took tramadol the night before admission for R shoulder pain and has been nauseous and vomiting since that time. She has been unable to take anything by mouth. Since then she has noted a high blood sugars over the past 24 hours. She uses an insulin pump and has been taking her insulin and bolusing frequently, but finger stick blood glucose remained in the high 300s to low 400s, so she became concerned that that she was in DKA. She has been in DKA a few times in the past and was worried that she would be unable to keep up with her fluid requirements given her nausea and vomiting, so she came into the ED. She attributes the nausea to the tramadol. She denies recent illness, fevers, diarrhea, [**Name13 (STitle) **], shortness of breath, chest pain, abdominal pain, rashes, dysuria, URI symptoms, or sick contacts. In the ED, initial vital signs were: T 97 HR 102 BP 116/75 RR 20 O2 sat 98% RA, pain 10. On admission, finger stick blood glucose was 349. Labs were notable for serum glucose of 383, urinalysis with 1000 glucose and 150 ketones. Lactate was 2.1. Lytes were notable for potassium of 5.1, bicarb of 14 and AG of 20. White count of 11.0 with a left shift. She was given lorazepam 2 mg x 2, Zofran 4 mg x 1, 2.5 L NS with potassium, and 8 units IV insulin and gtt at 5 units per hr (since 8pm). For access, she has two 18 gauge peripheral IVs. On arrival to the MICU, vital signs were T 98.4 HR 103 BP 99/43 RR 20 O2 100% . She was comfortable, noting that her nausea and vomiting had resolved and she was feeling much better. She clearly reported the history above and denied any additional symptoms. Finger stick blood glucose was 228 on arrival to the [**Hospital Unit Name 153**]. Review of systems: (+) Per HPI, also notes right shoulder pain. (-) Denies fever, recent weight loss or gain. Denies vision changes, headache, sinus tenderness, rhinorrhea or congestion. Denies shortness of breath, [**Hospital Unit Name **], or wheezing. Denies chest pain, chest pressure, palpitations. Denies constipation, abdominal pain, diarrhea, dark or bloody stools. Denies dysuria or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. Past Medical History: - Diabetes, type 1 (on insulin pump) - Hashimoto's thyroiditis Social History: Lives with husband, two children, and dog and works as a stay at home mom. She denies tobacco or illicit drugs. Endorses rare alcohol. Family History: Father died from adrenal failure, also had hypertension. Mother alive and healthy. No family history of diabetes or heart disease. Physical Exam: Admission Physical Exam: Vitals: T 98.4 HR 103 BP 99/43 RR 20 O2 100% General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic ejection murmur loudest at the base, no rubs or gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. Pertinent Results: Admission labs: [**2175-10-7**] 06:00PM BLOOD WBC-11.0 RBC-4.44 Hgb-14.8 Hct-45.1 MCV-102* MCH-33.3* MCHC-32.7 RDW-11.9 Plt Ct-450* [**2175-10-7**] 06:00PM BLOOD Neuts-91.6* Lymphs-7.2* Monos-0.6* Eos-0.2 Baso-0.3 [**2175-10-7**] 06:00PM BLOOD Glucose-383* UreaN-28* Creat-0.9 Na-136 K-5.1 Cl-102 HCO3-14* AnGap-25 [**2175-10-7**] 06:00PM BLOOD Calcium-9.8 Phos-5.2* Mg-2.1 [**2175-10-8**] 12:28AM BLOOD Type-[**Last Name (un) **] pO2-194* pCO2-28* pH-7.27* calTCO2-13* Base XS--12 Comment-GREEN TOP [**2175-10-7**] 06:15PM BLOOD Lactate-2.1* Micro: None Studies: [**2175-10-7**] CXR: The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vascularity isnormal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected. IMPRESSION: No acute cardiopulmonary abnormality. Brief Hospital Course: 34 year old woman with DM type 1 and Hashimoto's thyroiditis who presented to the ED with nausea, vomiting, and hyperglycemia concerning for DKA, admitted to the [**Hospital Unit Name 153**] for insulin drip. # DKA: Patient with type 1 diabetes diagnosed in [**2163**]. She follows with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3636**] at [**Last Name (un) **] and has very good glucose control at baseline (reports A1c in the 5 range). She was felt to be in DKA given persistently high FSBG readings at home, nausea, vomiting, electrolytes demonstrating an anion gap of 20, and urinalysis with glucose and ketones in the urine on arrival to the ED. VBG was notable for pH 7.27 and CO2 28. The etiology of her DKA is likely secondary to nausea, vomiting, and resulting hypovolemia from adverse reaction to tramadol that she had taken for shoulder pain. Unlikely infectious given that she is afebrile without any localizing symptoms, no dysuria, clean urinalysis (other than glucose and ketones), no rashes, no recent illness or sick contacts, no [**Name2 (NI) **] and clear chest x-ray. Serum glucose on arrival ranged from 350 - 400. She was started on an insulin drip at 5 units per hour and was bolused 3 L NS in the ED. As her serum glucose fell below 200, she was transitioned to D5 water with prn boluses of NS. Lytes were measured q2 hours until gap resolved the following morning and D5 was discontinued. Potassium remained within the range of 4.5 to 5.0 with repletion. She was seen by [**Last Name (un) **], who recommended restarting her home insulin pump at 0.7 units per hour basal with i:[**Doctor Last Name **] 1:15, CF 40, and target of 120. She remained hyperglycemic on these settings, [**First Name8 (NamePattern2) **] [**Last Name (un) **] recommended increasing her basal rate to 0.9 units/hr, i:[**Doctor Last Name **] to 1:12 and CF to 35. She was scheduled for a follow up appointment with [**Last Name (un) **]. # Right rotator cuff pain: Patient has rotator cuff injury for which she is seeing ortho. She has outpatient cortisone injection scheduled for early [**Month (only) 359**]. She was prescribed tramadol (which she had never taken) for pain refractory to ibuprofen, and developed nausea and vomiting which likely precipitated DKA (above). She was continued on ibuprofen, started on acetaminophen standing, and instructed on physical therapy exercises to help with pain and range of motion. She has ortho follow up already scheduled for early [**Month (only) 359**]. # Hashimotos thyroiditis: She is euthyroid on exam and was continued on her home dose of levothyroxine 50 mcg PO daily. # Insomnia: Patient recently started taking Zoloft for insomnia. She denies symptoms of depression. # FEN: IVF, replete electrolytes, insulin drip # Prophylaxis: SQH, pneumoboots # Contact: [**Name (NI) 4906**] [**Telephone/Fax (1) 43474**] # Code: Full (confirmed) # Transitional issues: - Patient will need close PCP/endocrine follow up given DKA - Basal settings for insulin pump changed in consultation with [**Last Name (un) **]: 0.9 units/hr, i:[**Doctor Last Name **] to 1:12 and CF to 35 -- this should be discussed with [**Last Name (un) **] provider at follow up appointment Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Levothyroxine Sodium 75 mcg PO DAILY 2. Ibuprofen 800 mg PO Q8H:PRN pain 3. Sertraline 50 mg PO DAILY 4. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Target glucose: 80-180 Discharge Medications: 1. Ibuprofen 800 mg PO Q8H:PRN pain 2. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Basal rate minimum: 0.7 units/hr Target glucose: 80-180 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Sertraline 50 mg PO DAILY 5. Acetaminophen 1000 mg PO Q8H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: - Diabetic ketoacidosis Secondary Diagnoses: - Diabetes type 1 - Hashimotos thyroiditis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms. [**Last Name (Titles) 6129**], You came into the ED because of nausea, vomiting, hyperglycemia, and were found to be in diabetic ketoacidosis (DKA). You were admitted to the ICU because you were required an insulin drip. You were also given several liters of fluid and your blood sugars came back down to normal. We monitored you overnight and your symptoms resolved and your sugars were controlled with your home insulin pump. You were also complaining of shoulder pain from your right rotator cuff and you are scheduled for follow up with ortho to have a cortisone injection. You should not take tramadol any longer due to the adverse reaction of nausea and vomiting which may have caused you to go into DKA. It was a pleasure taking care of you at the [**Hospital1 18**]! Followup Instructions: You have the following appoinments scheduled following discharge: Name: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3640**], NP Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3402**] Appt: Thursday, [**10-12**] at 10:30am NOTE: This appointment is with a member of Dr [**Last Name (STitle) 43475**] team as part of your transition from the hospital back to your primary care provider. [**Name10 (NameIs) 616**] this visit, you will see your regular provider. Department: ORTHOPEDICS When: MONDAY [**2175-10-23**] at 10:00 AM With: ORTHO XRAY (SCC 2) [**Telephone/Fax (1) 1228**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: SPINE CENTER When: MONDAY [**2175-10-23**] at 10:20 AM With: [**First Name4 (NamePattern1) 1141**] [**Last Name (NamePattern1) 4983**], NP [**Telephone/Fax (1) 8603**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 249**] When: MONDAY [**2175-11-13**] at 3:45 PM With: [**Name6 (MD) **] [**Name8 (MD) 10918**], MD [**Telephone/Fax (1) 2010**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Central [**Hospital **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage NOTE: Dr [**Last Name (STitle) **] is a resident and your new physician in [**Name9 (PRE) 191**]. Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43476**] over sees this doctor and both will be involved in your care. For insurance purposes, Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Doctor Last Name **] will be listed as your PCP in your record. Completed by:[**2175-10-9**]

250,245,V586,726,276,V458,780

{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Chronic lymphocytic thyroiditis,Long-term (current) use of insulin,Disorders of bursae and tendons in shoulder region, unspecified,Dehydration,Insulin pump status,Insomnia, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Nausea, vomiting, hyperglycemia PRESENT ILLNESS: Ms. [**Name13 (STitle) 6129**] is a 34 year old woman with DM type 1 and Hashimoto's thyroiditis who presented to the ED with nausea, vomiting, and hyperglycemia concerning for DKA. She took tramadol the night before admission for R shoulder pain and has been nauseous and vomiting since that time. She has been unable to take anything by mouth. Since then she has noted a high blood sugars over the past 24 hours. She uses an insulin pump and has been taking her insulin and bolusing frequently, but finger stick blood glucose remained in the high 300s to low 400s, so she became concerned that that she was in DKA. She has been in DKA a few times in the past and was worried that she would be unable to keep up with her fluid requirements given her nausea and vomiting, so she came into the ED. She attributes the nausea to the tramadol. She denies recent illness, fevers, diarrhea, [**Name13 (STitle) **], shortness of breath, chest pain, abdominal pain, rashes, dysuria, URI symptoms, or sick contacts. MEDICAL HISTORY: - Diabetes, type 1 (on insulin pump) - Hashimoto's thyroiditis MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Levothyroxine Sodium 75 mcg PO DAILY 2. Ibuprofen 800 mg PO Q8H:PRN pain 3. Sertraline 50 mg PO DAILY 4. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Target glucose: 80-180 ALLERGIES: tramadol PHYSICAL EXAM: Admission Physical Exam: Vitals: T 98.4 HR 103 BP 99/43 RR 20 O2 100% General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic ejection murmur loudest at the base, no rubs or gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. FAMILY HISTORY: Father died from adrenal failure, also had hypertension. Mother alive and healthy. No family history of diabetes or heart disease. SOCIAL HISTORY: Lives with husband, two children, and dog and works as a stay at home mom. She denies tobacco or illicit drugs. Endorses rare alcohol. ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Chronic lymphocytic thyroiditis,Long-term (current) use of insulin,Disorders of bursae and tendons in shoulder region, unspecified,Dehydration,Insulin pump status,Insomnia, unspecified'}

CHIEF COMPLAINT: s/p Multiple stabbing assault PRESENT ILLNESS: 33yo M found in his car with multiple stab wounds to his torso. He was taken to an area hospital where he was intubated, NGT and right chest tube placed. He was then transferred to [**Hospital1 18**] for further management of his injuries. Upon arrival he was taken to the operating room for trauma laparotomy. MEDICAL HISTORY: Unknown MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: 101.5, Tc 101.5, HR 137, BP 124/79, RR 20, SpO2 98% on CMV, FiO2 60%, PEEP 8; fentanyl@300, versed@8, propofol@50 Gen: Sedated, intubated HEENT: Head NC/AT. Mid-forehead superficial abrasion. R periorbital edema and ecchymosis. L pupil 2mm, R pupil 5mm, nonreactive to light bilaterally. R sclera injected with some conjunctival hemorrhage. Nose, midface, maxilla and mandible appears stable. CV: Tachycardic, no murmurs appreciated Resp: Intubated; R chest tube in place Torso: Multiple stab wounds covered with dressing including 3 on back, 2 on L torso, 4 on R torso, 3 on R arm. Abd: Vertical wound incision (from ex-lap) covered with dressing FAMILY HISTORY: Noncontributory SOCIAL HISTORY:

Internal injury to unspecified or ill-defined organs with open wound into cavity,Pneumonia due to other specified organism,Closed fracture of other facial bones,Other orbital disorders,Open wound(s) (multiple) of unspecified site(s), without mention of complication,Assault by unspecified means,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other and unspecified complications of medical care, not elsewhere classified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site

Internal injury NOS-open,Pneumon oth spec orgnsm,Fx facial bone NEC-close,Orbital disorders NEC,Open wound site NOS,Assault NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Complic med care NEC/NOS,Mth sus Stph aur els/NOS

Admission Date: [**2156-9-11**] Discharge Date: [**2156-9-29**] Date of Birth: [**2122-11-22**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 974**] Chief Complaint: s/p Multiple stabbing assault Major Surgical or Invasive Procedure: [**2156-9-11**] Exploratory laparotomy with liver packing; right thoracosotmy tube placement [**2156-9-11**] Bronchoscopy [**2156-9-12**] Exploratory laparotomy and removal of packing [**2156-9-22**] Tracheostomy and PEG tube placment [**2156-9-28**] Tracheostomy decannulation History of Present Illness: 33yo M found in his car with multiple stab wounds to his torso. He was taken to an area hospital where he was intubated, NGT and right chest tube placed. He was then transferred to [**Hospital1 18**] for further management of his injuries. Upon arrival he was taken to the operating room for trauma laparotomy. Past Medical History: Unknown Family History: Noncontributory Physical Exam: Upon admission: 101.5, Tc 101.5, HR 137, BP 124/79, RR 20, SpO2 98% on CMV, FiO2 60%, PEEP 8; fentanyl@300, versed@8, propofol@50 Gen: Sedated, intubated HEENT: Head NC/AT. Mid-forehead superficial abrasion. R periorbital edema and ecchymosis. L pupil 2mm, R pupil 5mm, nonreactive to light bilaterally. R sclera injected with some conjunctival hemorrhage. Nose, midface, maxilla and mandible appears stable. CV: Tachycardic, no murmurs appreciated Resp: Intubated; R chest tube in place Torso: Multiple stab wounds covered with dressing including 3 on back, 2 on L torso, 4 on R torso, 3 on R arm. Abd: Vertical wound incision (from ex-lap) covered with dressing Pertinent Results: [**2156-9-11**] 06:10AM BLOOD WBC-32.5* RBC-5.50 Hgb-17.0 Hct-48.4 MCV-88 MCH-31.0 MCHC-35.2* RDW-13.9 Plt Ct-184 [**2156-9-11**] 06:10AM BLOOD PT-14.9* PTT-23.7 INR(PT)-1.3* [**2156-9-11**] 06:10AM BLOOD Fibrino-155 [**2156-9-11**] 06:10AM BLOOD Glucose-115* UreaN-11 Creat-1.3* Na-140 K-4.2 Cl-105 HCO3-16* AnGap-23 [**2156-9-11**] 06:10AM BLOOD ALT-459* AST-493* AlkPhos-70 Amylase-144* TotBili-1.2 [**2156-9-12**] 01:57AM BLOOD CK(CPK)-2423* [**2156-9-11**] 06:10AM BLOOD Lipase-74* [**2156-9-11**] 06:10AM BLOOD Albumin-3.5 Calcium-8.1* Phos-5.7* Mg-2.3 [**2156-9-13**] 02:04AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE [**2156-9-13**] 02:04AM BLOOD HCV Ab-NEGATIVE [**2156-9-11**] 05:11AM BLOOD Type-ART pO2-98 pCO2-53* pH-7.10* calTCO2-17* Base XS--13 [**2156-9-11**] 05:42AM BLOOD Glucose-154* Lactate-4.3* Na-139 K-4.3 Cl-106 [**2156-9-11**] 05:11AM BLOOD Hgb-13.4* calcHCT-40 O2 Sat-96 COHgb-1.6 MetHgb-0 [**9-11**] CT Head: R orbital floor blowout fx, R proptosis [**2-14**] retrobulbar/intraconal hemorrhage, R periorbital/preseptal hematoma [**9-11**] CT Chest/Abd/Pelvis: small amount residual right ptx. perihepatic and perisplenic hematoma with suggestion of grade II splenic laceration (1cm). Fatty liver with regions of sparing but no discrete laceration. rt 10th rib fx. multiple bullet frags in chest. pneumoperitoneum without clear source. moderate rt hemothorax. malpositioned right chest tube and OGT. [**9-12**] CT C-spine: No acute fx or abnormal alignment. [**9-12**] CT maxillofacial: R orbital floor blowout fracture w/ comminuted lamina papyracea fx. Persistent R-sided proptosis from retrobulbar hemorrhage. [**9-12**] CXR: Decrease in R ptx, near complete reexpansion of RUL [**9-14**] CXR: No definite ptx, opacity at R base consistent with aspiration, pulmonary edema. [**9-15**] CXR: Areas of opacification b/l multifocal pneumonia vs pulmonary edema. [**9-21**] CT Chest: Findings most consistent with multifocal pneumonia including combined pneumonia and atelectasis at the right base with patchy areas of infection in both lungs. Fatty liver with unchanged appearance of focal high attenuating right liver lesion which is better described on prior imaging. [**9-22**] CXR: Low lung volumes, worsening right basal atelectasis, probable new small right pleural effusion. Right basal pleural tube, ET tube, left subclavian line in standard placements. Nasogastric tube can be traced as far as the mid stomach and passes out of view. No pneumothorax. Mild cardiomegaly unchanged. Left lung entirely clear. [**9-24**] CXR: NG tube appropriately placed. Brief Hospital Course: He was admitted to the Trauma Service and taken directly to the operating room for laparotomy and packing of his liver. Postoperatively he was taken to the Trauma ICU where he remained sedated and vented. On the following day he was taken back to the operating room for further exploration and removal of his liver packing. Plastic surgery was consulted because of his orbital fracture; this injury was deemed non-operable. It was recommended that an Ophthalmology consult be ordered given the retrobulbar hemorrhage sustained. No surgical intervention warranted; the hemorrhage did improve considerably throughout his hospital stay. He will require follow up as an outpatient in the [**Hospital 8183**] clinic. He did develop ARDS and a ventilator associated pneumonia for which Vancomycin, Zosyn and Ciprofloxacin were started. These were eventually stopped after appropriate course of treatment with exception of the Cipro, which will continue for an additional 5 days after hospital discharge for Serratia in sputum. Because he was difficult to wean form the ventilator a tracheostomy was performed. Enteral tube feedings were initiated early. He was eventually able to be weaned from the ventilator and once more hemodynamically stable he was transferred to the regular nursing unit. Once on the floor he continued to do well. Speech and swallow evaluation was obtained, his diet was quickly advanced to regular which he tolerated well. Because he was able to manage his secretions and had a strong cough the decision was made to remove his tracheostomy. He maintained his airway without any difficulties following it's removal. Social work was closely involved early during his hospital stay; once he was awake and oriented he was referred to the Center for Violence Prevention and recovery at the hospital. He was provided with information on counseling and victim's compensation programs. He was evaluated by Physical therapy and was cleared for safe discharge from a functional perspective. Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*100 Tablet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constiaption. 4. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. Disp:*10 Tablet(s)* Refills:*0* 5. Clonidine 0.1 mg Tablet Sig: * Tablet PO BID & DAILY: Take 2 tablets twice a day for 2 days; then 1 tablet twice a day for 2 days; then 1 tablet once daily for 2 days; then stop. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: s/p Multiple stab wounds: Retrobulbar hemorrhage Orbital fractures Liver laceration Spleen injury Pneumonia ARDS Hemopneumothorax Discharge Condition: Hemodynamically stable, tolerating a regular diet, pain adequately controlled. Discharge Instructions: Return to the Emergency room if you develop any fevers, chills, headache, dizziness, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, increased redness/drainage from your wounds and surgical incisions and/or any other symptoms that are concerning to you. Keep your wounds clean and dry; you may shower with the bandages off, then pat dry. Apply dry dressings as directed. Continue with the antibiotics until [**10-3**]. Followup Instructions: Follow up with Dr. [**Last Name (STitle) **] in Surgery Clinic in 2 weeks, call [**Telephone/Fax (1) 2359**] for an appointment. Follow up in 2 weeks in Plastic Surgery Clinic for your orbital fractures, call [**Telephone/Fax (1) 5343**] for an appointment. Follow up in [**Hospital 8095**] clinic for any concerns related to your eye, call [**Telephone/Fax (1) 253**] if an appoinmtent is needed. Completed by:[**2156-10-6**]

869,483,802,376,879,E968,272,401,999,041

{'Internal injury to unspecified or ill-defined organs with open wound into cavity,Pneumonia due to other specified organism,Closed fracture of other facial bones,Other orbital disorders,Open wound(s) (multiple) of unspecified site(s), without mention of complication,Assault by unspecified means,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other and unspecified complications of medical care, not elsewhere classified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: s/p Multiple stabbing assault PRESENT ILLNESS: 33yo M found in his car with multiple stab wounds to his torso. He was taken to an area hospital where he was intubated, NGT and right chest tube placed. He was then transferred to [**Hospital1 18**] for further management of his injuries. Upon arrival he was taken to the operating room for trauma laparotomy. MEDICAL HISTORY: Unknown MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: 101.5, Tc 101.5, HR 137, BP 124/79, RR 20, SpO2 98% on CMV, FiO2 60%, PEEP 8; fentanyl@300, versed@8, propofol@50 Gen: Sedated, intubated HEENT: Head NC/AT. Mid-forehead superficial abrasion. R periorbital edema and ecchymosis. L pupil 2mm, R pupil 5mm, nonreactive to light bilaterally. R sclera injected with some conjunctival hemorrhage. Nose, midface, maxilla and mandible appears stable. CV: Tachycardic, no murmurs appreciated Resp: Intubated; R chest tube in place Torso: Multiple stab wounds covered with dressing including 3 on back, 2 on L torso, 4 on R torso, 3 on R arm. Abd: Vertical wound incision (from ex-lap) covered with dressing FAMILY HISTORY: Noncontributory SOCIAL HISTORY: ### Response: {'Internal injury to unspecified or ill-defined organs with open wound into cavity,Pneumonia due to other specified organism,Closed fracture of other facial bones,Other orbital disorders,Open wound(s) (multiple) of unspecified site(s), without mention of complication,Assault by unspecified means,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other and unspecified complications of medical care, not elsewhere classified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 70 M with CHF EF 10%, s/p ICD biv placement through L subclavian vein approach on [**8-24**] complicated by L hemothorax. Chest tube placed in OR-no evidence for active bleeding. Procedure today was complicated by hitting subclavian artery became hypotensive to 90s, Hct 30 to OR out of concern for subclavian artery stick. Inserted chest tube for L hemothorax and pleural effusion Hct 16. 400 cc out, stopped draining overnight to [**8-25**]. Intubated for 24 hrs, then extubated successfully. Aggressive diuresis once BP stabilizes. Went into AFIB, cardioverted in AM, chest tube pulled today. . SBP 150s by arterial line s/p 2L of fluid s/p 3 URBC . ROS: Pt denies fever or chills. No night sweats or recent weight loss or gain. Denied headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. No rash. MEDICAL HISTORY: New biv icd- concerto [**Company **] CHF-ischemic cardiomyopathy EF %[**10-24**] (below) CAD s/p CABG AFIB s/p R arm surgery w rodding for congenital abnormality L CEA Multiple right ankle fractures arthritis DM Hyperlipidemia MEDICATION ON ADMISSION: Medications: Carvedilol 6.25mg daily Lasix 20mg daily Magnesium Oxide 400mg twice daily Lisinopril 25mg daily Digoxin 0.125mg daily Plavix 75mg daily Potassium 40meq daily Zoloft 50mg daily Simvastatin 40mg daily Aspirin 325mg daily Glyburide 5 mg twice daily *Instructed patient to hold the morning of the procedure Metformin 500mg daily *Instructed patient to hold the morning of ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 97.2 / 77 / 14 / 105-143/48-64 / 98%-100% RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, sclera anicteric. MMM, OP without lesions Neck: supple, no JVD or carotid bruits appreciated Pulm: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G appreciated Abdomen: soft, NT/ND, + BS, no masses or organomegaly noted. Ext: No edema b/t, 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary, or inguinal LAD. Skin: no rashes or lesions noted. Neurologic: -mental status: Alert & Oriented x 3. Able to relate history without difficulty. -cranial nerves: II-XII intact -motor: normal bulk, strength, and tone throughout. -sensory: No deficits to light touch throughout. -cerebellar: No nystagmus, dysarthria, intention or action tremor, dysdiadochokinesia noted. F->N and H->S WNL bilaterally. FAMILY HISTORY: He has a mother who died of complications of heart disease and diabetes. He has two brothers both of whom have heart disease and diabetes SOCIAL HISTORY: He has been happily married for 47 years. He has three adult children. He is retired. Prior to retiring he worked as an

Congestive heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Unspecified anomaly of upper limb,Anemia, unspecified

CHF NOS,Accidental op laceration,Atrial fibrillation,Aortocoronary bypass,Chr ischemic hrt dis NEC,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Upper limb anomaly NOS,Anemia NOS

Admission Date: [**2186-8-24**] Discharge Date: [**2186-8-31**] Date of Birth: [**2115-10-22**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Doctor First Name 1402**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: ICD/BiV pacer placement in L chest History of Present Illness: 70 M with CHF EF 10%, s/p ICD biv placement through L subclavian vein approach on [**8-24**] complicated by L hemothorax. Chest tube placed in OR-no evidence for active bleeding. Procedure today was complicated by hitting subclavian artery became hypotensive to 90s, Hct 30 to OR out of concern for subclavian artery stick. Inserted chest tube for L hemothorax and pleural effusion Hct 16. 400 cc out, stopped draining overnight to [**8-25**]. Intubated for 24 hrs, then extubated successfully. Aggressive diuresis once BP stabilizes. Went into AFIB, cardioverted in AM, chest tube pulled today. . SBP 150s by arterial line s/p 2L of fluid s/p 3 URBC . ROS: Pt denies fever or chills. No night sweats or recent weight loss or gain. Denied headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. No rash. Past Medical History: New biv icd- concerto [**Company **] CHF-ischemic cardiomyopathy EF %[**10-24**] (below) CAD s/p CABG AFIB s/p R arm surgery w rodding for congenital abnormality L CEA Multiple right ankle fractures arthritis DM Hyperlipidemia Social History: He has been happily married for 47 years. He has three adult children. He is retired. Prior to retiring he worked as an auto mechanic. He does not smoke or drink. He lives with his wife. Family History: He has a mother who died of complications of heart disease and diabetes. He has two brothers both of whom have heart disease and diabetes Physical Exam: Vitals: 97.2 / 77 / 14 / 105-143/48-64 / 98%-100% RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, sclera anicteric. MMM, OP without lesions Neck: supple, no JVD or carotid bruits appreciated Pulm: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G appreciated Abdomen: soft, NT/ND, + BS, no masses or organomegaly noted. Ext: No edema b/t, 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary, or inguinal LAD. Skin: no rashes or lesions noted. Neurologic: -mental status: Alert & Oriented x 3. Able to relate history without difficulty. -cranial nerves: II-XII intact -motor: normal bulk, strength, and tone throughout. -sensory: No deficits to light touch throughout. -cerebellar: No nystagmus, dysarthria, intention or action tremor, dysdiadochokinesia noted. F->N and H->S WNL bilaterally. -DTRs: 2+ biceps, patellar and 1+ ankle jerks bilaterally. Downgoing Babinskis bilaterally Pertinent Results: EKG: BiV paced . [**2186-8-26**] CXR: [**Location (un) 1131**] pending . [**2186-8-25**] CXR: There is no pneumothorax. Mild cardiomegaly is stable. No pulmonary edema or appreciable pleural effusion is present. Endotracheal tube was removed between 9:20 and 10:35 a.m. Transvenous right atrial and ventricular pacer leads are unchanged in their positions. The tip of the ventricular lead projects over the mid portion of the right ventricle, and probably along the anterior wall. The tip of the left pleural tube has also repositioned more inferiorly, now at the level of the left hilus. . TTE [**8-24**]: EF 10-20%, [**1-9**]+ AR, 1+ MR [**Name13 (STitle) 650**] global left ventricular hypokinesis. Overall left ventricular systolic function is severely depressed. LVEF< 20%. The right ventricular cavity is dilated. There is focal hypokinesis of the apical free wall of the right ventricle. Wires are visualized in the RA/RV/coronary sinus. There is a moderate left pleural effusion visualized with small loculations. The effusion mostly disappeared after chest tube drainage. . [**2186-8-24**] 11:23PM TYPE-ART TEMP-35.3 PO2-205* PCO2-38 PH-7.40 TOTAL CO2-24 BASE XS-0 INTUBATED-INTUBATED VENT-CONTROLLED [**2186-8-24**] 11:23PM O2 SAT-99 [**2186-8-24**] 09:57PM TYPE-ART TEMP-35.1 PO2-350* PCO2-33* PH-7.41 TOTAL CO2-22 BASE XS--2 -ASSIST/CON INTUBATED-INTUBATED [**2186-8-24**] 09:57PM GLUCOSE-147* LACTATE-0.8 NA+-138 K+-4.0 CL--109 [**2186-8-24**] 09:57PM O2 SAT-98 [**2186-8-24**] 09:57PM freeCa-1.16 [**2186-8-24**] 09:28PM GLUCOSE-153* UREA N-48* CREAT-1.1 SODIUM-139 POTASSIUM-4.1 CHLORIDE-110* TOTAL CO2-20* ANION GAP-13 [**2186-8-24**] 09:28PM CALCIUM-8.0* PHOSPHATE-3.8 MAGNESIUM-2.1 [**2186-8-24**] 09:28PM WBC-11.2* RBC-2.80* HGB-8.1* HCT-23.5* MCV-84 MCH-28.9 MCHC-34.5 RDW-16.3* [**2186-8-24**] 09:28PM PLT COUNT-159 [**2186-8-24**] 09:28PM PT-15.5* PTT-33.3 INR(PT)-1.4* [**2186-8-24**] 09:28PM FIBRINOGE-228 [**2186-8-24**] 08:27PM TYPE-ART PO2-305* PCO2-32* PH-7.42 TOTAL CO2-21 BASE XS--2 INTUBATED-INTUBATED VENT-CONTROLLED [**2186-8-24**] 08:27PM GLUCOSE-157* NA+-137 K+-3.8 [**2186-8-24**] 08:27PM HGB-6.8* calcHCT-20 [**2186-8-24**] 08:27PM freeCa-1.02* [**2186-8-24**] 08:02PM TYPE-ART PO2-348* PCO2-39 PH-7.33* TOTAL CO2-21 BASE XS--4 INTUBATED-INTUBATED VENT-CONTROLLED [**2186-8-24**] 08:03PM PLEURAL HCT-16* [**2186-8-24**] 08:02PM TYPE-ART PO2-348* PCO2-39 PH-7.33* TOTAL CO2-21 BASE XS--4 INTUBATED-INTUBATED VENT-CONTROLLED [**2186-8-24**] 08:02PM GLUCOSE-161* NA+-137 K+-4.4 [**2186-8-24**] 08:02PM O2 SAT-99 [**2186-8-24**] 08:02PM freeCa-1.02* [**2186-8-24**] 06:44PM GLUCOSE-186* UREA N-51* CREAT-1.2 SODIUM-137 POTASSIUM-5.0 CHLORIDE-104 TOTAL CO2-24 ANION GAP-14 [**2186-8-24**] 06:44PM WBC-13.4* RBC-3.47* HGB-9.8* HCT-29.3* MCV-85 MCH-28.2 MCHC-33.4 RDW-16.2* [**2186-8-24**] 06:44PM PLT COUNT-183 Brief Hospital Course: 70 M with CHF EF 10%, s/p BiV/ICD placement through L subclavian vein approach on [**8-24**] complicated by L hemothorax, now with L chest hematoma. . # L chest hemothorax: Patient has Class II-III CHF EF 10-20% and had a BiV/ICD pacer placed through the left subclavian vein. Patient developed L hemothorax and had a chest tube placed for one day for evacuation (chest tube pulled on [**8-26**]). He was also intubated and extubated after 1 day for airway protection. CXR showed good lead placement. His hematocrit dropped as low as 15 with SBP 90s, and he received 5 URBC to keep Hct above 30. Throughout, he was asymptomatic, with no chest pain, no shortness of breath. He was placed on ASA 325, plavix 75, carvedilol 6.25 [**Hospital1 **], Lisinopril 2.5 QD, Digoxin 0.125 QD, lasix 20 QD. He was given Vancomycin for 48 hrs s/p ICD placement. He was transferred to CCU stepdown, where he was placed on heparin for AFIB, and developed a 7x7 cm hematoma in his L chest. Pressure dressing was applied, and hematoma gradually diminished over the next 2 days. His pacemaker was checked inhouse by electrophysiology. He was discharged on coumadin 1.5 QD, to followup for Hematocrit and INR with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**] as his cardiologist, and Device Clinic. . # AFIB: Patient was in AFIB and was cardioverted on [**8-26**] to NSR. He remained in NSR, and was placed on heparin and coumadin for anticoagulation. He is s/p BiV/ICD placement on [**8-24**], and is paced at 75. For rate control, patient is on carvedilol 6.25 [**Hospital1 **], digoxin 0.125 QD. He was given 1 dose of ibutilide, then was started on amiodarone 600 x1, then 400 x 10 days, then 200 QD thereafter. . # DM2: Metformin and glyburide were held inhouse for hypoglycemic episodes, and patient was on insulin ss. These meds were reinstated upon discharge. Medications on Admission: Medications: Carvedilol 6.25mg daily Lasix 20mg daily Magnesium Oxide 400mg twice daily Lisinopril 25mg daily Digoxin 0.125mg daily Plavix 75mg daily Potassium 40meq daily Zoloft 50mg daily Simvastatin 40mg daily Aspirin 325mg daily Glyburide 5 mg twice daily *Instructed patient to hold the morning of the procedure Metformin 500mg daily *Instructed patient to hold the morning of the procedure Captopril 12.5mg twice daily Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever, pain. Disp:*60 Tablet(s)* Refills:*0* 2. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*2* 3. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 6. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for 5 days. Disp:*15 Tablet(s)* Refills:*0* 8. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. Disp:*60 Tablet(s)* Refills:*0* 14. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Please start taking after Amiodarone 400 QD x 9 days. Disp:*30 Tablet(s)* Refills:*2* 15. Warfarin 1 mg Tablet Sig: 1.5 Tablets PO once a day: You will need to have your INR checked by a doctor when you are taking this medication. Disp:*45 Tablet(s)* Refills:*2* 16. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 17. Glyburide 5 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 18. Hematocrit and INR check Sig: One (1) check Q3 days: Please fax to: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**] (cardiology) and Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (cardiology). Disp:*30 checks* Refills:*2* 19. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO once a day for 9 days. Disp:*9 Tablet(s)* Refills:*0* Discharge Disposition: Home with Service Facility: Meadowbrook - [**Location (un) 2624**] Discharge Diagnosis: Primary diagnosis: ICD/BiV pacer placement complicated by L hematoma in L chest Secondary diagnosis: AFIB cardioverted to NSR, CHF EF 10% Discharge Condition: VSS, good, moderate hematoma (5x5 cm) over L chest, ambulating Discharge Instructions: 1. Please take all medications as prescribed. 2. Please keep all appointments with your physicians as written below. 3. Please come to the emergency room if you experience chest pain, fatigue, dizziness. Followup Instructions: 1. Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2186-9-4**] 11:30 AM. You will have your hematocrit and INR checked. Please bring your prescription for hematocrit and INR check with you to this appointment. . 2. Please make an appointment to see Dr. [**Last Name (STitle) 7047**] ([**Telephone/Fax (1) 3183**]) within the next week. Dial this phone number, then press 0. Dr. [**Last Name (STitle) 7047**] is aware that you will be contacting him. Please bring your 'Hematocrit and INR check' prescription to this appointment. . 3. If you cannot get an appointment with Dr. [**Last Name (STitle) 7047**], please call [**Company 191**] outpatient clinic at [**Telephone/Fax (1) 250**], and state that you need a blood test performed (you need a hematocrit and INR check). Please bring your 'hematocrit and INR check' prescription to your appointment. . 3. If you get your hematocrit and INR checked by VNA nursing at home, please have the results faxed to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**]. . 4. **Changes in medication: a) DO NOT TAKE WARFARIN (COUMADIN) tonight (Thurs, [**8-31**]). b) Take Warfarin 1.5 mg by mouth once a day starting on Friday. c) Carvedilol 12.5 [**Hospital1 **] was changed to 6.25 [**Hospital1 **]. Completed by:[**2186-9-1**]

428,998,427,V458,414,250,272,458,755,285

{'Congestive heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Unspecified anomaly of upper limb,Anemia, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 70 M with CHF EF 10%, s/p ICD biv placement through L subclavian vein approach on [**8-24**] complicated by L hemothorax. Chest tube placed in OR-no evidence for active bleeding. Procedure today was complicated by hitting subclavian artery became hypotensive to 90s, Hct 30 to OR out of concern for subclavian artery stick. Inserted chest tube for L hemothorax and pleural effusion Hct 16. 400 cc out, stopped draining overnight to [**8-25**]. Intubated for 24 hrs, then extubated successfully. Aggressive diuresis once BP stabilizes. Went into AFIB, cardioverted in AM, chest tube pulled today. . SBP 150s by arterial line s/p 2L of fluid s/p 3 URBC . ROS: Pt denies fever or chills. No night sweats or recent weight loss or gain. Denied headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. No rash. MEDICAL HISTORY: New biv icd- concerto [**Company **] CHF-ischemic cardiomyopathy EF %[**10-24**] (below) CAD s/p CABG AFIB s/p R arm surgery w rodding for congenital abnormality L CEA Multiple right ankle fractures arthritis DM Hyperlipidemia MEDICATION ON ADMISSION: Medications: Carvedilol 6.25mg daily Lasix 20mg daily Magnesium Oxide 400mg twice daily Lisinopril 25mg daily Digoxin 0.125mg daily Plavix 75mg daily Potassium 40meq daily Zoloft 50mg daily Simvastatin 40mg daily Aspirin 325mg daily Glyburide 5 mg twice daily *Instructed patient to hold the morning of the procedure Metformin 500mg daily *Instructed patient to hold the morning of ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 97.2 / 77 / 14 / 105-143/48-64 / 98%-100% RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, sclera anicteric. MMM, OP without lesions Neck: supple, no JVD or carotid bruits appreciated Pulm: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G appreciated Abdomen: soft, NT/ND, + BS, no masses or organomegaly noted. Ext: No edema b/t, 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary, or inguinal LAD. Skin: no rashes or lesions noted. Neurologic: -mental status: Alert & Oriented x 3. Able to relate history without difficulty. -cranial nerves: II-XII intact -motor: normal bulk, strength, and tone throughout. -sensory: No deficits to light touch throughout. -cerebellar: No nystagmus, dysarthria, intention or action tremor, dysdiadochokinesia noted. F->N and H->S WNL bilaterally. FAMILY HISTORY: He has a mother who died of complications of heart disease and diabetes. He has two brothers both of whom have heart disease and diabetes SOCIAL HISTORY: He has been happily married for 47 years. He has three adult children. He is retired. Prior to retiring he worked as an ### Response: {'Congestive heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Unspecified anomaly of upper limb,Anemia, unspecified'}

CHIEF COMPLAINT: 6.3 cm aneurysm of the infrarenal abdominal aorta PRESENT ILLNESS: Mr. [**Known lastname 1124**] is a 77-year-old patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred by way of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43078**] for evaluation and treatment of an abdominal aortic aneurysm. Mr. [**Known lastname 1124**] recently saw Dr. [**Last Name (STitle) **] complaining of some left lateral chest wall pain. He was admitted to the [**Hospital 1263**] Hospital where myocardial infarction was ruled out. As part of his extensive cardiac evaluation, he underwent a CT scan and a 6.4-cm aneurysm of the infrarenal abdominal aorta was identified quite unexpectedly. He denies any recent back or abdominal pain and the pain he did have at that time had resolved. He denies any family history of aneurysm, although his father died of mysterious circumstances from a rupture of a "vessel." MEDICAL HISTORY: PMH: 6.4-cm infrarenal AAA diagnosed by CT scan. Moderate aortic stenosis. DVT LLL. Prostate CA w/ radical prostatectomy ([**2163**]),degenerative arthritis and obesity. PS:lumbar spine surgery, radical prostatectomy ([**2163**]), tonsillectomy FH: Father die of "a vessel rupture" MEDICATION ON ADMISSION: Lipitor 40 mg QD, Cetirizine[Zyrtec]10 mg Tablet QD, Escitalopram [Lexapro]20 mg Tablet QD, Metoprolol 50 mg QD Nitroglycerin 0.4 mg Tablet prn, Aspirin 81 mg QD, Ferrous Sulfate 325 mg, Lactobacillus Rhamnosus 1 Capsule [**Hospital1 **] ,Centrum Silver 1 Tablet QD,Niacin 500 mg Tablet QD, Omeprazole 20 mg 1 Tablet QD ALLERGIES: Penicillins / Tetanus / Almond Oil / Pollen Extracts PHYSICAL EXAM: [**Year (4 digits) 4650**]: 97, 74, 119/64, 20 97%RA GEN:NAD Cards:RRR Lungs:CTA ABD: soft, NT Wound: C/D/I, mild erythema rt flank FAMILY HISTORY: SOCIAL HISTORY: Quit smoking 25 years ago

Abdominal aneurysm without mention of rupture,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Aortic valve disorders,Personal history of venous thrombosis and embolism,Unspecified essential hypertension

Abdom aortic aneurysm,Morbid obesity,Obstructive sleep apnea,Aortic valve disorder,Hx-ven thrombosis/embols,Hypertension NOS

Admission Date: [**2178-6-30**] Discharge Date: [**2178-7-7**] Date of Birth: [**2101-5-14**] Sex: M Service: SURGERY Allergies: Penicillins / Tetanus / Almond Oil / Pollen Extracts Attending:[**First Name3 (LF) 2597**] Chief Complaint: 6.3 cm aneurysm of the infrarenal abdominal aorta Major Surgical or Invasive Procedure: Resection and repair of abdominal aortic aneurysm now using 16 mm Dacron tube graft History of Present Illness: Mr. [**Known lastname 1124**] is a 77-year-old patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred by way of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43078**] for evaluation and treatment of an abdominal aortic aneurysm. Mr. [**Known lastname 1124**] recently saw Dr. [**Last Name (STitle) **] complaining of some left lateral chest wall pain. He was admitted to the [**Hospital 1263**] Hospital where myocardial infarction was ruled out. As part of his extensive cardiac evaluation, he underwent a CT scan and a 6.4-cm aneurysm of the infrarenal abdominal aorta was identified quite unexpectedly. He denies any recent back or abdominal pain and the pain he did have at that time had resolved. He denies any family history of aneurysm, although his father died of mysterious circumstances from a rupture of a "vessel." Past Medical History: PMH: 6.4-cm infrarenal AAA diagnosed by CT scan. Moderate aortic stenosis. DVT LLL. Prostate CA w/ radical prostatectomy ([**2163**]),degenerative arthritis and obesity. PS:lumbar spine surgery, radical prostatectomy ([**2163**]), tonsillectomy FH: Father die of "a vessel rupture" Social History: Quit smoking 25 years ago Physical Exam: [**Year (4 digits) 4650**]: 97, 74, 119/64, 20 97%RA GEN:NAD Cards:RRR Lungs:CTA ABD: soft, NT Wound: C/D/I, mild erythema rt flank Pertinent Results: [**2178-7-7**] 06:25AM BLOOD WBC-5.0 RBC-3.05* Hgb-8.8* Hct-27.4* MCV-90 MCH-29.0 MCHC-32.2 RDW-14.6 Plt Ct-286# [**2178-7-7**] 06:25AM BLOOD Plt Ct-286# [**2178-7-7**] 06:25AM BLOOD Glucose-92 UreaN-17 Creat-0.7 Na-140 K-3.9 Cl-101 HCO3-29 AnGap-14 [**2178-7-7**] 06:25AM BLOOD Calcium-8.2* Phos-3.5 Mg-1.9 Brief Hospital Course: [**2178-6-30**] Underwent AAA repair. Transferred to CVICU for monitoring [**2178-7-1**] [**Hospital 83185**] transferred to CVICU. IVF infusing, electrolytes repleted. SBP maintained >140 for aortic stenosis [**Date range (1) 40836**] In CVICU. Electrolytes repleted. Kept NPO. Negative flatus/BS [**7-4**] [**Month/Day (4) 4650**]. contact dermatitis RT shoulder, started on sarna and hydrocortisone cream [**2178-7-5**] [**Last Name (LF) 4650**], [**First Name3 (LF) **]/foley discontinued. Lasix given X1. ambulating with PT/nursing. Tolerating regular diet. [**2178-7-6**] [**Month/Day/Year 4650**], contact dermatitis improved. PT cleared for home [**2178-7-7**] [**Month/Day/Year 4650**]. no events. Discharged to home. Post op visit scheduled. Follow up with PCP scheduled for next week as Lopressor held during this hospitalization to maintain BP >140 (aortic stenosis) Medications on Admission: Lipitor 40 mg QD, Cetirizine[Zyrtec]10 mg Tablet QD, Escitalopram [Lexapro]20 mg Tablet QD, Metoprolol 50 mg QD Nitroglycerin 0.4 mg Tablet prn, Aspirin 81 mg QD, Ferrous Sulfate 325 mg, Lactobacillus Rhamnosus 1 Capsule [**Hospital1 **] ,Centrum Silver 1 Tablet QD,Niacin 500 mg Tablet QD, Omeprazole 20 mg 1 Tablet QD Discharge Medications: 1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 5. Escitalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 8. Hydrocortisone 0.5 % Ointment Sig: One (1) Appl Topical TID (3 times a day) as needed for right neck/shoulder rash. Disp:*1 1* Refills:*0* 9. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical DAILY (Daily) as needed for to back and abdomen . Disp:*1 1* Refills:*0* 10. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day as needed for allergy symptoms. 11. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO On HOLD until f/u with PCP: [**Name10 (NameIs) **] been on hold in hospital to maintain BP >140 (Aortic stenosis). Discharge Disposition: Home Discharge Diagnosis: 6.4-cm infrarenal AAA Resection and repair of abdominal aortic aneurysm now using 16 mm Dacron tube graft PMH: 6.4-cm infrarenal AAA diagnosed by CT scan. Moderate aortic stenosis. DVT LLL. Prostate CA w/ radical prostatectomy ([**2163**]),degenerative arthritis and obesity. PS:lumbar spine surgery, radical prostatectomy ([**2163**]), tonsillectomy FH: Father die of "a vessel rupture" Discharge Condition: Good Follow up with PCP regarding restarting Metoprolol (on hold to maintain BP >140 for aotic stenosis) Discharge Instructions: Division of Vascular and Endovascular Surgery Abdominal Aortic Aneurysm (AAA) Surgery Discharge Instructions What to expect when you go home: 1. It is normal to feel weak and tired, this will last for [**6-8**] weeks ?????? You should get up out of bed every day and gradually increase your activity each day ?????? You may walk and you may go up and down stairs ?????? Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have incisional and leg swelling: ?????? Wear loose fitting pants/clothing (this will be less irritating to incision) ?????? Elevate your legs above the level of your heart (use [**2-3**] pillows or a recliner) every 2-3 hours throughout the day and at night ?????? Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time ?????? You will probably lose your taste for food and lose some weight ?????? Eat small frequent meals ?????? It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: ?????? No driving until post-op visit and you are no longer taking pain medications ?????? You should get up every day, get dressed and walk, gradually increasing your activity ?????? You may up and down stairs, go outside and/or ride in a car ?????? Increase your activities as you can tolerate- do not do too much right away! ?????? No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? You may shower (let the soapy water run over incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? Take all the medications you were taking before surgery, unless otherwise directed ?????? Take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? Call and schedule an appointment to be seen in 2 weeks for staple/suture removal What to report to office: ?????? Redness that extends away from your incision ?????? A sudden increase in pain that is not controlled with pain medication ?????? A sudden change in the ability to move or use your leg or the ability to feel your leg ?????? Temperature greater than 101.5F for 24 hours ?????? Bleeding from incision ?????? New or increased drainage from incision or white, yellow or green drainage from incisions Followup Instructions: Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1490**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2178-7-15**] 3:45 You have an appointment to see your PCP [**Name9 (PRE) **],[**Name9 (PRE) **] [**Name Initial (PRE) **]. [**Telephone/Fax (1) 14328**] Wed [**7-15**] 1030am, [**Street Address(1) **] office fax [**Telephone/Fax (1) 24203**] Completed by:[**2178-7-7**]

441,278,327,424,V125,401

{'Abdominal aneurysm without mention of rupture,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Aortic valve disorders,Personal history of venous thrombosis and embolism,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: 6.3 cm aneurysm of the infrarenal abdominal aorta PRESENT ILLNESS: Mr. [**Known lastname 1124**] is a 77-year-old patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred by way of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43078**] for evaluation and treatment of an abdominal aortic aneurysm. Mr. [**Known lastname 1124**] recently saw Dr. [**Last Name (STitle) **] complaining of some left lateral chest wall pain. He was admitted to the [**Hospital 1263**] Hospital where myocardial infarction was ruled out. As part of his extensive cardiac evaluation, he underwent a CT scan and a 6.4-cm aneurysm of the infrarenal abdominal aorta was identified quite unexpectedly. He denies any recent back or abdominal pain and the pain he did have at that time had resolved. He denies any family history of aneurysm, although his father died of mysterious circumstances from a rupture of a "vessel." MEDICAL HISTORY: PMH: 6.4-cm infrarenal AAA diagnosed by CT scan. Moderate aortic stenosis. DVT LLL. Prostate CA w/ radical prostatectomy ([**2163**]),degenerative arthritis and obesity. PS:lumbar spine surgery, radical prostatectomy ([**2163**]), tonsillectomy FH: Father die of "a vessel rupture" MEDICATION ON ADMISSION: Lipitor 40 mg QD, Cetirizine[Zyrtec]10 mg Tablet QD, Escitalopram [Lexapro]20 mg Tablet QD, Metoprolol 50 mg QD Nitroglycerin 0.4 mg Tablet prn, Aspirin 81 mg QD, Ferrous Sulfate 325 mg, Lactobacillus Rhamnosus 1 Capsule [**Hospital1 **] ,Centrum Silver 1 Tablet QD,Niacin 500 mg Tablet QD, Omeprazole 20 mg 1 Tablet QD ALLERGIES: Penicillins / Tetanus / Almond Oil / Pollen Extracts PHYSICAL EXAM: [**Year (4 digits) 4650**]: 97, 74, 119/64, 20 97%RA GEN:NAD Cards:RRR Lungs:CTA ABD: soft, NT Wound: C/D/I, mild erythema rt flank FAMILY HISTORY: SOCIAL HISTORY: Quit smoking 25 years ago ### Response: {'Abdominal aneurysm without mention of rupture,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Aortic valve disorders,Personal history of venous thrombosis and embolism,Unspecified essential hypertension'}

CHIEF COMPLAINT: LGI Bleeding PRESENT ILLNESS: 72 year old male with CAD who was admitted to [**Hospital 4199**] Hospital [**2127-12-1**] after MVA causing R. tibial fracture. He subsequently underwent ORIF; post op he had increasing pain that was difficult to control; as sa result of increased pain meds he became sedated which was felt to have led to an aspiration event; he was given narcan. Subsequently on [**12-5**] he had a hypoxic event and a diagnosis of PE was made; which required intubation. Since that time he has required AC ventilation with requirements of FIO2 80%/PEEP 5. Of note, this hypoxic event was felt to be extensive and patients neurologic status has not improved since. He was transferred to [**Hospital1 **] for rehab on the ventilation while on heparin & today was transferred back to [**Last Name (un) 4199**] for evaluation for Trach/PEG. He was noted to have BRBPR, a hct was 22 (down from 27). PTT>150. He was given 1U prbcs and per report an EGD was done with no source of bleeding. The GI service felt pt would benefit from arteriogram with vasopressin adminstration; he was given peripheral vasopressin he was subsequently transferred to [**Hospital1 18**] for evaluation of GIB plus evaluation for trach/peg. MEDICAL HISTORY: CAD s/p MI [**2111**] and [**2114**]; most recent MI accompanied by cardiac arrest; tx medically with Sotalol Lumbar stenosis s/p lumbar surgery Polymyalgia Rheumatica s/p CCY Hyperlipidemia DJD COPD- 3 ppd history MEDICATION ON ADMISSION: acetaminophen 650mg q6prn aspirin 81mg atropine 0.5mg IV push q1hr prn calcium carbonate/vit D daily Colace 100mg [**Hospital1 **] Zetia 10mg daily Fentanyl 50mcg/hr topical patch q72hr heparin gtt (off since [**12-22**] at 8am) Glargine 40u SCqhs Inulin Regular Flovent 4puffs WID Jevity 1.2 cal; full strength at 60mg/hr; shut off 730am ([**12-22**]) Lactobacillus 2U per NGT TID Lactulose 30mg per NGT q12prn Lansoprazole 30mg disintegrating daily Ativan 2mg IV q1hr prn Morphine Sulfate 2mg IV q2prn Zosyn 3.375g q6; start date [**12-13**] propofol gtt sotalol 80mg PO q12 ALLERGIES: Vioxx / Protonix PHYSICAL EXAM: Vitals - T:99.3 BP:113/68 HR:77 RR:29 02 sat:100% GENERAL: sedated, intubated HEENT:Intubated, ET tube in place CARDIAC: Regular rate and rhythm LUNG: scattered rhonchi anteriorly ABDOMEN: Soft, non-distended, BS present EXT: edema R>L NEURO:not responsive to verbal stimuli Cool extremities FAMILY HISTORY: No history of malignancy in first degree relatives. History of coronary artery disease. SOCIAL HISTORY: 60 pack-year smoking history. He is now down to 6 cigarettes per day. He denies any alcohol consumption. He is married and lives with his wife. [**Name (NI) **] has 3 children. He used to work as a parking garage manager.

Other pulmonary embolism and infarction,Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Ventilator associated pneumonia,Malignant essential hypertension,Dependence on respirator, status,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Polymyalgia rheumatica,Bariatric surgery status,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle

Pulm embol/infarct NEC,Toxic encephalopathy,Gastrointest hemorr NOS,Ventltr assoc pneumonia,Malignant hypertension,Respirator depend status,Epilep NOS w/o intr epil,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Chr airway obstruct NEC,Polymyalgia rheumatica,Bariatric surgery status,Mv collision NOS-driver

Admission Date: [**2127-12-23**] Discharge Date: [**2127-12-28**] Date of Birth: [**2055-9-5**] Sex: M Service: MEDICINE Allergies: Vioxx / Protonix Attending:[**First Name3 (LF) 5608**] Chief Complaint: LGI Bleeding Major Surgical or Invasive Procedure: TRACHEOSTOMY PERCUTANEOUS GASTRIC TUBE PLACEMENT History of Present Illness: 72 year old male with CAD who was admitted to [**Hospital 4199**] Hospital [**2127-12-1**] after MVA causing R. tibial fracture. He subsequently underwent ORIF; post op he had increasing pain that was difficult to control; as sa result of increased pain meds he became sedated which was felt to have led to an aspiration event; he was given narcan. Subsequently on [**12-5**] he had a hypoxic event and a diagnosis of PE was made; which required intubation. Since that time he has required AC ventilation with requirements of FIO2 80%/PEEP 5. Of note, this hypoxic event was felt to be extensive and patients neurologic status has not improved since. He was transferred to [**Hospital1 **] for rehab on the ventilation while on heparin & today was transferred back to [**Last Name (un) 4199**] for evaluation for Trach/PEG. He was noted to have BRBPR, a hct was 22 (down from 27). PTT>150. He was given 1U prbcs and per report an EGD was done with no source of bleeding. The GI service felt pt would benefit from arteriogram with vasopressin adminstration; he was given peripheral vasopressin he was subsequently transferred to [**Hospital1 18**] for evaluation of GIB plus evaluation for trach/peg. Past Medical History: CAD s/p MI [**2111**] and [**2114**]; most recent MI accompanied by cardiac arrest; tx medically with Sotalol Lumbar stenosis s/p lumbar surgery Polymyalgia Rheumatica s/p CCY Hyperlipidemia DJD COPD- 3 ppd history Social History: 60 pack-year smoking history. He is now down to 6 cigarettes per day. He denies any alcohol consumption. He is married and lives with his wife. [**Name (NI) **] has 3 children. He used to work as a parking garage manager. Family History: No history of malignancy in first degree relatives. History of coronary artery disease. Physical Exam: Vitals - T:99.3 BP:113/68 HR:77 RR:29 02 sat:100% GENERAL: sedated, intubated HEENT:Intubated, ET tube in place CARDIAC: Regular rate and rhythm LUNG: scattered rhonchi anteriorly ABDOMEN: Soft, non-distended, BS present EXT: edema R>L NEURO:not responsive to verbal stimuli Cool extremities Pertinent Results: ================== ADMISSION LABS ================== [**2127-12-23**] 04:33AM BLOOD WBC-17.4*# RBC-2.68*# Hgb-8.2*# Hct-24.7*# MCV-92 MCH-30.5 MCHC-33.2 RDW-17.7* Plt Ct-233 [**2127-12-23**] 04:33AM BLOOD Neuts-89.7* Lymphs-7.6* Monos-2.1 Eos-0.4 Baso-0.2 [**2127-12-23**] 04:33AM BLOOD PT-13.7* PTT-27.4 INR(PT)-1.2* [**2127-12-23**] 04:33AM BLOOD Glucose-186* UreaN-32* Creat-0.6 Na-139 K-4.0 Cl-102 HCO3-32 AnGap-9 [**2127-12-23**] 04:33AM BLOOD Calcium-7.4* Phos-3.1 Mg-2.1 [**2127-12-23**] 04:33AM BLOOD Cortsol-22.2* Brief Hospital Course: 54 year old woman with past medical history of morbid obesity (s/p gastric lap banding), hypertension, hyperlipidemia, presenting with acute respiratory distress and malignant hypertension. . # RESPIRATORY FAILURE: The patient was initially intubated at an OSH following respiratory failure in the setting of increased sedation and PE. He was intubated and remained intubated upon transfer to rehab. He was referred for trach/PEG, but while undergoing the procedure he was found to have a GI bleed and transferred to [**Hospital1 18**]. On arrive the patient with respiratory failure likely multifactorial including PE, HAP/aspiration and volume overload. His prior sputum cultures had grown Enterobacter aerogenes and initially treated with Cefepime. However, his abx were changed to vancomycin/zosyn after repeat CXR [**12-11**] showed new left sided infiltrate. He completed a 14 day course of Vancomycin/Zosyn on [**2127-12-26**]. Additionally, given his pulmonary edema he was diuresed with IV lasix. He was also restarted on his heparin gtt for his prior PE, LENI were negative for DVT. The patient underwent trach and PEG on [**2127-12-26**] and weaned to PS support. The trach should not be changed for 10 days after placement and if he needed to be re-intubated it should be from above. The patient was on MMV ventilation on discharge TV 500, RR 6, FiO2 50%, PEEP 8 PSV 12 #. Mental Status: The patient with limited mental status after his accident and respiratory arrest. He was AAOx3 and fully functional prior to his accident. He was evaluated by neurology and underwent an EEG that showed some questional delta activity concerning for seizure. He was started on phenytoin per neuro. He also underwent an MRI that did not show evidence of anoxic brain injury. The etiology of his mental status is likely metabolic encephalopathy, but his prognosis is unclear. The plan is to lighten sedation and assess neurologic status. Per the wife [**Name (NI) 382**] if he does not have meaningful recovery and ventilator dependent then will likely be transitioned to comfort care. He will continue Dilantin 100mg TID and levels should be checked. #Hypotension- Patient initially hypotensive on arrival and on vasopressin. He was changed over the levophed and it was sucessfully weaned off on [**12-26**]. The patient's hypotension was likely multifactorial including infectious (pneumonia), GIB and sedation. #LGIB- The patient was noted to have bright red blood per rectum at rehab while on heparin gtt. His heparin gtt was held and after evaluation at the OSH he was noted to have 7pt Hct drop and received 1U prbcs. Per report, he had EGD and did not find a source of bleeding. On arrive the the [**Hospital1 18**] MICU he was noted to have brown stool that was guaiac positive, but no further episodes of BRBPR. The patient was transfused a total of 3U pRBC during his admssion, the most recent on [**12-24**]. Given that the patient did not have any further episodes of bleeding he was restarted on his heparin gtt without further evidence of bleeding. He was also evaluated by GI and recommended outpatient colonoscopy and follow-up given no evidence of acute bleeding. #LV Thrombus/PE: Pt with history of LV thrombus previously on coumadin. A repeat TTE did not show evidence of LV thrombus. He was transitioned to lovenox on discharge and will need to be started on coumadin. #H/o CAD s/p cardiac arrest [**2114**]: The pateint was continued on his home sotolol. His aspirin was held given his history of GI bleed. #DM: The patient was covered with an insulin sliding scale Medications on Admission: acetaminophen 650mg q6prn aspirin 81mg atropine 0.5mg IV push q1hr prn calcium carbonate/vit D daily Colace 100mg [**Hospital1 **] Zetia 10mg daily Fentanyl 50mcg/hr topical patch q72hr heparin gtt (off since [**12-22**] at 8am) Glargine 40u SCqhs Inulin Regular Flovent 4puffs WID Jevity 1.2 cal; full strength at 60mg/hr; shut off 730am ([**12-22**]) Lactobacillus 2U per NGT TID Lactulose 30mg per NGT q12prn Lansoprazole 30mg disintegrating daily Ativan 2mg IV q1hr prn Morphine Sulfate 2mg IV q2prn Zosyn 3.375g q6; start date [**12-13**] propofol gtt sotalol 80mg PO q12 Discharge Medications: 1. Calcium Carbonate 500 mg Tablet, Chewable [**Month/Year (2) **]: One (1) Tablet, Chewable PO DAILY (Daily). 2. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol [**Month/Year (2) **]: Four (4) Puff Inhalation Q6H (every 6 hours). 3. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 4. Sotalol 80 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a day). 5. Chlorhexidine Gluconate 0.12 % Mouthwash [**Last Name (STitle) **]: 1-2 MLs Mucous membrane [**Hospital1 **] (2 times a day). 6. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment [**Hospital1 **]: One (1) Appl Ophthalmic PRN (as needed) as needed for dry eyes. 7. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: [**11-22**] PO BID (2 times a day). 8. Fentanyl Citrate 25-50 mcg IV Q1:PRN pain For trach / peg pain 9. Fentanyl 25 mcg/hr Patch 72 hr [**Month/Day (2) **]: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). 10. Lovenox 80 mg/0.8 mL Syringe [**Month/Day (2) **]: One (1) Subcutaneous twice a day. 11. Phenytoin 50 mg Tablet, Chewable [**Month/Day (2) **]: Two (2) Tablet, Chewable PO Q8H (every 8 hours). 12. Insulin Regular Human 100 unit/mL Cartridge [**Month/Day (2) **]: One (1) unit Injection four times a day: Per sliding scale; see attached. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: Respiratory Failure Pulmonary Embolism Lower GI Bleed VAP Metabolic Encephalopathy Seizures Discharge Condition: Mental Status:Confused - always Level of Consciousness:Lethargic and not arousable Activity Status:Bedbound Discharge Instructions: You were admitted to the hospital for GI bleed and management of your respiratory status. You did not have any further bleeding. You did undergo a tracheostomy and PEG. You were evaluated by neurology and there was concern for seizures thus you were started on phenytoin, an anti-seizure medication. Followup Instructions: Please follow-up with GI as an outpatient You will be followed by the doctors [**First Name (Titles) **] [**Hospital3 105**] who will make recommendations regarding follow up when discharged.

415,349,578,997,401,V461,345,250,272,496,725,V458,E812

{'Other pulmonary embolism and infarction,Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Ventilator associated pneumonia,Malignant essential hypertension,Dependence on respirator, status,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Polymyalgia rheumatica,Bariatric surgery status,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: LGI Bleeding PRESENT ILLNESS: 72 year old male with CAD who was admitted to [**Hospital 4199**] Hospital [**2127-12-1**] after MVA causing R. tibial fracture. He subsequently underwent ORIF; post op he had increasing pain that was difficult to control; as sa result of increased pain meds he became sedated which was felt to have led to an aspiration event; he was given narcan. Subsequently on [**12-5**] he had a hypoxic event and a diagnosis of PE was made; which required intubation. Since that time he has required AC ventilation with requirements of FIO2 80%/PEEP 5. Of note, this hypoxic event was felt to be extensive and patients neurologic status has not improved since. He was transferred to [**Hospital1 **] for rehab on the ventilation while on heparin & today was transferred back to [**Last Name (un) 4199**] for evaluation for Trach/PEG. He was noted to have BRBPR, a hct was 22 (down from 27). PTT>150. He was given 1U prbcs and per report an EGD was done with no source of bleeding. The GI service felt pt would benefit from arteriogram with vasopressin adminstration; he was given peripheral vasopressin he was subsequently transferred to [**Hospital1 18**] for evaluation of GIB plus evaluation for trach/peg. MEDICAL HISTORY: CAD s/p MI [**2111**] and [**2114**]; most recent MI accompanied by cardiac arrest; tx medically with Sotalol Lumbar stenosis s/p lumbar surgery Polymyalgia Rheumatica s/p CCY Hyperlipidemia DJD COPD- 3 ppd history MEDICATION ON ADMISSION: acetaminophen 650mg q6prn aspirin 81mg atropine 0.5mg IV push q1hr prn calcium carbonate/vit D daily Colace 100mg [**Hospital1 **] Zetia 10mg daily Fentanyl 50mcg/hr topical patch q72hr heparin gtt (off since [**12-22**] at 8am) Glargine 40u SCqhs Inulin Regular Flovent 4puffs WID Jevity 1.2 cal; full strength at 60mg/hr; shut off 730am ([**12-22**]) Lactobacillus 2U per NGT TID Lactulose 30mg per NGT q12prn Lansoprazole 30mg disintegrating daily Ativan 2mg IV q1hr prn Morphine Sulfate 2mg IV q2prn Zosyn 3.375g q6; start date [**12-13**] propofol gtt sotalol 80mg PO q12 ALLERGIES: Vioxx / Protonix PHYSICAL EXAM: Vitals - T:99.3 BP:113/68 HR:77 RR:29 02 sat:100% GENERAL: sedated, intubated HEENT:Intubated, ET tube in place CARDIAC: Regular rate and rhythm LUNG: scattered rhonchi anteriorly ABDOMEN: Soft, non-distended, BS present EXT: edema R>L NEURO:not responsive to verbal stimuli Cool extremities FAMILY HISTORY: No history of malignancy in first degree relatives. History of coronary artery disease. SOCIAL HISTORY: 60 pack-year smoking history. He is now down to 6 cigarettes per day. He denies any alcohol consumption. He is married and lives with his wife. [**Name (NI) **] has 3 children. He used to work as a parking garage manager. ### Response: {'Other pulmonary embolism and infarction,Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Ventilator associated pneumonia,Malignant essential hypertension,Dependence on respirator, status,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Polymyalgia rheumatica,Bariatric surgery status,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}

CHIEF COMPLAINT: Left lower lobe lung cancer. PRESENT ILLNESS: Mr. [**Known lastname **] is an 86-year-old gentleman who had a chest x-ray which noted a left-sided opacity and underwent bronchoscopy which diagnosis a nonsmall- cell lung cancer. His staging was remarkable for suspicious hilar nodes but no other sign of mediastinal or distant disease. A mediastinoscopy was negative for any N2 or N3 adenopathy. today he is admitted for left lower lobectomy MEDICAL HISTORY: hypertension hyperlipidemia hypothyroidism GERD severe mitral regurgitation mild renal insufficiency MEDICATION ON ADMISSION: HCTZ 25',synthroid 100mcg',Omeprazole 20',felodipine 5' ALLERGIES: Penicillins / Amoxicillin PHYSICAL EXAM: general: well appearing 86 yo male in NAD HEENT: unremarkable Chest: CTA bilat COR RRR S1, S2 abd: soft, NT, ND, +BS extrem: no C/C/E neuro: intact. Inc: CDI FAMILY HISTORY: non-contributory SOCIAL HISTORY: quit smoking 35 yrs ago. smoked 1 ppd for 10 yrs. quit etoh 40 yrs ago. no IVDU. lives in [**Location **] with wife

Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Mitral valve disorders,Personal history of tobacco use,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Mal neo lower lobe lung,Mal neo lymph-intrathor,Mitral valve disorder,History of tobacco use,Hypothyroidism NOS,Esophageal reflux,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2137-4-17**] Discharge Date: [**2137-4-20**] Service: CARDIOTHORACIC Allergies: Penicillins / Amoxicillin Attending:[**First Name3 (LF) 5790**] Chief Complaint: Left lower lobe lung cancer. Major Surgical or Invasive Procedure: bronch, left lower lobectomy VATs History of Present Illness: Mr. [**Known lastname **] is an 86-year-old gentleman who had a chest x-ray which noted a left-sided opacity and underwent bronchoscopy which diagnosis a nonsmall- cell lung cancer. His staging was remarkable for suspicious hilar nodes but no other sign of mediastinal or distant disease. A mediastinoscopy was negative for any N2 or N3 adenopathy. today he is admitted for left lower lobectomy Past Medical History: hypertension hyperlipidemia hypothyroidism GERD severe mitral regurgitation mild renal insufficiency Social History: quit smoking 35 yrs ago. smoked 1 ppd for 10 yrs. quit etoh 40 yrs ago. no IVDU. lives in [**Location **] with wife Family History: non-contributory Physical Exam: general: well appearing 86 yo male in NAD HEENT: unremarkable Chest: CTA bilat COR RRR S1, S2 abd: soft, NT, ND, +BS extrem: no C/C/E neuro: intact. Inc: CDI Pertinent Results: [**2137-4-17**] Pathology Tissue: LEVEL 9, LEVEL 11, LEVEL [**2137-4-17**] [**Last Name (LF) 1533**],[**First Name3 (LF) 1532**] P. Not Finalized [**2137-4-17**] 03:55PM GLUCOSE-140* UREA N-28* CREAT-1.1 SODIUM-140 POTASSIUM-3.8 CHLORIDE-107 TOTAL CO2-21* ANION GAP-16 Brief Hospital Course: pt was admitted and taken to the OR for left VATS loer lobectomy. OR course was uncomplicated. Extubated but due to patient's age and co-morbidities he was admitted to the ICU for post op monitoring. He remained stable overnoc and was transferred to the floor on POD#1. The 2 pleural blakes placed in the OR were draining small amounts of serosang fluid and were placed to bulb sxn on POD#1. On POD#2 [**Doctor Last Name **] drains were d/c'd. Pt was tolerating reg diet, pain was well controlled on po pain med, ambulating w/ RA sats mid 90's. D/c'd to home w/ VNA services [**2137-4-20**] Medications on Admission: HCTZ 25',synthroid 100mcg',Omeprazole 20',felodipine 5' Discharge Medications: 1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*70 Tablet(s)* Refills:*0* 5. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Felodipine 5 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: left lower lobe VATs Discharge Condition: good Discharge Instructions: Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] if you develop fever, chills, chest pain, shortness of breath, redness or drainage from your incision site. You may shower on sunday. After showering, remove your chest tube site dressing and cover the site with a clean bandaid daily until healed. Followup Instructions: Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] for a folow up appointment Completed by:[**2137-4-20**]

162,196,424,V158,244,530,401,272

{'Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Mitral valve disorders,Personal history of tobacco use,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Left lower lobe lung cancer. PRESENT ILLNESS: Mr. [**Known lastname **] is an 86-year-old gentleman who had a chest x-ray which noted a left-sided opacity and underwent bronchoscopy which diagnosis a nonsmall- cell lung cancer. His staging was remarkable for suspicious hilar nodes but no other sign of mediastinal or distant disease. A mediastinoscopy was negative for any N2 or N3 adenopathy. today he is admitted for left lower lobectomy MEDICAL HISTORY: hypertension hyperlipidemia hypothyroidism GERD severe mitral regurgitation mild renal insufficiency MEDICATION ON ADMISSION: HCTZ 25',synthroid 100mcg',Omeprazole 20',felodipine 5' ALLERGIES: Penicillins / Amoxicillin PHYSICAL EXAM: general: well appearing 86 yo male in NAD HEENT: unremarkable Chest: CTA bilat COR RRR S1, S2 abd: soft, NT, ND, +BS extrem: no C/C/E neuro: intact. Inc: CDI FAMILY HISTORY: non-contributory SOCIAL HISTORY: quit smoking 35 yrs ago. smoked 1 ppd for 10 yrs. quit etoh 40 yrs ago. no IVDU. lives in [**Location **] with wife ### Response: {'Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Mitral valve disorders,Personal history of tobacco use,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58 year old white female first seen by Dr. [**Last Name (STitle) 261**] on [**2131-4-19**], for evaluation of a 5.1 centimeter mass in the upper pole of her left kidney first noted on CT of the abdomen on [**2131-4-12**]. The CT was performed in response to symptoms of diarrhea. A question of Crohn's disease was high on the list because of her known history of Sjogren's syndrome. No evidence of metastases were noted on chest, abdomen and pelvic CT and confirmed by MR. The patient is now being admitted for left laparoscopic nephrectomy. There is no history of urinary tract infection, gross hematuria, smoking history or family history of genitourinary cancer. Hemoglobin 14.4, alkaline phosphatase 113. Torso CT and MR showed a 5.1 centimeter mass upper pole of the left kidney, single LRA with negative lymph nodes and adrenals. Right kidney appears OK. MEDICAL HISTORY: 1. Idiopathic thrombocytopenic purpura treated with steroids last in [**2129**]. 2. Deep vein thrombosis. 3. Hyperlipidemia. 4. Irritable bowel syndrome. 5. Total abdominal hysterectomy, bilateral salpingo-oophorectomy for endometriosis. 6. Fibromyalgia. 7. Positive rheumatoid factor, Sjogren's syndrome. 8. Anserine bursitis. 9. Chondrocalcinosis. 10. Renal cell carcinoma. 11. Cholecystectomy. MEDICATION ON ADMISSION: 1. Elavil. 2. Lipitor. 3. Clonazepam. 4. Neurontin. 5. Tramadol. 6. Imodium. 7. Currently Ciprofloxacin ear drops for an otitis externa. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Malignant neoplasm of kidney, except pelvis,Acute posthemorrhagic anemia,Pulmonary collapse,Congestive heart failure, unspecified,Sicca syndrome,Unspecified otitis media,Rheumatoid arthritis,Other and unspecified hyperlipidemia

Malig neopl kidney,Ac posthemorrhag anemia,Pulmonary collapse,CHF NOS,Sicca syndrome,Otitis media NOS,Rheumatoid arthritis,Hyperlipidemia NEC/NOS

Admission Date: [**2131-5-7**] Discharge Date: [**2131-5-11**] Date of Birth: [**2072-5-20**] Sex: F Service: UROLOGY HISTORY OF PRESENT ILLNESS: The patient is a 58 year old white female first seen by Dr. [**Last Name (STitle) 261**] on [**2131-4-19**], for evaluation of a 5.1 centimeter mass in the upper pole of her left kidney first noted on CT of the abdomen on [**2131-4-12**]. The CT was performed in response to symptoms of diarrhea. A question of Crohn's disease was high on the list because of her known history of Sjogren's syndrome. No evidence of metastases were noted on chest, abdomen and pelvic CT and confirmed by MR. The patient is now being admitted for left laparoscopic nephrectomy. There is no history of urinary tract infection, gross hematuria, smoking history or family history of genitourinary cancer. Hemoglobin 14.4, alkaline phosphatase 113. Torso CT and MR showed a 5.1 centimeter mass upper pole of the left kidney, single LRA with negative lymph nodes and adrenals. Right kidney appears OK. PAST MEDICAL HISTORY: 1. Idiopathic thrombocytopenic purpura treated with steroids last in [**2129**]. 2. Deep vein thrombosis. 3. Hyperlipidemia. 4. Irritable bowel syndrome. 5. Total abdominal hysterectomy, bilateral salpingo-oophorectomy for endometriosis. 6. Fibromyalgia. 7. Positive rheumatoid factor, Sjogren's syndrome. 8. Anserine bursitis. 9. Chondrocalcinosis. 10. Renal cell carcinoma. 11. Cholecystectomy. MEDICATIONS ON ADMISSION: 1. Elavil. 2. Lipitor. 3. Clonazepam. 4. Neurontin. 5. Tramadol. 6. Imodium. 7. Currently Ciprofloxacin ear drops for an otitis externa. PHYSICAL EXAMINATION: In general, the patient is a well appearing female in no acute distress. Head, eyes, ears, nose and throat examination - No masses and no bruits. The chest is clear to auscultation bilaterally. Cardiovascular is regular rate and rhythm. The abdomen is soft, flat, nontender. Extremities - no cyanosis, clubbing or edema. Neurologic examination is intact. HOSPITAL COURSE: The patient was admitted on [**2131-5-7**], and taken directly to the operating room where a hand assisted laparoscopic left nephrectomy was performed. The patient initially tolerated the procedure well and was sent to the recovery room. After a few hours in the recovery room, the patient was sent to the regular urology floor. The patient received three doses of perioperative Kefzol. She received a Morphine PCA. She was left NPO and had a nasogastric tube placed to suction and a Foley catheter in place. In the evening of the day of her surgery, the patient became excessively somnolent and experienced a drop in oxygen saturation. It was determined that her ensuing hypercarbia and hypoxia secondary to hypoventilation was caused by narcotic overdose. The patient received a number of doses of Narcan to reverse the effects of the narcotics. The patient was transferred to the Intensive Care Unit for closer care. On Intensive Care Unit, the patient did fairly well recovering from her narcotic overdose within the next approximately twelve hours or so. The rest of the time the patient was alert and progressively improved. She did complain of a decrease in hearing bilaterally. It was determined by ENT consultation that the patient had otitis media. They told her to continue using her Ciprofloxacin drops for her otitis externa and to use decongestant and suggested that the otitis media would improve when the nasogastric tube was removed. It was also decided while in the Intensive Care Unit that the patient would be scheduled for a sleep study after discharge to be evaluated for sleep apnea as a possible exacerbating factor for her hypoventilation hypercarbic hypoxic episode the night of her surgery. Over the course of the next few days, the patient started to pass gas and her nasogastric tube and Foley catheter were removed at the appropriate times. She started a regular diet which she appeared to tolerate well. She also was able to be started on some Percocet which she tolerated well. It is now [**2131-5-10**], and the patient is in good condition. She is being discharged. She is to follow-up with Dr. [**Last Name (STitle) 261**] in approximately two weeks. She is to go for her sleep study evaluation on Sunday night. She is being sent home with Percocet for pain. She is also being sent home with Colace to insure that her stools remain soft. She is also being told to continue her home medications including her Ciprofloxacin drops for her ears. She is also being told to take Sudafed and Aspirin as needed to dry up her head secretions. She should avoid strenuous activity. She should not drive while on pain medications. She may shower although should not take baths. She may observe a regular diet. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 276**], M.D. [**MD Number(1) 19331**] Dictated By:[**Last Name (NamePattern4) 12487**] MEDQUIST36 D: [**2131-5-10**] 15:16 T: [**2131-5-14**] 10:41 JOB#: [**Job Number **]

189,285,518,428,710,382,714,272

{'Malignant neoplasm of kidney, except pelvis,Acute posthemorrhagic anemia,Pulmonary collapse,Congestive heart failure, unspecified,Sicca syndrome,Unspecified otitis media,Rheumatoid arthritis,Other and unspecified hyperlipidemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58 year old white female first seen by Dr. [**Last Name (STitle) 261**] on [**2131-4-19**], for evaluation of a 5.1 centimeter mass in the upper pole of her left kidney first noted on CT of the abdomen on [**2131-4-12**]. The CT was performed in response to symptoms of diarrhea. A question of Crohn's disease was high on the list because of her known history of Sjogren's syndrome. No evidence of metastases were noted on chest, abdomen and pelvic CT and confirmed by MR. The patient is now being admitted for left laparoscopic nephrectomy. There is no history of urinary tract infection, gross hematuria, smoking history or family history of genitourinary cancer. Hemoglobin 14.4, alkaline phosphatase 113. Torso CT and MR showed a 5.1 centimeter mass upper pole of the left kidney, single LRA with negative lymph nodes and adrenals. Right kidney appears OK. MEDICAL HISTORY: 1. Idiopathic thrombocytopenic purpura treated with steroids last in [**2129**]. 2. Deep vein thrombosis. 3. Hyperlipidemia. 4. Irritable bowel syndrome. 5. Total abdominal hysterectomy, bilateral salpingo-oophorectomy for endometriosis. 6. Fibromyalgia. 7. Positive rheumatoid factor, Sjogren's syndrome. 8. Anserine bursitis. 9. Chondrocalcinosis. 10. Renal cell carcinoma. 11. Cholecystectomy. MEDICATION ON ADMISSION: 1. Elavil. 2. Lipitor. 3. Clonazepam. 4. Neurontin. 5. Tramadol. 6. Imodium. 7. Currently Ciprofloxacin ear drops for an otitis externa. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Malignant neoplasm of kidney, except pelvis,Acute posthemorrhagic anemia,Pulmonary collapse,Congestive heart failure, unspecified,Sicca syndrome,Unspecified otitis media,Rheumatoid arthritis,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: Admit for carotid angiography and possible intervention. PRESENT ILLNESS: 64 year-old woman, patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **], with an extensive history of CAD, now s/p recent left upper lobectomy for lung cancer with an incidental finding of an old CVA on head CT postoperatively prompting a workup that revealed 90% left internal carotid stenosis on duplex, vs 55% on CTA of neck, now referred for left carotid angiography to more clearly define her carotid anatomy, and carotid intervention, if appropriate. Events were as follows: [**2128-9-28**] IMI - Treated with stenting of the RCA and LCx. Found to have severe MR [**First Name (Titles) **] [**Last Name (Titles) 12876**] and was referred for surgical repair. [**2128-10-27**] Mitral valve surgery aborted after TEE at time of surgery revealed largely normal mitral valve with improvement of inferior hypokinesis compared to month prior. [**3-/2129**] Cardiac Catheterization - Total occlusion of RCA stent and patent LCX stent, mild to mod MR [**7-/2129**] Pulmonary edema requiring intubation at an OSH. Transferred to [**Hospital1 18**] and had a cardiac cath revealing T.O RCA and 40% CX stenosis in prior stent. EF of 30% [**2129**] AICD placement [**2135-10-24**] Cath d/t worsening chronic angina and DOE and inferior ischemia on dobutamine viability study. Angiography revealed 40% MEDICAL HISTORY: s/p bronch/meds, 70 pck yr smoker, CAD s/p MI x 2 and stenting x 2, s/p AICD implant, EF 33%, hypothyroid, DM< s/p hysterectomy, s/p appy, s/p varicose vein removal MEDICATION ON ADMISSION: ECASA 325mg daily Lorazepam 0.5mg PRN anxiety Metformin 850mg TID Prilosec 20mg daily Coreg 12.5mg [**Hospital1 **] Lipitor 60mg daily Lisinopril 10mg daily Celexa 60mg daily Levoxyl .112mcg daily Sprinolactone 25mg daily Lasix 20mg daily ALLERGIES: Bactrim / Keflex / Catapres / Trazodone PHYSICAL EXAM: GEN: WD female in NAD HEENT: PERRL, EOMI NECK: No bruits, No LAD CV: RRR no m,r,g LUNG: CTA Bilat ABD: Soft, NT, ND BSNA EXT: No C/C/E Neuro: CN II-XII intact, A and O x 3, no focal defecits FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father had MI at 42yo and died. Mother had CVA 54yo. Both sisters are healthy. SOCIAL HISTORY: Married with two children who live close by. Husband will drive her to the procedure.(+) cigarette smoking 80 ppy history, quit in [**2128**], restarted in [**2129**], quit again [**9-6**]

Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of bronchus and lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Automatic implantable cardiac defibrillator in situ

Ocl crtd art wo infrct,CHF NOS,Pure hypercholesterolem,Hypertension NOS,Hypothyroidism NOS,DMII wo cmp nt st uncntr,Hx-bronchogenic malignan,Cor ath unsp vsl ntv/gft,Status-post ptca,Status autm crd dfbrltr

Admission Date: [**2136-4-3**] Discharge Date: [**2136-4-5**] Date of Birth: [**2072-2-4**] Sex: F Service: MEDICINE Allergies: Bactrim / Keflex / Catapres / Trazodone Attending:[**First Name3 (LF) 2704**] Chief Complaint: Admit for carotid angiography and possible intervention. Major Surgical or Invasive Procedure: S/P stenting of left carotid artery History of Present Illness: 64 year-old woman, patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **], with an extensive history of CAD, now s/p recent left upper lobectomy for lung cancer with an incidental finding of an old CVA on head CT postoperatively prompting a workup that revealed 90% left internal carotid stenosis on duplex, vs 55% on CTA of neck, now referred for left carotid angiography to more clearly define her carotid anatomy, and carotid intervention, if appropriate. Events were as follows: [**2128-9-28**] IMI - Treated with stenting of the RCA and LCx. Found to have severe MR [**First Name (Titles) **] [**Last Name (Titles) 12876**] and was referred for surgical repair. [**2128-10-27**] Mitral valve surgery aborted after TEE at time of surgery revealed largely normal mitral valve with improvement of inferior hypokinesis compared to month prior. [**3-/2129**] Cardiac Catheterization - Total occlusion of RCA stent and patent LCX stent, mild to mod MR [**7-/2129**] Pulmonary edema requiring intubation at an OSH. Transferred to [**Hospital1 18**] and had a cardiac cath revealing T.O RCA and 40% CX stenosis in prior stent. EF of 30% [**2129**] AICD placement [**2135-10-24**] Cath d/t worsening chronic angina and DOE and inferior ischemia on dobutamine viability study. Angiography revealed 40% LAD, 40% LCX ISRS, RCA totally occluded with distal filling via left to right collaterals. S/P Unsuccesful recanalization of the RCA. FFR of CX lesion demonstrated it to be a hemodynamically insignificant lesion. [**2136-2-2**] s/p VATS, left upper lobectomy and mediastinal lymph node dissection d/t adenocarcinoma. Patient d/c'd on [**2-8**] and readmitted on [**2-13**] d/t mental status changes and hypotension. A chest CT was done which was negative for a PE. A CT of the head was done revealing no evidence of intracranial hemorrhage, but a hypodensity at the right temporo-occipital junction. This could represent a late subacute to chronic infarct vs metastatic disease. A CT with contrast was done the following day revealing the same findings. A carotid series was therefore ordered and done on [**2136-2-15**]. This revealed an 80-99% stenosis of the left internal carotid artery and a <40% stenosis of the right internal carotid artery. A TTE was done on [**2136-2-15**]. This revealed an ef of 40% with 1+MR, small to moderate sized pericardial effusion. Mild symmetric LVH. Hypokinesis noted in the infero-septum, inferior and infero-lateral walls. Akinesis noted in the basal infero-septum and inferior wall. . The patient was subsequently referred to see Dr [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] as an outpatient who has recommended her for carotid angiography and intervention. The patient was then seen in clinic by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of neurology who is in agreement that the head CT scan abnormality is very likely an embolic stroke and feels that left carotid intervention is appropriate. The patient was also seen by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] of neurosurgery who felt that it is exceedingly unlikely that the lesion on CT scan represents a malignancy vs. metastasis and cleared her to undergo a carotid procedure. He recommended repeat head CT in 3 months. . Follow up studies have included: [**2136-2-23**] Chest XRAY: Normal post left upper lobectomy appearance. No evidence of any cardiopulmonary process. [**2136-3-8**] CTA of neck: approximately 55% left sided carotid stenosis at the bifurcation [**2136-3-20**] CT of brain with and without contrast: No change of right posterior temporal-occipital region, likely represents a chronic infarct. Noted to have tortuous basilar artery. Basilary artery summit positioned to the left of the midline. Just anterior to the summit is a 2-mm area of contrast enhancement--Finding could represent very tortuous origin of left posterior cerebral artery or contigious tiny aneurysm. . In terms of symptoms, the patient denies any neurological deficits, confusion,or lightheadedness. She further denies any chest pain. She does report having dyspnea after climbing one flight of stairs. . On day of admission, she underwent carotid angiography with stent placement Past Medical History: s/p bronch/meds, 70 pck yr smoker, CAD s/p MI x 2 and stenting x 2, s/p AICD implant, EF 33%, hypothyroid, DM< s/p hysterectomy, s/p appy, s/p varicose vein removal Social History: Married with two children who live close by. Husband will drive her to the procedure.(+) cigarette smoking 80 ppy history, quit in [**2128**], restarted in [**2129**], quit again [**9-6**] Family History: (+) [**Name (NI) 41900**] CAD Father had MI at 42yo and died. Mother had CVA 54yo. Both sisters are healthy. Physical Exam: GEN: WD female in NAD HEENT: PERRL, EOMI NECK: No bruits, No LAD CV: RRR no m,r,g LUNG: CTA Bilat ABD: Soft, NT, ND BSNA EXT: No C/C/E Neuro: CN II-XII intact, A and O x 3, no focal defecits Pertinent Results: [**2136-4-3**] 09:22PM WBC-11.6* RBC-3.81* HGB-11.2* HCT-32.4* MCV-85 MCH-29.4 MCHC-34.5 RDW-14.9 [**2136-4-3**] 09:22PM PLT COUNT-343 . Cardiac Cath COMMENTS: 1. Access was retrograde via the RCFA with catheter placemnt to the aortic arch and bilateral common carotid arteries. 2. The aortic arch was a Type I arch with mild tortuosity of the great vessels and no angiographically significant lesions. 3. The right CCA was angiographically normal. The [**Country **] had a mild 30% lesion at the bifurcation. The [**Country **] filled the ipsilateral ACA and MCA without cross-filling. There was mild tortuosity of the proximal intracerebral vessels. 4. The left CCA was angiographically normal. The [**Doctor First Name 3098**] had a calcified eccentric 90% lesion at the bifurcation and filled the ipsilateral ACA and MCA. 5. Successful stenting of the [**Doctor First Name 3098**] with a [**5-10**] x 30 mm Acculink stent (see PTA comments). FINAL DIAGNOSIS: 1. Severe left internal carotid artery stenosis. 2. Successful stenting of the left internal carotid artery. . ECG Sinus rhythm with ventricular premature complexes Low QRS voltages - clinical correlation is suggested Brief Hospital Course: A/P: 64 year-old woman with question of significant carotid stenosis, referred for carotid angiography. . PLAN: . # S/P Carotid Angiography with stent placement: She had left ICA stent placed on day of admission without event. Developed reflex hypotension and was placed on a low dose of Neo-synephrine. This was weaned and by HD #1, her BP was elevated and we resumed Carvedilol and ACE/Lasix at home doses which were well tolerated. We continued continue ASA, Statin, Plavix throughout admission. Her mental status remained unchanged and her neuro exam was without focal defecits. She did report occasional headache which responded well to PO meds. She was discharged to home on HD #2 without event. . # Hypothyroidism: Levothyroxine Sodium 112 mcg PO DAILY continued throughout admission. . #. DM: RISS and FS QACHS continued throughout admission. . # GERD: Cont. PPI throughout admission. . # PPx: PPI, Plavix, ASA . # CODE: FULL . # COMM: With pt . # DISP: To home with planned follow up as outlined above. . Medications on Admission: ECASA 325mg daily Lorazepam 0.5mg PRN anxiety Metformin 850mg TID Prilosec 20mg daily Coreg 12.5mg [**Hospital1 **] Lipitor 60mg daily Lisinopril 10mg daily Celexa 60mg daily Levoxyl .112mcg daily Sprinolactone 25mg daily Lasix 20mg daily Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Fioricet [**Medical Record Number 3668**] mg Tablet Sig: 1-2 Tablets PO every four (4) hours as needed for headache for 1 weeks: Max dose 6 tablets in 24 hours. . Disp:*48 Tablet(s)* Refills:*0* 6. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO once a day: to be restarted [**2136-4-6**]. 7. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day: to be restarted [**2136-4-6**]. 8. Metformin 850 mg Tablet Sig: One (1) Tablet PO three times a day: to be restarted [**2136-4-8**]. 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 10. Lipitor 20 mg Tablet Sig: Three (3) Tablet PO once a day. 11. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO once a day. 12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 13. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: S/P stenting of the left carotid artery Secondary diagnosis: Hypotension Hypertension Hypercholesterolemia Hypothyroidism Anxiety Discharge Condition: Stable Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Please keep all follow up appointments. Please take all medications as prescribed. You should restart you lasix and spironolactone tomorrow (Friday), you should not restart your metformin until Saturday [**2136-4-9**]. Seek medical attention for fevers, chills, chest pain, shortness of breath, lightheadedness, or any other concerning symtpoms. Followup Instructions: 2. Provider: [**Name10 (NameIs) 1532**] [**Name11 (NameIs) 1533**], MD Phone:[**0-0-**] Date/Time:[**2136-4-12**] 9:30 3. Provider: [**Name Initial (NameIs) 43**]/[**Doctor Last Name **] Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2136-4-19**] 4:30 4. Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2136-5-10**] 2:40

433,428,272,401,244,250,V101,414,V458,V450

{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of bronchus and lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Automatic implantable cardiac defibrillator in situ'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Admit for carotid angiography and possible intervention. PRESENT ILLNESS: 64 year-old woman, patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **], Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **], with an extensive history of CAD, now s/p recent left upper lobectomy for lung cancer with an incidental finding of an old CVA on head CT postoperatively prompting a workup that revealed 90% left internal carotid stenosis on duplex, vs 55% on CTA of neck, now referred for left carotid angiography to more clearly define her carotid anatomy, and carotid intervention, if appropriate. Events were as follows: [**2128-9-28**] IMI - Treated with stenting of the RCA and LCx. Found to have severe MR [**First Name (Titles) **] [**Last Name (Titles) 12876**] and was referred for surgical repair. [**2128-10-27**] Mitral valve surgery aborted after TEE at time of surgery revealed largely normal mitral valve with improvement of inferior hypokinesis compared to month prior. [**3-/2129**] Cardiac Catheterization - Total occlusion of RCA stent and patent LCX stent, mild to mod MR [**7-/2129**] Pulmonary edema requiring intubation at an OSH. Transferred to [**Hospital1 18**] and had a cardiac cath revealing T.O RCA and 40% CX stenosis in prior stent. EF of 30% [**2129**] AICD placement [**2135-10-24**] Cath d/t worsening chronic angina and DOE and inferior ischemia on dobutamine viability study. Angiography revealed 40% MEDICAL HISTORY: s/p bronch/meds, 70 pck yr smoker, CAD s/p MI x 2 and stenting x 2, s/p AICD implant, EF 33%, hypothyroid, DM< s/p hysterectomy, s/p appy, s/p varicose vein removal MEDICATION ON ADMISSION: ECASA 325mg daily Lorazepam 0.5mg PRN anxiety Metformin 850mg TID Prilosec 20mg daily Coreg 12.5mg [**Hospital1 **] Lipitor 60mg daily Lisinopril 10mg daily Celexa 60mg daily Levoxyl .112mcg daily Sprinolactone 25mg daily Lasix 20mg daily ALLERGIES: Bactrim / Keflex / Catapres / Trazodone PHYSICAL EXAM: GEN: WD female in NAD HEENT: PERRL, EOMI NECK: No bruits, No LAD CV: RRR no m,r,g LUNG: CTA Bilat ABD: Soft, NT, ND BSNA EXT: No C/C/E Neuro: CN II-XII intact, A and O x 3, no focal defecits FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father had MI at 42yo and died. Mother had CVA 54yo. Both sisters are healthy. SOCIAL HISTORY: Married with two children who live close by. Husband will drive her to the procedure.(+) cigarette smoking 80 ppy history, quit in [**2128**], restarted in [**2129**], quit again [**9-6**] ### Response: {'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of bronchus and lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Automatic implantable cardiac defibrillator in situ'}

CHIEF COMPLAINT: BRBPR PRESENT ILLNESS: 87 yo woman with A fib on coumadin, AS, CHF presents c/o large amount of rectal bleeding in the morning on the day of admission. She states she passed gas and noticed that her nightgown had blood thru it. States ~ a cup full of blood. She was transferred to ED. She denies any abdominal pain. States she's has not noticed previous episodes of brbpr. Denies cp/sob/palpitations. States that previously she had stomach ulcer and bleed after sphincertomy ~3 years ago. . In the ED she had ~4 more episodes of small bleeding. She was given vitamin K 10 mg po, 1 bag of FFP, and 2 large bore IVs were placed. She was given 1 unit prbcs and had a bleeding scan which was negative.. After transfer to the MICU she denied any discomfort or complaints. On ROS denies caugh/fever/chills/n/v/d MEDICAL HISTORY: 1. Aortic regurgitation, mitral regurgitation and aortic stenosis shown on echocardiogram done in [**2123-6-14**]. 2. Peptic ulcer disease with history of upper GI bleeding 3. Congestive heart failure. 4. Gout. 5. Hypothyroidism. 6. Depression 7. C-diff colitis in [**2123**]. 8. Carpal tunnel syndrome. 9. Afib - dx'd about 4 years ago, on warfarin 10. Carotid stenosis 11. Hernia repair around age 55 12. Colon surgery for bowel obstruction in her 60s 13. H/O mult blood transfusions for UGIB after ERCP with sphincterotomy a few years ago. MEDICATION ON ADMISSION: Coumadin 2mg q Mon/Wed/Fri/Sunday and 3mg on Tues/Thurs/Saturday ALLERGIES: Aspirin / Doxycycline Hyclate PHYSICAL EXAM: VS: T 98.6 BP 155/38 HR 84 RR 18 O2sat 99%RA. . GEN: Elderly female sitting in bed comfortably. HEENT: MMM, PERRL, oropharynx clear CHEST: scant basilar crackles bilaterally otw ctab CV: [**Last Name (un) **], nl s1, s2, +sem at RUSB and apex ABD: Soft, nt, nd, nl active bowel sounds EXT: no edema NEURO: A&O X 3, moves all extremities. CN II-XII intact RECTAL: External exam -> rectal tag, no external hemorrhoids. FAMILY HISTORY: She is divorced and lives alone in at [**Hospital1 **] Assisted lLving Facility. Remote smoking history, denies etOh. SOCIAL HISTORY: (+) FHx arrhythmias or sudden cardiac death: Father died of an MI at age 61. Denies fh of colon/gastric ca.

Diverticulosis of colon with hemorrhage,Atrial fibrillation,Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Gout, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pulmonary heart diseases

Dvrtclo colon w hmrhg,Atrial fibrillation,Mitr/aortic mult involv,Rheumatic heart failure,Ac posthemorrhag anemia,Thrombocytopenia NOS,Long-term use anticoagul,Gout NOS,Hypothyroidism NOS,Depressive disorder NEC,Chr pulmon heart dis NEC

Admission Date: [**2127-2-17**] Discharge Date: [**2127-2-24**] Service: MEDICINE Allergies: Aspirin / Doxycycline Hyclate Attending:[**First Name3 (LF) 19836**] Chief Complaint: BRBPR Major Surgical or Invasive Procedure: colonoscopy, bleeding scan History of Present Illness: 87 yo woman with A fib on coumadin, AS, CHF presents c/o large amount of rectal bleeding in the morning on the day of admission. She states she passed gas and noticed that her nightgown had blood thru it. States ~ a cup full of blood. She was transferred to ED. She denies any abdominal pain. States she's has not noticed previous episodes of brbpr. Denies cp/sob/palpitations. States that previously she had stomach ulcer and bleed after sphincertomy ~3 years ago. . In the ED she had ~4 more episodes of small bleeding. She was given vitamin K 10 mg po, 1 bag of FFP, and 2 large bore IVs were placed. She was given 1 unit prbcs and had a bleeding scan which was negative.. After transfer to the MICU she denied any discomfort or complaints. On ROS denies caugh/fever/chills/n/v/d Past Medical History: 1. Aortic regurgitation, mitral regurgitation and aortic stenosis shown on echocardiogram done in [**2123-6-14**]. 2. Peptic ulcer disease with history of upper GI bleeding 3. Congestive heart failure. 4. Gout. 5. Hypothyroidism. 6. Depression 7. C-diff colitis in [**2123**]. 8. Carpal tunnel syndrome. 9. Afib - dx'd about 4 years ago, on warfarin 10. Carotid stenosis 11. Hernia repair around age 55 12. Colon surgery for bowel obstruction in her 60s 13. H/O mult blood transfusions for UGIB after ERCP with sphincterotomy a few years ago. Social History: (+) FHx arrhythmias or sudden cardiac death: Father died of an MI at age 61. Denies fh of colon/gastric ca. Family History: She is divorced and lives alone in at [**Hospital1 **] Assisted lLving Facility. Remote smoking history, denies etOh. Physical Exam: VS: T 98.6 BP 155/38 HR 84 RR 18 O2sat 99%RA. . GEN: Elderly female sitting in bed comfortably. HEENT: MMM, PERRL, oropharynx clear CHEST: scant basilar crackles bilaterally otw ctab CV: [**Last Name (un) **], nl s1, s2, +sem at RUSB and apex ABD: Soft, nt, nd, nl active bowel sounds EXT: no edema NEURO: A&O X 3, moves all extremities. CN II-XII intact RECTAL: External exam -> rectal tag, no external hemorrhoids. Pertinent Results: ......85 7.3>---<178 ......32.2 N:68.7 L:24.1 M:3.7 E:2.6 Bas:0.8 . 141 | 105 | 47 ...........AGap=17 -------------<104 5.0 | 24 | 1.5 . CK: 56 MB: Notdone . PT: 21.8 PTT: 33.8 INR: 2.1 . [**2127-2-24**] 04:30AM BLOOD WBC-6.6 RBC-3.66* Hgb-10.9* Hct-30.6* MCV-84 MCH-29.9 MCHC-35.8* RDW-17.7* Plt Ct-139* . [**2127-2-24**] 04:30AM BLOOD Glucose-99 UreaN-15 Creat-0.7 Na-140 K-4.0 Cl-108 HCO3-24 AnGap-12 . [**2127-2-24**] 04:30AM BLOOD Calcium-9.0 Mg-2.0 . Imaging: [**2127-2-19**] colonoscopy: Multiple severe non-bleeding diverticula with wide-mouth openings were seen in the sigmoid colon and descending colon. . [**2127-2-17**] - Bleeding Scan - No evidence of bleeding during the time of the study. . EGD [**9-14**] - Gastric Ulcer. . TTE [**2-/2124**] - Conclusions: The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF> 55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets are moderately thickened. There is moderate aortic valve stenosis. Moderate to severe (3+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. There is moderate thickening of the mitral valve chordae. Moderate to severe (3+) mitral regurgitation is seen. There is severe pulmonary artery systolic hypertension. Brief Hospital Course: 87 y/o F who presents with AS, a. fib on coumadin at home presents with several episodes of BRBPR this AM. . # Bright red blood per rectum - GI was consulted and the patient was admitted. INR was reversed with vit K and FFPs. The patient stayed hemodynamically stable although required a total of 11 units of PRBCs to keep hct around 30. Initial bleeding scan was negative. Due to continued BRBPR however, a tagged RBC scan was repeated and showed faint/slow bleeding at splenic flexure. IR was called but did not feel that angio with embolization was indicated because her hemodynamic stability and such slow bleed. The patient's bowel prep was continued and underwent colonoscopy on [**2-19**] which showed multiple diverticulosis in the left colon without bleeding. It was thought that the patient had diverticular bleed which stopped spontaneously. The day after colonoscopy, the patient did not have any more episodes of BRBPR and was called out to the floor. Once on the floor she remained stable, with no further bleeds, and her hematocrit was been stable. . # A. fib - Coumadin was stopped and reversed with FFPs and vit K. The patient was continued on amiodarone but held [**Last Name (un) **] given acute bleed. Once out of the ICU she was continued on amiodarone, and restarted on losartan. Her dose of losartan is 50mg at time of discharge, and can be further titrated up to her previous dose of 100mg daily as tolerated by her PCP as an outpatient. . # CHF - Restarted [**Last Name (un) **] for hypertension, now at 50mg daily at time of discharge. Can be titrated back up to 100mg daily as tolerated as an outpatient by her PCP [**Name Initial (PRE) **]/or cardiologist. She was restarted on lasix 80mg daily. She is not restarted on aldactone at time of discharge, but this can be restarted as needed/tolerated as an outpatient. . # Gout - allopurinol . # Depresssion - Coninued oxazepam and prozac . # prophylaxis - Pneumoboots, on PPI (at home dose) . # Access - 2 large bore PIVs were maintained . # Code - DNR/DNI . Communication: HCP [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 99039**] Medications on Admission: Coumadin 2mg q Mon/Wed/Fri/Sunday and 3mg on Tues/Thurs/Saturday Lipitor 10mg daily Cozaar 100mg daily Aldactone 25mg daily Lasix 80mg daily Amiodarone 100mg daily Oxazepam 10mg qHS Levoxyl 88mcg daily Prontonix 40mg daily Mg Oxide 400mg daily Allopurinol 30mg daily Prozac 20mg daily Discharge Medications: 1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Oxazepam 10 mg Capsule Sig: One (1) Capsule PO HS (at bedtime) as needed. 3. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 5. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Ipratropium Bromide 0.02 % Solution Sig: One (1) nebulizer Inhalation Q6H (every 6 hours) as needed for dyspnea. 8. Furosemide 80 mg Tablet Sig: One (1) Tablet PO once a day. 9. Losartan 50 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 10. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO once a day. 11. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*2* 12. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary: diverticular bleed, congestive heart failure . Secondary: atrial fibrillation, gout, depression, peptic ulcer disesase Discharge Condition: Stable hematocrit, good oxygen saturation on room air, no fluid overload. Discharge Instructions: your stool, chest pain, increasing shortness of breath or trouble breathing, swelling in your ankles, weight gain, or any other health concern. . increasing. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2127-3-5**] 2:10 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. Phone:[**Telephone/Fax (1) 127**] Date/Time:[**2127-5-1**] 1:30 [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD, [**MD Number(3) 19838**] Completed by:[**2127-2-24**]

562,427,396,398,285,287,V586,274,244,311,416

{'Diverticulosis of colon with hemorrhage,Atrial fibrillation,Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Gout, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pulmonary heart diseases'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: BRBPR PRESENT ILLNESS: 87 yo woman with A fib on coumadin, AS, CHF presents c/o large amount of rectal bleeding in the morning on the day of admission. She states she passed gas and noticed that her nightgown had blood thru it. States ~ a cup full of blood. She was transferred to ED. She denies any abdominal pain. States she's has not noticed previous episodes of brbpr. Denies cp/sob/palpitations. States that previously she had stomach ulcer and bleed after sphincertomy ~3 years ago. . In the ED she had ~4 more episodes of small bleeding. She was given vitamin K 10 mg po, 1 bag of FFP, and 2 large bore IVs were placed. She was given 1 unit prbcs and had a bleeding scan which was negative.. After transfer to the MICU she denied any discomfort or complaints. On ROS denies caugh/fever/chills/n/v/d MEDICAL HISTORY: 1. Aortic regurgitation, mitral regurgitation and aortic stenosis shown on echocardiogram done in [**2123-6-14**]. 2. Peptic ulcer disease with history of upper GI bleeding 3. Congestive heart failure. 4. Gout. 5. Hypothyroidism. 6. Depression 7. C-diff colitis in [**2123**]. 8. Carpal tunnel syndrome. 9. Afib - dx'd about 4 years ago, on warfarin 10. Carotid stenosis 11. Hernia repair around age 55 12. Colon surgery for bowel obstruction in her 60s 13. H/O mult blood transfusions for UGIB after ERCP with sphincterotomy a few years ago. MEDICATION ON ADMISSION: Coumadin 2mg q Mon/Wed/Fri/Sunday and 3mg on Tues/Thurs/Saturday ALLERGIES: Aspirin / Doxycycline Hyclate PHYSICAL EXAM: VS: T 98.6 BP 155/38 HR 84 RR 18 O2sat 99%RA. . GEN: Elderly female sitting in bed comfortably. HEENT: MMM, PERRL, oropharynx clear CHEST: scant basilar crackles bilaterally otw ctab CV: [**Last Name (un) **], nl s1, s2, +sem at RUSB and apex ABD: Soft, nt, nd, nl active bowel sounds EXT: no edema NEURO: A&O X 3, moves all extremities. CN II-XII intact RECTAL: External exam -> rectal tag, no external hemorrhoids. FAMILY HISTORY: She is divorced and lives alone in at [**Hospital1 **] Assisted lLving Facility. Remote smoking history, denies etOh. SOCIAL HISTORY: (+) FHx arrhythmias or sudden cardiac death: Father died of an MI at age 61. Denies fh of colon/gastric ca. ### Response: {'Diverticulosis of colon with hemorrhage,Atrial fibrillation,Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Gout, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Other chronic pulmonary heart diseases'}

CHIEF COMPLAINT: Hypotension, fever PRESENT ILLNESS: 57 y/o f with h/o dyemyelinating syndrome, restrictive lung defect FVC 52%, h/o recurrent aspiration pneumonias, s/p G tube placement c/b gastrocutaneous fistula, s/p J tube placement [**4-19**] but removed due to intolerance, who was recently admitted and discharged [**2126-1-9**] after treatment for aspiration pneumonia, now p/w fever, nausea, RLQ pain, and RL back pain x 4 days. The pt states that her RLQ pain is sharp, [**9-24**], intermittent, without alleviating or exacerbating factors, unrelated to position or eating. She does not think her back pain is necessarily related to her RLQ pain. Her nausea has not been accompanied by emesis. The pt states she had a day of watery diarrhea 2 weeks ago accompanied by lower abdominal pain and alleviated with defecation. Over the past 4 days the pt has had a fever up to 107 and up to 103/104 after purchasing a new thermometer. She has had a persistent cough ever since her last discharge, productive of green sputum starting the day PTA. She also c/o nasal congestion starting over the past several days; also she has had decreased po intake x 4 days. Two weeks ago the pt also had an episode of vaginal and rectal bleeding; she is followed by OBGYN Dr. [**First Name (STitle) **] for her h/o vaginal bleeding. Of note, pt states she completed her full course of prednisone and levofloxacin after her last discharge. . In the ED initially she was febrile to 102.6, BP 113/60, then became hypotensive to BP 64/39, not responsive to 4L NS (bp up to only 86/38), unsuccessful IJ attempt, so R femoral line was placed, and levophed at 0.15 was started. With levophed her BP rose to 130/79, so it was titrated down to 0.1. She was also given Levofloxacin, Vancomycin, and Flagyl, as well as combivent nebs and Decadron 10 mg IV x1. MEDICAL HISTORY: -Mod to severe aspiration per S and S eval [**1-20**] -Asthma. -Restrictive lung disease [**1-17**] neuromusc disorder (FEV1 63% of pred, FVC 52% of pred, FEV/FVC 121 of pred) -Demyelinating syndrome (L leg paresis, bilateral arm weakness, demyelination on brain MRI, neurogenic bladder) -History of Adrenal insufficiency though not chronically maintained on prednisone -Osteoporosis. -Hypothyroidism. -History of chest nodules. -Dyslipidemia. -History of breast papilloma with nipple discharge. -Anxiety. -Labile hypertension. -History of right IJ thrombus in [**2112**]. -IgG deficiency. -Anemia. -Status post cholecystectomy in [**2112**]. -Dysfunctional uterine bleeding by history. -Atypical pap smears. -Common bile duct stenosis s/p sphincterotomy. -Gastritis and prepyloric ulcers per EGD. -Bilateral hearing loss. -G-tube placement leading to gastrocutaneous fistula --> removal MEDICATION ON ADMISSION: ADVAIR DISKUS 500-50MCG--Use one puff by mouth twice a day ALBUTEROL 90GM--Take 2 puffs four times a day ALBUTEROL SO4 0.083 %--One neb q 4-6 hrs as needed [**Doctor First Name **] 60MG [**Hospital1 **] BACLOFEN 20 mg TID BUSPIRONE HCL 10MG TID CLONAZEPAM 2 mg TID IPRATROPIUM BROMIDE 14 GM--2-3 puffs inh four times a day LEVOXYL 50MCG qd LIPITOR 10MG--One by mouth every day Ativan 2 mg TID Protonix 40 mg Vit B12 Folate ASA 325 Vit D [**Hospital1 **] 8 mg TID . MEDS on TRANSFER: Vancomycin HCl 1000 mg IV Q 12H Fexofenadine 60 mg PO BID Baclofen 10 mg PO TID Aspirin 325 mg PO DAILY Levothyroxine Sodium 50 mcg PO DAILY BusPIRone 10 mg PO TID Tizanidine HCl 8 mg PO TID Atorvastatin 10 mg PO DAILY Lorazepam 0.5-2 mg PO Q4-6H:PRN Pantoprazole 40 mg PO Q24H Cyanocobalamin 50 mcg PO DAILY Folic Acid 1 mg PO DAILY Vitamin D 400 UNIT PO DAILY Senna 1 TAB PO BID:PRN Docusate Sodium 100 mg PO BID Acetaminophen 325-650 mg PO Q4-6H:PRN Heparin 5000 UNIT SC TID Levofloxacin 500 mg PO Q24H Metronidazole 500 mg PO TID Clonazepam 2 mg PO TID Orabase w/ Benzocaine Paste 1 Appl TP PRN traMADOL 50-100 mg PO Q4-6H:PRN RISS Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN Prednisone 40 mg PO DAILY ALLERGIES: Azmacort / Clindamycin / Versed / Fentanyl / Morphine / Optiray 300 / Ceftriaxone / Clarithromycin PHYSICAL EXAM: PE: T 96.8 HR 81 BP 109/51 R 16-26 Sat 94%2LNC HEENT:ROMI PERRL, face symmetric, MMM, BL maxillary sinus ttp Neck: +HJR, no cervical or supraclavicular LAD CHEST: hyperresonant to percussion throughout, diffuse expiratory wheezing, 1:3 I:E ratio, poor inspiratory effort, decreased breath sounds throughout, diffuse rales CV: RRR, Grade 3/6 SEM LLSB, nl S1/S2 ABD: soft, NABS, voluntary guarding to palpation of epigastrium and RL quadrant, no rebound tenderness, no palpable masses, unable to assess for HSM due to vol. guarding EXT: No edema or rash, extrem warm Neuro: CN II-XII grossly intact, [**3-20**] strenght throughout R arm and R leg, 3/5 L biceps, triceps, and grip strength, 0/5 strength in L leg, a and o x3 FAMILY HISTORY: CAD. Father had [**Name2 (NI) 499**] cancer, her mother had breast cancer, and her sister had brain cancer. SOCIAL HISTORY: Quit tobacco 20 years ago, occ ETOH, no illicits; lives in S. [**Location (un) 86**] with husband and daughter, does not work but does volunteer

Hypotension, unspecified,Pneumonitis due to inhalation of food or vomitus,Other selective immunoglobulin deficiencies,Acidosis,Acute posthemorrhagic anemia,Other disorders of menstruation and other abnormal bleeding from female genital tract,Demyelinating disease of central nervous system, unspecified,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Unspecified essential hypertension,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of other specified malignant neoplasm,Anxiety state, unspecified,Asthma, unspecified type, unspecified

Hypotension NOS,Food/vomit pneumonitis,Selective ig defic NEC,Acidosis,Ac posthemorrhag anemia,Menstrual disorder NEC,Cns demyelination NOS,Hypothyroidism NOS,Osteoporosis NOS,Hypertension NOS,Family hx-gi malignancy,Family hx-breast malig,Family hx-malignancy NEC,Anxiety state NOS,Asthma NOS

Admission Date: [**2126-1-25**] Discharge Date: [**2126-1-30**] Date of Birth: [**2068-11-10**] Sex: F Service: MEDICINE Allergies: Azmacort / Clindamycin / Versed / Fentanyl / Morphine / Optiray 300 / Ceftriaxone / Clarithromycin Attending:[**First Name3 (LF) 759**] Chief Complaint: Hypotension, fever Major Surgical or Invasive Procedure: None History of Present Illness: 57 y/o f with h/o dyemyelinating syndrome, restrictive lung defect FVC 52%, h/o recurrent aspiration pneumonias, s/p G tube placement c/b gastrocutaneous fistula, s/p J tube placement [**4-19**] but removed due to intolerance, who was recently admitted and discharged [**2126-1-9**] after treatment for aspiration pneumonia, now p/w fever, nausea, RLQ pain, and RL back pain x 4 days. The pt states that her RLQ pain is sharp, [**9-24**], intermittent, without alleviating or exacerbating factors, unrelated to position or eating. She does not think her back pain is necessarily related to her RLQ pain. Her nausea has not been accompanied by emesis. The pt states she had a day of watery diarrhea 2 weeks ago accompanied by lower abdominal pain and alleviated with defecation. Over the past 4 days the pt has had a fever up to 107 and up to 103/104 after purchasing a new thermometer. She has had a persistent cough ever since her last discharge, productive of green sputum starting the day PTA. She also c/o nasal congestion starting over the past several days; also she has had decreased po intake x 4 days. Two weeks ago the pt also had an episode of vaginal and rectal bleeding; she is followed by OBGYN Dr. [**First Name (STitle) **] for her h/o vaginal bleeding. Of note, pt states she completed her full course of prednisone and levofloxacin after her last discharge. . In the ED initially she was febrile to 102.6, BP 113/60, then became hypotensive to BP 64/39, not responsive to 4L NS (bp up to only 86/38), unsuccessful IJ attempt, so R femoral line was placed, and levophed at 0.15 was started. With levophed her BP rose to 130/79, so it was titrated down to 0.1. She was also given Levofloxacin, Vancomycin, and Flagyl, as well as combivent nebs and Decadron 10 mg IV x1. Past Medical History: -Mod to severe aspiration per S and S eval [**1-20**] -Asthma. -Restrictive lung disease [**1-17**] neuromusc disorder (FEV1 63% of pred, FVC 52% of pred, FEV/FVC 121 of pred) -Demyelinating syndrome (L leg paresis, bilateral arm weakness, demyelination on brain MRI, neurogenic bladder) -History of Adrenal insufficiency though not chronically maintained on prednisone -Osteoporosis. -Hypothyroidism. -History of chest nodules. -Dyslipidemia. -History of breast papilloma with nipple discharge. -Anxiety. -Labile hypertension. -History of right IJ thrombus in [**2112**]. -IgG deficiency. -Anemia. -Status post cholecystectomy in [**2112**]. -Dysfunctional uterine bleeding by history. -Atypical pap smears. -Common bile duct stenosis s/p sphincterotomy. -Gastritis and prepyloric ulcers per EGD. -Bilateral hearing loss. -G-tube placement leading to gastrocutaneous fistula --> removal of G-tube and placement of J-tube in [**4-19**] -MRI [**1-20**]: multiple T2 hyperintense lesions in the cerebral white matter are to some extent visible on prior CTs and may be related to the history of post-infectious encephalomyelitis vs MS [**Name13 (STitle) **] [**8-19**]: nl systolic function, EF 55%, no diastolic dysfunction Social History: Quit tobacco 20 years ago, occ ETOH, no illicits; lives in S. [**Location (un) 86**] with husband and daughter, does not work but does volunteer Family History: CAD. Father had [**Name2 (NI) 499**] cancer, her mother had breast cancer, and her sister had brain cancer. Physical Exam: PE: T 96.8 HR 81 BP 109/51 R 16-26 Sat 94%2LNC HEENT:ROMI PERRL, face symmetric, MMM, BL maxillary sinus ttp Neck: +HJR, no cervical or supraclavicular LAD CHEST: hyperresonant to percussion throughout, diffuse expiratory wheezing, 1:3 I:E ratio, poor inspiratory effort, decreased breath sounds throughout, diffuse rales CV: RRR, Grade 3/6 SEM LLSB, nl S1/S2 ABD: soft, NABS, voluntary guarding to palpation of epigastrium and RL quadrant, no rebound tenderness, no palpable masses, unable to assess for HSM due to vol. guarding EXT: No edema or rash, extrem warm Neuro: CN II-XII grossly intact, [**3-20**] strenght throughout R arm and R leg, 3/5 L biceps, triceps, and grip strength, 0/5 strength in L leg, a and o x3 Pertinent Results: IMAGING: . CXR on admission: INDICATION: Dyspnea and abdominal pain. There is no free air seen under the diaphragm. Some mild increased interstitial markings are visualized with Kerley B lines noted. There is some blunting at the left costophrenic sulcus and increased retrocardiac density suggesting either atelectasis or pneumonia. Pulmonary vascular markings within normal limits. IMPRESSION: No free air under the diaphragm. Possible left atelectasis versus pneumonia in the retrocardiac region. . Transvaginal U/S: 1. No evidence of an endometrial abnormality on limited evaluation. 2. Ovaries not visualized. No adnexal abnormalities identified. 3. Small amount of free fluid. . CXR: chest findings have deteriorated during the last short time interval now presenting bilateral basal parenchymal infiltrates most of them located in the posterior segments as seen on the lateral view. Comparison is also made with a previous chest examination of [**1-10**] at which time these infiltrates on the bases were already noted more marked on the left than on the right side. On a more remote examination of [**2125-11-15**], these basal infiltrates were suspicious for representing aspiration pneumonias. Similar cause for the now new developed basal infiltrates is reasonable. It is noted that the patient has been scheduled for chest CT. IMPRESSION: New bilateral basal infiltrates consistent with aspiration pneumonitis. . CT abdomen: 1. No focal abscess is identified. 2. Small amount of free fluid around the liver, without definite etiology identified. 3. Stable low attenuations within the liver, too small to characterize. 4. Stable low attenuations within both kidneys, too small to characterize. . ADMIT LABS: [**2126-1-25**] 01:40AM BLOOD WBC-9.4 RBC-3.64* Hgb-12.5 Hct-36.2 MCV-100* MCH-34.3* MCHC-34.5 RDW-13.4 Plt Ct-309 [**2126-1-25**] 11:45PM BLOOD WBC-11.1* RBC-2.74* Hgb-9.2*# Hct-27.7* MCV-101* MCH-33.6* MCHC-33.3 RDW-13.7 Plt Ct-272 [**2126-1-25**] 01:40AM BLOOD Neuts-81.9* Lymphs-11.2* Monos-4.2 Eos-0.3 Baso-2.4* [**2126-1-25**] 01:40AM BLOOD Macrocy-1+ [**2126-1-25**] 01:40AM BLOOD PT-12.3 PTT-26.7 INR(PT)-1.1 [**2126-1-25**] 01:40AM BLOOD Plt Ct-309 [**2126-1-26**] 06:15AM BLOOD Ret Aut-1.2 [**2126-1-25**] 01:40AM BLOOD Glucose-111* UreaN-14 Creat-1.0 Na-138 K-3.1* Cl-103 HCO3-21* AnGap-17 [**2126-1-25**] 01:40AM BLOOD ALT-15 AST-17 CK(CPK)-48 AlkPhos-72 Amylase-38 TotBili-0.1 [**2126-1-25**] 01:40AM BLOOD Lipase-16 [**2126-1-25**] 11:45PM BLOOD Lipase-18 [**2126-1-26**] 06:15AM BLOOD Lipase-18 [**2126-1-25**] 01:40AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2126-1-25**] 01:40AM BLOOD Calcium-8.8 Phos-3.1 Mg-1.6 [**2126-1-28**] 03:44AM BLOOD calTIBC-247* Ferritn-161* TRF-190* [**2126-1-25**] 11:45PM BLOOD TSH-0.15* [**2126-1-25**] 06:57PM BLOOD Cortsol-26.5* [**2126-1-25**] 06:19PM BLOOD Cortsol-20.4* [**2126-1-25**] 05:20PM BLOOD Cortsol-2.7 [**2126-1-26**] 06:16PM BLOOD Vanco-12.3* [**2126-1-25**] 08:15PM BLOOD Type-ART Temp-36.7 pO2-43* pCO2-53* pH-7.16* calHCO3-20* Base XS--10 Intubat-NOT INTUBA [**2126-1-25**] 09:23PM BLOOD Type-ART Temp-36.7 pO2-53* pCO2-61* pH-7.15* calHCO3-22 Base XS--8 Intubat-NOT INTUBA [**2126-1-25**] 01:48AM BLOOD Lactate-1.0 [**2126-1-25**] 08:15PM BLOOD Lactate-4.7* . DISCHARGE LABS: [**2126-1-30**] 06:15AM BLOOD WBC-8.7 RBC-3.76* Hgb-11.9* Hct-35.8* MCV-95 MCH-31.7 MCHC-33.3 RDW-14.9 Plt Ct-259 [**2126-1-27**] 05:07AM BLOOD Neuts-82.4* Lymphs-14.2* Monos-3.2 Eos-0.1 Baso-0.2 [**2126-1-27**] 05:07AM BLOOD WBC-5.8 RBC-3.41* Hgb-11.3* Hct-32.9* MCV-97 MCH-33.1* MCHC-34.3 RDW-16.1* Plt Ct-222 [**2126-1-27**] 05:07AM BLOOD Anisocy-1+ Poiklo-1+ Macrocy-1+ [**2126-1-30**] 06:15AM BLOOD Plt Ct-259 [**2126-1-30**] 06:15AM BLOOD Glucose-77 UreaN-18 Creat-0.6 Na-149* K-3.2* Cl-107 HCO3-32 AnGap-13 [**2126-1-30**] 06:15AM BLOOD ALT-33 AST-14 AlkPhos-129* TotBili-0.2 [**2126-1-30**] 06:15AM BLOOD Calcium-8.6 Phos-2.9 Mg-1.7 Brief Hospital Course: On admission the pt was placed on continuous albuterol nebs. Levophed was weaned off within several hrs and her SBP initally held in the 90s. Given rales on lung exam and elevated JVP, the pt was given Lasix 10 mg IV x1. She diuresed 1 L, however her BP dropped back into the 70s. The pt was restarted on levophed with a 1L NS bolus. ABG: 7.23, 49, 41 with lacate up to 4.9. Hct dropped from 36.2 to 27.7. Stat AXR and CT chest/abdomen was unrevealing for hemorrhage, obstruction, ischemia, or other acute process to explain the lactate, hypotension, and RLQ pain. Wet read on CT abdomen showed no ileus, collapsed SB, dilated large bowel at 3 cm, and small amt of increased free fluid in the pelvis. The pts LFTs also increased that night, likely due to hepatic congestion. The pts [**Last Name (un) 104**] stim test was normal, however given that no etiology of the pts hypotension could be identified, the pt was started on hydrocort/fludrocort on the night of admission. She was also transfused 2 units of PRBC for her hct drop. Following 2units PRBC and 1 L NS bolus, the pts lactate dropped to 1.0. Repeat CT abdomen/pelvis/chest was unrevealing for a source of bleed. The pts levophed gtt was quickly titrated off the day following admission and the pts BP was stable. She required lasix 20 mg IVx1 on HD3 for mild volume overload. The etiology of the pts fever and hypotension remained unclear. . A/P: 57 y/o f with h/o demylinating syndrome, restrictive lung defect FVC 52%, h/o recurrent aspiration pneumonias p/w c/o RLQ pain and fever, found to be hypotensive with fever in the ED. . #Hypotension/ID: SIRS vs dehydration vs blood loss. Pt was noted to be febrile in the ED, with tachycardia, and hypotension resistant to fluids. Source of infection is unclear. WBC was not initially elevated but has risen to 11 with L shift. Lactate also rose up to 4.9. UA negative. CT of the abdomen is negative for infectious process or etiology to explain RLQ pain; repeat CT negative for acute pathology as well. Overnight pt had 10 pt hct drop and SBP dropped back to the 70s requiring reinitiation of levophed gtt and 1 L NS. Treated with broad spectrum antibiotics. Cultures did not grow anything. Switched to prednisone from hydrocort/fludricort and discharged with plan to taper off over 3 days with plan for endocrine followup. HD stable on discharge. . #O2 requirement/Hypercarbia: Asthma vs. volume overload vs. aspiration. Pt likely has reactive airway component given wheezing on exam, however she seemed initially to be volume overloaded s/p 4 L NS in ED. She had elevated JVD, signs of overload on CXR. Pt was s/p Lasix 10 mg IV x1 with 1 L diuresis prior to hypotension, requiring fluids again. ABG: 7.23/49/41 on 2LNC, but after placed on BIPAP with 40%FIo2, ABG: 7.37/43/140. Oxygenation improved while on the floor; on discharge was using O2 by N/C; she has this at home . #Elevated lactate: Pts lactate rose on admission from 1 up to 4.9. Given concern for ab pathology, AXR and CT abdomen were ordered, but neither revealed a source for infection/ischemia. CT lungs also negative for gross infiltrate. Lactate down to 1.1 this am after 1 L NS bolus and 1 unit PRBC. Lactate resolved and etiology of rise remained unclear. . #Acidosis: Pt had both resp and metabolic acidosis. Resp component likely due to reactive airway, metabolic component likely due to lactic acidosis. Pt also has a non-gap acidosis, likely related to receiving NS. On d/c acidosis resolved. . #Anemia/Hct drop: Pt hct dropped from 36 to 27 on DOA. Given no clear etiology, it is possible pt was initially hemoconcentrated on admission and pts hct dropped s/p aggressive fluid resuscitation. CT abdomen negative for acute hemorrhage. T Bili and LDH wnl (aka no hemolysis). Coags wnl. s/p 2 units PRBC transfusion. On d/c HCT stable. Guiaic negative. . #RLQ pain: Unclear etiology. CT negative for pathology but does show distended loops of large bowel. Pt reports no BM for 7 days. Had BM on floor prior to d/c. Also had TV ultrasound not demonstrating clear pathology. . #Elevated LFTs: LFTs and alk phos rose during the night of admission, felt to be due to hepatic congestion s/p fluid resuscitation. Should be followed up as an outpatient. . # NMD: Continued her on her outpatient medications/muscle relaxants of tizanidine and baclofen . # Anxiety: Continued her outpatient medications of buspar and klonopin . #Aspiration: Pt has mod-severe dysphagia and aspiration per video eval. Asp precautions; pt referred to another GI for eval for PEG (as Dr. [**Last Name (STitle) 2161**] feels that PEG is not warranted and does not decreased asp risk), pt was intolerant of J tube. Pt. kept on aspiration precautions. Also kept on regular diet as she refused thickened liquids/dysphagia diet. She was aware of the risks of aspiration. Medications on Admission: ADVAIR DISKUS 500-50MCG--Use one puff by mouth twice a day ALBUTEROL 90GM--Take 2 puffs four times a day ALBUTEROL SO4 0.083 %--One neb q 4-6 hrs as needed [**Doctor First Name **] 60MG [**Hospital1 **] BACLOFEN 20 mg TID BUSPIRONE HCL 10MG TID CLONAZEPAM 2 mg TID IPRATROPIUM BROMIDE 14 GM--2-3 puffs inh four times a day LEVOXYL 50MCG qd LIPITOR 10MG--One by mouth every day Ativan 2 mg TID Protonix 40 mg Vit B12 Folate ASA 325 Vit D [**Hospital1 **] 8 mg TID . MEDS on TRANSFER: Vancomycin HCl 1000 mg IV Q 12H Fexofenadine 60 mg PO BID Baclofen 10 mg PO TID Aspirin 325 mg PO DAILY Levothyroxine Sodium 50 mcg PO DAILY BusPIRone 10 mg PO TID Tizanidine HCl 8 mg PO TID Atorvastatin 10 mg PO DAILY Lorazepam 0.5-2 mg PO Q4-6H:PRN Pantoprazole 40 mg PO Q24H Cyanocobalamin 50 mcg PO DAILY Folic Acid 1 mg PO DAILY Vitamin D 400 UNIT PO DAILY Senna 1 TAB PO BID:PRN Docusate Sodium 100 mg PO BID Acetaminophen 325-650 mg PO Q4-6H:PRN Heparin 5000 UNIT SC TID Levofloxacin 500 mg PO Q24H Metronidazole 500 mg PO TID Clonazepam 2 mg PO TID Orabase w/ Benzocaine Paste 1 Appl TP PRN traMADOL 50-100 mg PO Q4-6H:PRN RISS Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN Prednisone 40 mg PO DAILY Discharge Medications: 1. Prednisone 5 mg Tablet Sig: see below for taper Tablet PO see below for taper for 2 days: [**1-31**] - 5 mg [**Hospital1 **] [**2-1**] - 5 mg qd [**2-2**] - off. Disp:*3 Tablet(s)* Refills:*0* 2. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Baclofen 10 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Buspirone 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 7. Tizanidine 2 mg Tablet Sig: Four (4) Tablet PO TID (3 times a day). 8. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Lorazepam 2 mg Tablet Sig: One (1) Tablet PO three times a day. 10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 11. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 15. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 16. Clonazepam 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 17. Advair Diskus 500-50 mcg/Dose Disk with Device Sig: One (1) Inhalation twice a day. 18. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q4H (every 4 hours) as needed. 19. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Inhalation four times a day. 20. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: [**1-18**] Inhalation four times a day. 21. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. 22. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day. Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary 1. Hypotension 2. Possible Adrenal insufficiency Secondary 1. Hypothyroidism 2. Demyelinating disease 3. Restrictive lung disease Discharge Condition: Good Discharge Instructions: You should return to the ER if you have further light headedness, dizziness, chest pain, nausea, vomiting, abdominal pain, shortness of breath. You should take all your medications as directed. You should follow up at [**Hospital 191**] clinic on [**2-7**] as below. You should finish a prednisone taper over the next two days as directed. Followup Instructions: You have an appointment on [**2-7**] in [**Hospital 191**] clinic (see below). You should be seen by the endocrine clinic in two months as well. You have an appointment for this on [**2126-3-18**] as below. You have the following appointment: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15101**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2126-2-7**] 3:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3031**], M.D. Date/Time:[**2126-4-22**] 12:00 Provider: [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 3972**] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2126-3-18**] 1:00

458,507,279,276,285,626,341,244,733,401,V160,V163,V168,300,493

{'Hypotension, unspecified,Pneumonitis due to inhalation of food or vomitus,Other selective immunoglobulin deficiencies,Acidosis,Acute posthemorrhagic anemia,Other disorders of menstruation and other abnormal bleeding from female genital tract,Demyelinating disease of central nervous system, unspecified,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Unspecified essential hypertension,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of other specified malignant neoplasm,Anxiety state, unspecified,Asthma, unspecified type, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Hypotension, fever PRESENT ILLNESS: 57 y/o f with h/o dyemyelinating syndrome, restrictive lung defect FVC 52%, h/o recurrent aspiration pneumonias, s/p G tube placement c/b gastrocutaneous fistula, s/p J tube placement [**4-19**] but removed due to intolerance, who was recently admitted and discharged [**2126-1-9**] after treatment for aspiration pneumonia, now p/w fever, nausea, RLQ pain, and RL back pain x 4 days. The pt states that her RLQ pain is sharp, [**9-24**], intermittent, without alleviating or exacerbating factors, unrelated to position or eating. She does not think her back pain is necessarily related to her RLQ pain. Her nausea has not been accompanied by emesis. The pt states she had a day of watery diarrhea 2 weeks ago accompanied by lower abdominal pain and alleviated with defecation. Over the past 4 days the pt has had a fever up to 107 and up to 103/104 after purchasing a new thermometer. She has had a persistent cough ever since her last discharge, productive of green sputum starting the day PTA. She also c/o nasal congestion starting over the past several days; also she has had decreased po intake x 4 days. Two weeks ago the pt also had an episode of vaginal and rectal bleeding; she is followed by OBGYN Dr. [**First Name (STitle) **] for her h/o vaginal bleeding. Of note, pt states she completed her full course of prednisone and levofloxacin after her last discharge. . In the ED initially she was febrile to 102.6, BP 113/60, then became hypotensive to BP 64/39, not responsive to 4L NS (bp up to only 86/38), unsuccessful IJ attempt, so R femoral line was placed, and levophed at 0.15 was started. With levophed her BP rose to 130/79, so it was titrated down to 0.1. She was also given Levofloxacin, Vancomycin, and Flagyl, as well as combivent nebs and Decadron 10 mg IV x1. MEDICAL HISTORY: -Mod to severe aspiration per S and S eval [**1-20**] -Asthma. -Restrictive lung disease [**1-17**] neuromusc disorder (FEV1 63% of pred, FVC 52% of pred, FEV/FVC 121 of pred) -Demyelinating syndrome (L leg paresis, bilateral arm weakness, demyelination on brain MRI, neurogenic bladder) -History of Adrenal insufficiency though not chronically maintained on prednisone -Osteoporosis. -Hypothyroidism. -History of chest nodules. -Dyslipidemia. -History of breast papilloma with nipple discharge. -Anxiety. -Labile hypertension. -History of right IJ thrombus in [**2112**]. -IgG deficiency. -Anemia. -Status post cholecystectomy in [**2112**]. -Dysfunctional uterine bleeding by history. -Atypical pap smears. -Common bile duct stenosis s/p sphincterotomy. -Gastritis and prepyloric ulcers per EGD. -Bilateral hearing loss. -G-tube placement leading to gastrocutaneous fistula --> removal MEDICATION ON ADMISSION: ADVAIR DISKUS 500-50MCG--Use one puff by mouth twice a day ALBUTEROL 90GM--Take 2 puffs four times a day ALBUTEROL SO4 0.083 %--One neb q 4-6 hrs as needed [**Doctor First Name **] 60MG [**Hospital1 **] BACLOFEN 20 mg TID BUSPIRONE HCL 10MG TID CLONAZEPAM 2 mg TID IPRATROPIUM BROMIDE 14 GM--2-3 puffs inh four times a day LEVOXYL 50MCG qd LIPITOR 10MG--One by mouth every day Ativan 2 mg TID Protonix 40 mg Vit B12 Folate ASA 325 Vit D [**Hospital1 **] 8 mg TID . MEDS on TRANSFER: Vancomycin HCl 1000 mg IV Q 12H Fexofenadine 60 mg PO BID Baclofen 10 mg PO TID Aspirin 325 mg PO DAILY Levothyroxine Sodium 50 mcg PO DAILY BusPIRone 10 mg PO TID Tizanidine HCl 8 mg PO TID Atorvastatin 10 mg PO DAILY Lorazepam 0.5-2 mg PO Q4-6H:PRN Pantoprazole 40 mg PO Q24H Cyanocobalamin 50 mcg PO DAILY Folic Acid 1 mg PO DAILY Vitamin D 400 UNIT PO DAILY Senna 1 TAB PO BID:PRN Docusate Sodium 100 mg PO BID Acetaminophen 325-650 mg PO Q4-6H:PRN Heparin 5000 UNIT SC TID Levofloxacin 500 mg PO Q24H Metronidazole 500 mg PO TID Clonazepam 2 mg PO TID Orabase w/ Benzocaine Paste 1 Appl TP PRN traMADOL 50-100 mg PO Q4-6H:PRN RISS Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN Prednisone 40 mg PO DAILY ALLERGIES: Azmacort / Clindamycin / Versed / Fentanyl / Morphine / Optiray 300 / Ceftriaxone / Clarithromycin PHYSICAL EXAM: PE: T 96.8 HR 81 BP 109/51 R 16-26 Sat 94%2LNC HEENT:ROMI PERRL, face symmetric, MMM, BL maxillary sinus ttp Neck: +HJR, no cervical or supraclavicular LAD CHEST: hyperresonant to percussion throughout, diffuse expiratory wheezing, 1:3 I:E ratio, poor inspiratory effort, decreased breath sounds throughout, diffuse rales CV: RRR, Grade 3/6 SEM LLSB, nl S1/S2 ABD: soft, NABS, voluntary guarding to palpation of epigastrium and RL quadrant, no rebound tenderness, no palpable masses, unable to assess for HSM due to vol. guarding EXT: No edema or rash, extrem warm Neuro: CN II-XII grossly intact, [**3-20**] strenght throughout R arm and R leg, 3/5 L biceps, triceps, and grip strength, 0/5 strength in L leg, a and o x3 FAMILY HISTORY: CAD. Father had [**Name2 (NI) 499**] cancer, her mother had breast cancer, and her sister had brain cancer. SOCIAL HISTORY: Quit tobacco 20 years ago, occ ETOH, no illicits; lives in S. [**Location (un) 86**] with husband and daughter, does not work but does volunteer ### Response: {'Hypotension, unspecified,Pneumonitis due to inhalation of food or vomitus,Other selective immunoglobulin deficiencies,Acidosis,Acute posthemorrhagic anemia,Other disorders of menstruation and other abnormal bleeding from female genital tract,Demyelinating disease of central nervous system, unspecified,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Unspecified essential hypertension,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of other specified malignant neoplasm,Anxiety state, unspecified,Asthma, unspecified type, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 89 year old female with a history of coronary artery disease, hypertension, congestive heart failure and atrial fibrillation, who presents after slipping on the ice while getting into a taxi cab. She fell onto her knees. She did not hit her head. She had no loss of consciousness. She had no residual pain in her knees. The patient also reports over the past two to three days increased shortness of breath with exertion, no chest pain. She does have a cough and has been experiencing chills as well. She has postnasal drip and increased fatigue overall. The patient states she got into the cab, felt short of breath, decided she did not want to go to her final destination and got back out of the cab, tried to walk to the house/apartment, felt short of breath. Some passers-by noticed that she was struggling to walk back to her house and activated EMS. The patient has been coughing up a little bit of white yellow sputum. She reports no nausea, vomiting or diarrhea. She has had some increased difficulty with swallowing liquids by self report over the past couple of weeks. She states "sometimes it just goes down the wrong pipe". MEDICAL HISTORY: 1. History of breast cancer, status post lumpectomy, radiation and treatment with Tamoxifen. 2. History of syncope in [**2158**]. MEDICATION ON ADMISSION: 1. Synthroid. 2. Verapamil. 3. Lasix. 4. Coumadin. 5. Amiodarone. ALLERGIES: Penicillin and Aspirin, reactions are unknown. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: She lives alone. She is very independent. She has a fifty pack year tobacco history.

Bronchopneumonia, organism unspecified,Acute and chronic respiratory failure,Septic shock,Congestive heart failure, unspecified,Cardiac arrest,Paralytic ileus,Cellulitis and abscess of leg, except foot,Asthma, unspecified type, with (acute) exacerbation

Bronchopneumonia org NOS,Acute & chronc resp fail,Septic shock,CHF NOS,Cardiac arrest,Paralytic ileus,Cellulitis of leg,Asthma NOS w (ac) exac

Admission Date: [**2164-12-19**] Discharge Date: [**2164-12-24**] Service: [**Location (un) 259**] HISTORY OF PRESENT ILLNESS: The patient is an 89 year old female with a history of coronary artery disease, hypertension, congestive heart failure and atrial fibrillation, who presents after slipping on the ice while getting into a taxi cab. She fell onto her knees. She did not hit her head. She had no loss of consciousness. She had no residual pain in her knees. The patient also reports over the past two to three days increased shortness of breath with exertion, no chest pain. She does have a cough and has been experiencing chills as well. She has postnasal drip and increased fatigue overall. The patient states she got into the cab, felt short of breath, decided she did not want to go to her final destination and got back out of the cab, tried to walk to the house/apartment, felt short of breath. Some passers-by noticed that she was struggling to walk back to her house and activated EMS. The patient has been coughing up a little bit of white yellow sputum. She reports no nausea, vomiting or diarrhea. She has had some increased difficulty with swallowing liquids by self report over the past couple of weeks. She states "sometimes it just goes down the wrong pipe". REVIEW OF SYSTEMS: No dark stools, no blood in the stools, no urinary symptoms. No history of recent headaches. PAST MEDICAL HISTORY: 1. History of breast cancer, status post lumpectomy, radiation and treatment with Tamoxifen. 2. History of syncope in [**2158**]. ALLERGIES: Penicillin and Aspirin, reactions are unknown. MEDICATIONS ON ADMISSION: 1. Synthroid. 2. Verapamil. 3. Lasix. 4. Coumadin. 5. Amiodarone. SOCIAL HISTORY: She lives alone. She is very independent. She has a fifty pack year tobacco history. FAMILY HISTORY: Noncontributory. PHYSICAL EXAMINATION: On physical examination, her temperature was 98.8 degrees, blood pressure 112/50, heart rate 114, respiratory rate 16, oxygen saturation 93% in room air. The patient was lying in bed, comfortable, breathing with some effort. Head, eyes, ears, nose and throat examination revealed a right surgical pupils, left pupil that was reactive. She had moist mucous membranes. Her neck was supple. She had slightly elevated neck veins. On chest examination, she had end expiratory wheezing heard throughout all lung fields. She had some transmitted upper airway noise as well. Cardiac examination demonstrated an irregular rhythm. Heart sounds were difficult to appreciated secondary to the breathing. The abdomen was obese, nontender, bowel sounds present. Extremities were warm. She had areas of erythema on the right lower extremity, 2+ pitting edema on the right, and 1+ pitting edema on the left. Neurologically, she was alert and oriented times three. Cranial nerves II through XII are intact. Motor strength was [**5-14**] throughout. LABORATORY DATA: On admission, she had a white blood cell count of 4.4, 74% neutrophils, 16% lymphocytes, and 9% monocytes. Her hematocrit was 39.0%. Platelet count 162,000. Her Chem7 revealed her sodium was 133, potassium 3.4, chloride 97, bicarbonate 27, blood urea nitrogen 33, creatinine 1.5, glucose 165. INR was 2.3. Chest x-ray demonstrated no evidence of pneumonia or congestive heart failure by report. Her electrocardiogram showed no acute ST changes and was significant only for atrial fibrillation rhythm. HOSPITAL COURSE: Impression was for an 89 year old woman with a history of coronary artery disease, congestive heart failure and atrial fibrillation on anticoagulation now presenting with a two to three day history of cough, postnasal drip, increased fatigue, shortness of breath. Physical examination was significant for some diffuse wheezing plus right erythematous, edematous lower extremity. In terms of her shortness of breath, she had an interstitial pattern of pulmonary disease on chest x-ray but no overt evidence of pneumonia. The differential diagnosis includes an upper respiratory tract infection versus community acquired pneumonia versus pulmonary embolus versus Amiodarone toxicity versus radiation changes. In terms of possible pulmonary embolism phenomenon, the patient was anticoagulated. Despite that, lower extremity Dopplers were checked and they were both negative for deep vein thrombosis. In terms of her history of radiation exposure and Amiodarone toxicity, we checked a CAT scan of her lungs that showed some new upper zone ground glass opacities of unclear significance but thought possibly to be a superimposed viral infection on top of chronic changes that have previously existed in the lungs. In terms of a possible community acquired pneumonia, we started treating her with Levaquin 250 mg once daily for a ten day course which she tolerated well. We had an incentive spirometer to her bedside. We had the nursing staff perform chest physical therapy with her. Her oxygen saturation remained stable at 94 to 96% on two liters which is unclear, this may possibly be her baseline. In terms of the leg cellulitis, we initially started treating her with Ancef for a ten day course, however, we decided to discontinue the Ancef and just continue the treatment with Levaquin as Levaquin will cover some of the skin flora that may be causing the infection. In terms of her history of coronary artery disease, congestive heart failure, and atrial fibrillation, we continued her Verapamil, Amiodarone and Coumadin. She was also on Lasix 20 mg twice a day which she tolerated well. In terms of her hypothyroidism, we continued her Synthroid. On hospital day two, we had physical therapy staff evaluate the patient and they felt that she was below her baseline in terms of functional mobility and could benefit from a short stay in acute rehabilitation facility. On hospital day three, we had the patient perform a speech and swallow evaluation which showed no evidence of aspiration and normal swallowing physiologic function. CONDITION ON DISCHARGE: The patient was discharged on hospital day six in stable condition. DISCHARGE STATUS: To an acute rehabilitation facility. DISCHARGE DIAGNOSES: 1. Upper respiratory tract infection. 2. Asthma exacerbation. 3. Atrial fibrillation. 4. Hypertension. 5. Coronary artery disease. MEDICATIONS ON DISCHARGE: 1. Albuterol nebulizer solution q4hours. 2. Amiodarone 200 mg p.o. once daily. 3. Docusate 100 mg p.o. twice a day. 4. Furosemide 20 mg p.o. twice a day. 5. Guaifenesin 10ml p.o. q6hours. 6. Lactulose 30 mg p.o. three times a day. 7. Levofloxacin 250 mg p.o. once daily. 8. Synthroid 25 mcg p.o. once daily. 9. Milk of Magnesia 30ml p.o. q6hours p.r.n. as needed. 10. Senna one tablet p.o. twice a day. 11. Verapamil SR 180 mg p.o. q24hours. 12. Warfarin 1 mg p.o. once daily. 13. Trazodone 25 mg p.o. q.h.s. p.r.n. insomnia. FOLLOW-UP PLANS: The patient is to follow-up with her primary care physician within one week. [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D. [**Last Name (un) 59667**] Dictated By:[**Last Name (NamePattern1) 3809**] MEDQUIST36 D: [**2164-12-23**] 15:54 T: [**2164-12-23**] 17:52 JOB#: [**Job Number 104937**] Name: [**Known lastname 3317**], [**Known firstname 1911**] L. Unit No: [**Numeric Identifier 16920**] ADMISSION DATE: [**2164-12-25**] DISCHARGE DATE: [**2165-1-10**] Date of Birth: [**2075-7-18**] SEX: F The following is an addendum to the previous discharge summary which covered the period of hospitalization from admission until [**2164-12-24**]. This addendum will cover the period from [**2164-12-25**] to [**2165-1-10**]. Although the patient was expected to be discharged to an acute rehabilitation facility, her respiratory status worsened and she remained hospitalized. On [**2164-12-27**] a repeat chest CT showed worsening of the left upper lobe, right upper lobe and right lower lobe ground glass opacities. The differential diagnosis included atypical infection and drug/hypersentitivity reaction. On [**2164-12-28**], her ECG showedatrial fibrillationwith a rapid ventricular response, left ventricular hypertrophywith ST-T wave changes. She wasadmitted to the MICU on [**2164-12-30**] with respiratory failure. She was intubated electively on [**2164-12-31**]. On the same day, she underwent a LUL wedge resection, which showed organizing pneumonitis, acute bronchitis/bronchiolitis, of moderate severity, and long-standing interstitial fibrosis. There was no evidence of malignancy. Tissue Gram's stain, and special stains for AFB and fungus are all negative. She was treated with steroids. A Swan-Ganz catheter was placed on [**2165-1-1**] to help monitor her fluid status. Her hypotension was felt to be due to cardiogenic shock, and she was maintained on pressors. While on the ventilator, she developed VAP, for which she received Vancomycin+Ceftazidime. She was unable to be weaned off pressors and ventilatory support. The patient's respiratory status continued to decline and she expired on [**2165-1-10**]. [**First Name8 (NamePattern2) **] [**Name8 (MD) 781**], M.D. [**Last Name (un) 1227**] Dictated By:[**Last Name (NamePattern1) 16921**] MEDQUIST36 D: [**2167-5-29**] T: [**2167-5-29**] Job#:

485,518,785,428,427,560,682,493

{'Bronchopneumonia, organism unspecified,Acute and chronic respiratory failure,Septic shock,Congestive heart failure, unspecified,Cardiac arrest,Paralytic ileus,Cellulitis and abscess of leg, except foot,Asthma, unspecified type, with (acute) exacerbation'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 89 year old female with a history of coronary artery disease, hypertension, congestive heart failure and atrial fibrillation, who presents after slipping on the ice while getting into a taxi cab. She fell onto her knees. She did not hit her head. She had no loss of consciousness. She had no residual pain in her knees. The patient also reports over the past two to three days increased shortness of breath with exertion, no chest pain. She does have a cough and has been experiencing chills as well. She has postnasal drip and increased fatigue overall. The patient states she got into the cab, felt short of breath, decided she did not want to go to her final destination and got back out of the cab, tried to walk to the house/apartment, felt short of breath. Some passers-by noticed that she was struggling to walk back to her house and activated EMS. The patient has been coughing up a little bit of white yellow sputum. She reports no nausea, vomiting or diarrhea. She has had some increased difficulty with swallowing liquids by self report over the past couple of weeks. She states "sometimes it just goes down the wrong pipe". MEDICAL HISTORY: 1. History of breast cancer, status post lumpectomy, radiation and treatment with Tamoxifen. 2. History of syncope in [**2158**]. MEDICATION ON ADMISSION: 1. Synthroid. 2. Verapamil. 3. Lasix. 4. Coumadin. 5. Amiodarone. ALLERGIES: Penicillin and Aspirin, reactions are unknown. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: She lives alone. She is very independent. She has a fifty pack year tobacco history. ### Response: {'Bronchopneumonia, organism unspecified,Acute and chronic respiratory failure,Septic shock,Congestive heart failure, unspecified,Cardiac arrest,Paralytic ileus,Cellulitis and abscess of leg, except foot,Asthma, unspecified type, with (acute) exacerbation'}

CHIEF COMPLAINT: hypotension PRESENT ILLNESS: HPI: 78 year old female with chief complaint of unresponsiveness at [**Hospital3 **] facility. Per report, she was arousable to shaking. At the time, she was found to have coarse breath sounds, coughing concerning for aspiration. She was sent to ED and while in transport she was hypoxic, placed on NRB and sat inproved to mid 80's. . In ED, T 98.2; HR 86; BP 159/61; RR18; 64% RA which improved to 80's on NRB. CXR revealed RLL infiltrate and she was started on Levaquin and clindamycin. Her BP dropped to 80's and given 4L fluid with persistent hypotension in 80's and was started on levophed, lactate 6.6. A L IJ was placed for access. . By transfer to ICU, she was off pressors. She is oriented to self and hospital, but not able to give significantly more history of why she is in hospital. She states that her breathing is at baseline and denies SOB. She denies CP, fever, chills, abd pain, diarrhea. She did have emesis but denies vomiting. Per son, went out for [**Name (NI) **] dinner, ate a big piece of steak tips and choked and vomited after eating. Son stayed with her at [**Hospital3 **] but she continue to cough. This AM, noted to be pale and tachypneic. Did get flu shot MEDICAL HISTORY: Past Medical History: Alzheimer dementia DMI HTN h/o duodenal ulcer PVDZ . MEDICATION ON ADMISSION: lipitor 80 daily plavix 75 daily aggrenox 200-25 [**Hospital1 **] exelon 6 mg [**Hospital1 **] namenda 5 mg [**Hospital1 **] caltrate 600 mg [**Hospital1 **] Fosamax 70 weekly iron zestril 10 daily MVI remeron 30 mg QHS insulin NPH 13 U QAM 13U QPM insulin regular 4U [**Hospital1 **] ALLERGIES: Codeine / Niacin PHYSICAL EXAM: PE: T100.2 ax 108/47 106 33 88% on NRB O2 Sats Gen: alert, oriented to person and hospital (per son, she is at baseline); yellow emesis on lips; pursed lip HEENT: with teeth, emesis NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or [**Last Name (un) 549**] LUNGS: crackles bilaterally ABD: Soft, NT, ND. hypoactive BS. No HSM EXT: No edema. 2+ DP pulses BL SKIN: ecchymosis on R back NEURO: CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**1-6**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred FAMILY HISTORY: NC . SOCIAL HISTORY: Lives at [**Location 35689**] House [**Hospital3 400**]. Denies Tob, EtOH, Illicit drug; son, [**Name (NI) **], very involved in care. .

Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension

Septicemia NOS,Septic shock,Food/vomit pneumonitis,Severe sepsis,Alzheimer's disease,Dementia w/o behav dist,DMII wo cmp nt st uncntr,Hypertension NOS

Admission Date: [**2168-3-28**] Discharge Date: [**2168-3-30**] Date of Birth: [**2089-12-27**] Sex: F Service: MEDICINE Allergies: Codeine / Niacin Attending:[**First Name3 (LF) 3556**] Chief Complaint: hypotension Major Surgical or Invasive Procedure: None History of Present Illness: HPI: 78 year old female with chief complaint of unresponsiveness at [**Hospital3 **] facility. Per report, she was arousable to shaking. At the time, she was found to have coarse breath sounds, coughing concerning for aspiration. She was sent to ED and while in transport she was hypoxic, placed on NRB and sat inproved to mid 80's. . In ED, T 98.2; HR 86; BP 159/61; RR18; 64% RA which improved to 80's on NRB. CXR revealed RLL infiltrate and she was started on Levaquin and clindamycin. Her BP dropped to 80's and given 4L fluid with persistent hypotension in 80's and was started on levophed, lactate 6.6. A L IJ was placed for access. . By transfer to ICU, she was off pressors. She is oriented to self and hospital, but not able to give significantly more history of why she is in hospital. She states that her breathing is at baseline and denies SOB. She denies CP, fever, chills, abd pain, diarrhea. She did have emesis but denies vomiting. Per son, went out for [**Name (NI) **] dinner, ate a big piece of steak tips and choked and vomited after eating. Son stayed with her at [**Hospital3 **] but she continue to cough. This AM, noted to be pale and tachypneic. Did get flu shot Past Medical History: Past Medical History: Alzheimer dementia DMI HTN h/o duodenal ulcer PVDZ . Social History: Lives at [**Location 35689**] House [**Hospital3 400**]. Denies Tob, EtOH, Illicit drug; son, [**Name (NI) **], very involved in care. . Family History: NC . Physical Exam: PE: T100.2 ax 108/47 106 33 88% on NRB O2 Sats Gen: alert, oriented to person and hospital (per son, she is at baseline); yellow emesis on lips; pursed lip HEENT: with teeth, emesis NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or [**Last Name (un) 549**] LUNGS: crackles bilaterally ABD: Soft, NT, ND. hypoactive BS. No HSM EXT: No edema. 2+ DP pulses BL SKIN: ecchymosis on R back NEURO: CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**1-6**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred Pertinent Results: CXR: Pulmonary edema, superimposed infection cannot be excluded. Follow up after diuresis. . EKG: sinus tachy, nl axis, nl intervals, RBBB, no ST or TW changes. . [**2167**] Echo: EF 65%, The left atrium is elongated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is 0-5mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Transmitral Doppler and tissue velocity imaging are consistent with Grade I (mild) LV diastolic dysfunction. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened. There is mild aortic valve stenosis (area 1.2-1.9cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The tricuspid valve leaflets are mildly thickened. The pulmonary artery systolic pressure could not be determined. There is a very small pericardial effusion (mostly around right atrium. No evidence for tamponade. Brief Hospital Course: Patients respiratory status continued to decline. She was DNR/DNI on admission and was made CMO. She expired on [**2168-3-30**]. Brief hospital Course: 1. Hypoxia: She came in with likely aspiration Pna vs pneumonitis given history of choking, and the team also considered and trated for CAP. CHF is a possibility given congestion seen on CXR, although overall, she did not seem total body overloaded based on CVP and exam, Given moderate AS (valve area 1.2-1.9), she is at risk for poor forward flow. DFA negative for influenza. She was continued on a non rebreather and desaturated on that and was switched to noninvasive ventilation wiht CPAP. She was intially given clindamycin and levaquin as well as Vancomycin in the ED. On the [**Hospital Unit Name 153**] she was on zosyn and flagyl. She continued to desaturate on CPAP and was made CMO 2. Septic shock: Patient was briefly on levophed for blood pressure control, but this was weaned off quickly. Her cultures remained negative. 3. Bandemia: may be from pna, but given hypoactive bowel sounds and ? diarrhea per family, also concern for c. diff. She was emperically treated with flagyl 4. HTN: hypotensive intially, and antihypertensives were stopped. Medications on Admission: lipitor 80 daily plavix 75 daily aggrenox 200-25 [**Hospital1 **] exelon 6 mg [**Hospital1 **] namenda 5 mg [**Hospital1 **] caltrate 600 mg [**Hospital1 **] Fosamax 70 weekly iron zestril 10 daily MVI remeron 30 mg QHS insulin NPH 13 U QAM 13U QPM insulin regular 4U [**Hospital1 **] Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: Aspiration pneumonia Discharge Condition: Expired Discharge Instructions: Patient expired. Followup Instructions: Patient expired. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**] Completed by:[**2168-4-13**]

038,785,507,995,331,294,250,401

{"Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: hypotension PRESENT ILLNESS: HPI: 78 year old female with chief complaint of unresponsiveness at [**Hospital3 **] facility. Per report, she was arousable to shaking. At the time, she was found to have coarse breath sounds, coughing concerning for aspiration. She was sent to ED and while in transport she was hypoxic, placed on NRB and sat inproved to mid 80's. . In ED, T 98.2; HR 86; BP 159/61; RR18; 64% RA which improved to 80's on NRB. CXR revealed RLL infiltrate and she was started on Levaquin and clindamycin. Her BP dropped to 80's and given 4L fluid with persistent hypotension in 80's and was started on levophed, lactate 6.6. A L IJ was placed for access. . By transfer to ICU, she was off pressors. She is oriented to self and hospital, but not able to give significantly more history of why she is in hospital. She states that her breathing is at baseline and denies SOB. She denies CP, fever, chills, abd pain, diarrhea. She did have emesis but denies vomiting. Per son, went out for [**Name (NI) **] dinner, ate a big piece of steak tips and choked and vomited after eating. Son stayed with her at [**Hospital3 **] but she continue to cough. This AM, noted to be pale and tachypneic. Did get flu shot MEDICAL HISTORY: Past Medical History: Alzheimer dementia DMI HTN h/o duodenal ulcer PVDZ . MEDICATION ON ADMISSION: lipitor 80 daily plavix 75 daily aggrenox 200-25 [**Hospital1 **] exelon 6 mg [**Hospital1 **] namenda 5 mg [**Hospital1 **] caltrate 600 mg [**Hospital1 **] Fosamax 70 weekly iron zestril 10 daily MVI remeron 30 mg QHS insulin NPH 13 U QAM 13U QPM insulin regular 4U [**Hospital1 **] ALLERGIES: Codeine / Niacin PHYSICAL EXAM: PE: T100.2 ax 108/47 106 33 88% on NRB O2 Sats Gen: alert, oriented to person and hospital (per son, she is at baseline); yellow emesis on lips; pursed lip HEENT: with teeth, emesis NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or [**Last Name (un) 549**] LUNGS: crackles bilaterally ABD: Soft, NT, ND. hypoactive BS. No HSM EXT: No edema. 2+ DP pulses BL SKIN: ecchymosis on R back NEURO: CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**1-6**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred FAMILY HISTORY: NC . SOCIAL HISTORY: Lives at [**Location 35689**] House [**Hospital3 400**]. Denies Tob, EtOH, Illicit drug; son, [**Name (NI) **], very involved in care. . ### Response: {"Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Severe sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension"}

CHIEF COMPLAINT: slurred speech, vomiting PRESENT ILLNESS: 80 yo M with PMH of htpertension and dyslipidemia who was last seen well by his wife at 6:30 this morning when he left with the dog for a walk and to buy the newspaper. About one hour later she heard the knob moving several times without success to open the door from outside. She opened the door and found Mr. [**Known lastname **] sitting down on the step with a very slurred speech. He also vomitted at this time. He could not stand up, however, she did not notice which side of the body was weak. She called 911 and he was taken to [**Hospital3 **] where he was found to have slurred speech, left facial droop and left hemiparesis. His vitals there were: T 97.5 HR 96 BP 148/79 Sat 97%. Head CT showed old R frontal infarct and suspicion for R MCA stroke. NIHSS there: 16. He received tPA at 8:30 am. He was also found to have pneumonia and was started on ceftriaxone and azythromycin. His EKG showed sinus rythm, @92, Right BBB. MEDICAL HISTORY: -HTN -Dyslipidemia MEDICATION ON ADMISSION: -aspirin 81mg -hydrochlrothiazide (unknown dose) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T-97.5 BP-148/79 HR-96 RR-18 91%O2Sat on 3L Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: unknown SOCIAL HISTORY: retired, used to be an electrial engineer, no hx of smoking or alcohol abuse. His wife reports he has been more forgetful for the past years, however, he continues to perform his daily activities regularly.

Cerebral embolism with cerebral infarction,Acute respiratory failure,Pneumonia, organism unspecified,Unspecified protein-calorie malnutrition,Atrial flutter,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Facial weakness,Long-term (current) use of anticoagulants,Muscle weakness (generalized),Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility

Crbl emblsm w infrct,Acute respiratry failure,Pneumonia, organism NOS,Protein-cal malnutr NOS,Atrial flutter,Hypertension NOS,Hyperlipidemia NEC/NOS,Facial weakness,Long-term use anticoagul,Muscle weakness-general,TPA adm status 24 hr pta

Admission Date: [**2130-3-1**] Discharge Date: [**2130-3-14**] Date of Birth: [**2049-7-13**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1838**] Chief Complaint: slurred speech, vomiting Major Surgical or Invasive Procedure: Tracheostomy, PEG placement History of Present Illness: 80 yo M with PMH of htpertension and dyslipidemia who was last seen well by his wife at 6:30 this morning when he left with the dog for a walk and to buy the newspaper. About one hour later she heard the knob moving several times without success to open the door from outside. She opened the door and found Mr. [**Known lastname **] sitting down on the step with a very slurred speech. He also vomitted at this time. He could not stand up, however, she did not notice which side of the body was weak. She called 911 and he was taken to [**Hospital3 **] where he was found to have slurred speech, left facial droop and left hemiparesis. His vitals there were: T 97.5 HR 96 BP 148/79 Sat 97%. Head CT showed old R frontal infarct and suspicion for R MCA stroke. NIHSS there: 16. He received tPA at 8:30 am. He was also found to have pneumonia and was started on ceftriaxone and azythromycin. His EKG showed sinus rythm, @92, Right BBB. Past Medical History: -HTN -Dyslipidemia Social History: retired, used to be an electrial engineer, no hx of smoking or alcohol abuse. His wife reports he has been more forgetful for the past years, however, he continues to perform his daily activities regularly. Family History: unknown Physical Exam: T-97.5 BP-148/79 HR-96 RR-18 91%O2Sat on 3L Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema Neurologic examination: Mental status: Awake, eyes closed. Oriented to person, place, and date. Dysarthric; naming intact; non-fluent. Good comprehension, follows commands such as squeezing hands but did not open his eyes spontaneously during the whole exam. Cranial Nerves: Pupils equally round and reactive to light, 4 to 2 mm bilaterally. Visual fields are full to confrontation. Extraocular movements intact bilaterally, no nystagmus. Decreased sensation on left fave V2-V3. Left facial weakness UMN pattern. Hearing intact to finger rub bilaterally. Palate elevation symmetrical. Sternocleidomastoid and trapezius normal bilaterally. Tongue midline, movements intact Motor: [**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IP H Q DF PF TE TF R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Triple flexion on left leg on noxious stimuli; no movement on left arm. Sensation: Decreased sensation to light touch, temperature on left arm and leg Reflexes: Biceps 1+ BL; triceps 1+ BL; patellar 2+ on left and 1+ on right side; achilles 1+ BL. Toes upgoing bilaterally Coordination: Patient did not cooperate with finger tapping or finger to nose exam Pertinent Results: [**2130-3-7**] 02:34AM BLOOD WBC-7.4 RBC-3.90* Hgb-12.5* Hct-34.9* MCV-90 MCH-31.9 MCHC-35.7* RDW-14.3 Plt Ct-174 [**2130-3-6**] 12:54AM BLOOD WBC-10.1 RBC-3.89* Hgb-12.5* Hct-34.4* MCV-88 MCH-32.1* MCHC-36.3* RDW-14.3 Plt Ct-166 [**2130-3-5**] 01:39AM BLOOD WBC-10.6 RBC-4.01* Hgb-12.7* Hct-35.5* MCV-89 MCH-31.6 MCHC-35.7* RDW-14.3 Plt Ct-141* [**2130-3-4**] 02:10AM BLOOD WBC-11.0 RBC-3.83* Hgb-12.4* Hct-34.7* MCV-91 MCH-32.4* MCHC-35.8* RDW-14.0 Plt Ct-141* [**2130-3-3**] 02:12AM BLOOD WBC-11.3* RBC-4.02* Hgb-13.0* Hct-36.3* MCV-90 MCH-32.4* MCHC-35.8* RDW-14.7 Plt Ct-139* [**2130-3-2**] 12:28AM BLOOD WBC-16.3* RBC-4.65 Hgb-14.6 Hct-42.4 MCV-91 MCH-31.4 MCHC-34.4 RDW-14.5 Plt Ct-168 [**2130-3-1**] 03:21PM BLOOD WBC-14.7* RBC-5.04 Hgb-16.0 Hct-46.2 MCV-92 MCH-31.7 MCHC-34.5 RDW-14.2 Plt Ct-195 [**2130-3-4**] 02:10AM BLOOD Neuts-84.4* Lymphs-9.6* Monos-5.7 Eos-0.3 Baso-0.1 [**2130-3-7**] 02:34AM BLOOD PT-13.9* PTT-40.7* INR(PT)-1.2* [**2130-3-6**] 12:54AM BLOOD PT-14.3* PTT-42.4* INR(PT)-1.2* [**2130-3-5**] 08:22AM BLOOD PT-13.8* PTT-33.2 INR(PT)-1.2* [**2130-3-4**] 04:10PM BLOOD PT-13.3 PTT-60.5* INR(PT)-1.1 [**2130-3-4**] 10:21AM BLOOD PT-13.7* PTT-55.5* INR(PT)-1.2* [**2130-3-3**] 02:12AM BLOOD PT-14.9* PTT-33.6 INR(PT)-1.3* [**2130-3-1**] 03:21PM BLOOD PT-14.9* PTT-32.7 INR(PT)-1.3* [**2130-3-7**] 02:34AM BLOOD Glucose-124* UreaN-30* Creat-0.7 Na-136 K-4.0 Cl-101 HCO3-29 AnGap-10 [**2130-3-6**] 12:54AM BLOOD Glucose-119* UreaN-25* Creat-0.8 Na-137 K-3.6 Cl-101 HCO3-28 AnGap-12 [**2130-3-5**] 01:05PM BLOOD Glucose-114* UreaN-25* Creat-0.8 Na-136 K-3.6 Cl-101 HCO3-26 AnGap-13 [**2130-3-5**] 01:39AM BLOOD Glucose-116* UreaN-27* Creat-0.8 Na-133 K-4.7 Cl-99 HCO3-26 AnGap-13 [**2130-3-4**] 04:10PM BLOOD Glucose-122* UreaN-27* Creat-0.7 Na-137 K-3.5 Cl-102 HCO3-26 AnGap-13 [**2130-3-4**] 02:10AM BLOOD Glucose-136* UreaN-29* Creat-0.8 Na-135 K-3.7 Cl-104 HCO3-25 AnGap-10 [**2130-3-3**] 02:12AM BLOOD Glucose-99 UreaN-27* Creat-0.9 Na-136 K-4.2 Cl-105 HCO3-24 AnGap-11 [**2130-3-2**] 10:39PM BLOOD Glucose-116* UreaN-26* Creat-0.9 Na-138 K-4.2 Cl-106 HCO3-26 AnGap-10 [**2130-3-2**] 02:06PM BLOOD Glucose-119* UreaN-30* Creat-1.0 Na-138 K-4.3 Cl-104 HCO3-25 AnGap-13 [**2130-3-2**] 12:28AM BLOOD Glucose-153* UreaN-34* Creat-1.3* Na-139 K-4.9 Cl-106 HCO3-22 AnGap-16 [**2130-3-1**] 03:21PM BLOOD Glucose-145* UreaN-33* Creat-1.2 Na-141 K-4.5 Cl-102 HCO3-26 AnGap-18 [**2130-3-3**] 02:12AM BLOOD CK(CPK)-104 [**2130-3-2**] 08:32PM BLOOD CK(CPK)-111 [**2130-3-2**] 02:06PM BLOOD CK(CPK)-127 [**2130-3-2**] 08:55AM BLOOD CK(CPK)-143 [**2130-3-2**] 12:28AM BLOOD CK(CPK)-121 [**2130-3-3**] 02:12AM BLOOD CK-MB-7 cTropnT-0.23* [**2130-3-2**] 08:32PM BLOOD CK-MB-7 cTropnT-0.23* [**2130-3-2**] 02:06PM BLOOD CK-MB-9 cTropnT-0.25* [**2130-3-2**] 08:55AM BLOOD CK-MB-11* MB Indx-7.7* cTropnT-0.23* [**2130-3-2**] 12:28AM BLOOD cTropnT-0.23* [**2130-3-1**] 03:21PM BLOOD CK-MB-9 cTropnT-0.18* [**2130-3-7**] 02:34AM BLOOD Calcium-8.3* Phos-3.0 Mg-2.0 [**2130-3-6**] 12:54AM BLOOD Calcium-8.2* Phos-4.1 Mg-2.0 [**2130-3-5**] 01:39AM BLOOD Calcium-8.3* Phos-3.2 Mg-1.9 [**2130-3-4**] 04:10PM BLOOD Calcium-8.4 Mg-1.8 [**2130-3-4**] 02:10AM BLOOD Calcium-8.0* Phos-2.0* Mg-2.0 [**2130-3-3**] 02:12AM BLOOD Calcium-8.2* Phos-2.2* Mg-2.2 [**2130-3-2**] 02:06PM BLOOD Calcium-8.4 Phos-2.8# Mg-2.0 [**2130-3-2**] 12:28AM BLOOD Calcium-8.6 Phos-4.5 Mg-2.0 [**2130-3-1**] 03:21PM BLOOD Calcium-9.3 Phos-4.3 Mg-1.9 Cholest-216* [**2130-3-1**] 03:21PM BLOOD Triglyc-97 HDL-58 CHOL/HD-3.7 LDLcalc-139* [**2130-3-7**] 08:45AM BLOOD Osmolal-284 [**2130-3-6**] 06:10PM BLOOD Osmolal-287 [**2130-3-6**] 05:50AM BLOOD Osmolal-289 [**2130-3-6**] 12:54AM BLOOD Osmolal-286 [**2130-3-5**] 07:56PM BLOOD Osmolal-286 [**2130-3-5**] 01:05PM BLOOD Osmolal-286 [**2130-3-5**] 07:34AM BLOOD Osmolal-286 [**2130-3-5**] 01:39AM BLOOD Osmolal-284 [**2130-3-6**] 05:50AM BLOOD Vanco-8.7* [**2130-3-4**] 06:32AM BLOOD Vanco-14.1 [**2130-3-3**] 06:19AM BLOOD Vanco-13.3 CTA Head/Neck [**2130-3-1**]: IMPRESSION: 1. Subtle loss of [**Doctor Last Name 352**]-white matter differentiation in the right frontal lobe and right insula consistent with right MCA occlusion. 2. Above findings are corroborated by CTA findings of complete occlusion of the right ICA and M1 segment of right MCA. 3. Secretions within the trachea and left mainstem bronchus with associated ground glass opacity within the dependent portions of the visualized upper and superior segment of the lower lobes bilaterally which raises the possibility of aspiration. 4. Mild pulmonary edema. 5. Multiple sub-4-mm pulmonary nodules for which no followup is needed if there is no history of malignancy. MRI Brain [**2130-3-2**]: IMPRESSION: 1. Significant increase in the size of the previously noted right MCA territory infarct, which now involves the entire right middle cerebral artery territory including the basal ganglia and internal capsule with mild-to- moderate mass effect on the right lateral ventricle. No acute hemorrhage within. 2. Two punctate foci of increased DWI signal in the occipital lobes, in the cortex, are of uncertain significance, and too small to be accurately characterized. Attention can be paid to this on followup study. 3. Non-visualization of flow void in the supraclinoid ICA, MCA on the right side, representing the known occlusion. Dedicated MRA not performed on the present study. 4. Paranasal sinus disease as described above. NCHCT [**2130-3-2**]: IMPRESSION: 1. Increase in the right MCA territory area of infarction, with mild mass effect on the right lateral ventricle. 2. No acute hemorrhage. 3. Unchanged appearance of the dense right middle cerebral artery consistent with thrombus within. Please note that dedicated CT is not performed on the present study. 4.Paranasal sinus disease as above NCHCT [**2130-3-3**]: IMPRESSION: 1. Evolving right MCA infarct with increased edema and mass effect with new shift of the normally midline structures leftward. No hemorrhagic transformation or herniation. 2. New right PCA infarct. NCHCT [**2130-3-4**]: IMPRESSION: Continued evolution of right MCA and right PCA territory infarction with continued slight increased edema and mass effect on the right lateral ventricle with slight increase in leftward shift of normally midline structures. No new hemorrhagic transformation seen. There is likely early right subfalcine herniation. NCHCT [**2130-3-6**]: IMPRESSION: Continued evolution of right MCA and PCA territory infarction with slightly worsened mass effect including increase in leftward shift. Carotid U/S [**2130-3-6**]: IMPRESSION: 1. High-resistance flow in the right internal carotid artery without diastolic flow consistent with the distal right internal carotid artery occlusion seen on the CT of [**2130-3-1**]. The degree of stenosis in the proximal right internal carotid artery is mild with non elevated peak systolic velocities although the exact degree of proximal stenosis is difficult to quantitate due to the presence of the distal occlusion 2. Less than 40% stenosis in the left internal carotid artery. TTE [**2130-3-1**]: The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe global left ventricular hypokinesis with relative preservation of the basal anterior and basal inferolateral walls (LVEF = 25 %). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size is normal with hypokinesis of the apical free wall. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets are mildly thickened. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is mild-moderate pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Mild symmetric left ventricular hypertrophy with severe global hypokinesis. Right ventricular free wall hypokinesis. Mild aortic regurgtitation. Mild mitral regurgitation. Pulmonary artery systolic hypertension. Dilated aortic root. In the absence of a history of systemic hypertension, an infiltrative process (e.g., amyloid, [**Location (un) 4223**]-Fabry's disease) should be considered. Brief Hospital Course: This 80 M was evaluated at [**Hospital1 18**] [**Location (un) 620**] for dysarthria and vomiting and found to have a large R-MCA stroke. He was given IV tPa and was transferred to [**Hospital1 18**] for futher care. He was admitted to the ICU. His CTA showed complete occlusion of the R-ICA and proximal segment of M1 branch of the R-MCA. Over the course of 3 days he developed significant edema and swelling. He was started on mannitol on [**3-4**] and this was weaned to off by [**3-7**] as his subsequent head CT's stabilized. He sustained a new small R-PCA stroke on [**3-3**]. He was found to have atrial fibrillation. At times he also has atrial flutter. Mr. [**Known lastname **] was started on heparin with a goal PTT of 40-60. He was then started on coumadin on [**3-6**]. He had a surface echo which showed no thrombus or atheroma, but was notable for an EF of 25%. His course was complicated by a suspicion for PNA, and he received a 2-week course of cipro. He recevied a tracheostomy and PEG tube on [**2130-3-6**]. He was transferred to the Step-Down Unit on [**3-8**], at which time, his exam was notable for ongoing flaccid left hemiparesis and eyelid apraxia. While on the Stroke floor he has been clinically stable with no significant events. He became therapeutic on coumadin and his heparin drip was stopped. Medications on Admission: -aspirin 81mg -hydrochlrothiazide (unknown dose) Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Aspirin 300 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily). 3. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 3 days. 4. Docusate Sodium 50 mg/5 mL Liquid Sig: Two (2) PO BID (2 times a day). 5. Senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a day) as needed. 6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed. 7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 8. Metoprolol Tartrate 100 mg Tablet Sig: 1.25 Tablets PO three times a day. 9. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed. 10. Metoprolol Tartrate 10 mg IV Q6 HR PRN sbp>160 11. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Left MCA/PCA infarct Discharge Condition: Stable Discharge Instructions: You were admitted because of a large stroke affecting the left side of your brain. You will need to go to a rehab facility for continuation of your therapies. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2130-6-13**] 11:00 Please call your PMD for a referral and then call Dr. [**First Name (STitle) **] prior to your visit

434,518,486,263,427,401,272,781,V586,728,V458

{'Cerebral embolism with cerebral infarction,Acute respiratory failure,Pneumonia, organism unspecified,Unspecified protein-calorie malnutrition,Atrial flutter,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Facial weakness,Long-term (current) use of anticoagulants,Muscle weakness (generalized),Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: slurred speech, vomiting PRESENT ILLNESS: 80 yo M with PMH of htpertension and dyslipidemia who was last seen well by his wife at 6:30 this morning when he left with the dog for a walk and to buy the newspaper. About one hour later she heard the knob moving several times without success to open the door from outside. She opened the door and found Mr. [**Known lastname **] sitting down on the step with a very slurred speech. He also vomitted at this time. He could not stand up, however, she did not notice which side of the body was weak. She called 911 and he was taken to [**Hospital3 **] where he was found to have slurred speech, left facial droop and left hemiparesis. His vitals there were: T 97.5 HR 96 BP 148/79 Sat 97%. Head CT showed old R frontal infarct and suspicion for R MCA stroke. NIHSS there: 16. He received tPA at 8:30 am. He was also found to have pneumonia and was started on ceftriaxone and azythromycin. His EKG showed sinus rythm, @92, Right BBB. MEDICAL HISTORY: -HTN -Dyslipidemia MEDICATION ON ADMISSION: -aspirin 81mg -hydrochlrothiazide (unknown dose) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T-97.5 BP-148/79 HR-96 RR-18 91%O2Sat on 3L Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: unknown SOCIAL HISTORY: retired, used to be an electrial engineer, no hx of smoking or alcohol abuse. His wife reports he has been more forgetful for the past years, however, he continues to perform his daily activities regularly. ### Response: {'Cerebral embolism with cerebral infarction,Acute respiratory failure,Pneumonia, organism unspecified,Unspecified protein-calorie malnutrition,Atrial flutter,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Facial weakness,Long-term (current) use of anticoagulants,Muscle weakness (generalized),Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility'}

CHIEF COMPLAINT: RLE stump wound infection, urinary tract infection and altered mental status PRESENT ILLNESS: Mr. [**Known lastname **] is a 56 year-old man with a history of kidney transplant x 2, DM, bilateral BKA with RLE non-healing ulcer (right BKA in [**2144-5-21**]), who presents from rehab with AMS. Of note, he was recently discharged on [**2144-6-13**] after being admitted with a CHF exacerbation; at that time, he also had a wound VAC placed on his right stump and was treated with two weeks of vancomycin for an enterococcus wound infection. He was doing well at his nursing home until the day prior to admission when he was noted to have worsening mental status. He was also found to have a UTI and was started on imipenem. On the day of admission, he was found standing next to his bed on his stumps and was combative and noncooperative with nursing home staff, pulling out both his PICC and foley. He was then transferred to the ED for further evaulation. . In the ED, initial vs were: T 99.2 P 51 BP 141/83 R 18 O2 97%ra sat. He was given vancomycin and zosyn, later spiked a temperature to 102.9 rectal which resolved with PR tylenol, and was placed in wrist restraints for combativeness. His right BKA was draining purulent material and vascular was consulted, with a recommendation to start broad spectrum antibiotics. He was also noted to have diarrhea and an abdominal CT was performed to rule out colitis or an abdominal process, with an initial read that was negative. Because of his history of VRE, he was also given linezolid and then ceftriaxone 2g/acyclovir 50 mg x 1 to cover for meningitis. An LP was attempted (3 passes) but was unsuccessful. He was admitted to the MICU because of his severe agitation and concern that he would fail management on the floor. . On the floor, he was agitated but intermittently cooperative with interview and exam. MEDICAL HISTORY: - CHF with Known EF 25-35% - PVDF with a right foot nonhealing ulcer s/p right SFA-to-DP bypass graft, a nonreverse saphenous vein in [**2134**], a left BKA in [**2133**], R BKA [**2144-5-21**] - ESRD secondary to his diabetes s/p failed LLRT in [**2116**], second MEDICATION ON ADMISSION: Loperamide 2 mg PO q8hr Flomax 0.4mg PO qHS Atorvastatin 20mg PO Daily Finasteride 5mg PO Daily Sirolimus 1mg PO Daily Aspirin 81mg PO Daily Metoprolol 12.5 mg PO BID Isosorbide mononitrate 60mg PO Daily Pantoprazole 40mg PO Daily Furosemide 80mg IV Daily Furosemide 40mg PO Daily Tacrolimus 2mg PO BID Morphine 4-8mg IV prn pain Prednisone 4mg PO Daily KCl 20 mEq PO Daily Alprazolam 0.5mg PO TID Percocet q6hr prn Glargine 8u SQ Daily Lispro ISS Pacrelipase 1cap PO w/ meals and qHS Imipenem 500mg IV q8hr Haldol 5mg PO q4hr prn ALLERGIES: Coreg PHYSICAL EXAM: Vitals: T: 98 BP: 128/70 P: 80 R: 18 O2: 97%ra General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: 2+ RLE edemma, no edema LLE. R BKA stump with erythema, s/p vac dressing removal, 3 cm ulcerated wound on anterior stump, base of stump also with ulcertation, erythema, and purulent vs fibrinous appearing material. FAMILY HISTORY: M: Colon Ca F: Prostate Ca SOCIAL HISTORY: Lives alone, recently in a rehab facility. Has an intermittent smoking history of approximately 20-30 packyears. Smoked 1 cigarette today. Denies EtOH or other drug use.

Unspecified septicemia,Acute kidney failure, unspecified,Infection (chronic) of amputation stump,Unspecified osteomyelitis, lower leg,Urinary tract infection, site not specified,Cellulitis and abscess of leg, except foot,Complications of transplanted kidney,Ulcer of other part of lower limb,Chronic systolic heart failure,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled,Background diabetic retinopathy,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction,Other chronic pulmonary heart diseases,Chronic kidney disease, unspecified,Below knee amputation status,Esophageal reflux,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Diarrhea

Septicemia NOS,Acute kidney failure NOS,Infection amputat stump,Osteomyelitis NOS-l/leg,Urin tract infection NOS,Cellulitis of leg,Compl kidney transplant,Ulcer oth part low limb,Chr systolic hrt failure,Severe sepsis,Athscl extrm ntv art NOS,DMI ophth uncntrld,Diabetic retinopathy NOS,Neuropathy in diabetes,Crnry athrscl natve vssl,Status-post ptca,Hx TIA/stroke w/o resid,Old myocardial infarct,Chr pulmon heart dis NEC,Chronic kidney dis NOS,Status amput below knee,Esophageal reflux,Long-term use of insulin,Hyperlipidemia NEC/NOS,Diarrhea

Admission Date: [**2144-6-27**] Discharge Date: [**2144-7-8**] Date of Birth: [**2088-4-18**] Sex: M Service: MEDICINE Allergies: Coreg Attending:[**First Name3 (LF) 2641**] Chief Complaint: RLE stump wound infection, urinary tract infection and altered mental status Major Surgical or Invasive Procedure: [**2144-7-6**] debridement, primary closure R BKA [**2144-7-1**] debridement right BK stump failed lumbar puncture times three History of Present Illness: Mr. [**Known lastname **] is a 56 year-old man with a history of kidney transplant x 2, DM, bilateral BKA with RLE non-healing ulcer (right BKA in [**2144-5-21**]), who presents from rehab with AMS. Of note, he was recently discharged on [**2144-6-13**] after being admitted with a CHF exacerbation; at that time, he also had a wound VAC placed on his right stump and was treated with two weeks of vancomycin for an enterococcus wound infection. He was doing well at his nursing home until the day prior to admission when he was noted to have worsening mental status. He was also found to have a UTI and was started on imipenem. On the day of admission, he was found standing next to his bed on his stumps and was combative and noncooperative with nursing home staff, pulling out both his PICC and foley. He was then transferred to the ED for further evaulation. . In the ED, initial vs were: T 99.2 P 51 BP 141/83 R 18 O2 97%ra sat. He was given vancomycin and zosyn, later spiked a temperature to 102.9 rectal which resolved with PR tylenol, and was placed in wrist restraints for combativeness. His right BKA was draining purulent material and vascular was consulted, with a recommendation to start broad spectrum antibiotics. He was also noted to have diarrhea and an abdominal CT was performed to rule out colitis or an abdominal process, with an initial read that was negative. Because of his history of VRE, he was also given linezolid and then ceftriaxone 2g/acyclovir 50 mg x 1 to cover for meningitis. An LP was attempted (3 passes) but was unsuccessful. He was admitted to the MICU because of his severe agitation and concern that he would fail management on the floor. . On the floor, he was agitated but intermittently cooperative with interview and exam. Past Medical History: - CHF with Known EF 25-35% - PVDF with a right foot nonhealing ulcer s/p right SFA-to-DP bypass graft, a nonreverse saphenous vein in [**2134**], a left BKA in [**2133**], R BKA [**2144-5-21**] - ESRD secondary to his diabetes s/p failed LLRT in [**2116**], second LRRT in [**2135**] (stable) - CAD s/p myocardial infarction, s/p angioplasty with stent placement - HTN - CVA [**2131**] - type 1 insulin dependent diabetes with triopathy - GERD - Hyperlipidemia on a statin - left AVF fistula - Chronic diarrhea [**3-9**] to ? diabetic autnomic neuropathy - Recent [**First Name9 (NamePattern2) **] [**Doctor Last Name **]. Enterococcus stump infection, on [**Doctor Last Name **] Social History: Lives alone, recently in a rehab facility. Has an intermittent smoking history of approximately 20-30 packyears. Smoked 1 cigarette today. Denies EtOH or other drug use. Family History: M: Colon Ca F: Prostate Ca Physical Exam: Vitals: T: 98 BP: 128/70 P: 80 R: 18 O2: 97%ra General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: 2+ RLE edemma, no edema LLE. R BKA stump with erythema, s/p vac dressing removal, 3 cm ulcerated wound on anterior stump, base of stump also with ulcertation, erythema, and purulent vs fibrinous appearing material. Pertinent Results: [**2144-6-27**] 06:00PM URINE COMMENT-SPERM SEEN [**2144-6-27**] 06:00PM URINE RBC-0-2 WBC-[**12-25**]* BACTERIA-FEW YEAST-NONE EPI-0-2 [**2144-6-27**] 06:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2144-6-27**] 06:00PM NEUTS-80.2* LYMPHS-14.2* MONOS-4.8 EOS-0.7 BASOS-0 [**2144-6-27**] 06:00PM WBC-7.2 RBC-3.44* HGB-10.0* HCT-30.9* MCV-90 MCH-29.0 MCHC-32.3 RDW-14.9 [**2144-6-27**] 06:00PM CK-MB-NotDone [**2144-6-27**] 06:00PM cTropnT-0.14* [**2144-6-27**] 06:00PM LIPASE-7 [**2144-6-27**] 06:00PM ALT(SGPT)-11 AST(SGOT)-24 CK(CPK)-83 ALK PHOS-263* TOT BILI-0.4 CT HEAD [**2144-6-27**]: IMPRESSION: No acute intracranial pathology including no hemorrhage. CT ABDOMEN PELVIS [**2144-6-28**]: 1. Cardiomegaly, small pericardial effusion and small bilateral pleural effusions, body wall edema. Findings likely secondary to volume overload. 2. Small amount of gas in bladder, mild bladder wall thickening and perivesical stranding may be seen in the setting of infection. Recommend clinicalcorrelation. 3. Bilateral atrophic native kidneys are in place. Transplanted kidney is noted within the right lower quadrant area. 4. Cholelithiasis with no evidence of cholecystitis. 5. Extensive atherosclerosis with prior right SFA stenting. KNEE XRAY [**2144-6-29**]: The patient is status post right-sided below-the-knee amputation. There is soft tissue gas in an ulcer adjacent to the distal tibial stump. However, the cortical margins are unchanged and preserved since the previous study. Underlying osteomyelitis is likely given the development of the ulcer extending to exposed bone (best seen on the lateral view). There is increase in the soft tissue swelling since the prior study. Vascular calcifications are identified. OPERATIVE REPORT [**2144-7-1**] DEBRIDEMENT: PREOPERATIVE DIAGNOSIS: Nonhealing right BKA stump POSTOPERATIVE DIAGNOSIS: Nonhealing right BKA stump ASSISTANT: [**First Name8 (NamePattern2) 5045**] [**Last Name (NamePattern1) 29242**], M.D. REASON FOR PROCEDURE: Mr. [**Known lastname **] is a 56-year-old male who underwent right below-the-knee amputation a bout a month ago. He was found standing next to his bed on his BKA stumps at rehab, confused and combative and was admitted to [**Hospital1 18**] for stump infection and MS changes. The decision was made to debide the stump back to viable bone and soft tissue. The procedure was discussed in detail and the patient signed an informed consent prior to the procedure. OPERATIVE NOTE: The patient was taken to the operating room and the right leg was prepped and draped in the usual sterile fashion. A spinal block was performed and level was confirmed. A ronjour was then used to trim the tibia to healthy, bleeding bone which only required removal of about 1cm of distal tibia. Skin and soft tissue was also debrided to healthy tissue. There was a pocket between the anterior and posterior compartments that contained a 20cc fluid collection. This fluid was sent for aerobic and anaerobic cultures. Hemostasis was achived and a occlusive negative pressure dressing was placed with continuous suction at 100mmHg. The patient's indwelling foley catheter was removed at the request of the primary team. The patient awoke from MAC sedation, tolerated the procedure well, and was taken to the PACU uneventfully. The estimated blood loss of the procedure minimal. Complications: none Brief Hospital Course: Patient is a 56 year old male s/p kidney transplant x 2, DM1, bilateral BKA with RLE stump who presented with AMS secondary to sepsis from UTI and osteomyleitis from stump site infection. Patient is s/p multiple debridements and primary closure done by vascular surgery currently on tobramycin. . # Right BKA stump infection / Osteomyelitis - S/p BKA procedure in [**5-14**] by vascular surgeon, Dr. [**Last Name (STitle) 1391**]. On previous admission [**2144-6-13**], pt had a wound VAC placed on his right stump and was treated with two weeks of vancomycin for an (VSE) enterococcus wound infection. Previously this infection cultured out VRE and required treatment with linezolid, but ID not recommending any antibiotics at this time. Initially presented with overlying cellulitis, responded well to 5 days of CTX that was given for UTI. Contributed to altered mental status on initial presentation. Was found to have osteo in the stump and underwent surgical debridement on [**7-1**]. Wound vac was changed on [**7-3**]. Went to OR today for primary clousure. Patient is to continue [**Hospital1 **] wet to dry dressings. Patient had wound vac placed by vascular surgery and to have outpatient follow up. Patient is having tobramycin given at 240mg IV, first day on [**2144-7-3**], initially dosed Q48H but will be dosed per through levels, <1.0. Pain medication regimen adjusted, percocet PO and dilaudid PO for breakthru pain. ID will assist in medication dosing. . # Resolved Altered mental status: On intial exam and at time of admission to unit and at time of my initial exam on the floor, patient had altered mental status. At ECF, patient was agitated and pulling out lines. Patient is calm at this time. AMS was thought to be in the setting of infection from UTI vs wound infection. Other causes were considered including, Meningitis less likely given absence of nuchal rigidity and photobia. Had failed LP x3, was placed on meningitis ppx with linezolid/ctx/acyclovir until cleared by neuro with exam with no focal deficits. Head CT negative. Agiation initially required physical and pharmacological restriants. Currently, alert and oriented times three and full insight but has waxing and [**Doctor Last Name 688**]. Patient may benefit from outpatient psych. . # Resolved Urinary tract infection - [**6-24**] from rehab had pan-sensitive E coli UTI that was being treated with imipeniem for unclear reasons. Had foley placed in ED. Patient's repeat UA on [**6-29**] was clean, IV ceftriaxone was stopped after 5d course. . # Stage 2 sacral decubti - stable, not superinfected . # Chronic diarrhea - has been worked up throughly by GI in the past. C diff negative again on this admission. Symptomatic treatment with loperamide . # Kidney Transplant/Acute renal failure: Status post failed LLRT in [**2116**], second LRRT in [**2135**], and on prednisone, tacrolimus and sirolimus as outpatient. Had tacrolimus dose decreased from 4 mg to 2 mg po bid during last admission. Transplant team following. Cr above baseline of 1.4. Function progressively improving. Continued tacrolimus and prednisone. Renal transplant to follow up as outpatient to determine restarting serolimus. . # chronic sCHF/CAD, EF 25%: Had troponin leak on this presentation, but setting of ARF. Completed ROMI. Echo from [**2144-6-5**] shows severe regional left ventricular systolic dysfunction, c/w multivessel CAD. Mild mitral regurgitation. Moderate pulmonary hypertension. Had CHF AE admission on [**2144-6-13**]. CAD s/p myocardial infarction, s/p angioplasty with PCI. Continue aspirin 81, metoprolol, atorvastatin. . # Diabetes mellitus, type 1, moderately controlled: continue ISS. [**Last Name (un) **] assisting but not formally consulting since he is dictating his own insulin dosages. . # ? hx of skin ca - unclear diagnosis. Patient should have outpatient derm for hx of skin cancers and now off serolimus. . # HTN - well controlled on diruetics and metoprolol . # CVA in [**2131**] - cont ASA 81 . # GERD - on pantoprazole 40mg PO daily . # Code: DNI/DNR, discussed with patient Medications on Admission: Loperamide 2 mg PO q8hr Flomax 0.4mg PO qHS Atorvastatin 20mg PO Daily Finasteride 5mg PO Daily Sirolimus 1mg PO Daily Aspirin 81mg PO Daily Metoprolol 12.5 mg PO BID Isosorbide mononitrate 60mg PO Daily Pantoprazole 40mg PO Daily Furosemide 80mg IV Daily Furosemide 40mg PO Daily Tacrolimus 2mg PO BID Morphine 4-8mg IV prn pain Prednisone 4mg PO Daily KCl 20 mEq PO Daily Alprazolam 0.5mg PO TID Percocet q6hr prn Glargine 8u SQ Daily Lispro ISS Pacrelipase 1cap PO w/ meals and qHS Imipenem 500mg IV q8hr Haldol 5mg PO q4hr prn Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 2. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 3. Atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 7. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 10. Prednisone 1 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 11. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for anxiety. 12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 13. Loperamide 2 mg Capsule Sig: Two (2) Capsule PO TID (3 times a day). 14. 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. 15. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. 16. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for breakthru pain. 17. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty (20) units Subcutaneous at bedtime. 18. Humalog 100 unit/mL Cartridge Sig: per sliding scale units Subcutaneous four times a day. 19. Sodium Polystyrene Sulfonate 15 g/60 mL Suspension Sig: Two (2) mg PO ONCE (Once) for 1 doses. 20. Tobramycin Sulfate 40 mg/mL Solution Sig: One [**Age over 90 11578**]y (180) mg Injection Q48H (every 48 hours) for 6 weeks: course finishes on [**2144-8-17**]. Discharge Disposition: Extended Care Facility: [**Hospital **] health care east region Discharge Diagnosis: Primary: R BKA stump infection with osteomyelitis and closure resolved urinary tract infection resolved altered mental status . Secondary: Stage 2 sacral decubti chronic sCHF EF 25% Chronic diarrhea s/p renal transplant Diabetes mellitus, type 1, moderately controlled Discharge Condition: stable, on antibiotics Discharge Instructions: You were admitted for an infection of your right BKA stump and the underlying bone and a urinary tract infection causing altered mental status. You initially were treated in the intensive care unit for your mental status and were given ceftriaxone antibiotic for you urinary tract infection for five days. You underwent two surgical procedures, on [**2144-7-1**] debridement right BK stump and [**2144-7-6**] debridement, primary closure R BKA. You had a wound vac placed to improve wound healing. Your blood sugars were better controlled as your insulin regimen was increased. You are to continue Tobramyicin as your antibiotic for six weeks for the treatment of your bone infection. . Please take all medications as prescribed and go to all scheduled follow up appointments. Your dosage of tobramycin will be adjusted based on trough levels. Sirolimus was stopped. . Please return to the hospital if you develop altered mental status, fevers, or another infection at your stump site. Please be compliant with your diabetic diet and take your insulin as per your sliding scale. . Follow up: Dr. [**Last Name (STitle) 1391**] - Vascular surgery on [**2144-8-12**] at 1:00pm at [**Last Name (NamePattern1) **]. Suite 5C in [**Hospital Unit Name **]. . Renal transplant:Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2144-7-30**] 9:20 . Dermatology:Provider: [**Name10 (NameIs) 6821**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2144-9-8**] 1:15 . Infectious Disease: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2144-8-14**] 9:30 Followup Instructions: Dr. [**Last Name (STitle) 1391**] - Vascular surgery on [**2144-8-12**] at 1:00pm at [**Last Name (NamePattern1) **]. Suite 5C in [**Hospital Unit Name **]. . Renal transplant:Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2144-7-30**] 9:20 . Dermatology:Provider: [**Name10 (NameIs) 6821**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2144-9-8**] 1:15 . Infectious Disease: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2144-8-14**] 9:30 Completed by:[**2144-7-8**]

038,584,997,730,599,682,996,707,428,995,440,250,362,357,414,V458,V125,412,416,585,V497,530,V586,272,787

{'Unspecified septicemia,Acute kidney failure, unspecified,Infection (chronic) of amputation stump,Unspecified osteomyelitis, lower leg,Urinary tract infection, site not specified,Cellulitis and abscess of leg, except foot,Complications of transplanted kidney,Ulcer of other part of lower limb,Chronic systolic heart failure,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled,Background diabetic retinopathy,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction,Other chronic pulmonary heart diseases,Chronic kidney disease, unspecified,Below knee amputation status,Esophageal reflux,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Diarrhea'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: RLE stump wound infection, urinary tract infection and altered mental status PRESENT ILLNESS: Mr. [**Known lastname **] is a 56 year-old man with a history of kidney transplant x 2, DM, bilateral BKA with RLE non-healing ulcer (right BKA in [**2144-5-21**]), who presents from rehab with AMS. Of note, he was recently discharged on [**2144-6-13**] after being admitted with a CHF exacerbation; at that time, he also had a wound VAC placed on his right stump and was treated with two weeks of vancomycin for an enterococcus wound infection. He was doing well at his nursing home until the day prior to admission when he was noted to have worsening mental status. He was also found to have a UTI and was started on imipenem. On the day of admission, he was found standing next to his bed on his stumps and was combative and noncooperative with nursing home staff, pulling out both his PICC and foley. He was then transferred to the ED for further evaulation. . In the ED, initial vs were: T 99.2 P 51 BP 141/83 R 18 O2 97%ra sat. He was given vancomycin and zosyn, later spiked a temperature to 102.9 rectal which resolved with PR tylenol, and was placed in wrist restraints for combativeness. His right BKA was draining purulent material and vascular was consulted, with a recommendation to start broad spectrum antibiotics. He was also noted to have diarrhea and an abdominal CT was performed to rule out colitis or an abdominal process, with an initial read that was negative. Because of his history of VRE, he was also given linezolid and then ceftriaxone 2g/acyclovir 50 mg x 1 to cover for meningitis. An LP was attempted (3 passes) but was unsuccessful. He was admitted to the MICU because of his severe agitation and concern that he would fail management on the floor. . On the floor, he was agitated but intermittently cooperative with interview and exam. MEDICAL HISTORY: - CHF with Known EF 25-35% - PVDF with a right foot nonhealing ulcer s/p right SFA-to-DP bypass graft, a nonreverse saphenous vein in [**2134**], a left BKA in [**2133**], R BKA [**2144-5-21**] - ESRD secondary to his diabetes s/p failed LLRT in [**2116**], second MEDICATION ON ADMISSION: Loperamide 2 mg PO q8hr Flomax 0.4mg PO qHS Atorvastatin 20mg PO Daily Finasteride 5mg PO Daily Sirolimus 1mg PO Daily Aspirin 81mg PO Daily Metoprolol 12.5 mg PO BID Isosorbide mononitrate 60mg PO Daily Pantoprazole 40mg PO Daily Furosemide 80mg IV Daily Furosemide 40mg PO Daily Tacrolimus 2mg PO BID Morphine 4-8mg IV prn pain Prednisone 4mg PO Daily KCl 20 mEq PO Daily Alprazolam 0.5mg PO TID Percocet q6hr prn Glargine 8u SQ Daily Lispro ISS Pacrelipase 1cap PO w/ meals and qHS Imipenem 500mg IV q8hr Haldol 5mg PO q4hr prn ALLERGIES: Coreg PHYSICAL EXAM: Vitals: T: 98 BP: 128/70 P: 80 R: 18 O2: 97%ra General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: 2+ RLE edemma, no edema LLE. R BKA stump with erythema, s/p vac dressing removal, 3 cm ulcerated wound on anterior stump, base of stump also with ulcertation, erythema, and purulent vs fibrinous appearing material. FAMILY HISTORY: M: Colon Ca F: Prostate Ca SOCIAL HISTORY: Lives alone, recently in a rehab facility. Has an intermittent smoking history of approximately 20-30 packyears. Smoked 1 cigarette today. Denies EtOH or other drug use. ### Response: {'Unspecified septicemia,Acute kidney failure, unspecified,Infection (chronic) of amputation stump,Unspecified osteomyelitis, lower leg,Urinary tract infection, site not specified,Cellulitis and abscess of leg, except foot,Complications of transplanted kidney,Ulcer of other part of lower limb,Chronic systolic heart failure,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled,Background diabetic retinopathy,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction,Other chronic pulmonary heart diseases,Chronic kidney disease, unspecified,Below knee amputation status,Esophageal reflux,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Diarrhea'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a [**Age over 90 **] year old female with multiple medical problems. She was brought to the Emergency Department by paramedics after vomiting coffee ground emesis. According to her visiting nurse, she has also had a question of melena over the past week. The patient was hypotensive at EMT arrival with a systolic blood pressure of 80. MEDICAL HISTORY: Coronary artery disease; status post myocardial infarction in [**12-4**]. Chronic obstructive pulmonary disease on home oxygen, 1.5 liters. Hypertension. Peptic ulcer disease. Diverticulitis. Status post cholecystectomy. Status post total abdominal hysterectomy bilateral salpingo-oophorectomy. MEDICATION ON ADMISSION: Lipitor 10 mg q. day. Mavic 2 mg q. day. Multi-vitamin one daily. Protonic 40 mg q. day. Tamoxifen 10 mg twice a day. Colace 100 mg twice a day. Lopressor 25 mg twice a day. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Born in [**Country 2784**], immigrated to the United States during the World War II. Widowed times ten years. No children. 70 pack year smoking history. No alcohol use. Lives alone in an apartment. Has VNA. Health care proxy is [**Name (NI) **] [**Name (NI) 12982**], [**Telephone/Fax (1) 99018**], [**Telephone/Fax (1) 99019**]. Case manager is [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 99020**], [**Telephone/Fax (1) 99021**] and [**Telephone/Fax (1) 53844**]. Primary medical doctors are Dr. [**First Name (STitle) 1158**] Tray and [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) 141**].

Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Alkalosis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension, unspecified

Gastrointest hemorr NOS,Chr blood loss anemia,Alkalosis,Chr airway obstruct NEC,CHF NOS,Second malig neo liver,Hyp kid NOS w cr kid V,Hypotension NOS

Admission Date: [**2119-2-10**] Discharge Date: [**2119-2-14**] Service: HISTORY OF PRESENT ILLNESS: This is a [**Age over 90 **] year old female with multiple medical problems. She was brought to the Emergency Department by paramedics after vomiting coffee ground emesis. According to her visiting nurse, she has also had a question of melena over the past week. The patient was hypotensive at EMT arrival with a systolic blood pressure of 80. Arrival in Emergency Department revealed a temperature of 100.4; heart rate of 92; blood pressure 102/85; respiratory rate of 30; saturation 96% on room air. Nasogastric tube was placed and drained coffee grounds but lavage cleared with 750 cc. No recent ANSAID use. The patient is demented but complained of abdominal pain. This pain is longstanding per past records. PAST MEDICAL HISTORY: Coronary artery disease; status post myocardial infarction in [**12-4**]. Chronic obstructive pulmonary disease on home oxygen, 1.5 liters. Hypertension. Peptic ulcer disease. Diverticulitis. Status post cholecystectomy. Status post total abdominal hysterectomy bilateral salpingo-oophorectomy. Breast cancer, diagnosed in [**2112**], infiltrative ductal type; ER positive; status post lumpectomy; status post XRT, currently on Tamoxifen. Congestive heart failure. Dementia. Chronic renal failure. Creatinine of 1.5 to 2.0. Rectal prolapse. MEDICATIONS ON ADMISSION: Lipitor 10 mg q. day. Mavic 2 mg q. day. Multi-vitamin one daily. Protonic 40 mg q. day. Tamoxifen 10 mg twice a day. Colace 100 mg twice a day. Lopressor 25 mg twice a day. SOCIAL HISTORY: Born in [**Country 2784**], immigrated to the United States during the World War II. Widowed times ten years. No children. 70 pack year smoking history. No alcohol use. Lives alone in an apartment. Has VNA. Health care proxy is [**Name (NI) **] [**Name (NI) 12982**], [**Telephone/Fax (1) 99018**], [**Telephone/Fax (1) 99019**]. Case manager is [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 99020**], [**Telephone/Fax (1) 99021**] and [**Telephone/Fax (1) 53844**]. Primary medical doctors are Dr. [**First Name (STitle) 1158**] Tray and [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) 141**]. PHYSICAL EXAMINATION: On admission vital signs revealed a temperature of 100.2; blood pressure 99/60; pulse of 90; respiratory rate of 36; 96% on 100% non rebreather. In general: No acute distress, resting in bed. HEAD, EYES, EARS, NOSE AND THROAT: Mucous membranes dry. Extraocular movements intact. Pupils are equal, round, and reactive to light and accommodation. Neck: No jugular venous distention, bruits or lymphadenopathy. Chest was clear bilaterally. Mild expiratory wheezes. Cardiovascular: Distant heart sounds. Abdomen: Positive bowel sounds, no rebound, guarding, non distended. Extremities showed no clubbing, cyanosis or edema. Neurologic: Alert, not oriented to place or time, otherwise nonfocal neurological examination. Skin: No jaundice or visible external lesions. LABORATORY DATA: On admission, white count was 18; hematocrit of 30.9; platelets of 471. Sodium of 143; potassium of 5.5; chloride 102; C02 of 25; BUN 113; creatinine 2.8; glucose of 122. Urinalysis showed a few bacteria, otherwise negative. Blood cultures times two were drawn. Electrocardiogram showed normal sinus rhythm at 90; Q's in 2, 3 and F and V1, no ST or T wave changes, unchanged from previous. ASSESSMENT AND PLAN: [**Age over 90 **] year old female, multiple medical problems; long history of gastrointestinal bleed with documented gastritis and duodenal angioectasia and diverticulosis. Now with hematemesis and coffee grounds. HOSPITAL COURSE: The patient was admitted to the Intensive Care Unit over night on [**2119-2-10**]. The patient was made n.p.o. and was given intravenous blocker. Code status was documented as DNR/DNI. Her blood pressure medications were held overnight. The patient was transfused two units of packed red blood cells. Hematocrit increased to 36.8. The patient had a pelvic x-ray which showed no fracture of the left hip. Abdominal and pelvic CT showed no evidence of diverticulitis or other acute inflammatory process in the abdomen, sigmoid diverticulosis, [**Date Range **] atherosclerosis and a left upper pelvic cyst. Esophagogastroduodenoscopy was not performed with a stable hematocrit and the patient's guaiac subsequently became negative. She was transferred to the floor on [**2119-2-11**] in stable condition. She was kept on chronic obstructive pulmonary disease treatments with nebulizers and maintained saturation greater than 95% on two liters. She remained afebrile throughout her hospital stay. Metoprolol was reinstituted after she was hemodynamically stable. Overall, the patient's hematocrit remained stable throughout her stay in the hospital. On [**2-13**], hematocrit was 37.4 without further transfusions. The patient remained guaiac negative. Mentally, she continued at her baseline. DISCHARGE CONDITION: Stable. DISPOSITION: The patient was discharged back to an extended facility. DISCHARGE MEDICATIONS: As above except Mavic was held and continues to be held with some mild renal insufficiency. CODE STATUS: The patient continues to be DNR/DNI. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**], M.D. [**MD Number(1) 144**] Dictated By:[**Last Name (NamePattern1) 1324**] MEDQUIST36 D: [**2119-2-14**] 12:33 T: [**2119-2-14**] 13:03 JOB#: [**Job Number 99022**]

578,280,276,496,428,197,403,458

{'Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Alkalosis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: This is a [**Age over 90 **] year old female with multiple medical problems. She was brought to the Emergency Department by paramedics after vomiting coffee ground emesis. According to her visiting nurse, she has also had a question of melena over the past week. The patient was hypotensive at EMT arrival with a systolic blood pressure of 80. MEDICAL HISTORY: Coronary artery disease; status post myocardial infarction in [**12-4**]. Chronic obstructive pulmonary disease on home oxygen, 1.5 liters. Hypertension. Peptic ulcer disease. Diverticulitis. Status post cholecystectomy. Status post total abdominal hysterectomy bilateral salpingo-oophorectomy. MEDICATION ON ADMISSION: Lipitor 10 mg q. day. Mavic 2 mg q. day. Multi-vitamin one daily. Protonic 40 mg q. day. Tamoxifen 10 mg twice a day. Colace 100 mg twice a day. Lopressor 25 mg twice a day. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Born in [**Country 2784**], immigrated to the United States during the World War II. Widowed times ten years. No children. 70 pack year smoking history. No alcohol use. Lives alone in an apartment. Has VNA. Health care proxy is [**Name (NI) **] [**Name (NI) 12982**], [**Telephone/Fax (1) 99018**], [**Telephone/Fax (1) 99019**]. Case manager is [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 99020**], [**Telephone/Fax (1) 99021**] and [**Telephone/Fax (1) 53844**]. Primary medical doctors are Dr. [**First Name (STitle) 1158**] Tray and [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) 141**]. ### Response: {'Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Alkalosis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypotension, unspecified'}

CHIEF COMPLAINT: cerebellar mass PRESENT ILLNESS: 86yo F h/o CHF, Afib on coumadin, HTN, s/p PPM who was in USOH at NH interactive and functional, aware of current events, who is transferred here from [**Hospital3 **] for increasing lethargy and cerebellar mass of acute onset since mid-day yesterday. She complained yesterday of N/V and did not feel well and was brought to [**Hospital3 **]. While there, her hospital course was marked by considerable increase in lethargy and serial CT scans showed progressive effacement of her fourth ventricle and she was transferred here for neurosurgical intervention. MEDICAL HISTORY: CHF Afib on coumadin HTN s/p PPM MEDICATION ON ADMISSION: unknown except for coumadin ALLERGIES: Sulfa (Sulfonamides) / Penicillins / Codeine PHYSICAL EXAM: P/E V/S 98.2 73 199/100 88%NRB -> 100% intubated Gen elderly woman intubated CV rrr Pulm ctab abd soft ext no edema FAMILY HISTORY: Noncontributory SOCIAL HISTORY: lives in nursing home

Neoplasm of unspecified nature of brain,Obstructive hydrocephalus,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ

Brain neoplasm NOS,Obstructiv hydrocephalus,Atrial fibrillation,CHF NOS,Hypertension NOS,Status cardiac pacemaker

Admission Date: [**2160-9-19**] Discharge Date: [**2160-9-20**] Service: NEUROSURGERY Allergies: Sulfa (Sulfonamides) / Penicillins / Codeine Attending:[**First Name3 (LF) 2724**] Chief Complaint: cerebellar mass Major Surgical or Invasive Procedure: [**9-19**]: External ventriculostomy placed History of Present Illness: 86yo F h/o CHF, Afib on coumadin, HTN, s/p PPM who was in USOH at NH interactive and functional, aware of current events, who is transferred here from [**Hospital3 **] for increasing lethargy and cerebellar mass of acute onset since mid-day yesterday. She complained yesterday of N/V and did not feel well and was brought to [**Hospital3 **]. While there, her hospital course was marked by considerable increase in lethargy and serial CT scans showed progressive effacement of her fourth ventricle and she was transferred here for neurosurgical intervention. On arrival, she had reactive pupils and was moving all of her extremities to painful stimuli. She was intubated with paralytics to protect her respiratory status. She was given proplex and FFP to reverse her INR and the decision was made to take her to the OR. Past Medical History: CHF Afib on coumadin HTN s/p PPM Social History: lives in nursing home Family History: Noncontributory Physical Exam: P/E V/S 98.2 73 199/100 88%NRB -> 100% intubated Gen elderly woman intubated CV rrr Pulm ctab abd soft ext no edema NEURO MS unresponsive to painful stimuli CN pupils equal and reactive, +corneal responses, +gag reflex Motor moves all limbs to noxious stimuli and spontaneously Reflexes b/l upgoing toes Pertinent Results: [**2160-9-19**] 05:52PM GLUCOSE-96 UREA N-16 CREAT-1.1 SODIUM-139 POTASSIUM-3.7 CHLORIDE-103 TOTAL CO2-25 ANION GAP-15 [**2160-9-19**] 05:52PM CALCIUM-9.6 PHOSPHATE-1.6* MAGNESIUM-3.0* [**2160-9-19**] 04:56PM TYPE-ART TEMP-36.1 RATES-12/ TIDAL VOL-563 PEEP-5 O2-40 PO2-198* PCO2-32* PH-7.50* TOTAL CO2-26 BASE XS-2 INTUBATED-INTUBATED VENT-CONTROLLED [**2160-9-19**] 04:56PM freeCa-1.19 [**2160-9-19**] 10:08AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-POS barbitrt-NEG tricyclic-NEG [**2160-9-19**] 03:46AM WBC-16.2* RBC-3.73* HGB-11.1*# HCT-31.4*# MCV-84 MCH-29.6 MCHC-35.2* RDW-14.3 [**2160-9-19**] 03:46AM NEUTS-97.8* BANDS-0 LYMPHS-1.4* MONOS-0.7* EOS-0 BASOS-0 [**2160-9-19**] 03:46AM PLT COUNT-164 [**2160-9-19**] 03:46AM PT-13.0 PTT-23.4 INR(PT)-1.1 Brief Hospital Course: Pt admitted to hospital on [**9-19**] w/ a Head CT from OSH which showed heterogenous, ill-defined cerebellar mass w/ effaced fourth ventricle. Serial Head CT upon arrival to [**Hospital1 18**] showed progressive effacement of her fourth ventricle. The decision was made to take the patient to the operating room for placement of an external ventricular draingiven unclear pathology and at that time perserved brain stem functions. The following am exam continued to deteriorate and pt had no response to noxious stimuli; no corneals; no gag; pupils small and unreactive. ICP 3. On [**9-29**] after long discussion with patient's family, they decided to make her comfort care and the pt passed away on [**9-20**] while in the ICU. Medications on Admission: unknown except for coumadin Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: cerebellar mass Discharge Condition: Cerebellar mass resulting in death Discharge Instructions: none Followup Instructions: none Completed by:[**2160-10-1**]

239,331,427,428,401,V450

{'Neoplasm of unspecified nature of brain,Obstructive hydrocephalus,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: cerebellar mass PRESENT ILLNESS: 86yo F h/o CHF, Afib on coumadin, HTN, s/p PPM who was in USOH at NH interactive and functional, aware of current events, who is transferred here from [**Hospital3 **] for increasing lethargy and cerebellar mass of acute onset since mid-day yesterday. She complained yesterday of N/V and did not feel well and was brought to [**Hospital3 **]. While there, her hospital course was marked by considerable increase in lethargy and serial CT scans showed progressive effacement of her fourth ventricle and she was transferred here for neurosurgical intervention. MEDICAL HISTORY: CHF Afib on coumadin HTN s/p PPM MEDICATION ON ADMISSION: unknown except for coumadin ALLERGIES: Sulfa (Sulfonamides) / Penicillins / Codeine PHYSICAL EXAM: P/E V/S 98.2 73 199/100 88%NRB -> 100% intubated Gen elderly woman intubated CV rrr Pulm ctab abd soft ext no edema FAMILY HISTORY: Noncontributory SOCIAL HISTORY: lives in nursing home ### Response: {'Neoplasm of unspecified nature of brain,Obstructive hydrocephalus,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: shortness of breath and hemoptysis PRESENT ILLNESS: This a [**Age over 90 **]y/o female with a history of COPD, hypertension, gastroespohageal reflux who presented with shortness of breath and dyspnea on exertion X 3 days. Per nursing home records, the patient was reported to have had 10cc of hemoptysis. O2 sat was 92%. Patient reports substernal chest pain radiating to the back, lasting seconds. By history the pain is pleuritic, because coughing makes it worse. . On presentation peak flow was 140; improved to 240 after 1st neb in the ED. Chest X-ray showed multilobular consolidation. CT-A showed no PE or obstructive bronchial lesion, but central bilateral consolidation secondary to pneumonia and CHF was noted. An EKG showed TWI in I and avL, and in V4-V6, unchanged from previous. Trop was 0.10 in the setting of renal insufficiency. MEDICAL HISTORY: COPD Rash back of neck GERD HTN MEDICATION ON ADMISSION: Acetaminophen Aluminum Hydroxide Suspension Albuterol 0.083% Neb Soln Amlodipine Bicitra Calcium Carbonate Cyanocobalamin Fexofenadine Fluticasone-Salmeterol (250/50) Furosemide Hydrocortisone Cream 1% Hyoscyamine Ipratropium Bromide Neb Isosorbide Dinitrate Pantoprazole Prednisone Simethicone Sorbitol ALLERGIES: Nsaids / Ace Inhibitors PHYSICAL EXAM: VS t98.8, hr82, bp, r26, 99%on2lNC Gen elderly petite Caucasian female sitting upright in stretcher, in mod distress, using accessory muscles to breath HEENT MMM, OP, -JVD, bruits Heart nl rate, S1S2, unable to assess due to breathing Lungs coarse, rhonchorous breath sounds Abdomen round, soft, nt, nd, +bs Extremities [**1-2**]+pitting edema, posterior aspect of legs bilaterally Neuro: A&O X3, II-XII grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Hospital 100**] Rehab Denies alcohol and ciggarette smokine

Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Unspecified pleural effusion,Other chronic pulmonary heart diseases,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diarrhea,Delirium due to conditions classified elsewhere

Acute respiratry failure,Obs chr bronc w(ac) exac,CHF NOS,Pneumonia, organism NOS,Urin tract infection NOS,Acute kidney failure NOS,Subendo infarct, initial,Pleural effusion NOS,Chr pulmon heart dis NEC,Hy kid NOS w cr kid I-IV,Diarrhea,Delirium d/t other cond

Admission Date: [**2174-11-25**] Discharge Date: [**2174-12-5**] Service: MEDICINE Allergies: Nsaids / Ace Inhibitors Attending:[**First Name3 (LF) 7934**] Chief Complaint: shortness of breath and hemoptysis Major Surgical or Invasive Procedure: - History of Present Illness: This a [**Age over 90 **]y/o female with a history of COPD, hypertension, gastroespohageal reflux who presented with shortness of breath and dyspnea on exertion X 3 days. Per nursing home records, the patient was reported to have had 10cc of hemoptysis. O2 sat was 92%. Patient reports substernal chest pain radiating to the back, lasting seconds. By history the pain is pleuritic, because coughing makes it worse. . On presentation peak flow was 140; improved to 240 after 1st neb in the ED. Chest X-ray showed multilobular consolidation. CT-A showed no PE or obstructive bronchial lesion, but central bilateral consolidation secondary to pneumonia and CHF was noted. An EKG showed TWI in I and avL, and in V4-V6, unchanged from previous. Trop was 0.10 in the setting of renal insufficiency. Past Medical History: COPD Rash back of neck GERD HTN Social History: Lives in [**Hospital 100**] Rehab Denies alcohol and ciggarette smokine Family History: Non-contributory Physical Exam: VS t98.8, hr82, bp, r26, 99%on2lNC Gen elderly petite Caucasian female sitting upright in stretcher, in mod distress, using accessory muscles to breath HEENT MMM, OP, -JVD, bruits Heart nl rate, S1S2, unable to assess due to breathing Lungs coarse, rhonchorous breath sounds Abdomen round, soft, nt, nd, +bs Extremities [**1-2**]+pitting edema, posterior aspect of legs bilaterally Neuro: A&O X3, II-XII grossly intact Pertinent Results: Labs on Admission [**2174-11-25**] 11:30AM BLOOD WBC-17.1*# RBC-3.86* Hgb-11.2* Hct-34.6* MCV-90 MCH-29.0 MCHC-32.4 RDW-14.0 Plt Ct-290 [**2174-11-25**] 11:30AM BLOOD Plt Ct-290 [**2174-11-25**] 11:30AM BLOOD Glucose-119* UreaN-47* Creat-1.9* Na-142 K-4.4 Cl-101 HCO3-31 AnGap-14 [**2174-11-25**] 11:30AM BLOOD CK(CPK)-48 [**2174-11-25**] 11:30AM BLOOD CK-MB-3 cTropnT-0.10* . Chest X-ray [**2174-11-25**] 1. Multilobar consolidation, which could reflect asymmetrical edema and/or multilobar pneumonia. A postobstructive process in the right middle lobe cannot be excluded. By report, the patient is scheduled to undergo CTA, which will be helpful for more complete characterization of these findings. 2. Bilateral pleural effusions, right greater than left. . CT-A [**2174-11-25**] 1. No parenchymal mass lesion or mediastinal lymphadenopathy. No acute pulmonary embolus. 2. Central bilateral consolidation mainly along the inferior hilar regions with patchy areas of consolidation in the upper and lower lobes. Enlargement of the central arterial pulmonary vasculature and mild cardiac enlargement suggestive of background pulmonary hypertension. Small bibasilar pleural effusions. These findings may all be due to cardiac failure with pulmonary hypertension. Infective consolidation should be also considered depending on the current clinical correlation. Interval followup post-treatment initially with chest x-ray is advised. Brief Hospital Course: 1. Pneumonia The patient was initially maintained on ceftriaxone and azithromycin for community acquired pneumonia. Because the patient came from rehabilitation, the decision was made to change the antibiotic coverage to Levaquin. Her treatment also consisted of Q2 nebulizer treatments, oxygen and her home dose of prednisone. On the morning of HD #2, the patient's course was complicated by transient desaturation to 88% on 6L NC and a shovel mask. On exam the patient had rhonchorous breath sounds, difficulty mobilizing her secretions. O2 sats improved with coughing to 91%. Despite improvement in her O2 sats, the patient continued to have labored breathing. She received 10 of IV lasix and nebulizer treatments. O2sats improved to 95-99% on the same amount of O2. Respiratory therapy recommmended humidified air to help loosen the secretions. Patient course deteriorated on the morning of HD #3. 02sats were initially stable in the 90s. The patient became tachypneic breathing at an average rate of 30. Antibiotic coverage was changed to Ceftazadine because prelim sputum cultures grew gram negative rods. Despite lasix, morphine and frequent nebulizer treatments, patient's O2sats decreased to 86% on 6LNC and 100%NRB. The decision was made to transfer her to the [**Hospital Unit Name 153**] for further management. . In the [**Hospital Unit Name 153**], the pt continued to desaturate to the 80s on NC and FM. She had one episode of desaturation to the 80s which did not resolve after one minute. CXR showed mucus plugging of the entire left lung. Pt was placed on her right side and had rigorous chest PT, and saturations improved to low 90s. Family was called in. After several days of pt's respiratory status not improving, pt's status was discussed with family, who decided to make her CMO. Pt was placed on morphine gtt and died on [**2174-12-5**] am surrounded by her family. . 2. Leukocytosis: Pt's leukocytosis was likely [**2-2**] to pneumonia and UTI. Pt was afebrile throughout admission. Pt was placed on levaquin, and blood cultures were negative. . 3. Hemoptysis: Pt had episodes of hemoptysis on the floor, but not in the [**Hospital Unit Name 153**]. This was likely [**2-2**] pneumonia. Pt's Hct stayed stable, and stool was guaiac negative. . 4. Chest pain: Pt had episodes of fleeting, pleuritic chest pain on the floor, with Trop 0.10, which was likely due to renal insufficiency. The family and patient agreed not to have any intervention for any possible cardiac issues. . 5. Acute renal failure: Pt's acute renal failure was likely due to a dye load with the CT. Cr improved with fluids. . 6. HTN: Pt was continued on Isordil and norvasc. . 7. CHF: Pt had evidence of CHF on CXR, with trace edema on the posterior aspect of her legs. She was continued on daily lasix prn. Medications on Admission: Acetaminophen Aluminum Hydroxide Suspension Albuterol 0.083% Neb Soln Amlodipine Bicitra Calcium Carbonate Cyanocobalamin Fexofenadine Fluticasone-Salmeterol (250/50) Furosemide Hydrocortisone Cream 1% Hyoscyamine Ipratropium Bromide Neb Isosorbide Dinitrate Pantoprazole Prednisone Simethicone Sorbitol Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: Primary Diagnoses: pneumonia non ST elevation myocardial infarction congestive heart failure, EF 15-20% COPD Secondary Diagnoses: Hypertension GERD Discharge Condition: expired Discharge Instructions: None. Followup Instructions: None Completed by:[**2175-3-26**]

518,491,428,486,599,584,410,511,416,403,787,293

{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Unspecified pleural effusion,Other chronic pulmonary heart diseases,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diarrhea,Delirium due to conditions classified elsewhere'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: shortness of breath and hemoptysis PRESENT ILLNESS: This a [**Age over 90 **]y/o female with a history of COPD, hypertension, gastroespohageal reflux who presented with shortness of breath and dyspnea on exertion X 3 days. Per nursing home records, the patient was reported to have had 10cc of hemoptysis. O2 sat was 92%. Patient reports substernal chest pain radiating to the back, lasting seconds. By history the pain is pleuritic, because coughing makes it worse. . On presentation peak flow was 140; improved to 240 after 1st neb in the ED. Chest X-ray showed multilobular consolidation. CT-A showed no PE or obstructive bronchial lesion, but central bilateral consolidation secondary to pneumonia and CHF was noted. An EKG showed TWI in I and avL, and in V4-V6, unchanged from previous. Trop was 0.10 in the setting of renal insufficiency. MEDICAL HISTORY: COPD Rash back of neck GERD HTN MEDICATION ON ADMISSION: Acetaminophen Aluminum Hydroxide Suspension Albuterol 0.083% Neb Soln Amlodipine Bicitra Calcium Carbonate Cyanocobalamin Fexofenadine Fluticasone-Salmeterol (250/50) Furosemide Hydrocortisone Cream 1% Hyoscyamine Ipratropium Bromide Neb Isosorbide Dinitrate Pantoprazole Prednisone Simethicone Sorbitol ALLERGIES: Nsaids / Ace Inhibitors PHYSICAL EXAM: VS t98.8, hr82, bp, r26, 99%on2lNC Gen elderly petite Caucasian female sitting upright in stretcher, in mod distress, using accessory muscles to breath HEENT MMM, OP, -JVD, bruits Heart nl rate, S1S2, unable to assess due to breathing Lungs coarse, rhonchorous breath sounds Abdomen round, soft, nt, nd, +bs Extremities [**1-2**]+pitting edema, posterior aspect of legs bilaterally Neuro: A&O X3, II-XII grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Hospital 100**] Rehab Denies alcohol and ciggarette smokine ### Response: {'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Unspecified pleural effusion,Other chronic pulmonary heart diseases,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diarrhea,Delirium due to conditions classified elsewhere'}

CHIEF COMPLAINT: altered mental status, electrolyte derangements PRESENT ILLNESS: This is a 49 year old male with a past history of HTN, bipolar disorder who is transferred to [**Hospital1 18**] from [**Hospital **] hospital for management of multiple electrolyte derangements. He initially called EMS yesterday when he felt confused, and was found to have diffuse ecchymoses and petechiae and to be acutely disoriented. At [**Hospital **] hospital, he was found to be in acute renal failure, profoundly hyponatremic to 108, hyperkalemic, thrombocytopenic, and anemic. He was also noted to have a tiny R apical PTX on CXR which was incidental. He also received a CT head and C spine which confirmed a small apical ptx but was otherwise unremarkable. He was transferred to [**Hospital1 18**] for management of possible TTP. In the [**Hospital1 18**] ED, his initial labs were notable for a normal platelet count, sodium 110, K 4.7, BUN/Cr 72/6.2, elevated LFT's, and an MB fraction greater than 400 (initial CK 7 at [**Hospital1 **], currently pending, but initial value is critically high per stat lab). He was oriented to person/place but doesn't understand what's going on. That being said, he has been calm, with a sitter throughout his ED stay. He has been hemodynamically stable, 75 151/65 100% room air and making good urine (225cc/hr). Getting NS @ 75cc/hr. Renal and heme aware. EKG showed a prolonged QTc without STTWC. Surgery was consulted for the PTX, and recommended monitoring for the ptx. He is transferred to the ICU for multiple electrolyte derangements and altered mental status. . On the floor, he was oriented to p/p/d, however was intermittently not making sense, with hallucinations. He denies recent trauma, falls, ingestions, or medication misuse. He denies any pain, nausea/vomiting/diarrhea, chest pain, palpitations, headache or disordered thinking. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. MEDICAL HISTORY: Bipolar Disorder HTN s/p laminectomy MEDICATION ON ADMISSION: per pharmacy ([**Last Name (un) 50239**] in [**Location (un) 13011**] - [**Telephone/Fax (1) 56497**]) Cymbalta 40mg po bid Ambien 10mg po qhs lamotrigine 200mg po bid Geodon 20mg po qAM 40mg po qPM Atenolol 50mg daily HCTZ 12.5 mg po daily Klonopin 1mg po qid fluocinonide cream ALLERGIES: Hydrochlorothiazide PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, but affect strange, ?confusion. no acute distress HEENT: Sclerae anicteric, MMM, oropharynx clear. Large abrasion over nose and smaller bruises over forehead with evidence of excoriation. Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, with scattered rhonchi FAMILY HISTORY: unknown at this time SOCIAL HISTORY: lives alone, parents are HCP's. Denies alcohol or other ingestions. In sales.

Acute kidney failure, unspecified,Rhabdomyolysis,Hyposmolality and/or hyponatremia,Anemia, unspecified,Unspecified essential hypertension,Bipolar disorder, unspecified

Acute kidney failure NOS,Rhabdomyolysis,Hyposmolality,Anemia NOS,Hypertension NOS,Bipolar disorder NOS

Admission Date: [**2125-5-17**] Discharge Date: [**2125-5-24**] Date of Birth: [**2075-7-16**] Sex: M Service: MEDICINE Allergies: Hydrochlorothiazide Attending:[**First Name3 (LF) 4365**] Chief Complaint: altered mental status, electrolyte derangements Major Surgical or Invasive Procedure: None History of Present Illness: This is a 49 year old male with a past history of HTN, bipolar disorder who is transferred to [**Hospital1 18**] from [**Hospital **] hospital for management of multiple electrolyte derangements. He initially called EMS yesterday when he felt confused, and was found to have diffuse ecchymoses and petechiae and to be acutely disoriented. At [**Hospital **] hospital, he was found to be in acute renal failure, profoundly hyponatremic to 108, hyperkalemic, thrombocytopenic, and anemic. He was also noted to have a tiny R apical PTX on CXR which was incidental. He also received a CT head and C spine which confirmed a small apical ptx but was otherwise unremarkable. He was transferred to [**Hospital1 18**] for management of possible TTP. In the [**Hospital1 18**] ED, his initial labs were notable for a normal platelet count, sodium 110, K 4.7, BUN/Cr 72/6.2, elevated LFT's, and an MB fraction greater than 400 (initial CK 7 at [**Hospital1 **], currently pending, but initial value is critically high per stat lab). He was oriented to person/place but doesn't understand what's going on. That being said, he has been calm, with a sitter throughout his ED stay. He has been hemodynamically stable, 75 151/65 100% room air and making good urine (225cc/hr). Getting NS @ 75cc/hr. Renal and heme aware. EKG showed a prolonged QTc without STTWC. Surgery was consulted for the PTX, and recommended monitoring for the ptx. He is transferred to the ICU for multiple electrolyte derangements and altered mental status. . On the floor, he was oriented to p/p/d, however was intermittently not making sense, with hallucinations. He denies recent trauma, falls, ingestions, or medication misuse. He denies any pain, nausea/vomiting/diarrhea, chest pain, palpitations, headache or disordered thinking. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: Bipolar Disorder HTN s/p laminectomy Social History: lives alone, parents are HCP's. Denies alcohol or other ingestions. In sales. Family History: unknown at this time Physical Exam: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, but affect strange, ?confusion. no acute distress HEENT: Sclerae anicteric, MMM, oropharynx clear. Large abrasion over nose and smaller bruises over forehead with evidence of excoriation. Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, with scattered rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, +rub Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema however diffuse scattered ecchymoses and excoriated abrasions over upper and lower extremities, left chest and right back. No evidence of compartment syndrome. Pertinent Results: [**2125-5-17**] 05:04AM GLUCOSE-66* UREA N-72* CREAT-6.2* SODIUM-110* POTASSIUM-4.7 CHLORIDE-74* TOTAL CO2-19* ANION GAP-22* ALT(SGPT)-584* AST(SGOT)-3568* LD(LDH)-3498* CK(CPK)-[**Numeric Identifier 56496**]* TOT BILI-1.6* DIR BILI-0.7* INDIR BIL-0.9 WBC-12.5* RBC-3.24* HGB-10.8* HCT-29.3* MCV-90 MCH-33.2* MCHC-36.8* RDW-12.6 NEUTS-86.4* LYMPHS-7.6* MONOS-5.7 EOS-0.1 BASOS-0.1 PLT COUNT-175 PT-11.6 PTT-27.2 INR(PT)-1.0 LIPASE-43 CK-MB-484* MB INDX-0.2 cTropnT-0.05* CALCIUM-7.6* HAPTOGLOB-<20* OSMOLAL-259* ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG URINE HOURS-RANDOM UREA N-463 CREAT-64 SODIUM-39 URINE OSMOLAL-364 URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.011 URINE BLOOD-LG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG URINE RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE EPI-0 URINE SPERM-MOD [**2125-5-17**] 08:20AM CALCIUM-7.5* PHOSPHATE-6.7* MAGNESIUM-3.0* [**2125-5-17**] 11:43AM freeCa-0.97* TYPE-[**Last Name (un) **] PH-7.38 CARBAMZPN-<1.0* LITHIUM-LESS THAN 0.2 VALPROATE-<3.0* LACTATE-4.2* Upon Discharge ([**2125-5-24**]) Na 144 K 3.7 Cl 105 HCO3 27 BUN 26 Cr 1.6 Glc 83 ALT 131 AST 114 CPK 2111 WBC 9.7 Hgb 8.9 Hct 26.8 MCV 99 Plt 421 IMAGING ([**2125-5-17**]) Chest XRay: IMPRESSION: Small right apical pneumothorax. No evidence of infiltrate or effusion. ([**2125-5-17**]) Knee XRay: IMPRESSION: No acute fracture. ([**2125-5-21**]) Shoulder XRay: FINDINGS: No acute fractures or dislocations are seen. There is normal osseous mineralization. The visualized left lung apex is clear. ([**2125-5-24**]) Chest XRay: IMPRESSION: Tiny residual pneumothorax of [**5-20**] not visible anymore. Seventh rib fracture in unchanged position. ([**2125-5-24**]) Shoulder MRI: IMPRESSION: 1. No abnormality of the rotator cuff tendons. 2. Pronounced edema in the imaged the supraspinatus, infraspinatus, and teres minor, and deltoid muscles for which the differential is broad including includes myositis from trauma or connective tissue disorder, drugs including statins, and neuropathy involving both the axillary and suprascapular nerves. However, given the clinical history these findings can be seen in the setting of muscle injury related to rhabdomyolysis. Brief Hospital Course: This is a 49 yo M with a history of bipolar disorder on multiple psychiatric medications who presented with confusion, profound hyponatremia, renal failure and rhabdomyolysis. # Altered Mental Status - On admission, the patient had many reasons to be altered, including hyponatremia, uremia, drug or toxin ingestion. Initially, he tremulous and diaphoretic and he required large amounts of valium to control his agitation, without great effect. Per psychiatry recommendations, the patient's was changed to ativan PRN for agitation. However, ativan did not help much with the patient's agitation or hallucinations. With closer nursing monitoring and frequent redirection he became less agitated and required less benzos. Also, the patient's psychiatrist ([**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) was reached, who could not provide much information other than that he often sometimes showed up to appointments with alcohol on his breath. Over the course of several days, the patient's agitation and hallucinations improved. Psych recommended haldol for agitation instead of ativan while following QTc given borderline prolongation at baseline. Since the night of [**5-19**], the patient has been off of restraints. At the time of discharge, the patient was fully oriented and denied any hallucinations. Physical therapy was also consulted # Acute Renal Failure - It was felt that the patient's acute renal failure was likely ATN secondary to rhabdomyolysis, as he presented with a critically high CK and evidence of myoglobinuria. The underlying etiology of his rhabdomyolysis was unclear, and the differential included alcohol, drugs and toxins infections (including HIV), electrolyte abnormalities (unclear what was the precipitant), endocrinopathies and inflammatory myopathy. NMS was also on the differential, but patient's tone and temperature were normal. The patient had no obvious signs of infection. His increased osm gap raised suspicion for ingestion, but initial basic tox screens were only positive for benzos. His diffuse ecchymoses were throught to be an indication for injury, and recent fall 4 days prior to admission was confirmed with patient's mother. [**Name (NI) **] was started on various IV fluid regimens. Ultimately, he was put on 200 cc NS per hour to raise his sodium, which was changed to 150 cc 1/2 NS per hour if his sodium level began increasing rapidly. After several days of IVF hydration, the patient's CPK levels were trending down and his BUN and creatinine were improving. At time of discharge, the patient was tolerating PO fluids and Creatinine was 1.6. # Hyponatremia - The etiology of the patient's hyponatremia was unclear. Possible precipitants included the patient's HCTZ, misure/overdose of psychiatric medications, and psychogenic polydipsia. Renal felt that it was most likely the latter and that he likely dropped his sodium quickly. He was started on various IV fluid regimens in an attempt to correct his sodium. Ultimately, he was put on 200 cc NS per hour to raise his sodium, which was changed to 150 cc 1/2 NS per hour if his sodium level began increasing rapidly. While on this IVF therapy, the patients sodium levels rose slowly. On [**5-18**], his sodium level did drop slightly, and he was given a dose of 40 mg lasix IV. By [**5-20**], his sodium level had begun to normalize, the patient was taking PO fluids, and on the day of discharge, sodium was 144. . # Bipolar D/o - The patient was on several different psych meds at home, including ambien, cymbalta, lamictal, clonazepam, and geodon. Considering his altered mental status and his profound hyponatremia, all of these psych meds were held on admission. Levels of several psych meds, including lithium, carbamazepine, and valproic acid, were drawn but they were within normal limits. Once the patient's mental status and hyponatremia had improved, psych was consulted for their recommendations for restarting his psych meds. The primary team spoke with inpatient psychiatry as well as the patient's outpatient psych team (Dr. [**Last Name (STitle) **], who agreed that reintroduction of psychiatric meds should occur gradually. At the time of discharge, lamictal, ambien, and cymbalta were being held. Clonazepam 1mg TID still being administered, though goal is to taper the patient off completely. Geodon 20mg Qdaily was restarted while monitoring with EKG for QTc prolongation. The patient did not wish to be admitted to inpatient rehabilitation services, though the psychiatry team felt it necessary as he was deemed unable to care for self. The patient therefore fell under the guidelines for Section 12 and was discharged to rehabilitation. # Pneumothorax - The patient's initial CXR showed a right sided apical pneumothorax. Surgery was consulted and recommended to follow-up with a repeat CXR. The patient had several repeat CXR's which showed improvement and eventually resolution of the pneumothorax. The patient did still complain of rib pain, and incentive spirometry was used as inpatient. . # HTN - At home, the patient took atenolol and HCTZ for his HTN. However, on admission, his atenolol was held due to a low heart rate and his HCTZ was held due to his profound hyponatremia. While in the MICU, hydralazine was used to keep his SBP less than 160. Also, considering the extreme hyponatremia he presented with, it was felt that he should never be restarted on HCTZ, and it was added to his list of allergies. While on the floors, SBP ranged between 140 and 160 when the patient was on metoprolol 25mg PO BID. This dose was uptitrated on the day of discharge to 37.5mg PO BID. The patient should follow up with his PCP for better BP control. . # Other Electrolyte Abnormalities - The patient also required repletion of his potassium, calcium, and magnesium. Care was taken in repleting his electrolytes to not overshoot and make them too high. The patient was consistenly receiving potassium repletion daily and was discharged on 20meq PO of potassium daily. #Physical Activity- Patient was cleared by physical therapists for ADL's. #Poor nutritional intake- Patient had poor oral intake and ensure was added to diet order. It was thought that psychiatric factors played into poor oral intake. Medications on Admission: per pharmacy ([**Last Name (un) 50239**] in [**Location (un) 13011**] - [**Telephone/Fax (1) 56497**]) Cymbalta 40mg po bid Ambien 10mg po qhs lamotrigine 200mg po bid Geodon 20mg po qAM 40mg po qPM Atenolol 50mg daily HCTZ 12.5 mg po daily Klonopin 1mg po qid fluocinonide cream Discharge Medications: Geodon 20mg PO Qdaily Metoprolol 37.5mg PO BID Clonazepam 1mg PO TID Discharge Disposition: Extended Care Discharge Diagnosis: Primary Diagnoses 1. Acute Renal Failure 2. Altered Mental Status 3. Electrolyte Disturbance with Profound hyponatremia 4. Pneumothorax 5. Rhabdomyolysis Secondary Diagnoses 1. Bipolar Disorder 2. Hypertension 3. Poor nutritional intake Discharge Condition: Vital signs stable, medically clear. Deemed unable to care for self from psychiatric standpoint. Discharge Instructions: You were admitted to the hospital because you were confused and had kidney failure. The reason for your confusion was not entirely clear, but many of your blood tests were abnormal. You were in the intensive care unit for three days until you were transferred to the general medical floors. You received medications to keep you calm until you were thinking clearly. You are currently still taking clonazepam 1mg three times a day. You had kidney failure, which was probably the result of muscle breakdown from pressure on some part of your body for a long period of time. We thought that some injury you might have sustained caused this in light of the bruises on your body when you were admitted. Because of your kidney failure, some of your bloodwork was abnormal. We gave you fluids through an IV and your kidney function improved. You will need to take potassium supplements everyday after you leave the hospital because your potassium levels are still low. When you were admitted, your psychiatric medications were stopped, except for the clonazepam. We are beginning to restart your psychiatric medications gradually after talking to your hospital psychiatric team and with Dr. [**Last Name (STitle) **]. You are leaving on a reduced dose of Geodon at 20mg a day. Your other psychiatric medications will gradually be added back. You are being sent to an inpatient rehabilitation center because your psychiatrists have deemed you unable to care for yourself upon discharge. When you were admitted, you also had a pocket of air between your lung and chest wall called a pneumothorax. This was probably because of an injury you sustained. Before you were discharged, we did an XRay of your chest that showed that this had resolved. You were also admitted with a fracture of one of your ribs on the right side and with swelling of your left shoulder (due to muscle breakdown). These injuries should heal on their own and you should take tylenol as needed every six hours. Do not take more than 4 grams of tylenol in 24 hours. Your blood pressure was also high while you were in the hospital. Your atenolol and hydrochlorothiazide medications were stopped because of your abnormal blood tests and your kidney failure. You were started on metoprolol 37.5 mg twice a day for your blood pressure. Please follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1968**], for blood pressure control. Please return to the hospital or call Dr. [**Last Name (STitle) 1968**] at [**Telephone/Fax (1) 56498**] if you are feeling confused or have any symptoms that are concerning to you. IMMEDIATELY return to the emergency room or call Dr. [**Last Name (STitle) 1968**], Dr. [**Last Name (STitle) **], or Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 56499**]) if you feel that you want to hurt yourself or somebody else. Followup Instructions: 1. Please follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1968**], [**Telephone/Fax (1) 56498**] in [**11-24**] weeks after discharge from the extended care facility. 2. Please follow up with your psychiatrist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (([**Telephone/Fax (1) 56500**]) 3. Please follow up with your psychologist, Dr. [**Last Name (STitle) **] upon discharge from the extended care facility ([**Telephone/Fax (1) 56499**])

584,728,276,285,401,296

{'Acute kidney failure, unspecified,Rhabdomyolysis,Hyposmolality and/or hyponatremia,Anemia, unspecified,Unspecified essential hypertension,Bipolar disorder, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: altered mental status, electrolyte derangements PRESENT ILLNESS: This is a 49 year old male with a past history of HTN, bipolar disorder who is transferred to [**Hospital1 18**] from [**Hospital **] hospital for management of multiple electrolyte derangements. He initially called EMS yesterday when he felt confused, and was found to have diffuse ecchymoses and petechiae and to be acutely disoriented. At [**Hospital **] hospital, he was found to be in acute renal failure, profoundly hyponatremic to 108, hyperkalemic, thrombocytopenic, and anemic. He was also noted to have a tiny R apical PTX on CXR which was incidental. He also received a CT head and C spine which confirmed a small apical ptx but was otherwise unremarkable. He was transferred to [**Hospital1 18**] for management of possible TTP. In the [**Hospital1 18**] ED, his initial labs were notable for a normal platelet count, sodium 110, K 4.7, BUN/Cr 72/6.2, elevated LFT's, and an MB fraction greater than 400 (initial CK 7 at [**Hospital1 **], currently pending, but initial value is critically high per stat lab). He was oriented to person/place but doesn't understand what's going on. That being said, he has been calm, with a sitter throughout his ED stay. He has been hemodynamically stable, 75 151/65 100% room air and making good urine (225cc/hr). Getting NS @ 75cc/hr. Renal and heme aware. EKG showed a prolonged QTc without STTWC. Surgery was consulted for the PTX, and recommended monitoring for the ptx. He is transferred to the ICU for multiple electrolyte derangements and altered mental status. . On the floor, he was oriented to p/p/d, however was intermittently not making sense, with hallucinations. He denies recent trauma, falls, ingestions, or medication misuse. He denies any pain, nausea/vomiting/diarrhea, chest pain, palpitations, headache or disordered thinking. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. MEDICAL HISTORY: Bipolar Disorder HTN s/p laminectomy MEDICATION ON ADMISSION: per pharmacy ([**Last Name (un) 50239**] in [**Location (un) 13011**] - [**Telephone/Fax (1) 56497**]) Cymbalta 40mg po bid Ambien 10mg po qhs lamotrigine 200mg po bid Geodon 20mg po qAM 40mg po qPM Atenolol 50mg daily HCTZ 12.5 mg po daily Klonopin 1mg po qid fluocinonide cream ALLERGIES: Hydrochlorothiazide PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, but affect strange, ?confusion. no acute distress HEENT: Sclerae anicteric, MMM, oropharynx clear. Large abrasion over nose and smaller bruises over forehead with evidence of excoriation. Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, with scattered rhonchi FAMILY HISTORY: unknown at this time SOCIAL HISTORY: lives alone, parents are HCP's. Denies alcohol or other ingestions. In sales. ### Response: {'Acute kidney failure, unspecified,Rhabdomyolysis,Hyposmolality and/or hyponatremia,Anemia, unspecified,Unspecified essential hypertension,Bipolar disorder, unspecified'}

CHIEF COMPLAINT: Hypoglycemia PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 yo M with ESRD on HD, CAD s/p CABG, Afib, elevated PSA, admitted for hypoglycemia following complicated ED course. Briefly, patient states he went to ED yesterday evening for back pain and "couldn't get out of chair." Has new wheelchair with a seat that is sunken in and couldn't get out of it, called ambulence. States he never had back pain prior to yesterday. Pain is in lumbar spine. Denies weakness in his lower extremities. Denies numbness, pain in legs, saddle anesthesia, bladder/bowel difficulties. Admits to fall approx 1 month ago in which he hit his forehead, no falls since. In the ED, patient was given pain meds and discharged. He was brought by ambulence to the nursing home in which he resided in the past (not where he is currently living). They did not accept him there [**2-2**] him not being a current resident. Did not leave the ambulence and brought back to ED. When back at ED, noted to be more somnolent; FS checked and noted to be 26; given D50 and glucagon; repeats 46 then 62. Denies having injections Report of chest pain in ED; however, patient currently denying current or recent CP. No SOB, dizziness, lightheadedness, HA, abd pain, fever. MEDICAL HISTORY: 1. CAD: s/p CABG x 3 (LIMA-LAD, SVG-OM, SVG-Diag in [**9-4**] at [**Location (un) 7349**] [**Hospital1 **] after presenting with loss of consciousness). Followed by Dr. [**First Name (STitle) **] [**Name (STitle) **]. 2. s/p MV repair: [**9-4**] (#28 Physio ring) 3. s/p AICD implant: [**9-4**] for VT 4. AFib 5. ESRD: [**2-2**] IgA nephropathy. was on peritoneal dialysis. Now on HD (since [**10-6**]). Follows with Dr. [**First Name (STitle) 805**] 6. HTN 7. s/p Left-sided CVA 8. dyslipidemia 9. Gout 10. Elevated PSA with enlarged, firm prostate, sclerotic lesions on CT scan, but bone scan [**9-6**] negative. No prostate bx yet. MEDICATION ON ADMISSION: NIFEdipine CR 30 mg PO DAILY Furosemide 40 mg PO DAILY FoLIC Acid 1 mg PO DAILY Multivitamins 1 CAP PO DAILY Fluticasone-Salmeterol (100/50) 1 INH IH [**Hospital1 **] Pantoprazole 40 mg PO Q24H Calcitriol 0.25 mcg PO DAILY Tamsulosin HCl 0.4 mg PO HS Paroxetine 10 mg PO DAILY Atorvastatin 40 mg PO DAILY Amiodarone 200 mg PO DAILY Metoprolol 100 mg PO TID Aspirin 325 mg PO DAILY Clopidogrel Bisulfate 75 mg PO DAILY ALLERGIES: Vancomycin PHYSICAL EXAM: VS: T 97.4, BP 133/75, P 72, R 20, 99%RA. FS: 108, 92 here General: Thin male, NAD. HEENT: NC. + soft tissue swelling above L eyebrow, mildly tender. sclera anicteric. MMM, OP clear. Chest: clear with few end expiratory crackles Heart: RRR, S1 S2, loud holosystolic murmur at apex Abdomen: thin, soft, NT/ND +BS Back: (limited) no CVA tenderness; +TTP low thoracic and lumbar spine Extrem: thin, warm. No edema. L 2nd toe amputation Neuro: Alert, oriented x 3 FAMILY HISTORY: His parents are both deceased of unclear cause. He has two siblings, both deceased of unclear cause. He has three children. SOCIAL HISTORY: He emigrated from [**Location (un) 6847**] in [**2172**].

Other staphylococcal septicemia,End stage renal disease,Unspecified pleural effusion,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, heel,Unspecified protein-calorie malnutrition,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Aortocoronary bypass status,Gout, unspecified,Other and unspecified hyperlipidemia,Automatic implantable cardiac defibrillator in situ

Staphylcocc septicem NEC,End stage renal disease,Pleural effusion NOS,Atrial fibrillation,Hyp kid NOS w cr kid V,Pressure ulcer, heel,Protein-cal malnutr NOS,SIRS-noninf w/o ac or ds,Aortocoronary bypass,Gout NOS,Hyperlipidemia NEC/NOS,Status autm crd dfbrltr

Admission Date: [**2187-9-6**] Discharge Date: [**2187-9-9**] Date of Birth: [**2113-5-5**] Sex: M Service: MEDICINE Allergies: Vancomycin Attending:[**First Name3 (LF) 12077**] Chief Complaint: Hypoglycemia Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname **] is a 74 yo M with ESRD on HD, CAD s/p CABG, Afib, elevated PSA, admitted for hypoglycemia following complicated ED course. Briefly, patient states he went to ED yesterday evening for back pain and "couldn't get out of chair." Has new wheelchair with a seat that is sunken in and couldn't get out of it, called ambulence. States he never had back pain prior to yesterday. Pain is in lumbar spine. Denies weakness in his lower extremities. Denies numbness, pain in legs, saddle anesthesia, bladder/bowel difficulties. Admits to fall approx 1 month ago in which he hit his forehead, no falls since. In the ED, patient was given pain meds and discharged. He was brought by ambulence to the nursing home in which he resided in the past (not where he is currently living). They did not accept him there [**2-2**] him not being a current resident. Did not leave the ambulence and brought back to ED. When back at ED, noted to be more somnolent; FS checked and noted to be 26; given D50 and glucagon; repeats 46 then 62. Denies having injections Report of chest pain in ED; however, patient currently denying current or recent CP. No SOB, dizziness, lightheadedness, HA, abd pain, fever. Past Medical History: 1. CAD: s/p CABG x 3 (LIMA-LAD, SVG-OM, SVG-Diag in [**9-4**] at [**Location (un) 7349**] [**Hospital1 **] after presenting with loss of consciousness). Followed by Dr. [**First Name (STitle) **] [**Name (STitle) **]. 2. s/p MV repair: [**9-4**] (#28 Physio ring) 3. s/p AICD implant: [**9-4**] for VT 4. AFib 5. ESRD: [**2-2**] IgA nephropathy. was on peritoneal dialysis. Now on HD (since [**10-6**]). Follows with Dr. [**First Name (STitle) 805**] 6. HTN 7. s/p Left-sided CVA 8. dyslipidemia 9. Gout 10. Elevated PSA with enlarged, firm prostate, sclerotic lesions on CT scan, but bone scan [**9-6**] negative. No prostate bx yet. Social History: He emigrated from [**Location (un) 6847**] in [**2172**]. Family History: His parents are both deceased of unclear cause. He has two siblings, both deceased of unclear cause. He has three children. Physical Exam: VS: T 97.4, BP 133/75, P 72, R 20, 99%RA. FS: 108, 92 here General: Thin male, NAD. HEENT: NC. + soft tissue swelling above L eyebrow, mildly tender. sclera anicteric. MMM, OP clear. Chest: clear with few end expiratory crackles Heart: RRR, S1 S2, loud holosystolic murmur at apex Abdomen: thin, soft, NT/ND +BS Back: (limited) no CVA tenderness; +TTP low thoracic and lumbar spine Extrem: thin, warm. No edema. L 2nd toe amputation Neuro: Alert, oriented x 3 Pertinent Results: [**2187-9-6**] WBC-3.8* HGB-12.8*# HCT-39.2*# MCV-96# MCH-31.4 MCHC-32.7 RDW-18.0* PLT-94* NEUTS-83.6* BANDS-0 LYMPHS-9.1* MONOS-5.9 EOS-0.9 BASOS-0.5 HYPOCHROM-2+ ANISOCYT-2+ POIKILOCY-1+ MACROCYT-2+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+ GLUCOSE-285* UREA N-94* CREAT-7.3*# SODIUM-133 POTASSIUM-5.8* CHLORIDE-97 TOTAL CO2-22 ANION GAP-20 CALCIUM-7.8* PHOSPHATE-6.8*# MAGNESIUM-2.1 CK(CPK)-77 CK-MB-NotDone cTropnT-0.15* (baseline ~0.2) . Elbow Xray ([**2187-9-6**]): Cortical irregularity at the medial aspect of the coracoid process, suspicious for a non-displaced fracture in the appropriate clinical setting. Please correlate with focal tenderness in this area. . CXR ([**2187-9-6**]) : 1. Stable, bilateral pleural effusions moderate to large on the right and moderate on the left with bibasilar atelectasis. 2. No evidence of pulmonary edema. . CT head ([**2187-9-6**]) : 1) No evidence of intracranial hemorrhage or edema. 2) Subcutaneous soft tissue hematoma along the frontal scalp anteriorly on the left. 3) Small amount of subcutaneous air within the scalp along the right temporal bone. . AXR ([**2187-9-6**]): A relative paucity of gas is again identified within the abdomen, as seen on the previous exam. Vascular calcifications are seen. No dilated loops of large or small bowel are seen. . CT chest ([**2187-6-25**]): Interval increase in bilateral pleural effusions, large on the right and moderate on the left with lateral left-sided loculated component. No abnormal pleural enhancement or suggestion of pleural disease. 2. Multifocal sclerotic lesions within the bones. Differential diagnosis includes calcified hemangiomas, perhaps related to underlying renal disease; however, osteoblastic metastatic lesions cannot be excluded. Suggest correlation with PSA and bone scan if needed. Brief Hospital Course: 74 year old male with ESRD on HD, CAD s/p CABG, afib, no history of diabetes; presents to ED with back pain and hypoglycemia to 26, transferred to MICU for hypotension/hypothermia, he was transferred to the medical floor on [**2187-9-8**] and signed out against medical advice on [**2187-9-9**]. Hypotension - Resolved in the MICU. Originally presumed and treated as septic shock given hypothermia and hypoglycemia. Hct was stable with normal cortisol levels. Blood pressures were stable upon call out from MICU. There was no explanation for initial hypotension. Heart failure was unlikely given clinical exam, no chest pain, sob, or EKG changes. Patient signed out Against medical advice the morning after transfer from the MICU. No further workup done as this patient decided to leave AMA. Hypothermia - Infectious workup begun in the MICU. Concern was for sepsis, though patient was without fevers in the MICU. Blood pressures had also stabilized upon callout from the MICU. Patient did have sources of infection with right heel ulcer, left elbow effusion and pleural effusion. On the night of [**2187-9-8**], one blood culture grew out gram + cocci. Patient was on ceftriaxone. Vancomycin could not be started given history of red man syndrome. The following morning, Mr. [**Known lastname **] decided to sign out AMA. He was told about his likely blood infection and the possibility of sepsis and death. He stated he understood and did not want to be treated. Mr. [**Known lastname **] son was present and agreed with his father. Mr. [**Known lastname **] was given a prescription for Dicloxacillin and signed out AMA. He was told to follow up with his PCP [**Name Initial (PRE) 2227**]. Hypoglycemia: Etiology was unclear. [**Name2 (NI) **] was being followed by endocrine, w/u underway. Differential diagnosis included prostate cancer, early-onset diabetes, insulinoma. He was told to follow up with his PCP regarding this matter. He signed out AMA on [**2187-9-9**] without further workup. ESRD: Patient is on Hemodyalysis via right arm fistula (tu/th/sa). HD continued as an inpatient. Pleural effusions: Patient with bilateral, chronic effusions. Etiology was unclear, diagnostic pleural tap was being considered but patient signed out AMA before tap could be done. Mr. [**Known lastname **] was told to follow up with his PCP regarding this matter. Pancytopenia: Mr. [**Known lastname **] was seen by heme/onc who felt pancytopenia likely represented sepsis vs medications vs prostate ca. Anemia is at baseline, and is attributed to CKD. Prostate enlargement: PSA elevated to 40.1, followed by urology (Dr. [**Last Name (STitle) 770**], has firm prostate on admission exam, will need CT ABD/PELVIS and bone scan per email from Dr. [**Last Name (STitle) 11189**]. CT TORSO performed to evaluate for metastatic prostate ca, which found evidence of extensive sclerotic lesions in the bone. Bone scan was considered but patient left AMA before further workup could be pursued. He was told to follow up with his PCP regarding this matter. Elevated INR - Patient was given vitamin K for elevated INR. Patient left AMA before further workup could be initiated. Back pain: Patient complaining of back pain on admission. It resolved upon transfer to the medical floor. Patient left AMA before further workup could be initiated Elbow pain: Patient with left elbow effusion of unknown etiology. Mr. [**Known lastname **] left AMA before further workup could be initiated. Medications on Admission: NIFEdipine CR 30 mg PO DAILY Furosemide 40 mg PO DAILY FoLIC Acid 1 mg PO DAILY Multivitamins 1 CAP PO DAILY Fluticasone-Salmeterol (100/50) 1 INH IH [**Hospital1 **] Pantoprazole 40 mg PO Q24H Calcitriol 0.25 mcg PO DAILY Tamsulosin HCl 0.4 mg PO HS Paroxetine 10 mg PO DAILY Atorvastatin 40 mg PO DAILY Amiodarone 200 mg PO DAILY Metoprolol 100 mg PO TID Aspirin 325 mg PO DAILY Clopidogrel Bisulfate 75 mg PO DAILY Discharge Medications: Mr. [**Known lastname **] left against medical advice Discharge Disposition: Home Discharge Diagnosis: Patient left AMA Hypothermia, hypotension, hypoglycemia Discharge Condition: Patient left against medical advice Discharge Instructions: Patient left against medical advice You were admitted with back pain, low blood sugar and hypothermia. You were treated in the medical intensive care unit for your low blood pressures and low blood sugars. Endocrinology was following your blood sugars and recommended workup which could not be concluded since you have decided to leave against medical advice. A blood culture showed possible bacterial blood infection. You are to take an antibiotic Dicloxacillin 250mg every 6 hours for 14 days. You were also found to have fluid in your lungs and in your abdomen. Your prostate as been noted to be enlarged and your PSA level is elevated, these factors point towards the possibility of prostate cancer. Please follow up with your primary care doctor regarding this issue. Your primary care doctor was notified by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 34382**] about your admission and regarding your wishes to leave against medical advice. If you experience fevers, shortness of breath, chest pain, abdominal pain, back pain, nausea, vomiting, fainting, dizziness, lightheadedness, falls or any other concering symptoms then please call your doctor immediately or report to the nearest emergency room. Followup Instructions: Patient left against medical advice 1. Please call your primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on monday [**2187-9-10**] for a follow up appointment ([**Telephone/Fax (1) 34383**]. Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2187-11-13**] 3:00

038,585,511,427,403,707,263,995,V458,274,272,V450

{'Other staphylococcal septicemia,End stage renal disease,Unspecified pleural effusion,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, heel,Unspecified protein-calorie malnutrition,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Aortocoronary bypass status,Gout, unspecified,Other and unspecified hyperlipidemia,Automatic implantable cardiac defibrillator in situ'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Hypoglycemia PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 yo M with ESRD on HD, CAD s/p CABG, Afib, elevated PSA, admitted for hypoglycemia following complicated ED course. Briefly, patient states he went to ED yesterday evening for back pain and "couldn't get out of chair." Has new wheelchair with a seat that is sunken in and couldn't get out of it, called ambulence. States he never had back pain prior to yesterday. Pain is in lumbar spine. Denies weakness in his lower extremities. Denies numbness, pain in legs, saddle anesthesia, bladder/bowel difficulties. Admits to fall approx 1 month ago in which he hit his forehead, no falls since. In the ED, patient was given pain meds and discharged. He was brought by ambulence to the nursing home in which he resided in the past (not where he is currently living). They did not accept him there [**2-2**] him not being a current resident. Did not leave the ambulence and brought back to ED. When back at ED, noted to be more somnolent; FS checked and noted to be 26; given D50 and glucagon; repeats 46 then 62. Denies having injections Report of chest pain in ED; however, patient currently denying current or recent CP. No SOB, dizziness, lightheadedness, HA, abd pain, fever. MEDICAL HISTORY: 1. CAD: s/p CABG x 3 (LIMA-LAD, SVG-OM, SVG-Diag in [**9-4**] at [**Location (un) 7349**] [**Hospital1 **] after presenting with loss of consciousness). Followed by Dr. [**First Name (STitle) **] [**Name (STitle) **]. 2. s/p MV repair: [**9-4**] (#28 Physio ring) 3. s/p AICD implant: [**9-4**] for VT 4. AFib 5. ESRD: [**2-2**] IgA nephropathy. was on peritoneal dialysis. Now on HD (since [**10-6**]). Follows with Dr. [**First Name (STitle) 805**] 6. HTN 7. s/p Left-sided CVA 8. dyslipidemia 9. Gout 10. Elevated PSA with enlarged, firm prostate, sclerotic lesions on CT scan, but bone scan [**9-6**] negative. No prostate bx yet. MEDICATION ON ADMISSION: NIFEdipine CR 30 mg PO DAILY Furosemide 40 mg PO DAILY FoLIC Acid 1 mg PO DAILY Multivitamins 1 CAP PO DAILY Fluticasone-Salmeterol (100/50) 1 INH IH [**Hospital1 **] Pantoprazole 40 mg PO Q24H Calcitriol 0.25 mcg PO DAILY Tamsulosin HCl 0.4 mg PO HS Paroxetine 10 mg PO DAILY Atorvastatin 40 mg PO DAILY Amiodarone 200 mg PO DAILY Metoprolol 100 mg PO TID Aspirin 325 mg PO DAILY Clopidogrel Bisulfate 75 mg PO DAILY ALLERGIES: Vancomycin PHYSICAL EXAM: VS: T 97.4, BP 133/75, P 72, R 20, 99%RA. FS: 108, 92 here General: Thin male, NAD. HEENT: NC. + soft tissue swelling above L eyebrow, mildly tender. sclera anicteric. MMM, OP clear. Chest: clear with few end expiratory crackles Heart: RRR, S1 S2, loud holosystolic murmur at apex Abdomen: thin, soft, NT/ND +BS Back: (limited) no CVA tenderness; +TTP low thoracic and lumbar spine Extrem: thin, warm. No edema. L 2nd toe amputation Neuro: Alert, oriented x 3 FAMILY HISTORY: His parents are both deceased of unclear cause. He has two siblings, both deceased of unclear cause. He has three children. SOCIAL HISTORY: He emigrated from [**Location (un) 6847**] in [**2172**]. ### Response: {'Other staphylococcal septicemia,End stage renal disease,Unspecified pleural effusion,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, heel,Unspecified protein-calorie malnutrition,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Aortocoronary bypass status,Gout, unspecified,Other and unspecified hyperlipidemia,Automatic implantable cardiac defibrillator in situ'}

CHIEF COMPLAINT: PRESENT ILLNESS: Sixty-year-old male with past medical history of hypertension, TIA, who was transferred from an outside hospital with history of left arm tingling, numbness that rapidly progressed to left hemiparesis and decreased mental status. The patient was intubated at outside hospital, given sedation, and paralytic agents. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Intracerebral hemorrhage,Other convulsions,Gout, unspecified

Intracerebral hemorrhage,Convulsions NEC,Gout NOS

Admission Date: [**2128-11-9**] Discharge Date: [**2128-11-17**] Date of Birth: [**2067-11-10**] Sex: M Service: HISTORY OF PRESENT ILLNESS: Sixty-year-old male with past medical history of hypertension, TIA, who was transferred from an outside hospital with history of left arm tingling, numbness that rapidly progressed to left hemiparesis and decreased mental status. The patient was intubated at outside hospital, given sedation, and paralytic agents. At outside hospital, CT scan showed a right thalamic to parenchymal hemorrhage 3 x 3 with midline shift. The patient denied headache. Patient also has a left visual field deficit in the past. MEDICATIONS: Aspirin. VITAL SIGNS: Blood pressure 180/100. Pulse of 66. O2 saturation was 100%. PHYSICAL EXAMINATION: Pupils are 1.5 minimally reactive, no corneals. Positive gag, cough. Moving localizing his right upper extremity briskly to pain, question moving his left extremity to extensor posturing. Moves bilateral lower extremities to pains, following commands. Does not open eyes to commands. The patient had a left facial droop. LABORATORIES: White count was 4.6, hematocrit 50.3, platelets 175. Sodium 134, potassium 4.1, 96, 28, BUN 12, and creatinine 0.9. Patient was admitted to the ICU. Given mannitol IV. His head CT on comparison to the one from the outside hospital on the [**11-11**] showed an increased amount of blood in the ventricles most specifically in the occipital [**Doctor Last Name 534**] of the left lateral ventricles. There is also some evidence of some new blood in the subarachnoid space of the left hemisphere. It is felt that there is likely new hemorrhage within the right frontal hematoma, increased mass effect, and edema surrounding the hematoma. On the [**11-11**], he was moving his left arm slightly spontaneously. Turns head towards stimulation and had tonic posture in his lower extremities. His left pupil was 2.5 to 2. His right pupil 2.0 to 1.8, reactive. To stimulation, he is moving his right leg. His arm was nonpurposeful, not completely localizing on that side. He had some internal rotation of the left upper extremity and increased rigidity. He was given mannitol q.4h. Receiving calcium gluconate and magnesium for repletion of electrolytes. He is given Protonix and insulin-sliding scale as needed. He was kept on a ventilator during this time. On the [**11-11**], the patient had a repeat head CT which was unchanged. On the [**11-12**], his fluid was restricted to 1 liter per day. He continued to receive mannitol. IV fluids were 60-80 cc an hour. He had a full fever workup and a Doppler to his bilateral lower extremity workup for his fever. There was no evidence of a deep vein thrombosis in that area. He was started on tube feeds also on the 10th. On the [**11-13**], it was noted that the patient to be having seizure-like activity. At that time, he had a head CT repeated and there was no significant change within the study from the 10th. Again, there was a large right thalamic hemorrhage with severe edema causing a leftward subfalcine herniation. He was started on Dilantin. He was given a 1 gram bolus and then started at 100 mg t.i.d. On the [**11-14**], the mannitol had been held somewhat due to osms greater than 320. His pupils were noted to be 2.5 to 2 in his right and his left was 3 to 2.5. He was turning his head to stimulation of his right, right upper extremity localization, upgoing toes on the left. Blood pressures were kept below 180. We were double concentrating tube feeds. Mannitol was held for osms less than 320 and continued to follow his fever workup. On the [**11-16**], it was noted that the patient was more unresponsive, seemed to have posturing activity with his feet. Pupils: He had no corneal reflexes. A repeat CAT scan showed right cerebral herniation, ventricular dilation. It was felt that the large right interparenchymal hemispheric high density region was compatible with blood and it seemed to be measuring larger than the previous CAT scan from three days ago. Given this information, the family decided to make the patient comfort measures only. He was extubated and started on a Morphine drip. He died surrounded by his family on [**2128-11-17**] at exactly 1:30 a.m. [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D. [**MD Number(1) 343**] Dictated By: [**First Name11 (Name Pattern1) 3065**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3903**], N.P. MEDQUIST36 D: [**2128-11-17**] 01:53 T: [**2128-11-17**] 05:35 JOB#: [**Job Number 50367**]

431,780,274

{'Intracerebral hemorrhage,Other convulsions,Gout, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: Sixty-year-old male with past medical history of hypertension, TIA, who was transferred from an outside hospital with history of left arm tingling, numbness that rapidly progressed to left hemiparesis and decreased mental status. The patient was intubated at outside hospital, given sedation, and paralytic agents. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Intracerebral hemorrhage,Other convulsions,Gout, unspecified'}

CHIEF COMPLAINT: Chest pain at rest PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS: 69 yo M with history of HTN, HL, DMII presenting with exertional chest pain x 10 days, now occurring at rest. Patient was in [**Country 38213**] at onset of pain, and was evaluated at the hospital. EKG there showed evidence of "a blocked artery," but they did not have stress test or catheterization capability so he was sent to [**Country 5881**]. In [**Country 5881**], the patient refused to go to the hospital, as he wanted to come to the US for further care. He had to wait 7 days to get a plane ticket and arrived Sunday. On Monday, he saw his PCP who started nitroglycerin, imdur and atorvastatin (he has not yet taken the atorvastatin) and set him up for cardiology evaluation on Wednesday am. On the morning of admission, patient developed acutely worse pain while climbing stairs that did not resolve with rest, prompting him to seek medical attention. Patient presented to [**Hospital3 **] ED. Labs were notable for an elevated troponin to 3.29, BNP 987, ddimer 1563. EKG had no ST elevations. Patient was started on heparin gtt and nitro paste. He was transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: - Type 2 diabetes - Dyslipidemia - Hypertension - Asthma - Regarding cardiac disease, per patient: stress test 5-6 years ago treatment with medication, no cath. - Chronic Hepatitis C (untreated per patient preference) - Basal cell carcinoma (forehead) - medication noncompliance (per PCP all medications should be generic) MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. benazepril *NF* 5 mg Oral daily. please hold for SBP<100 2. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY. please hold for SBP<100 3. Hydrochlorothiazide 50 mg PO DAILY please hold for SBP<100 4. Prazosin 1 mg PO BID 5. Verapamil 240 mg PO Q24H . please hold for SBP<100, HR<60 6. MetFORMIN XR (Glucophage XR) 750 mg PO BID . Do Not Crush 7. Nitroglycerin SL 0.4 mg SL PRN CP ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION: VS: T97.5 BP 146/102 HR 75 RR 20 O2 93% on 2LNC GENERAL: obese male lying comfortably in bed in NAD HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink. Oropharynx clear with upper dentures. NECK: Supple with JVP to mandible, no carotid bruits 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: CTA bilaterally, mild crackles at left>right base, no wheeze ABDOMEN: Obese, +BS, soft, nontender, no HSM appreciated EXTREMITIES: No c/c/e. No femoral bruits. Tender to palpation of right calf without erythema or swelling SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 1+ PT 1+ Left: Carotid 2+ DP 1+ PT 1+ . DISCHARGE PHYSICAL EXAM: Physical Exam: VS: 97.9 110/76 (110-120/70s) 59 (60s) 18 96RA Gen: well appearing male in NAD HEENT: NCAT EOMI MMM Neck: Supple without JVD Pulm: CTA b/l without wheeze or crackles Cor: RRR (+)S1/S2 without m/r/g Abd: Soft, ND, NTP, NABS, no HSM Extrem: trace LE edema b/l with good distal pulses Neuro: AOx3, CNII-XII grossly intact, moving all extremities FAMILY HISTORY: No known family history of CAD, HTN, DM, or early MI, both parents died in 60s. SOCIAL HISTORY: Patient is married with children. He lives with his wife, who speaks [**Name (NI) 24075**]. He is originally from [**Country 38213**] but emigrated to the US in [**2113**]. He speaks [**Year (4 digits) 24075**] and Albanian. He is retired but worked in fruit/vegetable delivery. Denies tobacco use, alcohol use, or illicit drugs.

Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Subendo infarct, initial,Ac systolic hrt failure,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2154-8-20**] Discharge Date: [**2154-8-24**] Date of Birth: [**2085-8-18**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern1) 1171**] Chief Complaint: Chest pain at rest Major Surgical or Invasive Procedure: [**2154-8-21**]: Cardiac catheterization with 2 DEX to RCA, no intervention to totally occluded LCA. History of Present Illness: HISTORY OF PRESENTING ILLNESS: 69 yo M with history of HTN, HL, DMII presenting with exertional chest pain x 10 days, now occurring at rest. Patient was in [**Country 38213**] at onset of pain, and was evaluated at the hospital. EKG there showed evidence of "a blocked artery," but they did not have stress test or catheterization capability so he was sent to [**Country 5881**]. In [**Country 5881**], the patient refused to go to the hospital, as he wanted to come to the US for further care. He had to wait 7 days to get a plane ticket and arrived Sunday. On Monday, he saw his PCP who started nitroglycerin, imdur and atorvastatin (he has not yet taken the atorvastatin) and set him up for cardiology evaluation on Wednesday am. On the morning of admission, patient developed acutely worse pain while climbing stairs that did not resolve with rest, prompting him to seek medical attention. Patient presented to [**Hospital3 **] ED. Labs were notable for an elevated troponin to 3.29, BNP 987, ddimer 1563. EKG had no ST elevations. Patient was started on heparin gtt and nitro paste. He was transferred to [**Hospital1 18**] for further management. In the ED, initial vitals were 97.6 80 157/105 18 98% 2l. EKG was notable for sinus rhythm, Q waves with st depressions in inferior leads, no ST elevations. Posterior EKG showed no ST elevations. Labs were notable for troponin 1.08 with CK 144 and MB4, normal CBC, electrolytes (Cr 1.0), and u/a negative. Nitro paste was removed and converted to nitro drip, and patient was chest pain free. In addition, given evidence of heart failure, patient received 40mg IV lasix. Cardiology was consulted who recommended admission to [**Hospital1 1516**] for further management and catheterization. On arrival to the floor, initial vital signs were T97.5 BP 146/102 HR 75 RR 20 O2 93% on 2LNC. Patient denied ongoing chest pain, pressure or shortness of breath. He reports that he has had some right calf pain, without swelling or erythema. He has had fevers at home (but has no taken his temperature). Cardiac review of systems is notable for symptoms above, absence of ankle edema, palpitations, syncope or presyncope. Patient denies abdominal pain, diarrhea, constipation, BRBPR, melena, dysuria or hematuria. Past Medical History: - Type 2 diabetes - Dyslipidemia - Hypertension - Asthma - Regarding cardiac disease, per patient: stress test 5-6 years ago treatment with medication, no cath. - Chronic Hepatitis C (untreated per patient preference) - Basal cell carcinoma (forehead) - medication noncompliance (per PCP all medications should be generic) Social History: Patient is married with children. He lives with his wife, who speaks [**Name (NI) 24075**]. He is originally from [**Country 38213**] but emigrated to the US in [**2113**]. He speaks [**Year (4 digits) 24075**] and Albanian. He is retired but worked in fruit/vegetable delivery. Denies tobacco use, alcohol use, or illicit drugs. Family History: No known family history of CAD, HTN, DM, or early MI, both parents died in 60s. Physical Exam: ADMISSION PHYSICAL EXAMINATION: VS: T97.5 BP 146/102 HR 75 RR 20 O2 93% on 2LNC GENERAL: obese male lying comfortably in bed in NAD HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink. Oropharynx clear with upper dentures. NECK: Supple with JVP to mandible, no carotid bruits 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: CTA bilaterally, mild crackles at left>right base, no wheeze ABDOMEN: Obese, +BS, soft, nontender, no HSM appreciated EXTREMITIES: No c/c/e. No femoral bruits. Tender to palpation of right calf without erythema or swelling SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 1+ PT 1+ Left: Carotid 2+ DP 1+ PT 1+ . DISCHARGE PHYSICAL EXAM: Physical Exam: VS: 97.9 110/76 (110-120/70s) 59 (60s) 18 96RA Gen: well appearing male in NAD HEENT: NCAT EOMI MMM Neck: Supple without JVD Pulm: CTA b/l without wheeze or crackles Cor: RRR (+)S1/S2 without m/r/g Abd: Soft, ND, NTP, NABS, no HSM Extrem: trace LE edema b/l with good distal pulses Neuro: AOx3, CNII-XII grossly intact, moving all extremities Pertinent Results: Admission labs: [**2154-8-20**] 08:45PM BLOOD WBC-7.1 RBC-4.82 Hgb-15.1 Hct-43.0 MCV-89 MCH-31.2 MCHC-35.0 RDW-13.4 Plt Ct-176 [**2154-8-20**] 08:45PM BLOOD Neuts-75.9* Lymphs-16.4* Monos-4.9 Eos-2.5 Baso-0.4 [**2154-8-20**] 08:45PM BLOOD Glucose-198* UreaN-12 Creat-1.0 Na-143 K-3.7 Cl-106 HCO3-25 AnGap-16 [**2154-8-20**] 08:45PM BLOOD CK(CPK)-144 [**2154-8-20**] 08:45PM BLOOD CK-MB-4 [**2154-8-20**] 08:45PM BLOOD cTropnT-1.08* [**2154-8-21**] 08:20AM BLOOD Calcium-8.6 Phos-2.4* Mg-1.8 Cholest-166 . Other labs while admitted: [**2154-8-21**] 08:20AM BLOOD CK(CPK)-101 [**2154-8-21**] 11:02PM BLOOD CK(CPK)-79 [**2154-8-22**] 05:57AM BLOOD CK(CPK)-970 [**2154-8-22**] 04:03PM BLOOD CK(CPK)-105 . [**2154-8-21**] 08:20AM BLOOD CK-MB-3 cTropnT-0.89* [**2154-8-21**] 11:02PM BLOOD CK-MB-4 cTropnT-0.98* [**2154-8-22**] 05:57AM BLOOD CK-MB-6 cTropnT-1.13* [**2154-8-22**] 04:03PM BLOOD CK-MB-6 . [**2154-8-21**] 08:20AM BLOOD %HbA1c-8.0* eAG-183* [**2154-8-21**] 08:20AM BLOOD Triglyc-149 HDL-35 CHOL/HD-4.7 LDLcalc-101 . DISCHARGE LABS: [**2154-8-24**] 07:05AM BLOOD WBC-7.0 RBC-5.14 Hgb-15.3 Hct-45.8 MCV-89 MCH-29.7 MCHC-33.3 RDW-13.4 Plt Ct-170 [**2154-8-24**] 07:05AM BLOOD Glucose-188* UreaN-20 Creat-1.0 Na-138 K-4.2 Cl-101 HCO3-25 AnGap-16 [**2154-8-24**] 07:05AM BLOOD Calcium-8.8 Phos-2.5* Mg-1.9 . CXR [**2154-8-20**] Worsening mild pulmonary edema with small bilateral pleural effusions. . CARDIAC CATH [**2154-8-21**] 1)Selective coronary angiography of this right dominant system revealed three vessel disease with occlusion of RCA and mid LCx. The LMCA was normal. LAD had 50% mid, diffuse distal 70% lesion and D1 had 60-70% lesion. The LCx was with total occlusion after OM1 with faint L->L collaterals to distal OM. RCA with total occlusion with faint antegrade flow and L->R collaterals. 2) Resting hemodynamics showed aortic pressure of 95/53 and elevated right sided pressures with wedge of 25 and decreased cardiac output and index. FINAL DIAGNOSIS: 1. Three vessel coronary artery disease with occlusion of RCA and Cx (mid). 2. Admit to CCU for heart failure management. ** GOT DES x2 TO RCA ** . LENIS [**2154-8-21**] IMPRESSION: No evidence of deep vein thrombosis in the right leg. . CARDIAC ECHO [**2154-8-22**] LVEF 35% The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. Overall left ventricular systolic function is moderately depressed (LVEF= 35 %) secondary to hypokinesis of the inferior, posterior, and lateral walls. The right ventricular free wall thickness is normal. Right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets are mildly thickened (?#). The aortic valve is not well seen. There is no aortic valve stenosis. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. IMPRESSION: Suboptimal image quality. Inferoposterolateral myocardial infarct Brief Hospital Course: 69 year old gentleman with hypertension, hyperlipidemia, type 2 diabetes, chronic hepatitis C and asthma, who presented with ten days of exertional chest pain, which became constant at rest, as well as SOB. On admission to the floor, he was currently chest pain and pressure-free, denies DOB, denies nausea and vomiting. He was treated with a heparin drip for NSTEMI, and DVT was ruled out by LENIs (suspected due to elevated d-dimer). He underwent a cardiac catheterization on [**2154-8-21**] and received 2 drug eluting stents to the RCA. During the procedure, it was noted that he had an elevated wedge pressure, so he was transferred to the CCU post-cath. In the CCU he was diuresed, continued to be stable, and was transferred back to the Cardiology floor on [**2154-8-23**]. He also had an echocardiogram showing showing EF 35%, with inferior and posterior lateral hypokinesis. # NSTEMI- Symptoms and troponin leak consistent were consistent with ACS. He was treated with heparin drip and nitroglycerin drip titrated for chest pain. Given progression of symptoms over 10 days, flat MB, and Q waves in inferior leads, cardiac tissue was most likely infarcted. However, EKG showed anterior changes and rising troponin, and Mr. [**Known lastname 112186**] was loaded with clopidogrel and underwent catheterization for NSTEMI. He had 2 DES to his RCA and due to elevated wedge pressures, was admitted to the CCU for post-catheterization diuresis with an initial goal of >50cc/hr. Echocardiogram showed EF 35% with inferior and posterior lateral hypokinesis. Transferred back to the Cardiology floor, where he remained stable. - He was started on 81 mg aspirin daily, 80 mg of atorvastatin daily, 75 mg of clopidogrel daily, 20 mg of furosemide daily, 10 mg of lisinopril daily, and 100 mg of metoprolol succinate XL daily. - His home benazepril, isosorbide mononitrate, hydrochlorothiazide, prazosin, and verapamil were stopped. . # Systolic Heart Failure- Though he presented with evidence of decompensation in ED, on discharged he was without evidence of pulmonary edema on exam SOB. He was diuresed in the CCU, and continued on a regimen of furosemide 20 mg as an outpatient. He was also started on lisinopril and metoprolol as above. Echo showed EF of 35% and hypokinesis (please see attached report). . # HTN- Started Metoprolol, lisinopril, furosemide as above. Discontinued home benazapril, HCTZ, and verapamil. Blood pressures and HR were well-controlled on discharge. . # Hyperlipidemia- LDL of 101. - Started atorvastatin 80mg po daily (patient reports being started on this recently as an outpatient, but he was unsure of the dose) . # DMII- Elevated Hba1c of 8.0 should be followed up as an outpatient. Metformin was held in the hospital, and he was maintained on a diabetic diet with gentle insulin sliding scale. . Transitional Issues: - Multiple medication changes were made in the hospital, as noted above. Please consider checking his electrolytes as an outpatient (as he was started on diuretics in the hospital), as well as following up his CK. - Elevated Hba1c is concerning (8.0), he likely needs his outpatient diabetic regimen increased. - He was stented in the hospital with 2 drug-eluting stents. He will need to remain on aspirin and clopidogrel for at least one year following the procedure to avoid restenosis. - Please encourage medication compliance. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. benazepril *NF* 5 mg Oral daily. please hold for SBP<100 2. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY. please hold for SBP<100 3. Hydrochlorothiazide 50 mg PO DAILY please hold for SBP<100 4. Prazosin 1 mg PO BID 5. Verapamil 240 mg PO Q24H . please hold for SBP<100, HR<60 6. MetFORMIN XR (Glucophage XR) 750 mg PO BID . Do Not Crush 7. Nitroglycerin SL 0.4 mg SL PRN CP Discharge Medications: 1. Aspirin 81 mg PO DAILY please start [**2154-8-22**] AM 2. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Furosemide 20 mg PO DAILY Hold for SBP<90 RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Lisinopril 10 mg PO DAILY please hold for SBP<100 RX *lisinopril 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Metoprolol Succinate XL 100 mg PO DAILY Hold for SBP < 100, HR < 55. RX *metoprolol succinate 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Nitroglycerin SL 0.4 mg SL PRN CP 8. MetFORMIN XR (Glucophage XR) 750 mg PO BID Do Not Crush Discharge Disposition: Home Discharge Diagnosis: Primary: Myocardial infarction (NSTEMI) Acute on chronic systolic heart failure. . Secondary: Type 2 diabetes mellitus Hypertension Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 112186**], Thank you for choosing your healthcare to be at the Beath [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **]! You were hospitalized because you had ten days of worsening chest pain. You were found to have a blockage in your right coronary artery, which was treated with two drug eluting stents to open it up. Because of this stent, you need to make sure you take aspirin and clopidogrel (plavix) every day for at least a year. While you were admitted, some changes were made to your medications. Please see the medication sheet to see the changes. Please follow up with your primary care doctor as well as your cardiologist. You have been started on lasix which can alter your electrolytes. Please have your PCP check your electrolytes within one week. You will also need your "CK" checked in one month because you were started on atorvastatin. Followup Instructions: Please follow-up with your PCP and Cardiologist within one week.

410,428,414,250,401,272

{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest pain at rest PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS: 69 yo M with history of HTN, HL, DMII presenting with exertional chest pain x 10 days, now occurring at rest. Patient was in [**Country 38213**] at onset of pain, and was evaluated at the hospital. EKG there showed evidence of "a blocked artery," but they did not have stress test or catheterization capability so he was sent to [**Country 5881**]. In [**Country 5881**], the patient refused to go to the hospital, as he wanted to come to the US for further care. He had to wait 7 days to get a plane ticket and arrived Sunday. On Monday, he saw his PCP who started nitroglycerin, imdur and atorvastatin (he has not yet taken the atorvastatin) and set him up for cardiology evaluation on Wednesday am. On the morning of admission, patient developed acutely worse pain while climbing stairs that did not resolve with rest, prompting him to seek medical attention. Patient presented to [**Hospital3 **] ED. Labs were notable for an elevated troponin to 3.29, BNP 987, ddimer 1563. EKG had no ST elevations. Patient was started on heparin gtt and nitro paste. He was transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: - Type 2 diabetes - Dyslipidemia - Hypertension - Asthma - Regarding cardiac disease, per patient: stress test 5-6 years ago treatment with medication, no cath. - Chronic Hepatitis C (untreated per patient preference) - Basal cell carcinoma (forehead) - medication noncompliance (per PCP all medications should be generic) MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientPharmacy. 1. benazepril *NF* 5 mg Oral daily. please hold for SBP<100 2. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY. please hold for SBP<100 3. Hydrochlorothiazide 50 mg PO DAILY please hold for SBP<100 4. Prazosin 1 mg PO BID 5. Verapamil 240 mg PO Q24H . please hold for SBP<100, HR<60 6. MetFORMIN XR (Glucophage XR) 750 mg PO BID . Do Not Crush 7. Nitroglycerin SL 0.4 mg SL PRN CP ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION: VS: T97.5 BP 146/102 HR 75 RR 20 O2 93% on 2LNC GENERAL: obese male lying comfortably in bed in NAD HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink. Oropharynx clear with upper dentures. NECK: Supple with JVP to mandible, no carotid bruits 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: CTA bilaterally, mild crackles at left>right base, no wheeze ABDOMEN: Obese, +BS, soft, nontender, no HSM appreciated EXTREMITIES: No c/c/e. No femoral bruits. Tender to palpation of right calf without erythema or swelling SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 1+ PT 1+ Left: Carotid 2+ DP 1+ PT 1+ . DISCHARGE PHYSICAL EXAM: Physical Exam: VS: 97.9 110/76 (110-120/70s) 59 (60s) 18 96RA Gen: well appearing male in NAD HEENT: NCAT EOMI MMM Neck: Supple without JVD Pulm: CTA b/l without wheeze or crackles Cor: RRR (+)S1/S2 without m/r/g Abd: Soft, ND, NTP, NABS, no HSM Extrem: trace LE edema b/l with good distal pulses Neuro: AOx3, CNII-XII grossly intact, moving all extremities FAMILY HISTORY: No known family history of CAD, HTN, DM, or early MI, both parents died in 60s. SOCIAL HISTORY: Patient is married with children. He lives with his wife, who speaks [**Name (NI) 24075**]. He is originally from [**Country 38213**] but emigrated to the US in [**2113**]. He speaks [**Year (4 digits) 24075**] and Albanian. He is retired but worked in fruit/vegetable delivery. Denies tobacco use, alcohol use, or illicit drugs. ### Response: {'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: Melena, hypotension PRESENT ILLNESS: The patient is an 88 year old male with initially admitted with the chief complaint of lethargy. Pt has MMP as noted below with chronic diarrhea on immodium. Over the last 2 months he has noted increased urgency of stooling but no clear change in amount/freqency or consistancy, no black stool or blood in stool. He did have occasional nausea but no vomiting or abdominal pain. In this same time period he began to feel weak and fell in the bathtub. At that time he initiated outpt PT. Over the last week had increasing fatigue and malaise with LOA and a 10 lb wt loss. He was found by PT to be hypotensive with a BP 85/60 and lethargy w SOB. Sent to ED for evaluation. In ED noted to have black guiaic pos stool with dark NG lavage output, no clear coffee grounds, +congestion In the ED on [**2168-1-18**], he was found to have on EGD a non-bleeding large duodenal ulcer which was not cauterized at the time. Instead, the patient was transfused as needed and his hematocrits were followed serially. MEDICAL HISTORY: PMH: 1.s/p CVA [**2163-4-2**], residual mild intermittent aphasia 2.Diverticular bleed while on coumadin for CVA [**2163**] 3.Post-op respiratory failure->trach->MRSA pneumonia [**2163**] 4.AAA d/x'd 10 years ago 5.Hypothyroidism 6.Renal failure due to dehydration complicated by heart block [**2164**] 7.Left renal CA [**2157**] 8.Prostate CA [**2158**], s/p XRT,prostatectomy 9.Duodenal ulcers [**2164-6-1**] admission 10.H.pylori [**2164-6-1**] admission 11.Zoster right shoulder [**2164-6-1**] admission 12.Depression MEDICATION ON ADMISSION: Medications on transfer: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tc=95.9 P=68 BP=127/83 RR=16 97% RA FAMILY HISTORY: One brother died of ruptured aneurysm. Another brother had AAA repair. SOCIAL HISTORY: Lives with wife. Had 9 children, two deceased now. Ambulates using walker.Quit smoking at age 39 after 40 pack years. Occasional use of alcohol.

Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Unspecified septicemia,Severe sepsis,Septic shock,Acute respiratory failure,Acidosis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Intestinal infection due to Clostridium difficile,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified acquired hypothyroidism,Benign neoplasm of stomach

Chr duoden ulcer w hem,Ac posthemorrhag anemia,Septicemia NOS,Severe sepsis,Septic shock,Acute respiratry failure,Acidosis,Pneumonia, organism NOS,Thrombocytopenia NOS,Int inf clstrdium dfcile,Stomach ulcer NOS,Hypothyroidism NOS,Benign neoplasm stomach

Admission Date: [**2168-1-18**] Discharge Date: [**2168-2-8**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6994**] Chief Complaint: Melena, hypotension Major Surgical or Invasive Procedure: EGD x2 Intubated History of Present Illness: The patient is an 88 year old male with initially admitted with the chief complaint of lethargy. Pt has MMP as noted below with chronic diarrhea on immodium. Over the last 2 months he has noted increased urgency of stooling but no clear change in amount/freqency or consistancy, no black stool or blood in stool. He did have occasional nausea but no vomiting or abdominal pain. In this same time period he began to feel weak and fell in the bathtub. At that time he initiated outpt PT. Over the last week had increasing fatigue and malaise with LOA and a 10 lb wt loss. He was found by PT to be hypotensive with a BP 85/60 and lethargy w SOB. Sent to ED for evaluation. In ED noted to have black guiaic pos stool with dark NG lavage output, no clear coffee grounds, +congestion In the ED on [**2168-1-18**], he was found to have on EGD a non-bleeding large duodenal ulcer which was not cauterized at the time. Instead, the patient was transfused as needed and his hematocrits were followed serially. On [**2168-1-21**], the patient was transferred to the MICU after having large amounts of melanotic stool with a BP of 85/60. There, he underwent repeat EGD where his duodenal bulb was cauterized and he was transfused 1 unit PRBC although his Hct remained stable above 30. On [**2168-1-22**], the patient was transferred back to the floor as he was hemodynamically stable with a stable hematocrit. Past Medical History: PMH: 1.s/p CVA [**2163-4-2**], residual mild intermittent aphasia 2.Diverticular bleed while on coumadin for CVA [**2163**] 3.Post-op respiratory failure->trach->MRSA pneumonia [**2163**] 4.AAA d/x'd 10 years ago 5.Hypothyroidism 6.Renal failure due to dehydration complicated by heart block [**2164**] 7.Left renal CA [**2157**] 8.Prostate CA [**2158**], s/p XRT,prostatectomy 9.Duodenal ulcers [**2164-6-1**] admission 10.H.pylori [**2164-6-1**] admission 11.Zoster right shoulder [**2164-6-1**] admission 12.Depression PSH: 1.Bilateral inguinal hernia repair [**2117**] 2.TURP [**2149**] 3.Left nephrectomy ~[**2157**] 4.Prostatectomy, orchiectomy ~[**2158**] 5.Subtotal colectomy and ileostomy [**10/2163**] 6.Tracheostomy [**10/2163**], closed 7.PEG [**10/2163**], removed 8.Reversal of ileostomy and small bowel resection by Dr.[**Last Name (STitle) 519**] [**6-1**] Social History: Lives with wife. Had 9 children, two deceased now. Ambulates using walker.Quit smoking at age 39 after 40 pack years. Occasional use of alcohol. Family History: One brother died of ruptured aneurysm. Another brother had AAA repair. Physical Exam: Tc=95.9 P=68 BP=127/83 RR=16 97% RA General: NAD, AOx3 HEENT: PERRL CV: s1 s2 reg, no m/r Pulm: Minimal bibasilar crackles GI: NABS, soft, NT Ext: trace pitting edema w/ chronic venous stasis changes in L leg Neuro: non-focal Pertinent Results: [**2168-1-18**] 09:28PM HCT-21.7* [**2168-1-18**] 04:40PM PT-12.8 PTT-34.5 INR(PT)-1.0 [**2168-1-18**] 03:41PM WBC-6.3 RBC-3.06* HGB-9.5* HCT-28.3* MCV-92 MCH-31.0 MCHC-33.6 RDW-15.2 [**2168-1-21**] Hct 6am: 34.2, plt 74 Hct 7pm: 35 Brief Hospital Course: He was found by PT to be hypotensive with a BP 85/60 and lethargy w SOB. Sent to ED for evaluation. In ED noted to have black guiaic pos stool with dark NG lavage output, no clear coffee grounds, +congestion In the ED on [**2168-1-18**], he was found to have on EGD a non-bleeding large duodenal ulcer which was not cauterized at the time. Instead, the patient was transfused as needed and his hematocrits were followed serially. On [**2168-1-21**], the patient was transferred to the MICU after having large amounts of melanotic stool with a BP of 85/60. There, he underwent repeat EGD where his duodenal bulb was cauterized and he was transfused 1 unit PRBC although his Hct remained stable above 30. On [**2168-1-22**], the patient was transferred back to the floor as he was hemodynamically stable with a stable hematocrit. 1. Hypotension/ Sepsis: Meets the septic criteria by lactates/ physiology. Found to have positive C.diff +/- urosepsis (>100K E. coli) and infiltrate on CXR. Found to have a random cortisol 70s so did not need steroids. Was transiently on pressors to maintain MAP > 65. -TTE: mild global LV HK; no effusion 2. Respiratory failure: likely secondary to PNA - [**1-29**]: doing great on PSV; RSBI 70, however, CXR without improvement - [**1-29**]: bronch'd only small plug in rll. airway looked okay - [**1-30**] extubated - [**2-1**] re-intubated for respiratory distress; ? recurrent aspiration. Per family all hypoxic episodes noted after eating? - currently on levo/vanco - [**2-4**] doing well on cpap - by discharge the patient was doing well on nasal canula 4. Trombocytopenia: No evidence of hemolysis. Held all heparin products Transfused to keep platelets > 35 3. ARF; FeNA 0.2%. Was likely pre renal. Cr trended down with hydration. 4. UGIB: large duodenal bulb ulcer [**2-3**]--recurrent melenotic stool with hct slowly trending downwards. BICAP applied to to clot inorder to achieve hemostasis. Kept on sulcrafate and PPI Family meeting was held [**2168-2-7**] where the family including the wife decided to make the patient [**Name (NI) 3225**]. The patient was called out to floor and comfort care was initiated. His TLC and NGT were pulled on [**2167-2-7**]. He will be going home with [**Hospital 269**] hospice. Medications on Admission: Medications on transfer: Neutra-Phos 1 PKT PO TID Fentanyl Citrate 25 mcg IV ONCE Midazolam HCl 1 mg IV ONCE Pantoprazole 40 mg PO Q12H Oxycodone 5 mg PO Q4-6H:PRN Tolterodine 2 mg PO BID Zolpidem Tartrate 5 mg PO HS:PRN Acetaminophen 325-650 mg PO Q4-6H:PRN Multivitamins 1 CAP PO DAILY Loperamide HCl 2 mg PO QID:PRN Levothyroxine Sodium 100 mcg PO DAILY Discharge Medications: 1. Morphine Concentrate 20 mg/mL Solution Sig: 2-20 mg PO q1h as needed for pain. Disp:*30 mL* Refills:*0* Discharge Disposition: Home With Service Facility: Hospice of the Good [**Doctor Last Name 9995**] Discharge Diagnosis: GI bleed Acute Renal Failure Respiratory Failure Discharge Condition: Stable Discharge Instructions: Patient is going home with hospice care. Followup Instructions: Will follow up with home hospice

532,285,038,995,785,518,276,486,287,008,531,244,211

{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Unspecified septicemia,Severe sepsis,Septic shock,Acute respiratory failure,Acidosis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Intestinal infection due to Clostridium difficile,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified acquired hypothyroidism,Benign neoplasm of stomach'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Melena, hypotension PRESENT ILLNESS: The patient is an 88 year old male with initially admitted with the chief complaint of lethargy. Pt has MMP as noted below with chronic diarrhea on immodium. Over the last 2 months he has noted increased urgency of stooling but no clear change in amount/freqency or consistancy, no black stool or blood in stool. He did have occasional nausea but no vomiting or abdominal pain. In this same time period he began to feel weak and fell in the bathtub. At that time he initiated outpt PT. Over the last week had increasing fatigue and malaise with LOA and a 10 lb wt loss. He was found by PT to be hypotensive with a BP 85/60 and lethargy w SOB. Sent to ED for evaluation. In ED noted to have black guiaic pos stool with dark NG lavage output, no clear coffee grounds, +congestion In the ED on [**2168-1-18**], he was found to have on EGD a non-bleeding large duodenal ulcer which was not cauterized at the time. Instead, the patient was transfused as needed and his hematocrits were followed serially. MEDICAL HISTORY: PMH: 1.s/p CVA [**2163-4-2**], residual mild intermittent aphasia 2.Diverticular bleed while on coumadin for CVA [**2163**] 3.Post-op respiratory failure->trach->MRSA pneumonia [**2163**] 4.AAA d/x'd 10 years ago 5.Hypothyroidism 6.Renal failure due to dehydration complicated by heart block [**2164**] 7.Left renal CA [**2157**] 8.Prostate CA [**2158**], s/p XRT,prostatectomy 9.Duodenal ulcers [**2164-6-1**] admission 10.H.pylori [**2164-6-1**] admission 11.Zoster right shoulder [**2164-6-1**] admission 12.Depression MEDICATION ON ADMISSION: Medications on transfer: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tc=95.9 P=68 BP=127/83 RR=16 97% RA FAMILY HISTORY: One brother died of ruptured aneurysm. Another brother had AAA repair. SOCIAL HISTORY: Lives with wife. Had 9 children, two deceased now. Ambulates using walker.Quit smoking at age 39 after 40 pack years. Occasional use of alcohol. ### Response: {'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Unspecified septicemia,Severe sepsis,Septic shock,Acute respiratory failure,Acidosis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Intestinal infection due to Clostridium difficile,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified acquired hypothyroidism,Benign neoplasm of stomach'}

CHIEF COMPLAINT: Confusion, headache, speech difficulties PRESENT ILLNESS: 82M with PMH of right cerebellar stroke with no residual deficits, CAD s/p CABGx5. T2DM, HTN, HLD presents as intubated transfer from OSH with L temporal ICH without mass effect. MEDICAL HISTORY: T2DM on oral meds HTN HLD CAD s/p CABG Previous stroke with no residual deficit [**2166**]/99 where he was noted to be dizzy and incoordinated. Old right cerebellar infarct is currently present on CT. MEDICATION ON ADMISSION: Glipizidde 10mg [**Hospital1 **] Valsartan 320mg qd Clonnidine 0.2mg [**Hospital1 **] Simvastatin 40mg qd Aspirin ? dose qd ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Initial Exam: Vitals: T: 100.1 P: 50 SR R: 15 on vent BP: Initially 206/60 then after nicardipine 176/56 SaO2: 100% on 100% vent CMV f 14 Vt500 FAMILY HISTORY: Mother - stroke in 80s Father - died CAD Only child SOCIAL HISTORY: Lives with wife. Retired [**Name2 (NI) 90999**]. Uses cane to mobilise Never smoked. Minimal alcohol. No illicits

Intracerebral hemorrhage,Cerebral edema,Other amyloidosis,Aphasia,Unspecified cerebrovascular disease,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Intracerebral hemorrhage,Cerebral edema,Amyloidosis NEC,Aphasia,Cerebrovasc disease NOS,Hypertension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hx TIA/stroke w/o resid

Admission Date: [**2179-11-20**] Discharge Date: [**2179-11-27**] Date of Birth: [**2097-4-20**] Sex: M Service: NEUROLOGY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern1) 1838**] Chief Complaint: Confusion, headache, speech difficulties Major Surgical or Invasive Procedure: intubation at previous hospital and extubation History of Present Illness: 82M with PMH of right cerebellar stroke with no residual deficits, CAD s/p CABGx5. T2DM, HTN, HLD presents as intubated transfer from OSH with L temporal ICH without mass effect. Patient was in his usual state of health until am of [**11-20**] when he had slept on eth sofa overnight and on waking was sitting in the chair and wife found him to be pale and did not feel himself. He had no recent falls or head injury. He had also vomited at some point overnight with vomitus on the floor beside the sofa but had not recalled that he had done this. He then got up to have lunch and was noted to be confused and was clutching his head due to headache. He then at one point attempted to drink a cup of soapy dish water and then at one point thought he was holding a cup although he was not. His wife called EMS and by this point, his speech had deteriorated to only be able to say "yes" as a response. He was taken to OSH where he was noted to be markedly hypertensive initially in 190s and then lattterly as high as 249/90. He was given labetalol which transiently decreased his BP and was intubated with etomidate/midazfor airway protection with no documented worsening GCS for [**Location (un) **]. Prior to intubbation OSH documentation states moving all 4 extremities and GCS 13 E3 V4 M6 with good power and no particular decline of mental status noted. At [**Hospital1 18**] he was intubated and markedly hypertensive with SBP 200s, started on propofol and nicardipine infusion which decreased SBP to 170s. He was spontaneously moving all 4 limbs and moving his head, resisting eye opening. Past Medical History: T2DM on oral meds HTN HLD CAD s/p CABG Previous stroke with no residual deficit [**2166**]/99 where he was noted to be dizzy and incoordinated. Old right cerebellar infarct is currently present on CT. Past Surgical History: CABGx5 Hernia op many years ago Social History: Lives with wife. Retired [**Name2 (NI) 90999**]. Uses cane to mobilise Never smoked. Minimal alcohol. No illicits Family History: Mother - stroke in 80s Father - died CAD Only child Physical Exam: Initial Exam: Vitals: T: 100.1 P: 50 SR R: 15 on vent BP: Initially 206/60 then after nicardipine 176/56 SaO2: 100% on 100% vent CMV f 14 Vt500 General: Intubated oving all 4 limbs spontaneously. Moving head and forecfully closing eyes. HEENT: NC/AT, no scleral icterus noted, MMM Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally save decreased BS right base Cardiac: RRR, HS 1+2+ loud ESM ? loudset at aortic area but presnet throughout praecordium and radiates to carotids no R/G noted Abdomen: soft, ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C bilaterally. Mild pitting edema to mid shn 1+ bilaterally. 2+ radial, DP pulses on right easily palpable and PT on left. Good cap refill. Calves soft. Skin: no rashes or lesions noted. Neurologic: -Mental Status: GCS E2 (resisting eye opening) VT M4-5 in UE Intubated, sedated and ventilated. Will grimmace to pain. No tracking. Movving all 4 limmbs spontaneously. -Cranial Nerves: I: Olfaction not tested. II: PERRL 3 to 2mm and brisk. Funduscopic exam revealed no papilledema. III, IV, VI: No spontaneous eye movements. V: Unable to assess VII: No facial droop, facial musculature symmetric intubbated. VIII: Unable to assess. IX, X: Good gag and cough. [**Doctor First Name 81**]: Not assessed. XII: Not assessed. -Motor: Normal bulk, tone throughout. No adventitious movements, such as tremor, noted. No asterixis noted. Moving all 4 limbs spontaneously perhaps right less than left. Withdraws to pain in both LE and flexes in RUE and almmost localises in LUE. -Sensory: Grimaces and withdraws all 4 limbs. -DTRs: [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach L 2+ 2+ 2+ 3 1 R 2+ 2+ 2+ 3 1 Reflexes brisk throughoutt save ankle jerks. Plantar response was equivocal on left and prob extensor on right. Discharge Exam: Awake and alert, communicative. A+Ox3. Some memory difficulty [**2-11**] at 5 minutes. Good strength all 4 limbs, weaker on the right. Extensor plantar on right. PERRL. Receptive aphasia with more problems with body parts. At times perseverative. Follows simple, not complex commands. Able to walk independently with walker (w/ supervision) Pertinent Results: Admission Labs: [**2179-11-20**] 04:47PM TYPE-ART TIDAL VOL-500 O2-100 PO2-429* PCO2-43 PH-7.39 TOTAL CO2-27 BASE XS-1 AADO2-243 REQ O2-48 -ASSIST/CON INTUBATED-INTUBATED [**2179-11-20**] 03:30PM GLUCOSE-285* UREA N-28* CREAT-1.1 SODIUM-138 POTASSIUM-3.3 CHLORIDE-100 TOTAL CO2-24 ANION GAP-17 [**2179-11-20**] 03:30PM WBC-5.3 RBC-4.45* HGB-12.6* HCT-38.2* MCV-86 MCH-28.3 MCHC-33.0 RDW-13.2 [**2179-11-20**] 03:30PM PLT COUNT-127* [**2179-11-20**] 03:30PM PT-13.2 PTT-21.0* INR(PT)-1.1 [**2179-11-20**] 03:30PM ALBUMIN-4.1 CALCIUM-8.8 PHOSPHATE-3.8 MAGNESIUM-2.0 Urine: [**2179-11-20**] 07:38PM URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG Other Pertinent Labs: [**2179-11-20**] 09:52PM CK(CPK)-96 [**2179-11-20**] 09:52PM CK-MB-4 cTropnT-0.02* [**2179-11-20**] 03:30PM ALT(SGPT)-13 AST(SGOT)-24 ALK PHOS-46 TOT BILI-0.9 [**2179-11-20**] 03:30PM cTropnT-0.01 [**2179-11-20**] 03:30PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG Labs at discharge: [**2179-11-24**] 05:05AM BLOOD WBC-5.6 RBC-4.45* Hgb-12.5* Hct-38.4* MCV-86 MCH-28.0 MCHC-32.4 RDW-13.1 Plt Ct-164 [**2179-11-24**] 05:05AM BLOOD Plt Ct-164 [**2179-11-24**] 05:05AM BLOOD PT-12.3 PTT-24.6 INR(PT)-1.0 [**2179-11-24**] 05:05AM BLOOD Glucose-187* UreaN-23* Creat-1.0 Na-145 K-3.2* Cl-106 HCO3-28 AnGap-14 [**2179-11-22**] 03:05AM BLOOD CK(CPK)-389* [**2179-11-24**] 05:05AM BLOOD Calcium-8.8 Phos-2.9 Mg-2.1 Imaging: [**2179-11-20**] CT HEAD W/O CONTRAST FINDINGS: A 2.3 x 0.9 cm oblong left temporal intra-axial hematoma is redemonstrated, with minimal peripheral rim of edema, unchanged as compared to the preceding reference examination. There is no significant mass effect, edema, or shift of normally midline structures. A large area of right cerebellar encephalomalacia is again noted. The [**Doctor Last Name 352**]-white matter differentiation elsewhere in the brain appears maintained. Ventricles and sulci are prominent, compatible with age-related involution. Periventricular white matter hypoattenuation is consistent with small vessel ischemic disease. Suprasellar and basilar cisterns are patent. With the exception of minimal ethmoidal air cell and posterior right maxillary mucosal thickening, paranasal sinuses and mastoid air cells are well aerated. Vascular calcifications are seen in cavernous carotid arteries and right vertebral artery. The globes and soft tissues are unremarkable. IMPRESSION: 1. Stable left temporal hematoma with minimal peripheral edema and no significant mass effect, midline shift, or herniation. 2. No new focal intra-axial or extra-axial hemorrhage. 3. Right cerebellar encephalomalacia. 4. Age-related involution and small vessel ischemic disease. 5. Ethmoidal and right maxillary sinus disease, mild. [**2179-11-21**] CT HEAD W/O CONTRAST FINDINGS: Again seen is a 2.3 x 1 cm ovoid hyperdensity in the left temporal lobe, compatible with acute hemorrhage. There is surrounding rim of vasogenic edema, with effacement of regional sulci. There is no significant shift of the normal midline structures. Severe global atrophy persists, with prominent ventricles and sulci. Periventricular and subcortical white matter hypodensities reflect small vessel ischemic disease. There are dense calcifications in the bilateral cavernous carotid arteries and vertebral arteries. Again noted is a large area of encephalomalacia in the right lateral cerebellum, reflecting remote infarct. Minimal mucosal thickening persists in the ethmoid and maxillary sinuses. Middle ear cavities and mastoid air cells are clear. Note is made of disconjugate gaze/strabismus. IMPRESSION: 1. Stable left temporal hematoma. 2. Severe global atrophy and right cerebellar encephalomalacia. [**2179-11-22**] ECHO IMPRESSION: Mild aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Dilated thoracic aorta. Pulmonary artery hypertension. CLINICAL IMPLICATIONS: The patient has mild aortic valve stenosis. Based on [**2174**] ACC/AHA Valvular Heart Disease Guidelines, a follow-up echocardiogram is suggested in 3 years. [**2179-11-22**] MRI head: Again seen is an acute-early subacute hematoma in the left temporal lobe with surrounding edema. The study is limited because of extensive motion artifacts. Within these limitations, there are no other foci of abnormal susceptibility seen. There is no acute intracranial infarction. Assessment of diffusion abnormality in the hematoma/vicinity is confounded by the presence of blood products. A moderate sized area of encephalomalacia is again seen in the right lateral cerebellum with foci of abnormal susceptibility suggestive of remote infarction with mineralization. Diffuse prominence of ventricles and sulci are consistent with volume loss. There are multiple confluent periventricular hyperintensities seen likely representing small vessel ischemic disease. Major intracranial flow voids are preserved. [**2179-11-20**] ECG: Sinus bradycardia with first degree A-V delay. Left atrial abnormality. Intraventricular conduction delay of the left bundle-branch block type. Left axis deviation. Prominent U waves in the anterior precordial leads. Consider hypokalemia. No previous tracing available for comparison. TRACING #1 Intervals Axes Rate PR QRS QT/QTc P QRS T 56 [**Telephone/Fax (3) 91000**]/495 53 -52 111 [**2179-11-21**] ECG: Probable sinus rhythm with frequent atrial premature beats and first degree A-V delay. Baseline artifact. Intraventricular conduction delay of the left bundle-branch block type. Left axis deviation. Compared to tracing #2 lateral T wave changes are less prominent. There is now frequent atrial ectopy and the rate is faster. TRACING #3 Intervals Axes Rate PR QRS QT/QTc P QRS T 69 332 144 460/475 94 -56 118 [**2179-11-21**] ECG: Sinus bradycardia. Compared to tracing #1 the P-R interval is shorter. Anterolateral T wave inversions are more prominent and U waves are less pronounced. The other findings are similar. TRACING #2 Intervals Axes Rate PR QRS QT/QTc P QRS T 47 188 142 558/535 86 -58 -167 [**2179-11-20**] Chest Xray: FINDINGS: There is an orogastric tube whose side port is above the GE junction. This could be advanced 5-10 cm for more optimal placement. The endotracheal tube is at the level of the aortic knob appropriately sited. There is some coarsening of bronchovascular markings without overt pulmonary edema, focal consolidation or pleural effusions. No pneumothoraces are seen. Brief Hospital Course: 82 RHM with PMH of right cerebellar stroke with no residual deficits, CAD s/p CABGx5. T2DM, HTN, HLD presents as intubated transfer from OSH with L temporal ICH without mass effect. Patient had been confused at admission (OSH), with headache and vomiting; in addition to visuospatial deficit and considerable speech problems, latterly with perseveration and on arrival to OSH was markedly hypertensive up to SBP 240s. CT showed a left temporal 2.5x1.2cm hemorrhage without significant mass effect or edema and no intraventricular extension and hypodensity in R cerebellum in keeping with old infarct. He was given labetalol and intubated for airway protection for [**Location (un) **]. Prior to this OSH documentation states moving all 4 extremities and GCS 13 E3 V4 M6 with good power. At [**Hospital1 18**] he arrived intubated and markedly hypertensive, started on propofol and nicardipine infusion which decreased SBP 200s to 170s. Repeat CTs were stable at [**Hospital1 18**]. Patient was weaned off nicardipine infusion and extubated on [**11-21**]. MRI w and w/o contrast showed left temporal hematoma- acute-early subacute, with mild surrounding edema and no definite underlying enhancing lesion seen and old right cerebellar stroke. Etiology likely amyloid. Patient was hypertensive and was transitioned to home anti-HTN but transfer to floor had to be delayed due to persistent hypertension. Added and uptitrated hydral and amlodipine and transferring to the floor [**11-23**]. He persisted hypertensive, Metoprolol was increased to 25 mg tid however concerns for bradycardia led to stopping betablockers. Neurologic deficit significantly improved, awake and alert, communicative. A+Ox3. Poor memory for recent events. Good strength all 4 limbs, weaker on the right. On discharge his BP were better controlled with SBP 140s. His blood glucose was less well controlled and he will be restarting glipizide 10mg [**Hospital1 **] (outpt medication) in addition to insulin sliding scale. He did not have pain or headache on discharge. = = = = = = = = = = = ================================================================ . Transitional issues: 1. Intraparenchymal hemorrhage: likely [**2-10**] amyloid. He will need tighter control of his modifiable risk factors including BP, blood glucose, dyslipidemia. He will be discharged with his home dose stating, BP meds and glipizide with insulin Sliding scale. He will continue on aspirin 81mg. He will have follow up with Neurology in [**6-16**] weeks. Medications on Admission: Glipizidde 10mg [**Hospital1 **] Valsartan 320mg qd Clonnidine 0.2mg [**Hospital1 **] Simvastatin 40mg qd Aspirin ? dose qd Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 3. valsartan 320 mg Tablet Sig: One (1) Tablet PO once a day. 4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 5. insulin regular human 100 unit/mL Solution Sig: see below units Injection qACHS: please administer sliding scale insulin for FS >150 qACHS. 6. clonidine 0.2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital1 **] Pavilion - [**Location (un) **] Discharge Diagnosis: left temporal intraparenchymal hemorrhage amyloid angiopathy hypertensive emergency Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Neuro: ao x [**2-11**]; language is fluent with intact naming. follows simple but not complex commands. Sundowns at night. Gait is unsteady. Discharge Instructions: Dear Mr. [**Known lastname **], It was a pleasure taking care of you during your hospital stay. You were admitted to the hospital for evaluation of confusion and speech troubles. You were found to have a small bleed in the left side of your brain in the temporal lobe. The etiology of the bleed is most likely due to a condition called amyloid angiopathy, which means that the blood vessels in your head are more likely to bleed. Your blood pressure was very high when you first arrived at the hospital and sometimes very high blood pressures can also cause brain blood vessels to bleed. It is very important for you to try to keep your blood pressure under control. We have started one new blood pressure medication during your stay and continued your previous medications. Medication changes: STARTED AMLODIPINE 10MG by mouth DAILY RESTART GLIPIZIDE 10mg on discharge and continue insulin sliding scale Please continue taking all your previous medications including aspirin 81mg, valsartan 320mg po daily, clonidine 0.2mg po bid, simvastatin 40mg po daily. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) **] in the [**Hospital 18**] [**Hospital 878**] clinic, you have an appointment on [**2180-1-5**] at 1:30 pm. The clinic is located on the [**Hospital1 18**] [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Bldg, [**Location (un) **]. Phone:[**Telephone/Fax (1) 657**]. Before you go to your appointment you have to ask your PCP for an insurance referal. Also, call registration (phone: [**Telephone/Fax (1) 10676**]) to update your information.

431,348,277,784,437,401,414,V458,250,272,V125

{'Intracerebral hemorrhage,Cerebral edema,Other amyloidosis,Aphasia,Unspecified cerebrovascular disease,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Confusion, headache, speech difficulties PRESENT ILLNESS: 82M with PMH of right cerebellar stroke with no residual deficits, CAD s/p CABGx5. T2DM, HTN, HLD presents as intubated transfer from OSH with L temporal ICH without mass effect. MEDICAL HISTORY: T2DM on oral meds HTN HLD CAD s/p CABG Previous stroke with no residual deficit [**2166**]/99 where he was noted to be dizzy and incoordinated. Old right cerebellar infarct is currently present on CT. MEDICATION ON ADMISSION: Glipizidde 10mg [**Hospital1 **] Valsartan 320mg qd Clonnidine 0.2mg [**Hospital1 **] Simvastatin 40mg qd Aspirin ? dose qd ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Initial Exam: Vitals: T: 100.1 P: 50 SR R: 15 on vent BP: Initially 206/60 then after nicardipine 176/56 SaO2: 100% on 100% vent CMV f 14 Vt500 FAMILY HISTORY: Mother - stroke in 80s Father - died CAD Only child SOCIAL HISTORY: Lives with wife. Retired [**Name2 (NI) 90999**]. Uses cane to mobilise Never smoked. Minimal alcohol. No illicits ### Response: {'Intracerebral hemorrhage,Cerebral edema,Other amyloidosis,Aphasia,Unspecified cerebrovascular disease,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

CHIEF COMPLAINT: Pancreatic Mass Gas and Fluid filled collection near right lobe of liver PRESENT ILLNESS: This is a 82 year old female, previously healthy, recently discharged from OSH ([**2-12**]) after work-up of obstructive jaundice s/p ERCP complicated by submucosal air injection. She is now admitted with a hepatic gas and fluid collection. She first noticed jaundice, [**Male First Name (un) 1658**]-colored floating stools, dark urine, and achylower abdominal pain radiating to back 1 week ago. She denies weight loss, no N/V. She went to PCP and was [**Name9 (PRE) 105874**] to [**Hospital3 **] hospital. A MRCP there showed cholelithiasis and severe dilation of CBD (2-cm) due to presumed distal CBD stricture. She had an ERCP on [**2-9**] c/b submucosal air injection leading to retroperitoneal air, PTX, and pneumopericardium. She was placed on Unasyn and did not have a fever. She then had a PTC on [**2198-2-12**] to relieve the strictured CBD. She was discharged without ABX and received Percocet for pain control, and her PTC was capped. MEDICAL HISTORY: PSH: ERCP and PTC Right shoulder repair with titanium rods MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Tm 99.7 126/58 80 14 96%3L sitting in chair, alert, comfortable, conversant. Mild Jaundice FAMILY HISTORY: grandmother - pancreatic CA father-melanoma Aunt - gallstones SOCIAL HISTORY: Retired. family runs Bed&Breakfast. 1 son [**Name (NI) 1139**] - 3 ppd x 25 years, quit 40 years ago EtOH - wine each night

Abscess of liver,Obstruction of bile duct,Malignant neoplasm of head of pancreas,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Pulmonary collapse,Hypovolemia

Abscess of liver,Obstruction of bile duct,Mal neo pancreas head,Delirium d/t other cond,Pleural effusion NOS,Pulmonary collapse,Hypovolemia

Admission Date: [**2198-2-16**] Discharge Date: [**2198-2-21**] Date of Birth: [**2115-12-6**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 148**] Chief Complaint: Pancreatic Mass Gas and Fluid filled collection near right lobe of liver Major Surgical or Invasive Procedure: CT guided drainage History of Present Illness: This is a 82 year old female, previously healthy, recently discharged from OSH ([**2-12**]) after work-up of obstructive jaundice s/p ERCP complicated by submucosal air injection. She is now admitted with a hepatic gas and fluid collection. She first noticed jaundice, [**Male First Name (un) 1658**]-colored floating stools, dark urine, and achylower abdominal pain radiating to back 1 week ago. She denies weight loss, no N/V. She went to PCP and was [**Name9 (PRE) 105874**] to [**Hospital3 **] hospital. A MRCP there showed cholelithiasis and severe dilation of CBD (2-cm) due to presumed distal CBD stricture. She had an ERCP on [**2-9**] c/b submucosal air injection leading to retroperitoneal air, PTX, and pneumopericardium. She was placed on Unasyn and did not have a fever. She then had a PTC on [**2198-2-12**] to relieve the strictured CBD. She was discharged without ABX and received Percocet for pain control, and her PTC was capped. Past Medical History: PSH: ERCP and PTC Right shoulder repair with titanium rods Social History: Retired. family runs Bed&Breakfast. 1 son [**Name (NI) 1139**] - 3 ppd x 25 years, quit 40 years ago EtOH - wine each night Family History: grandmother - pancreatic CA father-melanoma Aunt - gallstones Physical Exam: VS: Tm 99.7 126/58 80 14 96%3L sitting in chair, alert, comfortable, conversant. Mild Jaundice nc/at, eomi, op clear supple crackles left base, [**Month (only) **] air movement s1s2 nl, rrr, no m/r/g soft, obese, nt/nd, PTC capped and in place. no guarding or rebound tenderness. +foley warm, no warm, good distal pulses, no tremor, nl tone oriented to self, date, place, why she's here. registration and delayed recall [**4-2**] with prompting. able to count days of week and months of year backwards correctly. Pertinent Results: [**2198-2-17**] 06:00AM BLOOD WBC-26.6* RBC-3.60* Hgb-11.3* Hct-33.4* MCV-93 MCH-31.5 MCHC-33.9 RDW-13.4 Plt Ct-320 [**2198-2-19**] 04:50AM BLOOD WBC-12.2* RBC-3.37* Hgb-10.7* Hct-31.8* MCV-95 MCH-31.8 MCHC-33.7 RDW-13.3 Plt Ct-335 [**2198-2-19**] 04:50AM BLOOD Glucose-109* UreaN-13 Creat-0.4 Na-139 K-3.7 Cl-103 HCO3-27 AnGap-13 [**2198-2-16**] 08:50PM BLOOD ALT-147* AST-37 AlkPhos-212* Amylase-29 TotBili-2.3* DirBili-1.4* IndBili-0.9 [**2198-2-19**] 04:50AM BLOOD ALT-67* AST-47* AlkPhos-155* TotBili-1.3 [**2198-2-16**] 08:50PM BLOOD Lipase-35 [**2198-2-17**] 11:48PM BLOOD Lipase-38 [**2198-2-16**] 08:50PM BLOOD Albumin-3.3* Calcium-8.8 Phos-2.9 Mg-2.0 [**2198-2-17**] 11:48PM BLOOD Albumin-2.9* Calcium-8.4 Phos-2.5* Mg-2.1 . CTA ABD W&W/O C & RECONS [**2198-2-16**] 10:54 AM IMPRESSION: 1. Subcapsular collection about the right lobe of the liver containing gas and fluid. This may relate to the PTC catheter in place, although infection cannot be excluded. Finding was discussed with Dr. [**Last Name (STitle) **] and a drainage procedure is planned. 2. Gas and fluid-containing collection posterior to the duodenum, small right psoas abscess, and retroperitoneal gas are consistent with duodenal perforation. 3. Ill-defined mass in the head of the pancreas with pancreatic ductal dilation is worrisome for carcinoma. 4. Multiple hypodense hepatic lesions including a cyst at the dome of the liver and additional lesions too small to accurately characterize. 5. Bilateral hypodense renal lesions are too small to characterize. 6. Bilateral pleural effusions and atelectasis. 7. Intraperitoneal air, in the setting of extensive extraperitoneal air, may relate to the patient's recent procedures and/or duodenal perforation. 8. Diverticulosis without evidence of diverticulitis. . CT HEPATIC DRAINAGE [**2198-2-17**] 3:06 PM IMPRESSION: 1. Successful placement of an 8 French locking pigtail catheter within a subhepatic fluid collection without complication. 2. CT cholangiogram demonstrating opacification of the biliary tree, free flow of contrast into the duodenum and into the gallbladder. No evidence of contrast tracking retrograde via the PTC catheter contributing to or causing this subhepatic fluid collection. 3. No change in small amount of intraperitoneal and retroperitoneal air, slight increase in atelectasis and bilateral pleural effusions compared to the study done one day earlier. Brief Hospital Course: This is a 82 year old female with a pancreatic mass, s/p ERCP and stent placement at an OSH on [**2198-2-9**], now with a gas and fluid filled collection posterior to the duodenum. Mental status change: On HD 2, she had an acute mental status change, was tachycardic, and had an increased O2 requirement. She was transferred to the ICU for further care. Neuro: Her mental status improved, although was still forgetful at times. Likely related to infection, medications, environment change, pain. She was back to her baseline at time of discharge. Fluid collection: Later that day she went for successful placement of an 8 French locking pigtail catheter within a subhepatic fluid collection without complication. A CT cholangiogram demonstrating opacification of the biliary tree, free flow of contrast into the duodenum and into the gallbladder. No evidence of contrast tracking retrograde via the PTC catheter contributing to or causing this subhepatic fluid collection. The PTC was capped and the new pigtail drain was draining. The drain put out ~100cc of clear, yellow fluid initially, and at time of discharge was only putting out a scant amount. Her diet was advanced over the next few days as she had return of bowel function. Resp: A CXR revealed pleural effusion and atelectasis. She was requiring O2 by NC and still had labored breathing. This was likely due to atelectasis, inability to take full breaths secondary to pain. Once back on the floor, she was weaned off her O2 as she increased her activity and continued to improve. Hypovolemia: She received IV fluid bolus for low urine output with good response. Medications on Admission: None Discharge Medications: 1. Oxycodone 5 mg Tablet Sig: 0.5-1 Tablet PO Q4H (every 4 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 7 days. Disp:*21 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Abscess in the right upper quadrant above the liver Biliary and pancreatic duct dilation Ill-defined pancreatic head mass Discharge Condition: Good Tolerating a diet Pain well controlled Drain in place PTC drain capped Discharge Instructions: -Avoid swimming and baths until your follow-up appointment, it is OK to shower. -Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. * Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your skin, or the whites of your eyes become yellow. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. . * Please resume all regular home medications and take any new meds as ordered. * Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * Continue to increase activity daily and work towards daily ambulation. * No heavy lifting (>[**11-14**] lbs) until your follow up appointment. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) **] on [**2198-3-2**] at 11:45am. Call [**Telephone/Fax (1) 1231**] with questions or concerns. Completed by:[**2198-2-22**]

572,576,157,293,511,518,276

{'Abscess of liver,Obstruction of bile duct,Malignant neoplasm of head of pancreas,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Pulmonary collapse,Hypovolemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Pancreatic Mass Gas and Fluid filled collection near right lobe of liver PRESENT ILLNESS: This is a 82 year old female, previously healthy, recently discharged from OSH ([**2-12**]) after work-up of obstructive jaundice s/p ERCP complicated by submucosal air injection. She is now admitted with a hepatic gas and fluid collection. She first noticed jaundice, [**Male First Name (un) 1658**]-colored floating stools, dark urine, and achylower abdominal pain radiating to back 1 week ago. She denies weight loss, no N/V. She went to PCP and was [**Name9 (PRE) 105874**] to [**Hospital3 **] hospital. A MRCP there showed cholelithiasis and severe dilation of CBD (2-cm) due to presumed distal CBD stricture. She had an ERCP on [**2-9**] c/b submucosal air injection leading to retroperitoneal air, PTX, and pneumopericardium. She was placed on Unasyn and did not have a fever. She then had a PTC on [**2198-2-12**] to relieve the strictured CBD. She was discharged without ABX and received Percocet for pain control, and her PTC was capped. MEDICAL HISTORY: PSH: ERCP and PTC Right shoulder repair with titanium rods MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Tm 99.7 126/58 80 14 96%3L sitting in chair, alert, comfortable, conversant. Mild Jaundice FAMILY HISTORY: grandmother - pancreatic CA father-melanoma Aunt - gallstones SOCIAL HISTORY: Retired. family runs Bed&Breakfast. 1 son [**Name (NI) 1139**] - 3 ppd x 25 years, quit 40 years ago EtOH - wine each night ### Response: {'Abscess of liver,Obstruction of bile duct,Malignant neoplasm of head of pancreas,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Pulmonary collapse,Hypovolemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 56-year-old right-handed gentleman seen in consultation for evaluation of a cystic enhancing mass in the right frontal brain with neurologic problems beginning in [**2154**] when he experienced generalized tonic clonic seizure and initially thought it was from his asthma medication. Eventually, he had a head CT which did not show any abnormality. He was started on Dilantin and phenobarbital. He was on Dilantin in [**2157**] but was still having focal motor seizures with jerks in his left arm. He also experienced problems with his thoughts. He had loss of consciousness and typically awoke while in an ambulance. In [**2167-8-7**], he stopped taking his Dilantin. In [**Month (only) 1096**], he had generalized tonic clonic seizure again and later saw a neurologist at [**Hospital 11084**] [**Hospital **] Medical Center who ordered an MRI. The MRI showed a mass in the right posterior frontal brain. The mass was initially biopsied by Dr. [**Last Name (STitle) **] and the pathology was an astrocytoma. The patient underwent a gross total surgical resection by Dr. [**Last Name (STitle) **] in [**2168**] and the pathology changed to low-grade oligodendroglioma. MEDICAL HISTORY: 1. Valvular heart disease. 2. Asthma. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Malignant neoplasm of brain, unspecified,Other convulsions,Asthma, unspecified type, unspecified

Malig neo brain NOS,Convulsions NEC,Asthma NOS

Admission Date: [**2177-5-14**] Discharge Date: [**2177-5-16**] Date of Birth: [**2120-6-6**] Sex: M Service: HISTORY OF THE PRESENT ILLNESS: The patient is a 56-year-old right-handed gentleman seen in consultation for evaluation of a cystic enhancing mass in the right frontal brain with neurologic problems beginning in [**2154**] when he experienced generalized tonic clonic seizure and initially thought it was from his asthma medication. Eventually, he had a head CT which did not show any abnormality. He was started on Dilantin and phenobarbital. He was on Dilantin in [**2157**] but was still having focal motor seizures with jerks in his left arm. He also experienced problems with his thoughts. He had loss of consciousness and typically awoke while in an ambulance. In [**2167-8-7**], he stopped taking his Dilantin. In [**Month (only) 1096**], he had generalized tonic clonic seizure again and later saw a neurologist at [**Hospital 11084**] [**Hospital **] Medical Center who ordered an MRI. The MRI showed a mass in the right posterior frontal brain. The mass was initially biopsied by Dr. [**Last Name (STitle) **] and the pathology was an astrocytoma. The patient underwent a gross total surgical resection by Dr. [**Last Name (STitle) **] in [**2168**] and the pathology changed to low-grade oligodendroglioma. After surgery, he was followed by a neurologist, Dr. [**Last Name (STitle) 8026**], and had an MRI once every six months. He presents now with the MRI scan now showing an enhancing multicystic lesion in the right parietal lobe. His most recent generalized tonic clonic seizure was two years ago. He is admitted status post a right parietal craniotomy for excision of this mass. PHYSICAL EXAMINATION ON ADMISSION: General: The patient was a middle-aged man in no acute distress. Cardiac: Regular rate and rhythm. Abdomen: Soft. Lungs: Clear. Neurologic: Awake, oriented times three. PAST MEDICAL HISTORY: 1. Valvular heart disease. 2. Asthma. ADMISSION MEDICATIONS: 1. Dilantin. 2. Neurontin. 3. Lorazepam. 4. Decadron. PAST SURGICAL HISTORY: 1. Hernia repair times three. 2. Ganglion cyst removal. 3. Right paracentesis in [**2168**]. HOSPITAL COURSE: The patient underwent a right parietal craniotomy. Postoperatively, his vital signs were stable. He was awake, alert, and oriented times three, moving all extremities with good strength. EOMs full. No nystagmus. The tongue was midline. His dressing was clean, dry, and intact. He remained in the Recovery Room overnight. He remained neurologically stable. He was transferred to the regular floor on postoperative day number one. He had an MRI scan which showed good resection. He was out of bed ambulating, tolerating a regular diet, voiding spontaneously. He was discharged to home on postoperative day number two in stable condition and will follow-up with Dr. [**First Name (STitle) **] in the Brain [**Hospital 341**] Clinic on [**2177-5-26**] at 1:00 p.m. for staple removal and for further follow-up for further treatment. CONDITION ON DISCHARGE: Stable. DISCHARGE MEDICATIONS: 1. Famotidine 20 mg p.o. b.i.d. 2. Decadron currently at 4 q. six, to wean down to 4 b.i.d. and then down to 2 b.i.d. and stay at 2 b.i.d. 3. Percocet one to two tablets p.o. q. four hours p.r.n. pain. 4. Gabapentin 400 mg two tablets t.i.d. 5. Dilantin 330 mg or 360 mg alternating days. 6. Neurontin 800 t.i.d. 7. Decadron, weaned down to 2 b.i.d. over seven to ten days. [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D. [**MD Number(1) 343**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2177-5-16**] 03:24 T: [**2177-5-20**] 15:25 JOB#: [**Job Number 54804**]

191,780,493

{'Malignant neoplasm of brain, unspecified,Other convulsions,Asthma, unspecified type, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 56-year-old right-handed gentleman seen in consultation for evaluation of a cystic enhancing mass in the right frontal brain with neurologic problems beginning in [**2154**] when he experienced generalized tonic clonic seizure and initially thought it was from his asthma medication. Eventually, he had a head CT which did not show any abnormality. He was started on Dilantin and phenobarbital. He was on Dilantin in [**2157**] but was still having focal motor seizures with jerks in his left arm. He also experienced problems with his thoughts. He had loss of consciousness and typically awoke while in an ambulance. In [**2167-8-7**], he stopped taking his Dilantin. In [**Month (only) 1096**], he had generalized tonic clonic seizure again and later saw a neurologist at [**Hospital 11084**] [**Hospital **] Medical Center who ordered an MRI. The MRI showed a mass in the right posterior frontal brain. The mass was initially biopsied by Dr. [**Last Name (STitle) **] and the pathology was an astrocytoma. The patient underwent a gross total surgical resection by Dr. [**Last Name (STitle) **] in [**2168**] and the pathology changed to low-grade oligodendroglioma. MEDICAL HISTORY: 1. Valvular heart disease. 2. Asthma. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Malignant neoplasm of brain, unspecified,Other convulsions,Asthma, unspecified type, unspecified'}

CHIEF COMPLAINT: AAA PRESENT ILLNESS: This 83-year-old lady has an enlarging abdominal aortic aneurysm. It is tender to the touch. Maximum diameter is about 7 cm. It extends up to the renal arteries and is not suitable for endovascular repair MEDICAL HISTORY: PMH: COPD, AAA, HTN, carotid stenosis, bladder incontinence PSH: cysto, bladder suspension, right ear drum repair MEDICATION ON ADMISSION: advair, albuterol, norvasc 5, ASA 81, atenolol 50, calcium, lisinopril 10 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On physical examination, she is a thin spry-appearing elderly lady in no acute distress. Blood pressure is 172/100. Pulse is 61. Respirations are 15. She has no cervical bruits. Chest is clear. Heart is in regular rhythm. Abdomen is soft, with pos bs. It starts at the level of the left upper quadrant and extends below the umbilicus. Femoral and popliteal pulses are strongly palpable without evident peripheral aneurysm. Her foot pulses are nonpalpable. FAMILY HISTORY: n/c SOCIAL HISTORY: She has a long cigarette smoking history of two packs a day for most of her adult life

Abdominal aneurysm without mention of rupture,Urinary tract infection, site not specified,Other acute postoperative pain,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder

Abdom aortic aneurysm,Urin tract infection NOS,Acute postop pain NEC,Hypertension NOS,Ocl crtd art wo infrct,Chr airway obstruct NEC,Tobacco use disorder

Admission Date: [**2194-4-8**] Discharge Date: [**2194-4-16**] Date of Birth: [**2111-5-7**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2597**] Chief Complaint: AAA Major Surgical or Invasive Procedure: Resection and repair of abdominal aortic aneurysm with 18-mm Dacron tube graft. History of Present Illness: This 83-year-old lady has an enlarging abdominal aortic aneurysm. It is tender to the touch. Maximum diameter is about 7 cm. It extends up to the renal arteries and is not suitable for endovascular repair Past Medical History: PMH: COPD, AAA, HTN, carotid stenosis, bladder incontinence PSH: cysto, bladder suspension, right ear drum repair Social History: She has a long cigarette smoking history of two packs a day for most of her adult life Family History: n/c Physical Exam: On physical examination, she is a thin spry-appearing elderly lady in no acute distress. Blood pressure is 172/100. Pulse is 61. Respirations are 15. She has no cervical bruits. Chest is clear. Heart is in regular rhythm. Abdomen is soft, with pos bs. It starts at the level of the left upper quadrant and extends below the umbilicus. Femoral and popliteal pulses are strongly palpable without evident peripheral aneurysm. Her foot pulses are nonpalpable. Pertinent Results: [**2194-4-14**] 06:20AM BLOOD WBC-6.8 RBC-3.80* Hgb-11.8* Hct-34.7* MCV-91 MCH-31.1 MCHC-34.0 RDW-14.0 Plt Ct-240# [**2194-4-14**] 06:20AM BLOOD Glucose-88 UreaN-9 Creat-0.5 Na-137 K-3.6 Cl-103 HCO3-28 AnGap-10 [**2194-4-14**] 06:20AM BLOOD Calcium-8.4 Phos-2.2* Mg-1.9 [**2194-4-8**] 12:09PM BLOOD Hgb-13.7 calcHCT-41 CXR: IMPRESSION: Clear lungs. Normal tube and line placement. Brief Hospital Course: Mrs. [**Known lastname **],[**Known firstname **] was admitted on [**4-8**] with AAA. She agreed to have an elective surgery. Pre-operatively, she was consented. A CXR, EKG, UA, CBC, Electrolytes, T/S - were obtained, all other preparations were made. It was decided that she would undergo a Resection and repair of abdominal aortic aneurysm with 18-mm Dacron tube graft. She was prepped, and brought down to the operating room for surgery. Intra-operatively, she was closely monitored and remained hemodynamically stable. She tolerated the procedure well without any difficulty or complication. Post-operatively, she was extubated and transferred to the [**Month/Year (2) 13042**] for further stabilization and monitoring. While in the [**Name (NI) 13042**], pt had respiratory distress. She had to be re intubated. She was then transferred to the CVICU intubated. She was eventually weaned from her vent, She was then transferred to the VICU in stable condition. While in the VICU she received monitored care. When stable she was delined. Her diet was advanced. A PT consult was obtained. When she was stabilized from the acute setting of post operative care, she was transferred to floor status On the floor, she remained hemodynamically stable with his pain controlled. She progressed with physical therapy to improve her strength and mobility. She continues to make steady progress without any incidents. She was discharged to a rehabilitation facility in stable condition. Medications on Admission: advair, albuterol, norvasc 5, ASA 81, atenolol 50, calcium, lisinopril 10 Discharge Medications: 1. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: 1-2 Puffs Inhalation Q6H (every 6 hours) as needed for wheeze. 2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): (new med). 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for pain. 8. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). Discharge Disposition: Extended Care Facility: Life Care Center of [**Location 15289**] Discharge Diagnosis: abdominal aortic aneurysm Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - Independent Discharge Instructions: Division of Vascular and Endovascular Surgery Endovascular Abdominal Aortic Aneurysm (AAA) Discharge Instructions Medications: ?????? Take Aspirin 325mg (enteric coated) once daily ?????? Do not stop Aspirin unless your Vascular Surgeon instructs you to do so. ?????? 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 What to expect when you go home: It is normal to have slight swelling of the legs: ?????? Elevate your leg above the level of your heart (use [**2-19**] pillows or a recliner) every 2-3 hours throughout the day and at night ?????? Avoid prolonged periods of standing or sitting without your legs elevated It is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? Drink plenty of fluids and eat small frequent meals ?????? It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: ?????? When you go home, you may walk and go up and down stairs ?????? You may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? After 1 week, you may resume sexual activity ?????? After 1 week, gradually increase your activities and distance walked as you can tolerate ?????? No driving until you are no longer taking pain medications ?????? Call and schedule an appointment to be seen in [**4-22**] weeks for post procedure check and CTA What to report to office: ?????? 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 or incision) ?????? Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call vascular office. If bleeding does not stop, call 911 for transfer to closest Emergency Room. Followup Instructions: Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2194-4-28**] 12:50 Completed by:[**2194-4-16**] Name: [**Known lastname 13605**],[**Known firstname **] Unit No: [**Numeric Identifier 13606**] Admission Date: [**2194-4-8**] Discharge Date: [**2194-4-16**] Date of Birth: [**2111-5-7**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1546**] Addendum: Prior to discharge, the nurse was concerned that the pt may have a urinary tract infection and a urinalysis was sent. GENERAL URINE INFORMATION Type Color Appear Sp [**Last Name (un) **] [**2194-4-16**] 12:23PM Yellow Hazy 1.006 Source: CVS DIPSTICK URINALYSIS Blood Nitrite Protein Glucose Ketone Bilirub Urobiln pH Leuks [**2194-4-16**] 12:23PM LG POS 30 NEG NEG NEG NEG 7.0 MOD Source: CVS MICROSCOPIC URINE EXAMINATION RBC WBC Bacteri Yeast Epi TransE RenalEp [**2194-4-16**] 12:23PM [**3-21**]* 21-50* MOD NONE 0-2 Source: CVS [**2194-4-16**] 12:23PM Source: CVS We have started her on cipro 500mg [**Hospital1 **] x 5 days. Discharge Disposition: Extended Care Facility: Life Care Center of [**Location 2075**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1548**] MD [**MD Number(1) 1549**] Completed by:[**2194-4-16**]

441,599,338,401,433,496,305

{'Abdominal aneurysm without mention of rupture,Urinary tract infection, site not specified,Other acute postoperative pain,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: AAA PRESENT ILLNESS: This 83-year-old lady has an enlarging abdominal aortic aneurysm. It is tender to the touch. Maximum diameter is about 7 cm. It extends up to the renal arteries and is not suitable for endovascular repair MEDICAL HISTORY: PMH: COPD, AAA, HTN, carotid stenosis, bladder incontinence PSH: cysto, bladder suspension, right ear drum repair MEDICATION ON ADMISSION: advair, albuterol, norvasc 5, ASA 81, atenolol 50, calcium, lisinopril 10 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On physical examination, she is a thin spry-appearing elderly lady in no acute distress. Blood pressure is 172/100. Pulse is 61. Respirations are 15. She has no cervical bruits. Chest is clear. Heart is in regular rhythm. Abdomen is soft, with pos bs. It starts at the level of the left upper quadrant and extends below the umbilicus. Femoral and popliteal pulses are strongly palpable without evident peripheral aneurysm. Her foot pulses are nonpalpable. FAMILY HISTORY: n/c SOCIAL HISTORY: She has a long cigarette smoking history of two packs a day for most of her adult life ### Response: {'Abdominal aneurysm without mention of rupture,Urinary tract infection, site not specified,Other acute postoperative pain,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder'}

CHIEF COMPLAINT: fevers, chills PRESENT ILLNESS: History of Present Illness: 89 y/o male with multiple medical problems from [**Name (NI) **] [**Hospital **] nursing home with hx of CAD s/p 3-vessel CABG, hx CHF (EF 50-55% in [**1-5**]), HTN, COPD (on intermittent home oxygen), hx CKD III (Baseline Cr 1.3) who presents after being discharged from [**Hospital1 **] [**2159-11-27**] when he had ERCP for cholecystitis with sphincterotomy and sphincteroplasty, now p/w 2-3 days of worsening RUQ pain. +nausea today, no vomiting. No diarrhea or subjective fever. No BM in 10 days. . He has significant memory problems and is somewhat of a poor historian, but he states the pain comes on abruptly and then gradually decreases. He does not know what precipitated his pain and he does not know if anything makes it better. He was admitted to [**Hospital1 18**] several weeks ago for cholecystitis at which time he had ERCP with removal of sludge and small stones. He does not remember when he had his most recent bowel movement or whether eating affects his pain. . In the ED, initial VS were: 5, 98.5, 66, 113/45, 16, 95% RA. Labs notable for WBC 16.1, ALT 17, AST 18, AP 100, lipase 24, Tbili 1.1, albumin 3.7, lactate 1.0. Bcx pending. CT abd/pelvis showing, "dilated GB with pericholecystic stranding and gb wall thickening concerning for acute cholecystitis. Air in GB likely secondary to recent ERCP. Urinary bladder wall thickening and enhancement concerning for cystitis. Unchanged right inguinal bowel containing hernia and appendix containing right spigelian hernia." Surgery was called: likely needs perc chole tube, they will call IR. . Pt is being admitted for acute cholecystitis. IR was paged. Pt given IV unasyn and 500 cc IVF prior to transfer. In the MICU, they did percutaneous cholecystostomy in IR, with improvement in his pain, but still mildly tender. Cefepime was added given concern for UTI and resistant E. coli in the past. He was continued on Flagyl for anaerobic coverage. He was given IVF's, and is now +2L for LOS. MEDICAL HISTORY: CAD s/p CABG in [**2158-3-27**] Coronary bypass grafting x3: Reverse saphenous vein graft from aorta to posterior descending coronary artery; reverse saphenous vein single graft from aorta to second obtuse marginal coronary artery; as well as reverse saphenous vein single graft from aorta to the first diagonal coronary artery. Mild cognitive impairment per OMR notes Congestive heart failure with preserved LVEF (last TTE [**12/2158**]) Hypertension Hypercholesterolemia COPD on intermittent home oxygen PTSD- WWII Veteran Right Facial Nerve Palsy Stage III chronic kidney disease (baseline Cr: ~1.3) History of herpes Zoster Bilateral Cataract Surgery Left Inguinal Hernia Repair Right Inguinal Hernia- Not repaired Benign Prostatic Hypertrophy Anemia Eczema Hard of hearing GERD Malaria over 30 years ago while in [**Country 480**] MEDICATION ON ADMISSION: 1. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for sob/wheezing. 5. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: Two (2) Capsule, Ext Release 24 hr PO at bedtime. 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. Zyprexa 2.5 mg Tablet Sig: 0.5 Tablet PO twice a day. 9. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 10. diazepam 5 mg Tablet Sig: 0.5 Tablet PO at bedtime as needed for insomnia. 11. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual q5min x3 as needed for chest pain. 12. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION: FAMILY HISTORY: Brothers/sisters with CAD, no hx of DM, HTN, cancer SOCIAL HISTORY: Worked in hospital administration. Quit smoking cigarettes over 20 years ago. Quit smoking pipe in his mid 50s. Denies alcohol or drug use.

Acute cholecystitis,Toxic encephalopathy,Acute cystitis,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified Escherichia coli [E. coli],Aortocoronary bypass status,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia, unspecified, without behavioral disturbance,Pure hypercholesterolemia,Esophageal reflux,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Contact dermatitis and other eczema, unspecified cause

Acute cholecystitis,Toxic encephalopathy,Acute cystitis,CHF NOS,Hy kid NOS w cr kid I-IV,DMII wo cmp nt st uncntr,E.coli infection NEC/NOS,Aortocoronary bypass,Chr airway obstruct NEC,Chr kidney dis stage III,BPH w/o urinary obs/LUTS,Demen NOS w/o behv dstrb,Pure hypercholesterolem,Esophageal reflux,Anemia NOS,Depend-supplement oxygen,Dermatitis NOS

Admission Date: [**2159-12-12**] Discharge Date: [**2159-12-18**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 783**] Chief Complaint: fevers, chills Major Surgical or Invasive Procedure: Placement of Percutaneous cholecystostomy tube History of Present Illness: History of Present Illness: 89 y/o male with multiple medical problems from [**Name (NI) **] [**Hospital **] nursing home with hx of CAD s/p 3-vessel CABG, hx CHF (EF 50-55% in [**1-5**]), HTN, COPD (on intermittent home oxygen), hx CKD III (Baseline Cr 1.3) who presents after being discharged from [**Hospital1 **] [**2159-11-27**] when he had ERCP for cholecystitis with sphincterotomy and sphincteroplasty, now p/w 2-3 days of worsening RUQ pain. +nausea today, no vomiting. No diarrhea or subjective fever. No BM in 10 days. . He has significant memory problems and is somewhat of a poor historian, but he states the pain comes on abruptly and then gradually decreases. He does not know what precipitated his pain and he does not know if anything makes it better. He was admitted to [**Hospital1 18**] several weeks ago for cholecystitis at which time he had ERCP with removal of sludge and small stones. He does not remember when he had his most recent bowel movement or whether eating affects his pain. . In the ED, initial VS were: 5, 98.5, 66, 113/45, 16, 95% RA. Labs notable for WBC 16.1, ALT 17, AST 18, AP 100, lipase 24, Tbili 1.1, albumin 3.7, lactate 1.0. Bcx pending. CT abd/pelvis showing, "dilated GB with pericholecystic stranding and gb wall thickening concerning for acute cholecystitis. Air in GB likely secondary to recent ERCP. Urinary bladder wall thickening and enhancement concerning for cystitis. Unchanged right inguinal bowel containing hernia and appendix containing right spigelian hernia." Surgery was called: likely needs perc chole tube, they will call IR. . Pt is being admitted for acute cholecystitis. IR was paged. Pt given IV unasyn and 500 cc IVF prior to transfer. In the MICU, they did percutaneous cholecystostomy in IR, with improvement in his pain, but still mildly tender. Cefepime was added given concern for UTI and resistant E. coli in the past. He was continued on Flagyl for anaerobic coverage. He was given IVF's, and is now +2L for LOS. Past Medical History: CAD s/p CABG in [**2158-3-27**] Coronary bypass grafting x3: Reverse saphenous vein graft from aorta to posterior descending coronary artery; reverse saphenous vein single graft from aorta to second obtuse marginal coronary artery; as well as reverse saphenous vein single graft from aorta to the first diagonal coronary artery. Mild cognitive impairment per OMR notes Congestive heart failure with preserved LVEF (last TTE [**12/2158**]) Hypertension Hypercholesterolemia COPD on intermittent home oxygen PTSD- WWII Veteran Right Facial Nerve Palsy Stage III chronic kidney disease (baseline Cr: ~1.3) History of herpes Zoster Bilateral Cataract Surgery Left Inguinal Hernia Repair Right Inguinal Hernia- Not repaired Benign Prostatic Hypertrophy Anemia Eczema Hard of hearing GERD Malaria over 30 years ago while in [**Country 480**] Social History: Worked in hospital administration. Quit smoking cigarettes over 20 years ago. Quit smoking pipe in his mid 50s. Denies alcohol or drug use. Family History: Brothers/sisters with CAD, no hx of DM, HTN, cancer Physical Exam: PHYSICAL EXAM ON ADMISSION: Vitals: 100.3, 120/55, 94, 24, 94% 2L NC GA: NAD, resting comfortably in bed w/o complaints HEENT: PERRLA. MM dry. no LAD. no JVD. neck supple. Cards: RRR S1/S2 heard though distant heart sounds. no murmurs/gallops/rubs appreciated. Pulm: CTAB no crackles or wheezes though very diminished breath sounds throughout Abd: soft, tenderness over RUQ, +BS. No hepatosplenomegaly. Extremities: wwp, no edema. DPs, PTs 1+. Skin: Dry and intact Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities. PHYSICAL EXAM ON DISCHARGE: Pertinent Results: Lab Results on Admission: [**2159-12-12**] 02:00PM BLOOD WBC-16.1*# RBC-4.25* Hgb-13.2* Hct-37.4* MCV-88 MCH-31.1 MCHC-35.4* RDW-13.5 Plt Ct-200# [**2159-12-12**] 02:00PM BLOOD Neuts-89.8* Lymphs-4.8* Monos-5.0 Eos-0.3 Baso-0.1 [**2159-12-12**] 08:08PM BLOOD PT-13.5* PTT-27.0 INR(PT)-1.1 [**2159-12-12**] 02:00PM BLOOD Glucose-210* UreaN-29* Creat-1.1 Na-133 K-4.3 Cl-96 HCO3-27 AnGap-14 [**2159-12-12**] 02:00PM BLOOD ALT-17 AST-18 AlkPhos-100 TotBili-1.1 [**2159-12-12**] 02:00PM BLOOD Lipase-24 [**2159-12-12**] 02:00PM BLOOD Albumin-3.7 Calcium-8.9 Phos-3.3 Mg-2.1 [**2159-12-12**] 02:41PM BLOOD Lactate-1.0 Studies: [**12-12**] ECG's: Sinus tachycardia. The tracing is marred by baseline artifact. There is frequent ventricular ectopy. Right bundle-branch block persists. Repeat tracing of diagnostic quality is suggested. Sinus rhythm. Right bundle-branch block. Non-specific inferior ST-T wave flattening. Compared to the previous tracing of [**2159-11-22**] ventricular ectopy is no longer recorded. The rate has slowed. Otherwise, no diagnostic interim change. [**12-12**] CT Abdomen and Pelvis: IMPRESSION: 1. Findings concerning for acute cholecystitis. 2. Findings concerning for UTI/cystitis. 3. Extensive diverticulosis without diverticulitis. 4. Right Spigelian hernia containing the appendix and small bowel containing right inguinal hernia, no associated bowel obstruction. [**12-12**] Gallbladder Drainage: IMPRESSION: Uncomplicated placement of percutaneous cholecystostomy catheter (8 French [**Last Name (un) 2823**] catheter) via a right subcostal transhepatic approach. Specimen sent for microbiology analysis. [**12-13**] CXR: IMPRESSION: Persistent left basilar scarring. No acute cardiopulmonary process. [**12-13**] Abdominal Xray: IMPRESSION: No evidence of obstruction or ileus. [**Date range (1) 47017**] Blood Cultures: negative [**2159-12-12**] 11:24 pm URINE Source: Catheter. **FINAL REPORT [**2159-12-17**]** URINE CULTURE (Final [**2159-12-17**]): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. Piperacillin/tazobactam sensitivity testing available on request. Cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | ENTEROCOCCUS SP. | | AMIKACIN-------------- <=2 S AMPICILLIN------------ =>32 R <=2 S AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ =>16 R MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- 32 S <=16 S TETRACYCLINE---------- =>16 R TOBRAMYCIN------------ 8 I TRIMETHOPRIM/SULFA---- =>16 R VANCOMYCIN------------ 2 S [**2159-12-12**] 11:23 pm MRSA SCREEN Source: Nasal swab. **FINAL REPORT [**2159-12-15**]** MRSA SCREEN (Final [**2159-12-15**]): No MRSA isolated. [**2159-12-13**] 12:11 am BILE **FINAL REPORT [**2159-12-17**]** GRAM STAIN (Final [**2159-12-13**]): Reported to and read back by DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] ON [**2159-12-13**] AT 0305. 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 3+ (5-10 per 1000X FIELD): GRAM NEGATIVE ROD(S). FLUID CULTURE (Final [**2159-12-16**]): ESCHERICHIA COLI. MODERATE GROWTH. Piperacillin/tazobactam sensitivity testing available on request. Cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ =>16 R MEROPENEM-------------<=0.25 S TOBRAMYCIN------------ 2 S TRIMETHOPRIM/SULFA---- <=1 S ANAEROBIC CULTURE (Final [**2159-12-17**]): NO ANAEROBES ISOLATED. LAB RESULTS ON DISCHARGE: [**2159-12-17**] 04:42AM BLOOD WBC-7.3 RBC-4.05* Hgb-12.6* Hct-36.3* MCV-90 MCH-31.0 MCHC-34.6 RDW-13.3 Plt Ct-182 [**2159-12-13**] 02:58AM BLOOD Neuts-94.0* Lymphs-3.0* Monos-2.9 Eos-0.1 Baso-0 [**2159-12-14**] 04:47AM BLOOD PT-14.3* PTT-31.1 INR(PT)-1.2* [**2159-12-18**] 09:22AM BLOOD Glucose-352* UreaN-23* Creat-1.1 Na-133 K-4.0 Cl-97 HCO3-27 AnGap-13 [**2159-12-14**] 04:47AM BLOOD ALT-15 AST-17 LD(LDH)-144 AlkPhos-77 TotBili-0.4 [**2159-12-18**] 09:22AM BLOOD Calcium-8.3* Phos-2.3* Mg-2.0 Brief Hospital Course: PRIMARY REASON FOR HOSPITALIZATION: Patient is an 89yo male with multiple medical problems including CAD s/p 3-vessel CABG, hx CHF (EF 50-55%), COPD (on intermittent home oxygen), CKD III (Baseline Cr 1.3) who presents after being discharged from [**Hospital1 **] [**2159-11-27**] when he had ERCP for cholecystitis with sphincterotomy and sphincteroplasty, now presented with 2-3 days of worsening RUQ pain and nausea, with radiographic evidence concerning for acute cholecystitis. He underwent percutaneous cholecystostomy resulting in relief of symptoms. . 1. Acute cholecystitis: Patient presented with worsening right upper quadrant abdominal pain and tenderness. He had elevated WBC count with left shift and evidence on CT of gallbladder wall distension, thickening, pericholecystic stranding, all concerning for recurrent cholecystitis. His case was discussed with ERCP team, and there is no evidence for biliary dilation or stone which is visualized on CT abdomen. After discussion with surgery and IR, patient underwent a percutaneous cholecystostomy tube placement as he was not a cadidate for cholecystectomy at this time. After placement patient's abdominal pain decreased. He was placed on a course of Unasyn and flagyl which he completed. Patient remained hemodynamically stable and his diet was advanced. He was discharged with symptomatic relief, hemodynamic stability, and percutaneous cholecystostomy tube in place. . 2. Cystitis: Patient had evidence of cystitis on CT scan. UA was consistent with bacterial infection. Has had previous UTI with resistant E. coli. Patient was covered with IV flagyl and cefepime to cover both UTI as well as intra-abdominal infection. He maintained adequate urine output. He was discharged after completing an antibiotic course, with falling WBC count and no symptoms of dysuria. . CHRONIC CARE: 1. Right inguinal hernia and appendix containing right spigelian hernia: per surgery, while impressive, does not warrant surgical management as he is not obsructing. . 2. CAD s/p CABG x 3: Continued aspirin, metoprolol, simvastatin . 3. CHF with preserved EF: Currently appears euvolemic. Continued home medications . 4. HTN: continued home metoprolol . 5. HLD: Continued statin . 6. COPD: Continued home fluticasone, ipratropium-albuterol . 7. Stage 3 CKD: baseline Cr 1.3 and currently improved from baseline. . 8. GERD: Continued home omeprazole . TRANSITIONS IN CARE: 1. FOLLOW-UP APPOINTMENTS: PCP, [**Name Initial (NameIs) **] 2. MEDICATION CHANGES: 1. START Cefpodoxime 400mg by mouth twice daily for 8 more days 2. START Acetaminophen 500mg by mouth every 6 hours as needed for pain 3. STOP taking diazepam nightly for sleep. You may speak with your PCP about alternative sleep medications or other therapies. You did not require this while you were here and this medication can cause confusion. Medications on Admission: 1. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for sob/wheezing. 5. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: Two (2) Capsule, Ext Release 24 hr PO at bedtime. 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. Zyprexa 2.5 mg Tablet Sig: 0.5 Tablet PO twice a day. 9. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 10. diazepam 5 mg Tablet Sig: 0.5 Tablet PO at bedtime as needed for insomnia. 11. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual q5min x3 as needed for chest pain. 12. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. Discharge Medications: 1. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation every six (6) hours as needed for shortness of breath or wheezing. 5. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: Two (2) Capsule, Ext Release 24 hr PO HS (at bedtime). 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. olanzapine 2.5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 10. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual every 5 minutes for maximum three doses as needed for chest pain: notify your doctor if you take 3 tabs and still have pain. 11. cefpodoxime 100 mg Tablet Sig: Four (4) Tablet PO Q12H (every 12 hours) for 8 days. Disp:*64 Tablet(s)* Refills:*0* 12. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. 13. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain: do not take more than 4 grams per day of acetaminophen. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary: Cholecystitis Secondary: Urinary tract infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted to the hospital for belly pain and were found to have gallbladder inflammation. We placed a drain into the gallbladder to drain fluid that had built up and relieve the inflammation. After placing the drain your belly pain has improved. We also treated you with antibiotics for a urinary tract infection that we found. You are doing well on antibiotics for this. You will continue to have the drain in until you see the surgeons for follow-up. Please make the following changes to your medications when you are discharged: 1. START Cefpodoxime 400mg by mouth twice daily for 8 more days 2. START Acetaminophen 500mg by mouth every 6 hours as needed for pain 3. STOP taking diazepam nightly for sleep. You may speak with your PCP about alternative sleep medications or other therapies. You did not require this while you were here and this medication can cause confusion. Please take all other medications as prescribed Please keep your follow-up appointments. Physical therapy and VNA will be coming to your home to work with you upon discharge. Followup Instructions: Please follow-up with the following appointments: Department: [**Hospital1 18**] [**Location (un) 2352**] When: WEDNESDAY [**2159-12-26**] at 2:30 PM With: [**First Name4 (NamePattern1) 1575**] [**Last Name (NamePattern1) 1576**], MD [**Telephone/Fax (1) 1144**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site Name: [**Last Name (LF) **], [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD Specialty: SURGERY Address: [**Street Address(2) **],STE 1W, [**Location (un) **],[**Numeric Identifier 822**] Phone: [**Telephone/Fax (1) 8792**] Appointment: TUESDAY [**1-8**] AT 10:30AM Department: [**Hospital1 18**] [**Location (un) 2352**] When: MONDAY [**2160-2-18**] at 11:30 AM With: [**First Name4 (NamePattern1) 1575**] [**Last Name (NamePattern1) 1576**], MD [**Telephone/Fax (1) 1144**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

575,349,595,428,403,250,041,V458,496,585,600,294,272,530,285,V462,692

{'Acute cholecystitis,Toxic encephalopathy,Acute cystitis,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified Escherichia coli [E. coli],Aortocoronary bypass status,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia, unspecified, without behavioral disturbance,Pure hypercholesterolemia,Esophageal reflux,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Contact dermatitis and other eczema, unspecified cause'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: fevers, chills PRESENT ILLNESS: History of Present Illness: 89 y/o male with multiple medical problems from [**Name (NI) **] [**Hospital **] nursing home with hx of CAD s/p 3-vessel CABG, hx CHF (EF 50-55% in [**1-5**]), HTN, COPD (on intermittent home oxygen), hx CKD III (Baseline Cr 1.3) who presents after being discharged from [**Hospital1 **] [**2159-11-27**] when he had ERCP for cholecystitis with sphincterotomy and sphincteroplasty, now p/w 2-3 days of worsening RUQ pain. +nausea today, no vomiting. No diarrhea or subjective fever. No BM in 10 days. . He has significant memory problems and is somewhat of a poor historian, but he states the pain comes on abruptly and then gradually decreases. He does not know what precipitated his pain and he does not know if anything makes it better. He was admitted to [**Hospital1 18**] several weeks ago for cholecystitis at which time he had ERCP with removal of sludge and small stones. He does not remember when he had his most recent bowel movement or whether eating affects his pain. . In the ED, initial VS were: 5, 98.5, 66, 113/45, 16, 95% RA. Labs notable for WBC 16.1, ALT 17, AST 18, AP 100, lipase 24, Tbili 1.1, albumin 3.7, lactate 1.0. Bcx pending. CT abd/pelvis showing, "dilated GB with pericholecystic stranding and gb wall thickening concerning for acute cholecystitis. Air in GB likely secondary to recent ERCP. Urinary bladder wall thickening and enhancement concerning for cystitis. Unchanged right inguinal bowel containing hernia and appendix containing right spigelian hernia." Surgery was called: likely needs perc chole tube, they will call IR. . Pt is being admitted for acute cholecystitis. IR was paged. Pt given IV unasyn and 500 cc IVF prior to transfer. In the MICU, they did percutaneous cholecystostomy in IR, with improvement in his pain, but still mildly tender. Cefepime was added given concern for UTI and resistant E. coli in the past. He was continued on Flagyl for anaerobic coverage. He was given IVF's, and is now +2L for LOS. MEDICAL HISTORY: CAD s/p CABG in [**2158-3-27**] Coronary bypass grafting x3: Reverse saphenous vein graft from aorta to posterior descending coronary artery; reverse saphenous vein single graft from aorta to second obtuse marginal coronary artery; as well as reverse saphenous vein single graft from aorta to the first diagonal coronary artery. Mild cognitive impairment per OMR notes Congestive heart failure with preserved LVEF (last TTE [**12/2158**]) Hypertension Hypercholesterolemia COPD on intermittent home oxygen PTSD- WWII Veteran Right Facial Nerve Palsy Stage III chronic kidney disease (baseline Cr: ~1.3) History of herpes Zoster Bilateral Cataract Surgery Left Inguinal Hernia Repair Right Inguinal Hernia- Not repaired Benign Prostatic Hypertrophy Anemia Eczema Hard of hearing GERD Malaria over 30 years ago while in [**Country 480**] MEDICATION ON ADMISSION: 1. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for sob/wheezing. 5. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: Two (2) Capsule, Ext Release 24 hr PO at bedtime. 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. Zyprexa 2.5 mg Tablet Sig: 0.5 Tablet PO twice a day. 9. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 10. diazepam 5 mg Tablet Sig: 0.5 Tablet PO at bedtime as needed for insomnia. 11. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual q5min x3 as needed for chest pain. 12. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION: FAMILY HISTORY: Brothers/sisters with CAD, no hx of DM, HTN, cancer SOCIAL HISTORY: Worked in hospital administration. Quit smoking cigarettes over 20 years ago. Quit smoking pipe in his mid 50s. Denies alcohol or drug use. ### Response: {'Acute cholecystitis,Toxic encephalopathy,Acute cystitis,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified Escherichia coli [E. coli],Aortocoronary bypass status,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage III (moderate),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia, unspecified, without behavioral disturbance,Pure hypercholesterolemia,Esophageal reflux,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Contact dermatitis and other eczema, unspecified cause'}

CHIEF COMPLAINT: Nausea, vomiting, coffee ground emesis PRESENT ILLNESS: 66 yo male with recent dx of alcoholic hepatitis and alcoholic cirrhosis just discharged [**9-9**] who presents with nausea and vomiting. MEDICAL HISTORY: Alcoholic cirrhosis, recently diagnosed with acute alcoholic hepatitis Hepatic mass: Found to have 10mm hypodensity posteriorly in the right lobe of the liver, AFP was 4.7. History of GIB with positive NG lavage but couldn't tolerate EGD in the past, patient says was told he had polyps BPH HTN GERD MEDICATION ON ADMISSION: Thiamine HCl 100mg po daily Folic acid 1mg po daily Omeprazole 20mg po daily Metoprolol 25mg po bid Prednisone 40mg po daily x 24 days Spironolactone 100mg po daily Furosemide 40mg po daily Sulfamethoxazole-Trimethoprim 800-160mg po daily MVI 1 tab po daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 98.2 BP 118/81 HR 127 RR 20 O2 Sat 95%3L GEN: Awake, alert, lying in bed in NAD. HEENT: PERRLA, EOMI, sclera icteric. MM slightly dry without lesions. No palpable lymphadenopathy. No thyromegaly. RESP: CTA b/l with good air movement throughout CV: RRR with III/VI systolic murmur at LUSB ABD: Distended with +BS, no tenderness, + fluid wave, ? palpbale spleen EXT: 1+ peripheral edema, nonpitting SKIN: Spider angioma notble across chest, skin jaundiced throughout NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. FAMILY HISTORY: Father died of gall bladder cancer, mother died of "poor diet." SOCIAL HISTORY: Hispanic, speaks Spanish & English, married to his wife [**Name (NI) 1439**]. [**Name2 (NI) **] heavy EtOH consumption (1 L hard liquor/day) since age of 17 (x50yrs) but quit 2 months ago. No drinking since recent discharge. Denies tobacco or IVDU. Works for department of transportation.

Sepsis,Hyposmolality and/or hyponatremia,Portal hypertension,Alcoholic cirrhosis of liver,Urinary tract infection, site not specified,Disorders of phosphorus metabolism,Other specified disorders of biliary tract,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Other specified disorders of stomach and duodenum,Other and unspecified alcohol dependence, in remission,Other nonspecific abnormal serum enzyme levels,Unspecified disorder of liver,Diarrhea,Anemia in chronic kidney disease,Chronic kidney disease, unspecified,Long-term (current) use of steroids,Do not resuscitate status,Esophageal varices with bleeding,Unspecified septicemia,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Other secondary thrombocytopenia

Sepsis,Hyposmolality,Portal hypertension,Alcohol cirrhosis liver,Urin tract infection NOS,Dis phosphorus metabol,Dis of biliary tract NEC,Enterococcus group d,Hypertension NOS,BPH w/o urinary obs/LUTS,Esophageal reflux,Gastroduodenal dis NEC,Alcoh dep NEC/NOS-remiss,Abn serum enzy level NEC,Liver disorder NOS,Diarrhea,Anemia in chr kidney dis,Chronic kidney dis NOS,Long-term use steroids,Do not resusctate status,Esophag varices w bleed,Septicemia NOS,Acute necrosis of liver,Ac kidny fail, tubr necr,Sec thrombocytpenia NEC

Admission Date: [**2124-9-13**] Discharge Date: [**2124-9-30**] Date of Birth: [**2058-2-21**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1377**] Chief Complaint: Nausea, vomiting, coffee ground emesis Major Surgical or Invasive Procedure: Inutbation EGD History of Present Illness: 66 yo male with recent dx of alcoholic hepatitis and alcoholic cirrhosis just discharged [**9-9**] who presents with nausea and vomiting. He was admitted to [**Hospital1 18**] [**Date range (1) **] with peripheral edema, jaundice and progressive abdominal distention and was diagnosed with acute alcoholic hepatitis and alcoholic cirrhosis. He also had an NG tube placed for dietary supplementations. He was discharged 5 days ago. Since then, he reports feeling tired. Last night he developed the acute onset of nausea with 2 episodes of vomiting. He had been on continuous tube feeds at 60cc/hr. He reports dark vomitus but no overt blood. At that time he vomited up his NG tube. Also reports dark, loose, occasionally sticky stools for multiple weeks, unchanged in last few days. He reports having 1 BM per hour for multiple days. He went to [**Hospital3 **] where he was noted to have coffee ground emesis and guaiac-positive melena. He was also hyponatremia to 125, hyperkalemia to 6.2 with peaked T waves, and abnormal LFTs. He was given 150mg IV solumedrol, kayexelate, and protonix and transferred here. In our ED, initial vitals were 97.6 112 152/80 18 95%4L. Labs were notable for Na 128, K 6.9, Hct 33.0 (baseline 39), WBC 20.8, plts 108. ECG showed hyperacute T waves. He was given 2g IV calcium gluconate. 1 amp D50W, 10mg IV insulin. Did diagnostic paracentesis which had WBC 95. NG lavage was attempted but when he sat up, he felt ill and had an episode of chest pain and dropped his SBP 90's. He was given another dose of protonix and zofran, as well as morphine for chest pain. ECG was reportedly unchanged with the chest pain episode. 2 PIV 18g were placed. Type and crossed x 4 units, not transfused. Vitals on transfer were BP 120/70 HR 120 RR 28-32 94-96%2L. Hct 6 points lower than at discharge. Not gotten blood, type and screened, add on cross x4. Review of Systems: Negative for fever, chills, night sweats, HA, chest pain (prior to admission), SOB, abdominal pain, constipation, urinary changes. Past Medical History: Alcoholic cirrhosis, recently diagnosed with acute alcoholic hepatitis Hepatic mass: Found to have 10mm hypodensity posteriorly in the right lobe of the liver, AFP was 4.7. History of GIB with positive NG lavage but couldn't tolerate EGD in the past, patient says was told he had polyps BPH HTN GERD Social History: Hispanic, speaks Spanish & English, married to his wife [**Name (NI) 1439**]. [**Name2 (NI) **] heavy EtOH consumption (1 L hard liquor/day) since age of 17 (x50yrs) but quit 2 months ago. No drinking since recent discharge. Denies tobacco or IVDU. Works for department of transportation. Family History: Father died of gall bladder cancer, mother died of "poor diet." Physical Exam: VS: T 98.2 BP 118/81 HR 127 RR 20 O2 Sat 95%3L GEN: Awake, alert, lying in bed in NAD. HEENT: PERRLA, EOMI, sclera icteric. MM slightly dry without lesions. No palpable lymphadenopathy. No thyromegaly. RESP: CTA b/l with good air movement throughout CV: RRR with III/VI systolic murmur at LUSB ABD: Distended with +BS, no tenderness, + fluid wave, ? palpbale spleen EXT: 1+ peripheral edema, nonpitting SKIN: Spider angioma notble across chest, skin jaundiced throughout NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. Pertinent Results: Admission Labs: [**2124-9-13**] 10:15AM WBC-20.8*# RBC-3.26* HGB-11.4* HCT-33.0* MCV-101* MCH-35.0* MCHC-34.6 RDW-18.6* [**2124-9-13**] 10:15AM NEUTS-90* BANDS-1 LYMPHS-3* MONOS-3 EOS-0 BASOS-0 ATYPS-0 METAS-2* MYELOS-1* NUC RBCS-1* [**2124-9-13**] 10:15AM PLT SMR-LOW PLT COUNT-108*# [**2124-9-13**] 10:15AM PT-20.3* PTT-36.8* INR(PT)-1.9* [**2124-9-13**] 10:15AM CALCIUM-8.2* PHOSPHATE-5.1*# MAGNESIUM-2.1 [**2124-9-13**] 10:15AM ALT(SGPT)-135* AST(SGOT)-140* TOT BILI-13.6* [**2124-9-13**] 10:15AM LIPASE-54 [**2124-9-13**] 10:15AM cTropnT-0.01 [**2124-9-13**] 10:15AM GLUCOSE-208* UREA N-47* CREAT-0.9 SODIUM-128* POTASSIUM-6.9* CHLORIDE-96 TOTAL CO2-23 ANION GAP-16 [**2124-9-13**] 10:55AM ASCITES WBC-95* RBC-925* POLYS-9* LYMPHS-9* MONOS-0 PLASMA-1* MESOTHELI-5* MACROPHAG-74* OTHER-2* [**2124-9-13**] 10:21AM K+-6.8* [**2124-9-13**] 10:55AM ASCITES ALBUMIN-LESS THAN [**2124-9-13**] 11:43AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-100 KETONE-15 BILIRUBIN-MOD UROBILNGN-4* PH-6.5 LEUK-NEG [**2124-9-13**] 11:43AM URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.023 [**2124-9-13**] 03:10PM LACTATE-9.3* [**2124-9-13**] 03:10PM TYPE-[**Last Name (un) **] PO2-153* PCO2-31* PH-7.44 TOTAL CO2-22 BASE XS--1 COMMENTS-GREEN TOP Micro: [**9-13**] Urine cx- no growth [**9-13**] Peritoneal fluid- no growth (prelim) [**9-13**] Blood cx- pending [**9-13**] C. diff- negative [**9-14**] C. diff- negative [**9-15**] CMV VL- pending Studies: CXR [**2124-9-13**]: Low lung volumes and bibasilar atelectasis. [**9-14**] EGD Impression: Varices at the middle third of the esophagus, lower third of the esophagus and gastroesophageal junction (ligation) Erythema, congestion, abnormal vascularity and mosaic appearance in the whole stomach compatible with portal hypertensive gastropathy Otherwise normal EGD to third part of the duodenum Recommendations: Clear liquid diet for the next 24 hours, then soft diet for the following 24 hours. Continue PPI and Octreotide gtts, start Carafate slurry 1gram PO QID, continue antibiotics. Will need f/u endoscopy in 2 weeks. [**2124-9-14**] Echo: The left atrium is normal in size. Left ventricular wall thicknesses are normal. Left ventricular systolic function is hyperdynamic (EF 80%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). There is a mild resting left ventricular outflow tract obstruction. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: hyperdynamic left ventricle; mild left ventricular outflow tract obstruction [**2124-9-15**] Abd U/S w/ Dopplers: 1. Patent main, right, and left portal veins. 2. Cirrhosis with portal hypertension, mild splenomegaly, moderate ascites, as before. Brief Hospital Course: 66 yo male with recent dx of alcoholic hepatitis and alcoholic cirrhosis just discharged [**9-9**] who presents with nausea and vomiting and likely upper GI bleed. * Pt's condition deteriorated and family decided to take him home with [**Month/Year (2) **] when recovery of liver function was very unlikely. . #. Upper GI bleed: Had melena in the ED with reports of coffee ground emesis at the OSH. Hct was as low as 28. Given initial concern for active bleeding, patient was transfused 2u PRBCs on admission. EGD here with 2 grade III varices with stigmata of recent bleeding and portal hypertensive gastropathy. Treated with iv PPI, octreotide, CTX x5 days. HCT was stable at 32 for several days, and patient required no further transfusions. His metoprolol was stopped, and he was started on Nadolol 40mg po daily for prophylaxis. No active bleeding throughout admission. # Decompensated Alcoholic Cirrhosis: Recent diagnosis of alcoholic hepatitis and alcoholic cirrhosis. Tbili was initially 13.6 on admission, and climbed to.... transaminases peaked in the 800s. A RUQ US was performed that showed no portal vein thrombosis. Patient's acute on chronic liver decompensation was attributed to shock liver in the setting of likely hypotension during his UGIB. Last drink was 2 months ago. [**Hospital **] hospital course was complicated by encephelopathy for which he was treated with lactulose and rifaximin. He was continued on thiamine, folic acid, MVI. Held steroids and diuretics on admission. Diuretics (lasix 40 and spironolactone 100) were restarted when patient was transferred out of the ICU. Came to the floor and had progressively worsening MELD to 45. Had likely shock liver from bleed followed by cholestasis of sepsis [**1-25**] UTI. Pt was not transplant candidate and decision was made with family to take him home with [**Month/Day (2) **] because his liver function was not recovering. # HRS - renal fxn began to decline, Cr rose to >5 over 4 days despite volume challenges, octreotide and midodrine. Started on HD but were unable to take off sufficient volume due to hypotension. Decided to stop HD when family decided to take him home with [**Month/Day (2) **]. #. Chest pain and elevated troponin: Had episode of chest pain in the ED. No known h/o CAD. Trop 0.01-->0.08--->0.05 felt to be [**1-25**] tachycardia in setting of acute Hct drop. ECG with some new TWI in lateral precordial leads but rate also increased and in the setting of hyperkalemia. CK and MB did not bump. No ASA given GIB. #. Leukocytosis: WBC elevated to 20.8 on admission (was 9.2 on [**9-9**]). No e/o infection, CXR, UA, stool, and blood negative. Thought to be [**1-25**] steroids given on last admission. Initially treated for severe c/diff with iv flagyl and po vanco, but negative x2. Patient was continued on Ceftriaxone for variceal bleed. Found to have enterococcal UTI, copmleted course of linezolid. #. Hyponatremia: Had slowly downtrending Na at the time of prior discharge on [**9-9**]. Thought this is most likely related to his new use of diuretics which were held on admission. Na normalized to 135. #. Hepatic mass: Needs outpatient MRI to evaluate. Concern for HCC. AFP at last admission 4.7. #. GERD: Patient was initally on IV PPI which was transitioned to a PO PPI. #. Code: DNR/DNI. Medications on Admission: Thiamine HCl 100mg po daily Folic acid 1mg po daily Omeprazole 20mg po daily Metoprolol 25mg po bid Prednisone 40mg po daily x 24 days Spironolactone 100mg po daily Furosemide 40mg po daily Sulfamethoxazole-Trimethoprim 800-160mg po daily MVI 1 tab po daily Discharge Medications: 1. morphine concentrate 20 mg/mL Solution Sig: 0.1-0.2 ml PO every 4-6 hours as needed. Disp:*10 mL* Refills:*0* 2. Ativan 0.5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed. Disp:*60 Tablet(s)* Refills:*0* 3. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day: Take for volume overload to increase urine output. Disp:*30 Tablet(s)* Refills:*2* 4. rifaximin 550 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. white petrolatum-mineral oil 56.8-42.5 % Ointment Sig: One (1) Appl Ophthalmic PRN (as needed) as needed for Dry eyes. 6. sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 7. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q2H (every 2 hours). 8. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Discharge Disposition: Home With Service Facility: comunity nurse [**First Name (Titles) **] [**Last Name (Titles) **] care Discharge Diagnosis: Primary: Esophageal variceal bleed UTI Hepatorenal syndrome Liver failure Secondary: Alcoholic hepatitis and cirrhosis HTN Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted to the hospital with bleeding from your varices. You were taken to the ICU and stabilized there. When you came to the floor, your liver began to fail from the lack of blood flow during the bleed. With the liver failure, your kidney function began to decline as well. You also developed a urinary tract infection which we treated with antibiotics. Unfortunately, your liver function did not recover as well as we hoped and your kidneys continued to worsen. We started hemodialysis to attempt to recover your kidney function, but were not able to remove enough fluid with each session due to your blood pressure being too low. With the bleed that brought you to the hospital and the subsequent infection, your liver continued to fail. After a long discussion with you and the family, it was decided that you would go home with [**Last Name (Titles) **] services. It was a pleasure taking care of you in the hospital. Your [**Last Name (Titles) **] team will manage all of your medications and services at home. Followup Instructions: [**Last Name (Titles) **] at home [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**] Completed by:[**2124-9-30**]

995,276,572,571,599,275,576,041,401,600,530,537,303,790,573,787,285,585,V586,V498,456,038,570,584,287

{'Sepsis,Hyposmolality and/or hyponatremia,Portal hypertension,Alcoholic cirrhosis of liver,Urinary tract infection, site not specified,Disorders of phosphorus metabolism,Other specified disorders of biliary tract,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Other specified disorders of stomach and duodenum,Other and unspecified alcohol dependence, in remission,Other nonspecific abnormal serum enzyme levels,Unspecified disorder of liver,Diarrhea,Anemia in chronic kidney disease,Chronic kidney disease, unspecified,Long-term (current) use of steroids,Do not resuscitate status,Esophageal varices with bleeding,Unspecified septicemia,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Other secondary thrombocytopenia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Nausea, vomiting, coffee ground emesis PRESENT ILLNESS: 66 yo male with recent dx of alcoholic hepatitis and alcoholic cirrhosis just discharged [**9-9**] who presents with nausea and vomiting. MEDICAL HISTORY: Alcoholic cirrhosis, recently diagnosed with acute alcoholic hepatitis Hepatic mass: Found to have 10mm hypodensity posteriorly in the right lobe of the liver, AFP was 4.7. History of GIB with positive NG lavage but couldn't tolerate EGD in the past, patient says was told he had polyps BPH HTN GERD MEDICATION ON ADMISSION: Thiamine HCl 100mg po daily Folic acid 1mg po daily Omeprazole 20mg po daily Metoprolol 25mg po bid Prednisone 40mg po daily x 24 days Spironolactone 100mg po daily Furosemide 40mg po daily Sulfamethoxazole-Trimethoprim 800-160mg po daily MVI 1 tab po daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 98.2 BP 118/81 HR 127 RR 20 O2 Sat 95%3L GEN: Awake, alert, lying in bed in NAD. HEENT: PERRLA, EOMI, sclera icteric. MM slightly dry without lesions. No palpable lymphadenopathy. No thyromegaly. RESP: CTA b/l with good air movement throughout CV: RRR with III/VI systolic murmur at LUSB ABD: Distended with +BS, no tenderness, + fluid wave, ? palpbale spleen EXT: 1+ peripheral edema, nonpitting SKIN: Spider angioma notble across chest, skin jaundiced throughout NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. FAMILY HISTORY: Father died of gall bladder cancer, mother died of "poor diet." SOCIAL HISTORY: Hispanic, speaks Spanish & English, married to his wife [**Name (NI) 1439**]. [**Name2 (NI) **] heavy EtOH consumption (1 L hard liquor/day) since age of 17 (x50yrs) but quit 2 months ago. No drinking since recent discharge. Denies tobacco or IVDU. Works for department of transportation. ### Response: {'Sepsis,Hyposmolality and/or hyponatremia,Portal hypertension,Alcoholic cirrhosis of liver,Urinary tract infection, site not specified,Disorders of phosphorus metabolism,Other specified disorders of biliary tract,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Other specified disorders of stomach and duodenum,Other and unspecified alcohol dependence, in remission,Other nonspecific abnormal serum enzyme levels,Unspecified disorder of liver,Diarrhea,Anemia in chronic kidney disease,Chronic kidney disease, unspecified,Long-term (current) use of steroids,Do not resuscitate status,Esophageal varices with bleeding,Unspecified septicemia,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Other secondary thrombocytopenia'}

CHIEF COMPLAINT: Bladder pain, nausea and vomiting. PRESENT ILLNESS: This is a 65-year-old woman who presented to the [**Hospital1 69**] on [**2110-4-28**] complaining of some discomfort suprapubic, nausea and vomiting. She had a 1??????-week recent history of dysuria, pain and burning when she urinated, suprapubic pain, and had been in contact with her primary care physician. [**Name10 (NameIs) **] had been seen in an outside hospital emergency room on [**2110-4-21**] and received antibiotics but she did not take these and the subsequently saw her primary care physician two days later, and was prescribed Cipro but she didn't take that because of some reported allergy. The follow-up results of those urine cultures actually was negative. On [**4-25**] she was seen also in an emergency room for bladder pain, and then a urinary tract infection was seen at that time on her urinalysis. Keflex was started, which again she didn't take. She did get some Pyridium as well and that actually improved some of her symptoms, and then she subsequently developed nausea and vomiting. She was noted to have slightly altered thinking and ended up coming into the Emergency Department but refused tests and IV. In addition to this she had a remote history of bipolar disorder and was deemed in the emergency room as incompetent to leave and was hospitalized therefore. MEDICAL HISTORY: 1. Bipolar disorder. 2. Hypercholesterolemia. 3. Chronic pelvic pain. 4. Femur fracture. 5. High blood pressure. 6. Urinary tract infections. 7. Chronic bladder pain. MEDICATION ON ADMISSION: 1. Lipitor. 2. Lopressor. She was not on lithium prior to her admission and per the family she evidently had stopped taking it on her own. ALLERGIES: Levofloxacin gives a rash, question of chest pain; ampicillin gives a rash; Bactrim gives a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She did not have any tobacco history, although she did have one drink per day of alcohol until about two months prior to her admission. She lives with a male partner with a history of verbal abuse .

Femoral hernia with obstruction, unilateral or unspecified (not specified as recurrent),Urinary tract infection, site not specified,Acute pancreatitis,Pneumonia due to Klebsiella pneumoniae,Mechanical complication of tracheostomy,Pneumonitis due to inhalation of food or vomitus

Unil femoral hern w obst,Urin tract infection NOS,Acute pancreatitis,K. pneumoniae pneumonia,Tracheostomy - mech comp,Food/vomit pneumonitis

Admission Date: [**2110-4-28**] Discharge Date: [**2110-5-30**] Date of Birth: [**2042-7-13**] Sex: F Service: HISTORY OF PRESENT ILLNESS: This is a 65-year-old woman who presented to the [**Hospital1 69**] on [**2110-4-28**] complaining of some discomfort suprapubic, nausea and vomiting. She had a 1??????-week recent history of dysuria, pain and burning when she urinated, suprapubic pain, and had been in contact with her primary care physician. [**Name10 (NameIs) **] had been seen in an outside hospital emergency room on [**2110-4-21**] and received antibiotics but she did not take these and the subsequently saw her primary care physician two days later, and was prescribed Cipro but she didn't take that because of some reported allergy. The follow-up results of those urine cultures actually was negative. On [**4-25**] she was seen also in an emergency room for bladder pain, and then a urinary tract infection was seen at that time on her urinalysis. Keflex was started, which again she didn't take. She did get some Pyridium as well and that actually improved some of her symptoms, and then she subsequently developed nausea and vomiting. She was noted to have slightly altered thinking and ended up coming into the Emergency Department but refused tests and IV. In addition to this she had a remote history of bipolar disorder and was deemed in the emergency room as incompetent to leave and was hospitalized therefore. On further review of systems it turns out she had a 30-pound weight loss in the last six months from poor appetite, chronic constipation requiring frequent Fleet enemas, and multiple trips to the primary care physician but refused [**Name Initial (PRE) **] colonoscopy which was recommended. PAST MEDICAL HISTORY: 1. Bipolar disorder. 2. Hypercholesterolemia. 3. Chronic pelvic pain. 4. Femur fracture. 5. High blood pressure. 6. Urinary tract infections. 7. Chronic bladder pain. MEDICATIONS ON ADMISSION: 1. Lipitor. 2. Lopressor. She was not on lithium prior to her admission and per the family she evidently had stopped taking it on her own. PAST SURGICAL HISTORY: No previous abdominal surgeries. SOCIAL HISTORY: She did not have any tobacco history, although she did have one drink per day of alcohol until about two months prior to her admission. She lives with a male partner with a history of verbal abuse . ALLERGIES: Levofloxacin gives a rash, question of chest pain; ampicillin gives a rash; Bactrim gives a rash. HOSPITAL COURSE: She was admitted and placed on a 1:1 sitter for safety, was n.p.o. on intravenous fluids. She initially refused work-up, including abdominal imaging and was seen by the psychiatry staff. She subsequently developed lower abdominal pain and a surgical consultation was obtained. A nasogastric tube was placed and approximately two liters of dark brown fluid was drained. A Foley catheter was placed as well and left lower lobe pneumonia was diagnosed. She was started on ceftriaxone on the third hospital day. A subsequent CT scan showed a small bowel obstruction with a right inguinal hernia without bowel wall thickening, free fluid or air, and the hernia seemed to be the cause of the obstruction. The patient was brought to the operating room with the findings actually of a right femoral hernia. Perioperative she had to be reintubated in the operating room for precipitous drop in her saturations. The operation was on [**2110-5-1**]. They did not find any evidence of a bowel ischemia or infarction, however the right femoral hernia was incarcerated and the cause of the small bowel obstruction. Thus she had undergone an exploratory laparotomy, a small bowel resection, and a femoral hernia repair. Postoperatively she was followed by the psychiatry team and by the primary care team. Initially she had a Swan-Ganz catheter and eventually that was changed over to a triple-lumen catheter. Her postoperative course was significant for difficulty weaning off of the ventilator and her antibiotics had been broadened in the setting of her operation to ceftazidime, Flagyl, as well as fluconazole. Cultures from sputum were the only positive growth and that was yeast, Enterobacter and Klebsiella. All of these bacteria were sensitive to the antibiotics that were used. Her antibiotics were changed several times during her postoperative course. Meropenem and gentamicin were the subsequent antibiotic regimen that she underwent and she received a full 14-day course of these. Also, her perioperative course and postoperative course involved multiple bronchoscopies with lavage and pulmonary toilet and multiple cultures being sent. This was for ongoing fevers, difficulty weaning from the vent and essentially a worsening picture on her multiple x-rays, worsening pneumonia in the left middle and lower lung zones, and bilateral patchy opacities. The infectious disease team was consulted because no significant improvement was made in her lungs based on their x-ray appearance and based on her ventilator dependence, despite being on excellent antibiotic coverage for the bacteria that was grown. They recommended a tissue biopsy from the thoracic surgeons. Thoracic surgery was called and the patient underwent a video-assisted thoracoscopic surgery procedure on [**2110-5-22**], which subsequently grew out no bacteria. Antibiotics were stopped and she did have an approximately 14-day course or maybe slightly longer, and she continued to intermittently have a difficult time weaning off the ventilator. Some of this was believed to be an anxiety component and eventually she did tolerate a tracheostomy collar. A tracheostomy was placed after it was clear that she was unable to wean off the vent, and discussions were held with the family for improved pulmonary toilet and for pulmonary rehabilitation. A tracheostomy would be the best avenue, and she had that placed percutaneously at the bedside in the intensive care unit. Eventually the patient was transferred to the medical intensive care unit. A chest CT and VATS revealed no evidence of neoplastic disease, which was a concern given the lack of improvement in the x-rays. The patient eventually had a speech follow up with a Passy-Muir valve which was successful and she was able to speak. She had a postpyloric tube placed by interventional radiology and tolerating tube feeds at goal, which was 70 an hour with the aim to gradually wean off tube feeds as she can eat and be off the ventilator obviously. The patient has ongoing requirements for excellent pulmonary toilet, chest physical therapy encouragement, has been out of bed multiple times and will thusly need physical therapy however. The medical intensive care unit team is following her currently and the patient will be going to a rehabilitation center. On [**2110-5-28**] her tracheostomy was changed to a #6 Shiley cuffless tracheostomy because she was having some intermittent obstructive type symptoms with the previous tracheostomy, and since then she had had no problems. CURRENT MEDICATIONS: 1. Ativan 0.5 to 2 mg p.o. IV q. [**2-23**] p.r.n. 2. Tylenol p.r.n. for fever. 3. Subcutaneous heparin t.i.d. 4. Dilaudid 0.5 IV q. 3-4 hours p.r.n. 5. Colace 100 p.o. q.d. p.r.n. per her feeding tube. 6. Lopressor 25 mg p.o. t.i.d. through her tube or with valve in place swallowing. This will be held for heart rate less than 55 and systolic blood pressure of less than 100. 7. Pepcid 20 mg through her feeding tube b.i.d. 8. Dulcolax suppository q. day p.r.n. 9. Erythropoietin 20,000 units subcutaneous once weekly. 10. Atrovent nebulizers q. 6 hours, albuterol nebulizers q. 6 hours. TUBE FEEDS: Peptamen full strength 70 mL an hour, otherwise things go through her feeding tube, all her other medications. No intravenous fluids. DISPOSITION: She will require physical therapy. She is discharged to rehabilitation. Ongoing tracheostomy care and Passy-Muir with speech and swallow following as well as physical therapy. FOLLOW UP: She will have outpatient follow up with her primary care physician and also with Dr. [**Last Name (STitle) **] in two weeks from discharge. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(2) 35739**] Dictated By:[**Last Name (NamePattern1) 8344**] MEDQUIST36 D: [**2110-5-30**] 09:06 T: [**2110-5-30**] 09:31 JOB#: [**Job Number 102386**] Admission Date: [**2110-4-28**] Discharge Date: [**2110-5-30**] Date of Birth: [**2042-7-13**] Sex: F Service: CHIEF COMPLAINT: Bladder pain, nausea and vomiting. HISTORY OF PRESENT ILLNESS: this is a 67 year old female with a history of bipolar disorder, hypertension, hypercholesterolemia, who now complains of dysuria and bladder pain for one and a half weeks. The patient initially called her primary care physician numerous times and complained of this bladder discomfort and dysuria. She also reports having gone to [**Hospital6 **] Hospital Emergency Room on [**4-21**]. She received treatment but did not take it. She was again seen by her primary care physician on [**4-23**] for the same symptoms. She was prescribed Ciprofloxacin but did not take it, reporting that she was allergic to the medication because of a rash and chest pain that she developed. The patient was once again seen in the Emergency Department on [**4-25**] for the bladder pain. She was found to have a urinary tract infection which was seen on urinalysis. She received a prescription for Keflex at the time, which again she did not take. She did take some Pyridium with some improvement in symptoms. The urine culture from that date was contaminated. She presented to the Emergency Department at [**Hospital1 346**] on [**4-28**]. She complained of several days of nausea and vomiting and a vague history of ingesting some chemical that burned. She reported no suicidal or homicidal ideation but it was difficult to gather information, due to the patient's sedation from Ativan. At this time, the patient was also complaining of bladder pain and bilateral leg pain. The patient had been refusing all tests and intravenous in the Emergency Department. She was evaluated by psychiatry and deemed not competent to leave against medical advice and she was then started on fluids. She was given 2 mg of Ativan for sedation, in order to prepare her for a CT scan. PAST MEDICAL HISTORY: 1.) History of bipolar disorder. 2.) Hypercholesterolemia. 3.) History of pelvic pain. 4.) History of femur fracture. 5.) Hypertension. 6.) Urinary tract infection. 7.) Chronic bladder pain. ALLERGIES: Bactrim, develops a rash. Ampicillin, develops a rash. Levaquin, rash and chest pain. MEDICATIONS: On admission, she was on Lipitor, Lopressor, Keflex for three days, Pyridium. SOCIAL HISTORY: She lives with a male partner for 20 years. She has three children. She has a history of drinking one white russian per day. She reports to have stopped drinking two months ago. No history of tobacco or any other drug use. She also has a history of verbal and/or physical abuse from her male partner. REVIEW OF SYSTEMS: Positive for weight loss and ear pain. PHYSICAL EXAMINATION: On physical examination, her temperature was 96.5; blood pressure 102/58; heart rate 68; respiratory rate 17; oxygen saturation 94% on room air. General: She was an older female, lying in bed, asleep, arouses with difficulty to voice. She opened her eyes when asked to. HEAD, EYES, EARS, NOSE AND THROAT: Normal cephalic, atraumatic. Pupils are equal, round, and reactive to light and accommodation. Oropharynx clear. Mucous membranes slightly dry. Scabs on the lower lip. Neck examination: No jugular venous distention. Chest clear to auscultation bilaterally. Cardiovascular: Regular rate and rhythm, no murmurs, rubs or gallops. Abdomen: Positive bowel sounds, soft, nondistended with diffuse tenderness throughout to palpation, no masses palpable. Extremities: Trace edema bilaterally lower extremities. On admission, she was found to have a white blood cell count of 7.2 with 55 neutrophils and 28 bands, 12 lymphocytes and 5 monocytes. She also had an increase in creatinine from .8 which is her baseline to 1.8 and she had an anion gap of 21. She has a positive urinalysis with trace protein, moderate leukocytes, no microscopic analysis. A second urinalysis was also positive with trace blood, 30 protein, trace glucose, trace ketones, small bilirubin, negative leukocytes with 0 to 2 red blood cells, 0 white blood cells and no bacteria. A head CT was obtained and was negative for any acute process. HOSPITAL COURSE: Once the patient was admitted to the medicine service, she was found to have a pneumonia on chest x-ray. She was started on Ceftriaxone. She was initially refusing all work-up. On hospital day number four, [**5-1**], she was found to have an incarcerated femoral hernia on the right. At this time, the patient was taken to the operating room and transferred to the surgery service after a small bowel resection and a hernia repair. On postoperative day number four, the patient was unable to be weaned from the ventilator. Swan was placed with a wedge pressure of 8, pulmonary artery pressure of 45 over 25, stomach vascular resistance 714, cardiac index 2.8. On postoperative day number four, she also had a worsening pneumonia develop and she was treated with Meropenem for enterococcus flucon. On postoperative day number eight, she continued to have fevers. Bronchoscopy was performed at the time and it demonstrated left lower lobe collapse. Gram stain and cultures were taken. Gram negative rods grew and Gentamycin was added. She also grew Klebsiella on a sputum culture. Ultimately, three colonies grew and none of them were identified. The patient remained on SIMV with low blood pressures and fevers. On postoperative day number 11, the patient's ventilator changes were made from SIMV to pressure control. On postoperative day number 13, she was rebronchoscoped with minimal findings. On postoperative day number 14, the patient was taken for a tracheostomy and a #8 Pore-Tex tube was placed. On postoperative day number 18, infectious disease was consulted. She was continued on Meropenem, Gentamycin for Klebsiella in her sputum. On postoperative day number 18, she went for a VAC procedure. Antibiotics were held prior to VAC. Following the procedure, the patient continued with fevers and she had bilateral opacities on chest x-ray. She also had a chest CT done which showed a small left effusion, confluent opacities, left greater than right, positive air bronchograms in the left upper lobe, the lingula of the left lower lobe and the right middle lobe. She also had small nodular opacities diffusely, likely to be an infection versus septic emboli. On [**5-25**], which is postoperative day 21, the patient was bronchoscoped again with the findings of tracheal edema. The patient was heavily sedated at the time she had episodes of hypotension. The systolic blood pressure was to the 80's with bradycardia and high respiratory rates. This was relieved with bagged mask ventilation and Ativan. She was suctioned without much success and received 20 mg of Dexamethasone. On postoperative day number 22, her tracheostomy tube was changed for a longer one because the prior tube was rubbing up against the posterior wall. At this time, the patient was transferred to the Medical Intensive Care Unit service. After her transfer to the Medical Intensive Care Unit service, she was successfully weaned on day two to a tracheostomy collar. The ventilator she was on had no further signs of respiratory distress. She received aggressive chest therapy and physical therapy. She remained afebrile throughout the rest of her hospital course. On [**5-27**], one of her blood cultures that was drawn on [**5-26**] grew gram positive cocci in pairs and clusters and she was started on Vancomycin. Blood cultures were redrawn at the time. She also had an extensive work-up for the previous fevers. She had a transesophageal echocardiogram done which was negative for endocarditis. She had lower extremity Dopplers which were negative for deep vein thrombosis and she was also found to have an elevated lipase up to 546. CT scan of the abdomen showed no evidence of pancreatitis. It was sent to pathology. Preliminary [**Location (un) 1131**] was resolving pneumonia. Her blood cultures were further revealing to be coagulase negative staph. Vancomycin was stopped. The patient was also found to have a normal chromic anemia with a hematocrit of 34. Her iron studies were normal, most likely anemia of chronic disease. The patient was seen by psychiatry and deemed to be stable. She was restarted on Respiradol .5 p.o. twice a day. The patient remained on trach collar with no signs of respiratory distress. She continued to receive aggressive physical therapy. The patient was discharged in stable condition to a rehabilitation facility on a tracheostomy collar, on no antibiotics. DISCHARGE DIAGNOSES: incarcerated femoral hernia, status post small bowel resection. Tracheostomy for prolonged ventilator dependence. Post pyloric feeding tube placement. Enterobacter and Klebsiella pneumonia. Pancreatitis. Bipolar disorder. DISCHARGE MEDICATIONS: Heparin 5,000 subcutaneous three times a day. Albuterol one neb q. six hours. Ipitroprium bromide one neb q. six hours. Erythropoietin 20,000 units, one injection q. week. Bisacodyl 5 mg two tablets oral q. day. Lamtidine 20 mg tablets twice a day. Metoprolol 50 mg three times a day. Dulcosate 100 mg oral q. day. Acetaminophen 325 mg one to two tablets every four to six hours as needed. Lorazepam .5 mg tablet, one to four tablets p.o. every four to six hours as needed for anxiety. Oxycodone 5 mg every four to six hours as needed for pain. Respiratione .5 mg one tablet twice a day. FOLLOW-UP: The patient is to follow-up with Dr. [**Last Name (STitle) **] in two weeks. Please call to schedule an appointment. The patient is to call primary care physician for [**Name9 (PRE) 702**] in one to two weeks after discharge. It is crucial that she receive agressive chest physical therapy, and general PT. The goal is to red-cap her trach with plans for decanulation. [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D. [**MD Number(1) 7585**] Dictated By:[**Last Name (NamePattern1) 7586**] MEDQUIST36 D: [**2110-5-29**] 11:23 T: [**2110-5-29**] 22:37 JOB#: [**Job Number 102385**]

552,599,577,482,519,507

{'Femoral hernia with obstruction, unilateral or unspecified (not specified as recurrent),Urinary tract infection, site not specified,Acute pancreatitis,Pneumonia due to Klebsiella pneumoniae,Mechanical complication of tracheostomy,Pneumonitis due to inhalation of food or vomitus'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Bladder pain, nausea and vomiting. PRESENT ILLNESS: This is a 65-year-old woman who presented to the [**Hospital1 69**] on [**2110-4-28**] complaining of some discomfort suprapubic, nausea and vomiting. She had a 1??????-week recent history of dysuria, pain and burning when she urinated, suprapubic pain, and had been in contact with her primary care physician. [**Name10 (NameIs) **] had been seen in an outside hospital emergency room on [**2110-4-21**] and received antibiotics but she did not take these and the subsequently saw her primary care physician two days later, and was prescribed Cipro but she didn't take that because of some reported allergy. The follow-up results of those urine cultures actually was negative. On [**4-25**] she was seen also in an emergency room for bladder pain, and then a urinary tract infection was seen at that time on her urinalysis. Keflex was started, which again she didn't take. She did get some Pyridium as well and that actually improved some of her symptoms, and then she subsequently developed nausea and vomiting. She was noted to have slightly altered thinking and ended up coming into the Emergency Department but refused tests and IV. In addition to this she had a remote history of bipolar disorder and was deemed in the emergency room as incompetent to leave and was hospitalized therefore. MEDICAL HISTORY: 1. Bipolar disorder. 2. Hypercholesterolemia. 3. Chronic pelvic pain. 4. Femur fracture. 5. High blood pressure. 6. Urinary tract infections. 7. Chronic bladder pain. MEDICATION ON ADMISSION: 1. Lipitor. 2. Lopressor. She was not on lithium prior to her admission and per the family she evidently had stopped taking it on her own. ALLERGIES: Levofloxacin gives a rash, question of chest pain; ampicillin gives a rash; Bactrim gives a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She did not have any tobacco history, although she did have one drink per day of alcohol until about two months prior to her admission. She lives with a male partner with a history of verbal abuse . ### Response: {'Femoral hernia with obstruction, unilateral or unspecified (not specified as recurrent),Urinary tract infection, site not specified,Acute pancreatitis,Pneumonia due to Klebsiella pneumoniae,Mechanical complication of tracheostomy,Pneumonitis due to inhalation of food or vomitus'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 59-year-old male with a history of smoking, hypertension, hyperlipidemia, presenting with acute onset of substernal chest pain with exertion. The patient had baseline intermittent chest pain with exertion. His chest began eight years ago, and is induced by exercise and exposure to cold. One week ago, the patient began to take atenolol, which alleviated his pain. Cardiac risk factors include history of hypertension, hyperlipidemia, and heavy smoking history. No history of prior myocardial infarction. The patient was in his usual state of health until the day before admission, when he began exercising. He began to feel pain after three minutes. He characterized it as burning and substernal, which radiated to his shoulders bilaterally. The pain lasted less than ten minutes, but he went to [**Hospital1 69**]. Evaluation shows lateral wall motion defects and anteroapical reversible defects with an ejection fraction of 43%. Catheterization showed left circumflex 80% occlusion, 100% after the first branch, right coronary artery had mild disease, left main had 80% distal disease. MEDICAL HISTORY: Significant for benign aldosteronoma diagnosed in [**2146**], hypertension, hyperlipidemia, gastroesophageal reflux disease, asthma questionable. MEDICATION ON ADMISSION: ALLERGIES: Sulfa drugs. PHYSICAL EXAM: FAMILY HISTORY: Significant for a grandmother with diabetes. His father died of a stroke, and his mother died of some complication of vascular disease. SOCIAL HISTORY: Significant for two to three packs of smoking a week, and two cigars a week for 20 years. He denies alcohol abuse and intravenous drug use. He works as a patent lawyer, and lives with his wife.

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hyperglyceridemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Syncope and collapse,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Tobacco use disorder

Crnry athrscl natve vssl,Intermed coronary synd,Pure hyperglyceridemia,Abnorm electrocardiogram,Syncope and collapse,Hypertension NOS,Renal & ureteral dis NOS,Tobacco use disorder

Admission Date: [**2149-1-19**] Discharge Date: [**2149-1-28**] Date of Birth: [**2089-2-18**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 59-year-old male with a history of smoking, hypertension, hyperlipidemia, presenting with acute onset of substernal chest pain with exertion. The patient had baseline intermittent chest pain with exertion. His chest began eight years ago, and is induced by exercise and exposure to cold. One week ago, the patient began to take atenolol, which alleviated his pain. Cardiac risk factors include history of hypertension, hyperlipidemia, and heavy smoking history. No history of prior myocardial infarction. The patient was in his usual state of health until the day before admission, when he began exercising. He began to feel pain after three minutes. He characterized it as burning and substernal, which radiated to his shoulders bilaterally. The pain lasted less than ten minutes, but he went to [**Hospital1 69**]. Evaluation shows lateral wall motion defects and anteroapical reversible defects with an ejection fraction of 43%. Catheterization showed left circumflex 80% occlusion, 100% after the first branch, right coronary artery had mild disease, left main had 80% distal disease. PAST MEDICAL HISTORY: Significant for benign aldosteronoma diagnosed in [**2146**], hypertension, hyperlipidemia, gastroesophageal reflux disease, asthma questionable. ALLERGIES: Sulfa drugs. MEDICATIONS AT HOME: Atenolol 25 mg by mouth once daily, gemfibrozil 600 mg twice a day, aspirin 325 mg once daily. SOCIAL HISTORY: Significant for two to three packs of smoking a week, and two cigars a week for 20 years. He denies alcohol abuse and intravenous drug use. He works as a patent lawyer, and lives with his wife. FAMILY HISTORY: Significant for a grandmother with diabetes. His father died of a stroke, and his mother died of some complication of vascular disease. REVIEW OF SYSTEMS: Revealed recent weight loss, but negative for dyspnea, orthopnea, nocturia, palpitations, urinary frequency or burning. LABORATORY DATA: CBC of 7.7 white count, 42.7 hematocrit. PT 12, PTT 28, INR 1.0. Chemistry of 143/4.7/107/24/45/2.4, glucose 95. CKs were negative for acute infarct. HOSPITAL COURSE: The patient was taken to the operating room by the Cardiothoracic Surgery service under Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] for coronary artery bypass graft, off-pump, x 2. Postoperatively, the patient was transferred to the Intensive Care Unit, where he was on pressor support. The patient was intubated and remained intubated in the Intensive Care Unit. On [**2149-1-24**], the patient was doing well. He had been extubated in the interim, and transferred to the floor after discontinuation of his chest tube. The patient, on [**2149-1-25**], was doing well. His wires were discontinued without event. The patient was doing well, and Physical Therapy was involved. Physical Therapy felt that the patient was safe for discharge. A chest x-ray was done for a minor desaturation on [**2149-1-26**], which showed no acute pathology. On [**2149-1-27**], the patient was comfortable, was a Level V, with oxygen saturation of 94% on room air. The patient expressed a strong desire to go home, and rehabilitation services cleared him for discharge home on [**2149-1-28**]. The patient is being discharged on the following medications: Aspirin 325 mg by mouth once daily, Lopressor 25 mg by mouth twice a day, lasix 20 mg by mouth for another five days once a day, potassium 20 mEq by mouth for another five days only, Colace 100 mg by mouth twice a day, Plavix 75 mg by mouth once daily for three months total, Imdur 30 mg a day, Protonix 40 mg by mouth once daily, gemfibrozil 600 mg by mouth four times a day. The patient had a bad reaction to percocet, and he will not be going home on narcotics. The patient, upon discharge, is in good condition, with no acute pathology. His physical examination shows that his sternal wound is in good condition, with no discharge and no erythema. His leg wound is well approximated and healing. His pain is well controlled. He is to follow up with Dr. [**Last Name (STitle) 1537**]. He is to follow up with his primary care physician, [**Last Name (NamePattern4) **]. [**First Name11 (Name Pattern1) 1312**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 1313**]. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**Name8 (MD) 16758**] MEDQUIST36 D: [**2149-1-27**] 21:51 T: [**2149-1-28**] 00:05 JOB#: [**Job Number 98058**]

414,411,272,794,780,401,593,305

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hyperglyceridemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Syncope and collapse,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Tobacco use disorder'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 59-year-old male with a history of smoking, hypertension, hyperlipidemia, presenting with acute onset of substernal chest pain with exertion. The patient had baseline intermittent chest pain with exertion. His chest began eight years ago, and is induced by exercise and exposure to cold. One week ago, the patient began to take atenolol, which alleviated his pain. Cardiac risk factors include history of hypertension, hyperlipidemia, and heavy smoking history. No history of prior myocardial infarction. The patient was in his usual state of health until the day before admission, when he began exercising. He began to feel pain after three minutes. He characterized it as burning and substernal, which radiated to his shoulders bilaterally. The pain lasted less than ten minutes, but he went to [**Hospital1 69**]. Evaluation shows lateral wall motion defects and anteroapical reversible defects with an ejection fraction of 43%. Catheterization showed left circumflex 80% occlusion, 100% after the first branch, right coronary artery had mild disease, left main had 80% distal disease. MEDICAL HISTORY: Significant for benign aldosteronoma diagnosed in [**2146**], hypertension, hyperlipidemia, gastroesophageal reflux disease, asthma questionable. MEDICATION ON ADMISSION: ALLERGIES: Sulfa drugs. PHYSICAL EXAM: FAMILY HISTORY: Significant for a grandmother with diabetes. His father died of a stroke, and his mother died of some complication of vascular disease. SOCIAL HISTORY: Significant for two to three packs of smoking a week, and two cigars a week for 20 years. He denies alcohol abuse and intravenous drug use. He works as a patent lawyer, and lives with his wife. ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hyperglyceridemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Syncope and collapse,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Tobacco use disorder'}

CHIEF COMPLAINT: Intraabdominal bleed following appendectomy with polymicrobial superinfection, upper GI bleed documented by endoscopy PRESENT ILLNESS: Mr. [**Known lastname 1255**] is a 75 year-old male s/p open appendectomy 10 days ago at OSH complicated by infected intra-abdominal hematoma requiring blood transfusions as well as IR drainage of hematoma 2 days ago. He experienced an episode of coffee ground emesis with Hct drop from 31 to 28. No bright red blood per rectum. Pt was subsequently transferred to [**Hospital1 18**] for further management. He reported no fevers, chills, fatigue, or weight loss. No vision changes or focal weakness. No cough. No chest pain or shortness of breath. Abdominal pain improved since IR drainage. No dysuria. No rash or easy bruising. No myalgias. MEDICAL HISTORY: PMH: - Glaucoma - Hyperlipidemia - Erectile dysfunction - BPH MEDICATION ON ADMISSION: Zocor Flomax Eye drops ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon Discharge: Vitals - 98.1 98.0 87 120/58 18 100%RA Gen - AAOx3 NAD CV - RRR, +S1/S2, no murmurs/rubs/gallops Resp - CTAB Abd - soft, non-tender, non-distended, no palpable masses, +BS, no rebound/rigidity/guarding, drainage cathter in place with no erythema/drainage/induration, dressing clean/dry/intact and bag securely attached to patient. Ext - 1+edema of extremities b/l, no cyanosis, no clubbing FAMILY HISTORY: No history of PUD, IBD, GI malignancies. Otherwise noncontributory. SOCIAL HISTORY: Math professor [**First Name (Titles) **] [**Last Name (Titles) **]. Married, denies tobacco, illicts, ETOH.

Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Peritoneal abscess,Other postoperative infection,Acute posthemorrhagic anemia,Other and unspecified Escherichia coli [E. coli],Esophagitis, unspecified,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Pure hypercholesterolemia,Glaucoma stage, unspecified,Impotence of organic origin,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other acquired absence of organ,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Chr duoden ulcer w hem,Peritoneal abscess,Other postop infection,Ac posthemorrhag anemia,E.coli infection NEC/NOS,Esophagitis, unspecified,Stomach ulcer NOS,Pure hypercholesterolem,Glaucoma stage NOS,Impotence, organic orign,BPH w/o urinary obs/LUTS,Acq absence of organ NEC,Abn react-surg proc NEC

Admission Date: [**2111-9-24**] Discharge Date: [**2111-10-2**] Date of Birth: [**2036-4-8**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1481**] Chief Complaint: Intraabdominal bleed following appendectomy with polymicrobial superinfection, upper GI bleed documented by endoscopy Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname 1255**] is a 75 year-old male s/p open appendectomy 10 days ago at OSH complicated by infected intra-abdominal hematoma requiring blood transfusions as well as IR drainage of hematoma 2 days ago. He experienced an episode of coffee ground emesis with Hct drop from 31 to 28. No bright red blood per rectum. Pt was subsequently transferred to [**Hospital1 18**] for further management. He reported no fevers, chills, fatigue, or weight loss. No vision changes or focal weakness. No cough. No chest pain or shortness of breath. Abdominal pain improved since IR drainage. No dysuria. No rash or easy bruising. No myalgias. Past Medical History: PMH: - Glaucoma - Hyperlipidemia - Erectile dysfunction - BPH PSH: - Open appendectomy ([**2111-9-15**]) Social History: Math professor [**First Name (Titles) **] [**Last Name (Titles) **]. Married, denies tobacco, illicts, ETOH. Family History: No history of PUD, IBD, GI malignancies. Otherwise noncontributory. Physical Exam: Upon Discharge: Vitals - 98.1 98.0 87 120/58 18 100%RA Gen - AAOx3 NAD CV - RRR, +S1/S2, no murmurs/rubs/gallops Resp - CTAB Abd - soft, non-tender, non-distended, no palpable masses, +BS, no rebound/rigidity/guarding, drainage cathter in place with no erythema/drainage/induration, dressing clean/dry/intact and bag securely attached to patient. Ext - 1+edema of extremities b/l, no cyanosis, no clubbing Pertinent Results: EGD ([**9-26**]): - A single 20 mm ulcer was found in the first part of the duodenum with overlying clot and eschar. No visible vessel was seen. There was limited visibility past the first part of the duodenum secondary to old blood. - Esophagitis - Blood in the stomach - Ulcer in the first part of the duodenum - Duodenitis - Otherwise normal EGD to first part of the duodenum EGD ([**9-27**]): - Distal linear erosion of the esophagus was noted. Appearance was consistent with NG tube trauma - Three flat, small, circumferential ulcers were noted in the pre-pyloric region of the stomach. These had pigmented spots, but no evidence of visible vessel or overlying clot. These ulcers were not thought to be the source of the patient's bleed. - Fresh blood was noted in the duodenum. Remainder of duodenal sweep appeared normal - Single moderate sized clean based ulcer with pigmented spots was noted in the duodenal bulb. There was no visible vessel or overyling clot. This was copiously irrigated, and was not thought to be the primary source of the bleed. A large circumferential ulcer with evidence of active oozing was noted in D1. There was evidence of active bleeding from this site. The area was copiously irrigated. 8 cc of Epinephrine 1/[**Numeric Identifier 961**] was injected. hemostasis was achieved. Five endoclips were also successfully applied for the purpose of hemostasis. - Otherwise normal EGD to third part of the duodenum CT ABDOMEN/PELVIS WITH IV CONTRAST ([**2111-9-30**]): 1. There is a one large dominant lobulated fluid collection within the abdomen which contains an enhancing rim. This is amenable to percutaneous drainage. It contains also an internal calcification likely an appendicolith, which may serve as a nidus for infection. 2. There are at least four other smaller fluid collections that are not drainable. One of these appears to be a small hematoma anteriorly within the left lower quadrant. 3. Multiple endoclips are seen within the bowel, three in the duodenum and three within the colon which are likely passing. 4. The transgluteal drain sits within the pelvis and does not demonstrate any significant amount of surrounding fluid. DISCHARGE LABS: [**2111-10-2**] 04:49AM BLOOD WBC-9.5 RBC-2.73* Hgb-8.6* Hct-25.9* MCV-95 MCH-31.5 MCHC-33.3 RDW-18.8* Plt Ct-270 [**2111-10-2**] 04:49AM BLOOD Plt Ct-270 [**2111-10-2**] 04:49AM BLOOD Glucose-106* UreaN-18 Creat-1.1 Na-141 K-4.1 Cl-109* HCO3-30 AnGap-6* [**2111-9-25**] 01:00AM BLOOD ALT-22 AST-33 AlkPhos-81 TotBili-0.5 [**2111-10-2**] 04:49AM BLOOD Calcium-7.1* Phos-3.0 Mg-2.2 Brief Hospital Course: The patient was transfered to the General Surgical Service at [**Hospital1 18**] for evaluation and treatment of intra-abdominal hematoma in the context of open appendectomy with polymicrobial superinfection at an outside hospital, and upper GI bleed He was admitted to the ICU on the night of [**2111-9-24**]. He was kept NPO, on IV fluids, with a foley catheter, NGT, and pigtail catheter drain (placed at outside hospital) in place. The patient was hemodynamically stable. He was transfused 2 units of PRBCs upon arrival. Stool guaiac tests, as well as full labs, blood and urine cultures, and chest x-ray were obtained. He was placed on a pantoprazole infusion, as well as antibiotics (ciprofloxacin and flagyl). On HD#1 ([**9-25**]) he was transfused another 1 unit of PRBCs. He remained NPO, on IV fluids, with a foley catheter and NGT, on antibiotics, with PPI infusion running and sucralfate QID added to his regimen. His hematocrit was checked serially. Later this day, he was transfused another 2 units of PRBCs. On this day, he underwent an EGD (reader referred to 'Pertinent Results' section). On HD#2 ([**9-26**]), he continued to be NPO, on IV fluids, with foley catheter and pigtail drain and NGT in place, on antibiotics, on PPI infusion and sucralfate QID. On this day he was transfused 2 units of PRBCs, and underwent another EGD (reader once again referred to 'Pertinent Results' section for details). In the evening of this day, he required transfusion of 1 more unit of PRBCs. On HD#3 ([**9-27**]), the NGT was removed. He progressed well, and reported feeling stronger. On HD#4 ([**9-28**]), his staples were removed. He was permitted to take sips, and tolerated this well. His foley cathter and pigtal drain were maintained. He remained on PPI infusion and sucralfate QID. On HD#5 ([**9-29**]), he was transferred out of the ICU and onto the general surgical flor. He was transitioned to Q12 PPI. Sucralfate QID was continued, as were antibiotics. Hematocrit continued to be monitored closely. He was given clear liquids, which he tolerated very well. He ambulated multiple times during the day. On HD#6 ([**9-30**]), due to slight increase in his WBC count, Mr. [**Known lastname 1255**] underwent a CT scan to reassess his abdomen. The results of this may be found in the 'Pertinent Results' section. Based on the findings, it was determined to proceed with Interventional Radiology drainage the following morning. Consequently, the patient was made NPO at midnight. Throughout this day, he continued to feel well, ambulating frequently, and tolerating regular diet well prior to being made NPO at midnight. On HD#7 ([**10-1**]), the patient underwent IR drainage during which 100cc of red cloudy fluid was aspirated. Cultures were sent. His prior drain was removed. Antibiotics were continued. He was permitted to restart a regular diet after this procedure. He continued to ambulate regularly. On HD#8 ([**10-2**]), he continued to feel well. The drain was maintained. Antibiotics were continued. He ate a regular diet, ambulated regularly, and expressed no pain or other complaints. The patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. Good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. Electrolytes were routinely followed, and repleted when necessary. The patient's white blood count and fever curves were closely watched for signs of infection. Wound care was performed regularly and thoroughly. The patient's blood sugar was monitored throughout his stay; insulin dosing was adjusted accordingly. The patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Medications on Admission: Zocor Flomax Eye drops Discharge Medications: 1. Atorvastatin 20 mg PO HS 2. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q 8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 4. Ciprofloxacin HCl 500 mg PO/NG Q12H RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 6. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day Disp #*30 Capsule Refills:*0 7. Acetaminophen 650 mg PO Q6H:PRN fever/pain 8. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 9. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE [**Hospital1 **] 10. Sucralfate 1 gm PO QID RX *sucralfate 1 gram 1 tablet(s) by mouth four times a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Intraabdominal bleed following appendectomy with polymicrobial superinfection, upper GI bleed documented by endoscopy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the surgery service at [**Hospital1 18**] for evaluation and treatment of your intra-abdominal hematoma in the context of open appendectomy with polymicrobial superinfection at an outside hospital, and upper GI bleed. You have done well in the hospital and are now safe to return home to complete your recovery with the following instructions: Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than [**6-18**] lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *Note color, consistency, and amount of fluid in the drain. Call the doctor, nurse practitioner, or VNA nurse if the amount increases significantly or changes in character. *Be sure to empty the drain frequently. Record the output, if instructed to do so. *You may shower; wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation. Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within 8-12 hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Followup Instructions: Provider: [**Last Name (NamePattern4) **]. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Phone: [**Telephone/Fax (1) 2981**] Date/Time: [**2111-10-8**] 11:30AM Location: [**Hospital Unit Name 58920**] [**Location (un) 86**], [**Numeric Identifier 718**] Completed by:[**2111-10-2**]

532,567,998,285,041,530,531,272,365,607,600,V457,E878

{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Peritoneal abscess,Other postoperative infection,Acute posthemorrhagic anemia,Other and unspecified Escherichia coli [E. coli],Esophagitis, unspecified,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Pure hypercholesterolemia,Glaucoma stage, unspecified,Impotence of organic origin,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other acquired absence of organ,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Intraabdominal bleed following appendectomy with polymicrobial superinfection, upper GI bleed documented by endoscopy PRESENT ILLNESS: Mr. [**Known lastname 1255**] is a 75 year-old male s/p open appendectomy 10 days ago at OSH complicated by infected intra-abdominal hematoma requiring blood transfusions as well as IR drainage of hematoma 2 days ago. He experienced an episode of coffee ground emesis with Hct drop from 31 to 28. No bright red blood per rectum. Pt was subsequently transferred to [**Hospital1 18**] for further management. He reported no fevers, chills, fatigue, or weight loss. No vision changes or focal weakness. No cough. No chest pain or shortness of breath. Abdominal pain improved since IR drainage. No dysuria. No rash or easy bruising. No myalgias. MEDICAL HISTORY: PMH: - Glaucoma - Hyperlipidemia - Erectile dysfunction - BPH MEDICATION ON ADMISSION: Zocor Flomax Eye drops ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon Discharge: Vitals - 98.1 98.0 87 120/58 18 100%RA Gen - AAOx3 NAD CV - RRR, +S1/S2, no murmurs/rubs/gallops Resp - CTAB Abd - soft, non-tender, non-distended, no palpable masses, +BS, no rebound/rigidity/guarding, drainage cathter in place with no erythema/drainage/induration, dressing clean/dry/intact and bag securely attached to patient. Ext - 1+edema of extremities b/l, no cyanosis, no clubbing FAMILY HISTORY: No history of PUD, IBD, GI malignancies. Otherwise noncontributory. SOCIAL HISTORY: Math professor [**First Name (Titles) **] [**Last Name (Titles) **]. Married, denies tobacco, illicts, ETOH. ### Response: {'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Peritoneal abscess,Other postoperative infection,Acute posthemorrhagic anemia,Other and unspecified Escherichia coli [E. coli],Esophagitis, unspecified,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Pure hypercholesterolemia,Glaucoma stage, unspecified,Impotence of organic origin,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other acquired absence of organ,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: Scapular pain PRESENT ILLNESS: 65 y/o male s/p CABG in [**2179**] now experiencing mild scapular back pain. Cardiac cath revealed severe native coronary artery disease with patent grafts. Echo performed showed severe aortic stenosis with a valve are of 0.7cm2. He was then referred for surgical intervention. MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2179**], s/p PTCA of RCA [**2178**], Hypertension, Hypercholesterolemia, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Anemia, s/p Anal fistulotomy MEDICATION ON ADMISSION: Aspirin 325mg qd, Benicar 40mg qd, Avandamet 500mg qd, Ninpeolomine 3mg qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 70 14 140/80 5'9" 220# Skin: Unremarkable with well-healed MSI HEENT: EOMI, PERRL, NC/AT Neck: Supple, FROM, -JVD, -carotid bruit Chest: CTAB -w/r/r Heart: RRR, 4/6 SEM Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, 2+ pulses throughout, -edema or varicosities Neuro: A&O x 3, MAE, non-focal FAMILY HISTORY: Father died at age 77 from an MI. Mother was diabetic and had an MI in her 70's. SOCIAL HISTORY: Patient smoked one ppd x 53 years, quit in [**2189-5-23**] Divorced and lives alone. He has four children. Retired, used to work as a cop.

Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Cellulitis and abscess of hand, except fingers and thumb,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension

Aortic valve disorder,Surg compl-heart,Atrial fibrillation,Chr airway obstruct NEC,Crnry athrscl natve vssl,Cellulitis of hand,DMII wo cmp nt st uncntr,Anemia NOS,Hypertension NOS

Admission Date: [**2189-12-24**] Discharge Date: [**2189-12-30**] Date of Birth: [**2124-7-15**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Scapular pain Major Surgical or Invasive Procedure: [**2189-12-24**] Redo-Sternotomy, Coronary Artery Bypass Graft x 3 (SVG to Diag to OM, SVG to PDA), Aortic Valve Replacement w/ 25mm CE Magna pericardial tissue valve History of Present Illness: 65 y/o male s/p CABG in [**2179**] now experiencing mild scapular back pain. Cardiac cath revealed severe native coronary artery disease with patent grafts. Echo performed showed severe aortic stenosis with a valve are of 0.7cm2. He was then referred for surgical intervention. Past Medical History: Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2179**], s/p PTCA of RCA [**2178**], Hypertension, Hypercholesterolemia, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Anemia, s/p Anal fistulotomy Social History: Patient smoked one ppd x 53 years, quit in [**2189-5-23**] Divorced and lives alone. He has four children. Retired, used to work as a cop. Family History: Father died at age 77 from an MI. Mother was diabetic and had an MI in her 70's. Physical Exam: VS: 70 14 140/80 5'9" 220# Skin: Unremarkable with well-healed MSI HEENT: EOMI, PERRL, NC/AT Neck: Supple, FROM, -JVD, -carotid bruit Chest: CTAB -w/r/r Heart: RRR, 4/6 SEM Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, 2+ pulses throughout, -edema or varicosities Neuro: A&O x 3, MAE, non-focal Pertinent Results: [**2189-12-24**] Echo: PRE-CPB: The left atrium is mildly dilated. There is severe symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Transmitral Doppler and tissue velocity imaging are consistent with normal LV diastolic function. Right ventricular chamber size and free wall motion are normal. Right ventricular chamber size is normal. Right ventricular systolic function is normal. There are simple atheroma in the aortic root. There are simple atheroma in the ascending aorta. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are severely thickened/deformed. No masses or vegetations are seen on the aortic valve. There is moderate aortic valve stenosis (area 0.8-1.19cm2) Moderate (2+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. No mass or vegetation is seen on the mitral valve. There is a minimally increased gradient consistent with trivial mitral stenosis. Mild (1+) mitral regurgitation is seen. POST-CPB: On phenylephrine infusion. There is a well-seated bioprosthetic valve in the aortic position with no AI seen. Flow is seen in the LMCA. The measured gradient across the aortic valve is now 6 mmHg. There is preserved biventricular systolic function. LVEF 65%. There is no [**Male First Name (un) **]. MR is trace. The aortic contour is normal post decannulation. [**2189-12-29**] CXR: Bilateral pleural effusions have significantly decreased in size since prior exam. Small bilateral pleural effusions remain. The cardiac silhouette, mediastinal and hilar contours are stable in size status post CABG and AVR. The pulmonary vasculature is normal and there is no pneumothorax. No consolidations are seen bilaterally. [**2189-12-24**] 01:33PM BLOOD WBC-13.8*# RBC-3.33*# Hgb-7.3*# Hct-22.3*# MCV-67* MCH-21.9* MCHC-32.8 RDW-15.0 Plt Ct-65*# [**2189-12-26**] 05:10PM BLOOD WBC-8.2 RBC-2.90* Hgb-6.5* Hct-19.3* MCV-67* MCH-22.3* MCHC-33.6 RDW-15.5 Plt Ct-110* [**2189-12-30**] 05:50AM BLOOD WBC-7.4 RBC-3.51* Hgb-8.5* Hct-24.9* MCV-71* MCH-24.3* MCHC-34.3 RDW-18.7* Plt Ct-273# [**2189-12-24**] 01:33PM BLOOD PT-19.5* PTT-50.7* INR(PT)-1.9* [**2189-12-28**] 06:25AM BLOOD PT-16.0* INR(PT)-1.5* [**2189-12-29**] 06:10AM BLOOD PT-35.0* INR(PT)-3.8* [**2189-12-29**] 10:55AM BLOOD PT-43.4* INR(PT)-5.0* [**2189-12-30**] 05:50AM BLOOD PT-32.3* INR(PT)-3.5* [**2189-12-24**] 03:18PM BLOOD Glucose-93 UreaN-11 Creat-0.6 Cl-115* HCO3-28 [**2189-12-30**] 05:50AM BLOOD Glucose-113* UreaN-18 Creat-0.9 Na-139 K-4.1 Cl-100 HCO3-33* AnGap-10 Brief Hospital Course: Mr. [**Known lastname 80687**] was a same day admit (underwent pre-op work-up as on outpatient) and was brought directly to the operating room where he underwent a redo coronary artery bypass graft x 3 and aortic valve replacement. Please see operative report for surgical details. Following surgery he was transferred to the CSRU for invasive monitoring in stable condition. Later on op day he was weaned from sedation, awoke neurologically intact and extubated. Beta blockers and diuretics were initiated and he was gently diuresed towards his pre-op weight. He was then transferred to the telemetry floor. On post-op day three his chest tubes and epicardial pacing wires were removed. Post-op his HCT was low and on day three it was 19. He was therefore transfused with several units of blood. By discharge it was 24.9. Also on post-op day three he had an episode of atrial fibrillation. He was bolused with Amiodarone and given Lopressor. Lopressor was titrated, Amiodarone was eventually given PO and he was started on Heparin. Coumadin was started on post-op day four and titrated for goal INR between [**12-26**]. INR abruptly rose up to 5 by post-op day five and Coumadin was held and INR trended down towards therapeutic level by discharge. On post-op day five antibiotics were started d/t left arm phlebitis. Physical therapy followed patient during entire post-op course for strength and mobility. He appeared to be doing well on post-op day six and was discharged home with VNA services and the appropriate follow-up appointments. Dr. [**Last Name (STitle) **] was contact and will manage his Coumadin as an outpatient. Medications on Admission: Aspirin 325mg qd, Benicar 40mg qd, Avandamet 500mg qd, Ninpeolomine 3mg qd Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*1* 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 4. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*1* 5. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). Disp:*135 Tablet(s)* Refills:*1* 6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*1* 8. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*1* 9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*1* 10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): Take 400mg [**Hospital1 **] for 1 week. Then 200mg [**Hospital1 **] for 1 week. Then 200mg QD until stopped by your cardiologist. Disp:*60 Tablet(s)* Refills:*1* 11. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours) for 10 days. Disp:*30 Capsule(s)* Refills:*0* 12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10 days. Disp:*20 Tablet(s)* Refills:*0* 13. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10 days. Disp:*40 Capsule, Sustained Release(s)* Refills:*0* 14. Nifedipine (Bulk) Powder Sig: One (1) Miscellaneous TID (3 times a day) as needed for anal fissures: 0.2% gel rectally for anal fissures. Disp:*30 1* Refills:*0* 15. Psyllium Packet Sig: One (1) Packet PO TID (3 times a day). Disp:*90 Packet(s)* Refills:*0* 16. Warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day: Adust dosage according to Dr. [**Last Name (STitle) **]. Goal INR 2-3.0. Disp:*60 Tablet(s)* Refills:*1* Discharge Disposition: Home With Service Facility: Caregroup VNA Discharge Diagnosis: Coronary Artery Disease/Aortic Stenosis s/p Redo-Sternotomy, Coronary Artery Bypass Graft x 3, Aortic Valve Replacement PMH: s/p Coronary Artery Bypass Graft [**2179**], s/p PTCA of RCA [**2178**], Hypertension, Hypercholesterolemia, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Anemia, s/p Anal fistulotomy Discharge Condition: Good Discharge Instructions: Patient may shower, no baths. No creams, lotions or ointments to incisions. No driving for at least one month. No lifting more than 10 lbs for at least 10 weeks from the date of surgery. Monitor wounds for signs of infection. Please call with any concerns or questions. Dr. [**Last Name (STitle) **] will manage your Coumadin. Followup Instructions: Dr. [**Last Name (STitle) 914**] in 4 weeks Dr. [**Last Name (STitle) **] in 2 weeksProvider: [**Name6 (MD) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2190-1-29**] 12:00 Completed by:[**2189-12-30**]

424,997,427,496,414,682,250,285,401

{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Cellulitis and abscess of hand, except fingers and thumb,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Scapular pain PRESENT ILLNESS: 65 y/o male s/p CABG in [**2179**] now experiencing mild scapular back pain. Cardiac cath revealed severe native coronary artery disease with patent grafts. Echo performed showed severe aortic stenosis with a valve are of 0.7cm2. He was then referred for surgical intervention. MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2179**], s/p PTCA of RCA [**2178**], Hypertension, Hypercholesterolemia, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Anemia, s/p Anal fistulotomy MEDICATION ON ADMISSION: Aspirin 325mg qd, Benicar 40mg qd, Avandamet 500mg qd, Ninpeolomine 3mg qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 70 14 140/80 5'9" 220# Skin: Unremarkable with well-healed MSI HEENT: EOMI, PERRL, NC/AT Neck: Supple, FROM, -JVD, -carotid bruit Chest: CTAB -w/r/r Heart: RRR, 4/6 SEM Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, 2+ pulses throughout, -edema or varicosities Neuro: A&O x 3, MAE, non-focal FAMILY HISTORY: Father died at age 77 from an MI. Mother was diabetic and had an MI in her 70's. SOCIAL HISTORY: Patient smoked one ppd x 53 years, quit in [**2189-5-23**] Divorced and lives alone. He has four children. Retired, used to work as a cop. ### Response: {'Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Cellulitis and abscess of hand, except fingers and thumb,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 54 year old white female with a history of hypertension, hypercholesterolemia, and smoking history, who was transferred to [**Hospital1 69**] with acute anterior myocardial infarction, status post failed thrombolysis at outside hospital. MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Osteoporosis. 4. History of atypical colitis, steroid dependent since [**9-4**]. History of diagnosis of collagenous colitis in the past. 6. Status post tubal ligation. MEDICATION ON ADMISSION: 1. Zestril 2.5 mg p.o. once daily. 2. Prednisone 20 mg p.o. once daily. 3. Asacol 1600 mg p.o. three times a day. 4. Rowasa enemas PR once daily. 5. Fosamax 10 mg p.o. once daily. 6. Prempro p.o. once daily. 7. Serax p.r.n. 8. Zomig p.r.n. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: No history of early coronary artery disease or myocardial infarction. SOCIAL HISTORY: The patient lives in [**Location 38080**] with husband. She has two children. She has smoked one pack per day since college. She has one to two cocktails per night. Recently laid off.

Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Heart disease, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Other and unspecified noninfectious gastroenteritis and colitis,Tobacco use disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure

AMI anterior wall, init,Crnry athrscl natve vssl,Hematoma complic proc,Heart disease NOS,Hypertension NOS,Pure hypercholesterolem,Noninf gastroenterit NEC,Tobacco use disorder,Abn react-cardiac cath

Name: [**Known lastname **], [**Known firstname 1966**] Unit No: [**Numeric Identifier 6877**] Admission Date: [**2179-2-8**] Discharge Date: [**2179-2-12**] Date of Birth: [**2125-1-21**] Sex: F Service: DISCHARGE SUMMARY ADDENDUM: The patient also to be discharged on Lipitor 10 milligrams po once a day. LFTs drawn during this hospitalization were within normal limits; ALT 34, AST 37, alkaline phosphatase 52, total bilirubin 0.4. [**First Name8 (NamePattern2) 1500**] [**Last Name (NamePattern1) 2197**], M.D. [**MD Number(1) 3925**] Dictated By:[**Name8 (MD) 5455**] MEDQUIST36 D: [**2179-2-12**] 13:03 T: [**2179-2-12**] 13:51 JOB#: [**Job Number 6878**] Admission Date: [**2179-2-8**] Discharge Date: [**2179-2-12**] Date of Birth: [**2125-1-21**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: The patient is a 54 year old white female with a history of hypertension, hypercholesterolemia, and smoking history, who was transferred to [**Hospital1 69**] with acute anterior myocardial infarction, status post failed thrombolysis at outside hospital. The patient reports onset of symptoms on the morning of admission of acute midback pain with eventual radiation to the chest, seven out of ten, with radiation to her left upper extremity with associated shortness of breath, nausea and diaphoresis. She called EMS within five minutes and was brought to [**Hospital3 6454**] Emergency Department where she was found to have anterior ST elevations in V1 through V4. She was given Morphine 2 mg intravenously times two, sublingual Nitroglycerin and Nitroglycerin drip, Heparin and Reteplase times two. Per records, she arrived at the [**Hospital3 1280**] Emergency Department at 10:40 a.m. Symptom onset was approximated to be at 10:00 a.m. She received her first dose of Reteplase at 10:53 a.m. and her second dose at 11:23 a.m. Her symptoms did not improved and her ST elevation persisted and she was transferred to [**Hospital1 69**] for emergent catheterization. She arrived at the catheterization laboratory at 1:30 p.m. At cardiac catheterization, she was found to have a tortuous coronary circulation with a totally occluded distal left anterior descending which was stented with timi two flow post and complicated by grade B dissection distally. She was given intracoronary vasodilators and no further intervention was pursued. Her left circumflex, right coronary artery and left main coronary artery were without significant disease. A left ventriculogram was performed and notable for anteroapical and inferoapical akinesis with an ejection fraction of 40%. Right heart cardiac catheterization revealed pulmonary capillary wedge pressure of 18 and right atrial pressure of 13. Postprocedure, she was given full dose Integrilin for 18 hours. Upon arrival to the CCU, she had the chief complaint of nausea but denied shortness of breath or chest pain. PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Osteoporosis. 4. History of atypical colitis, steroid dependent since [**9-4**]. History of diagnosis of collagenous colitis in the past. 6. Status post tubal ligation. MEDICATIONS ON ADMISSION: 1. Zestril 2.5 mg p.o. once daily. 2. Prednisone 20 mg p.o. once daily. 3. Asacol 1600 mg p.o. three times a day. 4. Rowasa enemas PR once daily. 5. Fosamax 10 mg p.o. once daily. 6. Prempro p.o. once daily. 7. Serax p.r.n. 8. Zomig p.r.n. ALLERGIES: No known drug allergies. FAMILY HISTORY: No history of early coronary artery disease or myocardial infarction. SOCIAL HISTORY: The patient lives in [**Location 38080**] with husband. She has two children. She has smoked one pack per day since college. She has one to two cocktails per night. Recently laid off. PHYSICAL EXAMINATION: On examination, temperature is afebrile, blood pressure 135/74, heart rate 90, respiratory rate 16, oxygen saturation 98% on two liters. In general, the patient is somnolent in no apparent distress. Head, eyes, ears, nose and throat - The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Mucous membranes are mildly dry. The neck is soft, supple, no lymphadenopathy, jugular venous distention, thyromegaly or masses. Cardiac examination - regular rate and rhythm, no murmurs, S4 gallop. The lungs are clear to auscultation bilaterally. The abdomen is soft, nondistended, nontender, no organomegaly or masses, normoactive bowel sounds. Extremities - right groin with small hematoma. Extremities without edema, warm and with good distal pulses. Neurologically, the patient is alert and oriented times three, grossly nonfocal. LABORATORY DATA: White count 15.8, hematocrit 36.5, platelets 238,000. INR 1.1. Sodium 137, potassium 4.7, blood urea nitrogen 7, creatinine 0.6, glucose 150. CK peak 1148, CK MB peak 150. Initial electrocardiogram normal sinus rhythm, normal axis, intervals, 2.[**Street Address(2) 2811**] elevations in V2 through V4 with peaked T waves, 1.[**Street Address(2) 2811**] elevations in I and II, 0.[**Street Address(2) 38081**] elevations in V5 and V6. HOSPITAL COURSE: 1. Coronary artery disease - Status post acute anterior myocardial infarction, total occlusion of the distal left anterior descending, status post left anterior descending stent, complicated by distal dissection and with timi two flow post intervention. The patient was hemodynamically stable throughout her hospitalization. Her CK peaked at 1148 and then trended down. She was treated with Integrilin for 18 hours postcatheterization and then received Aspirin, Plavix, beta blocker and ace inhibitor. She was also started on Lipitor for a lipid panel with total cholesterol of 249, and LDL of 143. She will be discharged on Aspirin, Plavix to finish one month course, Atenolol, Zestril and Lipitor. 2. Pump - Left ventriculogram during cardiac catheterization was notable for apical akinesis and ejection fraction of 40%. She had no signs or symptoms of congestive heart failure during her hospitalization. She was started on beta blocker and ace inhibitor as above. Given her apical akinesis, she was started on anticoagulation initially with Heparin drip and then with low molecular weight Heparin as well as Coumadin. She will be discharged on Lovenox and Coumadin, to have INR followed up as an outpatient. 3. Electrophysiology - The patient with no adverse events on telemetry during her hospitalization except for rare premature ventricular contractions. 4. Hematology - The patient with right groin hematoma, status post cardiac catheterization. She was also noted on the following evening to have a bruit over that area. An ultrasound revealed 1.7 by 2.0 centimeter pseudoaneurysm which was treated with thrombin injection with good result. Her anticoagulation was held temporarily during these events and then restarted without complications. At the time of discharge, the patient still has residual ecchymosis over her right lower extremity as well as a small but stable hematoma. 5. Gastrointestinal - The patient had no gastrointestinal symptoms during her hospitalization and was continued on her outpatient regimen of Asacol and Rowasa enemas. She received stress dose steroids pericatheterization and then was switched to a p.o. Prednisone taper starting at 60 mg to be tapered down to her baseline of 20 mg. 6. Endocrine - The patient has been on Prempro as an outpatient. This was held in the setting of her acute myocardial infarction but she will be able to restart this as an outpatient. MEDICATIONS ON DISCHARGE: 1. Enteric Coated Aspirin 325 mg p.o. once daily. 2. Plavix 75 mg p.o. once daily, to continue one month course. 3. Coumadin 5 mg p.o. once daily. 4. Lovenox 60 mg subcutaneous times three more doses. 5. Zestril 2.5 mg p.o. once daily. 6. Atenolol 25 mg p.o. once daily. 7. Prednisone taper down to 20 mg once daily. 8. Asacol 1600 mg p.o. three times a day. 9. Rowasa enema once a day. 10. Fosamax 10 mg p.o. once daily. 11. Prempro p.o. once daily. 12. Serax p.r.n. The patient has been ask to discontinue Zomig in the setting of coronary artery disease. DISCHARGE FOLLOW-UP: With primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) 9959**] [**Name (STitle) 9960**], telephone [**2179**]. [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 5219**] Dictated By:[**Name8 (MD) 4925**] MEDQUIST36 D: [**2179-2-12**] 13:01 T: [**2179-2-15**] 17:11 JOB#: [**Job Number **]

410,414,998,429,401,272,558,305,E879

{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Heart disease, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Other and unspecified noninfectious gastroenteritis and colitis,Tobacco use disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 54 year old white female with a history of hypertension, hypercholesterolemia, and smoking history, who was transferred to [**Hospital1 69**] with acute anterior myocardial infarction, status post failed thrombolysis at outside hospital. MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Osteoporosis. 4. History of atypical colitis, steroid dependent since [**9-4**]. History of diagnosis of collagenous colitis in the past. 6. Status post tubal ligation. MEDICATION ON ADMISSION: 1. Zestril 2.5 mg p.o. once daily. 2. Prednisone 20 mg p.o. once daily. 3. Asacol 1600 mg p.o. three times a day. 4. Rowasa enemas PR once daily. 5. Fosamax 10 mg p.o. once daily. 6. Prempro p.o. once daily. 7. Serax p.r.n. 8. Zomig p.r.n. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: No history of early coronary artery disease or myocardial infarction. SOCIAL HISTORY: The patient lives in [**Location 38080**] with husband. She has two children. She has smoked one pack per day since college. She has one to two cocktails per night. Recently laid off. ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Heart disease, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Other and unspecified noninfectious gastroenteritis and colitis,Tobacco use disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

CHIEF COMPLAINT: Motor vehicle crash PRESENT ILLNESS: The patient is a 56 yo M non-restrained driver involved in a motor vehicle crash and transported by air to [**Hospital1 18**]. There was a 20-40 minute extraction, and [**4-19**] feet of intrusion into passenger compartment noted. A person in the other vehicle was killed. The patient was noted to have a GCS 15 on scene. He was evaluated and stabilized in the trauma bay and underwent imaging. A chest tube was placed for a right PTX. MEDICAL HISTORY: Knee arthritis Diverticulitis MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.2 R 105 118/64 24 94%RA Odor of EtOH noted PERRL, EOMI trachea midline CTAB tachy, regular MAE x 4 distal pulses: L DP palp, R DP nonpalp, R PT dopplerable normal rectal tone, guaiac neg back w/o step-off or deformity FAMILY HISTORY: N/C SOCIAL HISTORY: EtOH

Injury to liver without mention of open wound into cavity, hematoma and contusion,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Alcohol abuse, unspecified,Injury to spleen without mention of open wound into cavity, unspecified injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax

Liver hematoma/contusion,Traum pneumothorax-close,Fracture of sternum-clos,Food/vomit pneumonitis,Pneumococcal pneumonia,Alcohol abuse-unspec,Spleen injury NOS-closed,Mv collision NOS-driver,Lung contusion-closed

Admission Date: [**2138-6-22**] Discharge Date: [**2138-6-29**] Date of Birth: [**2082-6-3**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5880**] Chief Complaint: Motor vehicle crash Major Surgical or Invasive Procedure: Chest tube thoracostomy History of Present Illness: The patient is a 56 yo M non-restrained driver involved in a motor vehicle crash and transported by air to [**Hospital1 18**]. There was a 20-40 minute extraction, and [**4-19**] feet of intrusion into passenger compartment noted. A person in the other vehicle was killed. The patient was noted to have a GCS 15 on scene. He was evaluated and stabilized in the trauma bay and underwent imaging. A chest tube was placed for a right PTX. Past Medical History: Knee arthritis Diverticulitis Social History: EtOH Family History: N/C Physical Exam: 97.2 R 105 118/64 24 94%RA Odor of EtOH noted PERRL, EOMI trachea midline CTAB tachy, regular MAE x 4 distal pulses: L DP palp, R DP nonpalp, R PT dopplerable normal rectal tone, guaiac neg back w/o step-off or deformity Pertinent Results: [**2138-6-22**] 08:18PM HCT-36.9* [**2138-6-22**] 03:47PM HCT-33.6* [**2138-6-22**] 10:27AM HCT-36.2* [**2138-6-22**] 06:38AM GLUCOSE-363* UREA N-10 CREAT-0.8 SODIUM-138 POTASSIUM-4.5 CHLORIDE-102 TOTAL CO2-20* ANION GAP-21* [**2138-6-22**] 06:38AM CALCIUM-7.6* PHOSPHATE-3.4 MAGNESIUM-1.5* [**2138-6-22**] 06:38AM WBC-21.1* RBC-4.35* HGB-13.5* HCT-38.4* MCV-88 MCH-30.9 MCHC-35.0 RDW-13.1 [**2138-6-22**] 06:38AM PLT COUNT-162 [**2138-6-22**] 06:38AM PT-13.0 PTT-25.2 INR(PT)-1.1 [**2138-6-22**] 03:05AM TYPE-[**Last Name (un) **] PH-7.30* [**2138-6-22**] 03:05AM GLUCOSE-369* LACTATE-5.9* NA+-137 K+-3.6 CL--102 TCO2-18* [**2138-6-22**] 03:05AM HGB-14.2 calcHCT-43 O2 SAT-92 CARBOXYHB-8* MET HGB-0 [**2138-6-22**] 03:05AM freeCa-1.01* [**2138-6-22**] 02:50AM UREA N-11 CREAT-0.8 [**2138-6-22**] 02:50AM AMYLASE-33 [**2138-6-22**] 02:50AM ASA-NEG ETHANOL-250* ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2138-6-22**] 02:50AM URINE HOURS-RANDOM [**2138-6-22**] 02:50AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2138-6-22**] 02:50AM WBC-25.5* RBC-4.50* HGB-14.1 HCT-39.5* MCV-88 MCH-31.2 MCHC-35.6* RDW-13.0 [**2138-6-22**] 02:50AM PLT COUNT-207 [**2138-6-22**] 02:50AM PT-13.0 PTT-26.4 INR(PT)-1.1 [**2138-6-22**] 02:50AM FIBRINOGE-226 [**2138-6-22**] 02:50AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.021 [**2138-6-22**] 02:50AM URINE BLOOD-LGE NITRITE-NEG PROTEIN-500 GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2138-6-22**] 02:50AM URINE RBC->50 WBC-[**7-26**]* BACTERIA-MOD YEAST-NONE EPI-0-2 RENAL EPI-[**1-5**] [**2138-6-22**] 02:50AM URINE GRANULAR-[**7-26**]* . CT head: IMPRESSION: No evidence of acute intracranial hemorrhage or shift of normally midline structures. . CT C-spine: IMPRESSION: No evidence of acute fracture or spondylolisthesis. . CT torso: IMPRESSION: 1. Moderate-sized right pneumothorax. Likely lung contusions. Followup recommended. 2. Non-displaced right eighth, ninth and 10th rib fractures. 3. Hypodensity within the liver consistent with contusion. 4. Right adrenal hemorrahge versus mass. Follow-up imaging recommended for further evaluation. Discussed with Dr. [**First Name (STitle) 67020**] [**Name (STitle) 58703**] at 10am [**2138-6-22**]. 5. Possible small splenic laceration at the dome, with a tiny amount of fluid around the spleen. 6. No evidence of active extravasation. 7. 1.3-cm likely plaques seen in the aorta at approximately the level of the bifurcation. 8. Spondylosis and degenerative change is seen within the lower lumbar spine. . CTA chest: IMPRESSION: 1. No evidence of acute aortic injury. 2. Moderate-to-large right-sided pneumothorax, larger when compared to study performed half an hour earlier. 3. Multiple right rib fractures. 4. Likely lung contusions, follow-up recommended. 5. Increased lung opacities consistent with edema or aspiration. 6. Nondisplaced manubrium fracture. . Shoulder XR: : No evidence of acute fracture or dislocation within the right shoulder. Right rib fracture and right-sided chest tube seen. . Brief Hospital Course: The patient was admitted to the Trauma Service to the T-SICU. A chest tube was placed for the R PTX. The Acute Pain Service was consulted and an epidural catheter was placed for analgesia for the rib fractures. He was placed on a CIWA scale to monitor and treat any symptoms of withdrawal. His hematocrit remained stable. On HD 2 he spiked to 103.2 and CXR revealed pneumonia. He was started on Levaquin. A sputum culture grew out strep pneumoniae. The epidural catheter was removed and he was transitioned to PO pain meds. He was transferred to the floor, diet was advanced, and he worked with PT/OT. He continued to have an oxygen requirement with SaO2 88% on ambulation. He was afebrile x 72 hours. Prior to discharge he was ambulating without oxygen and maintaining an SaO2>91%. He will return to the Trauma Clinic for follow up. He will be maintained on RISS until he completes the course of Levaquin, at which time transition to oral agents would be appropriate (interaction between Levaquin and OHAs can cause profound hypoglycemia). Medications on Admission: None Discharge Medications: 1. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 2. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 3. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 6 days. 4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO three times a day: hold for sedation. 9. Insulin Regular Human Injection Discharge Disposition: Extended Care Facility: [**Location 54284**] Discharge Diagnosis: Motor vehicle crash Closed head injury Grade II splenic laceration Grade II intraparenchymal liver bleed Rib fractures Pneumothorax Pneumonia Glucose intolerance Discharge Condition: Good Discharge Instructions: 1. Take medications as prescribed. 2. Follow up with Trauma Clinic in 2 weeks, call for appointment: [**Telephone/Fax (1) **]. 3. Call your doctor or go to the ER for any of the following: uncontrollable pain, fever > 101.4, trouble breathing, abdominal pain, or other troubling concerns. 4. Use the incentive spirometer at least 3 times an hour while awake. Followup Instructions: As above.

864,860,807,507,481,305,865,E812,861

{'Injury to liver without mention of open wound into cavity, hematoma and contusion,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Alcohol abuse, unspecified,Injury to spleen without mention of open wound into cavity, unspecified injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Motor vehicle crash PRESENT ILLNESS: The patient is a 56 yo M non-restrained driver involved in a motor vehicle crash and transported by air to [**Hospital1 18**]. There was a 20-40 minute extraction, and [**4-19**] feet of intrusion into passenger compartment noted. A person in the other vehicle was killed. The patient was noted to have a GCS 15 on scene. He was evaluated and stabilized in the trauma bay and underwent imaging. A chest tube was placed for a right PTX. MEDICAL HISTORY: Knee arthritis Diverticulitis MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.2 R 105 118/64 24 94%RA Odor of EtOH noted PERRL, EOMI trachea midline CTAB tachy, regular MAE x 4 distal pulses: L DP palp, R DP nonpalp, R PT dopplerable normal rectal tone, guaiac neg back w/o step-off or deformity FAMILY HISTORY: N/C SOCIAL HISTORY: EtOH ### Response: {'Injury to liver without mention of open wound into cavity, hematoma and contusion,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Alcohol abuse, unspecified,Injury to spleen without mention of open wound into cavity, unspecified injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax'}

CHIEF COMPLAINT: rapidly progressive weakness PRESENT ILLNESS: Mr. [**Known lastname 58941**] is a 75 year old man with hx of BPH, HTN, depression and high cholesterol who presented yesterday evening to [**Hospital6 2561**] with "inability to speak". The history is very limited because the patient was unable to talk and no one accompanied him to the hospital to relay the history. From information gathered at [**Hospital3 **], the patient was feeling OK today until sometime this evening after eating dinner. Time course and exact contents of the meal are not known, but he apparently communicated (in writing) that the food was homemade and leftovers. He arrived at [**Hospital3 **] at 7:30-8:00PM. Vitals on arrival were: BP 154/86 HR77 RR21 98%on RA. While there, could only say one or two words at a time-other details of initial exam not documented in available paperwork. He had a head CT which was negative. Around 11:50PM, he vomited and was given Zofran. At 1:00AM, he wrote "please I need help, I think I'm dying". He was reassessed and seen by neurology at some point. He repeatedly wrote "I'm dying" on paper. He was noted to have "expressive aphasia" and bilateral ptosis. There was apparently concern for "cortical stroke" vs. toxin ingestion such as botulism. He was then transfered here for further evaluation and MRI. MEDICAL HISTORY: 1. HTN 2. Depression 3. BPH 4. High cholesterol MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: Thin, gaunt appearing male, in significant respiratory distress +accessory muscle use Neck: supple, no thyromegaly, no bruit CV: Tachy, regular 2/6SEM Lung: Clear to auscultation bilaterally aBd: decreased BS soft, nontender ext: no edema Neurologic examination: Mental status: Awake and alert, Oriented to person, place, and time. He was unable to speak,though occasionally grunted. Occasionally mouthed some words. Tried to communicate with gestures, very frustrated by inability to communicate. Comprehension appeared intact-could follow commands, cross midline. Unable to repeat or name. No evidence of apraxia or neglect. Respiratory distress prohibited further mental status testing. FAMILY HISTORY: No known family history of neurologic disease as per son. SOCIAL HISTORY: -lives in [**Hospital1 8**] by himself -Muslim -no tobacco or etoh use as per son

Botulism food poisoning,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia, organism unspecified,Cachexia,Gastroparesis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia

Botulism food poisoning,Acute respiratry failure,Food/vomit pneumonitis,Pneumonia, organism NOS,Cachexia,Gastroparesis,Constipation NOS,Hypertension NOS,Pure hypercholesterolem

Admission Date: [**2112-2-11**] Discharge Date: [**2112-3-2**] Date of Birth: [**2036-3-7**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5018**] Chief Complaint: rapidly progressive weakness Major Surgical or Invasive Procedure: Trach placement History of Present Illness: Mr. [**Known lastname 58941**] is a 75 year old man with hx of BPH, HTN, depression and high cholesterol who presented yesterday evening to [**Hospital6 2561**] with "inability to speak". The history is very limited because the patient was unable to talk and no one accompanied him to the hospital to relay the history. From information gathered at [**Hospital3 **], the patient was feeling OK today until sometime this evening after eating dinner. Time course and exact contents of the meal are not known, but he apparently communicated (in writing) that the food was homemade and leftovers. He arrived at [**Hospital3 **] at 7:30-8:00PM. Vitals on arrival were: BP 154/86 HR77 RR21 98%on RA. While there, could only say one or two words at a time-other details of initial exam not documented in available paperwork. He had a head CT which was negative. Around 11:50PM, he vomited and was given Zofran. At 1:00AM, he wrote "please I need help, I think I'm dying". He was reassessed and seen by neurology at some point. He repeatedly wrote "I'm dying" on paper. He was noted to have "expressive aphasia" and bilateral ptosis. There was apparently concern for "cortical stroke" vs. toxin ingestion such as botulism. He was then transfered here for further evaluation and MRI. Past Medical History: 1. HTN 2. Depression 3. BPH 4. High cholesterol Was hospitalized at [**Hospital3 **] in [**9-8**] for hyponatremia (?SIADH from SSRIs) and failure to thrive. At that time he was noted to have hx of weight loss in the past year of 20-25lbs Social History: -lives in [**Hospital1 8**] by himself -Muslim -no tobacco or etoh use as per son Family History: No known family history of neurologic disease as per son. Physical Exam: Gen: Thin, gaunt appearing male, in significant respiratory distress +accessory muscle use Neck: supple, no thyromegaly, no bruit CV: Tachy, regular 2/6SEM Lung: Clear to auscultation bilaterally aBd: decreased BS soft, nontender ext: no edema Neurologic examination: Mental status: Awake and alert, Oriented to person, place, and time. He was unable to speak,though occasionally grunted. Occasionally mouthed some words. Tried to communicate with gestures, very frustrated by inability to communicate. Comprehension appeared intact-could follow commands, cross midline. Unable to repeat or name. No evidence of apraxia or neglect. Respiratory distress prohibited further mental status testing. Cranial Nerves: Pupils equally round and reactive to light, 3 to 2mm bilaterally. +blink to threat from both directions. Eyes were midline and conjugate on neutral gaze. +vertical gaze palsy (unable to look up or down at all), bilateral abducens palsy. Bilateral ptosis. Facial diplegia. Hearing grossly intact. Palate elevation symmetrical. Gag absent. Unable to move tongue, no fasciculations observed. Motor: Normal bulk bilaterally. Tone slightly increased in lower extremities. Occasional fasciculations observed in left quad. No pronator drift. [**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IP H Q DF PF TE TF R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 L 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Sensation: Grossly intact to LT and pain Reflexes: B T Br Pa Ach Right 3 2 2 4 3 Left 3 2 2 4 3 **brisk throughout with 3-4 beats of clonus at the knees bilaterally Crossed adductors Toes were downgoing bilaterally Gait/Coordination: Unable to assess Pertinent Results: 138 101 18 / 116 AGap=10 3.9 31 0.8 \ CK: 68 Ca: 9.4 Mg: 1.8 P: 3.6 2.9 \ 13.9 / 199 / 44.1 \ N:85.8 Band:0 L:9.7 M:3.2 E:1.1 Bas:0.1 PT: 12.8 PTT: 23.0 INR: 1.0 ABG: 7.26/67/69 (prior to intubation) Chest CT [**2112-2-11**]: FINDINGS: The endotracheal and gastric tubes are in satisfactory position. There are no pathologically enlarged axillary, hilar, or mediastinal lymph nodes. There is a 5-mm rounded density, which is ill-defined, in the right upper lobe. There are multiple other smaller ill-defined densities adjacent to this. There are opacities in both lung apices, which could represent pleural thickening or scarring. There is patchy air space disease within the right lower lobe, with endobronchial spread. There is also airspace disease of the right middle and left lower lobes. There is calcification of the aortic arch and descending aorta. The heart, pericardium and great vessels otherwise are unrmarkable. The stomach is full of ingested material. Limited views of the upper abdomen show an unremarkable, liver, gallbladder, spleen, and upper pole of the kidneys. BONE WINDOWS: No suspicious osteolytic or sclerotic lesions. IMPRESSION: Airspace disease within the left lower lobe, right lower lobe, and right middle lobes, consistent with infection. Aspiration cannot be excluded. EMG [**2112-2-11**] Complex, abnormal study. The electrophysiologic findings are consistent with a neuromuscular transmission disorder, with evidence for pre- synaptic dysfunction and widespread fiber blocking, as seen in botulism. The differential diagnosis includes other pre-synaptic neuromuscular transmission disorders (e.g., [**Location (un) **] [**Location (un) **] myasthenic syndrome); however, the rapidly progressive clinical picture and pronounced ophthalmoplegia are atypical for this. Brief Hospital Course: The patient was admitted for management of his weakness. He was intubated in the ER for respiratory distress and transferred to the ICU. Subsequent blood testing revealed botulism toxin in his blood. Approximately 24 hours after admission the patient received the anti-toxin from the CDC flown in from [**Location (un) 9012**], [**State 3908**]. Over the course of this admission, the patient developed a pneumonia that was treated with a 7 day course of unasyn (although it is likely this pneumonia was more of a chemical pneumonitis as he was given activated charcoal prior to admission and may have aspirated). He also suffered from gastroparesis requiring frequent enemas, nutritional supplementation with TPN, and an aggressive bowel regimen. He was given several doses of neostigmine with the hopes of improving bowel motility but he did not pass any significant materail. He can continue TPN indefinitely until bowel has fully recovered per nutrition consult. PICC line placed on [**2112-2-20**] with tip in the distal SVC. His ocular weakness has improved in that he is able to move his eyes from side to side a bit, although still unable to open eyes (bilateral ptosis). He remains with good distal extremity muscle strength in the arms and legs, but poor proximal muscle strength, unable to lift any extremity off the bed. He remains on the ventilator with a trach collar. He is now being discharged to rehab, afebrile and in stable condition but requiring continued aggressive PT. Note: He is completely awake and alert and can answer questions using his hands. He is unable to open his eyes due to weakness of his eyelids. This patient would benefit from speech therapy and development of creative ways of communication (like pointing to pictures when he wants to express something he wants, etc.) He should undergo periodic trials of CPAP and pressure support vent settings to see if he has regained his ability to breath without the use of the vent. He should also have aggressive PT/OT and range of motion exercises. Medications on Admission: None Discharge Medications: 1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 2. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg PO BID (2 times a day). 3. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**2-7**] Drops Ophthalmic PRN (as needed). 4. Artificial Tear Ointment 0.1-0.1 % Ointment Sig: One (1) Appl Ophthalmic PRN (as needed). 5. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day). 6. Pantoprazole 40 mg IV Q24H 7. Metoclopramide 10 mg IV Q6H 8. Lorazepam 0.5 mg IV Q6H:PRN 9. Hydralazine HCl 10 mg IV Q4-6H:PRN SBP>150 10. Metoprolol 20 mg IV Q6H Hold for SBP<120, HR<65 11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed. 12. Famotidine in Normal Saline 20 mg/50 mL Piggyback Sig: One (1) injection Intravenous Q12H (every 12 hours). TPN Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: 1. Botulism toxin poisoning 2. Pneumonia 3. Constipation 4. Hypertension Discharge Condition: stable with improving strength Discharge Instructions: Please return to nearest ER if symptoms worsen. Please take all medications as prescribed. Please continue physical therapy. Followup Instructions: Please follow-up with Neurology, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], call [**Telephone/Fax (1) 1040**] to schedule a convenient time 4 months from now. [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

005,518,507,486,799,536,564,401,272

{'Botulism food poisoning,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia, organism unspecified,Cachexia,Gastroparesis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: rapidly progressive weakness PRESENT ILLNESS: Mr. [**Known lastname 58941**] is a 75 year old man with hx of BPH, HTN, depression and high cholesterol who presented yesterday evening to [**Hospital6 2561**] with "inability to speak". The history is very limited because the patient was unable to talk and no one accompanied him to the hospital to relay the history. From information gathered at [**Hospital3 **], the patient was feeling OK today until sometime this evening after eating dinner. Time course and exact contents of the meal are not known, but he apparently communicated (in writing) that the food was homemade and leftovers. He arrived at [**Hospital3 **] at 7:30-8:00PM. Vitals on arrival were: BP 154/86 HR77 RR21 98%on RA. While there, could only say one or two words at a time-other details of initial exam not documented in available paperwork. He had a head CT which was negative. Around 11:50PM, he vomited and was given Zofran. At 1:00AM, he wrote "please I need help, I think I'm dying". He was reassessed and seen by neurology at some point. He repeatedly wrote "I'm dying" on paper. He was noted to have "expressive aphasia" and bilateral ptosis. There was apparently concern for "cortical stroke" vs. toxin ingestion such as botulism. He was then transfered here for further evaluation and MRI. MEDICAL HISTORY: 1. HTN 2. Depression 3. BPH 4. High cholesterol MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: Thin, gaunt appearing male, in significant respiratory distress +accessory muscle use Neck: supple, no thyromegaly, no bruit CV: Tachy, regular 2/6SEM Lung: Clear to auscultation bilaterally aBd: decreased BS soft, nontender ext: no edema Neurologic examination: Mental status: Awake and alert, Oriented to person, place, and time. He was unable to speak,though occasionally grunted. Occasionally mouthed some words. Tried to communicate with gestures, very frustrated by inability to communicate. Comprehension appeared intact-could follow commands, cross midline. Unable to repeat or name. No evidence of apraxia or neglect. Respiratory distress prohibited further mental status testing. FAMILY HISTORY: No known family history of neurologic disease as per son. SOCIAL HISTORY: -lives in [**Hospital1 8**] by himself -Muslim -no tobacco or etoh use as per son ### Response: {'Botulism food poisoning,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia, organism unspecified,Cachexia,Gastroparesis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: Ms. [**Known lastname 44979**] is a 69 year old female with a symptomatic hiatal hernia, making it difficulty to eat, probably due to a situation of an hour glass type stomach, due to a large, mixed paraesophageal hernia. She presents for operative management. MEDICAL HISTORY: Osteoporosis GERD CAD HTN Angina chronic back pain Kyphosis Hepatitis C MEDICATION ON ADMISSION: Demerol 100mg 5x/day Nexium Dyazole HCTZ ALLERGIES: Keflex / Talwin Nx / Latex / Morphine / Darvon / Fiorinal / Motrin / Levaquin / Tetracycline / Codeine / Percodan PHYSICAL EXAM: Gen: alert and oriented CV: RRR lungs:cTA abd: soft nt nd ext no c/c/e FAMILY HISTORY: noncontributory SOCIAL HISTORY: noncontributory

Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified viral hepatitis C without hepatic coma,Other and unspecified angina pectoris,Esophageal reflux,Unspecified essential hypertension,Osteoporosis, unspecified,Scoliosis [and kyphoscoliosis], idiopathic,Coronary atherosclerosis of native coronary artery

Diaphragmatic hernia,Hpt C w/o hepat coma NOS,Angina pectoris NEC/NOS,Esophageal reflux,Hypertension NOS,Osteoporosis NOS,Idiopathic scoliosis,Crnry athrscl natve vssl

Admission Date: [**2181-3-6**] Discharge Date: [**2181-3-11**] Date of Birth: [**2111-6-22**] Sex: F Service: SURGERY Allergies: Keflex / Talwin Nx / Latex / Morphine / Darvon / Fiorinal / Motrin / Levaquin / Tetracycline / Codeine / Percodan Attending:[**First Name3 (LF) 1481**] Chief Complaint: abdominal pain Major Surgical or Invasive Procedure: laparoscopic paraesophageal hernia repair with fundoplication History of Present Illness: Ms. [**Known lastname 44979**] is a 69 year old female with a symptomatic hiatal hernia, making it difficulty to eat, probably due to a situation of an hour glass type stomach, due to a large, mixed paraesophageal hernia. She presents for operative management. Past Medical History: Osteoporosis GERD CAD HTN Angina chronic back pain Kyphosis Hepatitis C PSH: CCY TAH/BSO appy ERCP/sphincterotomy Social History: noncontributory Family History: noncontributory Physical Exam: Gen: alert and oriented CV: RRR lungs:cTA abd: soft nt nd ext no c/c/e Pertinent Results: [**2181-3-6**] 11:50PM GLUCOSE-124* UREA N-18 CREAT-0.8 SODIUM-140 POTASSIUM-4.4 CHLORIDE-105 TOTAL CO2-28 ANION GAP-11 [**2181-3-6**] 11:50PM CK-MB-17* MB INDX-4.2 cTropnT-0.04* [**2181-3-6**] 11:50PM MAGNESIUM-1.3* [**2181-3-6**] 11:50PM WBC-9.2# RBC-3.78* HGB-8.7* HCT-28.8* MCV-76* MCH-22.9* MCHC-30.1* RDW-18.6* [**2181-3-6**] 10:20PM TYPE-ART PO2-52* PCO2-47* PH-7.37 TOTAL CO2-28 BASE XS-1 Brief Hospital Course: Ms. [**Known lastname 44979**] was taken to the OR, she tolerated the procedure well, please see Dr.[**Name (NI) 1482**] Operative Note for detail. Post-operatively, the patient was noted to have shortness of breath and chest pain; there was some question of CHF as the etiology, she was diuresed. She was transferred to the ICU for closer monitoring of her respiratory status. On POD#1, Ms. [**Known lastname 44979**] had improved O2 sats and was transferred to the floor. Her pain was poorly controlled, and Acute Pain Service was consulted. They made changes to her pain regimen, which she was discharged home on. Physical Theraphy evaluated Ms. [**Known lastname 44979**] and cleared her safe for discharge on POD #5. By POD #5, Ms. [**Known lastname 44979**] was tolerating a regular diet and her pain was adequately controlled. She was discharged home in stable condition, with instructions to follow up with Dr. [**Last Name (STitle) **] and Pain Management in one week. Medications on Admission: Demerol 100mg 5x/day Nexium Dyazole HCTZ Discharge Medications: 1. Hydromorphone HCl 2 mg Tablet Sig: 1-1.5 Tablets PO Q2H (every 2 hours) as needed. Disp:*100 Tablet(s)* Refills:*1* 2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Methadone HCl 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*45 Tablet(s)* Refills:*0* 4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Acetaminophen Oral 6. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for anxiety. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: s/p laparoscopic hiatal hernia repair respiratory distress secondary to overnarcotization GERD osteoporosis CAD angina chronic back pain HTN kyphosis Hepatitis C Discharge Condition: Good Discharge Instructions: If you have any fevers/chills, nausea/vomiting, fevers/chills, chest pain, difficulty breathing, or belly pain, please seek medical attention. Followup Instructions: PLease follow up with Dr. [**Last Name (STitle) **] in [**12-3**] weeks, call for an appointment: [**Telephone/Fax (1) 2981**] Follow up with Dr. [**Last Name (STitle) **] as needed: [**Telephone/Fax (1) 41478**] Follow up with the [**First Name4 (NamePattern1) 1193**] [**Last Name (NamePattern1) 1194**] Management Center in 1 week for pain prescription renewals: [**Telephone/Fax (1) 1091**] Completed by:[**2181-3-22**]

553,070,413,530,401,733,737,414

{'Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified viral hepatitis C without hepatic coma,Other and unspecified angina pectoris,Esophageal reflux,Unspecified essential hypertension,Osteoporosis, unspecified,Scoliosis [and kyphoscoliosis], idiopathic,Coronary atherosclerosis of native coronary artery'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: Ms. [**Known lastname 44979**] is a 69 year old female with a symptomatic hiatal hernia, making it difficulty to eat, probably due to a situation of an hour glass type stomach, due to a large, mixed paraesophageal hernia. She presents for operative management. MEDICAL HISTORY: Osteoporosis GERD CAD HTN Angina chronic back pain Kyphosis Hepatitis C MEDICATION ON ADMISSION: Demerol 100mg 5x/day Nexium Dyazole HCTZ ALLERGIES: Keflex / Talwin Nx / Latex / Morphine / Darvon / Fiorinal / Motrin / Levaquin / Tetracycline / Codeine / Percodan PHYSICAL EXAM: Gen: alert and oriented CV: RRR lungs:cTA abd: soft nt nd ext no c/c/e FAMILY HISTORY: noncontributory SOCIAL HISTORY: noncontributory ### Response: {'Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified viral hepatitis C without hepatic coma,Other and unspecified angina pectoris,Esophageal reflux,Unspecified essential hypertension,Osteoporosis, unspecified,Scoliosis [and kyphoscoliosis], idiopathic,Coronary atherosclerosis of native coronary artery'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 yo M with CAD s/p MI, anxiety, HTN, Hyperlipidemia and chronic AFib, who presented to OSH on [**2176-7-19**] with NSTEMI, and was transferred to [**Hospital1 18**] on [**2176-7-22**] for cardiac cath. Cath demonstrated complex LAD and diagonal disease, and was evaluated by cardiac surgery for revasularization after plavix washout. . Mr. [**Known lastname **] presented initially on [**2176-7-19**] after developing substernal chest pain. The pain was associated with mild SOB and radiated to his left shoulder. In the OSH ED, he was given SL nitro and aspirin and the pain subsided. He was loaded with plavix. .At OSH, his troponin peaked at 0.40 on [**2176-7-19**] @ [**2120**]. . MEDICAL HISTORY: - CAD, h/o MI - Hypertension - Hyperlipidemia - Gout - Atrial fibrillation, chronic - anxiety - Bilateral TKR. -right hip replacement MEDICATION ON ADMISSION: HOME MEDICATIONS: - Aspirin 325 mg - Allopurinol 300 mg daily - Imdur 60 mg daily - Zestril 40 mg daily - amlodipine 5 mg daily - Xanax 0.125mg - Coumadin 2.5 mg daily - Tamsulosin 0.4 mg daily - Docusate 100 mg [**Hospital1 **] ALLERGIES: Lipitor / Gemfibrozil PHYSICAL EXAM: PHYSICAL EXAMINATION: VS - 96.9 157/82 79 16 99%2L Gen: WDWN male in NAD. Oriented x3. Mood, affect appropriate. HEENT: PERRL, EOMI. MMM. Neck: Supple with no elevation of JVP. CV: Irregular, normal S1, S2. No m/r/g. No S3 or S4. Chest: Nasal cannula in place. Resp were unlabored, no accessory muscle use. Lung exam limited by patient's inability to move post-procedure. Abd: Soft, NTND. No HSM or tenderness. Ext: No c/c/e. No femoral bruits. No hematoma. c/d/i. . Pulses: Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+ FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: The patient lives with his wife and a son. [**Name (NI) **] quit smoking in [**2147**], after smoking 3 ppd for 15 years. He drinks 4-5 beers per day.

Subendocardial infarction, initial episode of care,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Anxiety state, unspecified,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Long-term (current) use of antiplatelet/antithrombotic

Subendo infarct, initial,Hyposmolality,Crnry athrscl natve vssl,Atrial fibrillation,Old myocardial infarct,Hypertension NOS,Anxiety state NOS,Hyperlipidemia NEC/NOS,Gout NOS,Joint replaced knee,Lng use antiplte/thrmbtc

Name: [**Known lastname **],[**Known firstname 133**] A. Unit No: [**Numeric Identifier 13783**] Admission Date: [**2176-7-22**] Discharge Date: [**2176-7-30**] Date of Birth: [**2101-9-5**] Sex: M Service: CARDIOTHORACIC Allergies: Lipitor / Gemfibrozil Attending:[**First Name3 (LF) 741**] Addendum: Please Note: The attending physician was listed in error. Therefore the discharge summary lists the attending in error. Mr. [**Known lastname 13784**] surgery was performed by Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. A follow up appointment with Dr.[**Last Name (STitle) **] will be arranged by his office. Discharge Disposition: Home With Service Facility: [**Hospital1 328**] VNA [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**] Completed by:[**2176-8-6**] Admission Date: [**2176-7-22**] Discharge Date: [**2176-7-30**] Date of Birth: [**2101-9-5**] Sex: M Service: CARDIOTHORACIC Allergies: Lipitor / Gemfibrozil Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: coronary artery bypass graft x3 Coronary artery bypass grafting x3 with the left internal mammary artery to left anterior descending artery, and reverse saphenous vein graft to the obtuse marginal artery, and the diagonal artery. 2. Left atrial appendage resection. for chronic afib History of Present Illness: Mr. [**Known lastname **] is a 74 yo M with CAD s/p MI, anxiety, HTN, Hyperlipidemia and chronic AFib, who presented to OSH on [**2176-7-19**] with NSTEMI, and was transferred to [**Hospital1 18**] on [**2176-7-22**] for cardiac cath. Cath demonstrated complex LAD and diagonal disease, and was evaluated by cardiac surgery for revasularization after plavix washout. . Mr. [**Known lastname **] presented initially on [**2176-7-19**] after developing substernal chest pain. The pain was associated with mild SOB and radiated to his left shoulder. In the OSH ED, he was given SL nitro and aspirin and the pain subsided. He was loaded with plavix. .At OSH, his troponin peaked at 0.40 on [**2176-7-19**] @ [**2120**]. . Past Medical History: - CAD, h/o MI - Hypertension - Hyperlipidemia - Gout - Atrial fibrillation, chronic - anxiety - Bilateral TKR. -right hip replacement Social History: The patient lives with his wife and a son. [**Name (NI) **] quit smoking in [**2147**], after smoking 3 ppd for 15 years. He drinks 4-5 beers per day. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: PHYSICAL EXAMINATION: VS - 96.9 157/82 79 16 99%2L Gen: WDWN male in NAD. Oriented x3. Mood, affect appropriate. HEENT: PERRL, EOMI. MMM. Neck: Supple with no elevation of JVP. CV: Irregular, normal S1, S2. No m/r/g. No S3 or S4. Chest: Nasal cannula in place. Resp were unlabored, no accessory muscle use. Lung exam limited by patient's inability to move post-procedure. Abd: Soft, NTND. No HSM or tenderness. Ext: No c/c/e. No femoral bruits. No hematoma. c/d/i. . Pulses: Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Pertinent Results: Echo PREBYPASS The left atrium is moderately dilated. The left atrium is elongated. Mild spontaneous echo contrast is seen in the body of the left atrium. Mild spontaneous echo contrast is present in the left atrial appendage. The left atrial appendage emptying velocity is depressed (<0.2m/s). A left atrial appendage thrombus cannot be excluded due to presence of spontaneous echo contrast and difficulty visualizing tip of appendage. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricular cavity is mildly dilated with normal free wall contractility. There are simple atheroma in the aortic arch. The descending thoracic aorta is mildly dilated. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are mildly thickened. Trace aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. POSTBYPASS The patient is A-V paced and is not on any inotropes. The left atrial appendage has been ligated. We are unable to identify any remnants of the appendage and there is no flow in the area of the appendage on color Doppler. Left ventricular systolic function continues to be normal (LVEF>55%). Trace aortic regurgitation and trivial mitral regurgitation remain. The thoracic aorta is intact. Pre-op [**2176-7-22**] 11:25AM PT-18.4* PTT-33.8 INR(PT)-1.7* [**2176-7-22**] 11:25AM PLT COUNT-118* [**2176-7-22**] 11:25AM WBC-4.0 RBC-4.21* HGB-13.8* HCT-39.7* MCV-94 MCH-32.8* MCHC-34.8 RDW-13.6 [**2176-7-22**] 11:25AM TRIGLYCER-74 HDL CHOL-58 CHOL/HDL-2.9 LDL(CALC)-93 [**2176-7-22**] 11:25AM %HbA1c-5.3 eAG-105 [**2176-7-22**] 11:25AM ALBUMIN-3.8 CHOLEST-166 [**2176-7-22**] 11:25AM ALT(SGPT)-22 AST(SGOT)-24 ALK PHOS-67 TOT BILI-0.7 [**2176-7-22**] 11:25AM GLUCOSE-219* UREA N-9 CREAT-0.6 SODIUM-129* POTASSIUM-3.9 CHLORIDE-97 TOTAL CO2-24 ANION GAP-12 Discharge [**2176-7-29**] 05:55AM BLOOD WBC-6.9 RBC-3.01* Hgb-10.1* Hct-27.7* MCV-92 MCH-33.6* MCHC-36.5* RDW-14.2 Plt Ct-118* [**2176-7-29**] 05:55AM BLOOD Plt Ct-118* [**2176-7-29**] 05:55AM BLOOD Glucose-108* UreaN-15 Creat-0.6 Na-132* K-3.5 Cl-97 HCO3-31 AnGap-8 Radiology Report CHEST (PORTABLE AP) Study Date of [**2176-7-28**] 10:06 AM [**Hospital 93**] MEDICAL CONDITION: 74 year old man with removal of chest tubes REASON FOR THIS EXAMINATION: eval for PTX Final Report In comparison with the study of [**7-26**], all of the monitoring and support devices other than the right IJ catheter have been removed. No definite evidence of pneumothorax. Bibasilar changes of atelectasis persist, more prominent on the left, where there is some associated pleural effusion. DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**] Brief Hospital Course: The patient was admitted to the hospital and after a plavix washout was brought to the operating room on [**2176-7-25**] for a coronary artery bypass graft x 3 and left atrial appendage ligation. See operative report for details, in summary he had: Coronary artery bypass grafting x3 with the left internal mammary artery to left anterior descending artery, and reverse saphenous vein graft to the obtuse marginal artery, and the diagonal artery, Left atrial appendage resection. His CROSS-CLAMP TIME was 70 minutes with a bypass PUMP TIME of 83 minutes. Overall he tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. Vancomycin was used for surgical antibiotic prophylaxis. On the day of surgery he woke neurologically intact, was weaned from the ventilator and extubated. Beta blocker, statin and diuresis was initiated and he was gently diuresed toward his preoperative weight. Initially Mr. [**Known lastname **] was sensitive to lopressor and became bradycardic to the 40's after receiving one dose of 25mg lopressor. Lopressor was held temporarily and resumed at a lower dose and gently increased. Coumadin therapy was resumed for atrial fibrillation. The patient was transferred to the telemetry floor for further recovery on POD1. All tubes lines drains and pacing wires were discontinued per cardiac surgery protocol without complication. Mr. [**Known lastname **] has chronic hyponatremia and was placed on a fluid restriction, serum sodium levels were monitored. He was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD #4 Mr. [**Known lastname **] was ambulating freely, the wound was healing and pain was controlled with oral analgesics. He was discharged in good condition with appropriate follow up instructions. Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] was contact[**Name (NI) **] to follow his coumadin dosing. Medications on Admission: HOME MEDICATIONS: - Aspirin 325 mg - Allopurinol 300 mg daily - Imdur 60 mg daily - Zestril 40 mg daily - amlodipine 5 mg daily - Xanax 0.125mg - Coumadin 2.5 mg daily - Tamsulosin 0.4 mg daily - Docusate 100 mg [**Hospital1 **] ADDED AT OSH: - Plavix 75 mg daily (Plavix 300 mg load on [**2176-7-21**]) - Solumedrol 40 mg IVP [**2176-7-21**] and [**2176-7-22**] a.m. - Heparin 1000 units/hr Discharge Medications: 1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 2. Alprazolam 0.25 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO BID (2 times a day) as needed for anxiety. 3. Ezetimibe 10 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO DAILY (Daily). 4. Allopurinol 300 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO DAILY (Daily). 5. Aspirin 81 mg [**Month/Day/Year 8426**], Delayed Release (E.C.) Sig: One (1) [**Month/Day/Year 8426**], Delayed Release (E.C.) PO DAILY (Daily). 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. Acetaminophen 325 mg [**Month/Day/Year 8426**] Sig: Two (2) [**Month/Day/Year 8426**] PO Q4H (every 4 hours) as needed for pain. 8. Ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* 9. Metoprolol Tartrate 25 mg [**Month/Day/Year 8426**] Sig: 0.5 [**Month/Day/Year 8426**] PO BID (2 times a day). Disp:*30 [**Month/Day/Year 8426**](s)* Refills:*2* 10. Warfarin 1 mg [**Month/Day/Year 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] DAILY (Daily) as needed for AFIB: INR goal >2.0 for AFib. Disp:*60 [**Last Name (Titles) 8426**](s)* Refills:*0* 11. Furosemide 20 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO BID (2 times a day) for 3 days. Disp:*6 [**Last Name (Titles) 8426**](s)* Refills:*0* 12. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 3 days. Disp:*6 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 13. Warfarin 5 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO ONCE (Once) for 1 doses. Disp:*1 [**Last Name (Titles) 8426**](s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: Coronary artery disease s/p CABG x3 PMH: Gout, Myocardial infarction, Hypertension, Anxiety - takes xanax every night and wakes at times in panic, Hyperlipidemia, Atrial Fibrillation (on coumadin), s/p total hip arthroplasty right - [**2172**], s/p bilateral knee replacement - both in [**2173**] Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with tylenol Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema: trace bilat Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Surgeon: Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] on [**8-15**] @2:30 Cardiologist:Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**8-30**] @3:15P Please call to schedule appointments with your Primary Care Dr [**Last Name (STitle) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 29248**] in [**3-4**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Labs: PT/INR for Coumadin ?????? indication Atrial Fibrillation Goal INR 2-2.5 First draw [**2176-7-31**] Results to Dr [**Doctor Last Name 86963**] [**Telephone/Fax (1) 8725**] fax [**Telephone/Fax (1) 8719**] Completed by:[**2176-7-30**]

410,276,414,427,412,401,300,272,274,V436,V586

{'Subendocardial infarction, initial episode of care,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Anxiety state, unspecified,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Long-term (current) use of antiplatelet/antithrombotic'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 yo M with CAD s/p MI, anxiety, HTN, Hyperlipidemia and chronic AFib, who presented to OSH on [**2176-7-19**] with NSTEMI, and was transferred to [**Hospital1 18**] on [**2176-7-22**] for cardiac cath. Cath demonstrated complex LAD and diagonal disease, and was evaluated by cardiac surgery for revasularization after plavix washout. . Mr. [**Known lastname **] presented initially on [**2176-7-19**] after developing substernal chest pain. The pain was associated with mild SOB and radiated to his left shoulder. In the OSH ED, he was given SL nitro and aspirin and the pain subsided. He was loaded with plavix. .At OSH, his troponin peaked at 0.40 on [**2176-7-19**] @ [**2120**]. . MEDICAL HISTORY: - CAD, h/o MI - Hypertension - Hyperlipidemia - Gout - Atrial fibrillation, chronic - anxiety - Bilateral TKR. -right hip replacement MEDICATION ON ADMISSION: HOME MEDICATIONS: - Aspirin 325 mg - Allopurinol 300 mg daily - Imdur 60 mg daily - Zestril 40 mg daily - amlodipine 5 mg daily - Xanax 0.125mg - Coumadin 2.5 mg daily - Tamsulosin 0.4 mg daily - Docusate 100 mg [**Hospital1 **] ALLERGIES: Lipitor / Gemfibrozil PHYSICAL EXAM: PHYSICAL EXAMINATION: VS - 96.9 157/82 79 16 99%2L Gen: WDWN male in NAD. Oriented x3. Mood, affect appropriate. HEENT: PERRL, EOMI. MMM. Neck: Supple with no elevation of JVP. CV: Irregular, normal S1, S2. No m/r/g. No S3 or S4. Chest: Nasal cannula in place. Resp were unlabored, no accessory muscle use. Lung exam limited by patient's inability to move post-procedure. Abd: Soft, NTND. No HSM or tenderness. Ext: No c/c/e. No femoral bruits. No hematoma. c/d/i. . Pulses: Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+ FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: The patient lives with his wife and a son. [**Name (NI) **] quit smoking in [**2147**], after smoking 3 ppd for 15 years. He drinks 4-5 beers per day. ### Response: {'Subendocardial infarction, initial episode of care,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Anxiety state, unspecified,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Long-term (current) use of antiplatelet/antithrombotic'}

CHIEF COMPLAINT: Fall tSAH PRESENT ILLNESS: HPI: This is an 82 year old male with PMHx of MI with cardiac pacemaker, CABG and cardiac stents (on coumadin), and old prior CVA presents s/p fall this morning while standing. Has baseline difficult ambulating d/t prior stroke and l-sided weakness, but thinks his weakness has worsened over the past several days. He was using the bathroom and fall backwards, due to this weakness, and hit his head on bathroom floor. No LOC. Crawled back to bed, went to sleep for 2 hours, and awoke with a headache. Called ambulance. Upon arrival to [**Hospital3 1280**], had an INR of 4.0 - was give 10mg of Vit K only. CT scan positive for tSAH. Transferred to [**Hospital1 18**] for further care. Patient currently complains of a HA and abdmominal pain. Also, he does feel increased weakness on the L upper and lower extremity. He denies diplopia, nausea/vomiting, or sensory deficits. MEDICAL HISTORY: PMHx: 1.MI - s/p CABG. on Coumadin 2.HTN 3.Hypertension 4.Cardiac Pacemakes 5.R CVA with residual L-sided weakness MEDICATION ON ADMISSION: 1. Coumadin 2. Lasix 3. Digoxin 4. Lovastatin 5. Lisinopril 6. Atenolol 7. Metolazone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAM: O: T: 97.8 BP: 163/94 HR:72 R:18 O2Sats: 94% 4L Gen: WD/WN, comfortable, NAD. HEENT: Large hematoma to R occipital scalp with 2cm laceration. not actively bleeding Pupils: 2 bilat and minimally reactive FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Non-contributory

Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Encephalopathy, unspecified,Fall from other slipping, tripping, or stumbling,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Adjustment disorder with mixed disturbance of emotions and conduct,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Old myocardial infarction,Cardiac pacemaker in situ,Unspecified essential hypertension,Other late effects of cerebrovascular disease,Other disorders of muscle, ligament, and fascia

Subarachnoid hem-no coma,Encephalopathy NOS,Fall from slipping NEC,Unilat inguinal hernia,Adj dis-emotion/conduct,Heart valve replac NEC,Long-term use anticoagul,Aortocoronary bypass,Old myocardial infarct,Status cardiac pacemaker,Hypertension NOS,Late effect CV dis NEC,Muscle/ligament dis NEC

Admission Date: [**2120-4-17**] Discharge Date: [**2120-4-29**] Date of Birth: [**2038-3-13**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1835**] Chief Complaint: Fall tSAH Major Surgical or Invasive Procedure: None History of Present Illness: HPI: This is an 82 year old male with PMHx of MI with cardiac pacemaker, CABG and cardiac stents (on coumadin), and old prior CVA presents s/p fall this morning while standing. Has baseline difficult ambulating d/t prior stroke and l-sided weakness, but thinks his weakness has worsened over the past several days. He was using the bathroom and fall backwards, due to this weakness, and hit his head on bathroom floor. No LOC. Crawled back to bed, went to sleep for 2 hours, and awoke with a headache. Called ambulance. Upon arrival to [**Hospital3 1280**], had an INR of 4.0 - was give 10mg of Vit K only. CT scan positive for tSAH. Transferred to [**Hospital1 18**] for further care. Patient currently complains of a HA and abdmominal pain. Also, he does feel increased weakness on the L upper and lower extremity. He denies diplopia, nausea/vomiting, or sensory deficits. Past Medical History: PMHx: 1.MI - s/p CABG. on Coumadin 2.HTN 3.Hypertension 4.Cardiac Pacemakes 5.R CVA with residual L-sided weakness Social History: Non-contributory Family History: Non-contributory Physical Exam: PHYSICAL EXAM: O: T: 97.8 BP: 163/94 HR:72 R:18 O2Sats: 94% 4L Gen: WD/WN, comfortable, NAD. HEENT: Large hematoma to R occipital scalp with 2cm laceration. not actively bleeding Pupils: 2 bilat and minimally reactive EOMs intact. L nasolabial fold flattening, possible from prior CVA Abd: Soft, tender to palpation. Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**3-27**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 2 to 1.5 mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**5-29**] throughout the R side. Left side 5- in upper extremities, [**5-29**] LLE. Left pronator drift Sensation: Intact to light touch, propioception, pinprick and vibration bilaterally. Toes downgoing bilaterally On discharge: As above. Pertinent Results: ADMISSION LABS: [**2120-4-17**] 09:45AM PT-28.2* PTT-30.4 INR(PT)-2.8* [**2120-4-17**] 09:45AM WBC-7.3 RBC-4.10* HGB-11.7* HCT-35.3* MCV-86 MCH-28.4 MCHC-33.0 RDW-13.6 [**2120-4-17**] 09:45AM GLUCOSE-89 UREA N-36* CREAT-2.0* SODIUM-137 POTASSIUM-4.2 CHLORIDE-97 TOTAL CO2-31 ANION GAP-13 DISCHARGE LABS: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2120-4-27**] 06:40AM 5.6 3.65* 10.7* 32.8* 90 29.4 32.8 14.3 256 BASIC COAGULATION (PT [**Name (NI) 263**] [**2120-4-29**] 08:55AM 20.1* 1.9* _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ CT Head from [**Hospital3 1280**] [**4-17**]: 1.1cm area of subarachnoid centered within left sylvian fissure. No mass effect, no midline shift. Ct head [**4-17**]: 1. Left frontotemporal subarachnoid hemorrhage. No mass effect or midline shift. 2. Remote ischemia or infarct in the right putamen with ex vacuo dilatation of the right lateral ventricle. Small vessel ischemic disease and predominantly frontal atrophy as described. CT Torso [**4-17**]: 1. Moderate to severe left hydroureteronephrosis without definite obstructing stone or mass given of lack of IV contrast. Enlarged prostate with apparent bladder wall thickening, which could in part be relate to underdistension around the Foley, though chronic outlet obstruction cannot excluded, which could conceivably cause left hydroureternephrosis. Recommend urologic consultation/evaluation. 2. Left base pulmonary consolidation, infectious process not excluded. 3. Gallbladder sludge versus small stones. No cholecystitis. 4. Ventral hernia containing nonobstructed bowel. 5. Left inguinal hernia with soft tissue density within, possibly herniated omentum versus Prolene plug from prior repair. Please correlate with surgical history 6. Ill-defined sclerotic lesions are identified in the right ilium adjacent to the right SI joint as well as in the right acetabular roof. These are not definitely benign, and bony infarction or blastic lesions cannot be excluded. Please correlate clinically with history of primary malignancy, such as prostate, and consider nonemergent bone scan. 7. Mild L1 compression deformity and sclerosis of superior posterior endplate of L2, of indeterminate age. 8. Marked left atrial enlargement status post mitral valve replacement. Ct C-spine [**2120-4-17**]: prelim: No fracture or malalignment Ct Head [**2120-4-17**]: 1. No significant change in blood products in/adjacent to left sylvian fissure, most likely representing fall, subarachnoid hemorrhage and possible adjacent hemorrhagic contusions. 2. Geographic area of decreased decreased attenuation in the right frontal and parietal bones at the vertex, unchanged from prior, of uncertain nature. Comaprison with any remote iamges can be helpful. CT Head [**4-20**]: IMPRESSION: 1. Interval decrease in density of the known left Sylvian subarachnoid hemorrhage, compatible with expected evolution of subarachnoid hemorrhage. 2. Appearance of new tiny right frontal subdural hematoma, could represent interval increase of density of hyper-acute subdural hematoma from contrecoup injury. Cannot rule out new subdural hematoma. No significant mass effect. Recommend short-interval follow-up and monitoring. Brief Hospital Course: The patient was admitted to the NSurg stepdown unit for Q2 neuro checks and for reversal of his INR. His neurological exam remained unchanged throughout the day. Following 2 U FFP and 10mg Vit K x2, his INR reversed to 1.1 on [**4-18**]. His Cpsine imaging was negative for fracture and his collar was removed. Corrected dilantin level was 16.5. Floor orders were written. From a neurosurgical standpoint, he did well; specifically, a repeat Head CT demonstrated complete resolution of the SAH on [**4-20**], with an evolving R frontal SDH. He was seen by geriatrics on [**4-19**] for increased agitation and confusion. They made some simple recommendations regarding his medications, but attributed his delerium to the SAH. It was recommended by [**Female First Name (un) 1634**] and PT that the patient be sent to a rehab/nursing home facility. He refused discharge to anywhere but home; therefore social work consult was obtained to facilitate the discharge process. A psychiatry consult was also obtained to ascertain his competance to make decisions regarding his care. They concluded that there was no need for a capacity assessment given the patient's eventual agreement to go to a [**Hospital1 1501**]. He was restarted on his Coumadin on [**4-24**]. At the time of discharge, his INR was nearly therapeutic at 1.9. This is on 4 MG Daily. he was screened by a [**Hospital1 1501**], and was discharged to [**Hospital1 **] on [**2120-4-29**]. Medications on Admission: 1. Coumadin 2. Lasix 3. Digoxin 4. Lovastatin 5. Lisinopril 6. Atenolol 7. Metolazone Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheezing. 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day) as needed for until patient OOB. 9. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4 PM. 10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 11. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital 85916**] Hospital Discharge Diagnosis: tSAH Delerium Discharge Condition: Neurologically Stable Discharge Instructions: General Instructions ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. ?????? You were on Coumadin (Warfarin) prior to your injury, you were restarted on this medication on [**2120-4-24**]. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion, lethargy or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? New onset of the loss of function, or decrease of function on one whole side of your body. Followup Instructions: Follow-Up Appointment Instructions ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**Last Name (STitle) **] to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. You should have your INR checked weekly. Your INR should remain therapeutic between 2.0-3.0. Completed by:[**2120-4-29**]

852,348,E885,550,309,V433,V586,V458,412,V450,401,438,728

{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Encephalopathy, unspecified,Fall from other slipping, tripping, or stumbling,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Adjustment disorder with mixed disturbance of emotions and conduct,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Old myocardial infarction,Cardiac pacemaker in situ,Unspecified essential hypertension,Other late effects of cerebrovascular disease,Other disorders of muscle, ligament, and fascia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Fall tSAH PRESENT ILLNESS: HPI: This is an 82 year old male with PMHx of MI with cardiac pacemaker, CABG and cardiac stents (on coumadin), and old prior CVA presents s/p fall this morning while standing. Has baseline difficult ambulating d/t prior stroke and l-sided weakness, but thinks his weakness has worsened over the past several days. He was using the bathroom and fall backwards, due to this weakness, and hit his head on bathroom floor. No LOC. Crawled back to bed, went to sleep for 2 hours, and awoke with a headache. Called ambulance. Upon arrival to [**Hospital3 1280**], had an INR of 4.0 - was give 10mg of Vit K only. CT scan positive for tSAH. Transferred to [**Hospital1 18**] for further care. Patient currently complains of a HA and abdmominal pain. Also, he does feel increased weakness on the L upper and lower extremity. He denies diplopia, nausea/vomiting, or sensory deficits. MEDICAL HISTORY: PMHx: 1.MI - s/p CABG. on Coumadin 2.HTN 3.Hypertension 4.Cardiac Pacemakes 5.R CVA with residual L-sided weakness MEDICATION ON ADMISSION: 1. Coumadin 2. Lasix 3. Digoxin 4. Lovastatin 5. Lisinopril 6. Atenolol 7. Metolazone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAM: O: T: 97.8 BP: 163/94 HR:72 R:18 O2Sats: 94% 4L Gen: WD/WN, comfortable, NAD. HEENT: Large hematoma to R occipital scalp with 2cm laceration. not actively bleeding Pupils: 2 bilat and minimally reactive FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Non-contributory ### Response: {'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Encephalopathy, unspecified,Fall from other slipping, tripping, or stumbling,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Adjustment disorder with mixed disturbance of emotions and conduct,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Old myocardial infarction,Cardiac pacemaker in situ,Unspecified essential hypertension,Other late effects of cerebrovascular disease,Other disorders of muscle, ligament, and fascia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 75-year-old gentleman who is a patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47696**] who was transferred in from [**Hospital3 3583**] status post a myocardial infarction for cardiac catheterization. He was seen by Cardiology on admission. MEDICAL HISTORY: 1. Hypertension. 2. Myocardial infarction. 3. Hypercholesterolemia. 4. Myocardial infarction in [**2158**]. 5. Status post cancer and radiation therapy to the mouth. 6. Grave's disease with right eye diplopia. 7. Transient ischemic attack in [**2156**]. 8. Syncope. 9. Glaucoma. 10. Left carotid endarterectomy in [**2170**]. 11. Transurethral resection of prostate. MEDICATION ON ADMISSION: (Medications on admission were as follows) 1. Plavix 75 mg p.o. once per day 2. Aspirin 325 mg p.o. once per day. 3. Lopressor 25 mg p.o. twice per day. 4. Lisinopril 5 mg p.o. once per day. 6. Synthroid 0.025 mg p.o. once per day 7. Lipitor 10 mg p.o. once per day. 8. Flonase 2 puffs as needed. 9. Xalatan eyedrops once per day. 10. Trusopt one drop three times per day to both eyes. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Mitral valve insufficiency and aortic valve insufficiency,Encounter for palliative care,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery

Surg compl-heart,Parox ventric tachycard,Cardiogenic shock,CHF NOS,Acute kidney failure NOS,Mitral/aortic val insuff,Encountr palliative care,Subendo infarct, initial,Crnry athrscl natve vssl

Admission Date: [**2172-7-6**] Discharge Date: [**2172-7-10**] Date of Birth: [**2096-4-25**] Sex: M Service: Cardiothoracic Surgery Service HISTORY OF PRESENT ILLNESS: The patient is a 75-year-old gentleman who is a patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47696**] who was transferred in from [**Hospital3 3583**] status post a myocardial infarction for cardiac catheterization. He was seen by Cardiology on admission. He was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] and was seen on [**7-6**]. PAST MEDICAL HISTORY: 1. Hypertension. 2. Myocardial infarction. 3. Hypercholesterolemia. 4. Myocardial infarction in [**2158**]. 5. Status post cancer and radiation therapy to the mouth. 6. Grave's disease with right eye diplopia. 7. Transient ischemic attack in [**2156**]. 8. Syncope. 9. Glaucoma. 10. Left carotid endarterectomy in [**2170**]. 11. Transurethral resection of prostate. MEDICATIONS ON ADMISSION: (Medications on admission were as follows) 1. Plavix 75 mg p.o. once per day 2. Aspirin 325 mg p.o. once per day. 3. Lopressor 25 mg p.o. twice per day. 4. Lisinopril 5 mg p.o. once per day. 6. Synthroid 0.025 mg p.o. once per day 7. Lipitor 10 mg p.o. once per day. 8. Flonase 2 puffs as needed. 9. Xalatan eyedrops once per day. 10. Trusopt one drop three times per day to both eyes. PERTINENT RADIOLOGY/IMAGING: Cardiac catheterization showed left vein and 3-vessel disease with an ejection fraction of 45%. Cardiac catheterization today just showed left vein 60% left anterior descending artery, 60% to 80% first diagonal, 100% left circumflex, and 90% ostial right coronary artery. His preoperative chest x-ray showed no acute cardiopulmonary disease. On [**7-7**], he had ultrasounds done which showed a right internal carotid stenosis of 60% to 69%, a left internal carotid stenosis of less than 40%. Please refer to the final dictated report. PHYSICAL EXAMINATION ON PRESENTATION: On examination, blood pressure was 166/77, oxygen saturation was 100% on room air, respiratory rate was 18, and heart rate was 55. His left eye pupil appeared larger but both were reactive. Sclerae were anicteric. He had well-healed scars bilaterally on his neck. His lungs were clear. His heart was regular in rate and rhythm. Normal first heart sounds and second heart sounds. No murmurs. His abdominal examination was benign with good bowel sounds and no hepatosplenomegaly. His extremities were warm and well perfused with no cyanosis, clubbing, or edema, or varicosities. He had good peripheral pulses throughout. PERTINENT LABORATORY VALUES ON PRESENTATION: His creatine kinase peaked at [**Hospital3 3583**] at 384 with a troponin of 8.35. He had Q waves in his inferior leads. His preoperative laboratories were as follows; white blood cell count was 5.8, hematocrit was 36.5, and platelet count was 162,000. Prothrombin time was 13.1, partial thromboplastin time was 40.9, and INR was 1.1. Sodium was 134, potassium was 3.9, chloride was 104, bicarbonate was 22, blood urea nitrogen was 22, creatinine was 0.9, and blood glucose was 87. ALT was 22, AST was 28, alkaline phosphatase was 64, total bilirubin was 0.5, and albumin was 3.7. Creatine kinase was 270 followed by 320. Troponin was 8.3. HOSPITAL COURSE: Plavix was placed on hold. On [**8-3**], he underwent coronary artery bypass graft times four with a left internal mammary artery to the left anterior descending artery, saphenous vein graft to posterior descending artery, saphenous vein graft from obtuse marginal to diagonal. Coming off bypass, the patient experienced right ventricular failure and went back on bypass with drug manipulations. Additional echocardiography showed an ejection fraction still approximately 35% to 40% with moderate mitral regurgitation, moderate aortic insufficiency, and moderate tricuspid regurgitation and aortic regurgitation. Intra-aortic balloon pump was still in good position which had been placed. The patient went back on bypass a third time for increased right ventricular failure and increasingly unstable vital signs. The patient was placed on right heart bypass with cannulas in the right atrium and pulmonary artery going into the left pulmonary artery. This was confirmed by an echocardiogram. The patient was brought to the Cardiothoracic Intensive Care Unit with a right heart bypass cannulation in place. The patient was profoundly hypoxic and acidotic. He was unresponsive on examination and was successfully sedated. He was on the following drips: Amiodarone at 1, dobutamine at 2.5, epinephrine at 0.3, and Levophed at 0.8, lidocaine at 2, and pitressin at 0.2. His heart rate was 98. He was atrially paced with a blood pressure of 93/41. Intra-aortic balloon pump was at 1:1. He was fully supported by the ventilator with a blood gas of 7.27/35/41/17/-9. Temperature maximum was 93.9. Hematocrit was 20.8. He was on an insulin drip also. He remained fully on Swan-Ganz catheter and monitored with maximum pressors and inotropic support. He was critically hypoxic with instructions to do no cardiopulmonary resuscitation but to defibrillate only. The patient was seen by a Renal fellow on [**7-8**]. Please note to refer to the patient's Operative Note. In the operating room, the patient coded and was asystolic on the way out of the operating room and then went back to the operating room on bypass times three. That was when the intra-aortic balloon pump was placed and the right ventricular assist device was placed, as the right ventricular wall was not moving. In addition, to the saphenous vein graft to the right coronary artery. Please refer to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 15933**] Operative Report. It was the impression of the Renal consultation that the patient's urine output had slowly resumed. His blood pressure had increased to a mean arterial pressure of greater than 70, but the prognosis was very poor. They recommended continuous venovenous hemofiltration for fluid removal and oxygenation to help improve it, but the patient was clearly hypoxic and had cardiogenic shock. He also had lactic acidosis and congestive heart failure. The hypernatremia was likely secondary to multiple ampules of bicarbonate given during the operation. The left femoral venous dialysis was placed under sterile conditions in the Intensive Care Unit on [**7-8**] in preparation for continuous venovenous hemofiltration. The patient was seen again the next morning by the Renal Service with the right ventricular assist device still in place and massive volume overload after DOR noted on maximal ventilatory support with acute renal failure secondary to the prolong hypertension. The right ventricular assist device remained in place at that time. Blood pressure dropped with the fluid removal. On postoperative day two, the pressors were slowly weaned. The patient received two units of packed red blood cells, and his positive end-expiratory pressure was increased. The patient was unresponsive with no movement. The patient was on a Levophed drip, amiodarone drip, epinephrine drip, and Milrinone, as well as dobutamine drip, lidocaine drip, as well as pitressin drip. Heart rate was 76, A-paced. Blood pressure was 118/48. Blood gas that morning was 7.47/26/63/19/-2 with a temperature maximum of 99.5. White blood cell count was 16.7. Hematocrit was 45. Platelet count was 121. Sodium was 132, potassium was 4.6, blood urea nitrogen was 22, creatinine was 2.3, chloride was 97, bicarbonate was 18, and blood glucose was 104. The patient was continued on propofol sedation. Lidocaine was decreased to 1. The patient was continued on perioperative vancomycin. Levofloxacin was also added in. The patient remained critically ill in the Intensive Care Unit. The patient continued to have low-flows and low blood pressures on his right ventricular assist device with coarse breath sounds. He was sedated and intubated with massive anasarca. His extremities appeared to have anasarca emboli and were warm. His blood urea nitrogen was 27 with a creatinine of 2.6. His hematocrit dropped from 48 to 32.2. He remained on amiodarone drip at 0.5, lidocaine drip at 1, dobutamine drip at 2.5, epinephrine drip at 0.3, Levophed drip at 0.27, and Milrinone drip at 0.25, vasopressin drip at 0.08, Neo-Synephrine drip at 1.4, propofol drip at 20, insulin drip at 1, as well as perioperative antibiotics. He was continued on his right ventricular assist device and his intra-aortic balloon pump with acute tubular necrosis and was requiring vasopressors and on inotropic support. He had a poor potassium clearance, by Renal Service, suggesting extreme/extensive recirculation of fluid. He continued with continuous venovenous hemofiltration. The TE showed some right ventricular function remaining. A pericardial clot was evacuated at the bedside, and his pressure dropped slightly. He remained on all of his inotropic and vasopressor support. He was fully sedated, intubated, and paralyzed. He was continued on perioperative antibiotics. The plan was to try and wean his sedation, and try weaning his right ventricular assist device, and transfuse him as needed, with orders to defibrillate only. He was seen by clinical Nutrition Service for a discussion of starting some parenteral nutrition, but the patient continued to decline and stopped responding to his drugs with any full measure. On [**7-10**], at approximately 7:30 p.m., the family had made the decision to stop all pressors and withdraw support. At 7 p.m., all infusions were stopped. The patient developed profound hypotension, his rhythm deteriorated to asystole. At 7:25 p.m., the pupils were fixed and dilated. There was no cardiac activity or spontaneous respirations. The patient was pronounced dead. The family was present. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] was notified. Postmortem was declined by the family. Please refer to the death note by Dr. [**First Name4 (NamePattern1) 6644**] [**Last Name (NamePattern1) 47697**]. The patient expired in the Cardiothoracic Intensive Care Unit on [**7-10**] at 7:30 p.m. Please refer to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 15933**] Operative Report. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**Last Name (NamePattern1) 76**] MEDQUIST36 D: [**2172-7-29**] 14:46 T: [**2172-8-5**] 08:30 JOB#: [**Job Number 47698**] Name: [**Known lastname 8813**], [**Known firstname 133**] Unit No: [**Numeric Identifier 8814**] Admission Date: [**2172-7-6**] Discharge Date: [**2172-7-10**] Date of Birth: [**2096-4-25**] Sex: M Service: DISCHARGE DIAGNOSES: 1. Status post coronary artery bypass grafting x4 with intra-aortic balloon pump insertion and right ventricular assist device. 2. Glaucoma. 3. Grave's disease. 4. Cancer of the neck and tongue status post resection and XRT. 5. Hypertension. 6. Left carotid endarterectomy. 7. Transurethral resection of the prostate. 8. Hypercholesterolemia. 9. Syncope. DR.[**Last Name (STitle) **],[**First Name3 (LF) 63**] 02-248 Dictated By:[**Last Name (NamePattern1) 981**] MEDQUIST36 D: [**2172-7-29**] 14:49 T: [**2172-8-5**] 08:27 JOB#: [**Job Number 8815**]

997,427,785,428,584,396,V667,410,414

{'Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Mitral valve insufficiency and aortic valve insufficiency,Encounter for palliative care,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 75-year-old gentleman who is a patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47696**] who was transferred in from [**Hospital3 3583**] status post a myocardial infarction for cardiac catheterization. He was seen by Cardiology on admission. MEDICAL HISTORY: 1. Hypertension. 2. Myocardial infarction. 3. Hypercholesterolemia. 4. Myocardial infarction in [**2158**]. 5. Status post cancer and radiation therapy to the mouth. 6. Grave's disease with right eye diplopia. 7. Transient ischemic attack in [**2156**]. 8. Syncope. 9. Glaucoma. 10. Left carotid endarterectomy in [**2170**]. 11. Transurethral resection of prostate. MEDICATION ON ADMISSION: (Medications on admission were as follows) 1. Plavix 75 mg p.o. once per day 2. Aspirin 325 mg p.o. once per day. 3. Lopressor 25 mg p.o. twice per day. 4. Lisinopril 5 mg p.o. once per day. 6. Synthroid 0.025 mg p.o. once per day 7. Lipitor 10 mg p.o. once per day. 8. Flonase 2 puffs as needed. 9. Xalatan eyedrops once per day. 10. Trusopt one drop three times per day to both eyes. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Mitral valve insufficiency and aortic valve insufficiency,Encounter for palliative care,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 22-year-old female with no significant past medical history who was transferred here from an outside hospital after a Tylenol PM overdose. MEDICAL HISTORY: None. MEDICATION ON ADMISSION: Diet pills that the patient purchased over the internet. She is not clear exactly what they were. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history was noncontributory. SOCIAL HISTORY: The patient reportedly drinks alcohol socially. She uses tobacco socially. She does have a history of cocaine use; per her cousin she quit last year. No history of intravenous drug use. She works in a health club. Her parents are divorced. She lives with her father. She has some recreational Percocet use in the last year.

Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Acute and subacute necrosis of liver,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics

Pois-arom analgesics NEC,Acidosis,Acute necrosis of liver,Food/vomit pneumonitis,Acute kidney failure NOS,Pois-antiallrg/antiemet,Poison-analgesics

Admission Date: [**2194-12-28**] Discharge Date: [**2195-1-8**] Date of Birth: [**2172-11-19**] Sex: F Service: Medicine, [**Hospital1 139**] Firm HISTORY OF PRESENT ILLNESS: The patient is a 22-year-old female with no significant past medical history who was transferred here from an outside hospital after a Tylenol PM overdose. The patient was in her usual state of health until the day prior to admission when she had a "fight" with her boss at work. She was seen wondering about the house at approximately 11 p.m. speaking nonsensically by her father who encouraged her to go to sleep. She was then discovered on the day of admission at 1 p.m. in her bedroom and unresponsive by her father. Emergency Medical Service transported her to [**Hospital **] Hospital. It was subsequently discovered that she had ingested approximately one and a half bottles of Tylenol PM. At the outside hospital, the patient received 2 gram of ceftriaxone. She had a negative head computed tomography. She was intubated for altered mental status. A serum toxicology screen revealed a Tylenol level of over 200. The patient was given 140 mg/kg of N-acetylcysteine and charcoal followed by nasogastric lavage and bicarbonate. Nasogastric lavage was occult-blood positive and rectal examination was guaiac-positive. She was then transferred to [**Hospital1 346**] for further management in out Medical Intensive Care Unit. PAST MEDICAL HISTORY: None. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: Diet pills that the patient purchased over the internet. She is not clear exactly what they were. FAMILY HISTORY: Family history was noncontributory. SOCIAL HISTORY: The patient reportedly drinks alcohol socially. She uses tobacco socially. She does have a history of cocaine use; per her cousin she quit last year. No history of intravenous drug use. She works in a health club. Her parents are divorced. She lives with her father. She has some recreational Percocet use in the last year. PHYSICAL EXAMINATION ON PRESENTATION: Temperature was 96.2 degrees Fahrenheit, her heart rate was in the 120s, her blood pressure was 93 to 116/57 to 63, she was on pressure support ventilation of 20/5/40% with a rate of 21 and a tidal volume of 880. Her oxygen saturation was 97% to 99% on room air. In general, the patient was an obese, sedated, and intubated woman. Skin showed pressure shores on her left forearm and left hip. Head, eyes, ears, nose, and throat examination revealed pupils were 5 mm and minimally reactive to light. She had charcoal around her mouth. Neck examination revealed a large smooth bulge on the right side with no lymphadenopathy. Cardiovascular examination revealed tachycardia; otherwise regular. Pulmonary examination was clear. The abdomen was obese but soft and nontender. There were positive bowel sounds. Extremity examination revealed no edema. There were strong bilateral radial pulses. There was normal capillary refill in her left arm and fingers. On neurologic examination, the patient was sedated and intubated. She had absent deep tendon reflexes in her patellar and Achilles. Her toes were upgoing bilaterally. PERTINENT LABORATORY VALUES ON PRESENTATION: White blood cell count was 26.9 (differential with 84% neutrophils, 10% bands, 3% lymphocytes, and 3% monocytes), her hematocrit was 52.8, and her platelets were in the 300s. Her INR was 3.2, her prothrombin time was 22, and her partial thromboplastin time was 35.8. Chemistry-7 revealed her sodium was 141, potassium was 4.7, chloride was 113, bicarbonate was 6, blood urea nitrogen was 10, creatinine was 0.9, and her blood glucose was 186. Her anion gap was 22. Her calcium was 8, her phosphate was 3.2, and her magnesium was 2.2. Alanine-aminotransferase was 291, her aspartate aminotransferase was 312, her lactate dehydrogenase was 276, creatine kinase was 39,700. Her alkaline phosphatase was 92. Her total bilirubin was 2. Her albumin was 4.3. Her Tylenol level was 706. Serum osmolalities were 314. Her lactate was 13.5. Acetone was negative. Ethanol was negative. Urinalysis revealed a specific gravity of 1.025, large blood, 30 protein, 250 glucose, 27 red blood cells, 27 white blood cells, and a few bacteria. PERTINENT RADIOLOGY/IMAGING: Electrocardiogram revealed a narrow complex tachycardia and R prime in V1. IMPRESSION: The patient is a 22-year-old female status post a suicide attempt with a large number of Tylenol PM who presented with an altered mental status requiring intubation with severe anion gap metabolic acidosis, coagulopathy, liver enzyme abnormalities, leukocytosis, rhabdomyolysis, and left arm compression. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. TOXICOLOGIC ISSUES: The patient presented with both a Tylenol and Benadryl overdose. The Tylenol overdose was treated with an infusion of N-acetylcysteine at 17.5 mg/kg per hour to decrease any further toxicity to the liver and kidneys. Additionally, the patient underwent urgent hemodialysis in an effort to decrease the Tylenol level given that it was over 700 on presentation to [**Hospital1 69**] which was at least 20 hours after ingestion. N-acetylcysteine was continued until the patient's liver enzymes had normalized to be below 1000. For the Benadryl overdose, the patient was treated supportively with benzodiazepines as needed for agitation from the anticholinergic effects of the Benadryl. The remaining toxicology screens for possible other substances ingested were negative. 2. LIVER ISSUES: The patient's liver enzymes and coagulation times were carefully monitored to determine liver function. Her alanine-aminotransferase peaked at approximately 12,000. Her aspartate aminotransferase peaked at about 8500. Additionally, the patient's INR peaked at approximately 10. Her bilirubin peaked at approximately 12. All were consistent with her being in hepatic failure. The patient was evaluated by the Liver Transplant team on the day of arrival. During her hospital course, she was in fact placed on the transplant list. However, her liver function began to recover and is in fact nearing normal currently. Thus, she did not need a liver transplant. Currently, her INR is 1.3. Her bilirubin is 3. Her liver enzymes are nearly normal. 3. RENAL ISSUES: Initially, the patient's kidney function was normal. She underwent emergent hemodialysis for decreasing the Tylenol level. However, several days into her hospital course, the patient developed decreased urine output and with an increasing urine sodium; concerning for acute tubular necrosis secondary to Tylenol toxicity. The patient was therefore restarted on hemodialysis for her acute renal failure through a right femoral Quinton catheter. The patient tolerated this very well. Over her hospital course, the patient's kidney function began to recover. By the time of discharge she had excellent urine output of over 2 liters of urine per day, and her creatinine was starting to normalize without hemodialysis. Her creatinine went from 6.6 on [**1-7**] to 6 on [**2195-1-8**]. Her kidney function will need to continue to be followed daily for the next several days after discharge to insure that it continues to recover. 4. RHABDOMYOLYSIS ISSUES: Rhabdomyolysis likely secondary to her prolonged time down on her left side. The patient was treated with vigorous hydration to prevent renal failure secondary to elevated myoglobin levels. Her creatine kinases normalized while she was in the hospital. 5. COAGULOPATHY ISSUES: The patient's initial coagulopathy on presentation to the outside hospital was likely secondary to direct effects of Tylenol on Factor VII. However, she subsequently developed a significant coagulopathy secondary to her renal failure. The patient received multiple units of fresh frozen plasma while she was in the hospital to correct her coagulopathy for procedures and other line placements. Additionally, she received multiple doses of vitamin K. By the time of discharge, her INR was 1.3. 6. LEFT RADIAL NERVE PALSY ISSUES: Initially, when the patient presented she had left arm swelling. There was concern for a possible compartment syndrome. The Orthopaedic Service was consulted and felt that she did not show signs of compartment syndrome after she was extubated, and her mental status had improved, neurologic and motor testing on her left arm revealed decreased thumb extension and abduction which was consistent with a left radial nerve palsy which was likely from compression. The Orthopaedic Service recommended a wrist splint to prevent thumb flexion contractors, and she was to follow up with Dr. [**Last Name (STitle) **] in the Hand Clinic one to two weeks after discharge. 7. SUICIDE ATTEMPT ISSUES: The patient had no known prior history of depression or suicide attempts. She was maintained with a one-to-one sitter for her entire in the hospital. Once the patient was extubated and was able to speak, the Psychiatry Service was involved in her care. They are arranging for her to receive inpatient psychiatric treatment now that her medical issues have nearly resolved. 8. ANION GAP METABOLIC ACIDOSIS ISSUES: The patient initially presented with a severe anion gap metabolic acidosis which was most likely secondary to a lactic acidosis which was most likely from a combination of the rhabdomyolysis and the fact that her liver was failing and was not effectively clearing lactate. The patient was treated with fluids containing bicarbonate, and the metabolic acidosis resolved over the first several days she was in the hospital. 9. ALTERED MENTAL STATUS ISSUES: On presentation, the patient's altered mental status was likely secondary to her large ingestion of Benadryl. Her mental status improved as she cleared over the first several days. 10. ASPIRATION PNEUMONIA ISSUES: The patient came in with an elevated white blood cell count and began spiking fevers. Chest x-rays and computed tomography scans were consistent with aspiration pneumonia. The patient was treated with a 10-day course of levofloxacin and Flagyl with resolution of her sputum production and fevers as well as improvement in her white blood cell counts. 11. ANEMIA ISSUES: The patient was noted to develop a decrease in her hematocrit while she was here in the hospital. Her hematocrit on admission was most likely hemoconcentrated. Nevertheless, while she was in here toward the end of her hospital course, her hematocrit levels were consistently in the 27 to 31 range. The etiology of this are currently unclear as iron studies, B12, and folate studies were pending at the time of this dictation. Although, given her age and the fact that she was menstruating, this was most likely reflective of an iron deficiency anemia. If the laboratories are consistent with this, the patient will be started on iron daily. At the time of this dictation, the [**Hospital 228**] medical issues have largely resolved or are near resolution. Her only current outstanding issues is her kidney failure; which, at this time, appears to be progressing toward resolution with a decrease in her creatinine today. The patient will need her kidney function to be followed daily for at least the next several days, but at this time we do not expect that she will need any further hemodialysis. Therefore, she is medically stable to go to an inpatient psychiatric facility. CONDITION AT DISCHARGE: Condition on discharge was improved. The patient currently denies any suicidal ideation. DISCHARGE STATUS: To inpatient psychiatric facility. DISCHARGE DIAGNOSES: 1. Suicide attempt by Tylenol overdose. 2. Fulminant hepatic failure secondary to Tylenol toxicity; nearly resolved. 3. Acute renal failure secondary to Tylenol toxicity requiring hemodialysis; resolving. 4. Left radial nerve compression injury. 5. Rhabdomyolysis; resolved. 6. Anemia. 7. Aspiration pneumonia; resolved. 8. Anion gap metabolic acidosis; resolved. 9. Mental status changes; resolved. 10. Coagulopathy; resolved. MEDICATIONS ON DISCHARGE: 1. Protonix 40 mg by mouth once per day. 2. Calcium carbonate 1000 mg by mouth three times per day (with meals); to be continued as long as phosphate is elevated. 3. Robitussin DM 5 mL to 10 mL by mouth q.4h. as needed. 4. Cepacol lozenges as needed. 5. Ferrous sulfate 325 mg by mouth once per day. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient was instructed to follow up with Inpatient Psychiatry, and upon discharge from the psychiatric facility was to follow up with outpatient Psychiatry as they direct. 2. The patient was also instructed to follow up with Dr. [**Last Name (STitle) **] for her left hand and thumb weakness. The patient was to call telemetry [**Telephone/Fax (1) 4845**] to schedule an appointment in approximately one to two weeks; she was to continue wearing the wrist splint until then to prevent flexion contractures. 3. Finally, the patient was instructed to follow up with her primary care physician upon discharge to further assess her renal function and make sure that it has returned to [**Location 213**]. 4. Additionally, while the patient is at the psychiatric facility she should have a Chemistry-10 checked daily for the next several days until her renal function normalizes or is nearly normal; at which point she should have it checked every three days for approximately one more week. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D. [**MD Number(1) 736**] Dictated By:[**Last Name (NamePattern1) 8978**] MEDQUIST36 D: [**2195-1-8**] 14:33 T: [**2195-1-8**] 15:30 JOB#: [**Job Number 52902**]

965,276,570,507,584,963,E950

{'Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Acute and subacute necrosis of liver,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 22-year-old female with no significant past medical history who was transferred here from an outside hospital after a Tylenol PM overdose. MEDICAL HISTORY: None. MEDICATION ON ADMISSION: Diet pills that the patient purchased over the internet. She is not clear exactly what they were. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history was noncontributory. SOCIAL HISTORY: The patient reportedly drinks alcohol socially. She uses tobacco socially. She does have a history of cocaine use; per her cousin she quit last year. No history of intravenous drug use. She works in a health club. Her parents are divorced. She lives with her father. She has some recreational Percocet use in the last year. ### Response: {'Poisoning by aromatic analgesics, not elsewhere classified,Acidosis,Acute and subacute necrosis of liver,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}

CHIEF COMPLAINT: coffee-ground emesis & regurgitation of food PRESENT ILLNESS: [**Known firstname **] [**Known lastname 86480**] is a 87 y/o woman with Alzheimer's dementia who one week ago underwent a barium swallow and UGI with SBFF concerning to evaluate an esophageal mass. The UGI study showed a mass concerning for esophageal malignancy. She presents to the ED today after 4 episodes of hematemsis today; per daughter only 1 episode reported to her by ALF. Daughter provides majority of history as patient is unable to provide hx [**12-29**] dementia. Daughter states that patient has been having vomiting or gagging on food stuff for the past 1.5 months. She states that it has been as if food is getting stuck on it's way down and she often vomits directly after eating. Typically the vomitus is food-stuff. This is the first episode of coffee-ground emesis. She did have a hx of LGIB thought to be secondary to bleeding hemorrhoids several years ago. . In the ED, her vitals signs were T 96.4 HR 96 BP 119/65 RR 16 O2 100% Sat on 3L. She was given IV PPI and antiemetics. They did not preform a NG lavage given known esophageal mass. Her baseline HCT is 35; her Hct is currently 30. ED sign out reports that she is alert & oriented times one (to person) which is her baseline. Her stool is bronze colored and guiac positive. MEDICAL HISTORY: # Esophageal stricture, per UGI w/ SBFT ([**2154-5-29**]) # Alzheimer's dementia - baseline orineted to self only, gets disoriented easily, yells out when confused, usually redirectable with 1:1 sitter # Breast cancer diagnosed in [**2134**] status post lumpectomy, XRT and chemotherapy # anemia of chronic inflam (baseline HCT is 35) # guaic + stool, known stomach polyps # Cardiac: 1+MR, 1+AR, 1+TR (TTE [**2146**]) # hypothyroidism on replacement tx (TSH = 0.62 on [**2154-6-18**]) # h/o SCC # Hemmorhoids, h/o LGIB thought to be [**12-29**] # Urinary [**Last Name (LF) 101539**], [**First Name3 (LF) **]-standing . PSHx: [**2150-6-18**] - s/p Excision of right forearm SCC with layered closure [**2134**] s/p lumpectomy s/p R knee surgery MEDICATION ON ADMISSION: Levothyroxine 50 mcg PO daily Prevacid 30 mg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PE: ============= vitals: 98.6 HR 101 BP 116/7 RR 23 O2 sat 98% on 3L NC Gen: pleasantly demented, alert & oriented x1, follows commands, NAD HEENT: NCAT, sclera white, PERRL, oropharynx with tachy mucosa neck: no LAD, no JVD Lungs: CTA in all lung fields CV: regular rate, rapid rhythm, S1 & s2 nl, no m/r/g Abd: +bs, mildly tender to palpation in epigastrium, nd, soft, no masses. Ext: 2+ edema to mid tibia bilat, no cyanosis or clubbing. 2+ radial pulses. Neuro: CN grossly intact, MAE equally. . FAMILY HISTORY: Her mother died of breast cancer. Father had no CAD, hypertension or diabetes and her brother has no history of coronary artery disease. SOCIAL HISTORY: She lives in [**Hospital3 15333**] Dementia unit in [**Location (un) **]. She normally walks independently with no assist devices, and does not fall frequently. No alcohol, no smoking. She has two children, a son who is a physician in [**Name (NI) 3844**] and a daughter who lives locally with two grandchildren.

Ulcer of esophagus with bleeding,Malignant neoplasm of middle third of esophagus,Acute posthemorrhagic anemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Urinary incontinence, unspecified,Benign neoplasm of stomach,Impacted cerumen,Personal history of other malignant neoplasm of skin,Personal history of malignant neoplasm of breast

Ulcer esophagus w bleed,Mal neo middle 3rd esoph,Ac posthemorrhag anemia,Alzheimer's disease,Dementia w/o behav dist,Hypothyroidism NOS,Diaphragmatic hernia,Cardiac dysrhythmias NEC,Urinary incontinence NOS,Benign neoplasm stomach,Impacted cerumen,Hx-skin malignancy NEC,Hx of breast malignancy

Name: [**Known lastname 16318**],[**Known firstname 779**] S. Unit No: [**Numeric Identifier 16319**] Admission Date: [**2154-6-17**] Discharge Date: [**2154-6-24**] Date of Birth: [**2067-3-16**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 12957**] Addendum: Hematemesis: The esophageal ulcerations seen on EGD were likely the cause of the hematemesis. At the time of discharge, esophageal cancer was still considered a likely possibility. Discharge Disposition: Extended Care Facility: [**Hospital3 474**]- [**Location (un) 164**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 12958**] MD [**MD Number(2) 12959**] Completed by:[**2154-7-23**] Admission Date: [**2154-6-17**] Discharge Date: [**2154-6-24**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 9853**] Chief Complaint: coffee-ground emesis & regurgitation of food Major Surgical or Invasive Procedure: [**2154-6-18**] EGD [**2154-6-20**] EGD with biopsies of esophagus History of Present Illness: [**Known firstname **] [**Known lastname 86480**] is a 87 y/o woman with Alzheimer's dementia who one week ago underwent a barium swallow and UGI with SBFF concerning to evaluate an esophageal mass. The UGI study showed a mass concerning for esophageal malignancy. She presents to the ED today after 4 episodes of hematemsis today; per daughter only 1 episode reported to her by ALF. Daughter provides majority of history as patient is unable to provide hx [**12-29**] dementia. Daughter states that patient has been having vomiting or gagging on food stuff for the past 1.5 months. She states that it has been as if food is getting stuck on it's way down and she often vomits directly after eating. Typically the vomitus is food-stuff. This is the first episode of coffee-ground emesis. She did have a hx of LGIB thought to be secondary to bleeding hemorrhoids several years ago. . In the ED, her vitals signs were T 96.4 HR 96 BP 119/65 RR 16 O2 100% Sat on 3L. She was given IV PPI and antiemetics. They did not preform a NG lavage given known esophageal mass. Her baseline HCT is 35; her Hct is currently 30. ED sign out reports that she is alert & oriented times one (to person) which is her baseline. Her stool is bronze colored and guiac positive. Past Medical History: # Esophageal stricture, per UGI w/ SBFT ([**2154-5-29**]) # Alzheimer's dementia - baseline orineted to self only, gets disoriented easily, yells out when confused, usually redirectable with 1:1 sitter # Breast cancer diagnosed in [**2134**] status post lumpectomy, XRT and chemotherapy # anemia of chronic inflam (baseline HCT is 35) # guaic + stool, known stomach polyps # Cardiac: 1+MR, 1+AR, 1+TR (TTE [**2146**]) # hypothyroidism on replacement tx (TSH = 0.62 on [**2154-6-18**]) # h/o SCC # Hemmorhoids, h/o LGIB thought to be [**12-29**] # Urinary [**Last Name (LF) 101539**], [**First Name3 (LF) **]-standing . PSHx: [**2150-6-18**] - s/p Excision of right forearm SCC with layered closure [**2134**] s/p lumpectomy s/p R knee surgery Social History: She lives in [**Hospital3 15333**] Dementia unit in [**Location (un) **]. She normally walks independently with no assist devices, and does not fall frequently. No alcohol, no smoking. She has two children, a son who is a physician in [**Name (NI) 3844**] and a daughter who lives locally with two grandchildren. Family History: Her mother died of breast cancer. Father had no CAD, hypertension or diabetes and her brother has no history of coronary artery disease. Physical Exam: ADMISSION PE: ============= vitals: 98.6 HR 101 BP 116/7 RR 23 O2 sat 98% on 3L NC Gen: pleasantly demented, alert & oriented x1, follows commands, NAD HEENT: NCAT, sclera white, PERRL, oropharynx with tachy mucosa neck: no LAD, no JVD Lungs: CTA in all lung fields CV: regular rate, rapid rhythm, S1 & s2 nl, no m/r/g Abd: +bs, mildly tender to palpation in epigastrium, nd, soft, no masses. Ext: 2+ edema to mid tibia bilat, no cyanosis or clubbing. 2+ radial pulses. Neuro: CN grossly intact, MAE equally. . Pertinent Results: ADMISSION LABS: ================ [**2154-6-17**] 11:44PM HCT-30.9* [**2154-6-17**] 09:31PM cTropnT-<0.01 [**2154-6-17**] 08:10PM PT-12.5 PTT-25.5 INR(PT)-1.1 [**2154-6-17**] 07:40PM GLUCOSE-180* UREA N-17 CREAT-0.8 SODIUM-141 POTASSIUM-4.8 CHLORIDE-105 TOTAL CO2-26 ANION GAP-15 [**2154-6-17**] 07:40PM ALT(SGPT)-17 AST(SGOT)-30 ALK PHOS-98 TOT BILI-0.1 [**2154-6-17**] 07:40PM LIPASE-31 [**2154-6-17**] 07:40PM CK-MB-2 [**2154-6-17**] 07:40PM WBC-15.9*# RBC-3.74* HGB-9.3* HCT-30.7* MCV-82# MCH-24.9* MCHC-30.3* RDW-13.4 [**2154-6-17**] 07:40PM NEUTS-84.8* BANDS-0 LYMPHS-10.4* MONOS-2.7 EOS-1.6 BASOS-0.5 [**2154-6-17**] 07:40PM PLT COUNT-637* IMAGING: ========= EKG [**6-17**]: Sinus tachycardia. Modest non-specific ST-T wave changes are suggested but baseline artifact makes assessment difficult. Since the previous tracing of [**2152-12-15**] modest ST-T wave changes are suggested but baseline artifact makes comparison difficult. CXR [**6-17**]: The patient is rotated. The cardiomediastinal silhouette appears unremarkable. There is minimal atelectasis at the left lung base. The right lung is clear. Bilat LE U/S [**6-19**]: There is normal compressibility, augmentation, and respiratory variation in the deep veins of both lower extremities. There is no evidence of DVT. CXR [**6-22**]: There is increased retrocardiac density, consistent with left lower lobe collapse and/or consolidation. The left hemidiaphragm is elevated. There are small bilateral effusions. Compared with [**2154-6-20**] and allowing for technical differences, no significant change is detected. There is no CHF. No other focal infiltrate is identified. EGD [**6-18**]: Findings: Esophagus: 1. Lumen: A large size hiatal hernia was seen, displacing the Z-line to 32cm from the incisors, with hiatal narrowing at 36cm from the incisors. 2. Mucosa: Abnormal mucosa with discrete ulceration was noted in the esophagus from 20-22cm. Diffuse circumferential ulceration with narrowing was noted from 22-25cm. We were unable to pass the adult gastroscope through the narrowing at 22 cm. The area was friable. There appeared to be Barrett's esophagus at 32-25 cm with mucosal irregularity at the more proximal extent where the ulceration began. Stomach: 3. Protruding Lesions: Many sessile polyps of benign appearance were found in the fundus and stomach body. Duodenum: Normal duodenum. Impression: Abnormal mucosa in the esophagus Large hiatal hernia Polyps in the fundus and stomach body Otherwise normal EGD to second part of the duodenum EGD [**6-20**]: Esophageal stricture (biopsy) Hiatal hernia Otherwise normal EGD to stomach body DISCHARGE LABS: ============== [**2154-6-21**] 08:50AM BLOOD WBC-5.0 RBC-4.27 Hgb-11.2* Hct-35.0* MCV-82 MCH-26.1* MCHC-31.9 RDW-14.4 Plt Ct-454* [**2154-6-21**] 08:50AM BLOOD Glucose-105 UreaN-6 Creat-0.7 Na-140 K-3.9 Cl-106 HCO3-22 AnGap-16 [**2154-6-18**] 05:09AM BLOOD TSH-0.62 [**2154-6-21**] 08:50AM BLOOD Albumin-2.6* Calcium-8.0* Phos-3.5 Mg-1.8 Brief Hospital Course: Briefly, this is an 87 yo female with a history of Alzheimer's dementia, who was admitted from the [**Hospital3 537**] on [**6-17**] with complaints of hematemesis. She was initially admitted to the ICU for close monitoring overnight. She remained hemodynamically stable and underwent a EGD procedure on the morning after admission ([**6-18**]). Per EGD on [**6-18**], the patient had circumferential narrowing of the esophagus at 22 cm, unable to pass the scope through, ulceration, and Barrett's changes concerning for esophageal cancer. She received 2 units of PRBC while in the ICU. The following is her course after she was sent to the general medicine floor: . # Esophageal stricture/ulceration: Once the patient was on the general medicine floor, EGD was repeated on [**2154-6-20**]. This showed again a circumferential stricture, but the scope was able to pass through the stricture this time, and biopsies were taken. She was able to tolerate a mechanical soft diet for several meals without any post-prandial emesis. She had one episode of regurgitation of solid food on the evening of [**6-21**] and she was observed for an additional day during which she tolerated several more meals of soft mechanical diet. She was also started on sucralfate for the esophageal ulcerations as well as protonix twice daily. The pathology on the EGD biopsy should be back next week, and the GI fellow, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3037**], [**First Name3 (LF) **] be following up on the results. The patient has follow up with Dr. [**First Name (STitle) 3037**] on [**2154-7-3**]. If malignant, the family expressed they would not want chemo or surgical intervention. . # Chronic Anemia with acute blood loss: The patient's hematocrit was down to 24, and she received 2 units of PRBC while in the ICU. Her hematocrit stabilized at 31-34. # Hypothyroid: Continued home dose of levothyroxine . # Tachycardia/ calf pain: she had one episode of sinus tachycardia to the 130s with associated calf pain. Bilat LE u/s negative, tachycardia resolved with transfusion of 2 units PRBC and one liter NS bolus. # Advance Directives: DNR/DNI, no chemo or surgical interventions. Family would consider hospice care if biopsy results malignant. Medications on Admission: Levothyroxine 50 mcg PO daily Prevacid 30 mg PO daily Discharge Medications: 1. Sucralfate 100 mg/mL Suspension Sig: Ten (10) mL PO four times a day. Disp:*1 month supply* Refills:*2* 2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 3. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO once a day. 4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 5. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital3 537**]- [**Location (un) 538**] Discharge Diagnosis: Primary Diagnosis: ================== # Esophageal Stricture, biopsies pending # Hematemesis . Secondary Diagnosis: ==================== # Esophageal stricture, per UGI w/ SBFT [**2154-5-29**] # Alzheimer's dementia - gets disoriented easily, yells out when confused, usually redirectable with 1:1 sitter # Breast cancer diagnosed in [**2134**] status post lumpectomy, XRT and chemotherapy # Anemia of chronic inflam (baseline HCT is 35) # Guaic + stool, known stomach polyps # Cardiac: 1+MR, 1+AR, 1+TR (TTE [**2146**]) # Hypothyroidism on replacement tx (TSH = 0.62 on [**2154-6-18**]) # h/o SCC # Hemmorhoids, h/o LGIB thought to be [**12-29**] # Urinary [**Month/Day (2) 101539**], longstanding . PSHx: [**2150-6-18**] - s/p Excision of right forearm SCC with layered closure [**2134**] s/p lumpectomy s/p R knee surgery Discharge Condition: Stable Discharge Instructions: You were admitted to the hospital after it was noted that there was some blood in your vomit. You were given blood tranfusions and your blood count has remained stable since. A tube was passed down your throat on two occasions and tissue samples were obtained from a location where your esophagus is narrowed. . Please call your primary care provider [**Name Initial (PRE) **]/or come to the hospital if you have uncontrolled vomiting, any blood or "coffee grounds" in any vomit, chest pain/pressure, trouble breathing, pain in your throat or abdomen, difficulty walking, feel dizzy or light-headed, blood in your stools, black stools, severe pain or other health-related concerns. . New medications called protonix and sucralfate were added to help treat your irritated esophagus. . Please make and keep all of your follow-up apointments. Followup Instructions: Follow up with GI as scheduled on [**7-3**]. They will be able to tell you the final results of the pathology. GI: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2154-7-3**] 3:00 Follow up with your PCP [**Last Name (NamePattern4) **] [**11-28**] weeks. Call Dr.[**Name (NI) 5049**] office at [**Telephone/Fax (1) 133**] to make an appointment.

530,150,285,331,294,244,553,427,788,211,380,V108,V103

{"Ulcer of esophagus with bleeding,Malignant neoplasm of middle third of esophagus,Acute posthemorrhagic anemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Urinary incontinence, unspecified,Benign neoplasm of stomach,Impacted cerumen,Personal history of other malignant neoplasm of skin,Personal history of malignant neoplasm of breast"}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: coffee-ground emesis & regurgitation of food PRESENT ILLNESS: [**Known firstname **] [**Known lastname 86480**] is a 87 y/o woman with Alzheimer's dementia who one week ago underwent a barium swallow and UGI with SBFF concerning to evaluate an esophageal mass. The UGI study showed a mass concerning for esophageal malignancy. She presents to the ED today after 4 episodes of hematemsis today; per daughter only 1 episode reported to her by ALF. Daughter provides majority of history as patient is unable to provide hx [**12-29**] dementia. Daughter states that patient has been having vomiting or gagging on food stuff for the past 1.5 months. She states that it has been as if food is getting stuck on it's way down and she often vomits directly after eating. Typically the vomitus is food-stuff. This is the first episode of coffee-ground emesis. She did have a hx of LGIB thought to be secondary to bleeding hemorrhoids several years ago. . In the ED, her vitals signs were T 96.4 HR 96 BP 119/65 RR 16 O2 100% Sat on 3L. She was given IV PPI and antiemetics. They did not preform a NG lavage given known esophageal mass. Her baseline HCT is 35; her Hct is currently 30. ED sign out reports that she is alert & oriented times one (to person) which is her baseline. Her stool is bronze colored and guiac positive. MEDICAL HISTORY: # Esophageal stricture, per UGI w/ SBFT ([**2154-5-29**]) # Alzheimer's dementia - baseline orineted to self only, gets disoriented easily, yells out when confused, usually redirectable with 1:1 sitter # Breast cancer diagnosed in [**2134**] status post lumpectomy, XRT and chemotherapy # anemia of chronic inflam (baseline HCT is 35) # guaic + stool, known stomach polyps # Cardiac: 1+MR, 1+AR, 1+TR (TTE [**2146**]) # hypothyroidism on replacement tx (TSH = 0.62 on [**2154-6-18**]) # h/o SCC # Hemmorhoids, h/o LGIB thought to be [**12-29**] # Urinary [**Last Name (LF) 101539**], [**First Name3 (LF) **]-standing . PSHx: [**2150-6-18**] - s/p Excision of right forearm SCC with layered closure [**2134**] s/p lumpectomy s/p R knee surgery MEDICATION ON ADMISSION: Levothyroxine 50 mcg PO daily Prevacid 30 mg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PE: ============= vitals: 98.6 HR 101 BP 116/7 RR 23 O2 sat 98% on 3L NC Gen: pleasantly demented, alert & oriented x1, follows commands, NAD HEENT: NCAT, sclera white, PERRL, oropharynx with tachy mucosa neck: no LAD, no JVD Lungs: CTA in all lung fields CV: regular rate, rapid rhythm, S1 & s2 nl, no m/r/g Abd: +bs, mildly tender to palpation in epigastrium, nd, soft, no masses. Ext: 2+ edema to mid tibia bilat, no cyanosis or clubbing. 2+ radial pulses. Neuro: CN grossly intact, MAE equally. . FAMILY HISTORY: Her mother died of breast cancer. Father had no CAD, hypertension or diabetes and her brother has no history of coronary artery disease. SOCIAL HISTORY: She lives in [**Hospital3 15333**] Dementia unit in [**Location (un) **]. She normally walks independently with no assist devices, and does not fall frequently. No alcohol, no smoking. She has two children, a son who is a physician in [**Name (NI) 3844**] and a daughter who lives locally with two grandchildren. ### Response: {"Ulcer of esophagus with bleeding,Malignant neoplasm of middle third of esophagus,Acute posthemorrhagic anemia,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Urinary incontinence, unspecified,Benign neoplasm of stomach,Impacted cerumen,Personal history of other malignant neoplasm of skin,Personal history of malignant neoplasm of breast"}

CHIEF COMPLAINT: Fever, Hypotension PRESENT ILLNESS: This is a 59 y/o M with PMH of HTN, EtOH cirrhosis (no active EtOH use), hyperlipedemia, and neuropathic right heel ulceration s/p debridement and treatment with wound vac at rehab who was transferred from his rehabilitation facility to [**Hospital3 26615**] on [**2143-12-10**] with fevers, hypotension, and left shoulder pain. . At the OSH, initial vitals were remarkable for a BP of 78/31 and HR=119. Subsequently developed atrial fibrillation with RVR. Received digoxin and beta blockade after which he converted to sinus rythm. Labs notable for a WBC of 19.6, Na 127, Cl 99, HCO3 17, Cr 2.0, BUN 44. CE (-) x3. A renal US was unremarkable. CXR with ?left infiltrate, and UA with significant pyuria. He had been recently started on Augmentin 875mg [**Hospital1 **] for presumed UTI. He was treated with fluids and IV antibiotics (Vanc/Zosyn) at [**Hospital3 26615**] for presumed sepsis as well as lovenox for ?PE. VQ scan was low probability for a PE and the lovenox was stopped. A CT scan was done due to continued shoulder pain and SOB which showed a mediastinal mass with ?extravasation of blood from the aortic arch. The patient was transferred to [**Hospital1 18**] on a labetolol drip for further evaluation by cardiothoracic surgery. . At [**Hospital1 18**], the patient was found to be HD stable with HR in the 80s and sbp between 110 - 120. O2 saturation of 97% on 4L NC, breathing 25 breaths per minutes. Still reported left shoulder pain. The pain has been present for 3-4 days, feels sharp, wakes patient up from sleep occasionally. He denies any chest pain or pressure. MEDICAL HISTORY: - Alcoholic Cirrhosis (per reported history no drinks x1.5 yrs) MEDICATION ON ADMISSION: Metoprolol tartrate 25'', Aldactone 25, Vit C 500'', Prostat 30'' ALLERGIES: Heparin Agents PHYSICAL EXAM: On Admission: VS - 98.3 140/52 79 20 96%RA GENERAL - Patient appears comfortable, lying in bed. More alert than prior. LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - Soft, NT/ND, BSx4 EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs). Skin overlying right foot appears somewhat inflamed. Wrapped in bandage. SKIN - Many healed scars on overabdomen, UE and on legs. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, alert and oriented, moving all extremeties FAMILY HISTORY: CAD, father had vfib arrest. Per report, parents may have also had hepatitis SOCIAL HISTORY: Homeless, prior history of alcoholism but claims abstinence for 1.5 years, still smokes pack of cigarettes daily, former nurse who worked at [**Hospital1 2025**] and [**Location (un) 8599**]who has not worked since [**2137**].

Other specified septicemias,Perforation of intestine,Acute respiratory failure,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Hepatic encephalopathy,Ulcer of heel and midfoot,Urinary tract infection, site not specified,Unspecified pleural effusion,Acidosis,Paroxysmal ventricular tachycardia,Jaundice, unspecified, not of newborn,Unspecified disease of pericardium,Alcoholic cirrhosis of liver,Severe sepsis,Thoracic aneurysm without mention of rupture,Venous (peripheral) insufficiency, unspecified,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of Methicillin resistant Staphylococcus aureus,Encounter for palliative care

Septicemia NEC,Perforation of intestine,Acute respiratry failure,Pneumonia, organism NOS,Ac kidny fail, tubr necr,Hepatic encephalopathy,Ulcer of heel & midfoot,Urin tract infection NOS,Pleural effusion NOS,Acidosis,Parox ventric tachycard,Jaundice NOS,Pericardial disease NOS,Alcohol cirrhosis liver,Severe sepsis,Thoracic aortic aneurysm,Venous insufficiency NOS,Ben hy kid w cr kid I-IV,Chronic kidney dis NOS,Thrombocytopenia NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Hypothyroidism NOS,Alcohol abuse-unspec,Depressive disorder NEC,Hx Methicln resist Staph,Encountr palliative care

Admission Date: [**2143-12-11**] Discharge Date: [**2144-1-8**] Date of Birth: [**2084-11-13**] Sex: M Service: SURGERY Allergies: Heparin Agents Attending:[**First Name3 (LF) 695**] Chief Complaint: Fever, Hypotension Major Surgical or Invasive Procedure: Left Thoracentesis Right Hemicolectomy History of Present Illness: This is a 59 y/o M with PMH of HTN, EtOH cirrhosis (no active EtOH use), hyperlipedemia, and neuropathic right heel ulceration s/p debridement and treatment with wound vac at rehab who was transferred from his rehabilitation facility to [**Hospital3 26615**] on [**2143-12-10**] with fevers, hypotension, and left shoulder pain. . At the OSH, initial vitals were remarkable for a BP of 78/31 and HR=119. Subsequently developed atrial fibrillation with RVR. Received digoxin and beta blockade after which he converted to sinus rythm. Labs notable for a WBC of 19.6, Na 127, Cl 99, HCO3 17, Cr 2.0, BUN 44. CE (-) x3. A renal US was unremarkable. CXR with ?left infiltrate, and UA with significant pyuria. He had been recently started on Augmentin 875mg [**Hospital1 **] for presumed UTI. He was treated with fluids and IV antibiotics (Vanc/Zosyn) at [**Hospital3 26615**] for presumed sepsis as well as lovenox for ?PE. VQ scan was low probability for a PE and the lovenox was stopped. A CT scan was done due to continued shoulder pain and SOB which showed a mediastinal mass with ?extravasation of blood from the aortic arch. The patient was transferred to [**Hospital1 18**] on a labetolol drip for further evaluation by cardiothoracic surgery. . At [**Hospital1 18**], the patient was found to be HD stable with HR in the 80s and sbp between 110 - 120. O2 saturation of 97% on 4L NC, breathing 25 breaths per minutes. Still reported left shoulder pain. The pain has been present for 3-4 days, feels sharp, wakes patient up from sleep occasionally. He denies any chest pain or pressure. Past Medical History: - Alcoholic Cirrhosis (per reported history no drinks x1.5 yrs) - Chronic neuropathic heel ulcer with hx of MRSA in the wound 1 year ago, s/p debridement and treatment with wound vac at rehab. - HTN - Depression - Chronic venous stasis Social History: Homeless, prior history of alcoholism but claims abstinence for 1.5 years, still smokes pack of cigarettes daily, former nurse who worked at [**Hospital1 2025**] and [**Location (un) 8599**]who has not worked since [**2137**]. Family History: CAD, father had vfib arrest. Per report, parents may have also had hepatitis Physical Exam: On Admission: VS - 98.3 140/52 79 20 96%RA GENERAL - Patient appears comfortable, lying in bed. More alert than prior. LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - Soft, NT/ND, BSx4 EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs). Skin overlying right foot appears somewhat inflamed. Wrapped in bandage. SKIN - Many healed scars on overabdomen, UE and on legs. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, alert and oriented, moving all extremeties Pertinent Results: LABORATORY RESULTS On Admission: [**2143-12-11**] 09:15PM BLOOD WBC-22.8* RBC-3.02* Hgb-9.5* Hct-28.4* MCV-94 MCH-31.4 MCHC-33.4 RDW-15.8* Plt Ct-196 [**2143-12-11**] 09:15PM BLOOD PT-18.0* PTT-36.0 INR(PT)-1.7* [**2143-12-11**] 09:15PM BLOOD Glucose-143* UreaN-34* Creat-1.7* Na-133 K-4.5 Cl-108 HCO3-16* AnGap-14 [**2143-12-11**] 09:15PM BLOOD ALT-16 AST-32 AlkPhos-97 TotBili-1.4 [**2143-12-11**] 09:15PM BLOOD Calcium-7.8* Phos-3.9 Mg-1.5* [**2143-12-14**] 08:20AM BLOOD calTIBC-211* VitB12-GREATER TH Folate-9.3 Hapto-62 Ferritn-583* TRF-162* [**2143-12-12**] 02:46AM BLOOD %HbA1c-5.2 eAG-103 [**2143-12-17**] 08:19AM BLOOD TSH-5.3* [**2143-12-17**] 08:19AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE IgM HBc-NEGATIVE [**2143-12-17**] 08:19AM BLOOD AMA-NEGATIVE Smooth-POSITIVE * [**2143-12-16**] 07:25AM BLOOD Anti-Tg-LESS THAN Thyrogl-29 [**2143-12-17**] 08:19AM BLOOD HIV Ab-NEGATIVE STUDIES: . [**Hospital3 26615**] Hospital Microbiology: UCx [**12-10**]: MSSA 10,000 u/ml BCx [**12-10**]: MSSA Wound Cx from foot ulcer [**12-10**]: Abundant growth of pseudomonas, insensitive to gent otherwise pan-sensitive . STUDIES: . FROM [**Hospital3 **] . TTE without vegitations. . CT Chest [**12-11**]: 1. Leaking ascending thoracic aortic aneurysm with hematoma within the superior mediastinum 2. Large left pleurall effusion 3. Splenic varices and splenomegaly . Renal US [**12-11**]: 1. No hydronephrosis 2. Elongated son[**Name (NI) 15487**] area in the upper pole of the left kidney which could represent and elongated cyst or dilated calix. . CXR Three view [**12-10**]: Impression: Mild hazy opacity in LL base, could represent PNA, mild blunting of posterior costophrenic angles which could represent small effusions. . CXR Portable [**12-11**]: Impression: New CHF. Component of LLL PNA cannot be excluded . VQ Scan [**12-11**]: Impression: Low suspiscion lung scan for pulmonary embolic disease . AT [**Hospital1 18**]: . IMAGING: [**12-22**] CT torso: 1. The patient is now intubated, and there is focal parenchymal opacification distributed throughout the lungs bilaterally consistent with multifocal pneumonia. Bilateral pleural effusions > left side. 2. Stable appearance to a high-density fluid collection in the anterior - superior mediastinum when compared to prior imaging from [**2143-12-11**]. 3. Cirrhotic liver with sequelae of portal hypertension including splenomegaly, ascites and splenorenal varices. 4. No abdominal collection or abscess identified. No evidence for anastomotic leak. 5. Small seroma under the lower half of the laparotomy wound but there is no evidence for abdominal wall diastasis to suggest connection with the peritoneal cavity ascites. [**12-23**] TTE:Suboptimal image quality as the patient was difficult to position. Normal biventricular cavity sizes with preserved global and regional biventricular systolic function . [**12-24**] CXR: As compared to the previous radiograph, there is no relevant change. Low lung volumes with multiple parenchymal bilateral opacities and bilateral pleural effusions. Unchanged coexistence of both fluid overload and multifocal infection. No newly occurred focal parenchymal opacities. No evidence of pneumothorax. . [**12-24**] B/l LE U/s: No evidence of DVT. . [**12-25**]: Renal U/s: Very limited visualization of the kidneys due to the patient's body habitus. No gross abnormality is identified. Arterial and venous flow is seen bilaterally within the kidneys. Large amount of ascites . [**12-26**] CXR As compared to the previous radiograph, the patient position has completely unchanged. On this basis, the left hemithorax appears dense and the right hemithorax appears less dense than before. Overall; however, it is likely that the pre-existing multifocal opacities have not substantially changed. Moderate cardiomegaly with retrocardiac atelectasis and moderate left pleural effusion. No pneumothorax. Unchanged monitoring and support devices. . [**12-27**] Abdomen US: mod ascites . [**12-29**] CXR: Cardiomegaly and widened mediastinum are unchanged. Right PICC tip is in the lower SVC. ET tube is in standard position. NG tube tip is out of view below the diaphragm. There is no evident pneumothorax. Widened mediastinum is stable. Large left pleural effusion is probably unchanged allowing the difference in positioning of the patient with adjacent atelectasis. The right lung is grossly clear. Pulmonary edema has improved, almost resolved. [**12-31**] CXR: 1. Gradual mediastinal widening; consider a follow-up radiograph in supine positioning. 2. Mediastinal contours demonstrate the lymphadenopathy and contained dissection/pseudoaneurysm better seen on prior CT. 3. Moderate left pleural effusion with underlying atelectasis and mild pulmonary edema; underlying infection cannot be excluded. . [**1-1**] CXR: Widened mediastinum is stable allowing the difference in positioning of the patient. Cardiomegaly is also unchanged. Right central catheter tip is in the lower SVC. ET tube is seen in standard position. NG tube tip is out of view below the diaphragm. The stomach is very distended. Mild-to-moderate pulmonary edema is stable. Mild left pleural effusion is stable. . [**1-2**] CXR: In comparison with the study of [**1-1**], there is little overall change . [**1-2**] Renal U/s: 1. No hydronephrosis. Mildly echogenic kidneys bilaterally consistent with chronic renal disease. 2. No evidence of renal artery stenosis. 3. Mild ascites is noted. . [**1-3**] Cxr: P . [**1-5**] TTE: circumferential pericardial effusion [**1-7**] CXR: IMPRESSION: Endotracheal tube ends at the level of the clavicle, approximately 6.4 cm above carina. Consider advancing the endotracheal tube by approximately 2-3 cm for appropriate seating. Right internal jugular line ends at upper/mid SVC and right PICC line terminates at mid SVC. Given the history of recent pericardial window for pericardial tamponade, tip of a new line ending extending to the middle of cardiac silhouette may represent pericardial drain catheter. Bilateral moderate pleural effusions associated with lower lung atelectasis, left side more than right, and mild pulmonary edema is unchanged. Enlarged heart size and widened superior mediastinum is stable. [**1-7**] Echo: Suboptimal image quality. No pericardial effusion. Prominent left pleural effusion. MICRO: [**12-18**]: peritoneal fluid - 4+ PMNC, no organisms [**12-21**]: peritoneal fluid - no PMNC no organisms, cx: enterococci [**12-23**]: Sputum - >25 PMN, no microorganisms [**12-23**]: MRSA screen: No MRSA isolated. [**12-23**]: BAL gs: 4+pmn, no org. Bact/[**Doctor Last Name **]/AFB cx all NG, AFB Cx: P. Sputum culture negative. [**12-23**]: viral screen: insufficient sample for stain, cx: Negative [**12-25**]: Legionalla Urine antigen: Negative [**12-27**] Peritoneal Fluid: GS 4+ PMN's, no orgs, Cx: Negative [**12-28**] Catheter tip cx: Negative [**12-29**] BAL: GS: 3+ PMN's, no orgs, Resp Cx: Yeast [**12-29**] Resp Cx: Inadequate Specimen [**12-30**] MRSA: Neg [**12-31**] Peritoneal Fluid: 3+ PMN's, No Orgs, Fluid Cx: NG, Anaer Cx: NG [**1-3**] UCx: Yeast [**1-3**] BCx: P [**1-4**] Peritoneal - GS: 4+ PMNs, No orgs, Cx: NG [**1-4**] BCx: P [**1-6**] MRSA: Neg [**1-6**] BCx: P Brief Hospital Course: Mr. [**Known lastname 92542**] is a 59 y/o M with PMH of EtOH cirrhosis and neuropathic right heel ulceration s/p debridement who presented with MSSA bacteremia. . #. MSSA Bacteremia - The patient presented with hypotension and fever to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital. Initial vitals remarkable for BP of 78/31 and HR=119. Labs notable for a WBC of 19.6, Na 127, Cl 99, HCO3 17, Cr 2.0, BUN 44. CE (-) x3. A renal US was unremarkable. CXR with ?left infiltrate, and UA with significant pyuria. Given IVF and started on vanc/zosyn. Transferred to [**Hospital1 18**] for possible bleeding aneurism as discussed below. At [**Hospital1 18**] Blood cultures from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] grew MSSA. Also with urine culture growing MSSA. Now HD stable on cipro/nafcillin. Urine cultures here with staph aureus and blood cx negative. Most likely site of entry is debrided heel wound with subsequent seeding of the renal parenchyma. - Trend WBC, fever curve - F/u BCx, UCx - ID recs - Continue nafcillin/cipro for MSSA coverage - TEE . #. Aortic pseudoaneurysm - Per CT [**Doctor First Name **] there is no urgent need for surgery on this patient's pseudoaneurysm. There is some concern for infection in the area of the aneurism and surgery is deferring intervention. Will continue to follow on the floor. Cause of aneurysm is unclear. [**Name2 (NI) **] likely atherosclerosis/HTN given smoking history although will also consider mycotic aneurism related to infection. - F/u CT [**Doctor First Name **] and vascular recs - Tagged WBC scan pending today - Continue to treat infection as above - Per CT [**Doctor First Name **] will require repeat imaging once infection resolves . #. Pleural Effusion - Underwent successful [**Female First Name (un) 576**] with 1.5L removed from pleural space yesterday. Appeared serous. Chemistries show an exudative effusion. Unknwon etiology at this time although large # of WBC and low pH; suspect infectious process. - Continue to monitor for hypoxia - F/u Bcx as above; will obtain sputum Cx if has good expectorations - F/u pleural fluid culture and cytology - Continue cefepime to cover for HCAP; also continue on vancomycin as above . #. Atrial fibrillation - No known h/o of Afib although developed afib with RVR at the OSH. Most likely due to infection/sepsis vs. new aoritic aneurism. Does not have a history of underlying heart disease and CE (-). Now back in sinus rhythtym. - CHADs 2 score of 1 so will not require AC - Continue BBlocker for rate control - Monitor on tele - Consider cardioversion if reverts back to afib . #. HTN - Patient has a h/o HTN treated at home with BBlocker only. Has had difficult to control HTN in house which may explain developing aoritc aneurism. BPs have been well controlled over the past 48 hours. - Continue labetolol - Continue amlodipine - Target BP 120 per CT [**Doctor First Name **] - Hydralazine PRN for BP > 150 . #. [**Last Name (un) **] - New uptrending Cr over the past 2 days is concerning for worsening infection vs. ATN due to medications. Less likely pre-renal given low BUN:Cr ratio although will obtain urine lytes today. - Trend Cr - Treat bacteremia/bacteuria - F/u urine lytes - Consider renal c/s if Cr does not stabilize . #. Cirrhosis - The patient has a cirrhotic liver believed to be [**2-13**] prior EtOH abuse. CT Abdomen here shows cirrhosis. Albumin is low and INR elevated both of which are likely related to underlying liver disease. Bedside US yesterday surprisingly showed no ascites. Obtained [**Hospital1 2025**] records which were not particularly useful in determing progress to date of this patient's liver disease. Initiated work-up here. - Continue to monitor coags - Consider nadolol if concern for varices - Trnd LFTs; WNL here although this may be bland cirrhosis as seen in 5% of cirrhotic patients - Cirrhosis w/u pending including HCV, HBCV, anti-mito, anti-sm, alpha-1, ceruloplasmis - Nutrition consult . #. Elevated Lipase - Patient has an elevated lipase to 360. Unknown etiology. Patient does not appear to have an acute abdomen or other e/o pancreatitis. [**Month (only) 116**] be related to prior hypotension which has now resolved. - Repeat lipase is improved. No need fo further monitoring. . #. Anemia - Unknown baseline H&H. On admission here hgb was 9.5 and has been stable. No Signs of active bleeding or hemolysis. Most likely related to myelosupression from udnerlying cirrhosis with possibly chronically depressed renal function/decreased Epo. - Trend Hct - Iron studies indicate some element of ACD - Haptoglobin, retic count unremarkable - Folate, B12 WNL - Will transfuse for Hct < 20 . #. Neuropathic Joint - Unknown etiology of patient neuropathic heel which has led to ulceration and likely to present bacteremia. HgA1c here is not c/w DMII which would have been the most likely etiology. [**Month (only) 116**] be related to vascular disease (although appears well vascularized) and B12 deficiency from prior (current ?) EtOH use. Also consider syphillis as above. Wound culture from OSH growing gent resistant pseudomonas. - Continue treatment of infectious processes as above - Wound care consult - RPR neg - Podiatry recs. Feel wound is healing well. Continue wound vac. [**12-21**]: txfer'ed from floor for respiratory distress, intubated upon arrival. acidotic to pH 7.15 o/n, started on bicarb ggt. Hypotensive, briefly on neo gtt [**12-22**]: off neo gtt. hct: 26.7-3u-31.1-34, CTtorso (+PO contrast, -IV contrast) - multifocal PNA, no anastomotic leak. mini-BAL ordered, consider formal bronch. ET suctioning - AF 110s, SBP 130s - lopressor 5x2/dilt 10x2, lasix 80, decreasing PaO2, inc PEEP 10 to 12, TV 550-520-500. bladder pressure 17-18. Vanc held for trough 18.4. - nephrology following - recommend lasix gtt or HD if persistently deranged electrolytes [**12-23**]; continued on lasix [**Hospital1 **]; 600 cc negative; bronched with BAL sent, TTE - nl bivaentricular sizes, LVEF, no wall motion abnl. peritoneal fluid [**12-21**] enterococci [**12-25**]: Lasix held due to elev Cr, Repeat Urine lytes sent FeNa 0.3% and FeUrea 33.3%, d/c zosyn due to drug rash and start meropenem, allow pt to autodiurese [**12-26**]: lasix held again, auto-diuressing; Growing VRE from peritoneal cx, started Linezolid; Afib w HR 130-120's, rate controlled w lopressor and dilt 30'''', TF changed to nepro w goal 35, Attnd requested IR guided PICC placement, IR post pyloric dobhoff, U/S abd, ?ascites & tap, and IP consult to tap left pleural effusion. [**12-27**]: IP req repeat chest CT (no bedside u/s yet), plan IR dobhoff/PICC [**12-28**], bedside u/s - 2L paracentesis W13200 (P65) - ID to reconsult re: abx regimen. 12.5g25% alb. 20ivLasix - 785cc. CVP12-8. [**12-28**]: Lasix 40 mg x 2 given, dopoff advanced and picc placed. rate control held yesterday and then went into afib. slightly more alert. blood sputum suctioned from ETT. Negative 1L. [**12-29**]: lasix x 2 per primary team, bronchoscopy with blood secretions noted-> BAL taken [**12-30**]: continued blood secretions, no extubation per primary, rad Aline adjusted - not successful. AFib occurred with Physical therapy, rate controlled - Dilt 10iv x2. R heel VAC dsg by podiatry. persistent midline ascitic drainage - Midline VAC placed . Beneprotein dc'd from nepro TF for elevated BUN. held all pain medications/lopressor per primary team. [**12-31**]: tolerating CPAP, kept intubated per primary team. Following commands intermittently. U/S guided paracentesis done at bedside, 2.6L out; given 25% albumin x2 & NS bolus of 500 after tap for low UOP. Converted into Afib o/n, given Dilt 10 IV x 2 [**1-1**]: in Afib, Dilt 10 mg x 2, since dilt maxed at 90 qid, started metoprolol 25 [**Hospital1 **] can uptitrate. [**1-2**]: self extubated in AM, satting well on FM, continues to be azotemic. ?HRS - started on octreotide, midodrine. Albumin 25%25g [**Hospital1 **] standing x 3-5 days, HIT panel sent, hepatology/renal consults placed->may need CVVH in next day or so [**1-3**]: HIT positive, SHQ stopped, awaiting Heme recs on [**1-4**] ie anticoagulation; HD line placed, CVVH started, hypotensive to SBP 50's, staretd on neo, switched to vasopressin. Pt continues hypotensive, maxed out on vaso, started neo, given 1 U PRBC, will need bedside echo early this AM [**1-4**]: bedside TTE (CCU resident) c/w circumferential pericardial effusion with early tamponade physiology. hypotensive req vaso 1.2, neo .5 (stable o/n). cardiac surgery consultation called, discussion re decompressive pericardiocentesis v ex-lap for hypotensive etiology (cardiogenic v septic) - hepatobiliary team to OR for ex-lap - pericardial window ([**Doctor Last Name **] to bulb), ex-lap no leak, no clear intraabdominal pathology, 800cc pericardial fluid evacuated, 3L ascites drained, 12.5%25g albumin x 1 post-op, oliguric post-op, rising lactate 3-5.6 (pulsesx4/bladder pressure 13) [**1-5**]: transitioned from CPAP to CMV; continued dilt 90 qid for rate control with metoprolol; in PM dysynchronous from vent; sedation increased. Lactate still rising with metabolic acidosis. With improved sedation able to increase MV. Discussed with renal and diasylate changed to B32. Also given amp bicarb x 2 o/n, total 6 gm Ca repletion, mg repletion. ABG slowly improved. Continued on CVVH. [**1-6**]: Cardioverted with 50J x 2 for unstable Vtach with pulses, NSR with BP 70/40->vasopressin started, metoprolol d/c, dilt d/c, amio bolus and gtt, on neo/vasopressin, even I/O via CVVH [**1-7**]: CMO, remains intubated on mIVF (MAP 30s o/n, no ectopy) midaz/fent, no labs [**1-8**]: Expired Medications on Admission: Metoprolol tartrate 25'', Aldactone 25, Vit C 500'', Prostat 30'' Discharge Disposition: Expired Discharge Diagnosis: End stage liver disease s/p right colectomy for perforation heart failure Discharge Condition: Expired [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**] Completed by:[**2144-1-9**]

038,569,518,486,584,572,707,599,511,276,427,782,423,571,995,441,459,403,585,287,272,285,244,305,311,V120,V667

{'Other specified septicemias,Perforation of intestine,Acute respiratory failure,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Hepatic encephalopathy,Ulcer of heel and midfoot,Urinary tract infection, site not specified,Unspecified pleural effusion,Acidosis,Paroxysmal ventricular tachycardia,Jaundice, unspecified, not of newborn,Unspecified disease of pericardium,Alcoholic cirrhosis of liver,Severe sepsis,Thoracic aneurysm without mention of rupture,Venous (peripheral) insufficiency, unspecified,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of Methicillin resistant Staphylococcus aureus,Encounter for palliative care'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Fever, Hypotension PRESENT ILLNESS: This is a 59 y/o M with PMH of HTN, EtOH cirrhosis (no active EtOH use), hyperlipedemia, and neuropathic right heel ulceration s/p debridement and treatment with wound vac at rehab who was transferred from his rehabilitation facility to [**Hospital3 26615**] on [**2143-12-10**] with fevers, hypotension, and left shoulder pain. . At the OSH, initial vitals were remarkable for a BP of 78/31 and HR=119. Subsequently developed atrial fibrillation with RVR. Received digoxin and beta blockade after which he converted to sinus rythm. Labs notable for a WBC of 19.6, Na 127, Cl 99, HCO3 17, Cr 2.0, BUN 44. CE (-) x3. A renal US was unremarkable. CXR with ?left infiltrate, and UA with significant pyuria. He had been recently started on Augmentin 875mg [**Hospital1 **] for presumed UTI. He was treated with fluids and IV antibiotics (Vanc/Zosyn) at [**Hospital3 26615**] for presumed sepsis as well as lovenox for ?PE. VQ scan was low probability for a PE and the lovenox was stopped. A CT scan was done due to continued shoulder pain and SOB which showed a mediastinal mass with ?extravasation of blood from the aortic arch. The patient was transferred to [**Hospital1 18**] on a labetolol drip for further evaluation by cardiothoracic surgery. . At [**Hospital1 18**], the patient was found to be HD stable with HR in the 80s and sbp between 110 - 120. O2 saturation of 97% on 4L NC, breathing 25 breaths per minutes. Still reported left shoulder pain. The pain has been present for 3-4 days, feels sharp, wakes patient up from sleep occasionally. He denies any chest pain or pressure. MEDICAL HISTORY: - Alcoholic Cirrhosis (per reported history no drinks x1.5 yrs) MEDICATION ON ADMISSION: Metoprolol tartrate 25'', Aldactone 25, Vit C 500'', Prostat 30'' ALLERGIES: Heparin Agents PHYSICAL EXAM: On Admission: VS - 98.3 140/52 79 20 96%RA GENERAL - Patient appears comfortable, lying in bed. More alert than prior. LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - Soft, NT/ND, BSx4 EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs). Skin overlying right foot appears somewhat inflamed. Wrapped in bandage. SKIN - Many healed scars on overabdomen, UE and on legs. LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, alert and oriented, moving all extremeties FAMILY HISTORY: CAD, father had vfib arrest. Per report, parents may have also had hepatitis SOCIAL HISTORY: Homeless, prior history of alcoholism but claims abstinence for 1.5 years, still smokes pack of cigarettes daily, former nurse who worked at [**Hospital1 2025**] and [**Location (un) 8599**]who has not worked since [**2137**]. ### Response: {'Other specified septicemias,Perforation of intestine,Acute respiratory failure,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Hepatic encephalopathy,Ulcer of heel and midfoot,Urinary tract infection, site not specified,Unspecified pleural effusion,Acidosis,Paroxysmal ventricular tachycardia,Jaundice, unspecified, not of newborn,Unspecified disease of pericardium,Alcoholic cirrhosis of liver,Severe sepsis,Thoracic aneurysm without mention of rupture,Venous (peripheral) insufficiency, unspecified,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of Methicillin resistant Staphylococcus aureus,Encounter for palliative care'}

CHIEF COMPLAINT: fall off ladder PRESENT ILLNESS: 71M with Afib on coumadin, CAD s/p 1 vessel CABG, presenting s/p fall off a ladder earlier today. He was disassembling an awning outside his house and was on the 4th or 5th stair of his ladder. Noted that the ladder was on a slippery surface, and seemed to lean over to the left and he fell on his left side. Does not recall exact details of the actual fall. Unsure if he lost consciousness. Unwitnessed but his wife heard the fall. Able to get up immediately after and walk into his house. Denied any preceding dizziness, LH, CP, palps. Denied any HA, visual changes, pain in extremities; did note a feeling of muscle pull on his left torso/flank. Brought to OSH hospital, imaging suggestive of tiny SDH. Transferred to [**Hospital1 18**] for neurosurgical evaluation. . In the ED, initial vs were: T99.1 72 134/85 15 98% on RA. CT head confirmed tiny SDH, no change from this afternoon's OSH study; also possible tiny SAH. Neurosurgery consulted, recommended phenytoin for tiny subarachnoid. Also repeat head CT in AM. Needs Q2H neuro checks. Per ED, since no neurosurgical managment anticipated, neurosurg recommended admission to trauma ICU; TICU service refused admission and recommended admit to medicine. Patient was given phenytoin and oxycodone. MEDICAL HISTORY: - Aortic stenosis s/p tissue AVR [**9-/2179**] - CAD s/p single vessel CABG (LIMA to LAD) during AVR [**2179**] - Afib on coumadin - s/p PPM (bradycardia) ~ [**2174**] - Hyperlipidemia - GERD - BPH MEDICATION ON ADMISSION: warfarin 2.5 mg 4times weekly, 5 mg 3xweekly ASA 81 mg daily digoxin 250 mcg daily atenolol 100 mg [**Hospital1 **] diltiazem 240 mg daily crestor 10 mg daily prilosec 20 mg daily flomax 0.4 mg daily vit C 1000 mg daily vit D 1000 units daily ALLERGIES: Lipitor PHYSICAL EXAM: General: Alert, oriented, very pleasant, no acute distress. HEENT: Sclera anicteric, PERRL 3->2, EOMI, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Mostly regular with occ irreg beats, normal S1 + S2, 2-3/6 SM best at RUSB. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. No focal TTP over left sided ribs; describes whole area as mildly sore. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Hips with full painless ROM in flexion, int/ext rotation. LUE with significant edema and mild ecchymosis near elbow. Elbow with full active and passive ROM; painless but notes "tightness of skin". Neuro: Alert and oriented x3. CN II-XII intact. Sensation grossly intact. Muscle bulk and tone normal. Strength 5/5 in all UE and LE muscle groups. Gait not tested. FAMILY HISTORY: NC SOCIAL HISTORY: Lives with wife. Retired drafting technician. Does all ADLs and fair amount of handy work around house. Goes to gym regularly and walk/jogs for 1 hour. - Tobacco: Never - Alcohol: None - Illicits: none

Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of one rib,Accidental fall from ladder,Atrial fibrillation,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Heart valve replaced by transplant,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)

Subdural hemorr-coma NOS,Fracture one rib-closed,Fall from ladder,Atrial fibrillation,Thrombocytopenia NOS,Long-term use anticoagul,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Heart valve transplant,Status cardiac pacemaker,Hyperlipidemia NEC/NOS,Esophageal reflux,BPH w/o urinary obs/LUTS

Admission Date: [**2181-5-12**] Discharge Date: [**2181-5-14**] Date of Birth: [**2109-10-29**] Sex: M Service: MEDICINE Allergies: Lipitor Attending:[**First Name3 (LF) 800**] Chief Complaint: fall off ladder Major Surgical or Invasive Procedure: none History of Present Illness: 71M with Afib on coumadin, CAD s/p 1 vessel CABG, presenting s/p fall off a ladder earlier today. He was disassembling an awning outside his house and was on the 4th or 5th stair of his ladder. Noted that the ladder was on a slippery surface, and seemed to lean over to the left and he fell on his left side. Does not recall exact details of the actual fall. Unsure if he lost consciousness. Unwitnessed but his wife heard the fall. Able to get up immediately after and walk into his house. Denied any preceding dizziness, LH, CP, palps. Denied any HA, visual changes, pain in extremities; did note a feeling of muscle pull on his left torso/flank. Brought to OSH hospital, imaging suggestive of tiny SDH. Transferred to [**Hospital1 18**] for neurosurgical evaluation. . In the ED, initial vs were: T99.1 72 134/85 15 98% on RA. CT head confirmed tiny SDH, no change from this afternoon's OSH study; also possible tiny SAH. Neurosurgery consulted, recommended phenytoin for tiny subarachnoid. Also repeat head CT in AM. Needs Q2H neuro checks. Per ED, since no neurosurgical managment anticipated, neurosurg recommended admission to trauma ICU; TICU service refused admission and recommended admit to medicine. Patient was given phenytoin and oxycodone. Past Medical History: - Aortic stenosis s/p tissue AVR [**9-/2179**] - CAD s/p single vessel CABG (LIMA to LAD) during AVR [**2179**] - Afib on coumadin - s/p PPM (bradycardia) ~ [**2174**] - Hyperlipidemia - GERD - BPH Social History: Lives with wife. Retired drafting technician. Does all ADLs and fair amount of handy work around house. Goes to gym regularly and walk/jogs for 1 hour. - Tobacco: Never - Alcohol: None - Illicits: none Family History: NC Physical Exam: General: Alert, oriented, very pleasant, no acute distress. HEENT: Sclera anicteric, PERRL 3->2, EOMI, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Mostly regular with occ irreg beats, normal S1 + S2, 2-3/6 SM best at RUSB. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. No focal TTP over left sided ribs; describes whole area as mildly sore. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Hips with full painless ROM in flexion, int/ext rotation. LUE with significant edema and mild ecchymosis near elbow. Elbow with full active and passive ROM; painless but notes "tightness of skin". Neuro: Alert and oriented x3. CN II-XII intact. Sensation grossly intact. Muscle bulk and tone normal. Strength 5/5 in all UE and LE muscle groups. Gait not tested. Pertinent Results: ADMISSION LABS: [**2181-5-12**] 07:45PM BLOOD WBC-9.1 RBC-5.25# Hgb-15.4# Hct-46.8# MCV-89 MCH-29.4 MCHC-33.0 RDW-14.0 Plt Ct-141* [**2181-5-12**] 07:45PM BLOOD Neuts-78.6* Lymphs-14.6* Monos-4.9 Eos-1.1 Baso-0.8 [**2181-5-12**] 07:45PM BLOOD PT-21.4* PTT-30.8 INR(PT)-2.0* [**2181-5-12**] 07:45PM BLOOD Glucose-104* UreaN-20 Creat-1.1 Na-145 K-4.2 Cl-109* HCO3-26 AnGap-14 DISCHARGE LABS: [**2181-5-14**] 09:30AM BLOOD WBC-7.3 RBC-5.21 Hgb-15.7 Hct-46.3 MCV-89 MCH-30.1 MCHC-33.9 RDW-14.6 Plt Ct-138* [**2181-5-14**] 09:30AM BLOOD Glucose-164* UreaN-16 Creat-1.1 Na-140 K-4.3 Cl-102 HCO3-30 AnGap-12 [**2181-5-13**] 01:57AM BLOOD Phenyto-8.2* [**2181-5-14**] 09:30AM BLOOD Phenyto-6.7* CT HEAD #1 [**2181-5-12**]: Tiny subdural hematoma layering along the left tentorium, not progressed compared to images from outside hospital performed four hours prior. Scalp swelling along the left parietooccipital region, without underlying skull fracture. CT HEAD #2 [**2181-5-13**]: No interval change. CT HEAD #3 [**2181-5-14**]: No intracranial hemorrhage identified. L Elbow [**2181-5-12**]: Mineralization and alignment are within normal limits. No fracture or dislocation is evident. No joint effusion is noted. Soft tissue swelling is noted along the dorsal aspect of the distal upper arm. No embedded radiopaque foreign bodies are seen. Incidental note is made of a small enthesophyte at the distal insertion of the triceps tendon. Correlate clinically. CT C-SPINE [**2181-5-12**]: No fracture or malalignment involving the cervical spine. Multilevel spondylosis, causing moderate canal narrowing, particularly from C3 through C6. Consider MRI if there is concern for cord contusion or ligamentous injury. L RIBS [**2181-5-14**]: There is an equivocal nondisplaced fracture involving the anterolateral aspect of the left tenth rib. Brief Hospital Course: 71M with Afib on coumadin, CAD s/p CABG, s/p tissue AVR, presenting with fall and small tentorial SDH. . # SDH: No change on 3 serial Head CTs. Remained neurologically intact. No HA or visual changes. Loaded with dilantin and continued on 100mg TID which he will continue for total 3 days. Warfarin and ASA held on admission. ASA restarted on day of admission. Instructed pt to restart warfarin on [**2181-5-16**] and will continue going to [**Hospital3 4107**] to have INR followed. He was given phone number to schedule an appointment with Dr. [**Last Name (STitle) **] in 8 weeks and will have repeat Head CT at that time. # Mechanical Fall: Per patient, ladder gave out. He was seen by PT who reccommended home,no PT. # Non-displaced L 10th Rib Fx: Pt noted to have tenderness and mild swelling of left flank. Prescribed percocet for pain control and advised pt not to drink ETOH or drive while taking this medication. # Afib: Rate controlled. Holding coumadin till [**5-16**]. Continued diltiazem, atenolol, digoxin. . # CAD: No active issues. ASA held initially as above but ok for pt to restart at DC. Continued on crestor and atenolol. Medications on Admission: warfarin 2.5 mg 4times weekly, 5 mg 3xweekly ASA 81 mg daily digoxin 250 mcg daily atenolol 100 mg [**Hospital1 **] diltiazem 240 mg daily crestor 10 mg daily prilosec 20 mg daily flomax 0.4 mg daily vit C 1000 mg daily vit D 1000 units daily Discharge Medications: 1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours) for 8 days. Disp:*24 Capsule(s)* Refills:*0* 2. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO once a day. 5. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 6. Crestor 10 mg Tablet Sig: One (1) Tablet PO once a day. 7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 8. Ascorbic Acid 500 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: 2.5 Tablets PO DAILY (Daily). 10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for severe pain: do not drive or drink alcohol while taking this medication. Disp:*20 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary: Subdural hematoma, Non-displaced fracture of left 10th rib Secondary: Atrial fibrillation, s/p Aortic Valve Repair Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were transferred to this hospital for to manage a blood collection under your skull which you sustained after falling from a ladder. You had multiple Head CT scans that indicated that this blood collection is stable and not getting larger. You were seen by the neurosurgery team who suggested that you begin a medication called phenytoin to prevent seizures. We also found that you have a rib fracture on the left. This can take a few weeks to heal. You may take percocet as needed for severe pain. STOP TAKING: -Coumadin. You may restart this medication on [**2181-5-16**]. You should have an INR checked 2-3 days after you restart this medication to assure that you are becoming therapeutic. NEW MEDICATIONS: -Phenytoin (Dilantin) you will need to take this medication for a total of 10 days. You last doses of medication will be on [**2181-5-22**]. -Perocet: you can take 1 tablet every 4 hours as needed for pain. Do not drive or drink alcohol will taking this medication. We would suggest that you avoid using ladders. Because you take coumadin you are at increased risk of bleeding. Followup Instructions: You should go to your coumadin clinic at [**Hospital3 **] [**2-14**] days after your restart your coumadin on [**5-16**]. Follow-up with Dr. [**Last Name (STitle) **] in 8 weeks. Call [**Telephone/Fax (1) 1669**] to schedule an appointment. His assistant with also schedule you for a repeat Head CT. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**] Completed by:[**2181-5-14**]

852,807,E881,427,287,V586,414,V458,V422,V450,272,530,600

{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of one rib,Accidental fall from ladder,Atrial fibrillation,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Heart valve replaced by transplant,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: fall off ladder PRESENT ILLNESS: 71M with Afib on coumadin, CAD s/p 1 vessel CABG, presenting s/p fall off a ladder earlier today. He was disassembling an awning outside his house and was on the 4th or 5th stair of his ladder. Noted that the ladder was on a slippery surface, and seemed to lean over to the left and he fell on his left side. Does not recall exact details of the actual fall. Unsure if he lost consciousness. Unwitnessed but his wife heard the fall. Able to get up immediately after and walk into his house. Denied any preceding dizziness, LH, CP, palps. Denied any HA, visual changes, pain in extremities; did note a feeling of muscle pull on his left torso/flank. Brought to OSH hospital, imaging suggestive of tiny SDH. Transferred to [**Hospital1 18**] for neurosurgical evaluation. . In the ED, initial vs were: T99.1 72 134/85 15 98% on RA. CT head confirmed tiny SDH, no change from this afternoon's OSH study; also possible tiny SAH. Neurosurgery consulted, recommended phenytoin for tiny subarachnoid. Also repeat head CT in AM. Needs Q2H neuro checks. Per ED, since no neurosurgical managment anticipated, neurosurg recommended admission to trauma ICU; TICU service refused admission and recommended admit to medicine. Patient was given phenytoin and oxycodone. MEDICAL HISTORY: - Aortic stenosis s/p tissue AVR [**9-/2179**] - CAD s/p single vessel CABG (LIMA to LAD) during AVR [**2179**] - Afib on coumadin - s/p PPM (bradycardia) ~ [**2174**] - Hyperlipidemia - GERD - BPH MEDICATION ON ADMISSION: warfarin 2.5 mg 4times weekly, 5 mg 3xweekly ASA 81 mg daily digoxin 250 mcg daily atenolol 100 mg [**Hospital1 **] diltiazem 240 mg daily crestor 10 mg daily prilosec 20 mg daily flomax 0.4 mg daily vit C 1000 mg daily vit D 1000 units daily ALLERGIES: Lipitor PHYSICAL EXAM: General: Alert, oriented, very pleasant, no acute distress. HEENT: Sclera anicteric, PERRL 3->2, EOMI, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Mostly regular with occ irreg beats, normal S1 + S2, 2-3/6 SM best at RUSB. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. No focal TTP over left sided ribs; describes whole area as mildly sore. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Hips with full painless ROM in flexion, int/ext rotation. LUE with significant edema and mild ecchymosis near elbow. Elbow with full active and passive ROM; painless but notes "tightness of skin". Neuro: Alert and oriented x3. CN II-XII intact. Sensation grossly intact. Muscle bulk and tone normal. Strength 5/5 in all UE and LE muscle groups. Gait not tested. FAMILY HISTORY: NC SOCIAL HISTORY: Lives with wife. Retired drafting technician. Does all ADLs and fair amount of handy work around house. Goes to gym regularly and walk/jogs for 1 hour. - Tobacco: Never - Alcohol: None - Illicits: none ### Response: {'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of one rib,Accidental fall from ladder,Atrial fibrillation,Thrombocytopenia, unspecified,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Heart valve replaced by transplant,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}