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CHIEF COMPLAINT: SOB PRESENT ILLNESS: . HPI: 21 y/o with h/o asthma presents from Bounewood (for polysubstance abuse) with worsening shortness of breath starting [**2176-3-2**]. He is on proair and an undefined ? steroid inhaler at baseline. Reports increased proair use over the last few days. He claims compliance with steroid inhaler despite its abcense on his [**Hospital1 **] medication list. He reports sick contacts at [**Name2 (NI) 83698**] with rhinitis and dry cough over the last few days. Last exacerbation 3 months ago requiring hospitalization at [**Hospital **]. Treated with steroid taper. H/o approximately 3 hospitalizations over his life, denies intubation (despite ED report). Received neb x 2 at [**Hospital1 **] with Sat 93-99%, BP 110/70, HR 120-130s at [**Hospital1 **]. . On arrival at [**Hospital1 18**] VS 99.2, 127, 130/78, 100% on neb mask. He received combivent x 5, solumedrol 125mg, Mg 2gm, and benadryl 25mg IV. Peak flow increased from 275 to 320. Pt does not know his baseline peak flow. EKG with sinus tachycardia. COntinued expiratory wheezing and desating to 88% RA. CXR without infiltrate. PIV x [**Street Address(2) 8582**]. VS prior to transfer HR 131, 106/42, 94% on neb mask. MEDICAL HISTORY: - asthma with preivous hospitalization, +intubation; 4 wks ago @ [**Hospital3 **] - [**Hospital3 8372**] - ADHD - depression - multiple dual dx detoxes with poor results - curently admitted to [**Hospital1 **] ([**2176-2-29**]) for benzo depnedence, opaite dependence, and alcohol and cannibis use. MEDICATION ON ADMISSION: Meds at home: Wellbutrin 200mg PO BID, clonidine 0.1 [**Hospital1 **], seroquel 200mg qhs, neurontin 600 TID . Meds on transfer: ativan 1mg PO q4h prn Bentyl 20mg PO q6h prn loperamide 2mg PO prn CLonidine 0.1mg PO q6h prn trazodone 50mg PO qhs prn mylanta 30ml q4h prn MOM 30ml PO qhs prn multivit 1 tab daily ibuprofen 400mg PO q4h prn chlorpormazine 50mg PO q6h prn albuterol MDI 1 puff q6h prn Nicotine gum 2mg q 1hr prn. Allergies: NKDA . ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: VS: Temp: BP: / HR: RR: O2sat GEN: yound, mildly tachypneic, NAD HEENT: PERRL, EOMI, anicteric, DMM, op without lesions, no jvd, RESP: Reduced air movement throughout, diffuse expiratory wheeze CV: tachy, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, mild epigastic tenderness without gaurding or rebound, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. . FAMILY HISTORY: No known addiction or substance abuse. Asthma in Mother. . SOCIAL HISTORY: Social History: Per [**Hospital1 **] H+P: just d/ced from Bourneweeod [**2176-2-13**], immediately resumed abuse using [**Name (NI) 3755**] (pt states 5mg daily, [**Name (NI) 83698**] estimated as 12 pills, up 25-30mg daily), drinking daily (1 pint vodka chronically), smoking PCP (per [**Hospital1 **], pt denies) and cannabis, .5gm of heroin. [**First Name4 (NamePattern1) 11560**] [**Last Name (NamePattern1) **] tox screen was negative for opiates but positive for benzos, cannabis, and PCP. [**Name10 (NameIs) 13802**] in [**Location 7661**]. On SSI, lives with father. Active tobacco use, [**1-21**] ppd for few years. . Family History: No known addiction or substance abuse. Asthma in Mother. .

Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Influenza with other respiratory manifestations,Alcohol abuse, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Dysthymic disorder,Attention deficit disorder with hyperactivity

Asthma NOS w (ac) exac,Bipol I cur depres NOS,Flu w resp manifest NEC,Alcohol abuse-unspec,Opioid/other dep-unspec,Dysthymic disorder,Attn deficit w hyperact

Admission Date: [**2176-3-3**] Discharge Date: [**2176-3-8**] Date of Birth: [**2154-12-30**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1253**] Chief Complaint: SOB Major Surgical or Invasive Procedure: none History of Present Illness: . HPI: 21 y/o with h/o asthma presents from Bounewood (for polysubstance abuse) with worsening shortness of breath starting [**2176-3-2**]. He is on proair and an undefined ? steroid inhaler at baseline. Reports increased proair use over the last few days. He claims compliance with steroid inhaler despite its abcense on his [**Hospital1 **] medication list. He reports sick contacts at [**Name2 (NI) 83698**] with rhinitis and dry cough over the last few days. Last exacerbation 3 months ago requiring hospitalization at [**Hospital **]. Treated with steroid taper. H/o approximately 3 hospitalizations over his life, denies intubation (despite ED report). Received neb x 2 at [**Hospital1 **] with Sat 93-99%, BP 110/70, HR 120-130s at [**Hospital1 **]. . On arrival at [**Hospital1 18**] VS 99.2, 127, 130/78, 100% on neb mask. He received combivent x 5, solumedrol 125mg, Mg 2gm, and benadryl 25mg IV. Peak flow increased from 275 to 320. Pt does not know his baseline peak flow. EKG with sinus tachycardia. COntinued expiratory wheezing and desating to 88% RA. CXR without infiltrate. PIV x [**Street Address(2) 8582**]. VS prior to transfer HR 131, 106/42, 94% on neb mask. Pt endorsed depression and suicidal ideation in the last few days. Last Etoh 3-4 days ago. This is the patients 3rd detox in [**2176**] at [**Hospital1 **] for heroin, benzos, and alcohol (also PCP and [**Name9 (PRE) 83699**] use). He was in "moderate" withdrawal on admisison to [**Hospital1 **], and started on Ativan and methadone detox protocols. He endorsed depression and recent SI. . On arrival his breathing is improved but continues to be labored. He continues of anxiety. Continued dry cough. No F/C . ROS: + for diarrhea in setting of detox. Otherwise negative . Past Medical History: - asthma with preivous hospitalization, +intubation; 4 wks ago @ [**Hospital3 **] - [**Hospital3 8372**] - ADHD - depression - multiple dual dx detoxes with poor results - curently admitted to [**Hospital1 **] ([**2176-2-29**]) for benzo depnedence, opaite dependence, and alcohol and cannibis use. Social History: Social History: Per [**Hospital1 **] H+P: just d/ced from Bourneweeod [**2176-2-13**], immediately resumed abuse using [**Name (NI) 3755**] (pt states 5mg daily, [**Name (NI) 83698**] estimated as 12 pills, up 25-30mg daily), drinking daily (1 pint vodka chronically), smoking PCP (per [**Hospital1 **], pt denies) and cannabis, .5gm of heroin. [**First Name4 (NamePattern1) 11560**] [**Last Name (NamePattern1) **] tox screen was negative for opiates but positive for benzos, cannabis, and PCP. [**Name10 (NameIs) 13802**] in [**Location 7661**]. On SSI, lives with father. Active tobacco use, [**1-21**] ppd for few years. . Family History: No known addiction or substance abuse. Asthma in Mother. . Family History: mother - anxiety, depression, [**Name (NI) 8372**] father - anxiety, depression, [**Name (NI) 8372**] other - GF - DM Physical Exam: Physical Exam: VS: Temp: BP: / HR: RR: O2sat GEN: yound, mildly tachypneic, NAD HEENT: PERRL, EOMI, anicteric, DMM, op without lesions, no jvd, RESP: Reduced air movement throughout, diffuse expiratory wheeze CV: tachy, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, mild epigastic tenderness without gaurding or rebound, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. . Pertinent Results: [**2176-3-3**] 03:37AM BLOOD WBC-13.5* RBC-5.44 Hgb-16.1 Hct-46.4 MCV-85 MCH-29.5 MCHC-34.6 RDW-13.3 Plt Ct-159 [**2176-3-6**] 01:50PM BLOOD WBC-8.6 RBC-5.23 Hgb-15.7 Hct-46.4 MCV-89 MCH-30.0 MCHC-33.8 RDW-12.9 Plt Ct-221 [**2176-3-5**] 06:14AM BLOOD Glucose-104* UreaN-16 Creat-0.9 Na-140 K-3.8 Cl-108 HCO3-22 AnGap-14 [**2176-3-3**] 03:37AM BLOOD ALT-35 AST-22 LD(LDH)-175 AlkPhos-103 TotBili-0.3 [**2176-3-5**] 06:14AM BLOOD Calcium-8.9 Phos-4.4# Mg-2.2 [**2176-3-3**] 04:54PM BLOOD D-Dimer-247 [**2176-3-3**] 03:37AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2176-3-3**] 12:38PM BLOOD Type-ART pO2-70* pCO2-24* pH-7.44 calTCO2-17* Base XS--5 [**2176-3-3**] 06:25AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.010 [**2176-3-3**] 06:25AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2176-3-3**] 06:25AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG . MICRO: [**2176-3-6**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2176-3-6**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2176-3-5**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2176-3-3**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT . [**2176-3-3**] BLOOD CULTURE Blood Culture, Routine-PRELIMINARY {STAPHYLOCOCCUS, COAGULASE NEGATIVE}; Anaerobic Bottle Gram Stain-FINAL INPATIENT . [**2176-3-4**] Influenza A/B by DFA DIRECT INFLUENZA A ANTIGEN TEST- {POSITIVE FOR INFLUENZA A VIRAL ANTIGEN} . [**2176-3-3**] MRSA SCREEN MRSA SCREEN-negative Brief Hospital Course: 21 y/o with history of polysubstance abuse with active withdrawl (heroin, benzos, alcohol), presented from detox with asthma exacerbation in the setting of influenza and active smoking. . #. Asthma exacerbation: On admission had significantly decreased BS and wheezing. Likely exacerbated by influenza. Had poisitve DFA for influenza A. It appears that he was not reliably using his asthma maintenance medications. Active smoking is also likely contributing to uncontrolled asthma. Patient was started on Tamiflu + Levofloxacin received 3 days of Levofloxacin, but this was discontinued at the time of transfer out of the ICU. He also was treated with steroids which were gradually tapered, Advair 250/50 [**Hospital1 **], and nebs. Lung auscultation much improved with this. He was gradually weaned off of oxygen, and at the time of discharge, his breathing was back to baseline. He was discharged on Prednisone 10 mg po q day, which he will receive for several more days. . #. Polysubstance abuse and ?withdrawal: Recent use of benzos and heroin, as well as heavy EtOH 4 days prior to admission. History of withdrawal but not seizures. Patient was quite agitated, diaphoretic, and tachycardic, with improvement after administration of clonidine. He was treated with clonidine and valium on a CIWA scale. At the time of discharge, it appeared that his [**Doctor Last Name **] on the CIWA scale was due to his baseline psychiatric issues and not active withdrawl. Social work/Addictions followed throughout the hospitalization. . #. CoNS bacteremia; probable contaminant: Blood culture [**3-3**] was positive for CoNS. Pt was covered with Vancomycin IV while awaiting results of surveillance blood cultures and cardiac echo. Cardiac echo was normal and without evidence of endocarditis. Surveillance blood cultures were drawn, and remain negative >48 hours. The positive blood culture was likely a contaminant. . #. Tachycardia: Sinus tach on EKG. Negative d-dimer decreases concern for PE. Suspect significant component due to patient's significant anxiety issues. Tachycardia resolves during periods of lower anxiety. . #. Depression/bipolar disorder/ Anxiety: Psychiatry was consulted and assisted in management of his anxiety and other psychiatric issues. Pt was treated as follows: - Gabapentin 600 mg PO/NG [**Hospital1 **] - Clonazepam 0.5 mg PO/NG TID - BuPROPion (Sustained Release) 150 mg PO BID - Quetiapine extended-release 200 mg PO HS - traZODONE 50 mg PO/NG HS:PRN insomnia Pt was covered with a CIWA scale during the admission for his history of alcohol and benzo abuse, however, I strongly suspect that his CIWA actually reflected pt's anxiety and NOT active withdrawl at the time of discharge. . FEN: IVF, lytes prn, regular diet . Access: PIV x 1 . PPx: heparin SC, BM regimen . Comm: HCP father, [**Name (NI) **] [**Telephone/Fax (1) 83700**]. [**Name2 (NI) 16001**] [**Name (NI) 83701**], mother [**Telephone/Fax (1) 83702**] . Code: confirmed full, consent completed . DISPO: Patient is now medically stable for discharge to psychiatric facility for ongoing treatment of his substance abuse. Pt would medically benefit from resuming his drug treatment program as soon as possible. Medications on Admission: Meds at home: Wellbutrin 200mg PO BID, clonidine 0.1 [**Hospital1 **], seroquel 200mg qhs, neurontin 600 TID . Meds on transfer: ativan 1mg PO q4h prn Bentyl 20mg PO q6h prn loperamide 2mg PO prn CLonidine 0.1mg PO q6h prn trazodone 50mg PO qhs prn mylanta 30ml q4h prn MOM 30ml PO qhs prn multivit 1 tab daily ibuprofen 400mg PO q4h prn chlorpormazine 50mg PO q6h prn albuterol MDI 1 puff q6h prn Nicotine gum 2mg q 1hr prn. Allergies: NKDA . Discharge Medications: 1. bupropion HCl 150 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO BID (2 times a day). 2. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for opiate withdrawal. 3. quetiapine 200 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO HS (at bedtime). 4. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). 5. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 8. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 9. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 10. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 11. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 4 days. Discharge Disposition: Extended Care Facility: [**Hospital3 8063**] - [**Location (un) **] Discharge Diagnosis: # Asthma exacerbation # Influenza # Polysubstance abuse and withdrawal # CoNS bacteremia; probable contaminant # Depression/bipolar disorder/ Anxiety 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 with a severe asthma exacerbation that was initially managed in the ICU. Your breathing was treated with steroids and nebulizers. You were found to have influenza, which was treated with Tamiflu. You also had withdrawl symptoms from your multiple drugs of abuse and alcohol. This was treated with medication as well. Psychiatry helped with treatment of your anxiety. It is very important that you take your medications as prescribed, as we discussed. Followup Instructions: Please follow up with your primary care provider [**Name Initial (PRE) 176**] 2 weeks. Please call to schedule an appointment.

493,296,487,305,304,300,314

{'Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Influenza with other respiratory manifestations,Alcohol abuse, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Dysthymic disorder,Attention deficit disorder with hyperactivity'}

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 PRESENT ILLNESS: . HPI: 21 y/o with h/o asthma presents from Bounewood (for polysubstance abuse) with worsening shortness of breath starting [**2176-3-2**]. He is on proair and an undefined ? steroid inhaler at baseline. Reports increased proair use over the last few days. He claims compliance with steroid inhaler despite its abcense on his [**Hospital1 **] medication list. He reports sick contacts at [**Name2 (NI) 83698**] with rhinitis and dry cough over the last few days. Last exacerbation 3 months ago requiring hospitalization at [**Hospital **]. Treated with steroid taper. H/o approximately 3 hospitalizations over his life, denies intubation (despite ED report). Received neb x 2 at [**Hospital1 **] with Sat 93-99%, BP 110/70, HR 120-130s at [**Hospital1 **]. . On arrival at [**Hospital1 18**] VS 99.2, 127, 130/78, 100% on neb mask. He received combivent x 5, solumedrol 125mg, Mg 2gm, and benadryl 25mg IV. Peak flow increased from 275 to 320. Pt does not know his baseline peak flow. EKG with sinus tachycardia. COntinued expiratory wheezing and desating to 88% RA. CXR without infiltrate. PIV x [**Street Address(2) 8582**]. VS prior to transfer HR 131, 106/42, 94% on neb mask. MEDICAL HISTORY: - asthma with preivous hospitalization, +intubation; 4 wks ago @ [**Hospital3 **] - [**Hospital3 8372**] - ADHD - depression - multiple dual dx detoxes with poor results - curently admitted to [**Hospital1 **] ([**2176-2-29**]) for benzo depnedence, opaite dependence, and alcohol and cannibis use. MEDICATION ON ADMISSION: Meds at home: Wellbutrin 200mg PO BID, clonidine 0.1 [**Hospital1 **], seroquel 200mg qhs, neurontin 600 TID . Meds on transfer: ativan 1mg PO q4h prn Bentyl 20mg PO q6h prn loperamide 2mg PO prn CLonidine 0.1mg PO q6h prn trazodone 50mg PO qhs prn mylanta 30ml q4h prn MOM 30ml PO qhs prn multivit 1 tab daily ibuprofen 400mg PO q4h prn chlorpormazine 50mg PO q6h prn albuterol MDI 1 puff q6h prn Nicotine gum 2mg q 1hr prn. Allergies: NKDA . ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: VS: Temp: BP: / HR: RR: O2sat GEN: yound, mildly tachypneic, NAD HEENT: PERRL, EOMI, anicteric, DMM, op without lesions, no jvd, RESP: Reduced air movement throughout, diffuse expiratory wheeze CV: tachy, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, mild epigastic tenderness without gaurding or rebound, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. . FAMILY HISTORY: No known addiction or substance abuse. Asthma in Mother. . SOCIAL HISTORY: Social History: Per [**Hospital1 **] H+P: just d/ced from Bourneweeod [**2176-2-13**], immediately resumed abuse using [**Name (NI) 3755**] (pt states 5mg daily, [**Name (NI) 83698**] estimated as 12 pills, up 25-30mg daily), drinking daily (1 pint vodka chronically), smoking PCP (per [**Hospital1 **], pt denies) and cannabis, .5gm of heroin. [**First Name4 (NamePattern1) 11560**] [**Last Name (NamePattern1) **] tox screen was negative for opiates but positive for benzos, cannabis, and PCP. [**Name10 (NameIs) 13802**] in [**Location 7661**]. On SSI, lives with father. Active tobacco use, [**1-21**] ppd for few years. . Family History: No known addiction or substance abuse. Asthma in Mother. . ### Response: {'Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Influenza with other respiratory manifestations,Alcohol abuse, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Dysthymic disorder,Attention deficit disorder with hyperactivity'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 69 year-old gentleman who presented with unstable angina, question myocardial infarction, to the [**Hospital 1474**] Hospital on [**2106-12-8**]. He was transferred emergently to [**Hospital1 188**] where upon arrival he went to the Cardiac Catheterization Laboratory. In the catheterization laboratory the patient was found to have two vessel coronary artery disease and moderate diastolic ventricular dysfunction and inferior and inferior basilar akinesis with mildly reduced overall left systolic ventricular function. While in the catheterization laboratory he also had successful placement of a radial stent in the left circumflex. In summary, the patient's catheterization results include a 30 percent stenosis of the left main coronary artery at its mid portion, proximal 80 percent stenosis of the left circumflex, virtual total occlusion of the right coronary with either recanalization or good right to right bridging via collaterals to the distal RCA system. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Old myocardial infarction

Crnry athrscl natve vssl,Intermed coronary synd,CHF NOS,Surg compl-heart,Atrial fibrillation,Old myocardial infarct

Admission Date: [**2106-12-8**] Discharge Date: [**2106-12-13**] Date of Birth: [**2037-3-5**] Sex: M Service: PRESENT ILLNESS: This is a 69 year-old gentleman who presented with unstable angina, question myocardial infarction, to the [**Hospital 1474**] Hospital on [**2106-12-8**]. He was transferred emergently to [**Hospital1 188**] where upon arrival he went to the Cardiac Catheterization Laboratory. In the catheterization laboratory the patient was found to have two vessel coronary artery disease and moderate diastolic ventricular dysfunction and inferior and inferior basilar akinesis with mildly reduced overall left systolic ventricular function. While in the catheterization laboratory he also had successful placement of a radial stent in the left circumflex. In summary, the patient's catheterization results include a 30 percent stenosis of the left main coronary artery at its mid portion, proximal 80 percent stenosis of the left circumflex, virtual total occlusion of the right coronary with either recanalization or good right to right bridging via collaterals to the distal RCA system. PHYSICAL EXAMINATION: Height 5 foot, 9 inches, weight 90 kilograms, blood pressure 143/78, pulse 86. General appearance: not in any apparent distress. Alert and oriented times three. Neck full range of motion, supple. Chest clear to auscultation bilaterally. Cardiac: S1, S2, no murmur appreciated. Abdomen soft, nontender, nondistended. PERTINENT LABORATORY AND X-RAY RESULTS: Please refer to History of Present Illness. CO[**Last Name (STitle) 14945**]SUMMARY OF HOSPITAL COURSE: Upon admission to the [**Hospital1 69**] patient went to the catheterization laboratory. Please see History of Present Illness for catheterization laboratory results, and then was transferred emergently to the operating room and Dr. [**Last Name (Prefixes) 411**] for coronary artery bypass graft. Please see previously dictated operative note for more details. The patient had a coronary artery bypass graft. The left internal mammary artery was anastomosed to the left anterior descending artery. Saphenous vein graft was used as a conduit to the OM and saphenous vein graft was used as a conduit to the PDA. While in the operating room patient also received an intra-aortic balloon pump. Patient left the operating room with mean arterial pressure of 79, CVP of 8, PAD of 12, [**Doctor First Name 1052**] of 19, in normal sinus rhythm at 80 beats per minute. The patient was on propofol and a proteinase drip on leaving the operating room. After leaving the operating room patient was transferred to the Intensive Care Unit. On postoperative day #1 the patient was transferred to the patient care floor. Postoperative day #2 the patient's chest tubes were discontinued. On postoperative day #2 the patient went into atrial fibrillation with a ventricular rate ranging 120 to 130. This was rectified by repleting electrolytes, giving one unit of blood and giving patient Lopressor. Patient's heart rate remained in control and the remainder of his postoperative course was uneventful. Pacing wires were discontinued on postoperative day #3. The patient went from atrial fibrillation to sinus rhythm and was started on Coumadin for this. On postoperative day #5 the patient was ambulating well with physical therapy, tolerating p.o.s. Pain was controlled with p.o. pain medications and felt comfortable going home. Patient was discharged home. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSIS: Status post coronary artery bypass graft times three. DISCHARGE MEDICATIONS: Lasix 20 mg p.o. b.i.d. times one week, KayCiel 20 mEq p.o. b.i.d. times one week, Colace 100 mg p.o. b.i.d. while on Percocet, ASA 81 mg p.o. b.i.d., ibuprofen 400 to 600 mg p.o. q. 6 hour p.r.n., Lipitor 10 mg p.o. q.d., Zoloft 50 mg p.o. q.d., Asacol 400 mg p.o. t.i.d., Percocet 1 to 2 tabs p.o. q. 4 to 6 hours p.r.n., Lopressor 50 mg p.o. b.i.d., Coumadin dosing to be described. FO[**Last Name (STitle) 996**]P PLANS: Patient will follow up with primary care, Dr. [**First Name (STitle) **], in three weeks. In addition the patient will also follow up with Dr. [**Last Name (Prefixes) **] in three weeks. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Last Name (NamePattern1) 6355**] MEDQUIST36 D: [**2106-12-11**] 20:37 T: [**2106-12-11**] 21:06 JOB#: [**Job Number 14946**] Name: [**Known lastname 2380**], [**Known firstname 2381**] L Unit No: [**Numeric Identifier 2382**] Admission Date: [**2106-12-8**] Discharge Date: [**2106-12-13**] Date of Birth: [**2037-3-5**] Sex: M Service: ADDENDUM TO MEDICATION LIST: Amiodarone 400 mg p.o. t.i.d. x 3 more days, then the amiodarone will go to 400 mg p.o. b.i.d. for seven days, then will go to 400 mg p.o. once daily until follow up. [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 681**] Dictated By:[**Last Name (NamePattern1) 2383**] MEDQUIST36 D: [**2106-12-13**] 12:23 T: [**2106-12-17**] 09:53 JOB#: [**Job Number 2384**]

414,411,428,997,427,412

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,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 69 year-old gentleman who presented with unstable angina, question myocardial infarction, to the [**Hospital 1474**] Hospital on [**2106-12-8**]. He was transferred emergently to [**Hospital1 188**] where upon arrival he went to the Cardiac Catheterization Laboratory. In the catheterization laboratory the patient was found to have two vessel coronary artery disease and moderate diastolic ventricular dysfunction and inferior and inferior basilar akinesis with mildly reduced overall left systolic ventricular function. While in the catheterization laboratory he also had successful placement of a radial stent in the left circumflex. In summary, the patient's catheterization results include a 30 percent stenosis of the left main coronary artery at its mid portion, proximal 80 percent stenosis of the left circumflex, virtual total occlusion of the right coronary with either recanalization or good right to right bridging via collaterals to the distal RCA system. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Old myocardial infarction'}

CHIEF COMPLAINT: Initially admitted for LUE PICC line associated pain. Admitted to MICU with GI bleeding in setting of active Crohn's and anticoagulation. PRESENT ILLNESS: Ms. [**Name13 (STitle) 4027**] is a 41 year old woman with history of Crohns disease, admitted for Crohns flare and left arm pain on [**9-17**], now transfered to MICU for persistent BRBPR and orthostasis. Left sided PICC line was placed for TPN [**9-8**] for bowel rest, found to have PICC associated upper extremity clot, started on fondaparinux treatment on [**9-19**]. PICC was resited on right on [**2102-9-21**]. Patient had an episode of bright red blood per rectum yesterday evening, after which she has continued to pass frequent clots BRBPR overnight. Fondaparinux was discontinued this morning, last dose was given yesterday. Patient was transfused 2 units of pRBCs for a Hct of 32 yesterday afternoon, with appropriate Hct bump to 39. This morning, Hct noted to have dropped to 33.7, so she was transfused another 2u pRBCs with no bump in Hct. For repeat Hct of 33.8, patient was again transfused another 1u of pRBCs and transfered to the MICU for further management. She was also ordered for 1u FFP and 1u platelets. Vitals on floor prior to transfer to MICU were as follows: BP 130/70 HR 90 at rest in bed (120s-160s when standing). . On arrival to the MICU, patient reports abdominal cramping just prior to passing clots per rectum. Reports nausea and vomiting as well in the past week or so, which she reports is associated with her Crohns flare and potentially partially secondary to starting TPN. She has had Crohns since the age of 16, and prior flares were not associated with vomiting until last fall. Patient has never had this significant GI bleeding associated with Crohns flareups in the past. . She reports mild anxiety being transfered to the intensive care unit. She feels that her Crohns flares in the last couple months are likely associated with stress, as her mother was recently diagnosed with leukemia, now s/p bone marrow transplant at [**Hospital1 2025**]. MEDICAL HISTORY: 1. Crohn's disease. Diagnosed at age 16. Has tried and not tolerated the following: Remicaide (serum sickness), Humira (flu-like symptoms), methotrexate (fevers and chills), 6-MP (paresthesias); Has received cipro and Enterocort in the past. More recently on steroids without improvement as per HPI. No surgeries. PPD negative, last bone marrow density at [**Hospital1 112**], none in our system. 2. Depression and anxiety 3. GIB in setting of anticoagulation and active Crohn's MEDICATION ON ADMISSION: Clonazepam 0.25 mg PO BID Apri 0.15-30 mg-mcg 1 tab PO daily Dicyclomine 10 mg PO QID PRN cramps Famotidine 20 mg PO BID Zofran 4 mg PO 1-2 tabs TID PRN nausea Sertraline 150 mg PO daily Zyrtec 10 mg PO daily PRN allergy symptoms Loperamide 2 mg PO QID PRN loose stools Prednisone 20 mg PO daily Mesalamine 1000 mg suppository rectally QHS Oxycodone 5-10 mg PO q4-6h PRN pain Vitamin D 1000 units PO daily Bismuth subsalicylate 1 tab PO PRN Polyethylene glycol 17 g PO PRN constipation Sacchharomyces boulardii 250 mg packet PO daily Peptamen [**2-19**] cans PO daily Acidophilus PRN ALLERGIES: Methotrexate / Metronidazole / Remicade / Mercaptopurine / Prochlorperazine / Magnesium Citrate PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: T 98.3 BP 99/59 P 101 R 18 Sat 99%RA GENERAL: Well-appearing woman in NAD, comfortable, appropriate. FAMILY HISTORY: Father may have had inflammatory bowel disease. No other family history of inflammatory bowel disease. SOCIAL HISTORY: Lives at home with mother and 3 cats. Has a degree in nutrition but has never worked in this field. No work in 10 years due to chronic illness. No alcohol, drug use, or cigarettes.

Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of deep veins of upper extremity,Regional enteritis of large intestine,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Dysthymic disorder,Malnutrition of mild degree,Hyperpotassemia

Comp-oth vasc dev/graft,Ac DVT/embl up ext,Reg enteritis, lg intest,Ac posthemorrhag anemia,Urin tract infection NOS,Abn react-procedure NEC,Dysthymic disorder,Malnutrition mild degree,Hyperpotassemia

Admission Date: [**2102-9-17**] Discharge Date: [**2102-10-3**] Date of Birth: [**2061-5-22**] Sex: F Service: MEDICINE Allergies: Methotrexate / Metronidazole / Remicade / Mercaptopurine / Prochlorperazine / Magnesium Citrate Attending:[**Doctor First Name 2080**] Chief Complaint: Initially admitted for LUE PICC line associated pain. Admitted to MICU with GI bleeding in setting of active Crohn's and anticoagulation. Major Surgical or Invasive Procedure: 1) Right upper extremity PICC placement 2) Colonoscopy History of Present Illness: Ms. [**Name13 (STitle) 4027**] is a 41 year old woman with history of Crohns disease, admitted for Crohns flare and left arm pain on [**9-17**], now transfered to MICU for persistent BRBPR and orthostasis. Left sided PICC line was placed for TPN [**9-8**] for bowel rest, found to have PICC associated upper extremity clot, started on fondaparinux treatment on [**9-19**]. PICC was resited on right on [**2102-9-21**]. Patient had an episode of bright red blood per rectum yesterday evening, after which she has continued to pass frequent clots BRBPR overnight. Fondaparinux was discontinued this morning, last dose was given yesterday. Patient was transfused 2 units of pRBCs for a Hct of 32 yesterday afternoon, with appropriate Hct bump to 39. This morning, Hct noted to have dropped to 33.7, so she was transfused another 2u pRBCs with no bump in Hct. For repeat Hct of 33.8, patient was again transfused another 1u of pRBCs and transfered to the MICU for further management. She was also ordered for 1u FFP and 1u platelets. Vitals on floor prior to transfer to MICU were as follows: BP 130/70 HR 90 at rest in bed (120s-160s when standing). . On arrival to the MICU, patient reports abdominal cramping just prior to passing clots per rectum. Reports nausea and vomiting as well in the past week or so, which she reports is associated with her Crohns flare and potentially partially secondary to starting TPN. She has had Crohns since the age of 16, and prior flares were not associated with vomiting until last fall. Patient has never had this significant GI bleeding associated with Crohns flareups in the past. . She reports mild anxiety being transfered to the intensive care unit. She feels that her Crohns flares in the last couple months are likely associated with stress, as her mother was recently diagnosed with leukemia, now s/p bone marrow transplant at [**Hospital1 2025**]. Past Medical History: 1. Crohn's disease. Diagnosed at age 16. Has tried and not tolerated the following: Remicaide (serum sickness), Humira (flu-like symptoms), methotrexate (fevers and chills), 6-MP (paresthesias); Has received cipro and Enterocort in the past. More recently on steroids without improvement as per HPI. No surgeries. PPD negative, last bone marrow density at [**Hospital1 112**], none in our system. 2. Depression and anxiety 3. GIB in setting of anticoagulation and active Crohn's Social History: Lives at home with mother and 3 cats. Has a degree in nutrition but has never worked in this field. No work in 10 years due to chronic illness. No alcohol, drug use, or cigarettes. Family History: Father may have had inflammatory bowel disease. No other family history of inflammatory bowel disease. Physical Exam: ADMISSION PHYSICAL EXAM: VS: T 98.3 BP 99/59 P 101 R 18 Sat 99%RA GENERAL: Well-appearing woman in NAD, comfortable, appropriate. HEENT: NCAT, sclerae anicteric, MMM, OP clear. NECK: Supple, no LAD. HEART: RRR, no MRG, nl S1-S2. LUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding. EXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses. SKIN: No rashes or lesions. There is some erythema at the left PICC site, with minimal erythema in the medial aspect of the upper arm, with pain to palpation of the medial bicep. There is no evidence of thrombophlebitis and no masses on palpation of the areaLYMPH: No cervical LAD. NEURO: Awake, A&Ox3 Pertinent Results: LABS ON ADMISSION: [**2102-9-16**] 11:29PM BLOOD WBC-14.6* RBC-5.29 Hgb-14.0 Hct-42.7 MCV-81* MCH-26.5* MCHC-32.8 RDW-16.0* Plt Ct-523* [**2102-9-16**] 11:29PM BLOOD Neuts-83.8* Lymphs-10.4* Monos-5.1 Eos-0.3 Baso-0.3 [**2102-9-16**] 11:29PM BLOOD Plt Ct-523* [**2102-9-17**] 08:13AM BLOOD Plt Ct-397 [**2102-9-16**] 11:29PM BLOOD Glucose-73 UreaN-14 Creat-0.6 Na-141 K-3.8 Cl-102 HCO3-27 AnGap-16 [**2102-9-19**] 05:25AM BLOOD ALT-5 AST-6 AlkPhos-97 TotBili-0.2 [**2102-9-16**] 11:29PM BLOOD Calcium-8.8 Phos-3.0 Mg-2.0 [**2102-9-20**] 05:15AM BLOOD Triglyc-146 [**2102-9-16**] 11:35PM BLOOD Lactate-1.1 [**2102-9-24**] 07:10PM BLOOD freeCa-1.07* . LABS ON DISCHARGE: [**2102-10-3**] 05:49AM BLOOD WBC-18.1* RBC-3.82* Hgb-11.2* Hct-32.7* MCV-86 MCH-29.3 MCHC-34.2 RDW-16.9* Plt Ct-395 [**2102-10-2**] 05:06AM BLOOD Neuts-92.8* Lymphs-4.6* Monos-2.0 Eos-0.2 Baso-0.3 [**2102-10-3**] 05:49AM BLOOD Plt Ct-395 [**2102-10-3**] 05:49AM BLOOD Glucose-96 UreaN-11 Creat-0.5 Na-141 K-4.5 Cl-108 HCO3-27 AnGap-11 [**2102-10-3**] 05:49AM BLOOD Albumin-3.3* Calcium-8.3* Phos-1.8* Mg-2.0 . IMAGING: MRE [**2102-9-27**] IMPRESSION: 1. Abnormal mucosal thickening and enhancement evident at the splenic flexure, proximal transverse, descending colon and sigmoid colon, similar in appearance compared to the prior study. No abnormal enhancement seen in the terminal ileum. The remainder of the small bowel is normal in appearance. 2. Two short segments of colonic narrowing in the transverse colon may reflect slow colonic peristalsis versus stricture. 3. Simple cyst in the upper pole of the right kidney. . GI bleeding study [**2102-9-24**]: IMPRESSION: No GI bleed at 60 minutes. . MICRO: [**9-30**] CMV Viral Load (Final [**2102-10-3**]): CMV DNA not detected. Performed by PCR. . [**2102-9-29**] 9:52 pm URINE Source: CVS. **FINAL REPORT [**2102-10-2**]** URINE CULTURE (Final [**2102-10-2**]): ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. Piperacillin/tazobactam sensitivity testing available on request. 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 NITROFURANTOIN-------- <=16 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S . [**2102-9-18**] 6:03 pm STOOL CONSISTENCY: WATERY Source: Stool. **FINAL REPORT [**2102-9-19**]** CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2102-9-19**]): Feces negative for C.difficile toxin A & B by EIA. (Reference Range-Negative). . COLONOSCOPY Throughout the colon there were multple ulcerations of varying depth and size. In the sigmoid there was a single ulcer of 5cm in length that was nearly circumferential. The intervening mucosa from the anus to the descending colon was diffusely erythematous, edematous and friable with overlying exudate and pseudopolyps. These findings are consistent with severe Crohn's colitis. Cold forceps biopsies were performed for histology at the colon (areas of ulceration). Brief Hospital Course: 41F with hx of Crohns, admitted for Crohns flare, found to have left sided PICC-associated upper extremity [**Hospital 19601**] transfered to MICU with PRBC, plt, and frozen plasma transfusion for persistent BRBPR in setting of Fondaparinoux initiation. She received a MRE and colonoscopy. Please see below for detailed [**Hospital 11822**] hospital course. . # Crohn's Disease Flare Last Colonoscopy in [**5-/2101**] showed ulcerations in the terminal ileum and rectum, polyp (hyperplastic) at 22cm in the colon, and mild erythema adjacent to the anus. Biopsies of terminal ileum and cecum showed granulation tissue and focal granuloma, respectively. Patient has been tried on various immunomodulators as an outpatient which she did not tolerate, more recently on prednisone 20mg daily upon admission. She was switched to 16mg Q8H IV solu-medrol while on TPN. She subsequently experienced massive GI bleed in the context of fondaparinux anticoagulation for DVT. Dosage was increased to 20mg Q8H after colonoscopy in [**9-/2102**] showed severe erosions and progressive disease as likely cause of BRBPR. She continued to be NPO but refused TPN, subsequently tolerating solid foods and fluids by mouth. She was switched to PO prednisone 60mg daily 24 hours prior to discharge. She will f/u with Dr. [**Last Name (STitle) 79**] on [**Last Name (STitle) 2974**], [**10-6**]. . # Anemia Secondary to Acute GI Blood Loss After patient was started on Fondaparinoux she began having episodes of large blood bowel movements. Fondaparinoux was discontinued after 1st GIB. She was having 8-10 per day each BM was 200-300cc of BRB with clots, without stool. She was given 4 units PRBCs on the floor and was started on 5th unit but because of the need for units and not having an adequate bump in his H/H she was transfered to the MICU for further management. She received 8 units in total between floor and MICU as well as 2 units FFP and 1 unit Platelets, per transfusion protocol. She had 1 200 cc blood BM at 8pm night of MICU admission but otherwise did not have any other active GIB. Patient underwent MR Enterography with stable disease, but colonoscopy showed severe active disease. General Surgery saw patient but did not think acute surgery was required. Per surgery, she received a RBC tagged bleeding scan which was negative. She was discharged from the MICU >24 hours after last unit PRBC and hemodynamically stable. No BRBPR event on the floor thereafter, and hematocrit remained stable in the 30s. On discharge, anticoagulation is being held, given risks and benefits (see below). . # Catheter-Associated Upper Extremity Deep Vein Thrombosis Left sided PICC line was placed several days prior to admission, found to be associated with clot by upper extremity ultrasound on [**9-17**] ED visit. PICC was removed and new PICC placed on right side on [**2102-9-21**] for TPN. Fondaparinux started on [**2102-9-19**] after Lovenox/Coumadin bridge began. Anticoagulation was stopped on [**2102-9-23**] after life threatening GI bleeding started. She is currently on no anticoagluating agents on discharge given her bleed. Re-imaging can be considered as well as anticoagulation should her Crohn's ulceration improve. . # E.coli UTI: noted on urine culture from [**2102-9-29**]. Pan-sensitive per sensitivities. Patient was placed on bactrim [**Hospital1 **] x 3 days total. She began on the evening of [**10-1**] and has two doses left (one tablet on the evening of [**10-3**], and one tablet on the morning of [**10-4**]). . # Transitional Issues: - Was on fondaparinux/Lovenox/Coumadin and subsequently had GI bleed this admission. Currently has a left upper extremity DVT not on anticoagulation. F/u with gastroenterologist regarding anticoagulation. Consider repeat US in several weeks to re-assess clot burden. - F/u with GI regarding prednisone taper. - Follow up with general surgery regarding possible colectomy. - consider possible outpatient bubble study, per Dr. [**Last Name (STitle) 79**] - consider CBC at upcoming GI visit Medications on Admission: Clonazepam 0.25 mg PO BID Apri 0.15-30 mg-mcg 1 tab PO daily Dicyclomine 10 mg PO QID PRN cramps Famotidine 20 mg PO BID Zofran 4 mg PO 1-2 tabs TID PRN nausea Sertraline 150 mg PO daily Zyrtec 10 mg PO daily PRN allergy symptoms Loperamide 2 mg PO QID PRN loose stools Prednisone 20 mg PO daily Mesalamine 1000 mg suppository rectally QHS Oxycodone 5-10 mg PO q4-6h PRN pain Vitamin D 1000 units PO daily Bismuth subsalicylate 1 tab PO PRN Polyethylene glycol 17 g PO PRN constipation Sacchharomyces boulardii 250 mg packet PO daily Peptamen [**2-19**] cans PO daily Acidophilus PRN Discharge Medications: 1. clonazepam 0.25 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO twice a day. 2. dicyclomine 10 mg Capsule Sig: One (1) Capsule PO four times a day as needed. 3. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 4. Zofran 4 mg Tablet Sig: 1-2 Tablets PO three times a day as needed for nausea. 5. sertraline 50 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 6. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day as needed for allergy symptoms. 7. loperamide 2 mg Tablet Sig: 1-2 Tablets PO four times a day as needed for loose stools. 8. Vitamin D 1,000 unit Capsule Sig: One (1) Capsule PO once a day. 9. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) PO once a day as needed for constipation. 10. saccharomyces boulardii 250 mg Packet Sig: One (1) PO once a day. 11. Peptamen Liquid Sig: [**2-19**] cans PO once a day. 12. Acidophilus Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day as needed for loose stools. 13. bismuth subsalicylate 262 mg Tablet Sig: One (1) Tablet PO four times a day as needed for loose stools. 14. prednisone 20 mg Tablet Sig: Three (3) Tablet PO once a day. Disp:*90 Tablet(s)* Refills:*2* 15. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 16. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 days: Your 3-day course began on the evening of [**10-1**] and you have two doses left. Please take one tablet on the evening of [**10-3**], and one tablet on the morning of [**10-4**]. Disp:*2 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: 1) Catheter-Associated deep vein thrombosis of the left upper extremity 2) Crohn's disease flare 3) Acute anemia from GI loss . Secondary Diagnosis: 1) Depression and anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms. [**Name13 (STitle) 4027**], . It was a pleasure to take care of you during your stay at [**Hospital1 1535**]. One week after your PICC line placement, you came to the [**Hospital1 18**] emergency department with left arm swelling and pain where your PICC line was inserted. From an ultrasound of your arm, you were diagnosed with deep vein thrombosis of the left arm. While in the emergency room your PICC line was removed, and you were admitted to our service. . We believe your diarrhea was likely due to the Crohn's flare. You were treated with IV methylprednisolone, a steroid to help manage your Crohn's disease flare. We started managing your blood clot with blood thinners, but you developed a GI bleed and required transfusion and ICU transfer. . In the intensive care unit you received more blood products in an effort to keep up with your blood loss. You were switched to IV steroids for your Crohn's disease, and your blood thinner was stopped. You received a red blood cell scan while in the intensive care unit, which showed no active bleeding. . Your MR enterography showed stable small bowel disease, but your colonoscopy showed severe, active Crohn's disease. You met with the surgeons. You then spoke with your outpatient gastroenterologist Dr. [**Last Name (STitle) 79**]. On the floor instead of TPN you were started on slow transition to food and fluids by mouth, which you were able to tolerate. On discharge, your diarrhea decreased and abdominal pain improved. You were transitioned to PO prednisone. Your blood hematocrit was stable, and you have not had any bloody diarrhea. . MEDICATION: - STOP apri given your upper extremity blood clot - Please take 60 mg prednisone daily until your follow up appointment with Dr. [**Last Name (STitle) 79**] on [**10-6**]. - ADDED Bactrim. Your 3-day course began on the evening of [**10-1**] and you have two doses left. Please take one tablet on the evening of [**10-3**], and one tablet on the morning of [**10-4**]. - Other than stated above, please continue the same medications that you were taking prior to this admission as prescribed by your doctors. . APPOINTMENTS: - Please see below for your appointments. Followup Instructions: 1) Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2102-10-6**] 4:20 . 2) Name: [**Last Name (LF) 19602**], [**Name8 (MD) 19603**], MD Location: [**Hospital6 **] Address: [**Doctor First Name **] STE G, [**Location (un) **],[**Numeric Identifier 19604**] Phone: [**Telephone/Fax (1) 9251**] When: [**Last Name (LF) 2974**], [**10-6**], 1PM . 3) Department: SURGICAL SPECIALTIES When: TUESDAY [**2102-10-17**] at 10:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 274**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Completed by:[**2102-10-4**]

996,453,555,285,599,E879,300,263,276

{'Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of deep veins of upper extremity,Regional enteritis of large intestine,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Dysthymic disorder,Malnutrition of mild degree,Hyperpotassemia'}

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: Initially admitted for LUE PICC line associated pain. Admitted to MICU with GI bleeding in setting of active Crohn's and anticoagulation. PRESENT ILLNESS: Ms. [**Name13 (STitle) 4027**] is a 41 year old woman with history of Crohns disease, admitted for Crohns flare and left arm pain on [**9-17**], now transfered to MICU for persistent BRBPR and orthostasis. Left sided PICC line was placed for TPN [**9-8**] for bowel rest, found to have PICC associated upper extremity clot, started on fondaparinux treatment on [**9-19**]. PICC was resited on right on [**2102-9-21**]. Patient had an episode of bright red blood per rectum yesterday evening, after which she has continued to pass frequent clots BRBPR overnight. Fondaparinux was discontinued this morning, last dose was given yesterday. Patient was transfused 2 units of pRBCs for a Hct of 32 yesterday afternoon, with appropriate Hct bump to 39. This morning, Hct noted to have dropped to 33.7, so she was transfused another 2u pRBCs with no bump in Hct. For repeat Hct of 33.8, patient was again transfused another 1u of pRBCs and transfered to the MICU for further management. She was also ordered for 1u FFP and 1u platelets. Vitals on floor prior to transfer to MICU were as follows: BP 130/70 HR 90 at rest in bed (120s-160s when standing). . On arrival to the MICU, patient reports abdominal cramping just prior to passing clots per rectum. Reports nausea and vomiting as well in the past week or so, which she reports is associated with her Crohns flare and potentially partially secondary to starting TPN. She has had Crohns since the age of 16, and prior flares were not associated with vomiting until last fall. Patient has never had this significant GI bleeding associated with Crohns flareups in the past. . She reports mild anxiety being transfered to the intensive care unit. She feels that her Crohns flares in the last couple months are likely associated with stress, as her mother was recently diagnosed with leukemia, now s/p bone marrow transplant at [**Hospital1 2025**]. MEDICAL HISTORY: 1. Crohn's disease. Diagnosed at age 16. Has tried and not tolerated the following: Remicaide (serum sickness), Humira (flu-like symptoms), methotrexate (fevers and chills), 6-MP (paresthesias); Has received cipro and Enterocort in the past. More recently on steroids without improvement as per HPI. No surgeries. PPD negative, last bone marrow density at [**Hospital1 112**], none in our system. 2. Depression and anxiety 3. GIB in setting of anticoagulation and active Crohn's MEDICATION ON ADMISSION: Clonazepam 0.25 mg PO BID Apri 0.15-30 mg-mcg 1 tab PO daily Dicyclomine 10 mg PO QID PRN cramps Famotidine 20 mg PO BID Zofran 4 mg PO 1-2 tabs TID PRN nausea Sertraline 150 mg PO daily Zyrtec 10 mg PO daily PRN allergy symptoms Loperamide 2 mg PO QID PRN loose stools Prednisone 20 mg PO daily Mesalamine 1000 mg suppository rectally QHS Oxycodone 5-10 mg PO q4-6h PRN pain Vitamin D 1000 units PO daily Bismuth subsalicylate 1 tab PO PRN Polyethylene glycol 17 g PO PRN constipation Sacchharomyces boulardii 250 mg packet PO daily Peptamen [**2-19**] cans PO daily Acidophilus PRN ALLERGIES: Methotrexate / Metronidazole / Remicade / Mercaptopurine / Prochlorperazine / Magnesium Citrate PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: T 98.3 BP 99/59 P 101 R 18 Sat 99%RA GENERAL: Well-appearing woman in NAD, comfortable, appropriate. FAMILY HISTORY: Father may have had inflammatory bowel disease. No other family history of inflammatory bowel disease. SOCIAL HISTORY: Lives at home with mother and 3 cats. Has a degree in nutrition but has never worked in this field. No work in 10 years due to chronic illness. No alcohol, drug use, or cigarettes. ### Response: {'Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of deep veins of upper extremity,Regional enteritis of large intestine,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Dysthymic disorder,Malnutrition of mild degree,Hyperpotassemia'}

CHIEF COMPLAINT: SOB, cough PRESENT ILLNESS: 44 yo F with lung CA, metastatic to the R temporal lobe s/p cyberknife on [**1-3**], and on cisplatin and navelbine (last tx in [**10-29**]), who presents with SOB and cough x 1 week. She denies fevers or myalgias. She states she is having minimal CP w/ cough. She did see [**Name8 (MD) **] NP[**MD Number(3) 18184**] PCP's office on [**2107-1-20**], who prescribed her azithromycin and cefpodoxime, which she has been taking since [**2107-1-21**] with no improvement. . Of note, she is on decadron 2mg (last day of taper) and had been on keppra since surgery on [**1-3**] but states that she has completed course. She also has significant history of PEs and DVTs and has two IVC filters and is on lovenox. However, she developed new UE DVT while on lovenox. . In the ED, vitals 98.8 120 138/87 20 95%. CXR showed R sided infiltrate. She was given vancomycin in the ED. She also received 10mg of decadron IV in the ED. Dr [**Last Name (STitle) 6570**] [**Name (NI) 653**] in [**Name (NI) **], who requested a factor 10a level. MEDICAL HISTORY: Past Medical History - Lung adenocarcinoma with known mets to brain, dx [**6-/2106**] - Malignant pleural effusion s/p drainage - PE s/p IVF on chronic lovenox and s/p IVC filter - Mycobacterium gordonae - H/o SVC syndrome, SVC filter in place . Past Surgical History: - s/p CCY - s/p pericardiocentesis MEDICATION ON ADMISSION: DEXAMETHASONE 2mg daily (last day on [**2107-1-26**]) ENOXAPARIN - 60 mg/0.6 mL every twelve (12) hours Folic acid 1mg daily Vitamin B12 injection ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: VS: T 97.2 BP 140/84 HR 105 RR 20 O2 sat 100%RA GEN: AOx3, NAD HEENT: PERRLA. MMM. R face with swelling Cards: Tachy, RR S1/S2 normal. no murmurs/gallops/rubs. Pulm: crackles/wheezes Right sided, left lung field CTA Abd: soft, NT, +BS. no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**] sign. Extremities: wwp, no edema. Skin: no rashes or bruising Neuro/Psych: Mood and affect appropriate FAMILY HISTORY: Mother with diabetes. No family hx of cancer. SOCIAL HISTORY: Married. Worked at [**Last Name (un) 59330**]. Immigrated from the Phillipines in [**2092**]. Husband works in shipping warehouse. No smoking, alcohol, or illicit drug use. Husband, [**Name (NI) **] HCP, [**Telephone/Fax (1) 87460**]

Other specified diseases of pericardium,Pneumonia, organism unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acidosis,Pulmonary collapse,Malignant pleural effusion,Iron deficiency anemia secondary to blood loss (chronic),Compression of vein,Personal history of venous thrombosis and embolism,Unspecified disorder of autonomic nervous system

Pericardial disease NEC,Pneumonia, organism NOS,Mal neo upper lobe lung,Sec mal neo brain/spine,Acidosis,Pulmonary collapse,Malignant pleural effusn,Chr blood loss anemia,Compression of vein,Hx-ven thrombosis/embols,Autonomic nerve dis NEC

Admission Date: [**2107-1-26**] Discharge Date: [**2107-2-10**] Date of Birth: [**2062-8-16**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern1) 29226**] Chief Complaint: SOB, cough Major Surgical or Invasive Procedure: - Balloon Pericardectomy - PICC placement - Intubation - CT surgery pericardial window with L chest tube placement and pericardial drain placement - L pleurx catheter placement History of Present Illness: 44 yo F with lung CA, metastatic to the R temporal lobe s/p cyberknife on [**1-3**], and on cisplatin and navelbine (last tx in [**10-29**]), who presents with SOB and cough x 1 week. She denies fevers or myalgias. She states she is having minimal CP w/ cough. She did see [**Name8 (MD) **] NP[**MD Number(3) 18184**] PCP's office on [**2107-1-20**], who prescribed her azithromycin and cefpodoxime, which she has been taking since [**2107-1-21**] with no improvement. . Of note, she is on decadron 2mg (last day of taper) and had been on keppra since surgery on [**1-3**] but states that she has completed course. She also has significant history of PEs and DVTs and has two IVC filters and is on lovenox. However, she developed new UE DVT while on lovenox. . In the ED, vitals 98.8 120 138/87 20 95%. CXR showed R sided infiltrate. She was given vancomycin in the ED. She also received 10mg of decadron IV in the ED. Dr [**Last Name (STitle) 6570**] [**Name (NI) 653**] in [**Name (NI) **], who requested a factor 10a level. Past Medical History: Past Medical History - Lung adenocarcinoma with known mets to brain, dx [**6-/2106**] - Malignant pleural effusion s/p drainage - PE s/p IVF on chronic lovenox and s/p IVC filter - Mycobacterium gordonae - H/o SVC syndrome, SVC filter in place . Past Surgical History: - s/p CCY - s/p pericardiocentesis Social History: Married. Worked at [**Last Name (un) 59330**]. Immigrated from the Phillipines in [**2092**]. Husband works in shipping warehouse. No smoking, alcohol, or illicit drug use. Husband, [**Name (NI) **] HCP, [**Telephone/Fax (1) 87460**] Family History: Mother with diabetes. No family hx of cancer. Physical Exam: On admission: VS: T 97.2 BP 140/84 HR 105 RR 20 O2 sat 100%RA GEN: AOx3, NAD HEENT: PERRLA. MMM. R face with swelling Cards: Tachy, RR S1/S2 normal. no murmurs/gallops/rubs. Pulm: crackles/wheezes Right sided, left lung field CTA Abd: soft, NT, +BS. no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**] sign. Extremities: wwp, no edema. Skin: no rashes or bruising Neuro/Psych: Mood and affect appropriate Transfer Exam ([**2-6**]): Temp: 98.5 / BP 131/63 / Pulsus 13mmHg at 1545 (14mmHG in AM) / HR 110-120 / Sats 94-97% on 0-4L NC GENERAL: Young woman in no acute disress, appears comfortable, answering questions appropriately. Oriented x3. HEENT: NCAT, Round face, MMM CARDIAC: regular rate rhythm, distant heart sounds. No rubs or murmurs appreciated. Chest Tubes: One chest tube in pericardium sub-sternal at midline. Mostly sanginous output (far less bloody than prior) LUNGS: Resp were unlabored, no accessory muscle use. Decreased BS bilaterally right>L, otherwise CTA ABDOMEN: Soft, ND. No HSM. Mild abd discomfort- but nontender. Normoactive bowel sounds EXTREMITIES: No c/c/e. RUE slightly swollen but stable from prior (28 cm) PULSES: Right: Radial 2+ DP 2+ PT 2+ Left: Radial 2+ DP 2+ PT 2+ On discharge: VS: 97.9 130/78 96 18 93%RA Pulsus:10mmgHg GEN: AOx3, NAD HEENT: PERRL. MMM. no LAD. JVP 10cm. neck supple. Neck swollen R < L, improved. Right eye anhidrosis Cards: RR S1/S2 slightly muffled. No rubs noted. No murmurs/gallops. Substernal wound open, not draining at this time. L pleurex in place and clean. Pulm: No dullness to percussion, decreased BS at b/l bases but otherwise clear Abd: BS+, soft, NT, no rebound/guarding, no HSM, no [**Doctor Last Name 515**] sign Extremities: wwp, no edema. DPs, PTs 2+. Skin: no rashes or bruising Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. DTRs 2+ BL. sensation intact to LT, cerebellar fxn intact (FTN, HTS). gait WNL. Pertinent Results: Admission Labs: WBC-9.1# RBC-3.45* Hgb-11.4* Hct-33.5* MCV-97 MCH-33.1* MCHC-34.1 RDW-13.8 Plt Ct-302 Neuts-88.5* Lymphs-7.5* Monos-1.8* Eos-2.0 Baso-0.3 PT-12.8 PTT-35.8* INR(PT)-1.1 Glucose-145* UreaN-15 Creat-1.1 Na-137 K-4.7 Cl-98 HCO3-28 AnGap-16 Lactate-2.2* URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.004 Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG URINE UCG-NEG Transfer Labs ([**2-6**]): WBC-7.3 RBC-3.07* Hgb-10.4* Hct-29.1* MCV-95 MCH-33.8* MCHC-35.7* RDW-14.9 Plt Ct-291 Glucose-130* UreaN-18 Creat-0.9 Na-137 K-4.2 Cl-102 HCO3-29 AnGap-10 ALT-18 AST-22 LD(LDH)-256* AlkPhos-102 TotBili-0.2 Albumin-2.9* Calcium-8.3* Phos-4.4 Mg-1.9 Discharge labs: [**2107-2-10**] 05:56AM BLOOD WBC-30.6*# RBC-2.94* Hgb-9.2* Hct-28.8* MCV-98 MCH-31.4 MCHC-32.0 RDW-14.6 Plt Ct-305 [**2107-2-10**] 05:56AM BLOOD Glucose-106* UreaN-21* Creat-0.9 Na-139 K-4.4 Cl-104 HCO3-27 AnGap-12 [**2107-2-10**] 05:56AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.1 Micro: - Bcx (3/9,12,13): Neg - Ucx (3/9,12): Neg - Influenza DFA ([**1-26**]): Neg - Pericardial Fluid ([**1-27**], 11, 17): GRAM STAIN (Final [**2107-1-27**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2107-1-30**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2107-2-2**]): NO GROWTH. ACID FAST SMEAR (Final [**2107-1-28**]): No AFB ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED - Pleural Fluid ([**2-4**]): Gram Stain with no PMNs and no organisms Cultures NGTD - Sputum Cx ([**1-29**]): >25PMNs, <10 Epis Rare commensal flora Sparse yeast - Pleural fluid: Fluid Culture in Bottles (Final [**2107-2-10**]): NO GROWTH. CXR (PA & LAT) [**2107-1-26**]: There is elevation of the right hemidiaphragm which may in part be due to volume loss, although underlying small subpulmonic pleural effusion may also be present. Large area of right perihilar opacity likely relates to the patient's known underlying malignancy, although superimposed infectious process is difficult to exclude. The left lung is clear. SVC and IVC filters are noted. CTA Chest [**2107-1-26**]: CT OF THE CHEST WITH IV CONTRAST: A right paratracheal lymph node measures 1.2 cm in short axis and is stable. There is a filling defect in the left subclavian vein. This is also unchanged. A filter is seen in the SVC. Distal to the SVC, there is no evidence of clot. The right pleural effusion is significantly increased in size and is now large. There is a new left pleural effusion. There is a new pericardial effusion of moderate size. There is now near-complete atelectasis of the right upper lobe with some patchy opacities likely due to post-obstructive pneumonia. There is complete atelectasis of the right middle lobe. The right lower lobe is still aerated with some minimal atelectasis. The tumor in the right upper lobe is slightly increased in size, currently measuring 2.0 x 1.9 cm (previously 1.9 x 1.5 cm). There is some atelectasis in the lingula. No new lesions are seen in the aerated portions of the lungs; however, please note that the previously identified rounded foci in the right upper lobe and right middle lobe are now obscured by atelectasis. There is a small filling defect in a subsegmental artery to the left lower lobe (series 3, [**Female First Name (un) 899**] 51 through 54). The most proximal portions of the liver and spleen that are depicted on this examination are unremarkable. The thyroid gland is enlarged and this is stable. On bone windows, there are no concerning osteolytic or osteosclerotic lesions. IMPRESSION: 1. Increase in size of right pleural effusion which is now large and new left pleural effusion, small to moderate in size. New moderate size pericardial effusion. 2. Subsegmental PE in an artery to the left lower lobe. 3. New right upper lobe and right middle lobe collapse. Bronchi to the right upper lobe are increasingly obstructed. 4. Stable filling defects in the left brachiocephalic vein. 5. Slight increase in right paratracheal lymphadenopathy as well as mass in the right upper lobe. Please note that the known right supraclavicular lymph node metastasis is not depicted in its entirety on this examination. 6. Due to new atelectasis and pleural effusion previously seen lung nodules are obscured. Left UE ultrasound [**2107-1-27**]: FINDINGS: Grayscale and color ultrasound examination was performed on the left upper extremity. The left brachial, axillary and subclavian veins are compressible, show normal wall-to-wall filling and phasic flow. The left cephalic and basilic veins are normally compressible and show normal Doppler waveforms. The left internal jugular vein is compressible and shows normal color flow and Doppler waveforms. Minimal residual nonocclusive clot is seen in the lower left internal jugular vein. Note is made of multiple enlarged, necrotic-appearing left cervical lymph nodes as demonstrated on prior scans. IMPRESSION: No evidence of DVT in the left upper extremity. Previously seen left internal jugular venous thrombosis appears to have resolved. Small non-occlusive residual clot is seen in the lower IJ. CXR (Pa & Lat) [**2107-2-1**]: IMPRESSION: 1. Persistent postobstructive right upper and right middle lobe atelectasis likely secondary to centrally obstructing neoplasm. 2. Enlarged cardiac silhouette consistent with known pericardial effusion. 3. Persistent pneumothorax with anterior hydropneumothorax component on lateral radiograph Initial TTE [**2107-1-27**]: The left atrium is normal in size. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are structurally normal. No mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a moderate sized, circumferential pericardial effusion measuring 1.4 to 2 centimeters in greatest dimension at end diastole. There is brief right atrial diastolic collapse. There is significant, accentuated respiratory variation in tricuspid valve inflows, consistent with impaired ventricular filling. IMPRESSION: Moderate-sized, circumferential pericardial effusion with echocardiographic evidence of tamponade (RA diastolic collapse, respiratory variation on tricuspid valve inflows). Small echodense region appreciated near RV apex which is consistent with possible cellular debris (?hemorrhagic effusion in the setting of underlying malignancy versus shadow/artifact (clips 58 and 60)). Normal left ventricular cavity size and wall thickness with near-hyperdynamic biventricular systolic function. No clinically significant valvular disease. Indeterminate pulmonary artery systolic pressures. TTE [**1-29**], [**2-3**], [**2-4**] done for monitoring of pericardial effusion. Most Recent TTE [**2107-2-5**]: Conclusions Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. No aortic regurgitation is seen. Trivial mitral regurgitation is seen. There is a very small pericardial effusion. The effusion is echo dense, consistent with blood, inflammation or other cellular elements. There are no echocardiographic signs of tamponade. IMPRESSION: Very small echodense pericardial effusion without echocardiographic evidence of tamponade. PCXR [**2-5**]: One portable upright view. Comparison with the previous study of [**2107-2-4**]. A moderate right pneumothorax and right upper and middle lobe atelectasis persists. The right lung base is elevated consistent with a subpulmonic effusion as before. The left lung is expanded and clear. The heart and mediastinal structures are unchanged. Superior and inferior vena caval filters and a mediastinal drain remain in place. IMPRESSION: No significant change. Right UE ultrasound [**2107-2-7**]: FINDINGS: Occlusive thrombus is noted within the right internal jugular vein. The included portions of the right subclavian vein are widely patent. A PICC line is demonstrated coursing through the right brachial and axillary veins, which are widely patent. Nonocclusive thrombus is seen in the right cephalic vein, and the region of the antecubital fossa. Limited [**Month/Day/Year 2742**] of the left subclavian vein demonstrates patency of the vein with a normal waveform. IMPRESSION: 1. Occlusive thrombus identified in the right IJ vein. 2. Nonocclusive thrombus seen in the right cephalic vein. TTE [**2107-2-10**]: Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There is a very small pericardial effusion. The effusion is echo dense, consistent with blood, inflammation or other cellular elements. There are no echocardiographic signs of tamponade. IMPRESSION: Very small echodense pericardial effusion without tamponade. Brief Hospital Course: Assessment/Plan: Mrs. [**Known lastname 87457**] is a 44 year-old woman with metastatic lung CA, recurrent malignant pericardial effusion, recurrent DVT and PE s/p IVC, SVC and brachiocephalic filter placement who presented with cough and dyspnea for 1 week and was found to have CTA concerning for PE and pericardial effusion with tamponade physiology. She was taken semi-urgently to the catheterization laboratory for pericardiocentesis with balloon pericardiotomy and subseqnetly required surgical creation of 2 pericardial windows with internal drainage. . # Malignant Pericardial Effusion: She presented with her third occurence of malignant pericardial effusion with evidence of tamonade physiology that required drainage and balloon pericardiotomy. 240ml of sanguineous fluid was drained from pericardial sac and she tolerated the procedure well. A pericardial drain was left in overnight but removed the next afternoon when it had drained very little overnight. However, later that day she again was noted to have an increased pulsus up to 32mmHg with doppler with recurrence of tamonade physiology with new RV collapse on bedside ECHO. Overnight she was urgently taken to CT surgery for pericardial window with internal drainage. In that surgery window was created draining into the L pleural space and a L chest tube was placed that initially drained 400cc of serosanguinous fluid. Due to technical difficulties with window placement and concern that the window might not be effective, a pericardial incision was also made just righ of midline and 200cc of bloody fluid was drained from the pericardium and a pericardial drain was placed in that incision. Pt was intubated for the proceedure and kept intubated overnight as a precaution, but was extubated without incident the next day. After 24hrs the L chest tube was removed as it had decreasing drainage but the pericardial drain was left in place due to very high output (1L over first 24hrs and 500cc/day each of the following 2 days). Pt also received 1 unit PRBC on [**2-1**] as her Hct had drifted down to 22.4. There was concern that the window might not function when the pericardial drain was removed and the pt might go back into tamponade. As a result, the pericardial tube was clamped on [**2-3**] and the patient was monitored overnight without significant change in vital signs or symptoms. On [**2-4**] interventional pulmonology placed a pleurx catheter in the L pleural space and roughly 350cc was drained from the pleurx. On [**2-5**], the pericardial drain was removed after ECHO confirmed that there was constrictive physiology but no hemodynamically significant effusion 36hrs after the tube had been clamped. Although the initial plan was to drain every other day, the pleurx was also drained on the 19th due to significant weeping on the dressing where the pericardial drain had been in place. An additional 200cc of fluid was drained at that time with process stopped as pt started to experience pain. On the floor, another 150mL of fluid was drained from pleurx which again was terminated due to pain. Prior to discharge, she was drained one last time. She was given morphine po for these drainages. She was discharged with follow-up at IP and with VNA services as well as prescription for morhine for continued drainages. Pulsus remained stable at between 10 and 14mmHg for remainder of hospital stay. Oxygen saturation remained low 90s on room air and decreased to 88-89% with ambulation. She was discharged with home oxygen. She was scheduled for outpatient cardiology follow-up with outpatient echocardiogram for monitoring. . # Pulmonary embolism: She was first diagnosed with a pulmonary embolism in [**6-/2106**] along with BUE clots. She received SVC and IVC filters and has been on chronic lovenox. She was found to have an anti-factor Xa level of >2.0 consistent with therapeutic levels. CTA on this admission identified a subsegmental PE in an artery to the left lower lobe. Because of the reaccumulation of her pericadial effusion with solid pericardial mass component, it was determined that the heparin drip should not be resumed immedicately. From time of initial pericardial window, heparin gtt or other therapeutic anticoagulation was held until pt transfered back to OMED service on [**2-6**]. Upon transfer to floor, she was started back on heparin gtt and then transitioned to lovenox upon discharge. . # R anterior/apical pneumothorax: on [**2-1**], daily PCXR noted small apical R pneumothorax. This was confirmed by CXR Pa/Lat which also noted small anterior component to R apical pneumothorax. This finding was monitored with daily PCXR and found to be stable over the next 6 days. Cause of this PTX most likely related to significant R pleural effusion/atelectasis due to underlying lung malignancy more than any of the operative proceedures that were done as none of them in theory should have involved the R lung pleura. However, with intubation and line placement, iatrogenic PTX is on the differential. . # Infectious Disease: No cultures were positive during CCU stay. Around time pt went to OR for pericardial window, she had developed a temperature of 100 and was slightly more tachycardic. There was some concern for possible post-obstructive PNA in setting of known lung mass so initially started on vanco/cefepime for this on [**1-28**] and also knowing that pt would be going to OR and receiving operative instrumentation. Abx were stopped Am [**1-31**] after 48hrs when it became apparent that there was no significant infectious process as the cause of pts symptoms. . # Metastatic lung adenocarcinoma: Adenocarcinoma of the lung was discovered in [**6-/2106**], metastatic to right temporal lobe and now s/p stereotactic radiotherapy. S/P cisplatin and navelbine last Tx 12/[**2105**]. Pt was kept on prednisone at oncology request due to her brain mets. Neuro attending recommended that keppra be stopped. Upon transfer to oncology floor, she was started on chemotherapy with taxotere which she tolerated well. She also had 3 days of increased steroids (dexamethasone 8mg [**Hospital1 **] x 3 days) at the time of chemotherapy and also received neupogen to increase her counts after chemo. . # S/P Cyberknife for brain metastasis: She was finishing a decadron taper on admission. She received increased doses at 8mg [**Hospital1 **] x 3 days around the time of chemotherapy and was discharged back on dexamethasone 2mg daily until she meets with her neuro-oncologist for the swelling around her neck secondary to SVC syndrome. She also had Horner's syndrome with right eye ptosis and anhidrosis. She will need an outpatient MRI head and C-spine for further [**Hospital1 2742**] of her horner syndrome. . # Access: Pt had known right upper extremity DVTs on admission with swelling around right arm for which she had been on lovenox. She received a right PICC at the ICU for access. Later, on the floor, RUQ ultrasound revealed right IJ and right cephalic DVTs. Left UE US had small non-occlusive residual clot is seen in the lower IJ. Discussion was held with surgery and IV nurse regarding d/c-ing this right PICC given persistent DVTs. However, pt had very poor access and it was not guaranteed that access could be obtained in left arm given clot in left IJ as well. Thus, it was decided to continue to use right PICC while pt was in house with close monitoring of right arm circumference. Right arm swelling remained stable. Right PICC was d/c-ed upon discharge. She was scheduled for outpatient MRV to evaluate for access for future chemo sessions and will likely need chest port. Medications on Admission: DEXAMETHASONE 2mg daily (last day on [**2107-1-26**]) ENOXAPARIN - 60 mg/0.6 mL every twelve (12) hours Folic acid 1mg daily Vitamin B12 injection Discharge Medications: 1. oxygen Please provide 2-4L oxygen by nasal cannula when ambulating prn 2. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 3. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain: do not drive or operate machinery while on this medication; do not drive or operate machinery while on this medication. Disp:*30 Tablet(s)* Refills:*0* 6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for temperature >38.0. 7. benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*0* 8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for for wheeze. Disp:*1 inhaler* Refills:*0* 10. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*60 Tablet(s)* Refills:*0* 11. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 12. codeine-guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6 hours) as needed for cough: do not drive or operate machinery while on this medication. Disp:*250 ML(s)* Refills:*0* 13. enoxaparin 60 mg/0.6 mL Syringe Sig: Sixty (60) mg Subcutaneous Q12H (every 12 hours). Disp:*3600 mg* Refills:*0* 14. polyethylene glycol 3350 17 gram/dose Powder Sig: Seventeen (17) grams PO DAILY (Daily) as needed for contstipation. Disp:*30 packets* Refills:*0* 15. filgrastim 300 mcg/mL Solution Sig: Three Hundred (300) mcg Injection Q24H (every 24 hours) for 4 days. Disp:*1200 mcg* Refills:*0* 16. morphine 15 mg Tablet Sig: Two (2) Tablet PO every seventy-two (72) hours as needed for pain: To be used for pain from pleurex drainages; do not drive or operate machinery. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary: Pericardial effusion with tamponade Pleural effusion Secondary: Lung cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: It was a pleasure taking care of you in the hospital. You were admitted with shortness of breath and cough. You were found to have fluid around your lungs and around your heart. You were taken to the OR for a procedure where an incision was made in the pericardium so that the fluid around your heart could drain into your lung space. Another drain was placed in the lung space to drain this fluid. You will need to have this drained every 3-4 days. You will need follow up at Interventional Pulmonary as well as cardiology for these fluid collections. You were sent home with home oxygen because your oxygen levels may decrease particularly when ambulating. For the swelling around your neck, you should continue taking dexamethasone 2mg daily until you see Dr. [**Last Name (STitle) 6570**]. You will get a repeat MRI head and C-spine as outpatient which will be reviewed by Dr. [**Last Name (STitle) 6570**]. The following changes were made to your medications: 1) START Dexamethasone 2mg daily until you see Dr. [**Last Name (STitle) 6570**] 2) START ranitidine 150mg [**Hospital1 **] 3) START docusate sodium, senna, miralax, bisacodyl as needed for constipation 4) START benzonatate 5) START ipatropium inhalers 6) START guaifenesin-codeine for cough 7) START filgastram 300mcg/mL injection daily for 4 more days 8) START morphine 15-30mg prior to drainages from your pleurex 9) CONTINUE enoxaparin 60mg injections twice a day Followup Instructions: You will need to have an MRV to assess your veins for IV access as well as a repeat echocardiogram after discharge. Dr. [**Name (NI) 86074**] office will call you with appointment times for these. Dr. [**Last Name (STitle) 19**] will follow up on your echocardiogram. You have the following appointments scheduled for you: Department: HEMATOLOGY/ONCOLOGY When: THURSDAY [**2107-2-17**] at 9:00 AM With: [**First Name8 (NamePattern2) 828**] [**Name8 (MD) 829**], MD [**0-0-**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Hematology/Oncology: [**Last Name (LF) 766**], [**2-21**] at 10am With: Dr. [**Last Name (STitle) **] [**Name (STitle) **] (covering for Dr. [**First Name7 (NamePattern1) 2270**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]) Location: [**Hospital1 641**] Address: [**Street Address(2) 87458**], [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3468**] Hematology/Oncology: [**Last Name (LF) 766**], [**2-21**] at 10:30am With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 22650**], RN Location: [**Hospital1 641**] Address: [**Street Address(2) 87458**], [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3468**] Name: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 19**] When: You will be [**Last Name (NamePattern1) 653**] by Dr. [**Last Name (STitle) **] office regarding the time and date of your hospital follow up appointment that should be scheduled in [**2-25**] days after your discharge. If you have not heard from the office in 2 business days, please call the number listed below. Location: [**Hospital1 641**] Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 2258**] Department: Radiology- MRI When: [**Telephone/Fax (1) 766**] [**2107-2-28**] at 1 PM Location: [**Hospital1 **] Address: [**Hospital Ward Name 517**] [**Location (un) **], [**Location (un) 86**], MA Phone: [**Telephone/Fax (1) 10522**] Department: Neurology Name: Dr. [**First Name8 (NamePattern2) 1151**] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) 6570**] When: [**Last Name (NamePattern1) 766**] [**2107-2-28**] at 2:30 PM Location: [**Hospital1 **] Address: [**Location (un) **], TCC8, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 1844**] Completed by:[**2107-2-15**]

423,486,162,198,276,518,511,280,459,V125,337

{'Other specified diseases of pericardium,Pneumonia, organism unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acidosis,Pulmonary collapse,Malignant pleural effusion,Iron deficiency anemia secondary to blood loss (chronic),Compression of vein,Personal history of venous thrombosis and embolism,Unspecified disorder of autonomic nervous 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: SOB, cough PRESENT ILLNESS: 44 yo F with lung CA, metastatic to the R temporal lobe s/p cyberknife on [**1-3**], and on cisplatin and navelbine (last tx in [**10-29**]), who presents with SOB and cough x 1 week. She denies fevers or myalgias. She states she is having minimal CP w/ cough. She did see [**Name8 (MD) **] NP[**MD Number(3) 18184**] PCP's office on [**2107-1-20**], who prescribed her azithromycin and cefpodoxime, which she has been taking since [**2107-1-21**] with no improvement. . Of note, she is on decadron 2mg (last day of taper) and had been on keppra since surgery on [**1-3**] but states that she has completed course. She also has significant history of PEs and DVTs and has two IVC filters and is on lovenox. However, she developed new UE DVT while on lovenox. . In the ED, vitals 98.8 120 138/87 20 95%. CXR showed R sided infiltrate. She was given vancomycin in the ED. She also received 10mg of decadron IV in the ED. Dr [**Last Name (STitle) 6570**] [**Name (NI) 653**] in [**Name (NI) **], who requested a factor 10a level. MEDICAL HISTORY: Past Medical History - Lung adenocarcinoma with known mets to brain, dx [**6-/2106**] - Malignant pleural effusion s/p drainage - PE s/p IVF on chronic lovenox and s/p IVC filter - Mycobacterium gordonae - H/o SVC syndrome, SVC filter in place . Past Surgical History: - s/p CCY - s/p pericardiocentesis MEDICATION ON ADMISSION: DEXAMETHASONE 2mg daily (last day on [**2107-1-26**]) ENOXAPARIN - 60 mg/0.6 mL every twelve (12) hours Folic acid 1mg daily Vitamin B12 injection ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: VS: T 97.2 BP 140/84 HR 105 RR 20 O2 sat 100%RA GEN: AOx3, NAD HEENT: PERRLA. MMM. R face with swelling Cards: Tachy, RR S1/S2 normal. no murmurs/gallops/rubs. Pulm: crackles/wheezes Right sided, left lung field CTA Abd: soft, NT, +BS. no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**] sign. Extremities: wwp, no edema. Skin: no rashes or bruising Neuro/Psych: Mood and affect appropriate FAMILY HISTORY: Mother with diabetes. No family hx of cancer. SOCIAL HISTORY: Married. Worked at [**Last Name (un) 59330**]. Immigrated from the Phillipines in [**2092**]. Husband works in shipping warehouse. No smoking, alcohol, or illicit drug use. Husband, [**Name (NI) **] HCP, [**Telephone/Fax (1) 87460**] ### Response: {'Other specified diseases of pericardium,Pneumonia, organism unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acidosis,Pulmonary collapse,Malignant pleural effusion,Iron deficiency anemia secondary to blood loss (chronic),Compression of vein,Personal history of venous thrombosis and embolism,Unspecified disorder of autonomic nervous system'}

CHIEF COMPLAINT: angina PRESENT ILLNESS: 64 yo male with CAD and prior PTCA [**47**] years ago. Transferred in from OSH with unstable angina and + MIBI for infero-septal ischemia. Cardiac enzymes were negative x 2. Went home for plavix washout, to return for CABG in a few days. MEDICAL HISTORY: HTN Hyperlipidemia CAD /PTCA ~15 yrs ago - balloon angioplasty MEDICATION ON ADMISSION: HCTZ 25 mg daily atenolol 75 mg [**Hospital1 **] lipitor 80 mg daily imdur 60 mg daily norvasc 2.5 mg daily folic acid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 5'9 [**12-7**] " 212 # skin HEENT unremarkable neck supple , full ROM, no carotid bruits appreciated CTAB anteriorly RRR no murmur soft, NT, ND + BS warm, well-perfused with no edema or varicosities noted neruo grossly intact 2 + bil. fem/DP/PT/radials FAMILY HISTORY: Father died 69 with cerebral hemorrhage, mother died at 80 "old age". There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use- quit 20 yrs ago. There is no history of alcohol abuse.

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,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,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension

Crnry athrscl natve vssl,Intermed coronary synd,Acidosis,Abn react-anastom/graft,Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS,Hypertension NOS

Admission Date: [**2141-8-15**] Discharge Date: [**2141-8-19**] Date of Birth: [**2077-6-16**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: angina Major Surgical or Invasive Procedure: [**2141-8-15**] CABG x3 (LIMA to LAD, SVG to OM, SVG to PDA) History of Present Illness: 64 yo male with CAD and prior PTCA [**47**] years ago. Transferred in from OSH with unstable angina and + MIBI for infero-septal ischemia. Cardiac enzymes were negative x 2. Went home for plavix washout, to return for CABG in a few days. Past Medical History: HTN Hyperlipidemia CAD /PTCA ~15 yrs ago - balloon angioplasty Social History: Social history is significant for the absence of current tobacco use- quit 20 yrs ago. There is no history of alcohol abuse. Family History: Father died 69 with cerebral hemorrhage, mother died at 80 "old age". There is no family history of premature coronary artery disease or sudden death. Physical Exam: 5'9 [**12-7**] " 212 # skin HEENT unremarkable neck supple , full ROM, no carotid bruits appreciated CTAB anteriorly RRR no murmur soft, NT, ND + BS warm, well-perfused with no edema or varicosities noted neruo grossly intact 2 + bil. fem/DP/PT/radials Pertinent Results: Conclusions PREBYPASS 1. The left atrium is normal in size. No atrial septal defect or PFO is seen by 2D or color Doppler. 2. Left ventricular wall thicknesses and cavity size are normal. 3. Right ventricular chamber size and free wall motion are normal. 4. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. 5. The aortic valve leaflets (3) are mildly thickened. There is mild aortic valve stenosis (area 1.2-1.9cm2). No aortic regurgitation is seen. 6. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. 7. There is no pericardial effusion. 8. Dr. [**Last Name (STitle) **] was notified in person of the results on [**2141-8-15**] at 928. POST CPB: Preserved [**Hospital1 **]-ventricular systolic function. No change in valve structure or function. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2141-8-15**] 11:03 [**Known lastname **],[**Known firstname **] J [**Medical Record Number 101303**] M 64 [**2077-6-16**] Radiology Report CHEST (PORTABLE AP) Study Date of [**2141-8-17**] 8:14 AM [**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2141-8-17**] SCHED CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 101304**] Reason: ? PTX s/p CT removal [**Hospital 93**] MEDICAL CONDITION: 64 year old man s/p CABG REASON FOR THIS EXAMINATION: ? PTX s/p CT removal Provisional Findings Impression: SP [**Doctor First Name **] [**2141-8-17**] 4:01 PM No pneumothorax after instrument removal. Final Report TYPE OF EXAMINATION: Chest AP portable single view. INDICATION: Status post bypass surgery. Now extubated and tube removal. The patient is extubated and the previously described central venous line, pulmonary catheter, mediastinal and chest tubes have been removed. There is no pneumothorax and no significant pulmonary vascular congestion. When comparison is extended to the pre-operative single view study of [**2141-8-9**], postoperative findings include moderate enlargement of the heart silhouette and some retrocardiac density consistent with atelectasis. No new acute parenchymal infiltrates are identified. DR. [**First Name (STitle) **] [**Initials (NamePattern5) 3250**] [**Last Name (NamePattern5) 3251**] Approved: [**Doctor First Name **] [**2141-8-17**] 5:26 PM ?????? [**2135**] CareGroup IS. All rights reserved. [**2141-8-19**] 08:40AM BLOOD WBC-7.9 RBC-3.14* Hgb-10.3* Hct-28.4* MCV-91 MCH-32.8* MCHC-36.2* RDW-11.9 Plt Ct-187 [**2141-8-15**] 12:15PM BLOOD WBC-19.3*# RBC-3.69* Hgb-12.1* Hct-32.9* MCV-89 MCH-32.6* MCHC-36.6* RDW-12.6 Plt Ct-168 [**2141-8-19**] 08:40AM BLOOD Glucose-112* UreaN-13 Creat-0.8 Na-136 K-4.5 Cl-103 HCO3-26 AnGap-12 [**2141-8-16**] 02:59AM BLOOD Glucose-130* UreaN-13 Creat-0.7 Na-137 K-4.1 Cl-107 HCO3-26 AnGap-8 Brief Hospital Course: Admitted [**8-15**] and underwent CABG x3 with Dr. [**Last Name (STitle) **]. Please refer to Dr[**Last Name (STitle) **] operative report for further details. Transferred to the CVICU in stable condition on phenyleprine and propofol drips. Extubated later that afternoon. Gently diuresed toward his preop weight. Beta blockade titrated.Tubes and drains were discontinued in a timely fashion. POD#1 he was transfered to SDU for further telemetry monitoring and recovery. The remainder of his postoperative course was essentially uneventful. He continued to progress and on POD#4 he was discharged to home with VNA. All follow up appointments were advised. Medications on Admission: HCTZ 25 mg daily atenolol 75 mg [**Hospital1 **] lipitor 80 mg daily imdur 60 mg daily norvasc 2.5 mg daily folic acid Discharge Medications: 1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 7 days. Disp:*14 Packet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. 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* 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*45 Tablet(s)* Refills:*0* 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: .[**Hospital1 1474**] VNA Discharge Diagnosis: CAD s/p cabg x3 HTN elev. lipids Discharge Condition: good Discharge Instructions: no lotions, creams or powders to any incision no lifting greater than 10 pounds for 10 weeks call for fever greater than 100.5, redness, or drainage no driving for one month AND until off all narcotics shower daily and pat incisions dry Followup Instructions: see Dr. [**Last Name (un) **] in [**12-7**] weeks see Dr. [**Last Name (STitle) 7047**] in [**1-8**] weeks see Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] Completed by:[**2141-8-19**]

414,411,276,E878,458,272,401

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,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,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,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: angina PRESENT ILLNESS: 64 yo male with CAD and prior PTCA [**47**] years ago. Transferred in from OSH with unstable angina and + MIBI for infero-septal ischemia. Cardiac enzymes were negative x 2. Went home for plavix washout, to return for CABG in a few days. MEDICAL HISTORY: HTN Hyperlipidemia CAD /PTCA ~15 yrs ago - balloon angioplasty MEDICATION ON ADMISSION: HCTZ 25 mg daily atenolol 75 mg [**Hospital1 **] lipitor 80 mg daily imdur 60 mg daily norvasc 2.5 mg daily folic acid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 5'9 [**12-7**] " 212 # skin HEENT unremarkable neck supple , full ROM, no carotid bruits appreciated CTAB anteriorly RRR no murmur soft, NT, ND + BS warm, well-perfused with no edema or varicosities noted neruo grossly intact 2 + bil. fem/DP/PT/radials FAMILY HISTORY: Father died 69 with cerebral hemorrhage, mother died at 80 "old age". There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use- quit 20 yrs ago. There is no history of alcohol abuse. ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,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,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}

CHIEF COMPLAINT: left upper lobe nodule. PRESENT ILLNESS: MEDICAL HISTORY: CAD s/p stenting, hypothyroid, hyperchol, GERD, sciatica MEDICATION ON ADMISSION: fosamax 70 qweek, nexium 20', crestor 10', toprol 100', synthroid 100' ALLERGIES: Tetracycline / Codeine PHYSICAL EXAM: general: well appearing elderly female in NAD. Reap: CTA bilat. cor: RRR S1, S2 abd: soft, NT, Nd, +BS Extrem: no C/C/E neuro: A+OX3. no focal deficits. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives alone. Former smoker- one ppd quit [**2152**]. no etoh

Malignant neoplasm of upper lobe, bronchus or lung,Other and unspecified angina pectoris,Foreign body in main bronchus,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,Pure hypercholesterolemia

Mal neo upper lobe lung,Angina pectoris NEC/NOS,Foreign body bronchus,Hypothyroidism NOS,Crnry athrscl natve vssl,Status-post ptca,Esophageal reflux,Pure hypercholesterolem

Admission Date: [**2195-12-23**] Discharge Date: [**2195-12-31**] Date of Birth: [**2119-6-9**] Sex: F Service: CARDIOTHORACIC Allergies: Tetracycline / Codeine Attending:[**First Name3 (LF) 2969**] Chief Complaint: left upper lobe nodule. Major Surgical or Invasive Procedure: 76 yo F s/p Left thoracotomy, Left upper Lobectomy [**12-23**] Past Medical History: CAD s/p stenting, hypothyroid, hyperchol, GERD, sciatica Social History: lives alone. Former smoker- one ppd quit [**2152**]. no etoh Family History: non-contributory Physical Exam: general: well appearing elderly female in NAD. Reap: CTA bilat. cor: RRR S1, S2 abd: soft, NT, Nd, +BS Extrem: no C/C/E neuro: A+OX3. no focal deficits. Pertinent Results: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2195-12-29**] 05:20AM 7.5 3.15* 9.4* 25.8* 82 29.7 36.2* 14.1 246 RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2195-12-29**] 05:20AM 91 12 1.0 141 4.2 106 231 16 Brief Hospital Course: Pt was admitted on [**2195-12-23**] and taken to the OR for bronch, left VATS wedge biopsy proceeding to left mini thoracotomy for left upper lobectomy for nodule. PT was admitted to the PACU intubated d/t hypothemia nd slow awakening. Once recovered, she was extubated. Left chest tube and [**Doctor Last Name **] to wall sxn w/o leak draining moderate amts serosang drainage. CXR w/o PTX. Pain control in initial post op period unrelieved requiring increased epidural and toradol. POD#[**11-30**] Chest tubes water seal. Improved pain control. [**Last Name (un) **] Reg diet. POD#[**1-30**] pain well controlled. temp spike 103. pan cultured. Lethargic w/ mottled LE. HR and BP stable. CT obatined to eval for INfection vs. PE. Chest CT w/ IMPRESSION: 1. No evidence for pulmonary embolus. 2. Left hydropneumothorax, as described. Infection of this collection cannot be excluded. 3. The presumed residual left upper lobe has an abnormal appearance, as described. There is probable mucous plugging to the bronchus in this region. Differential diagnosis includes infection, post-obstructive pneumonitis, and re-expansion edema post-operatively. Given the probable mucous plugging, bronchoscopy could be considered. 4. Interval increase in the size of the largest right upper lobe nodule from the prior PET- CT from [**2195-11-11**]. The band- like parenchymal opacity also has a more nodular component on the current study. These findings may relate to interval progression of an infectious/inflammatory process, though a neoplastic process cannot be excluded. Correlation with the pathology findings from the left upper lobe is recommended. 5. Small-moderate right pleural effusion. 6. Left renal cyst, incompletely characterized on this study. Based on these findings pt was transferred to the CSRU and was bronched for large mucous plug at take off of LUL. started on Zosyn. POD#5 Mental status improved. Vanco added to zosyn. Repeat bronch w/ bloody secretions- lavaged until clear. Transferred from CSRU to floor. Epidural d/c'd. POD#[**5-4**] Cont's to improve. Chest tube and [**Doctor Last Name **] d/c'd. improved ambulation and activity tolerance. POD#8 d/c'd to daughter -in law's home w/ VNA and PT services. Also will be on po augmentin x 2weeks. Follow up w/ Dr. [**Last Name (STitle) **] in 2weeks. Medications on Admission: fosamax 70 qweek, nexium 20', crestor 10', toprol 100', synthroid 100' Discharge Medications: 1. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 3. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSAT (every Saturday). 5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: 15-30 MLs PO Q4H (every 4 hours) as needed. 6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* 7. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a day for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 8. 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:*2* 9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY (Daily). 11. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home With Service Facility: [**Hospital **] Home Health Care Discharge Diagnosis: Coronary artery disease s/p stents [**2189**] normal EF, hypothyroid, gastric esophogeal reflux disease left thoracotomy, left upper lobectomy Discharge Condition: good Discharge Instructions: Call Dr.[**Doctor Last Name 4738**] office/ Throacic Surgery office [**Telephone/Fax (1) 170**] for: fever, shortness of breath, chest pain, excessive foul smelling drainage at chest tube site. Take regular medications as prior, take new medications as directed. No driving if taking narcotic pain medication no tub baths for 4 weeks. You may shower 2 days after chest tube removed. VNA Services through Caritas Home Care. Followup Instructions: Call Dr.[**Doctor Last Name 4738**] office/ Throacic Surgery office [**Telephone/Fax (1) 170**] for appointment in [**9-10**] days. please arrive for your follow up appointment 45 minutes early and report to the [**Hospital Ward Name 23**] Clinical center [**Location (un) **] radiology for a follow up CXR before your appointment. Completed by:[**2195-12-31**]

162,413,934,244,414,V458,530,272

{'Malignant neoplasm of upper lobe, bronchus or lung,Other and unspecified angina pectoris,Foreign body in main bronchus,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,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: left upper lobe nodule. PRESENT ILLNESS: MEDICAL HISTORY: CAD s/p stenting, hypothyroid, hyperchol, GERD, sciatica MEDICATION ON ADMISSION: fosamax 70 qweek, nexium 20', crestor 10', toprol 100', synthroid 100' ALLERGIES: Tetracycline / Codeine PHYSICAL EXAM: general: well appearing elderly female in NAD. Reap: CTA bilat. cor: RRR S1, S2 abd: soft, NT, Nd, +BS Extrem: no C/C/E neuro: A+OX3. no focal deficits. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives alone. Former smoker- one ppd quit [**2152**]. no etoh ### Response: {'Malignant neoplasm of upper lobe, bronchus or lung,Other and unspecified angina pectoris,Foreign body in main bronchus,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Head injury after struck by falling tree. PRESENT ILLNESS: 76yo male transferred from outside hospital. Patient was struck by falling tree, unknown loss of consiousness. Complaining of left shoulder & hip pain to EMS. Patient was confused, agitated, and combative on-scene & was intubated due to concern for head injury. Vitals during transport were significant for hypertension & bradycardia. MEDICAL HISTORY: Hypertension Hyperlipidemia MEDICATION ON ADMISSION: Aciphex Cozaar Lipitor Norvasc ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HR-55, BP-110/60, RR-18, O2Sat-94% room air WN/WD male NAD, A&O x 3 HEENT - PERRL/EOMI, scalp abrasion, no facial trauma Neck - [**Location (un) 2848**] J collar in place, + mid cervical tenderness/pain with ROM Chest - Breath sounds CTA bilat, occlusive dressing covering chest tube wound CV - RRR, no murmur Abdomen - soft, NT/ND, NABS Pelvis - stable, +tenderness Extremity - no C/C/E, pneumo-boots in place, cap refill < 2sec, 2+ DP pulses FAMILY HISTORY: Non-contributory SOCIAL HISTORY:

Head injury, unspecified,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of pubis,Closed fracture of two ribs,Struck accidentally by falling object,Cervical spondylosis without myelopathy,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Head injury NOS,Traum pneumothorax-close,Fx sacrum/coccyx-closed,Fracture of pubis-closed,Fracture two ribs-closed,Struck by falling object,Cervical spondylosis,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2197-10-1**] Discharge Date: [**2197-10-5**] Date of Birth: [**2121-5-28**] Sex: M Service: [**Last Name (un) **] Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5880**] Chief Complaint: Head injury after struck by falling tree. Major Surgical or Invasive Procedure: Left chest tube placement [**2197-10-1**] - removed [**2197-10-3**] History of Present Illness: 76yo male transferred from outside hospital. Patient was struck by falling tree, unknown loss of consiousness. Complaining of left shoulder & hip pain to EMS. Patient was confused, agitated, and combative on-scene & was intubated due to concern for head injury. Vitals during transport were significant for hypertension & bradycardia. Past Medical History: Hypertension Hyperlipidemia Family History: Non-contributory Physical Exam: HR-55, BP-110/60, RR-18, O2Sat-94% room air WN/WD male NAD, A&O x 3 HEENT - PERRL/EOMI, scalp abrasion, no facial trauma Neck - [**Location (un) 2848**] J collar in place, + mid cervical tenderness/pain with ROM Chest - Breath sounds CTA bilat, occlusive dressing covering chest tube wound CV - RRR, no murmur Abdomen - soft, NT/ND, NABS Pelvis - stable, +tenderness Extremity - no C/C/E, pneumo-boots in place, cap refill < 2sec, 2+ DP pulses Pertinent Results: [**2197-10-4**] 05:17AM BLOOD WBC-5.1 RBC-2.71* Hgb-8.5* Hct-25.0* MCV-92 MCH-31.3 MCHC-34.0 RDW-12.9 Plt Ct-89* [**2197-10-3**] 06:00AM BLOOD PT-13.3 PTT-30.7 INR(PT)-1.1 [**2197-10-3**] 06:00AM BLOOD Glucose-138* UreaN-12 Creat-0.8 Na-141 K-3.9 Cl-106 HCO3-30* AnGap-9 [**2197-10-3**] 06:00AM BLOOD Calcium-8.4 Phos-2.9 Mg-1.9 [**2197-10-2**] 11:11AM BLOOD CK-MB-5 cTropnT-<0.01 [**2197-10-1**] 04:17PM BLOOD CK-MB-7 cTropnT-<0.01 [**2197-10-1**] CXR - L rib fx & pneumothorax, repeat CXR with chest tube placement XR Pelvis - bilateral superior & inferior pubic ramii fractures CT Head - no intracranial bleed or mass effect CT C/spine - no fracture/dislocation, + degenerative changes CT T/spine - no fracture/dislocation CT L/spine - no lumbar fracture/dislocation, + R sacral fracture CT Chest - no aortic injury, + L 3rd & 4th rib fx's, + pneumothorax CT Abd - no free fluid or injury CT Pelvis - bilateral superior/inferior pubic ramii fractures, R sacral fx [**2197-10-3**] CXR - interval resolution of pneumothorax, chest tube in place C/spine flex/ex - minimal C3 on C4 anterolisthesis with flex, severe DJD Brief Hospital Course: [**10-1**] - Pt transported from OSH to [**Hospital1 18**] ED. Following initial exam & studies, pt had left chest tube placed & was admitted to Trauma/SICU for observation. Orthopedics consulted for pelvic fractures. [**10-2**] - Pt extubated & transferred to Trauma [**Hospital1 **] team. [**10-3**] - Chest tube placed on water seal in AM & d/c'd in PM. C-spine films demonstrate evidence of possible ligamentous instability, cervical collar remains. [**10-4**] - Spine consulted regarding c-spine, no collar needed. [**10-5**] - D/C to rehab facility. Medications on Admission: Aciphex Cozaar Lipitor Norvasc Discharge Medications: 1. 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* 2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD (once a day). 3. Losartan Potassium 25 mg Tablet Sig: One (1) Tablet PO QD (once a day). 4. Amlodipine Besylate 5 mg Tablet Sig: One (1) Tablet PO QD (once a day). 5. Enoxaparin Sodium 30 mg/0.3 mL Syringe Sig: One (1) syringe Subcutaneous [**Hospital1 **] (2 times a day): Continue DVT prophylaxis until ambulatory . Disp:*60 syringe* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: Closed head injury. C3/C4 anterolisthesis. Left 3rd & 4th rib fracture. Left pneumothorax, s/p chest tube. Pelvic fractures: bilateral superior/inferior ramii, right sacrum. Discharge Condition: Good, stable. Discharge Instructions: -Weight bearing as tolerated, left lower extremity -Partial weight bearing as tolerated, right lower extremity Followup Instructions: Follow-up in Trauma Clinic in [**1-17**] weeks, call ([**Telephone/Fax (1) 55917**] for appointment & directions. Follow-up with Dr. [**Last Name (STitle) 1005**] in [**Hospital **] Clinic in [**1-18**] weeks, call ([**Telephone/Fax (1) 56732**] for appointment & directions.

959,860,805,808,807,E916,721,401,272

{'Head injury, unspecified,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of pubis,Closed fracture of two ribs,Struck accidentally by falling object,Cervical spondylosis without myelopathy,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: Head injury after struck by falling tree. PRESENT ILLNESS: 76yo male transferred from outside hospital. Patient was struck by falling tree, unknown loss of consiousness. Complaining of left shoulder & hip pain to EMS. Patient was confused, agitated, and combative on-scene & was intubated due to concern for head injury. Vitals during transport were significant for hypertension & bradycardia. MEDICAL HISTORY: Hypertension Hyperlipidemia MEDICATION ON ADMISSION: Aciphex Cozaar Lipitor Norvasc ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HR-55, BP-110/60, RR-18, O2Sat-94% room air WN/WD male NAD, A&O x 3 HEENT - PERRL/EOMI, scalp abrasion, no facial trauma Neck - [**Location (un) 2848**] J collar in place, + mid cervical tenderness/pain with ROM Chest - Breath sounds CTA bilat, occlusive dressing covering chest tube wound CV - RRR, no murmur Abdomen - soft, NT/ND, NABS Pelvis - stable, +tenderness Extremity - no C/C/E, pneumo-boots in place, cap refill < 2sec, 2+ DP pulses FAMILY HISTORY: Non-contributory SOCIAL HISTORY: ### Response: {'Head injury, unspecified,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of pubis,Closed fracture of two ribs,Struck accidentally by falling object,Cervical spondylosis without myelopathy,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: Ischemic Pain. PRESENT ILLNESS: This is a 56yo M with a long history of failed interventions to the LLE. Eight months ago, he underwent an endarterectomy of the femoral bifurcation and SFA stenting. He then underwent a L [**Name (NI) 85459**] PTFE graft. This occluded, and he had TPA in [**4-14**]. He embolized to his distal vessels and had incomplete clearance after balloon angioplasty of the distal PT. MEDICAL HISTORY: PMH: CAD s/p MI and cardiac stent, DM2 (IDDM), HIT PSH: cardiac stent, LN biopsy in neck, unknown LE vascular procedures MEDICATION ON ADMISSION: metformin 1000', metoprolol 25'', pravastatin 20', lisinopril 30', insulin, gabapentin 300'', cymbalta EC 30', nitroglycerin, oxycontin 30''', oxycodone 30''' per pain contract ALLERGIES: Heparin Agents PHYSICAL EXAM: On Admission: PHYSICAL EXAM Vital Signs: Temp: 100.1 RR: 20 Pulse: 87 BP: 132/71 Neuro/Psych: Oriented x3, Affect Normal, NAD. Neck: No right carotid bruit, No left carotid bruit. Heart: Regular rate and rhythm. Lungs: Clear, Normal respiratory effort. Gastrointestinal: No masses, abnormal: Obese. Rectal: Not Examined. Extremities: Abnormal: LLE rubor to mid-shin, BLE 1+ edema L>R. FAMILY HISTORY: nc SOCIAL HISTORY: mechanic, lives with wife, + tobacco, + etoh

Atherosclerosis of native arteries of the extremities with gangrene,Other complications due to other vascular device, implant, and graft,Heparin-induced thrombocytopenia (HIT),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,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Long-term (current) use of insulin,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction

Ath ext ntv art gngrene,Comp-oth vasc dev/graft,Heparin-indu thrombocyto,Abn react-anastom/graft,Hypertension NOS,Status-post ptca,Crnry athrscl natve vssl,Tobacco use disorder,Long-term use of insulin,DMII wo cmp nt st uncntr,Old myocardial infarct

Admission Date: [**2136-5-30**] Discharge Date: [**2136-6-8**] Date of Birth: [**2079-9-5**] Sex: M Service: SURGERY Allergies: Heparin Agents Attending:[**First Name3 (LF) 1234**] Chief Complaint: Ischemic Pain. Major Surgical or Invasive Procedure: OPERATION PERFORMED: Left below-the-knee amputation. History of Present Illness: This is a 56yo M with a long history of failed interventions to the LLE. Eight months ago, he underwent an endarterectomy of the femoral bifurcation and SFA stenting. He then underwent a L [**Name (NI) 85459**] PTFE graft. This occluded, and he had TPA in [**4-14**]. He embolized to his distal vessels and had incomplete clearance after balloon angioplasty of the distal PT. The patient underwent an angiogram last week, which showed continued occlusion. He is returning now for a left femoral-plantar bypass. Past Medical History: PMH: CAD s/p MI and cardiac stent, DM2 (IDDM), HIT PSH: cardiac stent, LN biopsy in neck, unknown LE vascular procedures Social History: mechanic, lives with wife, + tobacco, + etoh Family History: nc Physical Exam: On Admission: PHYSICAL EXAM Vital Signs: Temp: 100.1 RR: 20 Pulse: 87 BP: 132/71 Neuro/Psych: Oriented x3, Affect Normal, NAD. Neck: No right carotid bruit, No left carotid bruit. Heart: Regular rate and rhythm. Lungs: Clear, Normal respiratory effort. Gastrointestinal: No masses, abnormal: Obese. Rectal: Not Examined. Extremities: Abnormal: LLE rubor to mid-shin, BLE 1+ edema L>R. Pulse Exam (P=Palpation, D=Dopplerable, N=None) RLE Femoral: P. Popiteal: P. DP: P. PT: P. LLE Femoral: P. Popiteal: D. DP: N. PT: N. DESCRIPTION OF WOUND: left great toe erythematous with black eschars at tip well-healed L groin incision On Discharge: AFVSS Gen: NAD, AOx3 Pulm: No resp distress Abd: S/NT/ND Ext: LLE s/p BKA staples intact no erythema or drainage from wound. staples R and L LE intact no erythema or wound drainage Pertinent Results: Date: [**2136-5-29**] Signed by [**First Name11 (Name Pattern1) 1141**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], NP on [**2136-5-29**] at 3:37 pm Affiliation: [**Hospital1 18**] Cosigned by [**Name (NI) **] [**Last Name (NamePattern1) **], MD on [**2136-5-30**] at 10:13 am Lab called to report that patient is HIT + based on labs drawn during the [**Hospital 228**] hospital stay. [**2136-5-29**] 06:30AM BLOOD Hct-37.6* [**2136-5-30**] 08:30PM BLOOD WBC-9.5 RBC-4.98 Hgb-12.3* Hct-37.3* MCV-75* MCH-24.6* MCHC-32.9 RDW-17.4* Plt Ct-248 [**2136-5-31**] 06:50AM BLOOD WBC-8.2 RBC-4.74 Hgb-11.3* Hct-35.7* MCV-75* MCH-23.8* MCHC-31.5 RDW-17.3* Plt Ct-247 [**2136-5-31**] 11:50PM BLOOD WBC-8.8 RBC-3.85* Hgb-9.3* Hct-28.7* MCV-75* MCH-24.2* MCHC-32.4 RDW-17.3* Plt Ct-245 [**2136-6-1**] 06:03AM BLOOD Hct-27.7* [**2136-6-2**] 02:05AM BLOOD WBC-10.9 RBC-3.37* Hgb-8.5* Hct-25.7* MCV-76* MCH-25.3* MCHC-33.3 RDW-17.8* Plt Ct-202 [**2136-6-3**] 05:00AM BLOOD WBC-9.1 RBC-3.29* Hgb-8.3* Hct-25.1* MCV-77* MCH-25.4* MCHC-33.2 RDW-17.5* Plt Ct-199 [**2136-6-4**] 05:23AM BLOOD WBC-9.6 RBC-3.63* Hgb-9.3* Hct-27.7* MCV-76* MCH-25.5* MCHC-33.5 RDW-17.6* Plt Ct-254 [**2136-6-5**] 04:57AM BLOOD WBC-8.3 RBC-3.98* Hgb-10.2* Hct-30.1* MCV-76* MCH-25.6* MCHC-33.8 RDW-17.6* Plt Ct-306 [**2136-6-5**] 03:27PM BLOOD WBC-8.3 RBC-3.97* Hgb-10.1* Hct-30.4* MCV-77* MCH-25.5* MCHC-33.3 RDW-18.3* Plt Ct-312 [**2136-6-6**] 03:54AM BLOOD WBC-8.4 RBC-3.73* Hgb-9.5* Hct-29.0* MCV-78* MCH-25.6* MCHC-32.9 RDW-17.9* Plt Ct-327 [**2136-6-7**] 05:08AM BLOOD WBC-10.5 RBC-3.68* Hgb-9.0* Hct-28.4* MCV-77* MCH-24.5* MCHC-31.8 RDW-17.6* Plt Ct-430 [**2136-6-8**] 06:20AM BLOOD WBC-12.3* RBC-3.85* Hgb-9.6* Hct-29.1* MCV-76* MCH-24.9* MCHC-32.9 RDW-17.7* Plt Ct-477* [**2136-5-31**] 11:50PM BLOOD Neuts-80.9* Lymphs-13.4* Monos-4.6 Eos-0.8 Baso-0.3 [**2136-5-30**] 08:30PM BLOOD PT-12.7 PTT-25.7 INR(PT)-1.1 [**2136-5-31**] 05:53PM BLOOD PT-16.6* PTT-40.0* INR(PT)-1.5* [**2136-5-31**] 08:45PM BLOOD PT-18.2* PTT-45.1* INR(PT)-1.7* [**2136-6-1**] 06:03AM BLOOD PT-20.2* PTT-49.7* INR(PT)-1.9* [**2136-6-2**] 02:05AM BLOOD PT-22.7* PTT-52.6* INR(PT)-2.1* [**2136-6-2**] 09:07AM BLOOD PT-23.6* PTT-62.0* INR(PT)-2.2* [**2136-6-3**] 05:00AM BLOOD PT-26.0* PTT-72.4* INR(PT)-2.5* [**2136-6-4**] 05:23AM BLOOD PT-23.5* PTT-65.3* INR(PT)-2.2* [**2136-6-5**] 04:57AM BLOOD PT-28.2* PTT-79.3* INR(PT)-2.8* [**2136-6-5**] 04:57AM BLOOD Plt Ct-306 [**2136-6-5**] 03:27PM BLOOD Plt Ct-312 [**2136-6-6**] 03:54AM BLOOD Plt Ct-327 [**2136-6-7**] 05:08AM BLOOD Plt Ct-430 [**2136-6-8**] 06:20AM BLOOD Plt Ct-477* [**2136-5-29**] 06:30AM BLOOD UreaN-11 Creat-0.7 K-4.5 [**2136-5-30**] 08:30PM BLOOD Glucose-182* UreaN-11 Creat-0.7 Na-135 K-4.1 Cl-97 HCO3-26 AnGap-16 [**2136-5-31**] 06:50AM BLOOD Glucose-115* UreaN-10 Creat-0.6 Na-139 K-3.8 Cl-105 HCO3-27 AnGap-11 [**2136-5-31**] 11:50PM BLOOD Glucose-103* UreaN-6 Creat-0.4* Na-140 K-3.9 Cl-107 HCO3-25 AnGap-12 [**2136-6-2**] 02:05AM BLOOD Glucose-131* UreaN-8 Creat-0.5 Na-135 K-4.0 Cl-101 HCO3-27 AnGap-11 [**2136-6-3**] 05:00AM BLOOD Glucose-166* UreaN-7 Creat-0.5 Na-137 K-4.0 Cl-102 HCO3-28 AnGap-11 [**2136-6-4**] 05:23AM BLOOD Glucose-124* UreaN-5* Creat-0.5 Na-136 K-3.8 Cl-98 HCO3-28 AnGap-14 [**2136-6-5**] 03:27PM BLOOD Glucose-142* UreaN-7 Creat-0.5 Na-136 K-3.9 Cl-102 HCO3-23 AnGap-15 [**2136-6-6**] 03:54AM BLOOD Glucose-152* UreaN-6 Creat-0.5 Na-133 K-4.0 Cl-98 HCO3-27 AnGap-12 [**2136-6-8**] 06:20AM BLOOD Glucose-160* UreaN-6 Creat-0.4* Na-134 K-4.1 Cl-98 HCO3-25 AnGap-15 [**2136-6-1**] 10:29AM BLOOD CK-MB-3 cTropnT-<0.01 [**2136-6-5**] 03:27PM BLOOD cTropnT-<0.01 [**2136-6-6**] 03:54AM BLOOD cTropnT-<0.01 [**2136-5-30**] 08:30PM BLOOD Calcium-9.1 Phos-3.7 Mg-2.1 [**2136-6-6**] 03:54AM BLOOD Calcium-7.9* Phos-3.7 Mg-1.9 [**2136-5-31**] 01:15PM BLOOD Type-ART Rates-/10 Tidal V-700 FiO2-60 pO2-276* pCO2-46* pH-7.33* calTCO2-25 Base XS--1 Intubat-INTUBATED Vent-CONTROLLED Comment-ETT [**2136-5-31**] 02:26PM BLOOD Type-ART Rates-/12 Tidal V-700 FiO2-38 pO2-152* pCO2-40 pH-7.40 calTCO2-26 Base XS-0 Intubat-INTUBATED Vent-CONTROLLED Comment-ETT [**2136-5-31**] 03:46PM BLOOD Type-ART pO2-151* pCO2-40 pH-7.42 calTCO2-27 Base XS-1 Intubat-INTUBATED Vent-CONTROLLED [**2136-5-31**] 06:01PM BLOOD Type-ART Rates-12/ Tidal V-700 FiO2-33 pO2-111* pCO2-42 pH-7.40 calTCO2-27 Base XS-0 Intubat-INTUBATED Vent-CONTROLLED [**2136-5-31**] 08:55PM BLOOD Type-ART Rates-12/ Tidal V-700 O2 Flow-2 pO2-177* pCO2-40 pH-7.42 calTCO2-27 Base XS-1 Intubat-INTUBATED Vent-CONTROLLED [**2136-5-31**] 10:08PM BLOOD Type-ART pO2-177* pCO2-45 pH-7.37 calTCO2-27 Base XS-0 Intubat-INTUBATED Vent-CONTROLLED [**2136-5-31**] 11:56PM BLOOD Type-ART pO2-223* pCO2-43 pH-7.38 calTCO2-26 Base XS-0 [**2136-5-31**] 01:15PM BLOOD Glucose-84 Lactate-1.4 Na-136 K-3.7 Cl-102 [**2136-5-31**] 10:08PM BLOOD Glucose-93 Lactate-0.9 Na-136 K-4.0 Cl-103 [**2136-5-31**] 01:15PM BLOOD freeCa-1.13 [**2136-5-31**] 11:56PM BLOOD freeCa-1.07* Brief Hospital Course: [**Known lastname **],[**Known firstname 1575**] was admitted on [**5-30**] with Ischemic Pain. 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. Previously pt had LLE CFA to PT with PTFE. This was a known occlussion. Pt had known HIT, Argatroban started for goal PTT 60-80 It was decided that he would undergo: Left common femoral artery to plantar artery on bypass graft using left greater saphenous vein, right greater saphenous vein with venovenostomy, angioscopy vein inspection, valve lysis. Prepped, and brought down to the endo OR for surgery. Intra-operatively, was closely monitored and remained hemodynamically stable. Tolerated the procedure well without any difficulty or complications. He was extubated in the OR Post-operatively, transferred to the CVICU for further stabilization and monitoring. He was then transferd to the VICU in stable condition. Pt graft went down POD # 1. Family and patient aware. He was put on his home meds. While in the VICU, received monitored care. When stable was delined. Diet was advanced. C/w argatroban. Pain consult for Pain control. Recieved blood products. HCT stable. He has had progressive ischemia of the left foot, leading to gangrene of the left toes. Given these findings and the non salvageability of the foot, the patient was consented for left below-knee amputation. It was then decided to perform a Left below-the-knee amputation. Prepped, and brought down to the endo OR for surgery. Intra-operatively, was closely monitored and remained hemodynamically stable. Tolerated the procedure well without any difficulty or complications. He was extubated in the OR. Pt then recieved fundoperinox. Coumadin started for the treatmetn of HIT. He was then transferd to the VICU in stable condition. While in the VICU, received monitored care. When stable was delined. Diet was advanced. When stabilized from the acute setting of post operative care, was then transferred to floor status. On the floor, remained hemodynamically stable with pain controlled. Continues to make steady progress without any incidents. Discharged to Rehab in stable condition. Pain did see the patient. ON DC his pain is well controlled. Medications on Admission: metformin 1000', metoprolol 25'', pravastatin 20', lisinopril 30', insulin, gabapentin 300'', cymbalta EC 30', nitroglycerin, oxycontin 30''', oxycodone 30''' per pain contract Discharge Medications: 1. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Cilostazol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 4. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM: INR goal is [**2-8**]. . 5. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 10. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for heart burn. 11. Nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily): Please wean off. 12. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: Three (3) Tablet Sustained Release 12 hr PO Q8H (every 8 hours). 13. Lisinopril 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Fondaparinux 2.5 mg/0.5 mL Syringe Sig: One (1) Subcutaneous DAILY (Daily): DC when INR greater then 2. 15. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 16. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). 17. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3 times a day). 18. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 19. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO four times a day: prn for breakthrough pain. Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: POSTOPERATIVE DIAGNOSIS: Left lower extremity ischemia with gangrene. Heparin Induced Thrombocytopenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: DISCHARGE INSTRUCTIONS BELOW KNEE AMPUTATION This information is designed as a guideline to assist you in a speedy recovery from your surgery. Please follow these guidelines unless your physician has specifically instructed you otherwise. Please call our office nurse if you have any questions. Dial 911 if you have any medical emergency. ACTIVITY: There are restrictions on activity. On the side of your amputation you are non weight bearing for 4-6 weeks. You should keep this amputation site elevated when ever possible. No driving until cleared by your Surgeon. PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS: Redness in or drainage from your leg wound(s). New pain, numbness or discoloration of your foot or toes. Watch for signs and symptoms of infection. These are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. If you experience any of these or bleeding at the incision site, CALL THE DOCTOR. Exercise: Limit strenuous activity for 6 weeks. Do not drive a car unless cleared by your Surgeon. No heavy lifting greater than 20 pounds for the next 14 days. Try to keep leg elevated when able. BATHING/SHOWERING: You may shower immediately upon coming home. No bathing. A dressing may cover you??????re amputation site and this should be left in place for three (3) days. Remove it after this time and wash your incision(s) gently with soap and water. You will have sutures, which are usually removed in 4 weeks. This will be done by the Surgeon on your follow-up appointment. WOUND CARE: Sutures / Staples may be removed before discharge. If they are not, an appointment will be made for you to return for staple removal. When the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. These will stay on about a week and you may shower with them on. If these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. Avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. MEDICATIONS: Unless told otherwise you should resume taking all of the medications you were taking before surgery. You will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. CAUTIONS: NO SMOKING! We know you've heard this before, but it really is an important step to your recovery. Smoking causes narrowing of your blood vessels which in turn decreases circulation. If you smoke you will need to stop as soon as possible. Ask your nurse or doctor for information on smoking cessation. Avoid pressure to your amputation site. No strenuous activity for 6 weeks after surgery. DIET: There are no special restrictions on your diet postoperatively. Poor appetite is expected for several weeks and small, frequent meals may be preferred. For people with vascular problems we would recommend a cholesterol lowering diet: Follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. Additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. Since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and LDL (Low Density Lipoprotein-the bad cholesterol). Exercise will increase your HDL (High Density Lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. You may be self-referred or get a referral from your doctor. If you are overweight, you need to think about starting a weight management program. Your health and its improvement depend on it. We know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. If interested you can may be self-referred or can get a referral from your doctor. If you have diabetes and would like additional guidance, you may request a referral from your doctor. FOLLOW-UP APPOINTMENT: Be sure to keep your medical appointments. The key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. Things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. Don't let them go untreated! Please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are 8:30-5:30 Monday through Friday. PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2136-6-22**] 11:30 Completed by:[**2136-6-8**]

440,996,289,E878,401,V458,414,305,V586,250,412

{'Atherosclerosis of native arteries of the extremities with gangrene,Other complications due to other vascular device, implant, and graft,Heparin-induced thrombocytopenia (HIT),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,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Long-term (current) use of insulin,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Ischemic Pain. PRESENT ILLNESS: This is a 56yo M with a long history of failed interventions to the LLE. Eight months ago, he underwent an endarterectomy of the femoral bifurcation and SFA stenting. He then underwent a L [**Name (NI) 85459**] PTFE graft. This occluded, and he had TPA in [**4-14**]. He embolized to his distal vessels and had incomplete clearance after balloon angioplasty of the distal PT. MEDICAL HISTORY: PMH: CAD s/p MI and cardiac stent, DM2 (IDDM), HIT PSH: cardiac stent, LN biopsy in neck, unknown LE vascular procedures MEDICATION ON ADMISSION: metformin 1000', metoprolol 25'', pravastatin 20', lisinopril 30', insulin, gabapentin 300'', cymbalta EC 30', nitroglycerin, oxycontin 30''', oxycodone 30''' per pain contract ALLERGIES: Heparin Agents PHYSICAL EXAM: On Admission: PHYSICAL EXAM Vital Signs: Temp: 100.1 RR: 20 Pulse: 87 BP: 132/71 Neuro/Psych: Oriented x3, Affect Normal, NAD. Neck: No right carotid bruit, No left carotid bruit. Heart: Regular rate and rhythm. Lungs: Clear, Normal respiratory effort. Gastrointestinal: No masses, abnormal: Obese. Rectal: Not Examined. Extremities: Abnormal: LLE rubor to mid-shin, BLE 1+ edema L>R. FAMILY HISTORY: nc SOCIAL HISTORY: mechanic, lives with wife, + tobacco, + etoh ### Response: {'Atherosclerosis of native arteries of the extremities with gangrene,Other complications due to other vascular device, implant, and graft,Heparin-induced thrombocytopenia (HIT),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,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Long-term (current) use of insulin,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction'}

CHIEF COMPLAINT: The patient presented to the SICU with pancreatitis. PRESENT ILLNESS: A 47-year-old male with a history of cadaveric renal transplant in [**2149**] who was transferred from [**Hospital3 417**] Medical Center with pancreatitis on [**5-26**] complaining of abdominal pain. Abdominal CT showed pancreatitis. The patient was confused, combative, hallucinating. He was afebrile. He was sent to the EW. He vomited. He was sedated with Versed and propofol and intubated. The patient was treated with Kayexalate, D-5-W, insulin for hyperkalemia. He was transferred to the [**Hospital1 18**] and admitted to the SICU where he remained intubated. The patient continued to be agitated, associated with hallucinations. He required IV sedation. MEDICAL HISTORY: Significant for end-stage renal disease secondary to hypertension, hepatitis C, gout, HSV, history of motor vehicle accident with right tibia fracture, head injury, exploratory laparotomy and tracheostomy, history of CHF. MEDICATION ON ADMISSION: CellCept [**Pager number **] mg p.o. b.i.d., Prograf 4 mg p.o. b.i.d., Bactrim single strength 1 tablet p.o. daily, Protonix 40 mg p.o. daily, amlodipine 10 mg p.o. daily, atenolol 75 mg p.o. daily, Diovan 160 mg p.o. daily, clonidine 0.3 mg p.o. t.i.d., Tricor 48 mg p.o. daily and oxycodone p.r.n.. ALLERGIES: The patient was allergic to PENICILLIN, VICODIN and MOTRIN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Acute pancreatitis,Complications of transplanted kidney,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Alcohol withdrawal delirium,Acute respiratory failure,Cocaine abuse, unspecified,Other specified disorders of penis,Unspecified essential hypertension,Personal history of other infectious and parasitic diseases,Personal history of noncompliance with medical treatment, presenting hazards to health

Acute pancreatitis,Compl kidney transplant,Food/vomit pneumonitis,Hyperpotassemia,Delirium tremens,Acute respiratry failure,Cocaine abuse-unspec,Disorder of penis NEC,Hypertension NOS,Prsnl hst oth nfct parst,Hx of past noncompliance

Admission Date: [**2151-5-27**] Discharge Date: [**2151-6-15**] Date of Birth: [**2103-7-30**] Sex: M Service: [**Last Name (un) **] CHIEF COMPLAINT: The patient presented to the SICU with pancreatitis. HISTORY OF PRESENT ILLNESS: A 47-year-old male with a history of cadaveric renal transplant in [**2149**] who was transferred from [**Hospital3 417**] Medical Center with pancreatitis on [**5-26**] complaining of abdominal pain. Abdominal CT showed pancreatitis. The patient was confused, combative, hallucinating. He was afebrile. He was sent to the EW. He vomited. He was sedated with Versed and propofol and intubated. The patient was treated with Kayexalate, D-5-W, insulin for hyperkalemia. He was transferred to the [**Hospital1 18**] and admitted to the SICU where he remained intubated. The patient continued to be agitated, associated with hallucinations. He required IV sedation. PAST MEDICAL HISTORY: Significant for end-stage renal disease secondary to hypertension, hepatitis C, gout, HSV, history of motor vehicle accident with right tibia fracture, head injury, exploratory laparotomy and tracheostomy, history of CHF. PAST SURGICAL HISTORY: Cadaveric renal transplant on [**2150-1-21**] with ACR on [**2150-2-18**], exploratory laparotomy, tracheostomy in [**2134**], left AV fistula x2. MEDICATIONS ON ADMISSION: CellCept [**Pager number **] mg p.o. b.i.d., Prograf 4 mg p.o. b.i.d., Bactrim single strength 1 tablet p.o. daily, Protonix 40 mg p.o. daily, amlodipine 10 mg p.o. daily, atenolol 75 mg p.o. daily, Diovan 160 mg p.o. daily, clonidine 0.3 mg p.o. t.i.d., Tricor 48 mg p.o. daily and oxycodone p.r.n.. ALLERGIES: The patient was allergic to PENICILLIN, VICODIN and MOTRIN. PHYSICAL EXAMINATION ON ADMISSION: Temperature 99.7, heart rate 80, BP 172/79, respiratory rate 30, 100% intubated, sedated. The patient moved all extremities. Responded to pain. HEENT: Within normal limits. COR: Regular rate and rhythm. No murmurs, regurg, gallops. LUNGS: Coarse bilaterally. ABDOMEN: Distended and soft. EXTREMITIES: No C/C/E. Peripheral IV x2 in the right upper extremities. Intake and output at outside hospital 1220 cc in and 625 out. LABORATORIES ON ADMISSION: White count 14.4, hematocrit 41.8, platelets 124, 90.5% PMNs, sodium 139, potassium 6.6, BUN 30, creatinine 3.3, chloride 121, bicarbonate 12, amylase 1240, lipase 829, alkaline phosphatase 156, AST 20, ALT 16, direct bilirubin 0.4, indirect bilirubin 0.3, CK 193, CK-MB 2.4, troponin 0.2. ABGs 7.25/25.9/415.2/11.3, ammonia was 35. Tox screen was positive for cocaine on [**5-27**]. BRIEF HOSPITAL COURSE: The patient was admitted to the SICU. Abdominal CT demonstrated diffusely enlarged pancreatitis with infiltration of surrounding fat, renal transplant right iliac fossa. Head CT demonstrated no evidence of hemorrhage, midline shift or mass effect. He was treated with a beta blocker for hypertension. Remained intubated. He was n.p.o. with IV fluid hydration. Nephrology was consulted and followed throughout this hospital course. Renal ultrasound demonstrated normal renal transplant ultrasound. Chest x-ray on [**5-27**] demonstrated satisfactory position of NG tube and ETT tube. Mild pulmonary edema was noted with possible right lower lobe pneumonia. EKG demonstrated sinus rhythm with a rate of 80, with possible left ventricular hypertrophy, with late transition. An ultrasound of the gallbladder was done. This demonstrated extrahepatic biliary dilatation without intra-hepatic biliary dilatation. The patient was status post cholecystectomy, but the degree of biliary dilatation was more than would have been expected for a patient of this age. Given the presence of pancreatitis, a distal duct calculus or lesion was amongst the possible diagnoses. Correlation with cross sectional imaging preferably MRI was recommended to evaluate the distal duct, per radiology. The patient had a central line placed, new right subclavian central venous catheter tip terminated in the superior right atrium. No pneumothorax occurred. The patchy opacity in the right lower lobe was thought to represent atelectasis. The patient had serial chest x-rays that demonstrated development of vascular engorgement, and perihilar haziness was developing asymmetrical airspace disease within the right lung as well as a lingering right pleural effusion. Post pyloric feeding tube was placed with the tip in the distal duodenum. He was started on post pyloric feedings. His amylase and lipase decreased. The patient experienced intermittent bouts of hypertension up into the 180s with stimulation with heart rate in the 90 to100s with occasional PVCs. He continued to be treated with Versed and fentanyl drip for DTs and continued on a CIWA scale, ranging from 5 to 12. The patient was administered Ativan for extreme agitation with a good result. Lung sounds remained clear into the bases. He was suctioned for moderate amounts of thick tan secretions from the ETT tube and bloody secretions from the supraepiglottis tube. The patient was given TPN. He received fluid boluses for low CVP. Blood cultures were drawn as well as urine cultures. These were subsequently found to be negative. The patient continued to be hypertensive. This was treated with hydralazine and Lopressor. Hematocrit remained stable. The patient was extubated on [**5-30**]. He tolerated this without event. He received aggressive pulmonary toilet. He was out of bed. He also received clonidine 0.2 mg. t.i.d.. He experienced acute renal failure, most likely due to third spacing and pancreatitis as well as contrast effect. His creatinine was 3.2. On [**2151-5-30**] the patient required rapid sequence intubation with cricoid pressure for respiratory distress. O2 saturations were 89% and respiratory was 40. Pa02 was 60, down from 88 after diuresis of 20 of Lasix. On [**2151-6-5**] a bilateral upper extremity venous ultrasound was done to evaluate left arm edema. Chronic nonocclusive neural calcification of the superficial left brachial vein was noted. Otherwise, vasculature was patent of the bilateral upper extremities. On [**5-30**] the patient continued to demonstrate increasing symptoms of DTs. CIWA scale was monitored hourly. The patient required a one-to-one sitter. He was agitated, anxious, and diaphoretic, and tachycardia to 110 despite q.2h. Ativan and fentanyl drip as well as clonidine patch. He remained on a nitro drip for BP control as well as Ativan for DTs and fentanyl drip for pain. He was given Lopressor, hydralazine and clonidine as well as Norvasc. Blood pressure decreased to 130s to 150s. He was on AC with increased peak to 10. On [**5-31**], the first chest x-ray demonstrated consolidation more on the right. A bronchoscopy was done at the bedside, cultures were sent to the lab. Sputum culture demonstrated greater than 25 PMNs and less than 10 epithelial cells as well as 3+ budding yeast with pseudohyphae. He remained on IV vancomycin and cefepime. The patient also experienced herpetic lesions on his penis. Acyclovir was started. His white blood cell count was 5.2. Hematocrit was stable in the 27 to 28 range. He remained intubated. Infectious disease followed the patient making recommendations that included sending a swab of the penile lesions for GC and chlamydia. These were subsequently negative. Ciprofloxacin 500 mg IV was started x1 and then 250 mg IV daily, as well as Flagyl 500 mg IV q.8h.. A nasal aspirate was sent for viral pathogens. These were subsequently negative. Acyclovir was held. A VRE rectal swab as well as MRSA screening were both negative. An RPR was checked. This was negative. The patient was felt to have community-acquired pneumonia plus or minus aspiration. Levaquin, Flagyl, vancomycin and cefepime were recommended. CellCept was decreased to 1 gram q.12h. per Dr. [**Last Name (STitle) **]. His Prograf was adjusted as well. Repeat blood cultures were done. These were negative. The patient remained intubated and sedated. He continued on a pulse pyloric feeding tube, using Peptamen at 65 cc an hour. TPN was weaned off. IV sedation was weaned as well as vent settings. His amylase and lipase continued to decrease. Amylase of 5 and lipase 204. LFTs were within normal limits. Creatinine remained in the 3.0 to 3.1 range. White blood cell count 5.3, hematocrit 27. He was treated with IV Lasix drip to keep 2 liters negative for fluid overload. He was extubated without event, and creatinine decreased to 2.6. He was transferred from the SICU to the medical surgical unit where he gradually improved. His mental status was concerning for lack of return to baseline. A neuro consult was obtained. A head CT was done. This demonstrated no evidence of hemorrhage or mass effect. An RPR was sent. This was negative. TSH was normal. Ammonia level was normal. A fentanyl patch had been applied prior to leaving the SICU. This was removed. Patient's mental status gradually improved. Psychiatry was consulted for concern for delirium. The patient had also been receiving lorazepam. This was deceased to minimize benzodiazepine anticholinergics effects. A one-to- one sitter was present. He was given Haldol 0.5 mg b.i.d. The patient's mental status improved. He requested pain medication for chronic leg pain. He was given a minimal amounts of Percocet with decreased complaints of leg pain The patient continued to improve. A KUB was done. The abdomen appeared somewhat distended. There was no evidence of obstruction. Ossification in the paraspinal tissues was noted on the left. A CT of the abdomen was done that demonstrated peripancreatic stranding consistent with pancreatitis. There was no evidence of pseudocyst or pancreatic calcifications. The patient's amylase and lipase had returned to [**Location 213**]. Creatinine was down to 2.1. The patient continued to be hyperkalemic with a potassium of 5.9. He received treatment for this with insulin, dextrose, Kayexalate. This was repeated x2. The patient was found to be drinking Boost supplements. He was instructed not to drink these given potassium in the Boost supplement. Potassium decreased to 5.5. Gradually the patient was taking in increased amounts of p.o. fluid. His abdomen was nondistended, nontender. He was ambulatory. Alert and oriented. His Prograf remained in the range of 8.4 on 6 mg b.i.d.. He continued on CellCept. Physical therapy cleared him for discharge. DISCHARGE STATUS: The patient was discharged home off antibiotics. He completed a 10-day course for aspiration pneumonia. Vital signs were stable. DISCHARGE FOLLOWUP: The patient was scheduled to follow up in the outpatient clinic with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] within 1 week. He was instructed to make a follow-up appointment. DISCHARGE MEDICATIONS: He was discharged home on clonidine 0.3 mg per 24-hour patch to be changed weekly on Fridays, Protonix 40 mg p.o. daily, folic acid 1 mg p.o. daily, Thiamine 100 mg p.o. daily, CellCept [**Pager number **] mg p.o. b.i.d., amlodipine 10 mg p.o. daily, Percocet 5/325-mg tablets 1 tablet p.o. p.r.n. q.4-6h. as needed for leg pain with 20 tablets being dispensed, Prograf 1 mg p.o. b.i.d., Lasix 20 mg p.o. daily, bicarbonate 1300 mg p.o. b.i.d., Florinef 0.1 mg p.o. daily was initiated and a script given as well as Kayexalate 30 grams p.o. for p.r.n. use per transplant office if potassium is high. DISCHARGE DIAGNOSES: Pancreatitis, aspiration pneumonia, genital herpetic lesions, chronic pain, and cocaine abuse. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**MD Number(2) 3762**] Dictated By:[**Name8 (MD) 4664**] MEDQUIST36 D: [**2151-6-22**] 15:47:01 T: [**2151-6-24**] 11:11:41 Job#: [**Job Number 31799**]

577,996,507,276,291,518,305,607,401,V120,V158

{'Acute pancreatitis,Complications of transplanted kidney,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Alcohol withdrawal delirium,Acute respiratory failure,Cocaine abuse, unspecified,Other specified disorders of penis,Unspecified essential hypertension,Personal history of other infectious and parasitic diseases,Personal history of noncompliance with medical treatment, presenting hazards to health'}

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: The patient presented to the SICU with pancreatitis. PRESENT ILLNESS: A 47-year-old male with a history of cadaveric renal transplant in [**2149**] who was transferred from [**Hospital3 417**] Medical Center with pancreatitis on [**5-26**] complaining of abdominal pain. Abdominal CT showed pancreatitis. The patient was confused, combative, hallucinating. He was afebrile. He was sent to the EW. He vomited. He was sedated with Versed and propofol and intubated. The patient was treated with Kayexalate, D-5-W, insulin for hyperkalemia. He was transferred to the [**Hospital1 18**] and admitted to the SICU where he remained intubated. The patient continued to be agitated, associated with hallucinations. He required IV sedation. MEDICAL HISTORY: Significant for end-stage renal disease secondary to hypertension, hepatitis C, gout, HSV, history of motor vehicle accident with right tibia fracture, head injury, exploratory laparotomy and tracheostomy, history of CHF. MEDICATION ON ADMISSION: CellCept [**Pager number **] mg p.o. b.i.d., Prograf 4 mg p.o. b.i.d., Bactrim single strength 1 tablet p.o. daily, Protonix 40 mg p.o. daily, amlodipine 10 mg p.o. daily, atenolol 75 mg p.o. daily, Diovan 160 mg p.o. daily, clonidine 0.3 mg p.o. t.i.d., Tricor 48 mg p.o. daily and oxycodone p.r.n.. ALLERGIES: The patient was allergic to PENICILLIN, VICODIN and MOTRIN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Acute pancreatitis,Complications of transplanted kidney,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Alcohol withdrawal delirium,Acute respiratory failure,Cocaine abuse, unspecified,Other specified disorders of penis,Unspecified essential hypertension,Personal history of other infectious and parasitic diseases,Personal history of noncompliance with medical treatment, presenting hazards to health'}

CHIEF COMPLAINT: PCP: [**Name10 (NameIs) 1447**],[**First Name3 (LF) **] [**Telephone/Fax (1) 81526**] . CHIEF COMPLAINT: transferred from OSH for TIPS eval . REASON FOR MICU ADMISSION: GIB bleed PRESENT ILLNESS: 57 M with PMHx of alcoholic ESLD on [**Telephone/Fax (1) **] list, esophageal varices transferred from [**Hospital1 336**] for further evaluation of TIPs procedure. Patient originally presented to [**Hospital 107**] Hospital with hematemasis which started at 3am [**2145-8-31**]. Per wife his last drink was 2 years ago. She reports he was in USOH (occasional weakenss) until he started vomiting clear which subsequently turned red that morning and he had abdominal pain, became lightheaded, and almost passed out. At [**Hospital1 107**] he had hct 21.6, given 6 units PRBCs and 4 units of FFP for INR of 3. He was also given IVF for BP as low as 78/50. There he became ?pulselss for 1 min vs resp arrest ? aspiration. He had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 10045**] placed and intubated for AMS and airway protection. At [**Hospital1 336**] he was given 1 bag of platelets hct 44.9--->31.6, INR of 1.8 on admission [**Doctor Last Name **] given 5mg VitK subQ for 3 days. He was noted to be bleeding from nose and mouth. Scoped by GI and found blood in stomach and ulcer in lower third of esophagus. He received zosyn prophylactically. Scoped by ENT and found nothing. Given 6LNS. . He had recent hospitalization and [**Hospital1 18**] for GIB [**Date range (1) 74682**] attributed to portal hypertensive gastropathy and small ulcers where he had previous bands. He also had ARF that was thought to be pre-renal in origin. . Currently, patient was sedated. He was given 450mcg of fentanyl in transit as his propofol was turned off for "labile blood pressure." Wife was called and the history was confirmed upon arrival . ROS: could not be obtained because of sedation MEDICAL HISTORY: -End stage liver disease, with MELD 18, on [**Date range (1) **] list -alcoholic cirrhosis - decompensated in the past with ascites, peripheral edema and hepatic encephalopathy. -history of esophageal varices, never bled - esophageal/gastric ulcers -h/o hepatopulmonary syndrome -HTN -depression MEDICATION ON ADMISSION: 1. Clotrimazole 10 mg Troche %x/day 2. Lactulose (30) ML PO QID 3. Rifaximin 200 mg TID 4. Ferrous Sulfate 325 mg [**Hospital1 **] 5. Nadolol 20 mg DAILY 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) PO Q24H 7. Sucralfate 1 gram PO DAILY 8. Furosemide 20 mg PO DAILY 9. Spironolactone 25 mg Tablet PO DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Exam General Appearance: Well nourished Cardiovascular: (S1: Normal), (S2: Normal) Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse: Not assessed) Respiratory / Chest: (Breath Sounds: Clear : ) Abdominal: No(t) Distended Extremities: Right lower extremity edema: Absent, Left lower extremity edema: Absent Skin: Not assessed Neurologic: No(t) Attentive, Responds to: Not assessed, Movement: Not assessed, Tone: Not assessed FAMILY HISTORY: per d/c summary: unknown, except Mother - 90, alive Father - deceased 5y ago SOCIAL HISTORY: per d/c summary Smoke: quit 5y ago EtOH: stopped [**2143-10-9**]; prior to that: 1 case/week Drugs: never Lives: with wife [**Name (NI) **]: used to work for cable company; no longer working

Hepatic encephalopathy,Acute systolic heart failure,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Portal vein thrombosis,Other specified septicemias,Severe sepsis,End stage renal disease,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Other ascites,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pulmonary heart diseases,Cardiogenic shock

Hepatic encephalopathy,Ac systolic hrt failure,Bleed esoph var oth dis,Food/vomit pneumonitis,Portal vein thrombosis,Septicemia NEC,Severe sepsis,End stage renal disease,Subendo infarct, initial,Ac kidny fail, tubr necr,Acq coagul factor defic,Prim cardiomyopathy NEC,Surg compl-heart,Ascites NEC,Alcohol cirrhosis liver,Alcoh dep NEC/NOS-remiss,Abn react-org transplant,Chr pulmon heart dis NEC,Cardiogenic shock

Name: [**Known lastname **],[**Known firstname 13065**] Unit No: [**Numeric Identifier 13066**] Admission Date: [**2145-9-1**] Discharge Date: [**2145-12-7**] Date of Birth: [**2088-1-18**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 567**] Addendum: Other diagnoses # Fungemia : (beta glucan test positivity) # Hepatoadrenal Syndrome Adrenal Insufficiency: CRH stim testing and ACTH testing # Spontaneous Bacterial Peritonitis: [**2145-9-17**] parascentesis (klebsiella) # Hypophosphatemia: tracked over course of hospitalization, treated by repletion Last Day Labs Wbc 9 hg/hct 11.4/33.6 plt 63 Na 130, K 3.9, Cl 99, HCO3 17, Cr 1.5, BUN 17 ALT 251, AST 225, LDH 1483, Bili 2.1, Alk Phos 96 ABG 0936 on [**12-7**] 7.18, 46, 64, 18, -10 ; lactate 4.5 ABG from 0600 [**12-7**] 7.36, 30, 60, 18, -6 ; lactate 3.1 Other Tests + B-Glucan + CRH stim testing and low ACTH on different dates Last CXR Pulmonary artery catheter terminates in the interlobar portion of the right pulmonary artery. Ventricular assist device and nasogastric tube are unchanged. Slight worsening of asymmetrical pattern of pulmonary edema, worse on the left than the right, as well as possible increase in small-to-moderate left pleural effusion. Moderate-to-large right effusion also appears worse in the interval. Cardiac Cath [**11-29**] FINAL DIAGNOSIS: 1. No significant coronary artery disease. 2. Elevated left and right sided filling pressures. 3. Cardiogenic shock with cardiac index of 1.5l/min/m2. 4. Successful insertion of Impella 2.5 device. ECHO [**2145-12-6**] Left ventricular wall thicknesses and cavity size are normal. There is severe global left ventricular hypokinesis (LVEF <20%). No masses or thrombi are seen in the left ventricle. The aortic valve leaflets are mildly thickened (?#). An Impella device is seen crossing the aortic valve and appropriately within the left ventricular cavity. The mitral valve leaflets are mildly thickened. There is a trivial/physiologic pericardial effusion. ECHO [**2145-12-1**] There is severe global left ventricular hypokinesis (LVEF = 10 %). RV with depressed free wall contractility. Moderate to severe (3+) mitral regurgitation is seen. Tricuspid regurgitation is present but cannot be quantified. An Impella device is seen within the left ventricular cavity. Compared with the prior study (images reviewed) of [**2145-12-1**], the Impella device has been adjusted off the postero-medial papillary muscle by approx 0.5 cm. The Impella tip now lies just below the coaptation point of the mitral leaflets in partial contact with mitral chordae tendinae. ECHO [**11-14**] The left atrium is moderately dilated. A mass is seen in the body of the left atrium. No atrial septal defect is seen by 2D or color Doppler. Overall left ventricular systolic function is moderately depressed (LVEF= 30-40 %). The right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. The ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to XX cm from the incisors. There are three aortic valve leaflets. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate (2+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. ECHO [**2145-11-4**] The left atrium is mildly dilated. The right atrium is moderately dilated. The right atrial pressure is indeterminate. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). The right ventricular cavity is mildly dilated with normal free wall contractility. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. EXPLANTED LIVER 1. Cirrhosis, confirmed on trichrome stain, with foci of sinusoidal fibrosis (Stage 4 fibrosis). 2. marked iron deposition within hepatocytes and Kupffer cells. 3. Mild, patchy predominantly macrovesicular steatosis without ballooning degeneration or intracytoplasmic hyalin. 4. Mild septal and lobular mononuclear inflammation. 5. Moderate canalicular and hepatocellular cholestasis. 6. Negative vascular and biliary margins. 7. Gallbladder with mild chronic cholecystitis and cholelithiasis. 8. One reactive hilar lymph. MICRO [**2145-12-2**] BLOOD ENTEROCOCCUS FAECIUM | AMPICILLIN------------ =>32 R DAPTOMYCIN------------ S LINEZOLID------------- 2 S PENICILLIN G---------- =>64 R VANCOMYCIN------------ =>32 R URINE CULTURE (Final [**2145-11-1**]): YEAST. 10,000-100,000 ORGANISMS/ML.. URINE CULTURE (Final [**2145-10-21**]): ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ =>32 R LINEZOLID------------- 2 S NITROFURANTOIN-------- 128 R TETRACYCLINE---------- =>16 R VANCOMYCIN------------ =>32 R [**9-17**] - Parascentesis (WBC 2350) Fluid Culture in Bottles (Final [**2145-9-19**]): KLEBSIELLA PNEUMONIAE. _________________________________________________________ PERITONEAL KLEBSIELLA PNEUMONIAE | AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S BLOOD Aerobic Bottle Gram Stain (Final [**2145-9-18**]): GRAM NEGATIVE ROD(S). Anaerobic Bottle Gram Stain (Final [**2145-9-18**]): GRAM NEGATIVE ROD(S). Discharge Disposition: Extended Care Facility: [**Hospital3 14**] & Rehab Center - [**Hospital1 15**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 569**] MD [**MD Number(1) 570**] Completed by:[**2145-12-7**] Admission Date: [**2145-9-1**] Discharge Date: [**2145-12-7**] Date of Birth: [**2088-1-18**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4765**] Chief Complaint: PCP: [**Name10 (NameIs) 1447**],[**First Name3 (LF) **] [**Telephone/Fax (1) 81526**] . CHIEF COMPLAINT: transferred from OSH for TIPS eval . REASON FOR MICU ADMISSION: GIB bleed Major Surgical or Invasive Procedure: Orthotopic Liver [**Telephone/Fax (1) 1326**] Multiple HD line placement IJ line placement Impella Placement Multiple Paracentesis Swan-Ganz Catherization History of Present Illness: 57 M with PMHx of alcoholic ESLD on [**Telephone/Fax (1) **] list, esophageal varices transferred from [**Hospital1 336**] for further evaluation of TIPs procedure. Patient originally presented to [**Hospital 107**] Hospital with hematemasis which started at 3am [**2145-8-31**]. Per wife his last drink was 2 years ago. She reports he was in USOH (occasional weakenss) until he started vomiting clear which subsequently turned red that morning and he had abdominal pain, became lightheaded, and almost passed out. At [**Hospital1 107**] he had hct 21.6, given 6 units PRBCs and 4 units of FFP for INR of 3. He was also given IVF for BP as low as 78/50. There he became ?pulselss for 1 min vs resp arrest ? aspiration. He had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 10045**] placed and intubated for AMS and airway protection. At [**Hospital1 336**] he was given 1 bag of platelets hct 44.9--->31.6, INR of 1.8 on admission [**Doctor Last Name **] given 5mg VitK subQ for 3 days. He was noted to be bleeding from nose and mouth. Scoped by GI and found blood in stomach and ulcer in lower third of esophagus. He received zosyn prophylactically. Scoped by ENT and found nothing. Given 6LNS. . He had recent hospitalization and [**Hospital1 18**] for GIB [**Date range (1) 74682**] attributed to portal hypertensive gastropathy and small ulcers where he had previous bands. He also had ARF that was thought to be pre-renal in origin. . Currently, patient was sedated. He was given 450mcg of fentanyl in transit as his propofol was turned off for "labile blood pressure." Wife was called and the history was confirmed upon arrival . ROS: could not be obtained because of sedation Past Medical History: -End stage liver disease, with MELD 18, on [**Date range (1) **] list -alcoholic cirrhosis - decompensated in the past with ascites, peripheral edema and hepatic encephalopathy. -history of esophageal varices, never bled - esophageal/gastric ulcers -h/o hepatopulmonary syndrome -HTN -depression Social History: per d/c summary Smoke: quit 5y ago EtOH: stopped [**2143-10-9**]; prior to that: 1 case/week Drugs: never Lives: with wife [**Name (NI) **]: used to work for cable company; no longer working Family History: per d/c summary: unknown, except Mother - 90, alive Father - deceased 5y ago Physical Exam: Admission Exam General Appearance: Well nourished Cardiovascular: (S1: Normal), (S2: Normal) Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse: Not assessed) Respiratory / Chest: (Breath Sounds: Clear : ) Abdominal: No(t) Distended Extremities: Right lower extremity edema: Absent, Left lower extremity edema: Absent Skin: Not assessed Neurologic: No(t) Attentive, Responds to: Not assessed, Movement: Not assessed, Tone: Not assessed Pertinent Results: MICROBIOLOGY: [**9-1**] sputum cx OSH GPV in pairs [**9-1**] UCx pending . STUDIES: EKG: NSR at 75, NA, prolonged QT but no acute STTW changes . CXR: ET in right main bronchus with LLL collapse . CXR OSH [**9-1**]: increase density behind the heart on the right that may represent aspiration pneumonia . EGD [**7-10**] Varices at the distal esophagus(not bleeding) Mosaic pattern in the diffuse compatible with chronic gastritis Otherwise normal EGD to third part of the duodenum. . EGD [**8-14**]: Lesions 3 cords of grade II varices were seen in the lower third of the esophagus. Three bands were placed with success. Mosaic appearance in the stomach compatible with mild portal hypertensive gastropathy. Otherwise normal EGD to third part of the duodenum . EG [**8-27**] Portal gastropathy Varices appeared to be obliterated without need for further banding. There was evidence of three ulcers, two of which appeared to have band from previous EGD underneath. Otherwise normal EGD to third part of the duodenum . [**8-31**] EGD OSH: scar found in lower third of esophagus due to a prior intervention, ulcer found in the lower third of the esophagus, blood in entire stomach, portal gastropathy in entire stomach, hiatal hernia . [**9-1**] OSH abd U/S: thrombosis of mail portal vein extending retrograde into extrahepatic portal vein to the level of the portal. Cirrhosis with moderate ascites and splenomegaly, patent hepativ vein, hepatic artery and IVC. . [**9-1**] renal U/s: no hydronephrosis Multiple other studies no documented Brief Hospital Course: 57 yo M with PMHx of alcoholic ESLD on [**Month/Year (2) **] list, esophageal varices transferred from [**Hospital1 336**] for further evaluation of TIPs procedure after GI bleed. His hospital stay was 96 days. In that time he had an orthotopic liver [**Hospital1 **] and developed a severe cardiomyopathy and passed due to cardiopulmonary collapse. BY PROBLEM # GI Bleed # hx of Varices # Esophageal Ulcer : Based on the endoscopy at [**Hospital1 3278**], this was likely an upper GI bleed from an ulceration that arose from a former esophageal varix banding site. He was transferred for TIPS eval and did not have any more GIB. # Hospital Acquired/Aspiration Pneumonia Mechanical Ventilation: The patient arrived intubated for airway protection, and remained intubated because of poor mental status/wakefulness. He had a possible infiltrate on cxr and was treated for eight days with piperacillin-tazobactam based on a sputum gram stain that showed gram negative rods. After he showed more wakefulness and followed commands and was ultimately extubated. Reintubated following OLT and extubated after OLT (week). Though he remained on broad spectrum antibiotics, he never required re-intubation until is cardiopulmonary collapse # ESLD/Encephalopathy: Portal Vein Thrombosis s/p Orthotopic Liver Transplantation Thrombocytopenia Coagulopathy Complicated by variceal bleeds and hepatic encephalopathy. He was stabilized and received a liver [**Hospital1 **]. #Fever and Hypothermia/Sepsis # Klebsiella Sepsis # VRE Sepsis # [**Female First Name (un) 564**] UTI/Urosepsis Pt had several episodes of sirs vs septic shock and was on pressors, broad spectrum antibiotics until the end of his course # Acute Kidney Injury, ESRD # Hepatorenal Syndrome # Dialysis Dependance The patient had an elevated creatinine that was consistent with hypovolemia and prerenal azotemia. He improved at first and then developed hepatorenal syndrome and was dialysis depenedant. # Dilated Cardiomyopathy: patient discoved to have ef of [**9-16**]% post-operatively; declined for heart [**Date Range **] at [**Hospital1 **]. # Ventricular Tachycardia: patient on amiodarone, required lidocaine drip prior to death MICU Course: A 57 year old gentleman with ESLD admitted 59 days earlier for upper GI bleeding re-readmitted to the ICU for hypothermia and hypotension and continuing encephalopathy. Intially treated with broad spectrum antibiotics for presumed sepsis, but no organisms were ever identified. TSH and fT4 were WNL. Failed cortisol stimulation test, so received stress dose steroids with no change in BPs. BCx, UCx, and peritoneal fluids were not consistent with infection. Improved on antibiotics (daptomycin, meropenem, and ciprofloxacin). Discontinued Abx after 10 days. Weaned off pressors without issue. However, developed oliguric renal failure unresponsive to fluids, albumin, and mitodrine. Diagnosed with hepatorenal syndrome, and started on HD. Initially had a groin line which bled due to his coagulopathy of liver disease. Transfused PLT, FFP, and cryoprecipitate and bleeding slowed. Transitioned to an IJ line placed at IR without further complications. During his MICU course he was noted to have an axis change on telemetry. ECG showed V3-6 ST depressions with T wave inversions which were new. Cardiac enzymes were trended and showed a TnT elevation consistent with NSTEMI v strain. The ECG changes resolved. Cardiology was consulted and believed that this picture was more consistent with strain from SIRS but could not rule out NSTEMI. ECHO was unchanged with no focal wall motions abnormalities. Transfered back to the floor with stable vital signs, however ongoing significant encephalopathy. Responsive to pain and voice, but not able to follow commands. Given history of SBP, was maintained on prophylactic cipro. CCU Course: # Acute Systolic Heart Failure: After several days of persistent hypotension and worsening tachycardia, an echocardiogram was performed which showed severe heart failure of both ventricles, right heart failure was worse that the left. The LVEF was estimated at 10%. His heart failure is thought to be secondary to a nutrition or tachy cardiomyopathy. There was very low suspicion of ischemic heart disease. There are reports of [**Hospital1 **] patients developing post-op cardiomyopathies that have improved over several months. A PA catheter was placed to monitor his hemodynamics. He was given thiamine, selenium and L-carnitine repletion and continued on tube feeds. He was started on milrinone. He was given fluids to keep his CVP just below 20 as he required preload for his right ventricular failure. He required phenylepiphrine and vasopressin to suppport his blood pressure. His cardiac index did not significantly improve on milrinone. He required placement of Impella LVAD, but subsequent Echos did not show significant improvement in his systolic function. He ultimately succomed at 1035 on [**2144-12-7**], on 3 pressors, broadspectrum abx and an impella Medications on Admission: 1. Clotrimazole 10 mg Troche %x/day 2. Lactulose (30) ML PO QID 3. Rifaximin 200 mg TID 4. Ferrous Sulfate 325 mg [**Hospital1 **] 5. Nadolol 20 mg DAILY 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) PO Q24H 7. Sucralfate 1 gram PO DAILY 8. Furosemide 20 mg PO DAILY 9. Spironolactone 25 mg Tablet PO DAILY Discharge Medications: deceased Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: deceased Discharge Condition: deceased Discharge Instructions: deceased Followup Instructions: deceased Completed by:[**2145-12-7**] Name: [**Known lastname **],[**Known firstname 13065**] Unit No: [**Numeric Identifier 13066**] Admission Date: [**2145-9-1**] Discharge Date: [**2145-12-7**] Date of Birth: [**2088-1-18**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 567**] Addendum: This is a day by day account of the major events as discerned from chart review [**2145-8-11**]??????[**2145-8-17**] Admission for ??????weakness??????. Found to be anemic (hct 26.7) and in ARF (cr 4.0). Had hypotensinve episode with MICU transfer. EGD with no bleeding but variceal banding x 4. ARF resolved with fluids, albumin, discharged to follow up [**2145-8-31**] -> Patient presents to OSH with UGIB, required SB tube. [**Month (only) 412**] have had a Pulseless arrest [**2145-9-1**] ?????? Patient transferred to [**Hospital1 8**] for TIPS eval, intubated with HAP [**2145-9-6**] ?????? [**Hospital 13067**] Transferred to [**Hospital Ward Name **] 10 [**2145-9-17**] ?????? Reintubated, on pressors; Klebsiella sepsis from SBP, urine, ? Pna [**2145-10-15**] ?????? On Cipro daily [**2145-10-20**] ?????? Somnolent, answering some questions [**2145-10-22**] ?????? MELD 27 [**2145-10-23**] ?????? Hypothermic; Started on Cefepime, Vancomycin [**2145-10-25**] ?????? EGD negative for UGIB, Dx Para neg for SBP, received two units pRBC. MRI/MRA shows no sign of anoxic brain [**2145-10-28**]?????? New murmur heard: TTE shows EF > 70%. [**Last Name (un) **] stim test sluggish, started on diurnal steroids [**2145-10-29**] ?????? D/c Cefepime given negative cultures and normothermia [**2145-10-30**]?????? Temp 91.1, BP 82/54; transferred to MICU. Started on Levophed and vasopressin, Dapto/Cipro/Cefepime. Stress Dose steroids. Central (Left IJ placed). Para for 5.5 liters. Low urine output [**2145-10-31**] ?????? Temp normalizes, urine increases. Troponins flat at 0.10 to 0.12. Started on MIdodrine/Octreotide for HRS. [**2145-11-4**] ?????? Started Micagungin for [**Female First Name (un) **] in urine. Troponin 0.39?????? 0.54?????? 0.64. Echo EF > 55%, normal free wall contractility and 2+TR. [**2145-11-5**] ?????? D/c cefepime, Dapto; Started on Hemodialysis via Right Fem Line, ST Depression noted in EKG. Troponin 0.71 (CK 33, MB 5). VRE Positive [**2145-11-6**] ?????? MELD 42 [**2145-11-8**] ?????? Cards Consultation: cath or stress mibi prior to transplantation. No need for ASA/Plavix/Heparin [**2145-11-9**] ?????? Stopped Micafungin [**2145-11-11**] ?????? Called out [**2145-11-14**] ?????? TEE ?????? global hypokinesis, EF 30, 2+ MR [**2145-11-15**] ?????? OLT; ETT, NGT, Right Aline, LEFT Fem HD Line, Right Subclavian line, LEft IJ; ABx: Unasyn, Vanc, Zosyn, Micafungin. On Phenylephrine [**2145-11-17**] ?????? Right Subclavian d/c [**2145-11-19**] ?????? Endocrine consulted for AMS, hypothermia, abn thyroid studies and ? [**Doctor Last Name **] syndrome. Vanc/Zosyn/Micafungin d/c [**2145-11-21**] ?????? Foley D/c, straight cath QOD [**2145-11-23**] ?????? Left Temp Subclavian HD catheter [**2145-11-25**] ?????? Hypothermic, Hypotensive (sBP in 60??????s from 80-90??????s); Back on phenylephrine. TTE shows EF 10%. Severe MR/TR, RV dysfunction [**2145-11-25**]?????? Placed on milrinone, levophed, phenylephrine, and transferred to CCU. Boluses with Lopressor for runs of SVT. LIJ changed to a cordis. Pulmonary Artery Catheter attempted several times with coil in RV. Pt started on heparin gtt Thought by CCU team to be a reversible tachy-cardiomyopathy or secondary to release of cytokines intraoperatively. Goal to support RV with CVP > 20 [**2145-11-26**] ?????? Swan-Ganz floated [**2145-11-28**] ?????? Heart Transplant broached; Continues to have runs of SVT, has difficult time weaning from pressors, milrinone [**2145-11-29**] ?????? Impella placed; [**Hospital1 **] cardiac transplant program rejects application. TTE with EF < 15, progressive dilation, worsening hypokinesis (LV and free wall). Arterial Line changed [**2145-11-30**] ?????? loaded with Digoxin [**2145-12-1**] ?????? A Line replaced; Made DNR/DNI. TTE: Progressively worsening EF [**2145-12-2**] -- > Started Vanc/Zosyn/.Micafungin; added vasopressin. TTE: EF < 10% [**2145-12-3**] ?????? HD line (subclav) pulled; oozed with pressure held for hours. DIC by labs. DP pulse not palpable, Heparin switched to bivalrudin [**2145-12-4**] ?????? On Dapto; d/c Vanc [**2145-12-5**] ?????? New HD line placed in L Fem. Meropenem switched in place of Zosyn. Discharge Disposition: Extended Care Facility: [**Hospital3 14**] & Rehab Center - [**Hospital1 15**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 569**] MD [**MD Number(1) 570**] Completed by:[**2145-12-14**]

572,428,456,507,452,038,995,585,410,584,286,425,997,789,571,303,E878,416,785

{'Hepatic encephalopathy,Acute systolic heart failure,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Portal vein thrombosis,Other specified septicemias,Severe sepsis,End stage renal disease,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Other ascites,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pulmonary heart diseases,Cardiogenic shock'}

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: PCP: [**Name10 (NameIs) 1447**],[**First Name3 (LF) **] [**Telephone/Fax (1) 81526**] . CHIEF COMPLAINT: transferred from OSH for TIPS eval . REASON FOR MICU ADMISSION: GIB bleed PRESENT ILLNESS: 57 M with PMHx of alcoholic ESLD on [**Telephone/Fax (1) **] list, esophageal varices transferred from [**Hospital1 336**] for further evaluation of TIPs procedure. Patient originally presented to [**Hospital 107**] Hospital with hematemasis which started at 3am [**2145-8-31**]. Per wife his last drink was 2 years ago. She reports he was in USOH (occasional weakenss) until he started vomiting clear which subsequently turned red that morning and he had abdominal pain, became lightheaded, and almost passed out. At [**Hospital1 107**] he had hct 21.6, given 6 units PRBCs and 4 units of FFP for INR of 3. He was also given IVF for BP as low as 78/50. There he became ?pulselss for 1 min vs resp arrest ? aspiration. He had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 10045**] placed and intubated for AMS and airway protection. At [**Hospital1 336**] he was given 1 bag of platelets hct 44.9--->31.6, INR of 1.8 on admission [**Doctor Last Name **] given 5mg VitK subQ for 3 days. He was noted to be bleeding from nose and mouth. Scoped by GI and found blood in stomach and ulcer in lower third of esophagus. He received zosyn prophylactically. Scoped by ENT and found nothing. Given 6LNS. . He had recent hospitalization and [**Hospital1 18**] for GIB [**Date range (1) 74682**] attributed to portal hypertensive gastropathy and small ulcers where he had previous bands. He also had ARF that was thought to be pre-renal in origin. . Currently, patient was sedated. He was given 450mcg of fentanyl in transit as his propofol was turned off for "labile blood pressure." Wife was called and the history was confirmed upon arrival . ROS: could not be obtained because of sedation MEDICAL HISTORY: -End stage liver disease, with MELD 18, on [**Date range (1) **] list -alcoholic cirrhosis - decompensated in the past with ascites, peripheral edema and hepatic encephalopathy. -history of esophageal varices, never bled - esophageal/gastric ulcers -h/o hepatopulmonary syndrome -HTN -depression MEDICATION ON ADMISSION: 1. Clotrimazole 10 mg Troche %x/day 2. Lactulose (30) ML PO QID 3. Rifaximin 200 mg TID 4. Ferrous Sulfate 325 mg [**Hospital1 **] 5. Nadolol 20 mg DAILY 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) PO Q24H 7. Sucralfate 1 gram PO DAILY 8. Furosemide 20 mg PO DAILY 9. Spironolactone 25 mg Tablet PO DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Exam General Appearance: Well nourished Cardiovascular: (S1: Normal), (S2: Normal) Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse: Not assessed) Respiratory / Chest: (Breath Sounds: Clear : ) Abdominal: No(t) Distended Extremities: Right lower extremity edema: Absent, Left lower extremity edema: Absent Skin: Not assessed Neurologic: No(t) Attentive, Responds to: Not assessed, Movement: Not assessed, Tone: Not assessed FAMILY HISTORY: per d/c summary: unknown, except Mother - 90, alive Father - deceased 5y ago SOCIAL HISTORY: per d/c summary Smoke: quit 5y ago EtOH: stopped [**2143-10-9**]; prior to that: 1 case/week Drugs: never Lives: with wife [**Name (NI) **]: used to work for cable company; no longer working ### Response: {'Hepatic encephalopathy,Acute systolic heart failure,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Portal vein thrombosis,Other specified septicemias,Severe sepsis,End stage renal disease,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Other ascites,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pulmonary heart diseases,Cardiogenic shock'}

CHIEF COMPLAINT: mesenteric ischemia PRESENT ILLNESS: Ms [**Known lastname 32153**] is a 49yF with known history of chronic mesenteric ischemia ( post-prandial pain which is epigastric, sharp,). She has only been able to eat small meals consisting of soup and crackers. She has lost 50 lbs. She presents for elective angiogram and potential stenting. MEDICAL HISTORY: Chronic Mesenteric Ischemia, HTN, depression, hyperlipidemia, C-section, cholecystectomy, kidney stone, tobacco abuse (down to 2 cigs/day prior to admission) MEDICATION ON ADMISSION: fluoxetine 40mg', simvastating 20mg', ASA 81mg', prescribed pantoprazole but stopped taking ALLERGIES: fluconazole PHYSICAL EXAM: Physical Exam: Vitals: AFVSS GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: soft, ND, NT. No masses palpated, no peritonitis. Ext: No LE edema, LE warm and well perfused FAMILY HISTORY: SOCIAL HISTORY: Physical Exam: Physical Exam: Vitals: AFVSS GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: soft, ND, NT. No masses palpated, no peritonitis. Ext: No LE edema, LE warm and well perfused

Chronic vascular insufficiency of intestine,Celiac artery compression syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Hemorrhage of gastrointestinal tract, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Tobacco use disorder,Loss of weight,Other iatrogenic hypotension

Chr vasc insuff intest,Celiac art compress syn,Ac posthemorrhag anemia,Hemorrhage complic proc,Gastrointest hemorr NOS,Hypertension NOS,Depressive disorder NEC,Hyperlipidemia NEC/NOS,Tobacco use disorder,Abnormal loss of weight,Iatrogenc hypotnsion NEC

Admission Date: [**2180-4-27**] Discharge Date: [**2180-5-4**] Date of Birth: [**2130-6-23**] Sex: F Service: SURGERY Allergies: fluconazole Attending:[**First Name3 (LF) 2777**] Chief Complaint: mesenteric ischemia Major Surgical or Invasive Procedure: Angiogram and Superior Mesenteric Artery Stenting History of Present Illness: Ms [**Known lastname 32153**] is a 49yF with known history of chronic mesenteric ischemia ( post-prandial pain which is epigastric, sharp,). She has only been able to eat small meals consisting of soup and crackers. She has lost 50 lbs. She presents for elective angiogram and potential stenting. Past Medical History: Chronic Mesenteric Ischemia, HTN, depression, hyperlipidemia, C-section, cholecystectomy, kidney stone, tobacco abuse (down to 2 cigs/day prior to admission) Social History: Physical Exam: Physical Exam: Vitals: AFVSS GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: soft, ND, NT. No masses palpated, no peritonitis. Ext: No LE edema, LE warm and well perfused Pertinent Results: [**2180-5-4**] 11:00AM BLOOD WBC-6.5 RBC-3.32* Hgb-9.9* Hct-30.1* MCV-91 MCH-29.8 MCHC-32.9 RDW-15.7* Plt Ct-269 [**2180-5-4**] 05:00AM BLOOD Glucose-95 UreaN-10 Creat-0.5 Na-141 K-3.8 Cl-107 HCO3-27 AnGap-11 [**2180-5-4**] 05:00AM BLOOD Calcium-8.4 Phos-4.7* Mg-2.0 [**2180-4-28**]: CT ANGIOGRAM: There is arterial pooling of contrast in the mid jejunum (4A:82) which increases substantially on venous phase (4B:263-277). A stent is seen in the ostium of the superior mesenteric artery which appears patent. Narrowing of the origin of the celiac axis and narrowing of the origin of the inferior mesenteric artery with post-stenotic dilation are again seen. Diffuse non-calcified atherosclerotic plaque along the aorta is again seen. Visualized vasculature appears patent. No concerning lytic or sclerotic osseous lesions are seen. IMPRESSION: Brisk active arterial extravasation in the mid-jejunum Brief Hospital Course: Ms. [**Known lastname 32153**] was brought to the operating room electively on [**2180-4-27**] and underwent a superior mesenteric artery stenting for her symptoms of chronic mesenteric ischemia. The procedure was without complications. She was closely monitored in the PACU and then transferred to the VICU where she remained hemodynamically stable. On POD 1 she experienced abdominal pain and melena with anemia. A CTA showed active extravasation of blood into the lumen of the mid-jejunum. ACS was consulted and felt that the patient was hemodynamically stable and with a low volume bleed so no intervention was warranted. She received a total 6 units PRBCs. Her diet was gradually advanced to regular which she tolerated without pain. Her stools have been black but her HCT has stabilized around 30. She is ambulatory ad lib. She was discharged to home on POD # 7 in stable condition. Follow-up has been arranged with Dr. [**Last Name (STitle) 174**] of GI and Dr. [**Last Name (STitle) **]. Medications on Admission: fluoxetine 40mg', simvastating 20mg', ASA 81mg', prescribed pantoprazole but stopped taking Discharge Medications: 1. fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable 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. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Mesenteric ischemia Hyperlipidemia Depression 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 after an anngiogram and stenting of the superior mesenteric artery. After the procedure, you had some problems with pain and gastrointenstinal bleeding. This was felt to be secondary to increase blood flow to your bowel after the procedure. We did not need to do any additional procedures and the bleeding subsided. Division of Vascular and Endovascular Surgery Mesenteric Angioplasty/Stent Discharge Instructions Medications: ?????? Take Aspirin 81mg (enteric coated) once daily ?????? 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: ?????? 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 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, gradually increase your activities and distance walked as you can tolerate ?????? No driving until you are no longer taking pain medications Followup Instructions: Department: DIV. OF GASTROENTEROLOGY When: THURSDAY [**2180-5-25**] at 10:15 AM With: [**First Name4 (NamePattern1) 1386**] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 463**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **] Campus: EAST Best Parking: Main Garage Department: VASCULAR SURGERY When: WEDNESDAY [**2180-6-7**] at 11:30 AM [**Telephone/Fax (1) 1237**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Completed by:[**2180-5-4**]

557,447,285,998,578,401,311,272,305,783,458

{'Chronic vascular insufficiency of intestine,Celiac artery compression syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Hemorrhage of gastrointestinal tract, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Tobacco use disorder,Loss of weight,Other iatrogenic hypotension'}

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: mesenteric ischemia PRESENT ILLNESS: Ms [**Known lastname 32153**] is a 49yF with known history of chronic mesenteric ischemia ( post-prandial pain which is epigastric, sharp,). She has only been able to eat small meals consisting of soup and crackers. She has lost 50 lbs. She presents for elective angiogram and potential stenting. MEDICAL HISTORY: Chronic Mesenteric Ischemia, HTN, depression, hyperlipidemia, C-section, cholecystectomy, kidney stone, tobacco abuse (down to 2 cigs/day prior to admission) MEDICATION ON ADMISSION: fluoxetine 40mg', simvastating 20mg', ASA 81mg', prescribed pantoprazole but stopped taking ALLERGIES: fluconazole PHYSICAL EXAM: Physical Exam: Vitals: AFVSS GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: soft, ND, NT. No masses palpated, no peritonitis. Ext: No LE edema, LE warm and well perfused FAMILY HISTORY: SOCIAL HISTORY: Physical Exam: Physical Exam: Vitals: AFVSS GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: soft, ND, NT. No masses palpated, no peritonitis. Ext: No LE edema, LE warm and well perfused ### Response: {'Chronic vascular insufficiency of intestine,Celiac artery compression syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Hemorrhage of gastrointestinal tract, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Tobacco use disorder,Loss of weight,Other iatrogenic hypotension'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 62F w/hx of asthma (requiring intubations in past, last time [**1-16**] years ago) presenting with dyspnea x1 day. She recently finished a prednisone burst 1 week ago for an asthma exacerbation and had been feeling well during the intervening week, however was still taking her albuterol inhaler 4 times daily. She started to feel ill the past few days with increased cough and fatigue, but no fevers. Yesterday morning, she began to have markedly increased cough waking her from sleep with worsening shortness of breath. She took her usual meds including albuterol nebs and Advair, however did not get much relief from them. She went to work but continued to have worsening SOB and called her PCP's office who told her to report to the ED. She states being compliant with her Advair. Does admit to intermittent allergic rhinitis symptoms and is around smokers at home (husband, son). . In the ED, initial vs were: T 99.1 P 83 BP 152/89 R 24 O2 sat. 99%RA. Patient was noted to be moving poor air, using accessory muscles, and speaking in short sentences. She received magnesium sulfate 4gm IV, combivent nebs x3, solumedrol 125 mg IV, and was placed on continuous nebs for 1 hour. No ABG was obtained. An ETCO2 was checked and was 30. She improved symptomatically and was admitted to the [**Hospital Unit Name 153**] for further monitoring. On transfer, her viatls were 147/63 87 21 97%RA. . On the floor, the patient is complaining of being hungry and tired. She feels that her breathing is much improved. She is speaking in full sentences without difficulty. She does note that she has had some episodes of blood per rectum over the past couple weeks. . Review of systems: (+) Per HPI (-) Denies chills. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain, chest pressure, palpitations. Denies nausea, vomiting, diarrhea, constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . MEDICAL HISTORY: CANCER - BREAST, FEMALE, UNSPEC SITE ULCERATIVE COLITIS, UNSPEC ASTHMA Pap smear Anxiety associated with depression Screening cholesterol level Screening, diabetes mellitus Screening, iron deficiency anemia COPD, mild Impingement Syndrome, Shoulder, rt ASTHMA, UNSPEC, W EXACERB PAP SMEAR MURMUR NEVUS - ATYPICAL, UNSPEC SITE ARTHRALGIA - ELBOW THYROTOXICOSIS ARTHRALGIA - HAND HELICOBACTER PYLORI INFECTION FAMILY HISTORY COLON CANCER THYROID NODULE - HOT OSTEOPOROSIS MEDICATION ON ADMISSION: 1. Levothyroxine 75 mcg Oral Tablet TAKE ONE TABLET DAILY 2. Citalopram 20 mg Oral Tablet TAKE 1 TABLET EVERY MORNING 3. Mesalamine (ASACOL HD) 800 mg Oral Tablet, Delayed Release (E.C.) take 3 tablets in the morning and 2 tablets in the evening 4. Fluticasone-Salmeterol (ADVAIR DISKUS) 500-50 mcg/dose Inhalation Disk with Device use 1 inhalation twice daily and rinse mouth thoroughly afterward 5. Hydrochlorothiazide 25 mg Oral Tablet Take 1 tablet daily 7. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 8. Prednisone 10 mg Oral Tablet TAKE 6-6-5-5-4-4-3-3-2-2-1- 1-([**11-16**])-([**11-16**]) TABLET(S) DAILY ON CONSECUTIVE DAYS. TAKE IN THE MORNING WITH FOOD (finished last week) 9. Codeine-Guaifenesin 10-100 mg/5 mL Oral Liquid Take [**11-16**] teaspoons every 4-6 hours as needed for cough 10. Hydrocortisone Acetate (ANUCORT-HC) 25 mg Rectal Suppository Insert rectally twice daily as needed 11. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 12. Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA Aerosol Inhaler take 1 to 2 inhalations every four to six hours AS NEEDED ; rinse mouthpiece atleast once per week. 13. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Inhalation Solution for Nebulization use 1 vial every four hours AS NEEDED for asthma symptoms. 14. Omeprazole 20 mg Oral Capsule, Delayed Release(E.C.) TAKE 1 CAPSULE 30 MINUTES BEFORE THE FIRST MEAL OF DAY 15. FERREX 150 150 MG CAP (IRON POLYSACCHARIDES COMPLEX) take 1 tablet [**Hospital1 **] with [**Location (un) 2452**] or cranberry juice ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMITTING PHYSICAL EXAM: Vitals: T:97.9 BP:142/69 P:74 R: 13 O2: 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear Neck: supple, no LAD Lungs: diffuse wheezes bilaterally but moving good air CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley draining clear urine Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: AAOx3, CNII-XII intact, 5/5 strength upper/lower extremities, 2+ reflexes, gait deferred, cerebellar exam intact (able to write name) FAMILY HISTORY: (-)Glaucoma, (-)Macular Degeneration, (-)Retinal detachment, (-) Diabetes, (-)Hypertension Denies history of sudden cardiac death, MI. Mother passed of colon CA, father passed of esophageal CA. . SOCIAL HISTORY: Lives at home with husband and son who [**Name2 (NI) **]. STATE.CUST.SERVICE FOR UNEMPLOYMENT - Tobacco: Former Smoker ([**2113-11-15**]) 1.5 ppd, 30 pack-years - Alcohol: Occ - Illicits: denies

Chronic obstructive asthma with (acute) exacerbation,Hemorrhage of rectum and anus,Ulcerative colitis, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Personal history of malignant neoplasm of breast

Ch obst asth w (ac) exac,Rectal & anal hemorrhage,Ulceratve colitis unspcf,Hypothyroidism NOS,Depressive disorder NEC,Hypertension NOS,Hx of breast malignancy

Admission Date: [**2128-6-7**] Discharge Date: [**2128-6-11**] Date of Birth: [**2065-8-28**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 983**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: None History of Present Illness: 62F w/hx of asthma (requiring intubations in past, last time [**1-16**] years ago) presenting with dyspnea x1 day. She recently finished a prednisone burst 1 week ago for an asthma exacerbation and had been feeling well during the intervening week, however was still taking her albuterol inhaler 4 times daily. She started to feel ill the past few days with increased cough and fatigue, but no fevers. Yesterday morning, she began to have markedly increased cough waking her from sleep with worsening shortness of breath. She took her usual meds including albuterol nebs and Advair, however did not get much relief from them. She went to work but continued to have worsening SOB and called her PCP's office who told her to report to the ED. She states being compliant with her Advair. Does admit to intermittent allergic rhinitis symptoms and is around smokers at home (husband, son). . In the ED, initial vs were: T 99.1 P 83 BP 152/89 R 24 O2 sat. 99%RA. Patient was noted to be moving poor air, using accessory muscles, and speaking in short sentences. She received magnesium sulfate 4gm IV, combivent nebs x3, solumedrol 125 mg IV, and was placed on continuous nebs for 1 hour. No ABG was obtained. An ETCO2 was checked and was 30. She improved symptomatically and was admitted to the [**Hospital Unit Name 153**] for further monitoring. On transfer, her viatls were 147/63 87 21 97%RA. . On the floor, the patient is complaining of being hungry and tired. She feels that her breathing is much improved. She is speaking in full sentences without difficulty. She does note that she has had some episodes of blood per rectum over the past couple weeks. . Review of systems: (+) Per HPI (-) Denies chills. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain, chest pressure, palpitations. Denies nausea, vomiting, diarrhea, constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . Past Medical History: CANCER - BREAST, FEMALE, UNSPEC SITE ULCERATIVE COLITIS, UNSPEC ASTHMA Pap smear Anxiety associated with depression Screening cholesterol level Screening, diabetes mellitus Screening, iron deficiency anemia COPD, mild Impingement Syndrome, Shoulder, rt ASTHMA, UNSPEC, W EXACERB PAP SMEAR MURMUR NEVUS - ATYPICAL, UNSPEC SITE ARTHRALGIA - ELBOW THYROTOXICOSIS ARTHRALGIA - HAND HELICOBACTER PYLORI INFECTION FAMILY HISTORY COLON CANCER THYROID NODULE - HOT OSTEOPOROSIS Social History: Lives at home with husband and son who [**Name2 (NI) **]. STATE.CUST.SERVICE FOR UNEMPLOYMENT - Tobacco: Former Smoker ([**2113-11-15**]) 1.5 ppd, 30 pack-years - Alcohol: Occ - Illicits: denies Family History: (-)Glaucoma, (-)Macular Degeneration, (-)Retinal detachment, (-) Diabetes, (-)Hypertension Denies history of sudden cardiac death, MI. Mother passed of colon CA, father passed of esophageal CA. . Physical Exam: ADMITTING PHYSICAL EXAM: Vitals: T:97.9 BP:142/69 P:74 R: 13 O2: 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear Neck: supple, no LAD Lungs: diffuse wheezes bilaterally but moving good air CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley draining clear urine Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: AAOx3, CNII-XII intact, 5/5 strength upper/lower extremities, 2+ reflexes, gait deferred, cerebellar exam intact (able to write name) Pertinent Results: ADMISSION LABS: [**2128-6-7**] 02:57PM PT-12.0 PTT-22.5 INR(PT)-1.0 [**2128-6-7**] 01:26PM COMMENTS-GREEN TOP [**2128-6-7**] 01:26PM GLUCOSE-83 LACTATE-1.8 NA+-138 K+-4.1 CL--99* TCO2-22 [**2128-6-7**] 01:14PM UREA N-18 CREAT-0.9 [**2128-6-7**] 01:14PM estGFR-Using this [**2128-6-7**] 01:14PM WBC-11.3* RBC-4.31 HGB-12.8 HCT-36.7 MCV-85 MCH-29.6 MCHC-34.8 RDW-16.4* [**2128-6-7**] 01:14PM NEUTS-81.7* LYMPHS-12.5* MONOS-4.4 EOS-0.5 BASOS-0.8 [**2128-6-7**] 01:14PM PLT COUNT-275 ================ Imaging: ================ CXR [**2128-6-7**]: AP UPRIGHT VIEW OF THE CHEST: Bibasilar linear opacities suggestive of atelectasis, however, a developing infection cannot be excluded. There is no large effusion or pneumothorax. Heart size is top normal. Tortuosity of the thoracic aorta with atherosclerotic calcification of the aortic arch is noted, but the mediastinal silhouette is otherwise unremarkable. Hilar contours and pulmonary vasculature are normal. There is a large hiatal hernia. IMPRESSION: Probable bibasilar atelectasis, although developing infection cannot be excluded. If there is persistent clinical concern, conventional PA and lateral radiographs could be obtained for further evaluation. Brief Hospital Course: 62 y/o female with PMHx HTN, UC & asthma was admitted to the ICU for dyspnea and cough, thought to have an acute asthma exacerbation. . ICU COURSE: . # Asthma exacerbation - Patient appeared well in the unit speaking in full sentences and symptomatically improved with nebs. She was initially admitted to the ICU and treated with iv steroids+ nebs. The patient improved and was able to be transitioned to po steroids and transferred to the floor. CXR showed bibasilar small opacity(atalectasis vs early consolidation). She developed a worsening cough, but continued to have high O2 sat on RA and peak flow > 300. Levaquin was started and her symptoms improved. She was discharged on a extended steroid taper, bronchodilators(inhalers/nebulizers) and abx(levaquin 4 days-completed [**6-14**]). She will follow up with her pcp and [**Name9 (PRE) 3782**] pulmonology clinic. # Ulcerative colitis - Patient did admit to having blood per rectum recently, but denies fevers, chills, abdominal pain, diarrhea that would be more consistent with a flare. CBC was stable. She was continued on her mesalamine . . # Hypertension - Stable. Continued home hydrochlorothiazide. . # Depression - Stable. Continued home citalopram. . # Hypothyroidism - Stable. Continued home levothyroxine. Medications on Admission: 1. Levothyroxine 75 mcg Oral Tablet TAKE ONE TABLET DAILY 2. Citalopram 20 mg Oral Tablet TAKE 1 TABLET EVERY MORNING 3. Mesalamine (ASACOL HD) 800 mg Oral Tablet, Delayed Release (E.C.) take 3 tablets in the morning and 2 tablets in the evening 4. Fluticasone-Salmeterol (ADVAIR DISKUS) 500-50 mcg/dose Inhalation Disk with Device use 1 inhalation twice daily and rinse mouth thoroughly afterward 5. Hydrochlorothiazide 25 mg Oral Tablet Take 1 tablet daily 7. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 8. Prednisone 10 mg Oral Tablet TAKE 6-6-5-5-4-4-3-3-2-2-1- 1-([**11-16**])-([**11-16**]) TABLET(S) DAILY ON CONSECUTIVE DAYS. TAKE IN THE MORNING WITH FOOD (finished last week) 9. Codeine-Guaifenesin 10-100 mg/5 mL Oral Liquid Take [**11-16**] teaspoons every 4-6 hours as needed for cough 10. Hydrocortisone Acetate (ANUCORT-HC) 25 mg Rectal Suppository Insert rectally twice daily as needed 11. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 12. Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA Aerosol Inhaler take 1 to 2 inhalations every four to six hours AS NEEDED ; rinse mouthpiece atleast once per week. 13. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Inhalation Solution for Nebulization use 1 vial every four hours AS NEEDED for asthma symptoms. 14. Omeprazole 20 mg Oral Capsule, Delayed Release(E.C.) TAKE 1 CAPSULE 30 MINUTES BEFORE THE FIRST MEAL OF DAY 15. FERREX 150 150 MG CAP (IRON POLYSACCHARIDES COMPLEX) take 1 tablet [**Hospital1 **] with [**Location (un) 2452**] or cranberry juice Discharge Medications: 1. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. mesalamine 800 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day: Take 3 tabs in the am, 2 tabs at night. 4. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 5. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 6. Combivent 18-103 mcg/Actuation Aerosol Sig: [**11-16**] Inhalation every four (4) hours as needed for shortness of breath or wheezing. 7. Anucort-HC 25 mg Suppository Sig: One (1) Rectal twice a day as needed for diarrhea. 8. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 9. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: One (1) Inhalation every 4-6 hours as needed for shortness of breath or wheezing. 10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 11. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 12. dextromethorphan-guaifenesin 10-100 mg/5 mL Syrup Sig: Five (5) ML PO Q6H (every 6 hours) as needed for cough. 13. Ferrex 150 150 mg Capsule Sig: One (1) Capsule PO twice a day: with [**Location (un) 2452**] or cranberry juice. 14. prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day for 23 days: Take 6 tabs x 3 days, then 4 tabs x 5 days, then 2 tabs x 5 days, then 1 tab x 5 days, then [**11-16**] tab for 5 days. If symptoms worsen, then call your primary care physician. [**Name Initial (NameIs) **]:*56 Tablet(s)* Refills:*0* 15. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 4 days. [**Name Initial (NameIs) **]:*4 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Asthma exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You presented with an asthma exacerbation treated with steroids, inhalers and antibiotics. Your oxygen level was stable with no extra oxygen and your symptoms were improving with treatment. Please continue your steroid taper as directed, continue your antibiotics and use your inhalers/nebulizers as instructed Followup Instructions: You have a f/u with Dr. [**Last Name (STitle) 6589**] on [**6-15**] @ 840am you also have a new pt appointment in the pulmonary clinic: Name: [**Last Name (LF) 34792**], [**Name8 (MD) **] MD Location: [**Location (un) 2274**]-[**Hospital1 392**] Surgical Specialties/Pulmonology Address: [**Location (un) 64676**], [**Hospital1 392**], MA Phone: [**Telephone/Fax (1) 64677**] Appt: [**6-21**] at 2pm

493,569,556,244,311,401,V103

{'Chronic obstructive asthma with (acute) exacerbation,Hemorrhage of rectum and anus,Ulcerative colitis, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,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: Shortness of breath PRESENT ILLNESS: 62F w/hx of asthma (requiring intubations in past, last time [**1-16**] years ago) presenting with dyspnea x1 day. She recently finished a prednisone burst 1 week ago for an asthma exacerbation and had been feeling well during the intervening week, however was still taking her albuterol inhaler 4 times daily. She started to feel ill the past few days with increased cough and fatigue, but no fevers. Yesterday morning, she began to have markedly increased cough waking her from sleep with worsening shortness of breath. She took her usual meds including albuterol nebs and Advair, however did not get much relief from them. She went to work but continued to have worsening SOB and called her PCP's office who told her to report to the ED. She states being compliant with her Advair. Does admit to intermittent allergic rhinitis symptoms and is around smokers at home (husband, son). . In the ED, initial vs were: T 99.1 P 83 BP 152/89 R 24 O2 sat. 99%RA. Patient was noted to be moving poor air, using accessory muscles, and speaking in short sentences. She received magnesium sulfate 4gm IV, combivent nebs x3, solumedrol 125 mg IV, and was placed on continuous nebs for 1 hour. No ABG was obtained. An ETCO2 was checked and was 30. She improved symptomatically and was admitted to the [**Hospital Unit Name 153**] for further monitoring. On transfer, her viatls were 147/63 87 21 97%RA. . On the floor, the patient is complaining of being hungry and tired. She feels that her breathing is much improved. She is speaking in full sentences without difficulty. She does note that she has had some episodes of blood per rectum over the past couple weeks. . Review of systems: (+) Per HPI (-) Denies chills. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain, chest pressure, palpitations. Denies nausea, vomiting, diarrhea, constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . MEDICAL HISTORY: CANCER - BREAST, FEMALE, UNSPEC SITE ULCERATIVE COLITIS, UNSPEC ASTHMA Pap smear Anxiety associated with depression Screening cholesterol level Screening, diabetes mellitus Screening, iron deficiency anemia COPD, mild Impingement Syndrome, Shoulder, rt ASTHMA, UNSPEC, W EXACERB PAP SMEAR MURMUR NEVUS - ATYPICAL, UNSPEC SITE ARTHRALGIA - ELBOW THYROTOXICOSIS ARTHRALGIA - HAND HELICOBACTER PYLORI INFECTION FAMILY HISTORY COLON CANCER THYROID NODULE - HOT OSTEOPOROSIS MEDICATION ON ADMISSION: 1. Levothyroxine 75 mcg Oral Tablet TAKE ONE TABLET DAILY 2. Citalopram 20 mg Oral Tablet TAKE 1 TABLET EVERY MORNING 3. Mesalamine (ASACOL HD) 800 mg Oral Tablet, Delayed Release (E.C.) take 3 tablets in the morning and 2 tablets in the evening 4. Fluticasone-Salmeterol (ADVAIR DISKUS) 500-50 mcg/dose Inhalation Disk with Device use 1 inhalation twice daily and rinse mouth thoroughly afterward 5. Hydrochlorothiazide 25 mg Oral Tablet Take 1 tablet daily 7. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 8. Prednisone 10 mg Oral Tablet TAKE 6-6-5-5-4-4-3-3-2-2-1- 1-([**11-16**])-([**11-16**]) TABLET(S) DAILY ON CONSECUTIVE DAYS. TAKE IN THE MORNING WITH FOOD (finished last week) 9. Codeine-Guaifenesin 10-100 mg/5 mL Oral Liquid Take [**11-16**] teaspoons every 4-6 hours as needed for cough 10. Hydrocortisone Acetate (ANUCORT-HC) 25 mg Rectal Suppository Insert rectally twice daily as needed 11. Ipratropium-Albuterol (COMBIVENT) 18-103 mcg/Actuation Inhalation Aerosol Use 2 inhalations by mouth 4 times daily as needed 12. Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA Aerosol Inhaler take 1 to 2 inhalations every four to six hours AS NEEDED ; rinse mouthpiece atleast once per week. 13. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Inhalation Solution for Nebulization use 1 vial every four hours AS NEEDED for asthma symptoms. 14. Omeprazole 20 mg Oral Capsule, Delayed Release(E.C.) TAKE 1 CAPSULE 30 MINUTES BEFORE THE FIRST MEAL OF DAY 15. FERREX 150 150 MG CAP (IRON POLYSACCHARIDES COMPLEX) take 1 tablet [**Hospital1 **] with [**Location (un) 2452**] or cranberry juice ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMITTING PHYSICAL EXAM: Vitals: T:97.9 BP:142/69 P:74 R: 13 O2: 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear Neck: supple, no LAD Lungs: diffuse wheezes bilaterally but moving good air CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley draining clear urine Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: AAOx3, CNII-XII intact, 5/5 strength upper/lower extremities, 2+ reflexes, gait deferred, cerebellar exam intact (able to write name) FAMILY HISTORY: (-)Glaucoma, (-)Macular Degeneration, (-)Retinal detachment, (-) Diabetes, (-)Hypertension Denies history of sudden cardiac death, MI. Mother passed of colon CA, father passed of esophageal CA. . SOCIAL HISTORY: Lives at home with husband and son who [**Name2 (NI) **]. STATE.CUST.SERVICE FOR UNEMPLOYMENT - Tobacco: Former Smoker ([**2113-11-15**]) 1.5 ppd, 30 pack-years - Alcohol: Occ - Illicits: denies ### Response: {'Chronic obstructive asthma with (acute) exacerbation,Hemorrhage of rectum and anus,Ulcerative colitis, unspecified,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}

CHIEF COMPLAINT: respiratory failure s/p intubation PRESENT ILLNESS: 68F with COPD, CAD, systolic CHF, and tracheal stensosis s/p complicated respiratory failure history, transferred from OSH with recurrent respiratory failure for consideration of tracheostomy. She presented with acute respiratory distress to OSH one day PTA and was subsequently intubated for hypercarbic/hypoxic respiratory failure. . She was recently admitted to [**Hospital 105299**] hospital on [**2139-11-20**] after acute respiratory distress and short PEA arrest at home. Led to intubation. Per notes treated for CHF and pneumonia. She failed at least one extubation trial, and had subsequent transfer, while intubated, to [**Hospital1 18**] from [**Date range (1) 78750**] on the thoracics/IP service. She was extubated on the day of transfer. Bronch noted to have stable tracheal stenosis. Did well on nightly bipap and pulmonary toilet with O2 sats 90-92% on 4L during day. Discharged to [**Hospital **] rehab on [**12-15**]. Following this rehab admission she was sent to a different OSH on [**2139-12-21**], for acute CHF and at least one PEA arrest. Had AICD placement and reports ?cardiac cath. Intubated at least twice during that admission. Respiratory distress frequently accompanied by elevated blood pressures. Troponin during that admission elevated to 0.4 with one episode of resp distress. Also noted that anxiety seems to be a trigger, and was given scheduled 1 mg Ativan prior to Bipap removal. Following this admission she went to a rehab facility again. Discharged from rehab to home on [**1-11**]. That evening (yesterday) she became cyanotic at home reportedly after having a milkshake and Ativan. EMS brought patient to [**Hospital3 13313**] on bipap and she was eventually intubated in the ED, uncomplicated. On arrival to ED, tachypneic to 30s with bipap at 20/4, sats in low 90s on FiO2 1. HR 80, BP 170/62 initially. Prior to intubation given flumazenil and narcan. Lasix and bumex as well as IV ativan and versed at OSH. ABG at some point 7.15/76/84. CXR per notes with cardiomegaly, volume excess, new pacer. Patient reports also having an echo today but no report available. . On the floor, patient denies current respiratory difficulties. C/o pain in the throat and at her pacer site. Denies any chest pain, N/V, diaphoresis prior to onset of her recurrent dyspnea. Does endorse anxiety prior to symptoms onset. MEDICAL HISTORY: -Coronary artery disease s/p CABG in [**2118**] and "recent" PCI -CHF, last TTE [**2138-9-12**] EF 60% with mild LVH and some focal hypokinesis at base. -OSA -Dyslipidemia -HTN -Left total hip replacement-[**1-28**], elective. Complicated postoperative course with post-operative atrial fibrillation wtih RVR requiring cardioversion, sepsis, Pseudomonas VAP, VRE UT, and prolonged intubation leading to trach/PEG. Discharged to chronic wean facility but unable to decannulate. Bronchoscopy revealed tracheomalacia of subglottic region. -Supraglottic edema from GERD -Bipolar disorder -Depression -chronic atrial fibrillation, developed postop from THR, not anticoagulated -Chronic constipation -HIT during Fragmin therapy MEDICATION ON ADMISSION: Medications on transfer: ASA 81 mg daily Lipitor 80 mg daily Colchicine 0.6 mg daily Lasix 40 mg IV Q12H Protonix 40 mg IV daily Seroquel 100 mg HS and 50 mg TID Lamotrigine 100 mg HS Citalopram 20 mg daily Nitrofurantoin 50 mg QID planned thru [**1-19**] D51/2NS at 75 cc/hr . Medications at home: Nexium 40 mg daily Senna 2 tabs daily MVI daily ASA 81 mg daily Seroquel 50 mg TID and 100 mg HS Metoprolol tartrate 12.5 mg [**Hospital1 **] Lisinopril 5 mg daily Lipitor 80 mg daily Citalopram 20 mg [**Hospital1 **] (12pm and 4pm) Lamictal 100 mg [**Hospital1 **] Lasix 80 mg QAM, 40 mg QPM Clonazepam 2 mg [**Hospital1 **] KCL unknown dose [**Hospital1 **] Colchicine 0.6 mg daily ALLERGIES: Heparin Agents / Percocet / Lisinopril PHYSICAL EXAM: On admission: General: Alert, intubated but comfortable appearing, no acute distress. follows all commands and communicates by writing as well. HEENT: Sclera anicteric, MMM though c/o thirst, oropharynx clear, ETT and OGT in place. Neck: supple, JVD elevated though difficult to appreciate how high with body habitus and tubes, no LAD Lungs: Bilaterally rhonchorous, no appreciated rales. CV: Regular rate and rhythm, normal S1 + S2, [**2-27**] SM at LUSB. Pacer pocket site in L chest quite ecchymotic with swelling, ecchymoses tracing down toward axilla. Moderately tender to palpation. No erythema. No appreciated fluctuance. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or appreciable edema. Neuro: Follows complex commands. 5/5 strength in distal UEs/LEs. . On discharge: FAMILY HISTORY: Depression SOCIAL HISTORY: Married. Very supportive husband. When she is not hospitalized/in rehab, she lives with him. No ETOH or current smoking. Has 35 pack year smoking history, quit 13 years ago.

Acute respiratory failure,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Hyperosmolality and/or hypernatremia,Acute gouty arthropathy,Chronic airway obstruction, not elsewhere classified,Other diseases of trachea and bronchus,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Esophageal reflux,Atrial fibrillation,Dysthymic disorder,Bipolar disorder, unspecified,Anemia, unspecified,Pressure ulcer, stage II,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Dysphagia, oropharyngeal phase,Other and unspecified hyperlipidemia,Chest pain, unspecified,Other constipation,Automatic implantable cardiac defibrillator in situ,Personal history of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation

Acute respiratry failure,Ac on chr syst hrt fail,Acute kidney failure NOS,Urin tract infection NOS,Comp-oth cardiac device,Hyperosmolality,Acute gouty arthropathy,Chr airway obstruct NEC,Trachea & bronch dis NEC,Obstructive sleep apnea,Hypertension NOS,Esophageal reflux,Atrial fibrillation,Dysthymic disorder,Bipolar disorder NOS,Anemia NOS,Pressure ulcer, stage II,Oth gram negatv bacteria,Dysphagia, oropharyngeal,Hyperlipidemia NEC/NOS,Chest pain NOS,Constipation NEC,Status autm crd dfbrltr,Hx Methicln resist Staph,History of tobacco use,Status-post ptca,Abn react-artif implant

Admission Date: [**2140-1-13**] Discharge Date: [**2140-1-27**] Date of Birth: [**2071-3-16**] Sex: F Service: MEDICINE Allergies: Heparin Agents / Percocet / Lisinopril Attending:[**First Name3 (LF) 348**] Chief Complaint: respiratory failure s/p intubation Major Surgical or Invasive Procedure: intubation and mechanical ventilation flexible bronchoscopy with moderate sedation percutaneous tracheostomy placement PEG tube placement [**2140-1-19**] History of Present Illness: 68F with COPD, CAD, systolic CHF, and tracheal stensosis s/p complicated respiratory failure history, transferred from OSH with recurrent respiratory failure for consideration of tracheostomy. She presented with acute respiratory distress to OSH one day PTA and was subsequently intubated for hypercarbic/hypoxic respiratory failure. . She was recently admitted to [**Hospital 105299**] hospital on [**2139-11-20**] after acute respiratory distress and short PEA arrest at home. Led to intubation. Per notes treated for CHF and pneumonia. She failed at least one extubation trial, and had subsequent transfer, while intubated, to [**Hospital1 18**] from [**Date range (1) 78750**] on the thoracics/IP service. She was extubated on the day of transfer. Bronch noted to have stable tracheal stenosis. Did well on nightly bipap and pulmonary toilet with O2 sats 90-92% on 4L during day. Discharged to [**Hospital **] rehab on [**12-15**]. Following this rehab admission she was sent to a different OSH on [**2139-12-21**], for acute CHF and at least one PEA arrest. Had AICD placement and reports ?cardiac cath. Intubated at least twice during that admission. Respiratory distress frequently accompanied by elevated blood pressures. Troponin during that admission elevated to 0.4 with one episode of resp distress. Also noted that anxiety seems to be a trigger, and was given scheduled 1 mg Ativan prior to Bipap removal. Following this admission she went to a rehab facility again. Discharged from rehab to home on [**1-11**]. That evening (yesterday) she became cyanotic at home reportedly after having a milkshake and Ativan. EMS brought patient to [**Hospital3 13313**] on bipap and she was eventually intubated in the ED, uncomplicated. On arrival to ED, tachypneic to 30s with bipap at 20/4, sats in low 90s on FiO2 1. HR 80, BP 170/62 initially. Prior to intubation given flumazenil and narcan. Lasix and bumex as well as IV ativan and versed at OSH. ABG at some point 7.15/76/84. CXR per notes with cardiomegaly, volume excess, new pacer. Patient reports also having an echo today but no report available. . On the floor, patient denies current respiratory difficulties. C/o pain in the throat and at her pacer site. Denies any chest pain, N/V, diaphoresis prior to onset of her recurrent dyspnea. Does endorse anxiety prior to symptoms onset. Past Medical History: -Coronary artery disease s/p CABG in [**2118**] and "recent" PCI -CHF, last TTE [**2138-9-12**] EF 60% with mild LVH and some focal hypokinesis at base. -OSA -Dyslipidemia -HTN -Left total hip replacement-[**1-28**], elective. Complicated postoperative course with post-operative atrial fibrillation wtih RVR requiring cardioversion, sepsis, Pseudomonas VAP, VRE UT, and prolonged intubation leading to trach/PEG. Discharged to chronic wean facility but unable to decannulate. Bronchoscopy revealed tracheomalacia of subglottic region. -Supraglottic edema from GERD -Bipolar disorder -Depression -chronic atrial fibrillation, developed postop from THR, not anticoagulated -Chronic constipation -HIT during Fragmin therapy Social History: Married. Very supportive husband. When she is not hospitalized/in rehab, she lives with him. No ETOH or current smoking. Has 35 pack year smoking history, quit 13 years ago. Family History: Depression Physical Exam: On admission: General: Alert, intubated but comfortable appearing, no acute distress. follows all commands and communicates by writing as well. HEENT: Sclera anicteric, MMM though c/o thirst, oropharynx clear, ETT and OGT in place. Neck: supple, JVD elevated though difficult to appreciate how high with body habitus and tubes, no LAD Lungs: Bilaterally rhonchorous, no appreciated rales. CV: Regular rate and rhythm, normal S1 + S2, [**2-27**] SM at LUSB. Pacer pocket site in L chest quite ecchymotic with swelling, ecchymoses tracing down toward axilla. Moderately tender to palpation. No erythema. No appreciated fluctuance. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or appreciable edema. Neuro: Follows complex commands. 5/5 strength in distal UEs/LEs. . On discharge: Pertinent Results: today's at OSH: Na 143 K 3.5, CL 103, bicarb 31, BUN 21, creat 1.1. LFTs WNL. WBC 12K . Micro: OSH urine [**1-11**]: >10^5 GNRs, lactose fermentors [**1-11**] labs: CK 34, MB 3.2, troponin I 0.06, creat 1.3 . Images: OSH CXR report [**1-11**]: pacer and sternal wires present. Diffuse bilateral pulmonary vascular redistribution and diffusely increased interstitial markings. Later film with ETT tip 2.7 cm above carina. . OSH CXR report [**1-12**]: Diffuse changes of CHF. Improved lung volumes. Persistent LLL consolidation. . EKG at OSH: poor baseline, at least partially Apaced, rate 63, normal axis, normal intervals, inferior and precordial TWF/TWIs. . [**2140-1-13**] 11:14PM GLUCOSE-90 UREA N-34* CREAT-1.3* SODIUM-145 POTASSIUM-3.6 CHLORIDE-103 TOTAL CO2-32 ANION GAP-14 [**2140-1-13**] 11:14PM estGFR-Using this [**2140-1-13**] 11:14PM CK(CPK)-21* [**2140-1-13**] 11:14PM CK-MB-NotDone cTropnT-0.05* proBNP-1376* [**2140-1-13**] 11:14PM CALCIUM-9.1 PHOSPHATE-2.9 MAGNESIUM-1.9 [**2140-1-13**] 11:14PM WBC-5.9 RBC-3.42* HGB-10.2* HCT-30.8* MCV-90 MCH-29.9 MCHC-33.1 RDW-16.1* [**2140-1-13**] 11:14PM NEUTS-66.9 LYMPHS-23.8 MONOS-3.4 EOS-5.4* BASOS-0.5 [**2140-1-13**] 11:14PM PLT COUNT-239 [**2140-1-13**] 11:14PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.008 [**2140-1-13**] 11:14PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-MOD [**2140-1-13**] 11:14PM URINE RBC-1 WBC-21* BACTERIA-FEW YEAST-NONE EPI-1 [**2140-1-13**] 11:14PM URINE HYALINE-8* [**2140-1-13**] 11:14PM URINE MUCOUS-RARE [**2140-1-19**] 08:55AM 5.1 3.37* 9.7* 30.1* 89 28.8 32.3 16.6* 369 [**2140-1-18**] 12:40PM 6.2 3.46* 10.4* 31.2* 90 30.0 33.2 16.1* 327 [**2140-1-17**] 08:00AM 5.6 3.20* 9.3* 29.3* 92 29.0 31.7 16.8* 326 [**2140-1-16**] 02:52AM 6.1 3.64* 10.8* 32.6* 89 29.5 33.0 16.7* 251 [**2140-1-15**] 04:07AM 7.1 3.55* 10.4* 32.6* 92 29.2 31.9 16.4* 286 Source: Line-PIV [**2140-1-13**] 11:14PM 5.9 3.42* 10.2* 30.8* 90 29.9 33.1 16.1* 239 . On discharge: [**2140-1-26**] 10:45AM BLOOD WBC-9.0 RBC-3.53* Hgb-10.3* Hct-31.6* MCV-90 MCH-29.1 MCHC-32.5 RDW-16.0* Plt Ct-382 [**2140-1-26**] 10:45AM BLOOD PT-23.7* PTT-37.6* INR(PT)-2.3* [**2140-1-26**] 10:45AM BLOOD Glucose-109* UreaN-39* Creat-1.8* Na-140 K-4.6 Cl-98 HCO3-32 AnGap-15 [**2140-1-26**] 10:45AM BLOOD Calcium-9.3 Phos-4.0 Mg-2.5 . **FINAL REPORT [**2140-1-16**]** URINE CULTURE (Final [**2140-1-16**]): ENTEROBACTER ASBURIAE. >100,000 ORGANISMS/ML.. This organism may develop resistance to third generation cephalosporins during prolonged therapy. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. For serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROBACTER ASBURIAE | CEFEPIME-------------- <=1 S CEFTAZIDIME----------- =>64 R CEFTRIAXONE----------- 8 S CIPROFLOXACIN--------- 1 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- 64 I PIPERACILLIN/TAZO----- 16 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- 2 S Final Report CHEST RADIOGRAPH INDICATION: New tracheostomy tube, evaluation for interval change. COMPARISON: [**2140-1-13**]. FINDINGS: As compared to the previous radiograph, the tracheostomy tube has been placed and the ET tube and the nasogastric tube have been removed. The tip of the endotracheal tube projects 4.8 cm above the carina. Unchanged position and course of the pacemaker leads. The ventilation of the lung has improved. The costophrenic sinuses are substantially better visible than on the previous examination. Unchanged size of the cardiac silhouette, regression of the bilateral supradiaphragmatic areas of atelectasis. No evidence of newly occurred focal parenchymal opacities. . [**1-17**] CXR: IMPRESSION: Improved left basilar aeration. . [**1-17**] video swallow: Aspiration of all consistencies of barium in a neutral position. With the patient in chin tuck position, no aspiration was observed with puree consistency barium. . [**1-20**] CXR: FINDINGS: Comparison made to [**2140-1-18**]. Left pacemaker/ICD and intracardiac leads are unchanged in position. Cardiomediastinal contours are stable. Mild bibasilar atelectasis is unchanged. Mild pulmonary edema shows minimal improvement. There is no new or worsening airspace opacity. . [**1-24**] CXR: The left-sided AICD and tracheostomy are in unchanged position. Median sternotomy wires are seen. There is again seen cardiomegaly which is stable. There are low lung volumes with crowding of the pulmonary vascular markings at the bases; however, no definite consolidation is seen. Overall, these findings are unchanged. Brief Hospital Course: 68F with COPD, CAD, systolic CHF, and tracheal stenosis s/p complicated respiratory failure history, presenting with recurrent acute pulmonary edema of unclear etiology and respiratory failure now s/p tracheostomy. . # Respiratory failure: The patient has a complicated tracheal history as above with past trach now decannulated; she presented with multiple recent reintubations for acute onset respiratory distress and reported pulmonary edema since [**10-29**]. Etiology of acute pulmonary edema not entirely clear - there has been discussion of negative pressure edema from negative pressure generation with pulling against stenosed trachea, acute ischemic heart disease leading to diastolic dysfunction, other cause of acute afterload increase (particularly likely as seems to have clear relation to anxiety), but her respiratory failure seems less likely due total body volume overload given acuity of symptom onset. Respiratory failure does not seem to be OSA related though that is in her history (no nighttime occurances). It is likely that her respiratory failure is multifactorial, with anxiety leading to increased afterload and poor forward flow leading to dyspnea, then severe dyspnea leading to increased intrathoracic pressures and worse dynamic airway stenosis all contributing. She was originally admitted to the MICU. In order to provide more definitive airway management as well as to prevent further tracheal injury with repeated intubations, and bypass stenosed area if NPPE playing a role, the patient had a tracheostostomy placed and was successfully weaned to trach collar. She appeared euvolemic after IV lasix given in MICU and then transitioned back to PO lasix. She was able to eat with cuff down but failed swallow eval and was likely aspirating. She was then transferred to the floor. Had a lot of secretion and needed frequent suctioning. Unable to do PMV because of either trach size too big or tracheal stenosis. Once patient made NPO her sectretions improved and air movement improved. Repeat CXR showed improved aeration. She underwent a PEG placement. Continued CAD and CHF meds as below. Successfully weaned to trach collar, cont 70% FM currently as patient prefers to have oxygen high. Tried to encourage pt to suction upper airway secretions by herself but not really willing. Continued lasix to maintain euvolemia. We treated anxiety as below. Per IP we started [**Hospital1 **] PPI and H2B to help improved reflux and airway inflammation. Patient experienced peridoic asymptomatic desaturations, that improved with suction and nebulizer treatments. Patient was discharged home, with her husband and children instructed on suction technique. . # COPD and tracheal stenosis. Recent PFTs as per PMH. Bronch during last admission revealing mild tracheal stenosis. Unclear if this is contributing to her dyspnea and/or respiratory failure (primarily via negative pressure pulmonary edema and/or dynamic collapse of airways). No inhalers currently listed on home meds. Cont trach and 50%TM, inhalers prn. . # ARF: PO intake poor and started lasix, likely pre-renal. Cr fluctuated between 1.1 and 1.9 throughout this hospitalization. Avoided nephrotoxins and reduced her lasix to 40 PO daily. . # Foot pain: Consistent with gout flare, likely in the setting of diuresis improved today. Resumed home colchicine. . # Pacer pocket pain/swelling. Tender on exam though no erythema. Now about 3 weeks out from AICD lacement. Tender on exam though no erythema. Ultrasound chest pocket showed no abscess. Pain control prn. . # UTI. Ucx from [**1-12**] growing ENTEROBACTER ASBURIAE. Completed 7 day course of cipro. . # Systolic CHF. EF 40-50%, likely ischemic in nature. Patient appeared euvolemic on most of stay. Reportedly had TTE at OSH. Would benefit from excellent BP and rate control. CXR yesterday am patient looked improved. Continue metoprolol xl, lisinopril at 2.5mg, and lasix 80mg. (Does have documented allergy to lisinopril but tolerated it in house without complications.) . # CAD. Consideration of ischemia as cause of diastolic dysfunction. Underwent cardiac cath at [**Hospital2 **] [**Hospital3 6783**] in early [**Month (only) **] which showed some of her grafts were down which was not new. Had an AICD put on there because of the thought that her PEA arrests were [**2-23**] ischemic focus causing VFib/tach. Continue Statin, ASA, BB, ACEI . # Afib. Chronic. St. Vincents had put her on sotalol but this was not continued upon readmission to [**Hospital1 10478**] in [**12-29**]. Currently rate controlled. Has never been on anticoagulation for unclear reasons but was started on coumadin yesterday which she warrants for a CHADS2 of 2. Cont rate control with metoprolol 12.5mg PO BID. Cont asa and coumadin, INR was 2.6 on discharge, with a goal of [**2-24**]. Monitored on tele with no events. Should see EP as outpatient. . # Depression/anxiety. Significant player in her respiratory distress episodes; not well managed as an outpatient with frequent admissions as per HPI. Takes Ativan at home per patient, denies clonazepam. Continue citalopram, Seroquel, lamictal per home regimen. Started Ativan q4-6h PO PRN for anxiety. . # Anemia: Iron studies wnl. Hct at baseline. . #Stage II decub: Per patient chronic and not painful. Nurses assessed for wound care. . # Nutrition: Patient underwent a PEG placement during this admission. Tube feeds were initiaed with Isosource 1.5 Cal, with feeding from 1800 to 0600 @ 70 cc/hr with q 4 hr flushes and residual checks. All of her medications were given through the PEG to reduce risk of aspiration. . # Disposition. Given tracheostomy, PEG tube placement, and periodic episodes of desaturation, there was significant discussion with the family regarding appropriate disposition for Ms. [**Known lastname 16471**]. It was the initial assessment of the primary team that the patient had needs beyond what could be performed safely at home and recommended placement in a rehabilitation facility. She was accepted for a bed at a skilled nursing facility, but the patient refused placement and insisted on being discharged home. Extensive home services were arranged and family members were instructed on suction technique and appropriate home care. Family were also instructed regarding warning signs that would warrant contacting their physician, [**Name10 (NameIs) **] coming to the emergency room. Follow-up appointments were arranged with Dr. [**Last Name (STitle) 48006**] and Dr. [**Last Name (STitle) **]. Medications on Admission: Medications on transfer: ASA 81 mg daily Lipitor 80 mg daily Colchicine 0.6 mg daily Lasix 40 mg IV Q12H Protonix 40 mg IV daily Seroquel 100 mg HS and 50 mg TID Lamotrigine 100 mg HS Citalopram 20 mg daily Nitrofurantoin 50 mg QID planned thru [**1-19**] D51/2NS at 75 cc/hr . Medications at home: Nexium 40 mg daily Senna 2 tabs daily MVI daily ASA 81 mg daily Seroquel 50 mg TID and 100 mg HS Metoprolol tartrate 12.5 mg [**Hospital1 **] Lisinopril 5 mg daily Lipitor 80 mg daily Citalopram 20 mg [**Hospital1 **] (12pm and 4pm) Lamictal 100 mg [**Hospital1 **] Lasix 80 mg QAM, 40 mg QPM Clonazepam 2 mg [**Hospital1 **] KCL unknown dose [**Hospital1 **] Colchicine 0.6 mg daily Discharge Medications: 1. Quetiapine 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO QHS (once a day (at bedtime)). 2. Famotidine 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO QHS (once a day (at bedtime)). Disp:*30 Tablet(s)* Refills:*0* 3. Lisinopril 5 mg Tablet [**Hospital1 **]: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*0* 4. Atorvastatin 40 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily). 5. Multivitamin Tablet [**Hospital1 **]: One (1) Tablet PO once a day. 6. Aspirin 81 mg Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable PO DAILY (Daily). 7. Lamotrigine 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 8. Senna 8.6 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily) as needed for Constipation. 9. Lorazepam 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q4H (every 4 hours) as needed for anxiety. Disp:*30 Tablet(s)* Refills:*1* 10. Warfarin 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Once Daily at 4 PM. 11. Colchicine 0.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day. 12. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization [**Hospital1 **]: One (1) neb Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 13. Acetylcysteine 20 % (200 mg/mL) Solution [**Hospital1 **]: One (1) ML Miscellaneous Q6H (every 6 hours) as needed for secretions. 14. Citalopram 20 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily). 15. Quetiapine 25 mg Tablet [**Hospital1 **]: Two (2) Tablet PO TID (3 times a day). 16. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) neb Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 17. Tube Feeds Isosource 1.5 Cal Full strength; Starting rate:70 ml/hr Cycle start:1800 Cycle end:600 Residual Check:q4h Hold feeding for residual >= :200 ml Flush w/ 100 ml water q4h 18. Enteral Pump Please provide 1 enteral pump. 19. IV Pole Please provide IV Pole. 20. Feeding Tube Bags Please provide 30 feeding tube bags. Refill: 11 21. G tube supplies Please provide feeding tube supplies. Quantity sufficient. 22. Colchicine 0.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily) as needed for gout. 23. Hospital bed Semi-electric hospital bed. Diagnosis - Acute respiratory failure, gastric tube with risk for aspiration. Length of duration - lifetime. 24. Suction machine Suction machine with supplies. Diagnosis - tracheostomy. Length of need - lifetime. 14 french suction catheters. 25. Humidified O2 compressor Humidified O2 compresor. Cool mist to trach. Duration - lifetime. Diagnosis - trach. 26. Trach Portex Per-fit #7. Duration - lifetime. Diagnosis - respiratory failure s/p trach. 27. Lasix 20 mg Tablet [**Hospital1 **]: Three (3) Tablet PO once a day. Disp:*90 Tablet(s)* Refills:*2* 29. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR PO BID (2 times a day). Disp:*60 Tablet,Rapid Dissolve, DR(s)* Refills:*2* 30. Oxycodone 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 31. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: One (1) PO BID (2 times a day). Disp:*1 bottle* Refills:*2* 32. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: VNA Carenetwork Discharge Diagnosis: Primary: - Respiratory failure - Acute systolic heart failure - Enterobacter UTI - Subglottic edema c/b dysphagia Secondary: - Atrial fibrillation - Recurrent mutlifactorial respiratory failure c/b PEA arrest x 2 - Tracheostomy-reversed on [**3-25**] c/b tracheocuteous fistula. - Tracheocutaneous fistula repair [**8-28**] - Post-tracheostomy tracheal stenosis - Severe cervical tracheomalacia. - Mixed restrictive/obstructive airway disease - CKD stage II/III - CAD s/p CABG in [**2118**] - Anemia of chronic inflammation - Gout - Hypertension - Bipolar disorder - GERD - h/o HIT - MRSA/VRE - Left THR 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: You were admitted to [**Hospital3 **] Medical Center for respiratory failure. You had a tracheostomy placed to try to bypass the area of your airway that has become narrow--likely due to repeated intubations--to try to prevent this situation from occurring again. You also had fluid taken off with IV Lasix (furosemide). You were also found to have a urinary tract infection. . We have scheduled you an appointment to follow up with Dr. [**Last Name (STitle) **]. You will need to follow up with your PCP on Dr. [**Last Name (STitle) 48006**] on [**2140-2-5**] at 10:30 am. . The following changes were made to your medication regimen. 1)Lasix was changed to 60mg daily. 2)Celexa changed to 40mg daily 3)We added lansoprazole 40mg twice a day and famotidine 20mg daily to prevent the acid from irritating your airway. We stopped your nexium. 4)We also started you on coumadin to thin your blood. Goal INR [**2-24**]. . If you develop any of the following, chest pain, shortness of breath, cough, fever, chills, nausea, vomiting, diarrhea, abdominal pain, headache, or lightheadness, please contact your primary care physician or go to your local emergency room. Followup Instructions: You will need to follow up with Interventional Pulmonology. Provider: [**Name10 (NameIs) 12554**] CLINIC INTERVENTIONAL PULMONARY (SB) Phone:[**Telephone/Fax (1) 3020**] Date/Time:[**2140-2-16**] 10:30 Provider: [**Name10 (NameIs) **] INTAKE,ONE [**Name10 (NameIs) **] ROOMS/BAYS Date/Time:[**2140-2-16**] 11:00 Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 5072**] Date/Time:[**2140-2-16**] 11:30 . You will need to follow up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 48006**] on [**2140-2-5**] at 10:30 am. Fax PCP: [**Telephone/Fax (1) 105300**]. He will need to help coordinated your cardiology follow up as well as EP follow up for your new ICD.

518,428,584,599,996,276,274,496,519,327,401,530,427,300,296,285,707,041,787,272,786,564,V450,V120,V158,V458,E878

{'Acute respiratory failure,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Hyperosmolality and/or hypernatremia,Acute gouty arthropathy,Chronic airway obstruction, not elsewhere classified,Other diseases of trachea and bronchus,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Esophageal reflux,Atrial fibrillation,Dysthymic disorder,Bipolar disorder, unspecified,Anemia, unspecified,Pressure ulcer, stage II,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Dysphagia, oropharyngeal phase,Other and unspecified hyperlipidemia,Chest pain, unspecified,Other constipation,Automatic implantable cardiac defibrillator in situ,Personal history of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Surgical operation with implant of artificial internal device 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: respiratory failure s/p intubation PRESENT ILLNESS: 68F with COPD, CAD, systolic CHF, and tracheal stensosis s/p complicated respiratory failure history, transferred from OSH with recurrent respiratory failure for consideration of tracheostomy. She presented with acute respiratory distress to OSH one day PTA and was subsequently intubated for hypercarbic/hypoxic respiratory failure. . She was recently admitted to [**Hospital 105299**] hospital on [**2139-11-20**] after acute respiratory distress and short PEA arrest at home. Led to intubation. Per notes treated for CHF and pneumonia. She failed at least one extubation trial, and had subsequent transfer, while intubated, to [**Hospital1 18**] from [**Date range (1) 78750**] on the thoracics/IP service. She was extubated on the day of transfer. Bronch noted to have stable tracheal stenosis. Did well on nightly bipap and pulmonary toilet with O2 sats 90-92% on 4L during day. Discharged to [**Hospital **] rehab on [**12-15**]. Following this rehab admission she was sent to a different OSH on [**2139-12-21**], for acute CHF and at least one PEA arrest. Had AICD placement and reports ?cardiac cath. Intubated at least twice during that admission. Respiratory distress frequently accompanied by elevated blood pressures. Troponin during that admission elevated to 0.4 with one episode of resp distress. Also noted that anxiety seems to be a trigger, and was given scheduled 1 mg Ativan prior to Bipap removal. Following this admission she went to a rehab facility again. Discharged from rehab to home on [**1-11**]. That evening (yesterday) she became cyanotic at home reportedly after having a milkshake and Ativan. EMS brought patient to [**Hospital3 13313**] on bipap and she was eventually intubated in the ED, uncomplicated. On arrival to ED, tachypneic to 30s with bipap at 20/4, sats in low 90s on FiO2 1. HR 80, BP 170/62 initially. Prior to intubation given flumazenil and narcan. Lasix and bumex as well as IV ativan and versed at OSH. ABG at some point 7.15/76/84. CXR per notes with cardiomegaly, volume excess, new pacer. Patient reports also having an echo today but no report available. . On the floor, patient denies current respiratory difficulties. C/o pain in the throat and at her pacer site. Denies any chest pain, N/V, diaphoresis prior to onset of her recurrent dyspnea. Does endorse anxiety prior to symptoms onset. MEDICAL HISTORY: -Coronary artery disease s/p CABG in [**2118**] and "recent" PCI -CHF, last TTE [**2138-9-12**] EF 60% with mild LVH and some focal hypokinesis at base. -OSA -Dyslipidemia -HTN -Left total hip replacement-[**1-28**], elective. Complicated postoperative course with post-operative atrial fibrillation wtih RVR requiring cardioversion, sepsis, Pseudomonas VAP, VRE UT, and prolonged intubation leading to trach/PEG. Discharged to chronic wean facility but unable to decannulate. Bronchoscopy revealed tracheomalacia of subglottic region. -Supraglottic edema from GERD -Bipolar disorder -Depression -chronic atrial fibrillation, developed postop from THR, not anticoagulated -Chronic constipation -HIT during Fragmin therapy MEDICATION ON ADMISSION: Medications on transfer: ASA 81 mg daily Lipitor 80 mg daily Colchicine 0.6 mg daily Lasix 40 mg IV Q12H Protonix 40 mg IV daily Seroquel 100 mg HS and 50 mg TID Lamotrigine 100 mg HS Citalopram 20 mg daily Nitrofurantoin 50 mg QID planned thru [**1-19**] D51/2NS at 75 cc/hr . Medications at home: Nexium 40 mg daily Senna 2 tabs daily MVI daily ASA 81 mg daily Seroquel 50 mg TID and 100 mg HS Metoprolol tartrate 12.5 mg [**Hospital1 **] Lisinopril 5 mg daily Lipitor 80 mg daily Citalopram 20 mg [**Hospital1 **] (12pm and 4pm) Lamictal 100 mg [**Hospital1 **] Lasix 80 mg QAM, 40 mg QPM Clonazepam 2 mg [**Hospital1 **] KCL unknown dose [**Hospital1 **] Colchicine 0.6 mg daily ALLERGIES: Heparin Agents / Percocet / Lisinopril PHYSICAL EXAM: On admission: General: Alert, intubated but comfortable appearing, no acute distress. follows all commands and communicates by writing as well. HEENT: Sclera anicteric, MMM though c/o thirst, oropharynx clear, ETT and OGT in place. Neck: supple, JVD elevated though difficult to appreciate how high with body habitus and tubes, no LAD Lungs: Bilaterally rhonchorous, no appreciated rales. CV: Regular rate and rhythm, normal S1 + S2, [**2-27**] SM at LUSB. Pacer pocket site in L chest quite ecchymotic with swelling, ecchymoses tracing down toward axilla. Moderately tender to palpation. No erythema. No appreciated fluctuance. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or appreciable edema. Neuro: Follows complex commands. 5/5 strength in distal UEs/LEs. . On discharge: FAMILY HISTORY: Depression SOCIAL HISTORY: Married. Very supportive husband. When she is not hospitalized/in rehab, she lives with him. No ETOH or current smoking. Has 35 pack year smoking history, quit 13 years ago. ### Response: {'Acute respiratory failure,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other complications due to other cardiac device, implant, and graft,Hyperosmolality and/or hypernatremia,Acute gouty arthropathy,Chronic airway obstruction, not elsewhere classified,Other diseases of trachea and bronchus,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Esophageal reflux,Atrial fibrillation,Dysthymic disorder,Bipolar disorder, unspecified,Anemia, unspecified,Pressure ulcer, stage II,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Dysphagia, oropharyngeal phase,Other and unspecified hyperlipidemia,Chest pain, unspecified,Other constipation,Automatic implantable cardiac defibrillator in situ,Personal history of Methicillin resistant Staphylococcus aureus,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}

CHIEF COMPLAINT: brain mass PRESENT ILLNESS: This is a 69yo woman with history of metastatic small cell carcinoma of the lung, diagnosed in [**5-/2119**] and non-operable abdominal mets s/p palliative chemo and radiation. She went to [**State 1727**] for the weekend on [**2120-10-14**], but by [**2120-10-16**], she was feeling hot and vomiting and had unsteady gait; her husband had difficulty waking her up; her temperature was 102. She was admitted to [**Hospital **] Hospital in [**State 1727**] for febrile neutropenia and changes in mental status; she was treated with cefepime. MRI of the head on [**2120-10-16**], showed a 2.8 x 2.8 x 3.1 cm solitary mass in the right frontal lobe with rim enhancement and with an irregular wall and with apparent cystic or necrotic center; there was mild-to-moderate edema and mild mass effect on the right frontal [**Doctor Last Name 534**]; there was regional overlying dural enhancement; there were no other lesions in the brain. MEDICAL HISTORY: Oncologic past medical history: - small cell carcinoma of lung primary s/p chemo and radiation - Large R abdominal mass causing T12-L3 neurologic symptoms currently on palliative chemotherapy with taxol and recent initiation of radiation to the abdominal mass. - HTN - Anxiety - COPD - GERD MEDICATION ON ADMISSION: cipro, compazine, decadron, dilaudid, lisinopril, ativan, neurontin, omeprazole, oxycontin, zofran, spiriva ALLERGIES: Aspirin PHYSICAL EXAM: upon discharge: alert and oriented x 3, grossly full motor in all 4, incision well healing FAMILY HISTORY: No known fhx of lung cancer SOCIAL HISTORY: Married, lives with husband, retired from State Department processing tax forms. Continues to smoke [**1-15**] pack per day. No etoh or illicits.

Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Secondary malignant neoplasm of retroperitoneum and peritoneum,Urinary tract infection, site not specified,Unspecified essential hypertension,Anxiety state, unspecified,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Tobacco use disorder,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health

Sec mal neo brain/spine,Cerebral edema,Mal neo bronch/lung NOS,Sec mal neo peritoneum,Urin tract infection NOS,Hypertension NOS,Anxiety state NOS,Chr airway obstruct NEC,Esophageal reflux,Tobacco use disorder,Hx antineoplastic chemo,Hx of irradiation

Name: [**Known lastname 16961**],[**Known firstname 1163**] Unit No: [**Numeric Identifier 16962**] Admission Date: [**2120-11-1**] Discharge Date: [**2120-11-6**] Date of Birth: [**2051-4-24**] Sex: F Service: NEUROSURGERY Allergies: Aspirin Attending:[**First Name3 (LF) 599**] Addendum: Added Rx for Decadron taper Discharge Medications: 1. Docusate Sodium 100 mg PO BID 2. Gabapentin 600 mg PO TID 3. Lisinopril 5 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Tiotropium Bromide 1 CAP IH DAILY 6. Dexamethasone 2 mg po q12 hrs Duration: 60 Days RX *dexamethasone 2 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 7. Senna 1 TAB PO DAILY 8. LeVETiracetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 9. Lorazepam 0.5 mg PO HS 10. Ondansetron 8 mg PO Q8H:PRN n/v 11. Acetaminophen 325-650 mg PO Q6H:PRN pain, T>38.5 12. HYDROmorphone (Dilaudid) 1-2 mg PO Q3-4H pain RX *hydromorphone 2 mg 1 tablet(s) by mouth q3-4hr Disp #*60 Tablet Refills:*0 13. Oxycodone SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone [OxyContin] 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 14. Prochlorperazine 10 mg PO Q6H:PRN nausea, vomiting 15. Ciprofloxacin HCl 500 mg PO Q24H Duration: 5 Days RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth 5d Disp #*5 Tablet Refills:*0 16. Bisacodyl 10 mg PO/PR DAILY 17. Clotrimazole 1 TROC PO 5X/DAY 18. Dexamethasone 3 mg PO Q8HRS Duration: 4 Doses This is your current dose. After 4 doses please taper to 2mg every 8hrs. Tapered dose - DOWN RX *dexamethasone 1 mg 3 tablet(s) by mouth every eight (8) hours Disp #*24 Tablet Refills:*0 19. Dexamethasone 2 mg PO Q8HRS Duration: 6 Doses Begin after completing the 3mg Q8hrs taper. Tapered dose - DOWN Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) 102**] [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**] Completed by:[**2120-11-6**] Admission Date: [**2120-11-1**] Discharge Date: [**2120-11-6**] Date of Birth: [**2051-4-24**] Sex: F Service: NEUROSURGERY Allergies: Aspirin Attending:[**First Name3 (LF) 1835**] Chief Complaint: brain mass Major Surgical or Invasive Procedure: [**2120-11-1**]: Right Craniotomy and resection of mass History of Present Illness: This is a 69yo woman with history of metastatic small cell carcinoma of the lung, diagnosed in [**5-/2119**] and non-operable abdominal mets s/p palliative chemo and radiation. She went to [**State 1727**] for the weekend on [**2120-10-14**], but by [**2120-10-16**], she was feeling hot and vomiting and had unsteady gait; her husband had difficulty waking her up; her temperature was 102. She was admitted to [**Hospital **] Hospital in [**State 1727**] for febrile neutropenia and changes in mental status; she was treated with cefepime. MRI of the head on [**2120-10-16**], showed a 2.8 x 2.8 x 3.1 cm solitary mass in the right frontal lobe with rim enhancement and with an irregular wall and with apparent cystic or necrotic center; there was mild-to-moderate edema and mild mass effect on the right frontal [**Doctor Last Name 534**]; there was regional overlying dural enhancement; there were no other lesions in the brain. The patient was referred to Neurosurgery and the risks and benefits of undergoing surgical resection were discussed with the patient. She has decided to proceed with resection and now electively presents. Past Medical History: Oncologic past medical history: - small cell carcinoma of lung primary s/p chemo and radiation - Large R abdominal mass causing T12-L3 neurologic symptoms currently on palliative chemotherapy with taxol and recent initiation of radiation to the abdominal mass. - HTN - Anxiety - COPD - GERD Social History: Married, lives with husband, retired from State Department processing tax forms. Continues to smoke [**1-15**] pack per day. No etoh or illicits. Family History: No known fhx of lung cancer Physical Exam: upon discharge: alert and oriented x 3, grossly full motor in all 4, incision well healing Pertinent Results: [**11-1**] MRI Brain: IMPRESSION: Right frontal lobe lesion is stable to slightly increased in size since [**2120-10-16**]. [**11-1**] NCHCT: IMPRESSION: Status post resection of a right frontal lobe mass with expected postsurgical changes. No large intracranial hematoma. No evidence of an acute major vascular territorial infarction. [**11-2**] Brain MRI: Postoperative study with presence of blood products in the operative cavity which limits evaluation for residual neoplasm, although no definite neoplasm is identified at this time. Recommend followup imaging after resolution of acute postoperative changes. [**11-2**] CXR: Overall, cardiac and mediastinal contours are likely stable given the patient rotation on the current examination. The lungs appear well inflated without evidence of focal airspace consolidation to suggest pneumonia or aspiration. There is a small layering right effusion. The pulmonary vasculature is slightly less well defined and likely reflects interval development of mild interstitial edema. No pneumothorax. [**11-3**] CXR: FINDINGS: Right PICC terminates in the lower superior vena cava. Small to moderate, apparently partially loculated right pleural effusion has slightly increased in size from the prior radiograph. Otherwise, no relevant changes since the recent study. Brief Hospital Course: Pt electively presented and underwent a craniotomy and resection of mass. Surgery was without complication. She was extubated and transferred to the ICU. Post op Head CT revealed post operative changes without hemorrhage or evidence of stroke. She was confused but followed commands and MAE's. She remained stable overnight and on [**11-2**]. Routine post op MRI revealed good resection. She was started on SQH for DVT prophylaxsis. On [**11-3**] she continued to be confused but was stable so she was cleared for transfer to the floor. A slow decadron wean was initiated. She lost peripheral IV access, and due to her need for constant IV access (inpt and outpt) a PICC line was placed. In the evening her telemetry was showing a sustained HR in the 150's. She was given 5mg of Lopressor. Her HR came down to 130's but SBP was in the 90's so she wasn't given another dose. EKG revealed SVT, Labs were stable. She was given an IVF bolus and her HR returned to the 80's with a SBP in the 120's. She remained neurologically stable throughout this episode. On [**11-4**] speech and swallow were consulted for a safety evaluation. PT and OT were consulted for assistance with discharge planning who found her appropriate for discharge to home with services. Medications on Admission: cipro, compazine, decadron, dilaudid, lisinopril, ativan, neurontin, omeprazole, oxycontin, zofran, spiriva Discharge Medications: 1. Docusate Sodium 100 mg PO BID 2. Gabapentin 600 mg PO TID 3. Lisinopril 5 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Tiotropium Bromide 1 CAP IH DAILY 6. Dexamethasone 2 mg po q12 hrs Duration: 60 Days RX *dexamethasone 2 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 7. Senna 1 TAB PO DAILY 8. LeVETiracetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 9. Lorazepam 0.5 mg PO HS 10. Ondansetron 8 mg PO Q8H:PRN n/v 11. Acetaminophen 325-650 mg PO Q6H:PRN pain, T>38.5 12. HYDROmorphone (Dilaudid) 1-2 mg PO Q3-4H pain RX *hydromorphone 2 mg 1 tablet(s) by mouth q3-4hr Disp #*60 Tablet Refills:*0 13. Oxycodone SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone [OxyContin] 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 14. Prochlorperazine 10 mg PO Q6H:PRN nausea, vomiting 15. Ciprofloxacin HCl 500 mg PO Q24H Duration: 5 Days RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth 5d Disp #*5 Tablet Refills:*0 16. Bisacodyl 10 mg PO/PR DAILY 17. Clotrimazole 1 TROC PO 5X/DAY Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: Right frontal mass Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Craniotomy for Tumor Excision ?????? 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. ?????? Your wound was closed with staples so you must wait until after they are removed to wash your hair. 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) & Senna 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. ?????? You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? You are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (Prilosec, Protonix, or Pepcid), as these medications can cause stomach irritation. Make sure to take your steroid medication with meals, or a glass of milk. ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. ?????? Make sure to continue to use your incentive spirometer while at home. Followup Instructions: ?????? You have an appointment in the Brain [**Hospital 341**] Clinic on [**2120-11-25**] at 1pm. The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number is [**Telephone/Fax (1) 1844**]. Please call if you need to change your appointment, or require additional directions Completed by:[**2120-11-6**]

198,348,162,197,599,401,300,496,530,305,V874,V153

{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Secondary malignant neoplasm of retroperitoneum and peritoneum,Urinary tract infection, site not specified,Unspecified essential hypertension,Anxiety state, unspecified,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Tobacco use disorder,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}

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: brain mass PRESENT ILLNESS: This is a 69yo woman with history of metastatic small cell carcinoma of the lung, diagnosed in [**5-/2119**] and non-operable abdominal mets s/p palliative chemo and radiation. She went to [**State 1727**] for the weekend on [**2120-10-14**], but by [**2120-10-16**], she was feeling hot and vomiting and had unsteady gait; her husband had difficulty waking her up; her temperature was 102. She was admitted to [**Hospital **] Hospital in [**State 1727**] for febrile neutropenia and changes in mental status; she was treated with cefepime. MRI of the head on [**2120-10-16**], showed a 2.8 x 2.8 x 3.1 cm solitary mass in the right frontal lobe with rim enhancement and with an irregular wall and with apparent cystic or necrotic center; there was mild-to-moderate edema and mild mass effect on the right frontal [**Doctor Last Name 534**]; there was regional overlying dural enhancement; there were no other lesions in the brain. MEDICAL HISTORY: Oncologic past medical history: - small cell carcinoma of lung primary s/p chemo and radiation - Large R abdominal mass causing T12-L3 neurologic symptoms currently on palliative chemotherapy with taxol and recent initiation of radiation to the abdominal mass. - HTN - Anxiety - COPD - GERD MEDICATION ON ADMISSION: cipro, compazine, decadron, dilaudid, lisinopril, ativan, neurontin, omeprazole, oxycontin, zofran, spiriva ALLERGIES: Aspirin PHYSICAL EXAM: upon discharge: alert and oriented x 3, grossly full motor in all 4, incision well healing FAMILY HISTORY: No known fhx of lung cancer SOCIAL HISTORY: Married, lives with husband, retired from State Department processing tax forms. Continues to smoke [**1-15**] pack per day. No etoh or illicits. ### Response: {'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Secondary malignant neoplasm of retroperitoneum and peritoneum,Urinary tract infection, site not specified,Unspecified essential hypertension,Anxiety state, unspecified,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Tobacco use disorder,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}

CHIEF COMPLAINT: PRESENT ILLNESS: This patient is a 54-year-old male with metastatic renal cell carcinoma, admitted today to begin cycle 2 week 2 high-dose IL-2 therapy. His oncologic history began in [**2112-1-14**]. He presented with microscopic hematuria with workup revealing a right renal mass. He underwent right radical nephrectomy on [**2112-4-18**] revealing an 11.5 cm renal cell carcinoma, firm and grade 2. He had a recurrence on the skin of his left face in [**2112-12-16**], which on excisional biopsy showed clear cell neoplasm most consistent with metastatic renal cell carcinoma. MEDICAL HISTORY: Metastatic kidney cancer as above, hypertension, anxiety, depression, hypothyroidism after IL-2. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Married, lives with his wife, two children and son-in-law, works for an electronics company. Denies tobacco, alcohol and drug use. Speaks primarily Portuguese.

Encounter for antineoplastic immunotherapy,Acute kidney failure, unspecified,Shock, unspecified,Acidosis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of adrenal gland,Other iatrogenic hypotension,Unspecified essential hypertension,Dysthymic disorder,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of kidney

Immunotherapy encounter,Acute kidney failure NOS,Shock NOS,Acidosis,Second malig neo liver,Second malig neo adrenal,Iatrogenc hypotnsion NEC,Hypertension NOS,Dysthymic disorder,Hypothyroidism NOS,Hx of kidney malignancy

Unit No: [**Numeric Identifier 89886**] Admission Date: [**2116-6-22**] Discharge Date: [**2116-6-26**] Date of Birth: [**2061-12-15**] Sex: M Service: OME HISTORY OF PRESENT ILLNESS: This patient is a 54-year-old male with metastatic renal cell carcinoma, admitted today to begin cycle 2 week 2 high-dose IL-2 therapy. His oncologic history began in [**2112-1-14**]. He presented with microscopic hematuria with workup revealing a right renal mass. He underwent right radical nephrectomy on [**2112-4-18**] revealing an 11.5 cm renal cell carcinoma, firm and grade 2. He had a recurrence on the skin of his left face in [**2112-12-16**], which on excisional biopsy showed clear cell neoplasm most consistent with metastatic renal cell carcinoma. He underwent re-excision to obtain clean margins. He was followed with surveillance imaging and on CT on [**2116-1-14**], torso revealed liver lesions consistent with metastatic disease. He was referred here for discussion of high-dose IL- 2 therapy. He passed eligibility testing and began cycle 1 week 1 high-dose IL-2 on [**2116-3-9**] receiving 13 of 14 doses week 1 and 10 of 14 doses week 2. Follow-up CTs revealed disease regression in the hepatic and right adrenal mets, and he was admitted for cycle 2 week 1 of therapy on [**2116-6-8**]. During the week he received 11 of 14 doses with course complicated by toxic encephalopathy requiring an additional day of hospitalization. He has now recovered and is ready for week 2 of therapy. PAST MEDICAL HISTORY: Metastatic kidney cancer as above, hypertension, anxiety, depression, hypothyroidism after IL-2. ALLERGIES: No known drug allergies. SOCIAL HISTORY: Married, lives with his wife, two children and son-in-law, works for an electronics company. Denies tobacco, alcohol and drug use. Speaks primarily Portuguese. MEDICATIONS: Lisinopril 10 mg p.o. daily on hold, mirtazapine 50 mg p.o. daily, multivitamin 1 tablet daily, Colace 100 mg daily, levothyroxine 75 mcg p.o. daily. FAMILY HISTORY: Noncontributory. PHYSICAL EXAMINATION: Well-appearing male in no acute distress. Performance status 1. VITAL SIGNS: 97.2, 67, 16, 136/98. HEENT: Normocephalic, atraumatic. Sclerae anicteric. Moist oral mucosa without lesions. NECK: Supple. Lymph nodes in cervical, supraclavicular or bilateral axillary lymphadenopathy. HEART: Regular rate and rhythm, S1, S2. CHEST: Clear bilaterally. ABDOMEN: Soft, nontender. EXTREMITIES: No edema. SKIN: Intact. NEURO EXAM: Nonfocal. ADMISSION LABS: WBC 16.1, hemoglobin 12.3, hematocrit 35.5, platelet count 318,000, INR 1.2, BUN 16, creatinine 1.4, sodium 135, potassium 4.1, chloride 99, CO2 28, glucose 82, ALT 9, AST 19, CK 28, total bili 0.5, albumin 4.3, calcium 9.3, phosphorus 2.8, magnesium 2.2. HOSPITAL COURSE: This patient was admitted and went through interventional radiology for central line placement prior to therapy. His admission weight was 74 kg and he received interleukin-2 600,000 international units per kilo equalling 44.6 million units IV q. 8 hours x 14 potential doses. During this week he received 5 of 14 doses with therapy stopped early due to development of shock attributed to capillary leak syndrome from IL-2 therapy. He was initially hypotensive on treatment day #2 without response to fluid boluses and was subsequently placed on dopamine 6 mcg per kilogram per minute with Neo-Synephrine added secondary to persistent hypotension. He went to maximum dose dopamine and Neo-Synephrine, and was eventually weaned off Neo-synephrine followed by dopamine of the following day. He was placed on continuous blood pressure bedside and central telemetry monitoring. No cardiac arrhythmias were noted. IL-2 therapy was held until he was weaned from pressors and he was given his fifth dose of interleukin-2 on Wednesday at 4:00 p.m. He subsequently developed significant hypotension unresponsive to maximum dose Neo-Synephrine and dopamine, requiring the addition of Levophed, and was transferred to the ICU for further hemodynamic monitoring. Once in the ICU he was stabilized. Source of shock was felt to be hypovolemia related to capillary leak from IL-2 therapy. He returned to 11 Riceman on [**2116-6-25**] and further IL-2 was discontinued given the severity of side effects noted. Other side effects during this week included nausea and vomiting improved with antiemetic therapy; rigors improved with Demerol and significant fatigue. During this week he developed acute renal failure with a peak creatinine of 3.5 with associated oliguria and metabolic acidosis improved with bicarbonate replacement intravenously. Electrolytes were monitored and repleted per protocol. Strict urine output, serial creatinine bicarbonate levels were monitored. IV fluids were maintained given acute renal failure in the setting of hypotension. During this week he had no transaminitis, hyperbilirubinemia, myocarditis, coagulopathy or thrombocytopenia noted. He was anemic without need for packed red blood cell transfusion. By [**2116-6-26**] he had recovered from side effects to allow for discharge to home. CONDITION ON DISCHARGE: Alert, oriented, ambulatory. DISCHARGE STATUS: To home with his daughter. DISCHARGE DIAGNOSES: Metastatic renal cell carcinoma status post cycle 2 week 2 high-dose IL-2 therapy complicated by shock and acute renal failure. DISCHARGE MEDICATIONS: Sarna lotion topically q.i.d. p.r.n. pruritus, cephalexin 500 mg b.i.d. times 5 days, diphenhydramine 25 to 50 mg q.i.d. p.r.n. pruritus, Lomotil 2 to 2 tabs q.i.d. p.r.n. loose stools, Lasix 20 mg p.o. daily times 5 days, levothyroxine 75 mcg p.o. daily, lorazepam 0.5 to 1 mg t.i.d. p.r.n. nausea, vomiting, mirtazapine 15 mg at bedtime, Compazine 10 mg p.o. q.i.d. p.r.n. nausea/vomiting, ranitidine 150 mg b.i.d. p.r.n. indigestion, Eucerin cream topically. The patient will restart lisinopril 10 mg p.o. daily. FOLLOW-UP PLANS: This patient will return to clinic in 4 weeks after CT scans to assess disease response. I have reviewed the dictation summary as dictated by [**First Name8 (NamePattern2) 622**] [**Last Name (NamePattern1) 17265**]. I agree with the hospital course and disposition as noted. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 66804**] Dictated By:[**Last Name (NamePattern1) 18853**] MEDQUIST36 D: [**2116-6-26**] 16:49:14 T: [**2116-6-27**] 10:18:39 Job#: [**Job Number 89887**] cc:[**Numeric Identifier 89888**]

V581,584,785,276,197,198,458,401,300,244,V105

{'Encounter for antineoplastic immunotherapy,Acute kidney failure, unspecified,Shock, unspecified,Acidosis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of adrenal gland,Other iatrogenic hypotension,Unspecified essential hypertension,Dysthymic disorder,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of kidney'}

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 patient is a 54-year-old male with metastatic renal cell carcinoma, admitted today to begin cycle 2 week 2 high-dose IL-2 therapy. His oncologic history began in [**2112-1-14**]. He presented with microscopic hematuria with workup revealing a right renal mass. He underwent right radical nephrectomy on [**2112-4-18**] revealing an 11.5 cm renal cell carcinoma, firm and grade 2. He had a recurrence on the skin of his left face in [**2112-12-16**], which on excisional biopsy showed clear cell neoplasm most consistent with metastatic renal cell carcinoma. MEDICAL HISTORY: Metastatic kidney cancer as above, hypertension, anxiety, depression, hypothyroidism after IL-2. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Married, lives with his wife, two children and son-in-law, works for an electronics company. Denies tobacco, alcohol and drug use. Speaks primarily Portuguese. ### Response: {'Encounter for antineoplastic immunotherapy,Acute kidney failure, unspecified,Shock, unspecified,Acidosis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of adrenal gland,Other iatrogenic hypotension,Unspecified essential hypertension,Dysthymic disorder,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of kidney'}

CHIEF COMPLAINT: Presents for surgical manangement of distal esophageal neoplasm s/p course of neoadjuvant therapy. PRESENT ILLNESS: The patient is a delightful 65 yo gentleman with stage T2N1 adenocarcinoma of the distal esophagus who underwent preoperative staging, including staging laparoscopy with placement of a jejunostomy tube and neoadjuvant chemoradiotherapy. He has had an excellent response and is now being taken forward for a minimally invasive esophagogastrectomy. He first noted dysphagia in [**2186-6-18**], and the neoplasm was identified and staged by [**2186-8-18**] by EDG and US as being responsible for his symptoms of partial GE obstruction. Has since undergone neoadjuvant therapy and placement of a J-tube for weight-[**Last Name (un) 940**]. MEDICAL HISTORY: 1. Esophageal cancer 2. HTN 3. Lower GI bleed ([**2180**]) 4. Pilonidal cyst (distant past) MEDICATION ON ADMISSION: ANZEMET 100MG--COMPAZINE 10MG (during chemo) HYDROCHLOROTHIAZIDE 12.5 mg LIPITOR 10 mg LISINOPRIL 40 mg PROTONIX 40 mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Supportive SOCIAL HISTORY: Social history: alcohol: social drinker. Tobacco: two packs per day for 30 years, discontinued 10 years ago. Semiretired, dental lab.

Malignant neoplasm of lower third of esophagus,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Pure hypercholesterolemia,Unspecified essential hypertension,Status of other artificial opening of gastrointestinal tract

Mal neo lower 3rd esoph,Mal neo lymph intra-abd,Pure hypercholesterolem,Hypertension NOS,Enterostomy status NEC

Admission Date: [**2187-2-6**] Discharge Date: [**2187-2-13**] Date of Birth: [**2120-5-27**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1481**] Chief Complaint: Presents for surgical manangement of distal esophageal neoplasm s/p course of neoadjuvant therapy. Major Surgical or Invasive Procedure: Minimally invasive combined thoracoscopic and laparoscopic total esophagogastrectomy with cervical gastric anastomosis. History of Present Illness: The patient is a delightful 65 yo gentleman with stage T2N1 adenocarcinoma of the distal esophagus who underwent preoperative staging, including staging laparoscopy with placement of a jejunostomy tube and neoadjuvant chemoradiotherapy. He has had an excellent response and is now being taken forward for a minimally invasive esophagogastrectomy. He first noted dysphagia in [**2186-6-18**], and the neoplasm was identified and staged by [**2186-8-18**] by EDG and US as being responsible for his symptoms of partial GE obstruction. Has since undergone neoadjuvant therapy and placement of a J-tube for weight-[**Last Name (un) 940**]. Past Medical History: 1. Esophageal cancer 2. HTN 3. Lower GI bleed ([**2180**]) 4. Pilonidal cyst (distant past) Social History: Social history: alcohol: social drinker. Tobacco: two packs per day for 30 years, discontinued 10 years ago. Semiretired, dental lab. Family History: Supportive Pertinent Results: [**2187-2-6**] 09:14PM BLOOD WBC-10.7 RBC-3.48* Hgb-9.6* Hct-27.9* MCV-80* MCH-27.5 MCHC-34.3 RDW-14.2 Plt Ct-250 [**2187-2-9**] 12:31AM BLOOD WBC-8.8 RBC-3.40* Hgb-9.0* Hct-27.5* MCV-81* MCH-26.5* MCHC-32.8 RDW-13.8 Plt Ct-293 [**2187-2-6**] 04:45PM BLOOD Plt Ct-282 [**2187-2-6**] 09:14PM BLOOD PT-13.1 PTT-22.0 INR(PT)-1.1 [**2187-2-9**] 12:31AM BLOOD Plt Ct-293 [**2187-2-6**] 09:14PM BLOOD Glucose-159* UreaN-19 Creat-0.9 Na-141 K-4.1 Cl-108 HCO3-25 AnGap-12 [**2187-2-9**] 12:31AM BLOOD Glucose-117* UreaN-13 Creat-0.9 Na-138 K-3.7 Cl-101 HCO3-33* AnGap-8 [**2187-2-6**] 09:14PM BLOOD Albumin-3.4 Calcium-8.2* Phos-3.4 Mg-2.6 [**2187-2-9**] 12:31AM BLOOD Calcium-7.7* Phos-2.1* Mg-1.8 UGI ([**2-10**]): No evidence of anastomotic leak. Sluggish emptying of barium into the small bowel, which could be related to postop inflammation. Brief Hospital Course: Patient tolerated procedure well. Post operatively, he remained in SICU for 3 days till [**2-9**]. Pain was well controlled throughout hospitalization. Hospital course was uncomplicated. He had slight change in mental status and needed a 1:1 sitter and Ativan on [**2-8**]. On [**2-7**] Tube feeds were started at 1/2 strength. On [**2-9**] he was transferred to floor. On [**2-10**], the swallow study came back normal. On [**2-10**] NG and Left Chest Tube was removed. On [**2-10**] swallow study was found to be normal. He was started on sips and slowly advanced to clears. Tube feeds were advanced to 3/4 strength. On [**2-11**] Right Chst Tube was removed. On 3/38 foley and JP were removed. Patient was deemed suitable and stable for discharge on POD7. Medications on Admission: ANZEMET 100MG--COMPAZINE 10MG (during chemo) HYDROCHLOROTHIAZIDE 12.5 mg LIPITOR 10 mg LISINOPRIL 40 mg PROTONIX 40 mg Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs PO Q4-6H (every 4 to 6 hours) as needed. Disp:*150 ML(s)* Refills:*0* 2. Cyclobenzaprine HCl 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. Disp:*30 Tablet(s)* Refills:*0* 3. Docusate Sodium 100 mg Capsule Sig: [**11-19**] Capsules PO every [**2-21**] hours as needed for pain. Disp:*30 Capsule(s)* Refills:*2* 4. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) dose PO once a day. Disp:*60 doses* Refills:*2* 5. Lipitor 10 mg Tablet Sig: One (1) Tablet PO once a day. 6. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 7. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO once a day. Discharge Disposition: Home Discharge Diagnosis: Adenocarcinoma, stage T2N1 of the distal esophagus. Discharge Condition: Good, stable Discharge Instructions: Discharge to home with instructions to take medications as perscribed and follow-up with Dr. [**Last Name (STitle) **] as indicated. If you experience fever >101.5, unremitting abdominal, chest or throat pain; nausea/vomitting or any other symptoms concerning to you, please seek medication evaluation at a local ER. You may resume your regular diet with the soft-solid modification. however, do not engage in heaving lifting or stennous activity until you follow-up visit. You may shower, but do not bath, and always be careful to dry the incisions/wounds well. Keep a dry, sterile gauze dressing over the wounds, to be changed daily or as needed. There may continue to be minimal amounts of drainage from your chest tube sites as you resume your daily activities, but if this becomes copious, purulent or painful, seek medical evaluation. Crush pills. Followup Instructions: Please call Dr. [**Last Name (STitle) **] ( ) and Dr. [**Last Name (STitle) 952**] ( ) to schedule follow-up appointments . Follow up with PCP Completed by:[**2187-2-13**]

150,196,272,401,V444

{'Malignant neoplasm of lower third of esophagus,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Pure hypercholesterolemia,Unspecified essential hypertension,Status of other artificial opening of gastrointestinal tract'}

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: Presents for surgical manangement of distal esophageal neoplasm s/p course of neoadjuvant therapy. PRESENT ILLNESS: The patient is a delightful 65 yo gentleman with stage T2N1 adenocarcinoma of the distal esophagus who underwent preoperative staging, including staging laparoscopy with placement of a jejunostomy tube and neoadjuvant chemoradiotherapy. He has had an excellent response and is now being taken forward for a minimally invasive esophagogastrectomy. He first noted dysphagia in [**2186-6-18**], and the neoplasm was identified and staged by [**2186-8-18**] by EDG and US as being responsible for his symptoms of partial GE obstruction. Has since undergone neoadjuvant therapy and placement of a J-tube for weight-[**Last Name (un) 940**]. MEDICAL HISTORY: 1. Esophageal cancer 2. HTN 3. Lower GI bleed ([**2180**]) 4. Pilonidal cyst (distant past) MEDICATION ON ADMISSION: ANZEMET 100MG--COMPAZINE 10MG (during chemo) HYDROCHLOROTHIAZIDE 12.5 mg LIPITOR 10 mg LISINOPRIL 40 mg PROTONIX 40 mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Supportive SOCIAL HISTORY: Social history: alcohol: social drinker. Tobacco: two packs per day for 30 years, discontinued 10 years ago. Semiretired, dental lab. ### Response: {'Malignant neoplasm of lower third of esophagus,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Pure hypercholesterolemia,Unspecified essential hypertension,Status of other artificial opening of gastrointestinal tract'}

CHIEF COMPLAINT: chest tightness PRESENT ILLNESS: 69 year old female with diabetes and hypertension recently switched to a new PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17918**]. Upon seeing Dr. [**Last Name (STitle) 17918**], she reported chest tightness and dyspnea after walking for a few minutes. She also notices left arm/hand numbness, particularly if she has it raised or when working on the computer. She was referred for a stress test, which was abnormal. Over the last week she has noticed some dyspnea and slight chest tightness occurring at rest, which she feels is related [**Doctor First Name **] anxiety. She was referred for cardiac catheterization and was found to have three vessel disease. She is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: diabetes Type II hypertension hyperlipidemia remote back pain/sciatica seizure disorder; [**Doctor Last Name 11332**] mal: last seizure 5 yrs ago depression/anxiety gout diverticulosis Cerebrovascular disease s/p left cataract repair s/p right cataract repair s/p tonsillectomy MEDICATION ON ADMISSION: ALLOPURINOL 300 mg daily CLONAZEPAM 0.5 mg at bedtime GLYBURIDE 2.5 mg daily LEVETIRACETAM 500 mg twice a day LISINOPRIL 20 mg daily METFORMIN 1000 mg twice a day METOPROLOL TARTRATE 25 mg daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg daily ZONISAMIDE 600 mg q pm Crestor unsure of dose ASPIRIN 324 mg daily DIPHENHYDRAMINE-ACETAMINOPHEN 500 mg-25 mg - 2 Tablet at bedtime ALLERGIES: Codeine PHYSICAL EXAM: Pulse:56 Resp:16 O2 sat:99/RA B/P Right:103/58 Left:109/60 Height:5' Weight:172 lbs FAMILY HISTORY: noncontributory SOCIAL HISTORY: Lives with:Husband Occupation:Retired court receptionist from [**Hospital1 1474**] Court Cigarettes: Smoked no [] yes [x] Hx:quit smoking 30 years ago and smoked for 25 years Other Tobacco use:denies ETOH: denies Illicit drug use:denies

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,Generalized nonconvulsive epilepsy, without mention of intractable epilepsy,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),Personal history of tobacco use

Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Gen noncv ep w/o intr ep,Gout NOS,Dvrtclo colon w/o hmrhg,History of tobacco use

Name: [**Known lastname 2841**],[**Known firstname **] Unit No: [**Numeric Identifier 2842**] Admission Date: [**2173-9-2**] Discharge Date: [**2173-9-7**] Date of Birth: [**2103-10-5**] Sex: F Service: CARDIOTHORACIC Allergies: Codeine Attending:[**First Name3 (LF) 265**] Addendum: Pt. will resume preop Glyburide dose of 2.5 mg PO daily. Discharge Disposition: Home With Service Facility: [**Hospital1 328**] VNA [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**] Completed by:[**2173-9-7**] Name: [**Known lastname 2841**],[**Known firstname **] Unit No: [**Numeric Identifier 2842**] Admission Date: [**2173-9-2**] Discharge Date: [**2173-9-7**] Date of Birth: [**2103-10-5**] Sex: F Service: CARDIOTHORACIC Allergies: Codeine Attending:[**First Name3 (LF) 265**] Addendum: Wound check appt Thursday [**9-16**] at 10 AM [**Hospital Ward Name **] 2A Major Surgical or Invasive Procedure: [**2173-9-2**] Coronary artery bypass graft x4 (Left internal mammary artery > Left anterior descending proximal, Saphenous vein graft > Left anterior descending distal, Saphenous vein graft > obtuse marginal, Saphenous vein graft > posterior descending artery) Discharge Disposition: Home With Service Facility: [**Hospital1 328**] VNA [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**] Completed by:[**2173-9-7**] Admission Date: [**2173-9-2**] Discharge Date: [**2173-9-7**] Date of Birth: [**2103-10-5**] Sex: F Service: CARDIOTHORACIC Allergies: Codeine Attending:[**First Name3 (LF) 165**] Chief Complaint: chest tightness Major Surgical or Invasive Procedure: [**2173-9-2**] Coronary artery bypass graft x4 (Left internal mammary artery > Left anterior descending proximal, Saphenous vein graft > Left anterior descending distal, Saphenous vein graft > obtuse marginal, Saphenous vein graft > posterior descending artery) History of Present Illness: 69 year old female with diabetes and hypertension recently switched to a new PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17918**]. Upon seeing Dr. [**Last Name (STitle) 17918**], she reported chest tightness and dyspnea after walking for a few minutes. She also notices left arm/hand numbness, particularly if she has it raised or when working on the computer. She was referred for a stress test, which was abnormal. Over the last week she has noticed some dyspnea and slight chest tightness occurring at rest, which she feels is related [**Doctor First Name **] anxiety. She was referred for cardiac catheterization and was found to have three vessel disease. She is now being referred to cardiac surgery for revascularization. Past Medical History: diabetes Type II hypertension hyperlipidemia remote back pain/sciatica seizure disorder; [**Doctor Last Name 11332**] mal: last seizure 5 yrs ago depression/anxiety gout diverticulosis Cerebrovascular disease s/p left cataract repair s/p right cataract repair s/p tonsillectomy Social History: Lives with:Husband Occupation:Retired court receptionist from [**Hospital1 1474**] Court Cigarettes: Smoked no [] yes [x] Hx:quit smoking 30 years ago and smoked for 25 years Other Tobacco use:denies ETOH: denies Illicit drug use:denies Family History: noncontributory Physical Exam: Pulse:56 Resp:16 O2 sat:99/RA B/P Right:103/58 Left:109/60 Height:5' Weight:172 lbs General: Skin: Dry [X] intact [X] HEENT: PERRLA [X] EOMI [X] Neck: Supple [X] Full ROM [X] Chest: Lungs clear bilaterally [] Heart: RRR [X] Irregular [] Murmur [] grade ______ Abdomen: Soft [X] non-distended [] non-tender [] bowel sounds + [] Extremities: Warm [X], well-perfused [] Edema [] _____ Varicosities: None [x] Neuro: Grossly intact [X] Pulses: Femoral Right:Palpable Left:Palpable No palpable hematoma or pseudoaneurysm at puncture site (right side) DP Right: Palpable Left:Palpable PT [**Name (NI) 167**]: Palpable Left:Palpable Radial Right:Palpable Left:Palpable Carotid Bruit Right: None Left: None Pertinent Results: Conclusions PREBYPASS: Normal LV systolic function LVEF > 55%, no segmental wall motion abnormalities. The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. Normal TV trivial TR. Normal PV There is no pericardial effusion. No clot in LAA, intact IAS. POST CABG (ON PUMP) NO CHANGES. NO SWMA. No valvular issues. No dissection seen after cannula removed. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16164**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2173-9-2**] 14:46 [**2173-9-6**] 10:30AM BLOOD WBC-6.1 RBC-3.28* Hgb-10.0* Hct-29.9* MCV-91 MCH-30.6 MCHC-33.6 RDW-16.6* Plt Ct-166 [**2173-9-7**] 06:19AM BLOOD PT-14.0* INR(PT)-1.2* [**2173-9-7**] 06:19AM BLOOD Glucose-138* UreaN-40* Creat-1.3* Na-139 K-3.6 Cl-106 HCO3-26 AnGap-11 [**2173-9-6**] 10:30AM BLOOD Mg-2.1 Brief Hospital Course: Admitted same day surgery and was brought to the operating room for coronary artery bypass graft surgery. See operative report for further details. She received cefazolin for perioperative antibiotics and was transferred to the intensive care unit on phenylephrine and propofol for post operative management. That evening she was started on epinephrine drip for poor cardiac output with improvement and remained intubated overnight. On post operative day one she was weaned from sedation, awoke neurologically intact and was extubated without complications. Epinephrine and phenylephrine were weaned off and she hemodynamics remained stable and she was transferred to the floor later that day. Betablockers and diuretics were initiated. She continued to progress and physical therapy worked with her on strength and mobility. Chest tubes and pacing wires were removed without complication. Continued to make good progress and was cleared for discharge to home with VNA. All f/u appts were advised. Pt. should have home physical therapy done three times per week. Medications on Admission: ALLOPURINOL 300 mg daily CLONAZEPAM 0.5 mg at bedtime GLYBURIDE 2.5 mg daily LEVETIRACETAM 500 mg twice a day LISINOPRIL 20 mg daily METFORMIN 1000 mg twice a day METOPROLOL TARTRATE 25 mg daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg daily ZONISAMIDE 600 mg q pm Crestor unsure of dose ASPIRIN 324 mg daily DIPHENHYDRAMINE-ACETAMINOPHEN 500 mg-25 mg - 2 Tablet at bedtime Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 1 months. Disp:*60 Capsule(s)* Refills:*0* 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. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*1* 4. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*1* 5. zonisamide 100 mg Capsule Sig: Six (6) Capsule PO QPM (once a day (in the evening)). Disp:*180 Capsule(s)* Refills:*1* 6. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 8. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). Disp:*45 Tablet(s)* Refills:*1* 9. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 10. furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day for 1 weeks. Disp:*14 Tablet(s)* Refills:*0* 11. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO DAILY (Daily) for 1 weeks. Disp:*14 Tablet Extended Release(s)* Refills:*0* 12. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 13. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: Coronary artery disease s/p CABG diabetes mellitus type II hypertension hyperlipidemia sciatica seizure disorder; [**Doctor Last Name 11332**] mal: last seizure 5 yrs ago depression/anxiety gout diverticulosis cerebrovascular disease Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesics Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Edema 1+ BLE 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**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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 [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 766**] [**9-27**] @ 2:00 pm [**Hospital Ward Name **] 2A [**Telephone/Fax (1) 170**] Cardiologist: Dr [**Last Name (STitle) 7047**] ( office will call pt with appt for 3 weeks) Please call to schedule appointments with your Primary Care Dr [**Last Name (STitle) 17918**] in [**5-18**] weeks [**Telephone/Fax (1) 17919**] HOME Physical Therapy 3x per week **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2173-9-7**]

414,250,401,272,345,274,562,V158

{'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,Generalized nonconvulsive epilepsy, without mention of intractable epilepsy,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),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: chest tightness PRESENT ILLNESS: 69 year old female with diabetes and hypertension recently switched to a new PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17918**]. Upon seeing Dr. [**Last Name (STitle) 17918**], she reported chest tightness and dyspnea after walking for a few minutes. She also notices left arm/hand numbness, particularly if she has it raised or when working on the computer. She was referred for a stress test, which was abnormal. Over the last week she has noticed some dyspnea and slight chest tightness occurring at rest, which she feels is related [**Doctor First Name **] anxiety. She was referred for cardiac catheterization and was found to have three vessel disease. She is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: diabetes Type II hypertension hyperlipidemia remote back pain/sciatica seizure disorder; [**Doctor Last Name 11332**] mal: last seizure 5 yrs ago depression/anxiety gout diverticulosis Cerebrovascular disease s/p left cataract repair s/p right cataract repair s/p tonsillectomy MEDICATION ON ADMISSION: ALLOPURINOL 300 mg daily CLONAZEPAM 0.5 mg at bedtime GLYBURIDE 2.5 mg daily LEVETIRACETAM 500 mg twice a day LISINOPRIL 20 mg daily METFORMIN 1000 mg twice a day METOPROLOL TARTRATE 25 mg daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg daily ZONISAMIDE 600 mg q pm Crestor unsure of dose ASPIRIN 324 mg daily DIPHENHYDRAMINE-ACETAMINOPHEN 500 mg-25 mg - 2 Tablet at bedtime ALLERGIES: Codeine PHYSICAL EXAM: Pulse:56 Resp:16 O2 sat:99/RA B/P Right:103/58 Left:109/60 Height:5' Weight:172 lbs FAMILY HISTORY: noncontributory SOCIAL HISTORY: Lives with:Husband Occupation:Retired court receptionist from [**Hospital1 1474**] Court Cigarettes: Smoked no [] yes [x] Hx:quit smoking 30 years ago and smoked for 25 years Other Tobacco use:denies ETOH: denies Illicit drug use:denies ### Response: {'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,Generalized nonconvulsive epilepsy, without mention of intractable epilepsy,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),Personal history of tobacco use'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 37-year-old male with cardiac risk factors of mild hypercholesterolemia who had his first myocardial infarction on [**8-27**] of this year of the left anterior descending artery (proximally). MEDICAL HISTORY: (The patient's past medical history was significant for) 1. Mild hypercholesterolemia; treated with Zocor. 2. The patient also had an echocardiogram on [**2117-8-31**] which showed moderate regional left ventricular systolic dysfunction with an ejection fraction of 30% and anteroseptal, anterior, and apical kinesis. MEDICATION ON ADMISSION: The patient's home medications were enalapril 10 mg p.o. once per day, Lopressor 25 mg p.o. twice per day, Zocor 20 mg p.o. once per day, Coumadin 5 mg p.o. once per day, aspirin 81 mg p.o. once per day, folic acid 3 mg p.o. once per day, and Plavix. ALLERGIES: There were no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history was significant for no early cardiovascular disease. Two brother are healthy. One sister with diabetes mellitus. SOCIAL HISTORY: Social history was significant for no tobacco use. No intravenous drug use. Occasional alcohol. The patient had been following a regular exercise course. He is a business manager at [**Hospital1 **].

Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,Hypopotassemia

AMI anterior wall, init,Comp-oth cardiac device,Crnry athrscl natve vssl,Hypopotassemia

Admission Date: [**2117-10-24**] Discharge Date: [**2117-10-31**] Date of Birth: [**2080-6-16**] Sex: M Service: CICU Dictating for: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. HISTORY OF PRESENT ILLNESS: This is a 37-year-old male with cardiac risk factors of mild hypercholesterolemia who had his first myocardial infarction on [**8-27**] of this year of the left anterior descending artery (proximally). The patient had been doing well after discharge. He had been discharged on Plavix, aspirin, and Coumadin. On the day of admission, he had been exercising on his bike for 20 minutes when 20 minutes after exercise he experienced chest pressure, some shortness of breath, and diaphoresis. He immediately recognized the symptoms and went by ambulance to [**Hospital6 3426**] where electrocardiogram showed an anterior ST elevation myocardial infarction with elevation in V1 through V6. The patient received nitroglycerin, morphine, aspirin, and heparin and was transferred within one hour to [**Hospital1 1444**] for cardiac catheterization. Catheterization showed a total occlusion of the left anterior descending artery at the area of the stent placement. A balloon angioplasty was performed at the site without complications, and the patient was sent to the Coronary Care Unit. PAST MEDICAL HISTORY: (The patient's past medical history was significant for) 1. Mild hypercholesterolemia; treated with Zocor. 2. The patient also had an echocardiogram on [**2117-8-31**] which showed moderate regional left ventricular systolic dysfunction with an ejection fraction of 30% and anteroseptal, anterior, and apical kinesis. MEDICATIONS ON ADMISSION: The patient's home medications were enalapril 10 mg p.o. once per day, Lopressor 25 mg p.o. twice per day, Zocor 20 mg p.o. once per day, Coumadin 5 mg p.o. once per day, aspirin 81 mg p.o. once per day, folic acid 3 mg p.o. once per day, and Plavix. ALLERGIES: There were no known drug allergies. SOCIAL HISTORY: Social history was significant for no tobacco use. No intravenous drug use. Occasional alcohol. The patient had been following a regular exercise course. He is a business manager at [**Hospital1 **]. FAMILY HISTORY: Family history was significant for no early cardiovascular disease. Two brother are healthy. One sister with diabetes mellitus. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination revealed vital signs with temperature of 98.3, heart rate was 81, blood pressure was 105/71, respiratory rate was 20. In general, the patient was awake and alert, in no acute distress. Head, eyes, ears, nose, and throat examination revealed pupils were equal, round, and reactive to light. Extraocular muscles were intact. No increased jugular venous pressure. Cardiovascular examination revealed a regular rate and rhythm with no murmurs and a fourth heart sound. The abdomen was soft and benign. Lungs were clear to auscultation anteriorly. Extremities revealed the patient had a femoral sheath in the right groin with no hematoma and 2+ palpable dorsalis pedis pulses. PERTINENT LABORATORY DATA ON PRESENTATION: Laboratories showed white blood cell count was 15,000, hematocrit was 35.9, platelets were 207. INR was 3.3, PTT was greater than 150. Creatine kinase was 137, and potassium was measured at 3.5. Arterial blood gas showed pH of 7.25, PCO2 was 45, and PO2 was 180, with a bicarbonate of 21. The latest total cholesterol tests from [**2117-8-26**] showed a total cholesterol of 174, and high-density lipoprotein was 42, low-density lipoprotein was 108, triglycerides were 119. RADIOLOGY/IMAGING: Electrocardiogram measured at [**Hospital6 3426**] showed sinus rhythm with a rate of 81, 3-mm ST elevations in I, aVL, and V2 through V6; 2-mm ST depressions in II, III, and aVF. Electrocardiogram taken after cardiac catheterization at [**Hospital1 1444**] showed sinus rhythm at a rate of 89, P-R prolongation, decreased ST elevations in V2 through V6, and resolved abnormalities in II, III, and aVF. A chest x-ray showed no pulmonary edema. HOSPITAL COURSE: The patient did well. The patient was started on Plavix, Integrilin, Zocor, aspirin, beta blocker, and ACE inhibitors. Serial creatine phosphokinases and troponin I were done with a peak creatine phosphokinase of 1112 and a peak troponin of greater than 50. The patient was taken back for catheterization and evaluation for brachy therapy. The catheterization revealed no significant hyperplasia within the stent; and therefore brachy therapy was not performed. A repeat echocardiogram on [**2117-10-25**] showed an ejection fraction of 30%, hypokinesis of the anterior free wall and septum, and dyskinesis of the apex. A left ventricular mass or thrombus could not be excluded. Due to this patient's unusual situation of in-stent thrombosis while on Coumadin, aspirin, and Plavix, hypercoagulability studies were pursued. A lupus anticoagulant test was performed and was found to be negative. The right femoral catheter was removed on [**2117-10-27**]. This procedure was significant for the fact that 70 minutes of pressure had to be held at the site before bleeding stopped. In addition, the patient had a vagal episode with a heart rate down to the 50s and systolic blood pressure down to the 80s. He was given 0.5 mg of atropine and a 500-cc bolus of normal saline with improvement. On [**10-29**], the patient was exercising increasing pain in the right groin area where the catheter had been removed. The patient was given pain medications, and a CAT scan showed a hematoma without retroperitoneal bleed, and the patient was instructed to limit his movement to and from the bathroom. MEDICATIONS ON DISCHARGE: 1. Metoprolol 25 mg p.o. b.i.d. 2. Zestril 10 mg p.o. q.d. 3. Aspirin 325 mg p.o. q.d. 4. Plavix 75 mg p.o. q.d. 5. Zocor 20 mg p.o. q.d. 6. Folic acid 3 mg p.o. q.d. 7. Coumadin 5 mg p.o. q.d. CONDITION AT DISCHARGE: The patient's condition on discharge was good. DISCHARGE FOLLOWUP: The patient was instructed to follow up with his cardiologist. DISCHARGE DIAGNOSES: In-stent re-thrombosis with resulting ST elevation anterior wall myocardial infarction. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. [**MD Number(1) 1014**] Dictated By:[**Last Name (NamePattern1) 43960**] MEDQUIST36 D: [**2117-10-30**] 14:41 T: [**2117-11-3**] 12:42 JOB#: [**Job Number 43961**]

410,996,414,276

{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,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: This is a 37-year-old male with cardiac risk factors of mild hypercholesterolemia who had his first myocardial infarction on [**8-27**] of this year of the left anterior descending artery (proximally). MEDICAL HISTORY: (The patient's past medical history was significant for) 1. Mild hypercholesterolemia; treated with Zocor. 2. The patient also had an echocardiogram on [**2117-8-31**] which showed moderate regional left ventricular systolic dysfunction with an ejection fraction of 30% and anteroseptal, anterior, and apical kinesis. MEDICATION ON ADMISSION: The patient's home medications were enalapril 10 mg p.o. once per day, Lopressor 25 mg p.o. twice per day, Zocor 20 mg p.o. once per day, Coumadin 5 mg p.o. once per day, aspirin 81 mg p.o. once per day, folic acid 3 mg p.o. once per day, and Plavix. ALLERGIES: There were no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history was significant for no early cardiovascular disease. Two brother are healthy. One sister with diabetes mellitus. SOCIAL HISTORY: Social history was significant for no tobacco use. No intravenous drug use. Occasional alcohol. The patient had been following a regular exercise course. He is a business manager at [**Hospital1 **]. ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,Hypopotassemia'}

CHIEF COMPLAINT: asymptomatic PRESENT ILLNESS: 75 yo F with known infero-basilar left ventricular aneurysm, found to have ? contained rupture at OSH. MEDICAL HISTORY: PMH: CAD, s/p IMI [**2132-9-25**]--on cath at the time pt had RCA stent placement ([**Hospital1 **]) s/p admit at [**Hospital1 18**] [**2132-10-7**]--cath at time pt had cypher DES placed OM3. Anxiety MEDICATION ON ADMISSION: ASA 325, Plavix 75, Lisinopril 5, Lopressor 25", protonix 40, vytorin [**8-/2106**] ALLERGIES: Codeine / Morphine / Percocet PHYSICAL EXAM: HR 55 RR 20 Bp 116/60 NAD Lungs CTAB Heart RRR, no M/R/G Abdomen benign Extrem warm, no edema, no varicosities FAMILY HISTORY: Family History: No h/o CV or pulm dz. SOCIAL HISTORY: Social History: Lives with husband. [**Name (NI) 1403**] at [**Company 20598**] Museum. Denies ETOH, any hx of TOB, or illicits.

Aneurysm of heart (wall),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,Percutaneous transluminal coronary angioplasty status

Aneurysm of heart,Hypertension NOS,Hyperlipidemia NEC/NOS,Old myocardial infarct,Angina pectoris NEC/NOS,Status-post ptca

Admission Date: [**2133-12-23**] Discharge Date: [**2133-12-29**] Date of Birth: [**2058-4-15**] Sex: F Service: CARDIOTHORACIC Allergies: Codeine / Morphine / Percocet Attending:[**First Name3 (LF) 165**] Chief Complaint: asymptomatic Major Surgical or Invasive Procedure: emergent LV Aneurysm Repair and CABG x1 ([**12-23**]) History of Present Illness: 75 yo F with known infero-basilar left ventricular aneurysm, found to have ? contained rupture at OSH. Past Medical History: PMH: CAD, s/p IMI [**2132-9-25**]--on cath at the time pt had RCA stent placement ([**Hospital1 **]) s/p admit at [**Hospital1 18**] [**2132-10-7**]--cath at time pt had cypher DES placed OM3. Anxiety Social History: Social History: Lives with husband. [**Name (NI) 1403**] at [**Company 20598**] Museum. Denies ETOH, any hx of TOB, or illicits. Family History: Family History: No h/o CV or pulm dz. Physical Exam: HR 55 RR 20 Bp 116/60 NAD Lungs CTAB Heart RRR, no M/R/G Abdomen benign Extrem warm, no edema, no varicosities Pertinent Results: [**2133-12-28**] 04:20AM BLOOD WBC-9.8 RBC-3.50* Hgb-10.4* Hct-30.6* MCV-87 MCH-29.7 MCHC-34.1 RDW-14.8 Plt Ct-184 [**2133-12-28**] 04:20AM BLOOD Plt Ct-184 [**2133-12-26**] 02:16AM BLOOD PT-12.5 PTT-28.3 INR(PT)-1.1 [**2133-12-28**] 04:20AM BLOOD Glucose-109* UreaN-14 Creat-0.8 Na-142 K-4.6 Cl-105 HCO3-31 AnGap-11 CHEST (PORTABLE AP) [**2133-12-26**] 1:22 PM CHEST (PORTABLE AP) Reason: evaluation for pleural fluids. [**Hospital 93**] MEDICAL CONDITION: 75 year old woman s/p emergent LV aneurysm repair and CABG with low hct REASON FOR THIS EXAMINATION: evaluation for pleural fluids. CHEST SINGLE VIEW ON [**12-26**] HISTORY: LV aneurysm repair, low hematocrit, question pleural fluid. REFERENCE EXAM: [**12-25**]. FINDINGS: Again seen is a moderate left pleural effusion and dense retrocardiac opacity consistent with volume loss and effusion although an underlying infectious infiltrate cannot be excluded. There is a small amount of fluid in the right major fissure. There are some patchy areas of right lower lobe volume loss as well. Again seen is a small right apical pneumothorax. Brief Hospital Course: She was transferred from [**Hospital1 **] to [**Hospital Ward Name 121**] 6. She was taken emergently to the operating room, for ? of LV aneurysm rupture, where she underwent a CABG x 1 and LV aneurysm repair and thrombectomy. She was transferred to the ICU in stable condition on epi, neo and propofol. She was extubated on POD #1. She was transfused. She was transferred to the floor on POD #3. She did well postoperatively and was ready for discharge home on POD #5. Medications on Admission: ASA 325, Plavix 75, Lisinopril 5, Lopressor 25", protonix 40, vytorin [**8-/2106**] Discharge Medications: 1. 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* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 4. 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* 5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**2-28**] hours as needed. Disp:*50 Tablet(s)* Refills:*0* 6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Vytorin [**8-/2106**] 10-80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 8. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO DAILY (Daily). 9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital **] Hospice and VNA Discharge Diagnosis: LV Aneurysm s/p repair and CAD s/p CABG x1 CAD s/p PCI RCA(taxus DES) and LCx(Cypher DES), HTN, dyslipidemia, dressler syndrome Discharge Condition: Good. Discharge Instructions: Call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week, Shower, no baths, no lotions, creams or powders to incisions. No lifting more than 10 pounds for 10 weeks. No driving until follow up with surgeon. Followup Instructions: Dr. [**First Name (STitle) **] 2 weeks Dr. [**First Name (STitle) **] 4 weeks Dr. [**Last Name (STitle) 32255**] 2 weeks [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2133-12-29**]

414,401,272,412,413,V458

{'Aneurysm of heart (wall),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,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: asymptomatic PRESENT ILLNESS: 75 yo F with known infero-basilar left ventricular aneurysm, found to have ? contained rupture at OSH. MEDICAL HISTORY: PMH: CAD, s/p IMI [**2132-9-25**]--on cath at the time pt had RCA stent placement ([**Hospital1 **]) s/p admit at [**Hospital1 18**] [**2132-10-7**]--cath at time pt had cypher DES placed OM3. Anxiety MEDICATION ON ADMISSION: ASA 325, Plavix 75, Lisinopril 5, Lopressor 25", protonix 40, vytorin [**8-/2106**] ALLERGIES: Codeine / Morphine / Percocet PHYSICAL EXAM: HR 55 RR 20 Bp 116/60 NAD Lungs CTAB Heart RRR, no M/R/G Abdomen benign Extrem warm, no edema, no varicosities FAMILY HISTORY: Family History: No h/o CV or pulm dz. SOCIAL HISTORY: Social History: Lives with husband. [**Name (NI) 1403**] at [**Company 20598**] Museum. Denies ETOH, any hx of TOB, or illicits. ### Response: {'Aneurysm of heart (wall),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,Percutaneous transluminal coronary angioplasty status'}

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: 82M with progressive dyspnea on exertion. He becomes dyspneic on walking one flight of stairs, or [**Age over 90 **] yards. He is asymptomatic at rest and denies chest pain. There is evidence of prior infarcts on recent nuclear stress. He has Aortic Stenosis followed by echo since [**2132**]. [**Location (un) 109**] is 0.8cm2 with EF 40%. Cardiac cath reveals left main and two vessel CAD. MEDICAL HISTORY: Past Medical History: Severe aortic stenosis, CAD (old inferior MI per stress test) Hypertension Dyslipidemia Chronic systolic heart failure BPH Past Surgical History: Tonsillectomy Past Cardiac Procedures: none MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Doxazosin 8 mg PO HS 2. Lisinopril 10 mg PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Metoprolol Succinate XL 12.5 mg PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY 6. Aspirin 81 mg PO DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Pulse: 67 irregular Resp:18 O2 sat: 96%RA B/P Right: Left: 141/67 Height: 5'8" Weight: 173lb General: 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 [] grade [**3-14**] syst._ Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x] Extremities: Warm [x], well-perfused [x] Edema trace pedal Varicosities: mild, R>L Neuro: Grossly intact [x] Pulses: Femoral Right: 2+ Left:2+ DP Right: 2+ Left:2+ PT [**Name (NI) 167**]: 2+ Left:2+ Radial Right: 2+ Left:2+ Carotid Bruit: radiation of cardiac murmur FAMILY HISTORY: Family History:No premature coronary artery disease Brother with rheumatic heart disease, mother with hypertension Father died in his 90s SOCIAL HISTORY: Race: Caucasian Dental clearance in chartLives with: wife and 50yo son Contact: [**Name (NI) 111797**] [**Name (NI) 111798**], daughter. C: [**Telephone/Fax (1) 111799**] [**Name2 (NI) 27057**]tion: retired [**Hospital Ward Name **] Cigarettes: Smoked no [] yes [x] last cigarette: quit [**2089**] ETOH: [**3-15**] drinks/week [x] Illicit drug use: none

Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Aortic valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Atrial fibrillation,Thrombocytopenia, unspecified

Crnry athrscl natve vssl,Chr systolic hrt failure,Aortic valve disorder,Hypertension NOS,BPH w/o urinary obs/LUTS,Old myocardial infarct,Atrial fibrillation,Thrombocytopenia NOS

Admission Date: [**2140-10-16**] Discharge Date: [**2140-10-21**] Date of Birth: [**2058-3-7**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: [**2140-10-17**] AVR(25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue)CABG x3(LIMA-lad,SVG-om,SVG-pda) History of Present Illness: 82M with progressive dyspnea on exertion. He becomes dyspneic on walking one flight of stairs, or [**Age over 90 **] yards. He is asymptomatic at rest and denies chest pain. There is evidence of prior infarcts on recent nuclear stress. He has Aortic Stenosis followed by echo since [**2132**]. [**Location (un) 109**] is 0.8cm2 with EF 40%. Cardiac cath reveals left main and two vessel CAD. Past Medical History: Past Medical History: Severe aortic stenosis, CAD (old inferior MI per stress test) Hypertension Dyslipidemia Chronic systolic heart failure BPH Past Surgical History: Tonsillectomy Past Cardiac Procedures: none Social History: Race: Caucasian Dental clearance in chartLives with: wife and 50yo son Contact: [**Name (NI) 111797**] [**Name (NI) 111798**], daughter. C: [**Telephone/Fax (1) 111799**] [**Name2 (NI) 27057**]tion: retired [**Hospital Ward Name **] Cigarettes: Smoked no [] yes [x] last cigarette: quit [**2089**] ETOH: [**3-15**] drinks/week [x] Illicit drug use: none Family History: Family History:No premature coronary artery disease Brother with rheumatic heart disease, mother with hypertension Father died in his 90s Physical Exam: Admission Physical Exam: Pulse: 67 irregular Resp:18 O2 sat: 96%RA B/P Right: Left: 141/67 Height: 5'8" Weight: 173lb General: 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 [] grade [**3-14**] syst._ Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x] Extremities: Warm [x], well-perfused [x] Edema trace pedal Varicosities: mild, R>L Neuro: Grossly intact [x] Pulses: Femoral Right: 2+ Left:2+ DP Right: 2+ Left:2+ PT [**Name (NI) 167**]: 2+ Left:2+ Radial Right: 2+ Left:2+ Carotid Bruit: radiation of cardiac murmur Discharge PE VS T99.5 HR 65 BP 115/62 RR 18 O2sat 100% 2LNP Wt 80.9kg Gen: NAD Neuro: A&O x3, MAE. nonfocal exam CV: RRR, no murmur. Sternum stable-incision CDI Pulm: CTA-bilat Abdm: soft, NT/ND/NABS Ext: warm, well perfused 1+pedal edema bilat Pertinent Results: Admission labs: [**2140-10-16**] 05:00PM URINE MUCOUS-RARE [**2140-10-16**] 05:00PM URINE RBC-6* WBC-<1 BACTERIA-NONE YEAST-NONE EPI-0 [**2140-10-16**] 05:00PM URINE BLOOD-TR NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-5.0 LEUK-NEG [**2140-10-16**] 05:00PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.017 [**2140-10-16**] 05:25PM PT-13.4* PTT-33.4 INR(PT)-1.2* [**2140-10-16**] 05:25PM PLT COUNT-96* [**2140-10-16**] 05:25PM WBC-4.2 RBC-4.29* HGB-14.8 HCT-43.3 MCV-101* MCH-34.5* MCHC-34.2 RDW-14.6 [**2140-10-16**] 05:25PM %HbA1c-5.7 eAG-117 [**2140-10-16**] 05:25PM ALBUMIN-4.2 [**2140-10-16**] 05:25PM ALT(SGPT)-22 AST(SGOT)-26 LD(LDH)-216 ALK PHOS-208* TOT BILI-1.8* [**2140-10-16**] 05:25PM GLUCOSE-94 UREA N-28* CREAT-1.4* SODIUM-139 POTASSIUM-4.5 CHLORIDE-104 TOTAL CO2-25 ANION GAP-15 Discharge labs: [**2140-10-20**] 05:55AM BLOOD WBC-5.3 RBC-3.04* Hgb-10.1* Hct-30.8* MCV-101* MCH-33.1* MCHC-32.8 RDW-14.5 Plt Ct-119* [**2140-10-20**] 05:55AM BLOOD Plt Ct-119* [**2140-10-20**] 05:55AM BLOOD Glucose-91 UreaN-34* Creat-1.2 Na-138 K-4.2 Cl-102 HCO3-32 AnGap-8 Radiology Report CHEST (PORTABLE AP) Study Date of [**2140-10-19**] 10:40 AM Final Report: Patient has been extubated with increase in moderately severe right basal atelectasis. Moderate pulmonary edema is no worse, but moderate cardiomegaly has increased and there is new moderate right pleural effusion. No pneumothorax. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**] [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.0 cm <= 4.0 cm Left Atrium - Four Chamber Length: *6.3 cm <= 5.2 cm Right Atrium - Four Chamber Length: *6.2 cm <= 5.0 cm Left Ventricle - Septal Wall Thickness: *1.5 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.3 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: *6.3 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 35% to 40% >= 55% Left Ventricle - Stroke Volume: 106 ml/beat Right Ventricle - Diastolic Diameter: *4.8 cm <= 2.1 cm Aorta - Annulus: 2.2 cm <= 3.0 cm Aorta - Sinus Level: 3.4 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.9 cm <= 3.0 cm Aorta - Ascending: 3.1 cm <= 3.4 cm Aortic Valve - Peak Velocity: *3.9 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *62 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 37 mm Hg Aortic Valve - LVOT VTI: 28 Aortic Valve - LVOT diam: 2.2 cm Aortic Valve - Valve Area: *0.8 cm2 >= 3.0 cm2 Aortic Valve - Pressure Half Time: 470 ms Pericardium - Effusion Size: 1.5 cm Findings Multiplanar reconstructions were generated and confirmed on an independent workstation. LEFT ATRIUM: Marked LA enlargement. Mild spontaneous echo contrast in the body of the LA. Depressed LAA emptying velocity (<0.2m/s) No thrombus in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA. No spontaneous echo contrast in the body of the RA. LEFT VENTRICLE: Mild symmetric LVH. Moderately dilated LV cavity. Moderate-severe regional left ventricular systolic dysfunction. Moderate-severe global left ventricular hypokinesis. RIGHT VENTRICLE: Mildly dilated RV cavity. Mild global RV free wall hypokinesis. AORTA: Normal aortic diameter at the sinus level. Simple atheroma in ascending aorta. Simple atheroma in aortic arch. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Severely thickened/deformed aortic valve leaflets. Severe AS (area 0.8-1.0cm2). Mild (1+) AR. Eccentric AR jet directed toward the anterior mitral leaflet. MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: Moderate pericardial effusion. Effusion circumferential. GENERAL COMMENTS: Written informed consent was obtained from the patient. A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. Results were personally reviewed with the MD caring for the patient. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions Pre-Bypass: The left atrium is markedly dilated. Mild spontaneous echo contrast is seen in the left atrial appendage. The left atrial appendage emptying velocity is depressed (<0.2m/s). There is mild-mod symmetric left ventricular hypertrophy. The left ventricular cavity is moderately dilated. Estimated LVEF-30-35%. There is severe global hypokinesis, most notable in the mid-inferoseptal segment. The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. There are simple atheroma in the ascending aorta, aortic arch, and descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are severely thickened/deformed. There is severe aortic valve stenosis (valve area 0.8-1.0cm2). Mild (1+) aortic regurgitation is seen. The aortic regurgitation jet is eccentric and directed toward the anterior mitral leaflet. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. There is a moderate sized circumferential pericardial effusion (1.5-2cm). Post-Bypass: The patient is A-V Paced and on a norepinephrine infusion s/p CABG/AVR. There is a bioprosthetic valve in the aortic position. The valve appears well-seated with normally mobile leaflets. There is no evidence of a peri-valvular leak or regurgitation. Peak and mean gradients are 15/8 mmHg at a cardiac output of 5L/min. Left ventricular function appears slightly improved with an estimated EF 35-40%. Severe global hypokinesis remains, again most notable in the inferior septal wall segment. 1+MR [**First Name (Titles) 40124**] [**Last Name (Titles) 1506**]. Pericardial effusion is now gone. There is no echocardiographic evidence of aortic disection post de-cannulation. The remainder of the exam is [**Last Name (Titles) 1506**]. Dr [**Last Name (STitle) **] was notified of findings at time of study. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Name8 (MD) 17792**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2140-10-19**] 15:29 Brief Hospital Course: Mr [**Known lastname 111800**] was admitted one day prior to scheduled heart surgery with Dr [**Last Name (STitle) **] for testing. On [**10-17**] he was brought to the operating room for AVR/CABg please see operative report for details, in summary he had: Aortic Valve Replacement with #25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue valve and Coronary Artery Bypass Grafting x3 with Left Internal Mamary Artery to left anterior descending artery, reverse saphenous vein graft to Obtuse marginal and reverse saphenous vein graft to posterior descending artery. His bypass time was 106 minutes with a crossclamp of 90 minutes. he tolerated the operation well and post operatively was transferred to the cardiac suregry ICU. He remained hemodynamically stable in the early post op period, he woke neurologically intact, was weaned from the ventilator and extubated. All tubes lines and drains were removed per cardiac suregry protocol without complication. On POD1 he continued to be hemodynamically stable and was transferred to the cardiac stepdown floor. Once on the stepdown floor he worked with nursing and physical therapy to increase his strength and endurance. The remainder of his hospital course was uneventful. He was discharged to home on POD #5. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Doxazosin 8 mg PO HS 2. Lisinopril 10 mg PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Metoprolol Succinate XL 12.5 mg PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY 6. Aspirin 81 mg PO DAILY Discharge Medications: 1. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 2. Simvastatin 40 mg PO DAILY RX *simvastatin 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 3. Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0 4. Docusate Sodium 100 mg PO BID 5. Metoprolol Tartrate 25 mg PO TID hold HR<60 SBP<100 RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*1 6. Milk of Magnesia 30 mL PO DAILY:PRN constipation 7. Oxycodone-Acetaminophen (5mg-325mg) [**2-8**] TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg [**2-8**] tablet(s) by mouth every four (4) hours Disp #*75 Tablet Refills:*0 8. Potassium Chloride 20 mEq PO BID Duration: 14 Days to replace potassium lost while you are on lasix RX *potassium chloride 20 mEq 20 mEq by mouth twice a day Disp #*28 Tablet Refills:*0 9. Ranitidine 150 mg PO DAILY RX *ranitidine HCl 150 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 10. Doxazosin 8 mg PO HS 11. Furosemide 20 mg PO BID Duration: 14 Days to treat your lower extremity swelling after surgery RX *furosemide 20 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 12. Albuterol-Ipratropium [**2-8**] PUFF IH Q6H wheezes RX *ipratropium-albuterol [Combivent] 18 mcg-103 mcg (90 mcg)/actuation 1-2 puffs inhaled twice a day Disp #*1 Inhaler Refills:*0 13. Warfarin MD to order daily dose PO DAILY16 afib goal INR 2.0-2.5 RX *warfarin 1 mg as directed tablet(s) by mouth once a day Disp #*60 Tablet Refills:*1 Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: s/p AVR(25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue)CABG x3(LIMA-lad,SVG-om,SVG-pda)[**10-17**] PMH: Severe aortic stenosis, CAD (old inferior MI per stress test), Hypertension, Dyslipidemia, Chronic systolic heart failure, BPH, s/p Tonsillectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Percocet and Tylenol Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Edema- 1+ bilat pedal 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 one month or while taking narcotics. driving will be discussed at follow up appointment with surgeon. No lifting more than 10 pounds for 10 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** Followup Instructions: You are scheduled for the following appointments: Cardiac [**Hospital **] [**Hospital 409**] Clinic: [**2140-10-25**] at 11am in the [**Hospital **] medical office building, [**Doctor First Name **], [**Hospital Unit Name **] Surgeon: Dr [**First Name (STitle) **] [**Name (STitle) **] on [**2140-11-9**] at 1:30pmin the [**Hospital **] medical office building, [**Doctor First Name **], [**Hospital Unit Name **] Cardiologist:[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD/ [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5686**] MD Please call to schedule appointments with your Primary Care Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] H. [**Telephone/Fax (1) 39260**] in [**5-12**] weeks Coumadin Indication: afib Goal INR 2.0-2.5 First INR draw on [**2140-10-22**] and call results to Dr. [**Last Name (STitle) **] for your coumadin dosing (confirmed with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 73467**] PA- Phone [**Telephone/Fax (1) 39260**]; Fax [**Telephone/Fax (1) 111801**]. **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2140-10-25**]

414,428,424,401,600,412,427,287

{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Aortic valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Atrial fibrillation,Thrombocytopenia, 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: shortness of breath PRESENT ILLNESS: 82M with progressive dyspnea on exertion. He becomes dyspneic on walking one flight of stairs, or [**Age over 90 **] yards. He is asymptomatic at rest and denies chest pain. There is evidence of prior infarcts on recent nuclear stress. He has Aortic Stenosis followed by echo since [**2132**]. [**Location (un) 109**] is 0.8cm2 with EF 40%. Cardiac cath reveals left main and two vessel CAD. MEDICAL HISTORY: Past Medical History: Severe aortic stenosis, CAD (old inferior MI per stress test) Hypertension Dyslipidemia Chronic systolic heart failure BPH Past Surgical History: Tonsillectomy Past Cardiac Procedures: none MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Doxazosin 8 mg PO HS 2. Lisinopril 10 mg PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Metoprolol Succinate XL 12.5 mg PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY 6. Aspirin 81 mg PO DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Pulse: 67 irregular Resp:18 O2 sat: 96%RA B/P Right: Left: 141/67 Height: 5'8" Weight: 173lb General: 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 [] grade [**3-14**] syst._ Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x] Extremities: Warm [x], well-perfused [x] Edema trace pedal Varicosities: mild, R>L Neuro: Grossly intact [x] Pulses: Femoral Right: 2+ Left:2+ DP Right: 2+ Left:2+ PT [**Name (NI) 167**]: 2+ Left:2+ Radial Right: 2+ Left:2+ Carotid Bruit: radiation of cardiac murmur FAMILY HISTORY: Family History:No premature coronary artery disease Brother with rheumatic heart disease, mother with hypertension Father died in his 90s SOCIAL HISTORY: Race: Caucasian Dental clearance in chartLives with: wife and 50yo son Contact: [**Name (NI) 111797**] [**Name (NI) 111798**], daughter. C: [**Telephone/Fax (1) 111799**] [**Name2 (NI) 27057**]tion: retired [**Hospital Ward Name **] Cigarettes: Smoked no [] yes [x] last cigarette: quit [**2089**] ETOH: [**3-15**] drinks/week [x] Illicit drug use: none ### Response: {'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Aortic valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Atrial fibrillation,Thrombocytopenia, unspecified'}

CHIEF COMPLAINT: diabetic ketoacidosis PRESENT ILLNESS: 27 yo male with T1DM admitted with DKA. Unclear precipitant--had sudden onset abd pain/diarrhea/n/v this morning. No fever/chills. States compliant with insulin but has not seen his [**Name8 (MD) **] MD since [**2137**] MEDICAL HISTORY: T1DM on 75/25 split mix 50 units qam and 40-50 units q supper gastroparesis -- gastric emptying study in [**2137**] GERD MEDICATION ON ADMISSION: 75/25 insulin anzamet ALLERGIES: Penicillins PHYSICAL EXAM: Gen- no acute distress HEENT-anicteric, oral mucosa moist CV-rrr, no r/m/g resp-clear to auscultation bilaterally abdomen- soft, nontender, nondistended, good bowel sounds extremities- no edema FAMILY HISTORY: noncontributory SOCIAL HISTORY: lives with roomate

Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Esophageal reflux,Long-term (current) use of insulin

DMI keto nt st uncntrld,Acute kidney failure NOS,Gastroparesis,Esophageal reflux,Long-term use of insulin

Admission Date: [**2140-6-1**] Discharge Date: [**2140-6-5**] Date of Birth: [**2112-11-14**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 330**] Chief Complaint: diabetic ketoacidosis Major Surgical or Invasive Procedure: none History of Present Illness: 27 yo male with T1DM admitted with DKA. Unclear precipitant--had sudden onset abd pain/diarrhea/n/v this morning. No fever/chills. States compliant with insulin but has not seen his [**Name8 (MD) **] MD since [**2137**] Past Medical History: T1DM on 75/25 split mix 50 units qam and 40-50 units q supper gastroparesis -- gastric emptying study in [**2137**] GERD Social History: lives with roomate Family History: noncontributory Physical Exam: Gen- no acute distress HEENT-anicteric, oral mucosa moist CV-rrr, no r/m/g resp-clear to auscultation bilaterally abdomen- soft, nontender, nondistended, good bowel sounds extremities- no edema Pertinent Results: [**2140-6-1**] 08:30AM PLT SMR-NORMAL PLT COUNT-241 [**2140-6-1**] 08:30AM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2140-6-1**] 08:30AM NEUTS-92.6* BANDS-0 LYMPHS-4.6* MONOS-2.7 EOS-0 BASOS-0.1 [**2140-6-1**] 08:30AM WBC-11.7*# RBC-4.70 HGB-13.6* HCT-40.0 MCV-85 MCH-28.9 MCHC-34.0 RDW-11.9 [**2140-6-1**] 08:30AM CALCIUM-10.0 PHOSPHATE-3.3# MAGNESIUM-1.9 [**2140-6-1**] 08:30AM GLUCOSE-479* UREA N-26* CREAT-1.6* SODIUM-135 POTASSIUM-5.7* CHLORIDE-96 TOTAL CO2-18* ANION GAP-27* [**2140-6-1**] 08:43AM LACTATE-2.2* [**2140-6-1**] 08:55AM LACTATE-1.5 K+-4.3 [**2140-6-1**] 08:55AM TYPE-ART PO2-96 PCO2-31* PH-7.39 TOTAL CO2-19* BASE XS--4 COMMENTS-ADD ON K+ [**2140-6-1**] 08:55AM TYPE-ART PO2-96 PCO2-31* PH-7.39 TOTAL CO2-19* BASE XS--4 COMMENTS-ADD ON K+ [**2140-6-1**] 09:45AM URINE RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE EPI-0 [**2140-6-1**] 09:45AM URINE BLOOD-SM NITRITE-NEG PROTEIN-TR GLUCOSE-1000 KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG [**2140-6-1**] 09:45AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.026 [**2140-6-1**] 09:45AM URINE GR HOLD-HOLD [**2140-6-1**] 09:45AM URINE UHOLD-HOLD [**2140-6-1**] 09:45AM URINE HOURS-RANDOM [**2140-6-1**] 09:45AM URINE HOURS-RANDOM [**2140-6-1**] 01:00PM CALCIUM-9.1 PHOSPHATE-2.7 MAGNESIUM-1.8 [**2140-6-1**] 01:00PM GLUCOSE-213* UREA N-23* CREAT-1.3* SODIUM-142 POTASSIUM-4.0 CHLORIDE-108 TOTAL CO2-22 ANION GAP-16 [**2140-6-1**] 04:42PM %HbA1c-10.9* [Hgb]-DONE [A1c]-DONE [**2140-6-1**] 06:14PM CALCIUM-9.3 PHOSPHATE-3.1 MAGNESIUM-2.0 [**2140-6-1**] 06:14PM GLUCOSE-227* UREA N-20 CREAT-1.4* SODIUM-138 POTASSIUM-4.9 CHLORIDE-105 TOTAL CO2-20* ANION GAP-18 Brief Hospital Course: 27yo M with Type I DM and gastroparesis presented with DKA. He was on insulin drip for several day for aggressive control of anion gap. He remained nauseous and unable to take po intake until the anion gap is well controlled. IV fluid with dextrose was used while patient was NPO. As soon as the anion gap was well controlled, patient resumed extremely good appetite and was able to be transitioned to sc insulin [**First Name8 (NamePattern2) **] [**Last Name (un) **] reccomendation. Of note, patient also has domented gastroparesis on gastric emptying study and this also may have contributed to the nausea. Reglan was increased, LFTs and Ultrasound of the abdomen were normal. Of note, he was also hypertensive with sbp running 170-180 systolic. He was on ACE inhibitor a few years ago according to [**Last Name (un) 387**] records but has discontinued that due to insurance issue. ACE inhibitor was restarted while he was in the hospital. Social work consult was obtained to help him handle the medical insurance issue. As mentioned above, he had not seen a doctor for years and has discontinued/not compliant with medication. On the day of discharge, patient insisted on leaving. The ICU team explained to him that he had just been transitioned to sc insulin at that time and would need to stay for the afternoon for observation. He seem to have understood at the time of discussion and was very agreeable. However, he left without telling any medical staff shortly after that. Effort was made to contact him by phone but to no avail . Medications on Admission: 75/25 insulin anzamet Discharge Medications: 1. 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* 2. Metoclopramide HCl 10 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. Compazine 5 mg Tablet Sig: One (1) Tablet PO every 6-8 hours as needed for nausea. Disp:*20 Tablet(s)* Refills:*0* 4. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Diabetic ketoacidosis Discharge Condition: Left hospital AMA without telling staff. Condition was Good at time of last assessment by nursing personnel. Discharge Instructions: please return to the hospital or call your doctor if your blood sugar is out of control, if you have dizziness, nausea/vomiting or if there are any other concerns Please make sure you follow up with a PCP You have just been started on lisinopril for your blood pressure, you will need to have close follow up of your electrolytes Followup Instructions: Please call [**Telephone/Fax (1) 250**] to schedule an appointment with a PCP of your choice within 1 weeks of your discharge. Please call the [**Hospital **] CLinic for follow up appointment within 2 weeks of discharge Completed by:[**2140-6-22**]

250,584,536,530,V586

{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Esophageal reflux,Long-term (current) use of insulin'}

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: diabetic ketoacidosis PRESENT ILLNESS: 27 yo male with T1DM admitted with DKA. Unclear precipitant--had sudden onset abd pain/diarrhea/n/v this morning. No fever/chills. States compliant with insulin but has not seen his [**Name8 (MD) **] MD since [**2137**] MEDICAL HISTORY: T1DM on 75/25 split mix 50 units qam and 40-50 units q supper gastroparesis -- gastric emptying study in [**2137**] GERD MEDICATION ON ADMISSION: 75/25 insulin anzamet ALLERGIES: Penicillins PHYSICAL EXAM: Gen- no acute distress HEENT-anicteric, oral mucosa moist CV-rrr, no r/m/g resp-clear to auscultation bilaterally abdomen- soft, nontender, nondistended, good bowel sounds extremities- no edema FAMILY HISTORY: noncontributory SOCIAL HISTORY: lives with roomate ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Esophageal reflux,Long-term (current) use of insulin'}

CHIEF COMPLAINT: Diabetic ketoacidosis PRESENT ILLNESS: 32y Haitian Creole F with hx of Down Syndrome and type I DM presenting with hyperglycemia, BS>500, ketonuria and AG metabolic acidosis. She reported dysuria and vomiting at home but denied on eval. Had no other complaints on arrival. Attends day program. Diabetes mellitus, managed at the [**Last Name (un) **]. She continues on acombination of Humalog and 75/25 mix. Her A1Cs are monitored at [**Last Name (un) **]. Per [**2-/2132**] [**Last Name (un) **] note, emphasis was made to eat reg meals with concern about meal skipping to get better food at hospital. . ED course: Initial vitals were 98.7 122 140/74 16 100% on RA. Chest xray unremarkable. UA (straight cath) notable for ketone 150, gluc 1000, neg nitr or leuk, w few bacteria. Labs notable for lactate 4.9, wbc 13.9, Neut 92.7, no bands, K 4.8, MCV 100, and AG 26. She was started on an [**Last Name (un) 31217**] gtt after 10u regular [**Last Name (un) 31217**] and given 2L of NS, 3L 1/2 NS with KCL. EKG not obtained. Blood cultures sent. Vitals prior to transfer: 109, 135/81, 17, 100% on RA. Access 18 and 20. Repeat lactate 3.1 and K 4.6. Foley catheter placed for UO monitoring. . On the floor, history obtained from mother and cousin [**Name (NI) 483**] speaking) who state that patient was in USOH until last night. She awoke at 0400 to drink [**Location (un) 2452**] juice which mother says patient does when she feels "unwell." She continued to feel ill and received her AM [**Location (un) 31217**] dose of 32u Humalog. She vomited 3 times today and was tolerating water/diet ginger ale and FS glucose were rising so mother brought pt to [**Name (NI) **]. On arrival to the floor her [**Name (NI) 31217**] gtt at 2u/hr and FS 126. She denies recent fever, chills, headache, diarrhea, abd pain, recent illness/sick contacts, dysuria, chest pain or cough. Report increased urinary output. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: 1. Preseptal cellulitis, 02/[**2127**]. 2. Diabetes mellitus type 1 since age 15. Followed by [**Hospital **] Clinic. 3. Hypothyroidism. 4. Down syndrome. MEDICATION ON ADMISSION: 1. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY 2. [**Name Initial (PRE) **]: (32 humalog 75/25 in AM, 6 humalog in PM and 14 Humulin at night) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Vitals: T:98.6 BP:143/76 P: 121 R: 16 O2: 98/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: slightly distended, nontender, normoactive bowel sounds, firm to palpation b/l lower quadrants, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . Discharge Exam: VS: T 97-100 BP 97-126/50-80 HR 100-105 RR 18-20 O2 Sat 98% RA GEN: NAD HEENT: EOMI, NCAT, low set ears NECK: Supple, unable to asses JVP 2/2 habitus CV: Tachy, nl S1/S2, no S3/S4, no m/r/g PULM: CTAB, no increased WOB ABD: palpable uterus, moderatley distended, NABS, no rigidity, rebound or guarding EXT: WWP, no c/c/e NEURO: Non focal FAMILY HISTORY: Father: diabetes mellitus Strong family history on the father's side for diabetes. SOCIAL HISTORY: The patient is originally born here in [**Location (un) 86**]. She speaks and understands English, although she does not talk much. Her mother is originally from [**Country 2045**] and that is why they speak Creole and French. She denied smoking or alcohol. She goes to a day program everyday in [**Hospital1 392**] from 8:00-3:00 M-F. Mom home with pt full-time.

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Hypovolemia,Down's syndrome,Hordeolum externum,Other specified cardiac dysrhythmias,Leiomyoma of uterus, unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified,Long-term (current) use of insulin

DMI ketoacd uncontrold,Acute kidney failure NOS,Viral enteritis NOS,Hypovolemia,Down's syndrome,Hordeolum externum,Cardiac dysrhythmias NEC,Uterine leiomyoma NOS,Hypothyroidism NOS,Anemia NOS,Long-term use of insulin

Admission Date: [**2132-8-4**] Discharge Date: [**2132-8-10**] Date of Birth: [**2099-10-25**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 602**] Chief Complaint: Diabetic ketoacidosis Major Surgical or Invasive Procedure: None History of Present Illness: 32y Haitian Creole F with hx of Down Syndrome and type I DM presenting with hyperglycemia, BS>500, ketonuria and AG metabolic acidosis. She reported dysuria and vomiting at home but denied on eval. Had no other complaints on arrival. Attends day program. Diabetes mellitus, managed at the [**Last Name (un) **]. She continues on acombination of Humalog and 75/25 mix. Her A1Cs are monitored at [**Last Name (un) **]. Per [**2-/2132**] [**Last Name (un) **] note, emphasis was made to eat reg meals with concern about meal skipping to get better food at hospital. . ED course: Initial vitals were 98.7 122 140/74 16 100% on RA. Chest xray unremarkable. UA (straight cath) notable for ketone 150, gluc 1000, neg nitr or leuk, w few bacteria. Labs notable for lactate 4.9, wbc 13.9, Neut 92.7, no bands, K 4.8, MCV 100, and AG 26. She was started on an [**Last Name (un) 31217**] gtt after 10u regular [**Last Name (un) 31217**] and given 2L of NS, 3L 1/2 NS with KCL. EKG not obtained. Blood cultures sent. Vitals prior to transfer: 109, 135/81, 17, 100% on RA. Access 18 and 20. Repeat lactate 3.1 and K 4.6. Foley catheter placed for UO monitoring. . On the floor, history obtained from mother and cousin [**Name (NI) 483**] speaking) who state that patient was in USOH until last night. She awoke at 0400 to drink [**Location (un) 2452**] juice which mother says patient does when she feels "unwell." She continued to feel ill and received her AM [**Location (un) 31217**] dose of 32u Humalog. She vomited 3 times today and was tolerating water/diet ginger ale and FS glucose were rising so mother brought pt to [**Name (NI) **]. On arrival to the floor her [**Name (NI) 31217**] gtt at 2u/hr and FS 126. She denies recent fever, chills, headache, diarrhea, abd pain, recent illness/sick contacts, dysuria, chest pain or cough. Report increased urinary output. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. Past Medical History: 1. Preseptal cellulitis, 02/[**2127**]. 2. Diabetes mellitus type 1 since age 15. Followed by [**Hospital **] Clinic. 3. Hypothyroidism. 4. Down syndrome. Social History: The patient is originally born here in [**Location (un) 86**]. She speaks and understands English, although she does not talk much. Her mother is originally from [**Country 2045**] and that is why they speak Creole and French. She denied smoking or alcohol. She goes to a day program everyday in [**Hospital1 392**] from 8:00-3:00 M-F. Mom home with pt full-time. Family History: Father: diabetes mellitus Strong family history on the father's side for diabetes. Physical Exam: Admission Physical Exam: Vitals: T:98.6 BP:143/76 P: 121 R: 16 O2: 98/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: slightly distended, nontender, normoactive bowel sounds, firm to palpation b/l lower quadrants, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . Discharge Exam: VS: T 97-100 BP 97-126/50-80 HR 100-105 RR 18-20 O2 Sat 98% RA GEN: NAD HEENT: EOMI, NCAT, low set ears NECK: Supple, unable to asses JVP 2/2 habitus CV: Tachy, nl S1/S2, no S3/S4, no m/r/g PULM: CTAB, no increased WOB ABD: palpable uterus, moderatley distended, NABS, no rigidity, rebound or guarding EXT: WWP, no c/c/e NEURO: Non focal Pertinent Results: Admission Labs: [**2132-8-4**] 07:42PM URINE UCG-NEGATIVE [**2132-8-4**] 07:11PM TYPE-[**Last Name (un) **] PH-7.36 COMMENTS-GREEN TOP [**2132-8-4**] 07:11PM LACTATE-1.5 [**2132-8-4**] 06:53PM GLUCOSE-133* UREA N-11 CREAT-0.7 SODIUM-144 POTASSIUM-4.4 CHLORIDE-115* TOTAL CO2-16* ANION GAP-17 [**2132-8-4**] 06:53PM CALCIUM-8.3* PHOSPHATE-2.0* MAGNESIUM-1.9 [**2132-8-4**] 06:53PM URINE BLOOD-TR NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-80 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2132-8-4**] 06:53PM URINE RBC-<1 WBC-3 BACTERIA-NONE YEAST-NONE EPI-0 [**2132-8-4**] 04:30PM GLUCOSE-197* LACTATE-3.1* K+-4.6 [**2132-8-4**] 03:15PM URINE BLOOD-TR NITRITE-NEG PROTEIN-TR GLUCOSE-1000 KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2132-8-4**] 01:25PM GLUCOSE-417* UREA N-17 CREAT-1.1 SODIUM-143 POTASSIUM-4.8 CHLORIDE-104 TOTAL CO2-13* ANION GAP-31* [**2132-8-4**] 01:25PM WBC-13.9* RBC-4.48 HGB-15.5 HCT-44.8 MCV-100* MCH-34.7* MCHC-34.6 RDW-13.0 [**2132-8-4**] 01:25PM NEUTS-92.7* LYMPHS-4.6* MONOS-2.4 EOS-0.1 BASOS-0.2 . Discharge labs: [**2132-8-9**] 06:25AM BLOOD WBC-8.6 RBC-3.44* Hgb-11.8* Hct-33.4* MCV-97 MCH-34.3* MCHC-35.3* RDW-13.8 Plt Ct-304 [**2132-8-9**] 06:25AM BLOOD Glucose-165* UreaN-7 Creat-0.6 Na-142 K-3.4 Cl-104 HCO3-27 AnGap-14 [**2132-8-8**] 05:25AM BLOOD LD(LDH)-466* [**2132-8-8**] 05:25AM BLOOD Calcium-8.3* Phos-3.0 Mg-1.8 [**2132-8-8**] 05:25AM BLOOD Hapto-436* [**2132-8-5**] 04:11AM BLOOD %HbA1c-8.6* eAG-200* [**2132-8-5**] 04:58AM BLOOD Lactate-1.1 . Imaging: CXR PA/LAT ([**2132-8-4**]): Frontal and lateral chest radiographs demonstrate clear lungs without effusion or pneumothorax. The heart size is normal, the mediastinal contours are unremarkable. . Pelvic Ultrasound ([**2132-8-5**]): On transabdominal imaging, the uterus is enlarged containing multiple fibroids. The uterus measures 14.2 x 12.5 x 10.7 cm. The endometrium is distorted by the multiple fibroids and cannot be clearly delineated. The ovaries are not visualized. Endovaginal exam was declined by clinical team. . CT Abd/Pelvis ([**2132-8-7**]): Multiple fibroids, some of them are intramural and some of them are subserosal. The largest fibroid is an intramural one with cystic degeneration. We cannot rule out an infection within this fibroid. Further gynecologist assessment is recommended. Brief Hospital Course: 32 y/o woman with Down Syndrome, and type 1 DM admitted with hyperglycemia and DKA. # DKA/Fever: This was felt to be brought on by a viral gastroenteritis. She was initially admitted to the MICU and started on an [**Month/Day/Year 31217**] gtt and given IVF repletion. Her sugars improved and she was transferred to the medical floor. She was febrile to 101.5 and had an extensive infectious workup which was negative including serial blood and urine cultures, UA, CXR and CT abdomen. The only finding was a large degenerating uterine fibroid. Case was discussed with OB/GYN who felt that it would be unlikely that this would be the source of fever and that there was no other intervention required. Thyroid labs WNL, lactate WNL, pregnancy test negative. She defervesced and at the time of discharge. . Her mother assured medication and dietary compliance. [**Last Name (un) **] followed throughout her course and uptitrated her [**Last Name (un) 31217**], but recommended returning to admission [**Last Name (un) 31217**] regimen at discharge (pt eats more in the hospital than she does at home). At discharge her BG was 150-250 for >24 hour and all her electrolytes were WNL. . # Nausea and Vomiting: By report, pt had 6-7 episodes of NBNB emesis on the day prior to admission. She continued to have intermittent small volume, clear emesis throughout her course, but had not vomited for >24 hours at the time of discharge. Her nausea was likely related to a viral gastroenteritis. . # Hypothyroidism: continued on home levothyroxine. . # Stye: On the day of discharge, the patient was noted to have developed a new stye on the superior lid of her right eye. A translator was called in and her mother was instructed to administer warm compresses every hour until resolution of the stye. She was given instructions to call the pt's PCP if the stye does not improve, worsens or results in impaired vision, or pain. . # Elevated LDH: Pt was noted to have an elevated LDH in the course of working up her anemia. This result should be followed up by her PCP as an outpatient (pt not thought to be hemolyzing). . Transitional Issues: Mr [**Known lastname **] was discharged with PCP and [**Name9 (PRE) **] [**Name Initial (PRE) **]/u. Important issues to be addressed at these appointments include resolution of stye, repeat LDH, and ongoing BG management. . Medications on Admission: 1. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY 2. [**Name Initial (PRE) **]: (32 humalog 75/25 in AM, 6 humalog in PM and 14 Humulin at night) Discharge Medications: 1. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for fever, pain. 3. [**Name Initial (PRE) 31217**] lispro protam & lispro 100 unit/mL (75-25) Suspension Sig: One (1) 32 units Subcutaneous qam: inject 32 units sub-cutaneous every morning. 4. [**Name Initial (PRE) 31217**] lispro 100 unit/mL Solution Sig: One (1) 6 units Subcutaneous qpm: inject 6 units every afternoon . 5. [**Name Initial (PRE) 31217**] lispro 100 unit/mL Solution Sig: One (1) 14 Subcutaneous at bedtime. Discharge Disposition: Home Discharge Diagnosis: Diabetic Ketoacidosis Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms [**Known lastname **], It was a pleasure caring for you at the [**Hospital1 **]. You were admitted because your blood sugar was dangerously high. For this you were admitted to the intensive care unit, where doctors [**Name5 (PTitle) 20554**] [**Name5 (PTitle) **] [**Name5 (PTitle) 31217**] and fluids to bring your blood glucose down. It is unclear why this happened to you, but you may have had a stomach flu that caused you to be nauseated and vomit, which could have caused your sugars to rise. Your diabetes doctors also followed [**Name5 (PTitle) **] while you were in the hospital; we have arranged for you to see Dr [**Last Name (STitle) 978**] in about 1 week to make sure your blood sugars are well controlled. No changes were made to your medications. It is important that you eat a diabetic diet at home and not eat more or less than instructed by your Endocrinologist, as this may affect your blood sugars. If your sugars are elevated (>350) at home, you should call [**Last Name (un) **] ([**Telephone/Fax (1) 3402**]) and return to the ED if instructed to do so. Additionally, we noticed some swelling around your right eye on the day you were discharged. This is likely a small infection called a stye. For this, you should apply a hot compress to the eye every hour for 15 minutes until the redness goes away. If the redness worsens or you have changes in your vision, you should call your primary care doctor right away. Thank you for allowing us to participate in your care. Followup Instructions: Department: [**Hospital3 249**] When: MONDAY [**2132-8-18**] at 9:50 AM With: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage *This appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor in follow up. Name: [**Last Name (LF) 978**], [**First Name7 (NamePattern1) 7208**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3402**] When: Wednesday, [**8-27**], 2PM Department: [**Hospital3 249**] When: THURSDAY [**2132-10-2**] at 3:15 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 35591**], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

250,584,008,276,758,373,427,218,244,285,V586

{"Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Hypovolemia,Down's syndrome,Hordeolum externum,Other specified cardiac dysrhythmias,Leiomyoma of uterus, unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified,Long-term (current) use of insulin"}

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: Diabetic ketoacidosis PRESENT ILLNESS: 32y Haitian Creole F with hx of Down Syndrome and type I DM presenting with hyperglycemia, BS>500, ketonuria and AG metabolic acidosis. She reported dysuria and vomiting at home but denied on eval. Had no other complaints on arrival. Attends day program. Diabetes mellitus, managed at the [**Last Name (un) **]. She continues on acombination of Humalog and 75/25 mix. Her A1Cs are monitored at [**Last Name (un) **]. Per [**2-/2132**] [**Last Name (un) **] note, emphasis was made to eat reg meals with concern about meal skipping to get better food at hospital. . ED course: Initial vitals were 98.7 122 140/74 16 100% on RA. Chest xray unremarkable. UA (straight cath) notable for ketone 150, gluc 1000, neg nitr or leuk, w few bacteria. Labs notable for lactate 4.9, wbc 13.9, Neut 92.7, no bands, K 4.8, MCV 100, and AG 26. She was started on an [**Last Name (un) 31217**] gtt after 10u regular [**Last Name (un) 31217**] and given 2L of NS, 3L 1/2 NS with KCL. EKG not obtained. Blood cultures sent. Vitals prior to transfer: 109, 135/81, 17, 100% on RA. Access 18 and 20. Repeat lactate 3.1 and K 4.6. Foley catheter placed for UO monitoring. . On the floor, history obtained from mother and cousin [**Name (NI) 483**] speaking) who state that patient was in USOH until last night. She awoke at 0400 to drink [**Location (un) 2452**] juice which mother says patient does when she feels "unwell." She continued to feel ill and received her AM [**Location (un) 31217**] dose of 32u Humalog. She vomited 3 times today and was tolerating water/diet ginger ale and FS glucose were rising so mother brought pt to [**Name (NI) **]. On arrival to the floor her [**Name (NI) 31217**] gtt at 2u/hr and FS 126. She denies recent fever, chills, headache, diarrhea, abd pain, recent illness/sick contacts, dysuria, chest pain or cough. Report increased urinary output. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: 1. Preseptal cellulitis, 02/[**2127**]. 2. Diabetes mellitus type 1 since age 15. Followed by [**Hospital **] Clinic. 3. Hypothyroidism. 4. Down syndrome. MEDICATION ON ADMISSION: 1. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY 2. [**Name Initial (PRE) **]: (32 humalog 75/25 in AM, 6 humalog in PM and 14 Humulin at night) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Vitals: T:98.6 BP:143/76 P: 121 R: 16 O2: 98/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: slightly distended, nontender, normoactive bowel sounds, firm to palpation b/l lower quadrants, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . Discharge Exam: VS: T 97-100 BP 97-126/50-80 HR 100-105 RR 18-20 O2 Sat 98% RA GEN: NAD HEENT: EOMI, NCAT, low set ears NECK: Supple, unable to asses JVP 2/2 habitus CV: Tachy, nl S1/S2, no S3/S4, no m/r/g PULM: CTAB, no increased WOB ABD: palpable uterus, moderatley distended, NABS, no rigidity, rebound or guarding EXT: WWP, no c/c/e NEURO: Non focal FAMILY HISTORY: Father: diabetes mellitus Strong family history on the father's side for diabetes. SOCIAL HISTORY: The patient is originally born here in [**Location (un) 86**]. She speaks and understands English, although she does not talk much. Her mother is originally from [**Country 2045**] and that is why they speak Creole and French. She denied smoking or alcohol. She goes to a day program everyday in [**Hospital1 392**] from 8:00-3:00 M-F. Mom home with pt full-time. ### Response: {"Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Hypovolemia,Down's syndrome,Hordeolum externum,Other specified cardiac dysrhythmias,Leiomyoma of uterus, unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified,Long-term (current) use of insulin"}

CHIEF COMPLAINT: Bleeding from trach site on IV heparin PRESENT ILLNESS: 78 M w/CP on [**10-13**] found to have leak at site of previous anastamosis s/p CABG X3, re-do sternotomy, repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) Failure to wean. Trached. Anticoagulated for mech [**Year (2 digits) 1291**]. Sent to rehab([**Hospital1 **]). Returned to [**Hospital1 18**] on [**2139-11-14**] for eval of trach site bleeding. MEDICAL HISTORY: Bentall, mechanical VR, CABG X 3 10 years ago repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) trach AFib CAD hyperlipidemia HTN MEDICATION ON ADMISSION: coumadin, asa 81, clonazepam 0.5', coenzyme q10 100', HCTZ 12.5', Lanoxin 0.125', lopressor 200', mevacor 10mg', MVI, norvasc 10', heparin drip ALLERGIES: Lasix PHYSICAL EXAM: [**11-17**] - PHYSICAL EXAMINATION: T 97.1 P80-90 BP 110/54 R 21 96% FiO2 0.4 TM I/O 2.2L/1.8L Gen- awake, disoriented HEENT- anicteric, PERRLA, EOMI, moist mucus membrane, neck supple, no JVD CV- regular, no r/m/g resp- decreased breath sound bilateral bases, mild crackles anteriorly ABDOMEN- soft, nontender, nondistended EXT- no edema, surgical scars noted Neuro- follow commands, speech hard to comprehend, tremors/jerky movements noted, PERRLA, EOMI, CNII-XII intact, nml muscle tone, move all 4 symmetrically, gait not tested FAMILY HISTORY: non-contributory SOCIAL HISTORY: married, lives with wife

Other tracheostomy complications,Acute respiratory failure,Alkalosis,Unspecified pleural effusion,Atrial fibrillation,Diastolic heart failure, unspecified,Drug-induced delirium,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Essential and other specified forms of tremor,Other and unspecified hyperlipidemia,Heart valve replaced by other means,Aortocoronary bypass status,Unspecified drug or medicinal substance causing adverse effects in therapeutic use

Tracheostomy comp NEC,Acute respiratry failure,Alkalosis,Pleural effusion NOS,Atrial fibrillation,Diastolc hrt failure NOS,Drug-induced delirium,Hypertension NOS,Cor ath unsp vsl ntv/gft,Tremor NEC,Hyperlipidemia NEC/NOS,Heart valve replac NEC,Aortocoronary bypass,Adv eff medicinal NOS

Admission Date: [**2139-11-14**] Discharge Date: [**2139-11-25**] Date of Birth: [**2061-6-14**] Sex: M Service: MEDICINE Allergies: Lasix Attending:[**First Name3 (LF) 398**] Chief Complaint: Bleeding from trach site on IV heparin Major Surgical or Invasive Procedure: no surgical procedure pleural tap of right effusion History of Present Illness: 78 M w/CP on [**10-13**] found to have leak at site of previous anastamosis s/p CABG X3, re-do sternotomy, repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) Failure to wean. Trached. Anticoagulated for mech [**Year (2 digits) 1291**]. Sent to rehab([**Hospital1 **]). Returned to [**Hospital1 18**] on [**2139-11-14**] for eval of trach site bleeding. Past Medical History: Bentall, mechanical VR, CABG X 3 10 years ago repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) trach AFib CAD hyperlipidemia HTN Social History: married, lives with wife Family History: non-contributory Physical Exam: [**11-17**] - PHYSICAL EXAMINATION: T 97.1 P80-90 BP 110/54 R 21 96% FiO2 0.4 TM I/O 2.2L/1.8L Gen- awake, disoriented HEENT- anicteric, PERRLA, EOMI, moist mucus membrane, neck supple, no JVD CV- regular, no r/m/g resp- decreased breath sound bilateral bases, mild crackles anteriorly ABDOMEN- soft, nontender, nondistended EXT- no edema, surgical scars noted Neuro- follow commands, speech hard to comprehend, tremors/jerky movements noted, PERRLA, EOMI, CNII-XII intact, nml muscle tone, move all 4 symmetrically, gait not tested Pertinent Results: [**2139-11-14**] 09:24PM GLUCOSE-105 UREA N-41* CREAT-1.7* SODIUM-142 POTASSIUM-5.1 CHLORIDE-105 TOTAL CO2-33* ANION GAP-9 [**2139-11-14**] 09:24PM WBC-7.2 RBC-3.24* HGB-10.2* HCT-30.8* MCV-95 MCH-31.6 MCHC-33.2 RDW-18.7* [**2139-11-14**] 11:44PM TYPE-ART TIDAL VOL-500 PEEP-5 PO2-105 PCO2-50* PH-7.44 TOTAL CO2-35* BASE XS-7 INTUBATED-INTUBATED . [**11-17**] Head CT - CONCLUSION: Sphenoid and mastoid air cell partial opacification. Images of the brain demonstrate atrophy but no evidence of hemorrhage or infarction. . [**11-24**] - CXR - IMPRESSION: Improving pulmonary edema. Bilateral pleural effusions, right greater than left. Brief Hospital Course: Pt was initially admitted to the CSRU for eval of trach site bleeding. Heparin was stopped at [**Hospital1 **] prior to admission to [**Hospital1 18**], INR on admission was 1.3, PTT 29.4. The patient received 2 Unnits PRBCs, trach site was packed w/ surgicell. Pt was placed on ventilatory support initially then weaned to trach mask continuous w/ stable resp status. He continued to have large amount of secretions requiring suctioning. Large right pleural effusion was noted on CXR and tapped for 2100cc. Heparin was resumed on [**2139-11-16**] after pleural tap. CXR's were concerning for reaccumulation of effusion, although oxygenation was stable. The patient was initially started on ethacrynic acid for diuresis, however this was held after bicarbonate was noted to rise to 40. VBG revealed nl CO2 of 49. He will need on going trach collar care and weaning as tolerated. For the mechanical valve and a. fib he was continued on heparin drip until INR was therapeutic. Initially started on 4mg and then increased to 6 mg on [**2139-11-24**]. Heparin should be continued and Coumadin dose adjusted appropriately for goal INR 2.5-3.0. . In hospital course was complicated by delerium. Neurology was consulted and work-up including B12, RPR, folate, ammonia were unrevealing, no evidence of hypoxia, head ct negative for bleed, and mental status cleared slowly. Post pyloric dob-hoff was placed on [**11-25**] prior to transfer to rehab. Medications on Admission: coumadin, asa 81, clonazepam 0.5', coenzyme q10 100', HCTZ 12.5', Lanoxin 0.125', lopressor 200', mevacor 10mg', MVI, norvasc 10', heparin drip Discharge Medications: 1. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 2. Tramadol 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 3. Albuterol Sulfate 0.083 % Solution [**Last Name (STitle) **]: One (1) Inhalation Q6H (every 6 hours) as needed. 4. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a day). 5. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR [**Last Name (STitle) **]: One (1) Capsule, Sust. Release 24HR PO HS (at bedtime). 6. Ipratropium Bromide 0.02 % Solution [**Last Name (STitle) **]: [**12-22**] Inhalation Q6H (every 6 hours). 7. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Month/Day (2) **]: Six (6) Puff Inhalation Q4-6H (every 4 to 6 hours) as needed. 8. Albuterol 90 mcg/Actuation Aerosol [**Month/Day (2) **]: Six (6) Puff Inhalation Q6H (every 6 hours) as needed. 9. Docusate Sodium 150 mg/15 mL Liquid [**Month/Day (2) **]: One (1) PO BID (2 times a day). 10. Hexavitamin Tablet [**Month/Day (2) **]: One (1) Cap PO DAILY (Daily). 11. Magnesium Hydroxide 400 mg/5 mL Suspension [**Month/Day (2) **]: Thirty (30) ML PO Q6H (every 6 hours) as needed. 12. Insulin Regular Human 100 unit/mL Solution [**Month/Day (2) **]: One (1) Injection ASDIR (AS DIRECTED): Insulin sliding scale. 13. Miconazole Nitrate 2 % Powder [**Month/Day (2) **]: One (1) Appl Topical QID (4 times a day) as needed. 14. Amiodarone 200 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO DAILY (Daily). 15. Lactulose 10 g/15 mL Syrup [**Month/Day (2) **]: Thirty (30) ML PO BID (2 times a day) as needed for constilpation. 16. Heparin (Porcine) in D5W 100 unit/mL Parenteral Solution [**Month/Day (2) **]: One (1) Intravenous ASDIR (AS DIRECTED): Goal PTT 50-70. 17. Warfarin 2 mg Tablet [**Month/Day (2) **]: Three (3) Tablet PO DAILY (Daily). 18. Isosorbide Dinitrate 10 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO TID (3 times a day). 19. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN 10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units heparin) each lumen Daily and PRN. Inspect site every shift. 20. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 1121**] - [**Location (un) 1456**] Discharge Diagnosis: Respiratory failure Atrial fibrillation Mechanical valve re-do sternotomy, CABG X 3 repair ascending aortic graft on [**2139-10-14**] s/p mediastinal exploration for bleeding & delayed chest closure, s/p trach complicated by bleeding. Discharge Condition: deconditioned Discharge Instructions: Please continue to administer all medications as below and follow up with appointments as below. If you have any difficulty breathing, fevers, shortness of breath or bleeding episodes please return to the emergency room. Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] regarding any issues with his tracheostomy. [**Last Name (NamePattern4) 2138**]p Instructions: Call Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] office [**Telephone/Fax (1) 170**] for a follow up appointment. Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] regarding any issues with his tracheostomy. Completed by:[**2139-11-25**]

519,518,276,511,427,428,292,401,414,333,272,V433,V458,E947

{'Other tracheostomy complications,Acute respiratory failure,Alkalosis,Unspecified pleural effusion,Atrial fibrillation,Diastolic heart failure, unspecified,Drug-induced delirium,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Essential and other specified forms of tremor,Other and unspecified hyperlipidemia,Heart valve replaced by other means,Aortocoronary bypass status,Unspecified drug or medicinal substance 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: Bleeding from trach site on IV heparin PRESENT ILLNESS: 78 M w/CP on [**10-13**] found to have leak at site of previous anastamosis s/p CABG X3, re-do sternotomy, repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) Failure to wean. Trached. Anticoagulated for mech [**Year (2 digits) 1291**]. Sent to rehab([**Hospital1 **]). Returned to [**Hospital1 18**] on [**2139-11-14**] for eval of trach site bleeding. MEDICAL HISTORY: Bentall, mechanical VR, CABG X 3 10 years ago repair ascending aorta graft (Nemtal SJ valve, Cobral) [**10-14**] and takeback for closure [**10-15**]. s/p Bentall w/[**Doctor Last Name 10010**] modification/mech St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**]/CABGx2 ('[**28**]) trach AFib CAD hyperlipidemia HTN MEDICATION ON ADMISSION: coumadin, asa 81, clonazepam 0.5', coenzyme q10 100', HCTZ 12.5', Lanoxin 0.125', lopressor 200', mevacor 10mg', MVI, norvasc 10', heparin drip ALLERGIES: Lasix PHYSICAL EXAM: [**11-17**] - PHYSICAL EXAMINATION: T 97.1 P80-90 BP 110/54 R 21 96% FiO2 0.4 TM I/O 2.2L/1.8L Gen- awake, disoriented HEENT- anicteric, PERRLA, EOMI, moist mucus membrane, neck supple, no JVD CV- regular, no r/m/g resp- decreased breath sound bilateral bases, mild crackles anteriorly ABDOMEN- soft, nontender, nondistended EXT- no edema, surgical scars noted Neuro- follow commands, speech hard to comprehend, tremors/jerky movements noted, PERRLA, EOMI, CNII-XII intact, nml muscle tone, move all 4 symmetrically, gait not tested FAMILY HISTORY: non-contributory SOCIAL HISTORY: married, lives with wife ### Response: {'Other tracheostomy complications,Acute respiratory failure,Alkalosis,Unspecified pleural effusion,Atrial fibrillation,Diastolic heart failure, unspecified,Drug-induced delirium,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Essential and other specified forms of tremor,Other and unspecified hyperlipidemia,Heart valve replaced by other means,Aortocoronary bypass status,Unspecified drug or medicinal substance causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: fever PRESENT ILLNESS: 39 yo F with PMH significant for ESRD on HD [**3-12**] diabetic nephropathy, type I DM, HTN, hypercholesterolemia who presents today with fever at dialysis. The pt states she was in USOH when she went to dialysis today at [**Hospital1 3494**]. She reports she was "just hooked up to the machine" when she had a fever to 103 F associated with rigors and myalgias. Given Vancomycin 1 gm X 1 at HD and transferred to ED for further evaluation. The pt denies pain, redness, swelling, discharge from R SCV HD line which she has had for 7 months after her AVF "stopped working". Denies recent sick contacts, travel, headache, nausea, vomiting, diarrhea, abominal pain, chest pain, shortness of breath. . In the ED, T 104.2, BP 172/68, HR 112, RR 20, O2 sat 98% on RA. Given 2L IVF, 1 gm tylenol and motrin 600 mg X 1 with defervescence, ciprofloxacin 400 mg IV X 1, and gentamicin 30 mg IV X 1. Seen by renal and transplant surgery. Admitted to medicine for likely line infection and treatment with IV abx. MEDICAL HISTORY: 1. Type 1 DM 2. Hypercholesterolemia 3. HTN 4. ESRD [**3-12**] DM - pre-op for renal transplant 5. blindness in Right eye 6. Left leg weakness 7. Goiter MEDICATION ON ADMISSION: Sevelamer 800 mg tid Calcium Acetate 667 mg tid Pravastatin 40 mg qd Ursodiol 500 mg [**Hospital1 **] Nifedical 60 mg qd Metoprolol 100 mg [**Hospital1 **] Lisinopril 40 mg qd Losartan 25 mg qd Aspirin 325 mg qd Folic Acid 1 mg qd Docusate Sodium 100 mg [**Hospital1 **] Multivitamin,Tx-Minerals 1 tab qd Pantoprazole 40 mg qd Lantus 8 U qam Epogen 3700 qHD Hectoral 5 mg qHD ALLERGIES: Zocor PHYSICAL EXAM: PE: Tm 104.2 Tc 98.9 BP 125/62 HR 95 RR 18 100% on room air FS 417 Gen: thin female, laying comfortably in bed. No acute distress. Alert and oriented to person, place, and date. HEENT: Yellow dentition. Left pupil reactive to light. Sclerae anicteric. Right eye blind. MMM, OP clear, neck supple, no LAD, R SCV permacath with dressing c/d/i, no overlying warmth, erythema, non-tender to palpation, no drainage. CV: RRR. Normal S1 and S2. II/VI systolic murmur heard over LSB (not documented on prior d/c summary) Chest: CTA bilaterally. no w/r/r. Abd: Soft, NT, ND, normoactive BS Ext: no LE edema, + 2 DP pulses b/l, no palpable thrill over site of L arm AVF, no bruit appreciated. FAMILY HISTORY: Multiple family members on father's side with DM II. Denies family h/o CAD, CA. SOCIAL HISTORY: Lives at home with her mother, stepfather and sister. She denies

Infection and inflammatory reaction due to other vascular device, implant, and graft,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Esophageal hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bacteremia,Pure hypercholesterolemia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia of other chronic disease,Other iatrogenic hypotension,Goiter, unspecified

React-oth vasc dev/graft,DMI renl nt st uncntrld,Esophageal hemorrhage,Hyp kid NOS w cr kid V,End stage renal disease,Bacteremia,Pure hypercholesterolem,Mth sus Stph aur els/NOS,Anemia-other chronic dis,Iatrogenc hypotnsion NEC,Goiter NOS

Admission Date: [**2178-12-30**] Discharge Date: [**2179-1-14**] Date of Birth: [**2139-2-28**] Sex: F Service: MEDICINE Allergies: Zocor Attending:[**First Name3 (LF) 49413**] Chief Complaint: fever Major Surgical or Invasive Procedure: permenant tunneled line placement picc placement temporary dialysis line placement EGD x 2 History of Present Illness: 39 yo F with PMH significant for ESRD on HD [**3-12**] diabetic nephropathy, type I DM, HTN, hypercholesterolemia who presents today with fever at dialysis. The pt states she was in USOH when she went to dialysis today at [**Hospital1 3494**]. She reports she was "just hooked up to the machine" when she had a fever to 103 F associated with rigors and myalgias. Given Vancomycin 1 gm X 1 at HD and transferred to ED for further evaluation. The pt denies pain, redness, swelling, discharge from R SCV HD line which she has had for 7 months after her AVF "stopped working". Denies recent sick contacts, travel, headache, nausea, vomiting, diarrhea, abominal pain, chest pain, shortness of breath. . In the ED, T 104.2, BP 172/68, HR 112, RR 20, O2 sat 98% on RA. Given 2L IVF, 1 gm tylenol and motrin 600 mg X 1 with defervescence, ciprofloxacin 400 mg IV X 1, and gentamicin 30 mg IV X 1. Seen by renal and transplant surgery. Admitted to medicine for likely line infection and treatment with IV abx. Past Medical History: 1. Type 1 DM 2. Hypercholesterolemia 3. HTN 4. ESRD [**3-12**] DM - pre-op for renal transplant 5. blindness in Right eye 6. Left leg weakness 7. Goiter Social History: Lives at home with her mother, stepfather and sister. She denies tobacco, alcohol, and IVDU. Family History: Multiple family members on father's side with DM II. Denies family h/o CAD, CA. Physical Exam: PE: Tm 104.2 Tc 98.9 BP 125/62 HR 95 RR 18 100% on room air FS 417 Gen: thin female, laying comfortably in bed. No acute distress. Alert and oriented to person, place, and date. HEENT: Yellow dentition. Left pupil reactive to light. Sclerae anicteric. Right eye blind. MMM, OP clear, neck supple, no LAD, R SCV permacath with dressing c/d/i, no overlying warmth, erythema, non-tender to palpation, no drainage. CV: RRR. Normal S1 and S2. II/VI systolic murmur heard over LSB (not documented on prior d/c summary) Chest: CTA bilaterally. no w/r/r. Abd: Soft, NT, ND, normoactive BS Ext: no LE edema, + 2 DP pulses b/l, no palpable thrill over site of L arm AVF, no bruit appreciated. Pertinent Results: Initial labs: [**2178-12-30**] 01:20PM WBC-10.3# RBC-4.45 HGB-12.1 HCT-34.8*# MCV-78* MCH-27.1 MCHC-34.7 RDW-16.1* [**2178-12-30**] 01:20PM NEUTS-93.0* BANDS-0 LYMPHS-4.8* MONOS-1.7* EOS-0.4 BASOS-0 [**2178-12-30**] 01:20PM PLT SMR-NORMAL PLT COUNT-257 [**2178-12-30**] 01:20PM PT-13.4* PTT-47.9* INR(PT)-1.2* [**2178-12-30**] 01:20PM CALCIUM-7.9* PHOSPHATE-1.8*# MAGNESIUM-1.6 [**2178-12-30**] 01:20PM GLUCOSE-245* UREA N-19 CREAT-3.2*# SODIUM-137 POTASSIUM-3.2* CHLORIDE-94* TOTAL CO2-29 ANION GAP-17 [**2178-12-30**] 01:39PM GLUCOSE-241* LACTATE-1.5 NA+-137 K+-5.6* CL--99* [**2178-12-30**] 09:21PM POTASSIUM-3.5 . EKG: NSR @ 86 bpm, nl axis, nl intervals, LVH, TWI I, aVL, V2-V6, no peaked T waves. (new TWI V4-V6 compared to prior EKG [**8-13**]) . Imaging: [**12-30**] CXR - There has been interval placement of a large bore dual lumen catheter from right internal jugular approach. The distal tip is near the cavoatrial junction. The lungs are clear. The mediastinum is otherwise unremarkable. No pleural effusion or pneumothorax is seen. The visualized osseous structures are unremarkable. TTE: The left atrium is normal in size. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF 60%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. No masses or vegetations are seen on the aortic valve. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. No mass or vegetation is seen on the mitral valve. There is moderate pulmonary artery systolic hypertension. No vegetation/mass is seen on the pulmonic valve. There is no pericardial effusion. TEE 1. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. 2. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. There are multiple, mobile, very thin, fibrinous strands on the mitral annulus and valve, which probably do not represent infective endocarditis. 3. Compared with the prior study (images reviewed) of [**2179-1-1**], there is no significant change. [**1-7**] CXR: 1. No free air. 2. New small left lower lobe opacity, most likely atelectasis, although pneumonia cannot be excluded. 3. Appearance suggesting a small new left loculated pleural effusion. Findings discussed with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **]. RUQ US 1. Cholelithiasis without cholecystitis 2. Large right pleural effusion. 3. Echogenic and small right kidney consistent with the given history of renal failure. [**1-13**] CXR 1. New patchy left lower lobe opacity, concerning for infectious process such as pneumonia. 2. Right-sided PICC line croses midline into the left brachiocephalic vein. . Micro: Blood culture drawn off HD line at HD center - 4/4 bottles Staph Aureus sensitive to naficillin Blood culture [**12-30**] on admission - 1/4 bottles MSSA Blood cultures 11/23, [**1-1**] negative Blood culture [**1-2**]: CAPNOCYTOPHAGA SPECIES}; ANAEROBIC BOTTLE-FINAL {LACTOBACILLUS SPECIES, VEILLONELLA SPECIES, PREVOTELLA SPECIES} Blood cultures: [**Date range (1) 49484**], [**1-11**], [**1-12**]: negative Discharge labs: wbc 11.6 hgb 10.5 hct 30 plt 225 141 101 15 -----------< 106 4 29 3.5 Brief Hospital Course: 39 yo F c ESRD on HD with R SCV permacath HD line X 7 months, DM type I, HTN presents with fevers to 104.2 at dialysis, here with line infection and MSSA bacteremia. . 1) Fever - Pt with elevated temperature, tachycardia, and relative hypotension on admission concerning for peri-septic picture. Was placed on IV Vancomycin, dosed by level, IV Cipro, and IV Gentamicin dosed at HD for broad-spectrum coverage. BP meds were held on admission. Seen by both transplant surgery and renal consult in ED who recommended that HD line be kept in the interim until blood cultures positive off line. [**Name (NI) **] pt's HD center who confirmed that blood cultures drawn at HD center off HD line significant for 4/4 bottles of staph aureus sensitive to oxacillin, 1/2 blood cultures also positive here for staph aureus sensitive to oxacillin. As BPs stable, AF, and WBC stable, line was kept and pt dialyzed through line on the third hospital day to maintain her usual HD schedule. At HD, spiked temperature to 101.5 and became tachycardic and BPs elevated. Given dose of IV Vancomycin. The following day, blood cultures on admission with MSSA and vancomycin switched to IV Nafcillin. On [**1-2**] surveillance cx were positive for prevotella, lactobacillus, capnocytophagia and speciations were not done. Patient was already on zosyn which was continued for total of 14 days. Meropenem was briefly added for 1-2 doses when pts blood pressure dropped, but zosyn was resumed. Multiple surveillance cx were negative thereafter. Patient had a new permenant dialysis catheter placed. . 2) ESRD on HD - Seen by renal and transplant [**Doctor First Name **] consult. Pt usually on M/W/F HD schedule. Was dialyzed on third hospital day as above with spike in temperature. Given blood cultures off line at HD center and blood cultures on admission here positive for MSSA, R SCV tunneled line d/c'd. Patient had temporary line placed and then a permenant tunneled line. Pt with L AVF and per op note [**6-13**], thrombectomy of thrombosed AVF performed; however pt has had tunneled HD cath since [**6-13**] and reports her HD center being unable to access graft. . 3) DM type I - HbA1c 7.9 [**11-13**]. Reports taking lantus 8 U qam at home with HISS. Initially had a very elevated FS in 400s on admisison without anion-gap metabolic acidosis which resolved with 14 U Humalog. Placed on 10 U lantus qam for increased glycemic control in setting of infection, FS qid, and HISS. As infection cleared, patient had low blood sugars on this regimen and lantus was decreased to 5 units. . 4) HTN - Pt with relative hypotension on admission and BP meds held. During hospital course, BPs increased and BP meds were restarted, including metoprolol 100 mg [**Hospital1 **], lisinopril 40 mg qd, and nifedipine 60 mg qd. ASA continued. After TEE, pt had esophagitis and upper GI bleed which caused hypotension. All BP meds were again stopped. After bleeding was under control, metoprolol, nifedipine, lisinopril and diovan were restarted. . 5) Hypercholesterolemia - Pt refused lipitor stating that lipitor was "killing her liver" and her MD told her to d/c it. Deferred to outpt management and d/c lipitor. . 6) Anemia - Baseline Hct mid 30s. Hct currently at baseline. Iron studies suggest anemia of chronic disease. On epo at HD. . 7.) UGIB- this occurred in setting of elevated coags (DIC labs negative) and TEE trauma. Patient was hypotensive and had several episodes of hemoptysis. Transferred to unit. Given FFP, PRBCs, DDAVP, and protamine. Patient had EGD which showed erosive esophagitis and clot, but no active bleeding. Protonix [**Hospital1 **] started. Follow-up EGD showed no active bleeding. Patient should have EGD in one month. Hematocrit stable after 2nd EGD. Medications on Admission: Sevelamer 800 mg tid Calcium Acetate 667 mg tid Pravastatin 40 mg qd Ursodiol 500 mg [**Hospital1 **] Nifedical 60 mg qd Metoprolol 100 mg [**Hospital1 **] Lisinopril 40 mg qd Losartan 25 mg qd Aspirin 325 mg qd Folic Acid 1 mg qd Docusate Sodium 100 mg [**Hospital1 **] Multivitamin,Tx-Minerals 1 tab qd Pantoprazole 40 mg qd Lantus 8 U qam Epogen 3700 qHD Hectoral 5 mg qHD Discharge Medications: 1. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 4. Epoetin Alfa 10,000 unit/mL Solution Sig: as directed Injection ASDIR (AS DIRECTED). Disp:*qs qs* Refills:*2* 5. Sevelamer 800 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours) for 1 months. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 9. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*180 Capsule(s)* Refills:*2* 10. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Insulin Glargine 100 unit/mL Solution Sig: Five (5) units Subcutaneous once a day: take in am. Disp:*qs qs* Refills:*2* 12. Humalog 100 unit/mL Solution Sig: as directed Subcutaneous four times a day: see sliding scale. Disp:*qs qs* Refills:*2* 13. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. Disp:*30 Tablet Sustained Release(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary 1. Line sepsis 2. UGIB [**3-12**] esophagitis 3. HTN 4. DM 5. ESRD Discharge Condition: HD stable and afebrile. Discharge Instructions: You were admitted with fever and elevated white count and found to have an infection of your dialysis line. You were treated for 14 days with antibiotics IV. While in the hospital, you had a GI bleed from your esophagus requiring protonix therapy twice daily and a follow-up EGD in 1 month. Your blood counts have been stable. In addition, you have a small infiltrate on chest xray which may suggest pneumonia. You were already on antibiotics and Dr. [**Last Name (STitle) 4888**] wants to follow you closely and not add additional antibiotics at this time. Please take all medications as directed. Please follow-up with all outpatient appointments. Please return to the ED or call Dr. [**Last Name (STitle) 4888**] if you experience fevers, chills, shortness of breath, cough, chest pain, worsening diarrhea or any other concerning symptoms. Please be sure to take the protonix twice a day and avoid spicy foods for the next few weeks. Please take to Dr [**Last Name (STitle) 4888**] about scheduling a bilateral upper extremity venogram to assess your veins for dialysis access. Followup Instructions: Dr [**Last Name (STitle) 4888**] would like to see you in her office tomorrow, Friday [**2179-1-15**] at 1:45. Please see Dr. [**Last Name (STitle) 4888**] on Monday [**1-18**] at 1:30. Her phone number is [**Telephone/Fax (1) 6820**]. . You also need a follow-up EGD in one month. Please go to your appointment on [**3-1**] and arrive at 7am on the [**Location (un) **] of the [**Hospital Ward Name 121**] Building with Dr. [**First Name (STitle) 2643**]. . Please go to dialysis tomorrow. ([**Doctor First Name **] please call her unit and tell them she will be back tomorrow).

996,250,530,403,585,790,272,041,285,458,240

{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Esophageal hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bacteremia,Pure hypercholesterolemia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia of other chronic disease,Other iatrogenic hypotension,Goiter, 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: fever PRESENT ILLNESS: 39 yo F with PMH significant for ESRD on HD [**3-12**] diabetic nephropathy, type I DM, HTN, hypercholesterolemia who presents today with fever at dialysis. The pt states she was in USOH when she went to dialysis today at [**Hospital1 3494**]. She reports she was "just hooked up to the machine" when she had a fever to 103 F associated with rigors and myalgias. Given Vancomycin 1 gm X 1 at HD and transferred to ED for further evaluation. The pt denies pain, redness, swelling, discharge from R SCV HD line which she has had for 7 months after her AVF "stopped working". Denies recent sick contacts, travel, headache, nausea, vomiting, diarrhea, abominal pain, chest pain, shortness of breath. . In the ED, T 104.2, BP 172/68, HR 112, RR 20, O2 sat 98% on RA. Given 2L IVF, 1 gm tylenol and motrin 600 mg X 1 with defervescence, ciprofloxacin 400 mg IV X 1, and gentamicin 30 mg IV X 1. Seen by renal and transplant surgery. Admitted to medicine for likely line infection and treatment with IV abx. MEDICAL HISTORY: 1. Type 1 DM 2. Hypercholesterolemia 3. HTN 4. ESRD [**3-12**] DM - pre-op for renal transplant 5. blindness in Right eye 6. Left leg weakness 7. Goiter MEDICATION ON ADMISSION: Sevelamer 800 mg tid Calcium Acetate 667 mg tid Pravastatin 40 mg qd Ursodiol 500 mg [**Hospital1 **] Nifedical 60 mg qd Metoprolol 100 mg [**Hospital1 **] Lisinopril 40 mg qd Losartan 25 mg qd Aspirin 325 mg qd Folic Acid 1 mg qd Docusate Sodium 100 mg [**Hospital1 **] Multivitamin,Tx-Minerals 1 tab qd Pantoprazole 40 mg qd Lantus 8 U qam Epogen 3700 qHD Hectoral 5 mg qHD ALLERGIES: Zocor PHYSICAL EXAM: PE: Tm 104.2 Tc 98.9 BP 125/62 HR 95 RR 18 100% on room air FS 417 Gen: thin female, laying comfortably in bed. No acute distress. Alert and oriented to person, place, and date. HEENT: Yellow dentition. Left pupil reactive to light. Sclerae anicteric. Right eye blind. MMM, OP clear, neck supple, no LAD, R SCV permacath with dressing c/d/i, no overlying warmth, erythema, non-tender to palpation, no drainage. CV: RRR. Normal S1 and S2. II/VI systolic murmur heard over LSB (not documented on prior d/c summary) Chest: CTA bilaterally. no w/r/r. Abd: Soft, NT, ND, normoactive BS Ext: no LE edema, + 2 DP pulses b/l, no palpable thrill over site of L arm AVF, no bruit appreciated. FAMILY HISTORY: Multiple family members on father's side with DM II. Denies family h/o CAD, CA. SOCIAL HISTORY: Lives at home with her mother, stepfather and sister. She denies ### Response: {'Infection and inflammatory reaction due to other vascular device, implant, and graft,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Esophageal hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bacteremia,Pure hypercholesterolemia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia of other chronic disease,Other iatrogenic hypotension,Goiter, unspecified'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 74yo woman with h/o CAD s/p MI and CABG, MVR with porcine valve in [**2141**], chronic GI bleed [**1-1**] AVMs, recent tibial, fibular, and pelvic fractures, who presents from rehab with chest pain and dyspnea. Patient reports that 2 nights prior to admission, she had acute chest pain to the left of her sternum radiating to her arm and back. Pain felt like a pressure and was associated with dyspnea, nausea, and sweating. She also notes increased dyspnea that does not have a positional component over the last week. Patient received nitroglycerin and ASA without relief of her pain, and she was transferred to an OSH, where she ruled in for NSTEMI with peak TnI of 1.17. Echo done at OSH was significant for newly depressed EF (10-20% vs normal EF in [**2145-7-31**]). Heparin and integrilin gtt were started. Patient also had b/l LE ultrasound which was negative for DVT. . She is now transferred to [**Hospital1 18**] for cardiac cath. Of note, the patient woke at 4am today with 15/10 chest pain across her chest, relieved by fentanyl but not by nitroglycerin. Pain was reproducible on exam. She now c/o [**2148-1-3**] chest pain; she is not feeling SOB. MEDICAL HISTORY: Dyslipidemia IMI in [**2135**] treated with thrombolytics CABG: SVG to Ramus in [**2141**], concurrent MVR with 25mm porcine valve Occult GI bleeding [**1-1**] upper and lower AVMs, for which she has required numerous transfusions, most recently 1 unit [**Unit Number **] weeks ago and 2 units about 3 weeks ago GERD Diverticulosis s/p bilateral hip replacements with revision on the right recent fall with R tibia-fibula fractures recent pelvic fracture--3 weeks ago costochondritis pseudogout fibromyalgia anxiety depression . PCP: [**Name10 (NameIs) 60169**] [**Name11 (NameIs) **] Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . ALLERGIES: PCN-->rash and pruritus and hands swell morphine -->pruritus, reports she tolerates morphine when given benadryl MEDICATION ON ADMISSION: vicodin 5/500 1-2 tabs Q6 prn compazine 5mg po Q6 prn tylenol prn bisacodyl PR prn MVI daily simethicone 80mg tid baclofen 10mg tid gabapentin 300mg tid lidoderm to R hip lovenox 40mg subcut. daily NTG patch 0.2mg/hour on 12 hrs/off 12 hours ranitidine 150mg QHS zocor 40mg QHS sucralfate 1gm tid with meals fentanyl 50mcg/hr patch Q3D Aciphex 20mg [**Hospital1 **] ASA 81mg daily colace [**Hospital1 **] prn Folate 1mg QHS Colchicine 0.6mg po BID Lorazepam 1mg HS PRN anxiety Trazodone 600mg QHS [**Doctor First Name **] Vitamin D Vitamin B shot monthly ALLERGIES: Penicillins / Morphine Sulfate PHYSICAL EXAM: VS: 98.2 97.0 88/50 (SBP 88-125), 61 16 100% 3L GENERAL: No apparent distress, alert & oriented x 3, appropriate FAMILY HISTORY: +Mother w/ MI at 54yo (also a diabetic) Maternal uncle with MI at 42yo 2 half-sisters with DM SOCIAL HISTORY: Currently in rehab/short term [**Hospital1 1501**] at [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 731**] in [**Location (un) 47**]; otherwise, lives with husband in [**Name (NI) 47**]. Quit smoking 25 years ago (+tob x 15-20 years). No etoh, or illicit drug use.

Other chest pain,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Coronary atherosclerosis of unspecified type of vessel, native or graft,Tietze's disease,Myalgia and myositis, unspecified,Other chronic pulmonary heart diseases,Old myocardial infarction,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, other specified sites,Dysthymic disorder,Other specified hypotension,Other and unspecified hyperlipidemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Aortocoronary bypass status,Heart valve replaced by other means,Hip joint replacement,Long-term (current) use of aspirin

Chest pain NEC,Angio intes w hmrhg,Prim cardiomyopathy NEC,Cor ath unsp vsl ntv/gft,Tietze's disease,Myalgia and myositis NOS,Chr pulmon heart dis NEC,Old myocardial infarct,Esophageal reflux,Dvrtclo colon w/o hmrhg,Dis calcium metablsm NEC,Chondrocalc NOS-oth site,Dysthymic disorder,Hypotension NEC,Hyperlipidemia NEC/NOS,Elev transaminase/ldh,Aortocoronary bypass,Heart valve replac NEC,Joint replaced hip,Long-term use of aspirin

Admission Date: [**2145-10-12**] Discharge Date: [**2145-10-15**] Date of Birth: [**2071-10-8**] Sex: F Service: MEDICINE Allergies: Penicillins / Morphine Sulfate Attending:[**First Name3 (LF) 14820**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: Cardiac Catheterization History of Present Illness: 74yo woman with h/o CAD s/p MI and CABG, MVR with porcine valve in [**2141**], chronic GI bleed [**1-1**] AVMs, recent tibial, fibular, and pelvic fractures, who presents from rehab with chest pain and dyspnea. Patient reports that 2 nights prior to admission, she had acute chest pain to the left of her sternum radiating to her arm and back. Pain felt like a pressure and was associated with dyspnea, nausea, and sweating. She also notes increased dyspnea that does not have a positional component over the last week. Patient received nitroglycerin and ASA without relief of her pain, and she was transferred to an OSH, where she ruled in for NSTEMI with peak TnI of 1.17. Echo done at OSH was significant for newly depressed EF (10-20% vs normal EF in [**2145-7-31**]). Heparin and integrilin gtt were started. Patient also had b/l LE ultrasound which was negative for DVT. . She is now transferred to [**Hospital1 18**] for cardiac cath. Of note, the patient woke at 4am today with 15/10 chest pain across her chest, relieved by fentanyl but not by nitroglycerin. Pain was reproducible on exam. She now c/o [**2148-1-3**] chest pain; she is not feeling SOB. Past Medical History: Dyslipidemia IMI in [**2135**] treated with thrombolytics CABG: SVG to Ramus in [**2141**], concurrent MVR with 25mm porcine valve Occult GI bleeding [**1-1**] upper and lower AVMs, for which she has required numerous transfusions, most recently 1 unit [**Unit Number **] weeks ago and 2 units about 3 weeks ago GERD Diverticulosis s/p bilateral hip replacements with revision on the right recent fall with R tibia-fibula fractures recent pelvic fracture--3 weeks ago costochondritis pseudogout fibromyalgia anxiety depression . PCP: [**Name10 (NameIs) 60169**] [**Name11 (NameIs) **] Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . ALLERGIES: PCN-->rash and pruritus and hands swell morphine -->pruritus, reports she tolerates morphine when given benadryl Social History: Currently in rehab/short term [**Hospital1 1501**] at [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 731**] in [**Location (un) 47**]; otherwise, lives with husband in [**Name (NI) 47**]. Quit smoking 25 years ago (+tob x 15-20 years). No etoh, or illicit drug use. Family History: +Mother w/ MI at 54yo (also a diabetic) Maternal uncle with MI at 42yo 2 half-sisters with DM Physical Exam: VS: 98.2 97.0 88/50 (SBP 88-125), 61 16 100% 3L GENERAL: No apparent distress, alert & oriented x 3, appropriate HEENT: EOMI, pale conjunctiva. Oral mucosa moist and clear. NECK: supple. No carotid bruits. No thyromegaly or nodule. CHEST: scar from prior sternotomy w/ minor scabbing, no scoliosis or kyphosis. Lungs clear b/l CVS: RRR, nl S1/S2. No M/R/G. ABD: +BS. soft, NT/ND. The abdominal aorta was not palpated. No hepatosplenomegaly. EXT: Warm, without edema. NEURO: alert, oriented, answers questions appropriately . Pulses: Right: Carotid 2+ Femoral 2+ DP 2+ Left: Carotid 2+ Femoral 2+ DP 2+ Pertinent Results: [**2145-10-12**] 09:44PM BLOOD WBC-5.2 RBC-4.16* Hgb-12.4 Hct-37.1 MCV-89 MCH-29.9 MCHC-33.6 RDW-13.2 Plt Ct-259 [**2145-10-15**] 07:50AM BLOOD WBC-6.3 RBC-3.98* Hgb-11.9* Hct-34.8* MCV-88 MCH-29.8 MCHC-34.1 RDW-13.0 Plt Ct-205 [**2145-10-15**] 07:50AM BLOOD PT-13.1 PTT-31.0 INR(PT)-1.1 [**2145-10-12**] 09:44PM BLOOD Glucose-111* UreaN-23* Creat-1.3* Na-139 K-3.6 Cl-100 HCO3-30 AnGap-13 [**2145-10-13**] 04:45AM BLOOD Glucose-202* UreaN-23* Creat-1.5* Na-137 K-3.8 Cl-96 HCO3-30 AnGap-15 [**2145-10-13**] 07:44PM BLOOD Glucose-125* UreaN-19 Creat-1.2* Na-140 K-3.7 Cl-102 HCO3-29 AnGap-13 [**2145-10-15**] 07:50AM BLOOD Glucose-98 UreaN-19 Creat-1.1 Na-139 K-4.6 Cl-101 HCO3-29 AnGap-14 [**2145-10-12**] 09:44PM BLOOD ALT-32 AST-39 LD(LDH)-223 CK(CPK)-48 AlkPhos-72 TotBili-0.5 [**2145-10-15**] 07:50AM BLOOD ALT-74* AST-76* LD(LDH)-276* AlkPhos-82 Amylase-51 TotBili-0.5 [**2145-10-12**] 09:44PM BLOOD CK-MB-NotDone cTropnT-0.17* proBNP-[**Numeric Identifier **]* [**2145-10-13**] 04:45AM BLOOD CK-MB-NotDone cTropnT-0.24* [**2145-10-14**] 03:34AM BLOOD CK-MB-NotDone cTropnT-0.18* [**2145-10-12**] 09:44PM BLOOD ALT-32 AST-39 LD(LDH)-223 CK(CPK)-48 AlkPhos-72 TotBili-0.5 [**2145-10-13**] 04:45AM BLOOD CK(CPK)-93 [**2145-10-12**] 09:44PM BLOOD Triglyc-99 HDL-54 CHOL/HD-2.5 LDLcalc-61 . EKG: NSR with normal axis, inf Q waves and TWI in inferior and lateral leads, new compared to [**2141**] (T waves flat at that time). . 2D-ECHOCARDIOGRAM: [**2145-8-16**] (report from [**Hospital1 **]): "LVH, normal LV fxn, mild to mod pulmonic insufficiency" [**2145-10-12**] (report from [**Hospital1 **]): "limited 2d-echocardiogram: dense septal and apical akinesis with EF 10-20%, profoundly changed from prior." . ETT: p-[**First Name9 (NamePattern2) 1608**] [**2145-8-20**] (report from [**Hospital1 **]): "no significant perfusion defects" . CARDIAC CATH: ([**Hospital1 **] in [**2141**]): 40% occluded RCA, 50% LMCA . LABORATORY DATA: from [**Hospital1 **]: CPK 28-->43-->44 TnI 0.04-->1.17-->1.10 . CXR [**10-12**]: Cardiac size is top normal. The patient is post median sternotomy CABG and MVR. The lungs are grossly clear. There is no evidence of CHF or pneumonia. There are no sizeable pleural effusions. . CT abdomen/pelvis without contrast [**2145-10-13**]: 1. No evidence of intra-abdominal or retroperitoneal hematoma to account for patient's hematocrit drop. Hematoma in the left iliopsoas region likely relates to subacute pelvic fractures. 2. Left lobe hepatic cyst. 3. Small bilateral pleural effusions and atelectasis. . TTE [**2145-10-14**]: The left atrium is mildly dilated. Left ventricular wall thicknesses and cavity size are normal. Regional left ventricular wall motion is normal. There is mild global left ventricular hypokinesis (LVEF = 45-50%). The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. A bioprosthetic mitral valve prosthesis is present. The mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. Trivial mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion IMPRESSION: Mild global left ventricular systolic dysfunction. Normally-functioning mitral valve bioprosthesis. . Cardiac Cath [**2145-10-13**] (prelim report): No flow-limiting lesions; patent graft Brief Hospital Course: 74yo woman with CAD s/p CABG, chronic GI bleed from AVMs, and recent pelvic fracture who presents with chest pain. . # Chest pain: In setting of small troponin leak and new LV dysfunction, patient was initially suspected of having CAD, put on heparin gtt, and brought to cath lab. She did not have any flow-limiting lesions and her graft was patent (final report pending). Alternative explanations for her presentation were considered, including viral myocarditis or Takotsubo syndrome. Repeat echocardiogram done at [**Hospital1 18**], however, showed only mild global hypokinesis with EF 45%, which did not suggest Takutsobu syndrome. Moreover, her CKs were never elevated. The patient has multiple other potential causes of chest pain, including costochondritis, fibromyalgia, and anxiety. PE was deemed unlikely given that patient has been on lovenox and her RV pressures were not significantly elevated at cath. Some of her pain is reproducible on exam, suggesting a musculoskeletal component. She was put on IV morphine with good control of her pain and no symptomatic itch (although morphine is listed as an allergy for her). She was transitioned to MS contin with oxycodone for breakthrough pain. . # Acute systolic heart failure: Patient had no clinical evidence of heart failure by history or exam. She was put on lisinopril and metoprolol for medical management. Her doses of metoprolol and lisinopril should be increased as tolerated by her blood pressure. Also, her creatinine and K+ should be checked in one week given recent initiation of ACE I. . # Hypotension: Patient had asymptomatic hypotension with SBP in 70s after her cardiac catheterization. She was felt to be oversedated after receiving IV fentanyl on top of her fentanyl patch. Her fentanyl patch was stopped and she was monitored overnight in the unit. Her blood pressures improved and remained stable thereafter. . # CAD s/p CABG: Patient had no flow-limiting lesions on cath. Her troponins peaked at 0.24 and her CK was never elevated. She was medically treated for CAD with ASA, beta blocker, and simvastatin. Of note, her pain responded to opiates but not to nitrates. . # QT prolongation: Noted on EKG. QT prolonging agents should be avoided. . # multiple fractures, chronic pain/fibromyalgia: Pain control as discussed above. Bowel regimen while on narcotics. Continued gabapentin and lidoderm patch to right back. DVT prophylaxis with lovenox continued. Patient should follow-up with her orthopedist to determine her weight-bearing status and continue to have care with physical therapy. . # h/o GI bleeding from AVMs and GERD; Hematocrit drop: After cardiac cath, Hct was drawn and dropped from 37->22. CT abdomen/pelvis did not show evidence of retroperitoneal bleed, and recheck of Hct was 33. The hematocrit of 22 was felt to be lab error. She did receive a transfusion of 1 unit of pRBCs, and her Hct remained stable at 33-34 throughout the rest of admission. Protonix [**Hospital1 **], sucralfate, and ranitidine were continued. . # Mild transaminase elevation: Patient ALT and AST increased from 30s to 70s while on zocor. Her simvastatin was stopped and her ALT and AST should be rechecked in one week. Her cardiologist, Dr. [**First Name (STitle) **], should advise the patient as to whether to continue with simvastatin. . # Gout: Colchicine. . # Depression, Anxiety: Lorazepam continued. Patient's trazodone had been held at rehab. It was held during admission as well because of her hypotension. It can be restarted at 150mg QHS and titrated up as necessary by her PCP. Medications on Admission: vicodin 5/500 1-2 tabs Q6 prn compazine 5mg po Q6 prn tylenol prn bisacodyl PR prn MVI daily simethicone 80mg tid baclofen 10mg tid gabapentin 300mg tid lidoderm to R hip lovenox 40mg subcut. daily NTG patch 0.2mg/hour on 12 hrs/off 12 hours ranitidine 150mg QHS zocor 40mg QHS sucralfate 1gm tid with meals fentanyl 50mcg/hr patch Q3D Aciphex 20mg [**Hospital1 **] ASA 81mg daily colace [**Hospital1 **] prn Folate 1mg QHS Colchicine 0.6mg po BID Lorazepam 1mg HS PRN anxiety Trazodone 600mg QHS [**Doctor First Name **] Vitamin D Vitamin B shot monthly Discharge Medications: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Aciphex 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 5. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 6. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. 7. Baclofen 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 8. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 9. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 10. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed for constipation. 12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 13. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO twice a day. 16. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for anxiety. 17. Enoxaparin 40 mg/0.4 mL Syringe Sig: Forty (40) mg Subcutaneous DAILY (Daily): Until instructed to stop by orthopedics. 18. Vitamin D Oral 19. Vitamin B-12 Injection 20. [**Doctor First Name **] Oral 21. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 22. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 23. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain. 24. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). 25. Trazodone 150 mg Tablet Sig: One (1) Tablet PO at bedtime. Discharge Disposition: Extended Care Facility: [**Hospital 25499**] [**Hospital 731**] - [**Location (un) 47**] Discharge Diagnosis: Primary Diagnosis: Chest pain Secondary Diagnoses: Coronary Artery Disease s/p CABG; Chronic GI bleed from AVMs; recent pelvic fracture; Depression; Costochondritis Discharge Condition: Patient had chest pain felt to be musculoskeletal, responding to oral medications. Her blood pressure was stable and repeat echocardiogram demonstrated only mildly depressed ejection fraction. Vitals were stable, no fevers. Discharge Instructions: You were admitted with chest pain. You had a cardiac catheterization that showed that you have no blockages of the artieries to your heart muscle. 1. Please take all medications as prescribed. 2. Please attend all follow-up appointments listed below. 3. Please call your doctor or return to the hospital if you develop chest pain, shortness of breath, fevers, palpitations, or any other concerning symptom. Medication changes: - Stop your zocor (simvastatin) because your liver enzymes were a little elevated. Your liver tests will be rechecked in a week and your doctors [**Name5 (PTitle) **] let [**Name5 (PTitle) **] know whether you should restart zocor. - Stop your fentanyl patch because your blood pressure was very low when you were on fentanyl. Instead, you are on morphine and oxycodone pills for pain control. - Stop your nitroglycerin patch for now. You did not appear to benefit from the nitro patch, so we stopped it. If you find you have chest pain that responds to the nitroglycerin patch, you can restart it. - We started lisinopril and metoprolol, which are medications that will be good for your heart and blood pressure. Lisinopril is once a day; metoprolol is twice a day. - We also started senna to keep your bowels moving while you are on narcotics. - We are restarting your trazodone at a lower dose. Your primary doctor may need to adjust this as needed in the future. Followup Instructions: 1. Please arrange to see your primary care doctor in the next month. His number is [**Telephone/Fax (1) 60170**], Dr. [**Doctor Last Name 60171**] [**Name (STitle) **] 2. Please follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], your cardiologist, in the next 3-4 weeks. 3. Please see your orthopedics doctor to continue care for your hip. Completed by:[**2145-10-15**]

786,569,425,414,733,729,416,412,530,562,275,712,300,458,272,790,V458,V433,V436,V586

{"Other chest pain,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Coronary atherosclerosis of unspecified type of vessel, native or graft,Tietze's disease,Myalgia and myositis, unspecified,Other chronic pulmonary heart diseases,Old myocardial infarction,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, other specified sites,Dysthymic disorder,Other specified hypotension,Other and unspecified hyperlipidemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Aortocoronary bypass status,Heart valve replaced by other means,Hip joint replacement,Long-term (current) use of aspirin"}

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: 74yo woman with h/o CAD s/p MI and CABG, MVR with porcine valve in [**2141**], chronic GI bleed [**1-1**] AVMs, recent tibial, fibular, and pelvic fractures, who presents from rehab with chest pain and dyspnea. Patient reports that 2 nights prior to admission, she had acute chest pain to the left of her sternum radiating to her arm and back. Pain felt like a pressure and was associated with dyspnea, nausea, and sweating. She also notes increased dyspnea that does not have a positional component over the last week. Patient received nitroglycerin and ASA without relief of her pain, and she was transferred to an OSH, where she ruled in for NSTEMI with peak TnI of 1.17. Echo done at OSH was significant for newly depressed EF (10-20% vs normal EF in [**2145-7-31**]). Heparin and integrilin gtt were started. Patient also had b/l LE ultrasound which was negative for DVT. . She is now transferred to [**Hospital1 18**] for cardiac cath. Of note, the patient woke at 4am today with 15/10 chest pain across her chest, relieved by fentanyl but not by nitroglycerin. Pain was reproducible on exam. She now c/o [**2148-1-3**] chest pain; she is not feeling SOB. MEDICAL HISTORY: Dyslipidemia IMI in [**2135**] treated with thrombolytics CABG: SVG to Ramus in [**2141**], concurrent MVR with 25mm porcine valve Occult GI bleeding [**1-1**] upper and lower AVMs, for which she has required numerous transfusions, most recently 1 unit [**Unit Number **] weeks ago and 2 units about 3 weeks ago GERD Diverticulosis s/p bilateral hip replacements with revision on the right recent fall with R tibia-fibula fractures recent pelvic fracture--3 weeks ago costochondritis pseudogout fibromyalgia anxiety depression . PCP: [**Name10 (NameIs) 60169**] [**Name11 (NameIs) **] Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . ALLERGIES: PCN-->rash and pruritus and hands swell morphine -->pruritus, reports she tolerates morphine when given benadryl MEDICATION ON ADMISSION: vicodin 5/500 1-2 tabs Q6 prn compazine 5mg po Q6 prn tylenol prn bisacodyl PR prn MVI daily simethicone 80mg tid baclofen 10mg tid gabapentin 300mg tid lidoderm to R hip lovenox 40mg subcut. daily NTG patch 0.2mg/hour on 12 hrs/off 12 hours ranitidine 150mg QHS zocor 40mg QHS sucralfate 1gm tid with meals fentanyl 50mcg/hr patch Q3D Aciphex 20mg [**Hospital1 **] ASA 81mg daily colace [**Hospital1 **] prn Folate 1mg QHS Colchicine 0.6mg po BID Lorazepam 1mg HS PRN anxiety Trazodone 600mg QHS [**Doctor First Name **] Vitamin D Vitamin B shot monthly ALLERGIES: Penicillins / Morphine Sulfate PHYSICAL EXAM: VS: 98.2 97.0 88/50 (SBP 88-125), 61 16 100% 3L GENERAL: No apparent distress, alert & oriented x 3, appropriate FAMILY HISTORY: +Mother w/ MI at 54yo (also a diabetic) Maternal uncle with MI at 42yo 2 half-sisters with DM SOCIAL HISTORY: Currently in rehab/short term [**Hospital1 1501**] at [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 731**] in [**Location (un) 47**]; otherwise, lives with husband in [**Name (NI) 47**]. Quit smoking 25 years ago (+tob x 15-20 years). No etoh, or illicit drug use. ### Response: {"Other chest pain,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Coronary atherosclerosis of unspecified type of vessel, native or graft,Tietze's disease,Myalgia and myositis, unspecified,Other chronic pulmonary heart diseases,Old myocardial infarction,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, other specified sites,Dysthymic disorder,Other specified hypotension,Other and unspecified hyperlipidemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Aortocoronary bypass status,Heart valve replaced by other means,Hip joint replacement,Long-term (current) use of aspirin"}

CHIEF COMPLAINT: nausea, vomitting PRESENT ILLNESS: The patient is a 21 F presenting with 2 days of LLQ anterior flank pain, sharp, worse with coughing, one episode of vomiting earlier the am of presentation. Subjective fevers (not measured). She also reports some blood in stool. She reports nausea, on admission. MEDICAL HISTORY: No significant medical history Patient is a twin, and notes her sister has [**Name2 (NI) 14165**] trait, as does her father. MEDICATION ON ADMISSION: Ortho Evra (contraception) 1 patch applied weekly ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Examination on admission: VS: 101.2 126/85 114 18 99%RA FAMILY HISTORY: Patient denies any family history of blood clots, PEs. [**Name (NI) **] father with severe HTN, kidney disease. Patient's twin sister, father, and multiple other second-degree family members with [**Name2 (NI) 14165**] trait. SOCIAL HISTORY: Patient attends a local college. She lives at home with her family. She does not smoke or use illicit drugs. She reports drinking socially, most recently on [**9-30**] for her birthday when she drank 2 drinks--she denies any episodes of LOC, vomiting. She reports being sexually active and monogamous with her boyfriend. She reports her most recent HIV test was negative in [**2153-6-9**]. She reports having her period within a week of her presentation.

Acute pyelonephritis without lesion of renal medullary necrosis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Hypoxemia,Unspecified essential hypertension,Iron deficiency anemia, unspecified

Ac pyelonephritis NOS,Acute respiratry failure,Food/vomit pneumonitis,Hypopotassemia,Hypoxemia,Hypertension NOS,Iron defic anemia NOS

Admission Date: [**2153-10-14**] Discharge Date: [**2153-10-23**] Date of Birth: [**2132-9-30**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4891**] Chief Complaint: nausea, vomitting Major Surgical or Invasive Procedure: Bronchoscopy, while in Medical ICU Intubation for respiratory failure History of Present Illness: The patient is a 21 F presenting with 2 days of LLQ anterior flank pain, sharp, worse with coughing, one episode of vomiting earlier the am of presentation. Subjective fevers (not measured). She also reports some blood in stool. She reports nausea, on admission. In ED: VS: 98.2 117 127/74 14 100; Tmax 101; u/a + >50 WBC; CT shows changes ocnsistent with pyelo on left kidney. Patient received morphine, acetominophin, ondansetron 4 mg IV x 1, cipro 400 mg IV x 1 in the ED and was admitted for further management to the medicine service. ROS: Denies cp, sob, diarrhea, constipation, skin problems, [**Name (NI) 81803**], urinary frequency. Past Medical History: No significant medical history Patient is a twin, and notes her sister has [**Name2 (NI) 14165**] trait, as does her father. Social History: Patient attends a local college. She lives at home with her family. She does not smoke or use illicit drugs. She reports drinking socially, most recently on [**9-30**] for her birthday when she drank 2 drinks--she denies any episodes of LOC, vomiting. She reports being sexually active and monogamous with her boyfriend. She reports her most recent HIV test was negative in [**2153-6-9**]. She reports having her period within a week of her presentation. Family History: Patient denies any family history of blood clots, PEs. [**Name (NI) **] father with severe HTN, kidney disease. Patient's twin sister, father, and multiple other second-degree family members with [**Name2 (NI) 14165**] trait. Physical Exam: Examination on admission: VS: 101.2 126/85 114 18 99%RA GEN: Alert and oriented to person, place and situation; no apperent distress HEENT: no trauma, pupils round and reactive to light and accomodation, no LAD, oropharynx clear, no exudates CV: regular rate and rhythm, no murmurs/gallops/rubs PULM: clear to auscultation bilaterally, no rales/crackles/rhonchi GI: soft, non-tender, non-distended; no guarding/rebound EXT: no clubbing/cyanosis/edema; 2+ distal pulses; peripheral IV present DERM: no lesions appreciated; multiple tatoos Pertinent Results: Labs: Hematology: [**2153-10-13**] 10:27PM BLOOD WBC-24.5*# RBC-3.93* Hgb-11.8* Hct-36.6 MCV-93 MCH-30.1 MCHC-32.4 RDW-13.6 Plt Ct-272 [**2153-10-23**] 04:00PM BLOOD WBC-14.0* RBC-3.76* Hgb-11.3* Hct-34.6* MCV-92 MCH-30.1 MCHC-32.8 RDW-13.8 Plt Ct-621* [**2153-10-22**] 06:35AM BLOOD WBC-12.2* RBC-3.18* Hgb-9.8* Hct-29.1* MCV-91 MCH- 30.7 MCHC-33.6 RDW-14.3 Plt Ct-529* Serologies: [**2153-10-19**] 01:36PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE HBcAb-NEGATIVE [**2153-10-19**] 01:36PM BLOOD HCV Ab-NEGATIVE Rheumatologic: [**2153-10-19**] 01:36PM BLOOD ACA IgG-6.0 ACA IgM-15.6* [**2153-10-19**] 01:36PM BLOOD RheuFac-<3 [**2153-10-19**] 01:36PM BLOOD C3-114 C4-42* [**2153-10-19**] 01:36PM BLOOD ANCA-NEGATIVE B [**2153-10-19**] 01:36PM BLOOD [**Doctor First Name **]-NEGATIVE Chemistries: [**2153-10-23**] 04:00PM BLOOD Glucose-122* UreaN-6 Creat-1.1 Na-139 K-3.8 Cl-101 HCO3-28 AnGap-14 [**2153-10-22**] 06:35AM BLOOD Glucose-88 UreaN-4* Creat-0.9 Na-140 K-4.1 Cl-101 HCO3-29 AnGap-14 [**2153-10-19**] 03:51AM BLOOD Hapto-248* [**2153-10-18**] 03:23AM BLOOD calTIBC-208* Ferritn-141 TRF-160* [**2153-10-20**] 04:22AM BLOOD Homocys-5.8 Micro: URINE CULTURE (Final [**2153-10-15**]): MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION. [**2153-10-13**] 10:27PM URINE RBC-[**12-29**]* WBC->50 Bacteri-MANY Yeast-NONE Epi-[**4-13**] Imaging: [**2153-10-14**] CT abdomen/pelvis: 1. Striated left nephrogram. This finding in the setting of ipsilateral pain, leukocytosis and abnormal urinalysis is consistent with left pyelonephritis. 2. Hepatic steatosis. [**10-15**] Chest CT w Contrast Dense bilateral pulmonary consolidation. In light of the history of recent hematemesis, this could represent widespread aspiration, particularly since it has developed in such a short period since the CT abdomen dated [**2153-10-14**]. Other possibilities include haemorrhage and acute respiratory distress syndrome. No evidence of pulmonary embolism. [**10-16**] Renal U/S: No evidence of renal obstruction. 9/7 L Lower Extremity Doppler: No deep venous thrombosis in the left lower extremity. [**10-18**] CT Torso/Abd/Pelvis 1. Worsened striated nephrogram of the left kidney, again consistent with pyelonephritis, with more severe defects seen in the lower pole. Also new wedge-shaped defect in the lower pole of the right kidney, which may be due to infection and/or infarction. 2. Moderate improvement in diffuse pulmonary opacities suggesting improvement in aspiration or ARDS, less likely pneumonia or hemorrhage. 3. Heterogeneous attenuation of the liver, which can be seen in the setting of hepatitis. Recommend correlation with LFTs. 4. Gallbladder wall edema likely reactive, with no specific signs of cholecystitis. 5. Air within the bladder likely due to Foley catheter. [**10-22**] Limited Trans thoracic echo: Evidence of PFO on bubble study. [**10-22**] CT Torso with IV contrast (CTA): IMPRESSION: 1. No evidence of renal artery stenosis, vasculitis or fibromuscular dysplasia. 2. Continued findings of a striated nephrogram on the left, with focal nonenhancing area in the superior pole, related to pyelonephritis. 3. Area in the inferior right renal pole of peripheral non-enhancement may also relate to pyelonephritis, and infarction is felt less likely given the patency of the branches of the right renal artery. Brief Hospital Course: 21 yo F with no significant PMH admitted for treatment of pyelonephritis with episode of emesis. #Unknown Renal Process: Patient was admitted with LLQ abdominal pain, leukocytosis, pyuria and bacturia, which was presumed to be a pyelonephritis. A CT at that time demonstrated perinephric stranding, which is loosly correlated with pyelonephritis. She was started on ciprofloxacin in the ED, and was admitted to the floors. On the floors she was transitioned to IV CTX. Secondary to respiratory issues (as described below), the patient was transferred to the [**Hospital Unit Name 153**] and intubated. She was switched to piptazo for better coverage of anaerobes. While intubated, patient continued to have abdominal pain with a clean UA. Given concern for on ongoing intraabdominal process, patient received a second abdominal CT that demonstrated continued perinephric stranding of the L kidney, and a new wedge-shaped finding in the R kidney suspicious for an infectious process vs infarct. At this time, renal was consulted--they suspected an infectious process and less likely a vasculitis. A repeat CT with IV contrast further suggested infectious process. She completed 8 days of zosyn/vanco, and was transitioned to PO cipro on discharge. #Respiratory Distress: Patient was transferred to the [**Hospital Unit Name 153**] for sudden onset of tachypnea, dyspnea, desaturation. At the time denied sick contacts, but did report having had an episode of emesis one night prior. Patient had increasing oxygen requirements and became tacchypnic to the 40s-50s. At the time, the team considered PNA vs aspiration pneumonitis vs PE. Her CTA was negative for PE, but demonstrated demonstrated bilateral dense consolidations, that had not been observed on an abdominal CT from day prior. Given broad distribution of consolidations, sudden onset of symptoms in setting of recent episode of emesis, and afebrile picture, we thought that this was more likely PNA or pneumonitis [**3-13**] to aspiration. She was started on CTX+azithro for a CAP, then coverage was broaded to zosyn/vanco/flagyl for HAP. She was briefly covered with IV heparin until her CTA read ruled out PE. Pt remained intubated with moderate pressure support requirements ([**11-23**]). Patient was weaned from the vent over 3-4 days, with one failed SBT c/b tachypnea to the 40s. Pt was then extubated without issue, and weaned down to 2L of supplemental O2 via nasal cannula before being transferred to the floors. #Hypertension: Patient was noted to be running SBPs 130-160s several days into her admission. Per her outpatient clinic, the patient had a recent visit in [**Month (only) 116**] with a SBP of 150. It was thought that this could perhaps be related to her ongoing renal process of uncertain etiology. She was started on labetalol 200mg [**Hospital1 **] with moderate effect of SBPs in the 120s-130s. At the time of her transfer out of the [**Hospital Unit Name 153**], her HR would not tolerate further up-titration of her labetalol. She was ultimately titrated to labetalol 300mg [**Hospital1 **] with BPs in the 120s/80s-90s. She had no dizziness with this dose. #Anemia: Patient was noted to have a stable HCT of 26.3. On further work-up it was found to be normocytic, with a low TIBC/transferrin, normal ferritin. It was thought that this might be consistent with early iron deficiency anemia. Her reticulocytes were inappropriately suppressed, with a mild elevation in LDH and haptoglobin. Her Hct stabilized, although she remained anemic. Discussion with her PCP prior to discharge, included the need to followup on this. #Leukocytosis: On the day of discharge, she was noted to have a rising WBC. Her PCP was [**Name (NI) 653**] and was planning to check a CBC as well as Chemistries, to ensure that this resolved. She was to complete an additional 7 days of Cipro for the course for pyelonephritis. Medications on Admission: Ortho Evra (contraception) 1 patch applied weekly Discharge Medications: 1. Labetalol 100 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*0* 2. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a day for 6 days. Disp:*12 Tablet(s)* Refills:*0* Her Oral contraceptive was held, and the team suggested she discuss with her PCP re starting [**Name Initial (PRE) **] different [**Doctor Last Name 360**] that would not be associated with increased BP. Discharge Disposition: Home Discharge Diagnosis: Pyelonephritis Acute respiratory failure, secondary to ARDS or pneumonia Hypertension Discharge Condition: Discharge condition: stable, conversant (Blood pressure 120/90) Mental status: clear Ambulatory status: independent Discharge Instructions: Ms [**Known lastname **], It was a pleasure to take care of you during your admission. As you know, you were admitted with nausea and vomiting, and found to have a kidney infection. Your cultures did not tell us which bacteria caused your infection. You were treated with intravenous antibiotics (Vancomycin and Zosyn) for 8 days, and your shortness of breath and low oxygen level improved. You required intubation and an intensive care unit stay for shortness of breath. We found that you have elevated blood pressures, and it is unclear if this will be a long-term issue. Given your family history, we suggest that you continue to take the labetalol 300mg twice daily, and follow up with your PCP to discuss dose changes or new medications. The renal doctors [**Name5 (PTitle) **] also [**Name5 (PTitle) **] with you about further workup of your hypertension. New medications: Ciprofloxacin 500mg one tablet twice daily Labetalol 300mg (3 x 100mg tablets) twice daily Please discuss changing your birth control with your doctor, to one with only progesterone, as this can help with blood pressure control. Please also ask your doctor about further dietary changes which will help with lowering blood pressure. Please call your doctor if you develop diarrhea or vaginal itching while on the antibiotics. Followup Instructions: PCP [**Name Initial (PRE) **]: Tuesday, [**10-30**] at 10am With: [**Doctor First Name **] S.BRACKETT,MD Location: [**Hospital3 **] HEALTH CENTER Address: [**State **], [**Location (un) **],[**Numeric Identifier 38978**] Phone: [**Telephone/Fax (1) 14167**] ** Please note you still have an appointment on [**11-14**] @1:45pm but your doctors here would [**Name5 (PTitle) **] you seen before then at the appointment they aranged for you above. Department: WEST [**Hospital 2002**] CLINIC When: THURSDAY [**2153-10-25**] at 2:30 PM With: DR. [**First Name (STitle) **] [**Name (STitle) **] [**Telephone/Fax (1) 721**] Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **] Campus: WEST Best Parking: [**Street Address(1) 592**] Garage Followup labs (pending at discharge): Hemoglobin Electrophoresis to evaluate for [**Street Address(1) 14165**] trait Addendum: There was discussion of the labs done on the day of discharge with the PCP (Dr [**Last Name (STitle) 59353**] via telephone, and again on the am of [**10-24**]. Based on the rising WBC and mildly elevated BUN/Cr on the [**10-23**] bloodwork, we suggested followup blood work on the day following discharge ([**10-24**]) at the [**Hospital3 43089**] clinic to ensure improvement. A message was left with the patient, as she had left the hospital prior to the laboratory tests returning. A followup call confirmed that the patient had received the message and was planning to present to the PCP's office for the bloodwork.

590,518,507,276,799,401,280

{'Acute pyelonephritis without lesion of renal medullary necrosis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Hypoxemia,Unspecified essential hypertension,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: nausea, vomitting PRESENT ILLNESS: The patient is a 21 F presenting with 2 days of LLQ anterior flank pain, sharp, worse with coughing, one episode of vomiting earlier the am of presentation. Subjective fevers (not measured). She also reports some blood in stool. She reports nausea, on admission. MEDICAL HISTORY: No significant medical history Patient is a twin, and notes her sister has [**Name2 (NI) 14165**] trait, as does her father. MEDICATION ON ADMISSION: Ortho Evra (contraception) 1 patch applied weekly ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Examination on admission: VS: 101.2 126/85 114 18 99%RA FAMILY HISTORY: Patient denies any family history of blood clots, PEs. [**Name (NI) **] father with severe HTN, kidney disease. Patient's twin sister, father, and multiple other second-degree family members with [**Name2 (NI) 14165**] trait. SOCIAL HISTORY: Patient attends a local college. She lives at home with her family. She does not smoke or use illicit drugs. She reports drinking socially, most recently on [**9-30**] for her birthday when she drank 2 drinks--she denies any episodes of LOC, vomiting. She reports being sexually active and monogamous with her boyfriend. She reports her most recent HIV test was negative in [**2153-6-9**]. She reports having her period within a week of her presentation. ### Response: {'Acute pyelonephritis without lesion of renal medullary necrosis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Hypoxemia,Unspecified essential hypertension,Iron deficiency anemia, unspecified'}

CHIEF COMPLAINT: exertional chest pain/stable angina PRESENT ILLNESS: Mr. [**Known lastname 91391**] is a 57 year old gentleman with a PMH significant for severe hypertension, mild hyperlipidemia, and a family history of heart disease, who presented to his PCP at the end of [**Month (only) **] with two months of exertional sub-sternal chest pain. His symptoms started at the end of [**Month (only) 205**] when he noticed burning substernal pain while walking his dog briskly. Symptoms were predictable in onset with exertion and always subsided with rest. The pain occassionally radiated to his left arm, but he denies nausea/vomiting or diaphoresis. Never had symptoms at rest. He presented to his PCP who sent him to the [**Hospital1 3597**] ED, where he was noted to have hypertension to 244/110. His blood pressure medications were changed at that time. He has long-standing hypertension, but does not recall his prior regimen before this change. He also underwent exercise MIBI at [**Hospital3 7362**], during which he went 4 minutes 36 seconds on a [**Doctor First Name **] protocol and developed 2mm ST depressions in the inferior lateral leads. He did experience chest discomfort. Imaging showed a large and severe defect involving the mid anterior wall extending to the anterior apex. In addition there was another defect involving the mid to distal septum. There was transient ischemic dilation of the left ventricle. LVEF was noted at 64%. He was referred to [**Hospital1 18**] for left heart catheterization which revealed multivessel coronary artery disease.Cardiac surgery was consulted for coronary revascularization. MEDICAL HISTORY: Primary: Coronary Artery Disease pulmonary embolism (incidental finding pre-operatively) MEDICATION ON ADMISSION: CARVEDILOL - 25 mg PO BID HYDRALAZINE - 20 mg PO TID HYDROCHLOROTHIAZIDE - 25 mg PO qAM LEVOTHYROXINE - 112 mcg PO qAM LISINOPRIL - 40 mg PO qAM SIMVASTATIN - 40 mg PO qPM ASPIRIN - 81 mg PO QD ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION: VS: T=98.4 BP=135-158/77-83 HR=75 RR=18 O2 sat= 96(RA) GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. No elevated JVP. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, mildly obese, NTND. No HSM or tenderness. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. FAMILY HISTORY: Father died of early MI at age 46. Mother had some type of cancer and was in remission when she died in retirement home (cause unknown). No family hx of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Patient is divorced with three children. He lives with girlfriend and his girlfriend's two daughters. Previously worked at Papa Ginos as a general manager. Was laid off in [**Month (only) **]. Tobacco: Never ETOH: Rare Recreational drugs: Denies Home services: Denies

Coronary atherosclerosis of native coronary artery,Other pulmonary embolism and infarction,Paroxysmal ventricular tachycardia,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Personal history of traumatic fracture,Family history of ischemic heart disease,Tobacco use disorder

Crnry athrscl natve vssl,Pulm embol/infarct NEC,Parox ventric tachycard,Angina pectoris NEC/NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Hx traumatic fracture,Fam hx-ischem heart dis,Tobacco use disorder

Name: [**Known lastname 14390**],[**Known firstname 126**] Unit No: [**Numeric Identifier 14391**] Admission Date: [**2115-1-4**] Discharge Date: [**2115-1-11**] Date of Birth: [**2057-8-22**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 135**] Addendum: Mr. [**Known lastname **] was also discharged on HCTZ- his home dose of 25mg daily. Discharge Medications: 1. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*30 Capsule(s)* Refills:*2* 2. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Outpatient Lab Work Labs: PT/INR for Coumadin ?????? indication, pulmonary emboli Goal INR [**3-15**] First draw [**2115-1-12**], then Monday, Wednesday, Friday for 2 weeks. Results to phone [**0-0-**], Dr. [**Last Name (STitle) 14392**] (confirmed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]) 4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 5. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 8. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 10. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*2* 11. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Dr. [**Last Name (STitle) 14392**] to dose for goal INR [**3-15**]. dx: PE. Disp:*60 Tablet(s)* Refills:*2* 12. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: AllCare VNA [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**] Completed by:[**2115-1-11**] Admission Date: [**2115-1-4**] Discharge Date: [**2115-1-11**] Date of Birth: [**2057-8-22**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1406**] Chief Complaint: exertional chest pain/stable angina Major Surgical or Invasive Procedure: [**2115-1-7**] Coronary artery bypass x2: Left internal mammary artery to left anterior descending, and reverse saphenous vein graft to ramus. History of Present Illness: Mr. [**Known lastname 91391**] is a 57 year old gentleman with a PMH significant for severe hypertension, mild hyperlipidemia, and a family history of heart disease, who presented to his PCP at the end of [**Month (only) **] with two months of exertional sub-sternal chest pain. His symptoms started at the end of [**Month (only) 205**] when he noticed burning substernal pain while walking his dog briskly. Symptoms were predictable in onset with exertion and always subsided with rest. The pain occassionally radiated to his left arm, but he denies nausea/vomiting or diaphoresis. Never had symptoms at rest. He presented to his PCP who sent him to the [**Hospital1 3597**] ED, where he was noted to have hypertension to 244/110. His blood pressure medications were changed at that time. He has long-standing hypertension, but does not recall his prior regimen before this change. He also underwent exercise MIBI at [**Hospital3 7362**], during which he went 4 minutes 36 seconds on a [**Doctor First Name **] protocol and developed 2mm ST depressions in the inferior lateral leads. He did experience chest discomfort. Imaging showed a large and severe defect involving the mid anterior wall extending to the anterior apex. In addition there was another defect involving the mid to distal septum. There was transient ischemic dilation of the left ventricle. LVEF was noted at 64%. He was referred to [**Hospital1 18**] for left heart catheterization which revealed multivessel coronary artery disease.Cardiac surgery was consulted for coronary revascularization. Past Medical History: Primary: Coronary Artery Disease pulmonary embolism (incidental finding pre-operatively) Secondary: Hypertension Hyperlipidemia Hypothyroidism Left femur fracture Social History: Patient is divorced with three children. He lives with girlfriend and his girlfriend's two daughters. Previously worked at Papa Ginos as a general manager. Was laid off in [**Month (only) **]. Tobacco: Never ETOH: Rare Recreational drugs: Denies Home services: Denies Family History: Father died of early MI at age 46. Mother had some type of cancer and was in remission when she died in retirement home (cause unknown). No family hx of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: PHYSICAL EXAMINATION ON ADMISSION: VS: T=98.4 BP=135-158/77-83 HR=75 RR=18 O2 sat= 96(RA) GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. No elevated JVP. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, mildly obese, NTND. No HSM or tenderness. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: Labs on Admission: [**2115-1-4**] 09:40AM BLOOD WBC-9.3 RBC-4.26* Hgb-12.4* Hct-34.5* MCV-81* MCH-29.1 MCHC-35.9* RDW-13.2 Plt Ct-154 [**2115-1-4**] 09:40AM BLOOD Neuts-70.9* Lymphs-23.1 Monos-3.8 Eos-1.9 Baso-0.2 [**2115-1-4**] 09:40AM BLOOD PT-13.7* INR(PT)-1.2* [**2115-1-4**] 09:40AM BLOOD Glucose-193* UreaN-20 Creat-1.2 Na-141 K-3.3 Cl-106 HCO3-24 AnGap-14 [**2115-1-4**] 09:40AM BLOOD ALT-22 AST-26 AlkPhos-65 TotBili-0.6 [**2115-1-4**] 09:40AM BLOOD Albumin-3.6 Iron Studies/HgbA1c: Iron-64 [**2115-1-4**] 09:40AM BLOOD calTIBC-246* Ferritn-162 TRF-189* [**2115-1-4**] 09:40AM BLOOD %HbA1c-5.5 eAG-111 Urinanalysis: [**2115-1-5**] 12:00PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.019 [**2115-1-5**] 12:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-2* pH-6.5 Leuks-NEG Urine Metanephrines: Micro: [**2115-1-4**] 8:34 pm Staph aureus Screen Source: Nasal swab. [**2115-1-5**] 12:00 pm URINE Source: CVS. Imaging/Studies: Cardiac Cath [**2115-1-4**]: 1. Selective corobary angiography of this right dominant system demonstrated three vessel coronary artery disease. The LMCA is a large caliber vessel with a 30% ostial stenosis. The LAD has an ostial 90% stenosis prior to an ulcer, followed by a 95% stenosis. There is diffuse disease through the mid-LAD to 60%. The LAD is short and does not extend to the apex with TIMI 1 flow. The Lx is a large caliber vessel with diffuse plaquing. There is a modest ramus/OM1 with proximal 65% stenosis. There is a moderate OM2 with moderate origin stenosis. There is a tiny OM3. There is a tortuous branching OM4 with mild stenosis at the origin of the lower pole. There is a large OM5/LPL that is diffusely diseased to LPL2 with 60% mid-vessel stenosis. The RCA has an ectatic origin with a proximal-mid tubular 50% stenosis. There is diffuse plaquing throughout with a distal 30% stenosis into RPDA with 50% stenosis at the origin of its first lateral sidebranch. There are faint collaterals to the LAD. 2. Limited resting hemodynamics revealed mildly elevated left-sided filling pressures with LVEDP averaging 13, max 21 mmHg. 3. Left ventriculography revealed no mitral regurgitation, an LVEF of 70%, and no regional wall motion abnormalities. 4. Left radial artery hemostasis achieved with TR Band. Chest Xray PA/Lat [**2115-1-4**]: IMPRESSION: Heart is normal size. Lungs are clear. Fullness in the right tracheobronchial angle is explained by fat deposition in the mediastinum projecting over a transverse process of the thoracic spine. There is no good evidence for central lymph node enlargement or pleural abnormality. Lungs fully expanded and clear. TTE [**2115-1-5**]: The left atrium is mildly dilated. 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 aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. No pathologic valvular abnormality seen. Mildly dilated aortic root and ascending aorta. Renal Artery Ultrasound [**2115-1-5**]: IMPRESSION: 1. Normal kidneys and bladder. 2. Segmental arterial resistive indices within normal limits, ranging from 0.58 to 0.67. No evidence of renal artery stenosis. CTA Coronaries [**2115-1-6**]: Impression: 1.Extensive involvement of the coronary arteries by diffuse and focal abnormalities as described in details in the body of the report. Those findngs in conjunction with focal areas of coronary arteries dilataions ca raise the suspicion of vasculitis with some degree of atherosclerosis as well. Given the lack of coronary calcifications in the presence of such an extensive unvolvement of coronary arteries, vasculitis might first diagnostic consideration. 2.Segmental and subsegmental pulmonary embolism. 3. Persistent Left SVC Findings were discussed with Dr. [**Last Name (STitle) 8807**] over the phone by Dr [**Last Name (STitle) **] on Monday, [**2115-1-7**] at 10 am. DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**] Approved: MON [**2115-1-7**] 2:11 PM Imaging Lab [**2115-1-7**] Intra-op TEE Conclusions PRE-BYPASS: No spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. 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. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The descending thoracic aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results at time of surgery. POST-BYPASS: The patient is in sinus rhythm. The patient is on no inotropes. Biventricular function is unchanged. Mitral regurgitation is unchanged. The aorta is intact post-decannulation. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**Name6 (MD) 1509**] [**Name8 (MD) 1510**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2115-1-7**] 16:24 ?????? [**2106**] CareGroup IS. All rights reserved. [**2115-1-10**] 05:50AM BLOOD WBC-12.4* RBC-3.34* Hgb-9.9* Hct-28.8* MCV-86 MCH-29.7 MCHC-34.5 RDW-14.1 Plt Ct-139* [**2115-1-9**] 06:10AM BLOOD WBC-14.6* RBC-3.54* Hgb-10.5* Hct-29.8* MCV-84 MCH-29.5 MCHC-35.1* RDW-14.7 Plt Ct-125* [**2115-1-11**] 06:40AM BLOOD PT-17.5* INR(PT)-1.6* [**2115-1-10**] 05:50AM BLOOD PT-14.4* INR(PT)-1.3* [**2115-1-9**] 06:10AM BLOOD PT-14.0* INR(PT)-1.3* [**2115-1-7**] 05:06PM BLOOD PT-14.5* PTT-35.3* INR(PT)-1.3* [**2115-1-7**] 03:38PM BLOOD PT-14.9* PTT-30.0 INR(PT)-1.3* [**2115-1-4**] 09:40AM BLOOD PT-13.7* INR(PT)-1.2* [**2115-1-11**] 06:40AM BLOOD UreaN-18 Creat-1.0 Na-140 K-3.6 Cl-102 [**2115-1-10**] 05:50AM BLOOD Glucose-116* UreaN-18 Creat-1.1 Na-140 K-3.6 Cl-105 HCO3-30 AnGap-9 Brief Hospital Course: Mr. [**Known lastname 91391**] is a 57 year old gentleman with a history of hypertension, hyperlipidemia, and strong family hx of heart disease who presented for scheduled cardiac catherization after a positive stress MIBI at OSH, found to have severe CAD requiring admission for heparin drip and evaluation for cardiac bypass surgery. After conclusion of preoperative work up, Mr. [**Known lastname 91391**] was taken to the operating room on [**2115-1-7**] and underwent Coronary artery bypass x2(Left internal mammary artery to left anterior descending, and reverse saphenous vein graft to ramus) with Dr.[**Last Name (STitle) **]. Please see operative report for further surgical details. CARDIOPULMONARY BYPASS TIME: 54 minutes. CROSS-CLAMP TIME: 45 minutes. He tolerated the procedure well and was transferred to the CVICU intubated and sedated. He awoke neurologically intact and was extubated without incident. He weaned off pressor support and was started on Beta-blocker/Statin/Aspirin and diuresis. All lines and drains were discontinued per protocol. POD#1 he was transferred to the step down unit for further monitoring. Physical Therapy was consulted for evaluation of strength and mobility. Anticoagulation with Coumadin was initiated for Pulmonary embolism seen on MRA on [**2115-1-6**]. He continued to progress and on POD 4 he was cleared for discharge to home with VNA. All follow up appointments were advised. Medications on Admission: CARVEDILOL - 25 mg PO BID HYDRALAZINE - 20 mg PO TID HYDROCHLOROTHIAZIDE - 25 mg PO qAM LEVOTHYROXINE - 112 mcg PO qAM LISINOPRIL - 40 mg PO qAM SIMVASTATIN - 40 mg PO qPM ASPIRIN - 81 mg PO QD Discharge Medications: 1. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 2. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Outpatient Lab Work Labs: PT/INR for Coumadin ?????? indication, pulmonary emboli Goal INR [**3-15**] First draw [**2115-1-12**], then Monday, Wednesday, Friday for 2 weeks. Results to phone [**0-0-**], Dr. [**Last Name (STitle) **] (confirmed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 17**]) 4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 5. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 8. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 10. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*2* 11. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Dr. [**Last Name (STitle) **] to dose for goal INR [**3-15**]. dx: PE. Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: AllCare VNA Discharge Diagnosis: Primary: Coronary Artery Disease Secondary: Hypertension Hyperlipidemia Hypothyroidism Left femur fracture Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Edema 1+ 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**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2-14**] at 1:00pm Dr [**Last Name (STitle) 10166**] on [**2-12**] at 11:00am wound check on [**1-22**] at 10:45am Please call to schedule appointments with your Primary Care Dr.[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**2-11**] 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, pulmonary emboli Goal INR [**3-15**] First draw [**2115-1-12**], then Monday, Wednesday, Friday for 2 weeks. Results to phone [**0-0-**], Dr. [**Last Name (STitle) **] (confirmed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 17**]) Completed by:[**2115-1-11**]

414,415,427,413,401,272,244,V155,V173,305

{'Coronary atherosclerosis of native coronary artery,Other pulmonary embolism and infarction,Paroxysmal ventricular tachycardia,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Personal history of traumatic fracture,Family history of ischemic heart disease,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: exertional chest pain/stable angina PRESENT ILLNESS: Mr. [**Known lastname 91391**] is a 57 year old gentleman with a PMH significant for severe hypertension, mild hyperlipidemia, and a family history of heart disease, who presented to his PCP at the end of [**Month (only) **] with two months of exertional sub-sternal chest pain. His symptoms started at the end of [**Month (only) 205**] when he noticed burning substernal pain while walking his dog briskly. Symptoms were predictable in onset with exertion and always subsided with rest. The pain occassionally radiated to his left arm, but he denies nausea/vomiting or diaphoresis. Never had symptoms at rest. He presented to his PCP who sent him to the [**Hospital1 3597**] ED, where he was noted to have hypertension to 244/110. His blood pressure medications were changed at that time. He has long-standing hypertension, but does not recall his prior regimen before this change. He also underwent exercise MIBI at [**Hospital3 7362**], during which he went 4 minutes 36 seconds on a [**Doctor First Name **] protocol and developed 2mm ST depressions in the inferior lateral leads. He did experience chest discomfort. Imaging showed a large and severe defect involving the mid anterior wall extending to the anterior apex. In addition there was another defect involving the mid to distal septum. There was transient ischemic dilation of the left ventricle. LVEF was noted at 64%. He was referred to [**Hospital1 18**] for left heart catheterization which revealed multivessel coronary artery disease.Cardiac surgery was consulted for coronary revascularization. MEDICAL HISTORY: Primary: Coronary Artery Disease pulmonary embolism (incidental finding pre-operatively) MEDICATION ON ADMISSION: CARVEDILOL - 25 mg PO BID HYDRALAZINE - 20 mg PO TID HYDROCHLOROTHIAZIDE - 25 mg PO qAM LEVOTHYROXINE - 112 mcg PO qAM LISINOPRIL - 40 mg PO qAM SIMVASTATIN - 40 mg PO qPM ASPIRIN - 81 mg PO QD ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION: VS: T=98.4 BP=135-158/77-83 HR=75 RR=18 O2 sat= 96(RA) GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. No elevated JVP. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No m/r/g. LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, mildly obese, NTND. No HSM or tenderness. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. FAMILY HISTORY: Father died of early MI at age 46. Mother had some type of cancer and was in remission when she died in retirement home (cause unknown). No family hx of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Patient is divorced with three children. He lives with girlfriend and his girlfriend's two daughters. Previously worked at Papa Ginos as a general manager. Was laid off in [**Month (only) **]. Tobacco: Never ETOH: Rare Recreational drugs: Denies Home services: Denies ### Response: {'Coronary atherosclerosis of native coronary artery,Other pulmonary embolism and infarction,Paroxysmal ventricular tachycardia,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Personal history of traumatic fracture,Family history of ischemic heart disease,Tobacco use disorder'}

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 52-year-old man with a past medical history significant for diabetes, who presents after an episode of substernal chest pain. Patient states that he developed sudden onset of chest pain radiating to his jaw at 6 p.m. on [**2128-11-2**]. The patient returned home from work with persistent substernal chest pain. The following day on [**2128-11-3**], with persistent chest pain, the patient presented to [**Hospital1 1474**] ED for evaluation at 4:30 p.m. on [**2128-11-3**]. At this time, an EKG was obtained, which demonstrated likely inferior infarct with inferior Q waves and ST segment elevations. MEDICAL HISTORY: 1. Type 2 diabetes mellitus. 2. Right leg varicose veins. MEDICATION ON ADMISSION: 1. Metformin 1,000 mg b.i.d. 2. Glipizide 10 mg b.i.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: [**Name (NI) **] father died of cancer. Patient states that both he and his father have very low cholesterol. SOCIAL HISTORY: Patient denies significant tobacco, alcohol, or illicit drug use. He is married and works two jobs.

Acute myocardial infarction of other inferior wall, initial episode of care,Other specified complications of procedures not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary vasodilators causing adverse effects in therapeutic use,Asymptomatic varicose veins

AMI inferior wall, init,Oth spcf cmplc procd NEC,Crnry athrscl natve vssl,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr,Adv eff coronary vasodil,Asympt varicose veins

Admission Date: [**2128-11-3**] Discharge Date: [**2128-11-8**] Date of Birth: [**2075-12-31**] Sex: M Service: CCU HISTORY OF PRESENT ILLNESS: Patient is a 52-year-old man with a past medical history significant for diabetes, who presents after an episode of substernal chest pain. Patient states that he developed sudden onset of chest pain radiating to his jaw at 6 p.m. on [**2128-11-2**]. The patient returned home from work with persistent substernal chest pain. The following day on [**2128-11-3**], with persistent chest pain, the patient presented to [**Hospital1 1474**] ED for evaluation at 4:30 p.m. on [**2128-11-3**]. At this time, an EKG was obtained, which demonstrated likely inferior infarct with inferior Q waves and ST segment elevations. The patient was started on aspirin, Plavix, sublingual nitroglycerin, and nitroglycerin drip. On this regimen, the patient had persistent chest pain. In addition, his blood pressure markedly decreased. The patient was then started on IV fluids and thrombolytic therapy. Because the patient's pain also radiated to his back, he underwent a chest CT to rule out aortic dissection. The chest CT was negative for aortic dissection. He was then transferred to the [**Hospital1 1444**] for urgent cardiac catheterization. Selective coronary angiography demonstrated a right dominant system with two vessel coronary artery disease. The proximal RCA was totally occluded. The LAD had a 60% mid vessel stenosis. Resting hemodynamics demonstrated elevated left and right sided filling pressures. Mean RA pressure was 23. Mean wedge pressure was 32 mm Hg. The patient underwent successful stenting of the RCA. The patient was then transferred to the CCU team for further management. PAST MEDICAL HISTORY: 1. Type 2 diabetes mellitus. 2. Right leg varicose veins. SOCIAL HISTORY: Patient denies significant tobacco, alcohol, or illicit drug use. He is married and works two jobs. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Metformin 1,000 mg b.i.d. 2. Glipizide 10 mg b.i.d. ALLERGIES: No known drug allergies. FAMILY HISTORY: [**Name (NI) **] father died of cancer. Patient states that both he and his father have very low cholesterol. PHYSICAL EXAMINATION: Afebrile, heart rate 90, blood pressure 123/72, respiratory rate 16, sating 98% on 2 liters nasal cannula. HEENT: Sclerae are nonicteric. PERRL. Neck: Supple, no lymphadenopathy appreciated, jugular venous pressure at 6 cm. Pulmonary: Clear to auscultation bilaterally, no wheezes and no crackles on examination. Cardiac: Normal S1, S2, no murmurs, rubs, or gallops appreciated on examination. Abdomen: Normal bowel sounds, soft, nontender, nondistended. Extremities: Trace edema. Neurologic is alert and oriented times three. Cranial nerves II through XII intact. No focal deficits. LABORATORIES: Patient's admission laboratories were notable for a CK of 2,606 and a troponin-I greater than 50. CBC and Chem-7 were within normal limits. On cardiac catheterization, his cardiac output was measured at 3.34 and his cardiac index was measured at 1.47. EKG showed that the patient was in sinus rhythm with a rate in the 90s. He had ST segment elevations in III, II, and aVF. HOSPITAL COURSE: Patient was admitted to the CCU team. He remained hemodynamically stable overnight. The patient stated that he became chest pain free for the first time following cardiac catheterization. He did complain of back pain which he states was at baseline from a prior lower back injury. An echocardiogram was ordered to evaluate his cardiac pump function. Although the patient had an elevated wedge pressure, it was decided to hold diuresis initially given his likely decrease in right ventricular function. An EP consult was obtained to evaluate possible need for defibrillator. With the exception of an episode of hypotension, the patient remained stable and was transferred to the floor. He was maintained on aspirin, Plavix, low dosed Lipitor, metoprolol, and captopril. The patient was seen by EP consult, who suggested followup echocardiogram in three months and followup Holter in one month, and a stress in one month. In the CCU, the patient was on an insulin drip initially, but then was switched to Glipizide and metformin as these were his outpatient medications. The results from the transthoracic echocardiogram revealed that the patient's left atrium was mildly dilated. There was moderate global left ventricular hypokinesis and the left ventricular ejection fraction was measured at 30%. There was akinesis of the entire inferior wall and inferior septum. The patient continued to improve and was able to walk without difficulty. It was the consensus of the CCU team, that he was stable to return home with appropriate followup. However, the patient did spike a temperature to 101 and was kept overnight for additional observation. On [**2128-11-9**], the patient was discharged home with followup with EP service. DISCHARGE CONDITION: Stable. DISCHARGE STATUS: Home. DISCHARGE DIAGNOSIS: Myocardial infarction. DISCHARGE MEDICATIONS: 1. Aspirin 325 mg q.d. 2. Plavix 75 mg q.d. 3. Glipizide 10 mg q.d. 4. Metformin 1,000 mg q.d. 5. Atorvastatin 5 mg q.d. 6. Lisinopril 20 mg q.d. 7. Metoprolol succinate 50 mg q.d. Although the patient had a favorable cholesterol profile, he was started on atorvastatin given that this has been shown to benefit patients with diabetes in the setting of myocardial infarction. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 4786**] Dictated By:[**Name8 (MD) 9719**] MEDQUIST36 D: [**2128-11-9**] 16:41 T: [**2128-11-10**] 07:00 JOB#: [**Job Number **]

410,998,414,458,250,E942,454

{'Acute myocardial infarction of other inferior wall, initial episode of care,Other specified complications of procedures not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary vasodilators causing adverse effects in therapeutic use,Asymptomatic varicose veins'}

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: Patient is a 52-year-old man with a past medical history significant for diabetes, who presents after an episode of substernal chest pain. Patient states that he developed sudden onset of chest pain radiating to his jaw at 6 p.m. on [**2128-11-2**]. The patient returned home from work with persistent substernal chest pain. The following day on [**2128-11-3**], with persistent chest pain, the patient presented to [**Hospital1 1474**] ED for evaluation at 4:30 p.m. on [**2128-11-3**]. At this time, an EKG was obtained, which demonstrated likely inferior infarct with inferior Q waves and ST segment elevations. MEDICAL HISTORY: 1. Type 2 diabetes mellitus. 2. Right leg varicose veins. MEDICATION ON ADMISSION: 1. Metformin 1,000 mg b.i.d. 2. Glipizide 10 mg b.i.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: [**Name (NI) **] father died of cancer. Patient states that both he and his father have very low cholesterol. SOCIAL HISTORY: Patient denies significant tobacco, alcohol, or illicit drug use. He is married and works two jobs. ### Response: {'Acute myocardial infarction of other inferior wall, initial episode of care,Other specified complications of procedures not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary vasodilators causing adverse effects in therapeutic use,Asymptomatic varicose veins'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 64 yo M with past medical history significant for positive family history of premature coronary artery disease who was admitted to OSH [**2182-4-24**] with exertional chest pain. He ruled out for MI, but had a positive stress test and was transferred to [**Hospital1 18**] for cardiac catheterization. We are asked to consult for surgical revascularization MEDICAL HISTORY: coronary artery disease hypercholesterolemia Hypertension GERD colon polyps MEDICATION ON ADMISSION: ASA 325mg daily Colace 100mg po daily Lisinopril 10mg po daily Zolpidem 5mg po qHS PRN Simvastatin 40mg po daily Plavix - last dose:300mg [**4-26**] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse:71 Resp:18 O2 sat:97% RA B/P Right: Left: 157/91 Height:5'9" Weight:97.5kg FAMILY HISTORY: Twin Brother died of MI age 53 SOCIAL HISTORY: Occupation:Electrician Tobacco:quit 3-4 months ago [**2-16**] ppd x 30 years ETOH:couple of beers/week

Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other iatrogenic hypotension,Pure hypercholesterolemia,Unspecified essential hypertension,Esophageal reflux

Subendo infarct, initial,Urin tract infection NOS,Crnry athrscl natve vssl,Surg compl-urinary tract,Oliguria & anuria,Oth gram negatv bacteria,Iatrogenc hypotnsion NEC,Pure hypercholesterolem,Hypertension NOS,Esophageal reflux

Admission Date: [**2182-4-26**] Discharge Date: [**2182-5-4**] Date of Birth: [**2117-7-15**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: Coronary artery bypass grafting x3: Left internal mammary artery graft, left anterior descending, reverse saphenous vein graft to the marginal branch and the posterior descending artery. [**2182-4-30**] History of Present Illness: 64 yo M with past medical history significant for positive family history of premature coronary artery disease who was admitted to OSH [**2182-4-24**] with exertional chest pain. He ruled out for MI, but had a positive stress test and was transferred to [**Hospital1 18**] for cardiac catheterization. We are asked to consult for surgical revascularization Past Medical History: coronary artery disease hypercholesterolemia Hypertension GERD colon polyps Social History: Occupation:Electrician Tobacco:quit 3-4 months ago [**2-16**] ppd x 30 years ETOH:couple of beers/week Family History: Twin Brother died of MI age 53 Physical Exam: Pulse:71 Resp:18 O2 sat:97% RA B/P Right: Left: 157/91 Height:5'9" Weight:97.5kg General: NAD Skin: Dry [x] intact [x] HEENT: PERRLA [] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] Extremities: Warm[x] well-perfused[x] Edema/Varicosities: None [] Neuro: Grossly intact Pulses: Femoral Right: palp Left: palp DP Right: palp Left: palp PT [**Name (NI) 167**]: palp Left: palp Radial Right: palp Left: palp Carotid Bruit Right: none Left: none Pertinent Results: Pre-bypass: The left atrium and right atrium are normal in cavity size. No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. A patent foramen ovale is present. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic root is moderately dilated at the sinus level. The ascending aorta is mildly dilated. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Trivial mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. Post-bypass: The patient is not receiving inotropic support post-CPB. Biventricular systolic function is preserved. All findings are consistent with pre-bypass findings. The aorta is intact post-decannulation. All findings were communicated to the surgeon. [**2182-5-4**] 07:10AM BLOOD WBC-11.9* RBC-4.09* Hgb-11.0* Hct-34.2* MCV-84 MCH-27.0 MCHC-32.2 RDW-14.0 Plt Ct-289 [**2182-5-4**] 07:10AM BLOOD Glucose-88 UreaN-20 Creat-1.0 Na-140 K-4.2 Cl-101 HCO3-28 AnGap-15 Brief Hospital Course: The patient was admitted to the hospital for cardiac cath and preop testing. He did have a urinary tract infection which was treated with cipro. He was brought to the operating room on [**2182-4-30**] where the patient underwent coronary artery bypass x 3. Overall the patient 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 given the length of his preoperative stay. POD 1 found the patient extubated, alert and oriented and breathing comfortably. The patient was neurologically intact and hemodynamics were maintained with neo-synephrine. This was weaned and Beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. The patient was transferred to the telemetry floor for further recovery. Chest tubes and pacing wires were discontinued without complication. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD 4 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged to home in good condition with appropriate follow up instructions. Medications on Admission: ASA 325mg daily Colace 100mg po daily Lisinopril 10mg po daily Zolpidem 5mg po qHS PRN Simvastatin 40mg po daily Plavix - last dose:300mg [**4-26**] Discharge Medications: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain/fever . 4. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 2 weeks. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 6. Metoprolol Tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 7. 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* 8. Ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q12H (every 12 hours) for 1 doses. Disp:*3 Tablet(s)* Refills:*0* 9. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: One (1) Inhalation every six (6) hours as needed for shortness of breath or wheezing. Disp:*qs * Refills:*0* Discharge Disposition: Home With Service Facility: VNA Assoc. of [**Hospital3 **] Discharge Diagnosis: coronary artery disease PMH: hypercholesterolemia Hypertension GERD colon polyps Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with percocet prn Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 until follow up with surgeon No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Please call to schedule appointments Surgeon Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] Primary Care Dr.[**Last Name (STitle) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 55984**] in [**2-16**] weeks Cardiologist Dr. [**Last Name (STitle) **],[**First Name3 (LF) 177**] A. [**Telephone/Fax (1) 5315**] in [**2-16**] weeks Completed by:[**2182-5-4**]

410,599,414,997,788,041,458,272,401,530

{'Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other iatrogenic hypotension,Pure hypercholesterolemia,Unspecified essential hypertension,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: chest pain PRESENT ILLNESS: 64 yo M with past medical history significant for positive family history of premature coronary artery disease who was admitted to OSH [**2182-4-24**] with exertional chest pain. He ruled out for MI, but had a positive stress test and was transferred to [**Hospital1 18**] for cardiac catheterization. We are asked to consult for surgical revascularization MEDICAL HISTORY: coronary artery disease hypercholesterolemia Hypertension GERD colon polyps MEDICATION ON ADMISSION: ASA 325mg daily Colace 100mg po daily Lisinopril 10mg po daily Zolpidem 5mg po qHS PRN Simvastatin 40mg po daily Plavix - last dose:300mg [**4-26**] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse:71 Resp:18 O2 sat:97% RA B/P Right: Left: 157/91 Height:5'9" Weight:97.5kg FAMILY HISTORY: Twin Brother died of MI age 53 SOCIAL HISTORY: Occupation:Electrician Tobacco:quit 3-4 months ago [**2-16**] ppd x 30 years ETOH:couple of beers/week ### Response: {'Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other iatrogenic hypotension,Pure hypercholesterolemia,Unspecified essential hypertension,Esophageal reflux'}

CHIEF COMPLAINT: Hypoxia PRESENT ILLNESS: 83 yo male with recent complicated admission significant for: 1. Bladder CA, 7 cm mass, hematuria, with innumberable pulmonary nodules, likely metastases 2. Urosepsis, UCx + pseudomonas, h/o mutliple drug resistant UTIs, treated with 14 days of meropenem 3. Massive DVT, with IVC filter, not on anticoagulation [**1-25**] hematuria During this admission, palliative care was consulted, and significant efforts were made to address goals of care, given his poor prognosis. He was made DNR/DNI. He was discharged to a [**Hospital1 1501**] with the eventual goal of putting him under hospice care. MEDICAL HISTORY: 1. Pulmonary Embolism ([**2156-12-24**], IVC filter, not on anticoagulation) 2. Pancreatitis 3. Dementia 4. Type 2 Diabetes Mellitus 5. Hypertension, but not on antihypertensives 6. BPH 7. Bladder Cancer - s/p transurethral resection in [**7-31**] - completed [**3-29**] BCG treatment (missed treatment 5 [**1-25**] UTI) 8. s/p Stab Wounds 9. h/o RPR - treated in [**2119**] 10. s/p Penile Implant 11. Osteoarthritis MEDICATION ON ADMISSION: 1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO every twelve (12) hours. Disp:*30 Tablet(s)* Refills:*2* 2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). Tablet(s) 3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: Penicillins / Bactrim PHYSICAL EXAM: Vitals: BP: 52/31 P: 126 RR: 8 General: Agonal breathing, unresponsive CV: Regular Lungs: Coarse breath sounds bilaterally Ext: warm, well perfused FAMILY HISTORY: Could not complete due to patient's dementia. SOCIAL HISTORY: Per previous records, patient could not complete full history with me due to his delirium and dementia.

Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Hyperosmolality and/or hypernatremia,Severe sepsis,Malignant neoplasm of bladder, part unspecified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)

Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Secondary malig neo lung,Hyperosmolality,Severe sepsis,Malig neo bladder NOS,Hx-ven thrombosis/embols,Mental disor NEC oth dis,DMII wo cmp nt st uncntr,Hypertension NOS,BPH w/o urinary obs/LUTS

Admission Date: [**2157-3-1**] Discharge Date: [**2157-3-1**] Date of Birth: [**2073-4-5**] Sex: M Service: MEDICINE Allergies: Penicillins / Bactrim Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Hypoxia Major Surgical or Invasive Procedure: None History of Present Illness: 83 yo male with recent complicated admission significant for: 1. Bladder CA, 7 cm mass, hematuria, with innumberable pulmonary nodules, likely metastases 2. Urosepsis, UCx + pseudomonas, h/o mutliple drug resistant UTIs, treated with 14 days of meropenem 3. Massive DVT, with IVC filter, not on anticoagulation [**1-25**] hematuria During this admission, palliative care was consulted, and significant efforts were made to address goals of care, given his poor prognosis. He was made DNR/DNI. He was discharged to a [**Hospital1 1501**] with the eventual goal of putting him under hospice care. He was then found at his [**Hospital1 1501**] unresponsive. His VS on arrival to the ED were: T 98.0, HR 160s, BP 82/50, SpO2 40% on NRB, with rhonchi on exam. He received Vancomycin 1g IV, Levofloxacin 750mg IV, and Flagyl 500mg IV. On arrival to the floor, patient was unresponsive, was agonal breathing, with an SpO2 in the 60's on a 100% FM with 6L NC. Past Medical History: 1. Pulmonary Embolism ([**2156-12-24**], IVC filter, not on anticoagulation) 2. Pancreatitis 3. Dementia 4. Type 2 Diabetes Mellitus 5. Hypertension, but not on antihypertensives 6. BPH 7. Bladder Cancer - s/p transurethral resection in [**7-31**] - completed [**3-29**] BCG treatment (missed treatment 5 [**1-25**] UTI) 8. s/p Stab Wounds 9. h/o RPR - treated in [**2119**] 10. s/p Penile Implant 11. Osteoarthritis Social History: Per previous records, patient could not complete full history with me due to his delirium and dementia. Home: lives in [**Location 4367**] [**Hospital3 400**] Facility Occupation: retired long-distance truck driver EtOH: remote history of social alcohol use; denies EtOH in > 45 years Tobacco: remote history of 1 PPD smoking history, could not tell me when he quit Drugs: denies Family History: Could not complete due to patient's dementia. Physical Exam: Vitals: BP: 52/31 P: 126 RR: 8 General: Agonal breathing, unresponsive CV: Regular Lungs: Coarse breath sounds bilaterally Ext: warm, well perfused Pertinent Results: [**2157-3-1**] 01:15AM BLOOD WBC-19.4* RBC-4.96 Hgb-11.0* Hct-40.1 MCV-81* MCH-22.2* MCHC-27.4* RDW-18.2* Plt Ct-481* [**2157-3-1**] 01:15AM BLOOD PT-18.2* PTT-34.3 INR(PT)-1.6* [**2157-3-1**] 01:15AM BLOOD Fibrino-821* [**2157-3-1**] 01:15AM BLOOD UreaN-33* Creat-1.9* [**2157-3-1**] 01:15AM BLOOD Lipase-42 [**2157-3-1**] 01:27AM BLOOD Glucose-135* Lactate-11.0* Na-166* K-4.8 Cl-115* calHCO3-23 Brief Hospital Course: 83 year old man with a h/o of metastatic bladder CA, mutliple drug resistant UTIs, & massive DVT s/p IVC filter who presented in respiratory failure likely [**1-25**] pneumonia. On admission, the patient's HCP (his wife) expressed her desire to focus on his comfort. He received supplemental oxygen, antibiotics, and was placed on a morphine gtt and he expired within 2 hours of arriving in the ICU. Medications on Admission: 1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO every twelve (12) hours. Disp:*30 Tablet(s)* Refills:*2* 2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). Tablet(s) 3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever or pain. 8. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN (as needed) as needed for dryness. Disp:*1 bottle* Refills:*2* 9. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 10. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 11. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) packet PO DAILY (Daily) as needed for constipation. 12. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 13. Insulin Sliding scale Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: Respiratory failure Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

038,486,518,197,276,995,188,V125,294,250,401,600

{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Hyperosmolality and/or hypernatremia,Severe sepsis,Malignant neoplasm of bladder, part unspecified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,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: Hypoxia PRESENT ILLNESS: 83 yo male with recent complicated admission significant for: 1. Bladder CA, 7 cm mass, hematuria, with innumberable pulmonary nodules, likely metastases 2. Urosepsis, UCx + pseudomonas, h/o mutliple drug resistant UTIs, treated with 14 days of meropenem 3. Massive DVT, with IVC filter, not on anticoagulation [**1-25**] hematuria During this admission, palliative care was consulted, and significant efforts were made to address goals of care, given his poor prognosis. He was made DNR/DNI. He was discharged to a [**Hospital1 1501**] with the eventual goal of putting him under hospice care. MEDICAL HISTORY: 1. Pulmonary Embolism ([**2156-12-24**], IVC filter, not on anticoagulation) 2. Pancreatitis 3. Dementia 4. Type 2 Diabetes Mellitus 5. Hypertension, but not on antihypertensives 6. BPH 7. Bladder Cancer - s/p transurethral resection in [**7-31**] - completed [**3-29**] BCG treatment (missed treatment 5 [**1-25**] UTI) 8. s/p Stab Wounds 9. h/o RPR - treated in [**2119**] 10. s/p Penile Implant 11. Osteoarthritis MEDICATION ON ADMISSION: 1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO every twelve (12) hours. Disp:*30 Tablet(s)* Refills:*2* 2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). Tablet(s) 3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: Penicillins / Bactrim PHYSICAL EXAM: Vitals: BP: 52/31 P: 126 RR: 8 General: Agonal breathing, unresponsive CV: Regular Lungs: Coarse breath sounds bilaterally Ext: warm, well perfused FAMILY HISTORY: Could not complete due to patient's dementia. SOCIAL HISTORY: Per previous records, patient could not complete full history with me due to his delirium and dementia. ### Response: {'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Hyperosmolality and/or hypernatremia,Severe sepsis,Malignant neoplasm of bladder, part unspecified,Personal history of venous thrombosis and embolism,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}

CHIEF COMPLAINT: Tracheobronchomalacia PRESENT ILLNESS: 47yo male with ongoing dyspnea with exertion mostly and severe bouts of dry high-pitch cough for years. He was evaluated for on multiple occasions but only about 9 months ago underwent bronchoscopy showing tracheomalacia in the distal trachea. Further work up was complicated by a trial of stent resulting in R bronchial tear needing surgical repair with a muscle flap, tracheostomy and prolonged ICU course, rehab, eventual trach removal. On presentations he is bothered by a severe dry cough, DOE and decreased activity toleraNCE. He had a trial stent placedin early [**January 2130**] which improved his symptoms dramatically. The stent was removed for yeast laryngitis and he had completed a course of Diflucan. MEDICAL HISTORY: PMH Tracheomalacia HTN obesity anxiety/depression mild GERD Hx of portal vein thrombosis which resolved sinusitis s/p Right thoracotomy with repair of bronchial tear with intercostal muscle flap MEDICATION ON ADMISSION: Nasonex 50 mg 2 puffs [**Hospital1 **] Lipitor 40 mg PO Daily Cymbalta 60 mg 1 tab PO daily Nexium 40 mg 1 tab PO daily Divalproex 500 mg 1 tab PO daily Febofibrate 200 mg PO daily Notriptyline 25 mg PO Daily Lorazepam 1 mg POI Daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: BP: 130/73. Heart Rate: 92. Weight: 197. Height: 65.5. BMI: 32.3. Temperature: 98.7. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 99. Chest:CTAB, incisions healing well COR RRR Abd lg soft, NT Ext calves soft, no edema FAMILY HISTORY: Noncontributory SOCIAL HISTORY: From [**State 4260**] Married, supportive family. No A/T/D

Other diseases of trachea and bronchus,Unspecified pleural effusion,Acute posthemorrhagic anemia,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Other acute postoperative pain,Hypoxemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Other specified cardiac dysrhythmias

Trachea & bronch dis NEC,Pleural effusion NOS,Ac posthemorrhag anemia,Accidental op laceration,Hypertension NOS,Anxiety state NOS,Depressive disorder NEC,Esophageal reflux,Acute postop pain NEC,Hypoxemia,Acc cut/hem in surgery,Cardiac dysrhythmias NEC

Admission Date: [**2130-2-3**] Discharge Date: [**2130-2-12**] Date of Birth: [**2083-1-5**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 5790**] Chief Complaint: Tracheobronchomalacia Major Surgical or Invasive Procedure: [**2130-2-3**] Redo right thoracotomy, thoracic tracheoplasty with mesh, right mainstem bronchus bronchoplasty with mesh, left mainstem bronchus bronchoplasty with mesh, repair of bronchus intermedius laceration, bronchoscopy with bronchoalveolar lavage, pericardial fat pad buttress History of Present Illness: 47yo male with ongoing dyspnea with exertion mostly and severe bouts of dry high-pitch cough for years. He was evaluated for on multiple occasions but only about 9 months ago underwent bronchoscopy showing tracheomalacia in the distal trachea. Further work up was complicated by a trial of stent resulting in R bronchial tear needing surgical repair with a muscle flap, tracheostomy and prolonged ICU course, rehab, eventual trach removal. On presentations he is bothered by a severe dry cough, DOE and decreased activity toleraNCE. He had a trial stent placedin early [**January 2130**] which improved his symptoms dramatically. The stent was removed for yeast laryngitis and he had completed a course of Diflucan. Past Medical History: PMH Tracheomalacia HTN obesity anxiety/depression mild GERD Hx of portal vein thrombosis which resolved sinusitis s/p Right thoracotomy with repair of bronchial tear with intercostal muscle flap Social History: From [**State 4260**] Married, supportive family. No A/T/D Family History: Noncontributory Physical Exam: BP: 130/73. Heart Rate: 92. Weight: 197. Height: 65.5. BMI: 32.3. Temperature: 98.7. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 99. Chest:CTAB, incisions healing well COR RRR Abd lg soft, NT Ext calves soft, no edema Pertinent Results: [**2130-2-10**] 09:25AM BLOOD WBC-11.1* RBC-3.35* Hgb-9.8* Hct-29.0* MCV-87 MCH-29.3 MCHC-33.9 RDW-14.9 Plt Ct-182 [**2130-2-10**] 09:25AM BLOOD Plt Ct-182 [**2130-2-10**] 09:25AM BLOOD Glucose-91 UreaN-15 Creat-0.8 Na-136 K-3.9 Cl-96 HCO3-28 AnGap-16 [**2130-2-6**] 01:53AM BLOOD CK(CPK)-4430* [**2130-2-5**] 01:49PM BLOOD CK-MB-12* MB Indx-0.2 [**2130-2-10**] 09:25AM BLOOD Calcium-9.4 Phos-3.7 Mg-2.0 [**2130-2-7**] 09:40PM BLOOD Type-ART pO2-107* pCO2-47* pH-7.44 calTCO2-33* Base XS-6 [**2130-2-6**] 01:12PM BLOOD Lactate-0.8 [**2130-2-6**] 10:19AM BLOOD O2 Sat-87 [**2130-2-7**] 09:40PM BLOOD freeCa-1.08* Brief Hospital Course: The patient was admitted to the surgical service following Redo right thoracotomy, thoracic tracheoplasty with mesh, right mainstem bronchus bronchoplasty with mesh, left mainstem bronchus bronchoplasty with mesh, repair of bronchus intermedius laceration, bronchoscopy with bronchoalveolar lavage, pericardial fat pad buttress. Please see the dictated operative note for further details of the patient's procedure. Postoperatively the patient was taken to the surgical intensive care unit. Intensive care Unit Course: [**2-3**]: Admitted to the Surgical Intensive Care Unit status post redo tracheobronchoplasty for tracheobronchomalacia. He was extubated, weaned off pressor support. He continued to have sinus tachycardia overnight. His CK was increased to 7,000, his Creatinine was 1.3, he was making adequate urine [**2-4**]: Chest tube put to water seal. Repeat CXR showed increased pleural effusion on the right side, chest tube was put back to suction. He was started on ativan as needed for agitation, which is a home medication. His hematocrit had slow decline, unclear source as no evidence of active bleeding. His creatine kinase was downtrending from 8000 to 6000 with fluids. [**2-5**]: Poor pain control in AM, was evaluated by the acute pain service. The epidural was still working well and hence was adjusted to Bupivicaine+Dilaudid rate 12 (max) with good effect. CK from 7000->4500 in pm, his urine output was sufficient. [**2-6**]: Pt became increasingly tachypneic, with increased oxygen requirement. He received IV Lasix with good response and was placed on BiPAP w/ subsequent improvement in CXR, oxygenation, and symptoms. O2 sats remained stable on shovel mask overnight. Hct trend 21.8-->21.7--19.8 w/ complaints of dizziness. Transfused 1u PRBC w/ Hct increase to 23. Pain control tenuous; epidural rate to 14, split and dilaudid PCA added. [**2-7**]: Lasix given in the AM, with good UOP of about 600cc. Chest tube pulled in AM, repeat CXR showed no reaccumulation of effusion. HIs diet was advanced per thoracics attending. Lasix repeated in the evening, with overall negative -400. Hct stable. ABG stable. can most likely be transferred to the floor today. [**2-8**]: Epidural DC'd, HSQ increased to TID. Not using Dilaudid PCA (only took 0.5mg overnight), started Oxycodone w/ Dilaudid IV PRN for breakthrough, made bowel regimen standing. He was transferred to the floor. Upon transfer to the floor,the patient was doing well. He had no acute events, and hisoxygen was gradually weaned. His pain was controlled with oral pain medication. He was tolerating a regular diet. He was able to ambulate and void. A trending ambulatory pulse oximetry was done on [**2130-2-11**] which demonstrated that he was able to maintain his oxygenation at 93-96% on room air. His mental status was clear and coherent at his baseline. Hid home medications were restarted. He will be discharged and will remain in the area at a nearby hotel until seen in follow up, at which time he may be medically cleared to travel back to [**State 4260**] with his wife. Medications on Admission: Nasonex 50 mg 2 puffs [**Hospital1 **] Lipitor 40 mg PO Daily Cymbalta 60 mg 1 tab PO daily Nexium 40 mg 1 tab PO daily Divalproex 500 mg 1 tab PO daily Febofibrate 200 mg PO daily Notriptyline 25 mg PO Daily Lorazepam 1 mg POI Daily Discharge Medications: 1. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime. 4. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 5. Nasonex 50 mcg/actuation Spray, Non-Aerosol Sig: Two (2) nasal sprays Nasal once a day. 6. fenofibrate 160 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 7. nortriptyline 25 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 8. lorazepam 1 mg Tablet Sig: One (1) Tablet PO once a day as needed for anxiety. 9. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 11. Oxycodone 5-10mg PO Q4H prn pain Discharge Disposition: Home Discharge Diagnosis: tracheobronchomalacia 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 lung surgery and you've recovered well. You are now ready for discharge. * Continue to use your incentive spirometer 10 times an hour while awake. * Check your incisions daily and report any increased redness or drainage. Cover the area with a gauze pad if it is draining. * You will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. Make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. Use a stool softener or gentle laxative to stay regular. * No driving while taking narcotic pain medication. * Take Tylenol 650 mg every 6 hours in between your narcotic. If your doctor allows you may also take Ibuprofen to help relieve the pain. * Continue to stay well hydrated and eat well to heal your incisions * Shower daily. Wash incision with mild soap & water, rinse, pat dry * No tub bathing, swimming or hot tubs until incision healed * No lotions or creams to incision site * Walk 4-5 times a day and gradually increase your activity as you can tolerate. Call Dr.[**Name (NI) 5067**]/Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience: -Fevers > 101 or chills -Increased shortness of breath, chest pain or any other symptoms that concern you. Followup Instructions: As you know, you should remain in the area until seen in follow up in Dr.[**Name (NI) 2347**] clinic. At that time you may be cleared for travel back to [**State 4260**]. Please call Dr.[**Name (NI) 92303**] Clinic at [**Telephone/Fax (1) 92304**] to schedule your follow up appointment. Completed by:[**2130-3-9**]

519,511,285,998,401,300,311,530,338,799,E870,427

{'Other diseases of trachea and bronchus,Unspecified pleural effusion,Acute posthemorrhagic anemia,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Other acute postoperative pain,Hypoxemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation,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: Tracheobronchomalacia PRESENT ILLNESS: 47yo male with ongoing dyspnea with exertion mostly and severe bouts of dry high-pitch cough for years. He was evaluated for on multiple occasions but only about 9 months ago underwent bronchoscopy showing tracheomalacia in the distal trachea. Further work up was complicated by a trial of stent resulting in R bronchial tear needing surgical repair with a muscle flap, tracheostomy and prolonged ICU course, rehab, eventual trach removal. On presentations he is bothered by a severe dry cough, DOE and decreased activity toleraNCE. He had a trial stent placedin early [**January 2130**] which improved his symptoms dramatically. The stent was removed for yeast laryngitis and he had completed a course of Diflucan. MEDICAL HISTORY: PMH Tracheomalacia HTN obesity anxiety/depression mild GERD Hx of portal vein thrombosis which resolved sinusitis s/p Right thoracotomy with repair of bronchial tear with intercostal muscle flap MEDICATION ON ADMISSION: Nasonex 50 mg 2 puffs [**Hospital1 **] Lipitor 40 mg PO Daily Cymbalta 60 mg 1 tab PO daily Nexium 40 mg 1 tab PO daily Divalproex 500 mg 1 tab PO daily Febofibrate 200 mg PO daily Notriptyline 25 mg PO Daily Lorazepam 1 mg POI Daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: BP: 130/73. Heart Rate: 92. Weight: 197. Height: 65.5. BMI: 32.3. Temperature: 98.7. Resp. Rate: 16. Pain Score: 0. O2 Saturation%: 99. Chest:CTAB, incisions healing well COR RRR Abd lg soft, NT Ext calves soft, no edema FAMILY HISTORY: Noncontributory SOCIAL HISTORY: From [**State 4260**] Married, supportive family. No A/T/D ### Response: {'Other diseases of trachea and bronchus,Unspecified pleural effusion,Acute posthemorrhagic anemia,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified essential hypertension,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Other acute postoperative pain,Hypoxemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Other specified cardiac dysrhythmias'}

CHIEF COMPLAINT: Chest Discomfort PRESENT ILLNESS: MEDICAL HISTORY: ^chol. HTN NIDDM s/p gastrectomy for gastric ca s/p abdominoplasty s/p appy sleep apnea arthritis peripheral neuropathy hiatal hernia GERD depression b/l cataracts distant h/o VRE endometriosis knee [**Doctor First Name **] MEDICATION ON ADMISSION: Glucophage 500 mg PO TID Atenolol 50 mg PO daily Protonix 40 mg PO daily Lipitor 10 mg PO daily Lisinopril 20 mg PO daily ASA 81 mg PO daily Tramadol 50 mg PO TID Lorazepam ALLERGIES: Phenazopyridine PHYSICAL EXAM: 183/86 62 SR 66" 185# GEN: NAD HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: 2+ Pulses, no edema, no varicosities NEURO: Nonfocal FAMILY HISTORY: Father died of MI at age 78 SOCIAL HISTORY: .Disabled. Quit smoking in [**2090**] after smoking 16 years. Lives alone and drinks 1 drink of alcohol weekly.

Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of stomach,Pure hypercholesterolemia,Intermediate coronary syndrome

Crnry athrscl natve vssl,Parox ventric tachycard,Hypertension NOS,DMII wo cmp nt st uncntr,Hx of gastric malignancy,Pure hypercholesterolem,Intermed coronary synd

Admission Date: [**2147-8-10**] Discharge Date: [**2147-8-16**] Date of Birth: [**2089-7-12**] Sex: F Service: CARDIOTHORACIC Allergies: Phenazopyridine Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest Discomfort Major Surgical or Invasive Procedure: [**2147-8-10**] Three Vessel Coronary Artery Bypass Grafting(left internal mammary to left anterior descending, vein grafts to obtuse marginal and posterior descending artery) Past Medical History: ^chol. HTN NIDDM s/p gastrectomy for gastric ca s/p abdominoplasty s/p appy sleep apnea arthritis peripheral neuropathy hiatal hernia GERD depression b/l cataracts distant h/o VRE endometriosis knee [**Doctor First Name **] Social History: .Disabled. Quit smoking in [**2090**] after smoking 16 years. Lives alone and drinks 1 drink of alcohol weekly. Family History: Father died of MI at age 78 Physical Exam: 183/86 62 SR 66" 185# GEN: NAD HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: 2+ Pulses, no edema, no varicosities NEURO: Nonfocal Pertinent Results: [**2147-8-15**] 08:05AM BLOOD WBC-4.1 RBC-3.54* Hgb-9.4* Hct-29.0* MCV-82 MCH-26.7* MCHC-32.6 RDW-14.2 Plt Ct-234# [**2147-8-15**] 08:05AM BLOOD Glucose-131* UreaN-17 Creat-0.7 Na-140 K-4.4 Cl-97 HCO3-37* AnGap-10 RADIOLOGY Preliminary Report CHEST (PA & LAT) [**2147-8-15**] 5:29 PM PA AND LATERAL CHEST RADIOGRAPHS: Again seen are median sternotomy wires and clips from recent surgery. There is cardiomegaly, which is stable. There is left lower lobe atelectasis, which demonstrates slight improved aeration. Additionally, there is a probable small associated left pleural effusion. No pneumothorax is seen. Mediastinal contours are within normal limits. Pulmonary vasculature is normal. Within the right lower lung zone, there is linear area of density which may represent an ill-defined area of atelectasis. Degenerative changes are noted within the thoracic spine. IMPRESSION: Continued atelectasis within the left lower lobe, and a probable associated small pleural effusion. Linear opacity in the right lower lung zone may represent an area of atelectasis, though early consolidation is not excluded. Cardiology Report ECHO Study Date of [**2147-8-14**] LEFT ATRIUM: Normal LA size. Elongated LA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size. Normal regional LV systolic function. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV wall thickness. Normal RV chamber size. Normal RV systolic function. AORTA: Normal aortic root diameter. Normal ascending aorta diameter. AORTIC VALVE: Normal aortic valve leaflets. No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. No MR. TRICUSPID VALVE: Mild [1+] TR. Normal PA systolic pressure. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Left pleural effusion. Conclusions: 1. The left atrium is normal in size. The left atrium is elongated. 2. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size is normal. Right ventricular systolic function is normal. 4.The aortic valve leaflets appear structurally normal with good leaflet excursion. No aortic regurgitation is seen. 5.The mitral valve leaflets are mildly thickened. No mitral regurgitation is seen. 6.The estimated pulmonary artery systolic pressure is normal. 7.There is no pericardial effusion. Compared with the findings of the prior study (images reviewed) of [**2147-8-3**], no change. Brief Hospital Course: Ms. [**Known lastname 25309**] was admitted to the [**Hospital1 18**] on [**2147-8-10**] for surgical management of her coronary artery disease. She was taken directly to the operating room where she underwent coronary artery bypass grafting to three vessels. Postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. On postoperative day one, Ms. [**Known lastname 25309**] [**Last Name (Titles) 5058**] neurologically intact and was extubated. Drains and wires were removed per protocol. She developed some runs of supraventricular tachycardia which was treated with beta blockade. Aspirin and a statin were resumed. On postoperative day three, she was transferred to the step down unit for further recovery. She was gently diuresed towards her preoperative weight. The physical therapy service was consulted for assistance with her postoperative strength and mobility. The electrophysiology service was consulted for wide complex tachycardia which was likely nonsustained ventricular tachycardia. As her ejection fraction was normal, beta blockade therapy was maximized and her electrolytes were repleted. Ms. [**Known lastname 25309**] continued to make steady progress and was discharged home on postoperative day six. She will follow-up with Dr. [**Last Name (STitle) **], her cardiologist and her primary care physician as an outpatient. Medications on Admission: Glucophage 500 mg PO TID Atenolol 50 mg PO daily Protonix 40 mg PO daily Lipitor 10 mg PO daily Lisinopril 20 mg PO daily ASA 81 mg PO daily Tramadol 50 mg PO TID Lorazepam Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 4. 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:*2* 5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*2* 6. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 8. Lopressor 50 mg Tablet Sig: 1.5 Tablets PO three times a day. Disp:*135 Tablet(s)* Refills:*2* 9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7 days. Disp:*28 Capsule, Sustained Release(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Coronary Artery Disease - s/p coronary artery bypass grafting, Hypertension, Hypercholesterolemia, Type II Diabetes Mellitus, Anemia, Sleep Apnea, History of Gastric Cancer s/p Gastrectomy, Arthritis 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. Followup Instructions: Cardiac surgeon, Dr. [**Last Name (STitle) **] in [**3-22**] weeks. Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5263**] in [**1-20**] weeks. Local cardiologist, Dr. [**Last Name (STitle) 171**] in [**1-20**] weeks. Completed by:[**2147-8-25**]

414,427,401,250,V100,272,411

{'Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of stomach,Pure hypercholesterolemia,Intermediate coronary 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: Chest Discomfort PRESENT ILLNESS: MEDICAL HISTORY: ^chol. HTN NIDDM s/p gastrectomy for gastric ca s/p abdominoplasty s/p appy sleep apnea arthritis peripheral neuropathy hiatal hernia GERD depression b/l cataracts distant h/o VRE endometriosis knee [**Doctor First Name **] MEDICATION ON ADMISSION: Glucophage 500 mg PO TID Atenolol 50 mg PO daily Protonix 40 mg PO daily Lipitor 10 mg PO daily Lisinopril 20 mg PO daily ASA 81 mg PO daily Tramadol 50 mg PO TID Lorazepam ALLERGIES: Phenazopyridine PHYSICAL EXAM: 183/86 62 SR 66" 185# GEN: NAD HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: 2+ Pulses, no edema, no varicosities NEURO: Nonfocal FAMILY HISTORY: Father died of MI at age 78 SOCIAL HISTORY: .Disabled. Quit smoking in [**2090**] after smoking 16 years. Lives alone and drinks 1 drink of alcohol weekly. ### Response: {'Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of stomach,Pure hypercholesterolemia,Intermediate coronary syndrome'}

CHIEF COMPLAINT: transfer from MICU s/p seizures, EtOH withdrawal PRESENT ILLNESS: 55M with h/o seizures (since [**2100**], followed by Dr. [**Last Name (STitle) **] from Neurology), who presented to the ED after being struck by a brick thrown during a "road rage altercation." He suffered a traumatic mid-shaft open comminuted ulnar fracture ('nightstick'). Per nursing, patient was noted to have EtOH on breath, however BAL never checked. He was admitted to the ortho service initially on [**2120-7-13**] with plans for washings in the AM. He was placed on a CIWA scale (scores 0-2 overnight), given 200 mg of dilantin at MN, and received Ancef and Gentamycin. . The following morning, the patient was found unresponsive by the phlebotomist at 6:30 am. Per report, he was grinding his teeth, drooling and diaphoretic. VS at that point were BP 93/54, HR 100, RR 24, SaO2 95%/RA, BS 142. He did not open his eyes to commands. At 6:50 am, he had another episode of teeth grinding and was given 2 mg IV ativan with decrease in SaO2 to 69%. At 7:05 am, he had another episode of grinding teeth and eye deviation and was given another 2 mg IV ativan. At 7:20 am, again another similar episode occured and he received 2 mg IV ativan. Neurology and the MICU team were called for evaluation. He was then transferred to the MICU for further evaluation. Course c/b traumatic foley placement on floor, requiring urology evaluation and re-placement of foley. . On MICU arrival, the patient was somnolent and unresponsive to voice, but responsive to painful stimuli. ABG at that time was 7.03/36/285/10 on a NRB. Serum tox was sent and was positive only for EtOH = 70. Dilantin level returned sub-therapeutic at 1.8. He was loaded with 1200 mg IV dilantin per neurology recommendations. After this, the patient was more responsive and awake. Repeat ABG on NRB was 7.28/31/264, lactate 10.8. Also noted to have transaminitis (from ?anti-epileptic meds). While in the MICU, the patient was continued on q2hr CIWA scales and required approximately 7.5-10 mg per day. The patient's mental status improved, vitals stabilized, he had no futher seizure activity, and was transferred to the floor. . On evaluation, the patient complains of a painful left arm. Denies abdominal pain, SOB, CP, diaphoresis, hallucinations, tremulousness, or confusion. MEDICAL HISTORY: EtOH abuse h/o EtOH withdrawal seizures (last hospitalized [**2116**] per patient; followed by Dr. [**Last Name (STitle) **] from Neurology) MEDICATION ON ADMISSION: Dilantin 200/100/200 mg tid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: WDWN black male, soft-spoken, lying in bed, NAD Vitals: T 99.3 BP 120/88 HR 88 RR 20 O2sat 98% RA Skin: warm, no rash HEENT: PERRLA, EOMI, anicteric, OP clear Neck: supple, trachea midline, no LAD Pulm: left basilar fine crackles, no wheezes CV: regular, s1s2 normal, no m/r/g Abdomen: +BS, soft, nontender, nondistended, no HSM Extremities: no edema, cyanosis, or clubbing; left arm splinted Neuro: A&Ox3, speech soft but intelligible, CNII-XII intact, mild dysmetria, sensation intact and symmetric bilat, moves all extremities, mild tremulousness, no asterixis FAMILY HISTORY: noncontributory SOCIAL HISTORY: Lives with wife (who is currently in [**Name (NI) 108**] per the patient). Works as carpenter. Drinks approximately 6-pack beer per day plus occasional vodka. No tobacco or illicits.

Open fracture of shaft of ulna (alone),Other convulsions,Alcohol withdrawal,Alcohol abuse, continuous,Unspecified protein-calorie malnutrition,Mitral valve disorders,Diseases of tricuspid valve,Assault by striking by blunt or thrown object

Fx ulna shaft-open,Convulsions NEC,Alcohol withdrawal,Alcohol abuse-continuous,Protein-cal malnutr NOS,Mitral valve disorder,Tricuspid valve disease,Assault-striking w obj

Admission Date: [**2120-7-13**] Discharge Date: [**2120-7-20**] Date of Birth: [**2065-4-6**] Sex: M Service: ORTHOPAEDICS Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 11415**] Chief Complaint: transfer from MICU s/p seizures, EtOH withdrawal Major Surgical or Invasive Procedure: left forearm I&D History of Present Illness: 55M with h/o seizures (since [**2100**], followed by Dr. [**Last Name (STitle) **] from Neurology), who presented to the ED after being struck by a brick thrown during a "road rage altercation." He suffered a traumatic mid-shaft open comminuted ulnar fracture ('nightstick'). Per nursing, patient was noted to have EtOH on breath, however BAL never checked. He was admitted to the ortho service initially on [**2120-7-13**] with plans for washings in the AM. He was placed on a CIWA scale (scores 0-2 overnight), given 200 mg of dilantin at MN, and received Ancef and Gentamycin. . The following morning, the patient was found unresponsive by the phlebotomist at 6:30 am. Per report, he was grinding his teeth, drooling and diaphoretic. VS at that point were BP 93/54, HR 100, RR 24, SaO2 95%/RA, BS 142. He did not open his eyes to commands. At 6:50 am, he had another episode of teeth grinding and was given 2 mg IV ativan with decrease in SaO2 to 69%. At 7:05 am, he had another episode of grinding teeth and eye deviation and was given another 2 mg IV ativan. At 7:20 am, again another similar episode occured and he received 2 mg IV ativan. Neurology and the MICU team were called for evaluation. He was then transferred to the MICU for further evaluation. Course c/b traumatic foley placement on floor, requiring urology evaluation and re-placement of foley. . On MICU arrival, the patient was somnolent and unresponsive to voice, but responsive to painful stimuli. ABG at that time was 7.03/36/285/10 on a NRB. Serum tox was sent and was positive only for EtOH = 70. Dilantin level returned sub-therapeutic at 1.8. He was loaded with 1200 mg IV dilantin per neurology recommendations. After this, the patient was more responsive and awake. Repeat ABG on NRB was 7.28/31/264, lactate 10.8. Also noted to have transaminitis (from ?anti-epileptic meds). While in the MICU, the patient was continued on q2hr CIWA scales and required approximately 7.5-10 mg per day. The patient's mental status improved, vitals stabilized, he had no futher seizure activity, and was transferred to the floor. . On evaluation, the patient complains of a painful left arm. Denies abdominal pain, SOB, CP, diaphoresis, hallucinations, tremulousness, or confusion. Past Medical History: EtOH abuse h/o EtOH withdrawal seizures (last hospitalized [**2116**] per patient; followed by Dr. [**Last Name (STitle) **] from Neurology) Social History: Lives with wife (who is currently in [**Name (NI) 108**] per the patient). Works as carpenter. Drinks approximately 6-pack beer per day plus occasional vodka. No tobacco or illicits. Family History: noncontributory Physical Exam: General: WDWN black male, soft-spoken, lying in bed, NAD Vitals: T 99.3 BP 120/88 HR 88 RR 20 O2sat 98% RA Skin: warm, no rash HEENT: PERRLA, EOMI, anicteric, OP clear Neck: supple, trachea midline, no LAD Pulm: left basilar fine crackles, no wheezes CV: regular, s1s2 normal, no m/r/g Abdomen: +BS, soft, nontender, nondistended, no HSM Extremities: no edema, cyanosis, or clubbing; left arm splinted Neuro: A&Ox3, speech soft but intelligible, CNII-XII intact, mild dysmetria, sensation intact and symmetric bilat, moves all extremities, mild tremulousness, no asterixis Pertinent Results: [**2120-7-15**] 02:00AM BLOOD WBC-6.2 RBC-3.26* Hgb-11.3* Hct-31.7* MCV-97# MCH-34.7* MCHC-35.7* RDW-14.7 Plt Ct-180 [**2120-7-15**] 02:00AM BLOOD Neuts-79.7* Lymphs-16.1* Monos-3.5 Eos-0.5 Baso-0.3 [**2120-7-15**] 02:00AM BLOOD Glucose-102 UreaN-3* Creat-0.7 Na-132* K-3.5 Cl-97 HCO3-25 AnGap-14 [**2120-7-14**] 09:44AM BLOOD ALT-93* AST-176* LD(LDH)-239 AlkPhos-78 TotBili-0.9 [**2120-7-14**] 07:02AM BLOOD CK-MB-4 cTropnT-<0.01 [**2120-7-15**] 02:00AM BLOOD Calcium-8.7 Phos-2.2* Mg-2.3 [**2120-7-14**] 06:49PM BLOOD Phenyto-18.2 [**2120-7-14**] 07:02AM BLOOD ASA-NEG Ethanol-70* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG . EKG [**2120-7-13**] - NSR at 70 bpm, normal axis. Slightly prolonged PR interval. No acute ST-T wave changes. Compared to [**12-6**]. . CXR - Single AP view of the chest is obtained on [**2120-7-14**] at 19:00 hours and is compared with the prior study performed at 14:47 hours. Again the inspiratory effort is poor. Patchy increased lung markings remain at both bases, particularly on the right side, which may be due to the degree of underinflation. No frank dilatation is identified. . CT head - There is no evidence of hemorrhage. The [**Doctor Last Name 352**]-white matter differentiation appears preserved. There is no hydrocephalus or shift of normally midline structures. The basal cisterns appear patent. Visualized paranasal sinuses are clear. IMPRESSION: No evidence of hemorrhage. . EEG - This was an abnormal EEG in the waking and drowsy states due to the presence of theta frequency slowing in the left posterior quadrant. This finding suggests an abnormality in the subcortical region. No clear epileptiform activity was seen. Diffuse beta activity seen may be the result of certain medications such as benzodiazepines. . LEFT FOREARM, TWO VIEWS: There is a minimally displaced comminuted fracture through the distal third of the left ulna. There is moderate surrounding soft tissue swelling. The joint spaces of the elbow and wrist appear preserved. No radiopaque foreign bodies are identified. IMPRESSION: Distal left ulnar fracture as described above. Brief Hospital Course: 55 y/o male with h/o seizures, EtOH abuse presented with left ulnar fracture, EtOH withdrawal, and seizures. Patient has been continued on CIWA scales and without further seizure events. Transfer from MICU [**2120-7-15**] in fair condition. . * EtOH withdrawal - - The patient was placed on aggressive CIWA scales of diazepam 10mg po q4h prn CIWA>8 cover with diazepam 5mg po q2h prn tremulousness, agitation, hallucinations. He was also placed on thiamine IV, folate, and MVI. Neurology also saw the patient was made recommendations. . * Seizures: etiology of seizures likely EtOH withdrawal (possibly supported by EEG findings); also patient on dilantin at home, was subtherapeutic at presentation ?compliance. The patient was initially loaded with 1200 mg IV dilantin. No new seizure activity noted since patient therapeutic on dilantin. The dilantin levels were checked. He was also written for ativan PRN. . * Transaminitis: unclear etiology (?medication, EtOH). The AST:ALT ratio was approximately 2:1 which supports EtOH use. The LFT's were followed daily. . * Ulnar fracture: The patient was brought to the operating room on [**2120-7-18**] for ORIF of his ulna. See operative note for details. He tolerated the procedure well. He was extubated and brought to the recovery room in stable condition. Once stable in the PACU he was transferred to the floor. He worked with occupational therapy and a an orthoplast splint was made. . * Hematuria - s/p traumatic foley placement on floor. A 22F coudet was placed by urology. . The [**Hospital 228**] hospital course was otherwise without incident. His pain was well controlled. His labs and vitals remained stable. He is dicharged today in stable condition. Medications on Admission: Dilantin 200/100/200 mg tid Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours. Disp:*50 Tablet(s)* Refills:*0* 2. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day): Please take at 6am + 10pm. Disp:*60 Capsule(s)* Refills:*0* 3. Phenytoin 50 mg Tablet, Chewable Sig: Three (3) Tablet, Chewable PO DAILY (Daily): Please take at 2pm daily. Disp:*30 Tablet, Chewable(s)* Refills:*0* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 5. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO twice a day for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 6. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: L open midshaft ulna fracture Discharge Condition: Stable Discharge Instructions: Please continue to wear splint at all times. Do not bear weight on your left arm. Please keep incision/splint clean and dry. Dry sterile dressing under splint daily as needed. If you notice any increased redness, swelling, drainage, temperature >101.4, or shortness of Please take all medications as prescribed. You may resume any normal home medications. Please follow up as below. Call with any questions. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 1005**] in 2 weeks. Call [**Telephone/Fax (1) **] to make that appointment. Please follow up with Dr. [**Last Name (STitle) **] concerning your seizures. Call [**Telephone/Fax (1) **] to make that appointment. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**] Completed by:[**2120-7-31**]

813,780,291,305,263,424,397,E968

{'Open fracture of shaft of ulna (alone),Other convulsions,Alcohol withdrawal,Alcohol abuse, continuous,Unspecified protein-calorie malnutrition,Mitral valve disorders,Diseases of tricuspid valve,Assault by striking by blunt or thrown object'}

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: transfer from MICU s/p seizures, EtOH withdrawal PRESENT ILLNESS: 55M with h/o seizures (since [**2100**], followed by Dr. [**Last Name (STitle) **] from Neurology), who presented to the ED after being struck by a brick thrown during a "road rage altercation." He suffered a traumatic mid-shaft open comminuted ulnar fracture ('nightstick'). Per nursing, patient was noted to have EtOH on breath, however BAL never checked. He was admitted to the ortho service initially on [**2120-7-13**] with plans for washings in the AM. He was placed on a CIWA scale (scores 0-2 overnight), given 200 mg of dilantin at MN, and received Ancef and Gentamycin. . The following morning, the patient was found unresponsive by the phlebotomist at 6:30 am. Per report, he was grinding his teeth, drooling and diaphoretic. VS at that point were BP 93/54, HR 100, RR 24, SaO2 95%/RA, BS 142. He did not open his eyes to commands. At 6:50 am, he had another episode of teeth grinding and was given 2 mg IV ativan with decrease in SaO2 to 69%. At 7:05 am, he had another episode of grinding teeth and eye deviation and was given another 2 mg IV ativan. At 7:20 am, again another similar episode occured and he received 2 mg IV ativan. Neurology and the MICU team were called for evaluation. He was then transferred to the MICU for further evaluation. Course c/b traumatic foley placement on floor, requiring urology evaluation and re-placement of foley. . On MICU arrival, the patient was somnolent and unresponsive to voice, but responsive to painful stimuli. ABG at that time was 7.03/36/285/10 on a NRB. Serum tox was sent and was positive only for EtOH = 70. Dilantin level returned sub-therapeutic at 1.8. He was loaded with 1200 mg IV dilantin per neurology recommendations. After this, the patient was more responsive and awake. Repeat ABG on NRB was 7.28/31/264, lactate 10.8. Also noted to have transaminitis (from ?anti-epileptic meds). While in the MICU, the patient was continued on q2hr CIWA scales and required approximately 7.5-10 mg per day. The patient's mental status improved, vitals stabilized, he had no futher seizure activity, and was transferred to the floor. . On evaluation, the patient complains of a painful left arm. Denies abdominal pain, SOB, CP, diaphoresis, hallucinations, tremulousness, or confusion. MEDICAL HISTORY: EtOH abuse h/o EtOH withdrawal seizures (last hospitalized [**2116**] per patient; followed by Dr. [**Last Name (STitle) **] from Neurology) MEDICATION ON ADMISSION: Dilantin 200/100/200 mg tid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: WDWN black male, soft-spoken, lying in bed, NAD Vitals: T 99.3 BP 120/88 HR 88 RR 20 O2sat 98% RA Skin: warm, no rash HEENT: PERRLA, EOMI, anicteric, OP clear Neck: supple, trachea midline, no LAD Pulm: left basilar fine crackles, no wheezes CV: regular, s1s2 normal, no m/r/g Abdomen: +BS, soft, nontender, nondistended, no HSM Extremities: no edema, cyanosis, or clubbing; left arm splinted Neuro: A&Ox3, speech soft but intelligible, CNII-XII intact, mild dysmetria, sensation intact and symmetric bilat, moves all extremities, mild tremulousness, no asterixis FAMILY HISTORY: noncontributory SOCIAL HISTORY: Lives with wife (who is currently in [**Name (NI) 108**] per the patient). Works as carpenter. Drinks approximately 6-pack beer per day plus occasional vodka. No tobacco or illicits. ### Response: {'Open fracture of shaft of ulna (alone),Other convulsions,Alcohol withdrawal,Alcohol abuse, continuous,Unspecified protein-calorie malnutrition,Mitral valve disorders,Diseases of tricuspid valve,Assault by striking by blunt or thrown object'}

CHIEF COMPLAINT: blood per rectum PRESENT ILLNESS: 85yo F with history of atrial fibrillation and CHF who presents to the ED with melena and orthostasis for one day. Patient denies nausea/vomiting/chest pain/shortness of breath/hemetemesis. Patient woke up feeling dizzy and has been lying in bed since then. Her health aide came to see her and found her lying in a pool of blood. Patient denies prior occurence. Patient does not know her INR monitoring schedule as it is done routinely by clinic and she would be notified only if there was something wrong. She has not been sick and has not been taking any antibiotics. She denies OTC drug/new medication/herbal medication. Patient denies taking extra coumadin but there could be possible mix up in dosing [**Name8 (MD) **] NP. In the ED, her vital signs were T96.4 P86 BP 121/72 R 16 100% on RA. Her initial BP at home was reported as 60/palp. NO intervention between home and ED. Physical exam in ED reveals frank melena and external hemorrhoid. Her initial INR was 6.5. She received 1U PRBC in ED although her Hct was 34 given that she has frank melena. She also received 2 units of FFP. CXR was normal. Pt was admitted to MICU and GI consulted with plan for a scope. She was found to be hypernatremic with a sodium of 150 and a 3L free water deficit. She was started on D5W at 75 cc an hour and Na is now 147. She received a total of 5 units of pRBCs since admission and her HCT still is hovering around 29%. This AM pt had episode of chest pain in the MICU. She describes it as a ??????chest twinge??????. Lasted only seconds. She has had these before and states ??????they are a signal for me to slow down??????. During this time her heart rate dropped into the 40s. No EKG changes seen and first set of cardiac enzymes negative. Scope is deferred while pt is ruled out for MI in the setting of GIB. MEDICAL HISTORY: Atrial fibrillation on coumadin (for 8-10yrs) Congestive heart failure ( [**7-/2160**] >55%) Symptomatic cholecystectomy status post laparoscopic cholecystectomy. [**2163**] hypertension OA of knees b/l (wheel chair bound) MEDICATION ON ADMISSION: On transfer Neutra-Phos 1 PKT PO ONCE Potassium Chloride 20 mEq PO Calcium Carbonate 500 mg PO ONCE Metoprolol XL 50 mg PO Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea Digoxin 0.25 mg PO DAILY Pantoprazole 40 mg IV Q12H ALLERGIES: Codeine PHYSICAL EXAM: Tm/c: 98.3 BP: 115/43 HR: 65 RR: 24 O2Sat.: 96% RA I/O: 1200/1180 FAMILY HISTORY: Mother ?????? Rhuematic heart disease contracted during WWI died from complications at age 68. Father with ??????[**Name2 (NI) **] heart?????? SOCIAL HISTORY: Patient denies alcohol or smoking. She is currently living with her husband. [**Name (NI) **] [**Name2 (NI) **] a Hx of CVA and is now at [**Last Name (un) 14101**] house while she is her. He was a school board member in [**Location (un) **] for many years and she worked at the high school as secretary in Adult education. They live in a single family home in [**Location (un) **] and have [**Hospital 14102**] home health aides

Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension

Chr stomach ulc w hem,Ac posthemorrhag anemia,Atrial fibrillation,CHF NOS,Hyperosmolality,Hypertension NOS

Name: [**Known lastname 2188**],[**Known firstname 2189**] Unit No: [**Numeric Identifier 2190**] Admission Date: [**2167-10-28**] Discharge Date: [**2167-11-4**] Date of Birth: [**2082-5-10**] Sex: F Service: MEDICINE Allergies: Codeine Attending:[**First Name3 (LF) 2191**] Addendum: Pt was restarted on warafarin 3 mg po qd with a plan to check an INR in 3 days for dose adjustment. Discharge Disposition: Extended Care Facility: [**Hospital3 901**] - [**Location (un) 382**] [**First Name11 (Name Pattern1) 732**] [**Last Name (NamePattern4) 2192**] MD [**MD Number(2) 2193**] Completed by:[**2167-11-4**] Admission Date: [**2167-10-28**] Discharge Date: [**2167-11-4**] Service: MEDICINE Allergies: Codeine Attending:[**First Name3 (LF) 5827**] Chief Complaint: blood per rectum Major Surgical or Invasive Procedure: gastroduodenal endoscopy History of Present Illness: 85yo F with history of atrial fibrillation and CHF who presents to the ED with melena and orthostasis for one day. Patient denies nausea/vomiting/chest pain/shortness of breath/hemetemesis. Patient woke up feeling dizzy and has been lying in bed since then. Her health aide came to see her and found her lying in a pool of blood. Patient denies prior occurence. Patient does not know her INR monitoring schedule as it is done routinely by clinic and she would be notified only if there was something wrong. She has not been sick and has not been taking any antibiotics. She denies OTC drug/new medication/herbal medication. Patient denies taking extra coumadin but there could be possible mix up in dosing [**Name8 (MD) **] NP. In the ED, her vital signs were T96.4 P86 BP 121/72 R 16 100% on RA. Her initial BP at home was reported as 60/palp. NO intervention between home and ED. Physical exam in ED reveals frank melena and external hemorrhoid. Her initial INR was 6.5. She received 1U PRBC in ED although her Hct was 34 given that she has frank melena. She also received 2 units of FFP. CXR was normal. Pt was admitted to MICU and GI consulted with plan for a scope. She was found to be hypernatremic with a sodium of 150 and a 3L free water deficit. She was started on D5W at 75 cc an hour and Na is now 147. She received a total of 5 units of pRBCs since admission and her HCT still is hovering around 29%. This AM pt had episode of chest pain in the MICU. She describes it as a ??????chest twinge??????. Lasted only seconds. She has had these before and states ??????they are a signal for me to slow down??????. During this time her heart rate dropped into the 40s. No EKG changes seen and first set of cardiac enzymes negative. Scope is deferred while pt is ruled out for MI in the setting of GIB. Past Medical History: Atrial fibrillation on coumadin (for 8-10yrs) Congestive heart failure ( [**7-/2160**] >55%) Symptomatic cholecystectomy status post laparoscopic cholecystectomy. [**2163**] hypertension OA of knees b/l (wheel chair bound) Social History: Patient denies alcohol or smoking. She is currently living with her husband. [**Name (NI) **] [**Name2 (NI) **] a Hx of CVA and is now at [**Last Name (un) 14101**] house while she is her. He was a school board member in [**Location (un) **] for many years and she worked at the high school as secretary in Adult education. They live in a single family home in [**Location (un) **] and have [**Hospital 14102**] home health aides Family History: Mother ?????? Rhuematic heart disease contracted during WWI died from complications at age 68. Father with ??????[**Name2 (NI) **] heart?????? Physical Exam: Tm/c: 98.3 BP: 115/43 HR: 65 RR: 24 O2Sat.: 96% RA I/O: 1200/1180 Gen: Cooperative, AOX3, NAD. Pleasant lady seen in the MICU. Talkative, answers questions appropriately. Skin: Warm, dry. Rash on b/l LE. Brown, scaly plaque like excoriations on shins (present for some time per pt) [**Name (NI) 4459**]: NC/AT. PERRL. EOMI. sclera white. Mmm. OP benign without lesion, erythema,, exudates. Neck: Supple. No bruits, LAD, or JVD. Trachea midline. CV: Irregular, nl S1-S2 no m/r/g Chest: CTAB Abd: Soft. NT/ND. BS(+). No rebound or guarding. Extrem: Peripheral pulses palpable, No cyanosis, clubbing or edema. Neuro: CN II-XII intact. Strength 4/5. DTR [**3-6**] and symmetric. Gait not assessed. Pertinent Results: [**2167-10-28**] 08:58PM SODIUM-150* [**2167-10-28**] 08:58PM HCT-32.5* [**2167-10-28**] 08:58PM PT-17.8* PTT-36.5* INR(PT)-2.2 [**2167-10-28**] 03:08PM LACTATE-1.7 [**2167-10-28**] 02:40PM GLUCOSE-83 UREA N-83* CREAT-0.9 SODIUM-150* POTASSIUM-4.0 CHLORIDE-114* TOTAL CO2-28 ANION GAP-12 [**2167-10-28**] 02:40PM CALCIUM-7.8* PHOSPHATE-2.7 MAGNESIUM-1.8 [**2167-10-28**] 02:40PM HCT-28.9* [**2167-10-28**] 02:40PM PT-16.6* PTT-32.6 INR(PT)-1.9 [**2167-10-28**] 09:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2167-10-28**] 08:30AM GLUCOSE-165* UREA N-94* CREAT-1.1 SODIUM-147* POTASSIUM-5.1 CHLORIDE-110* TOTAL CO2-22 ANION GAP-20 [**2167-10-28**] 08:30AM AMYLASE-18 [**2167-10-28**] 08:30AM ALBUMIN-3.0* CALCIUM-8.1* PHOSPHATE-3.2 MAGNESIUM-1.9 IRON-177* [**2167-10-28**] 08:30AM calTIBC-286 FERRITIN-85 TRF-220 [**2167-10-28**] 08:30AM DIGOXIN-1.2 [**2167-10-28**] 08:30AM PT-29.4* PTT-39.5* INR(PT)-6.5 [**2167-10-28**] 08:30AM PLT COUNT-176 [**2167-10-28**] 08:30AM RET AUT-1.5 [**2167-11-2**] 1:10:30 PM - EGD report Esophagus: Lumen: A 4 cm hiatal hernia was seen. Stomach: Excavated Lesions A single non-bleeding ulcer was found in the posterior wall of stomach. Duodenum: Excavated Lesions A single diverticulum was found in the second part of the duodenum. Impression: Ulcer in the pre-pyloric region Small hiatal hernia Diverticulum in the second part of the duodenum Recommendations: Protonix 40 mg Twice daily Follow-up with Dr. [**Last Name (STitle) 5351**] as needed ECHO Study Date of [**2167-11-2**] The left atrium is moderately dilated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF 70%). No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild to moderate ([**2-1**]+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. CT abd/pel [**2167-11-3**] CT OF ABDOMEN AND PELVIS. Two small granulomas are identified within the liver. The liver otherwise appears unremarkable. The patient is status post cholecystectomy. No intra- or extra-hepatic biliary dilatation is identified. The pancreas is unremarkable. Normal spleen. The adrenal glands appear normal. A small amount of contrast material is identified within the excretory system of both kidneys. Some contrast material is also identified within the bladder. The kidneys and adrenals are normal. Multiple small lymph nodes are identified within the upper abdomen. No obvious masses are identified within the stomach or upper GI system. The visualized portions of the large and small bowel appear unremarkable. CT PELVIS. Excess soft tissue is identified at the region of the introitus suggesting prolapse. Correlation with clinical symptoms is identified. Contrast material is identified within the bladder. These appearances should be correlated with history of recent contrast administration. The bladder otherwise appears unremarkable. CT OF BONES. Multilevel severe degenerative disease is identified within the dorsal spine. In addition, extensive degenerative disease is identified in both hips. Brief Hospital Course: *melena: In the setting of elevated INR,pt was intially treated with volume rescucitation and transfused to a HCT goal of >30. She was started on IV pantropazole with a plan for endoscopic evaluation. Pt had episode of cheestpain and bradycardia (see below). EGD was delayed until cardiac status was stabilized/assessed. Pt recieved a total of 6 units of pRBCs during her hospitalization. Her HCT stabilized on PPI at a level between 30 and 33. EGD showed a non-bleeding ulcer in the posterior wall of the stomach. Given her age and weight loss there was a concern for malignancy. GI felt that on visual inspection that the ulcer had a non-malignant appearance and did not neeed to be biopsied. A CT of the abdomen did not show any suspicious lymphadenopathy. Pt should be continued of oral PPI [**Hospital1 **]. GI states there is no need to rescope. They also feel it is safe to restart her anticoagulation at this time. *r/o MI ?????? Had chest pain and bradycardia in the setting of GI bleed.3 sets of cardiac enzymes were negative and there were no ekg changes. *Bradycardia- episodes of brady down to the 30s with one 4 second long pause. These episodes were asymptomatic. Cardiology was consulted who felt that the bradycardia was related to vagal tone during sleep and nodal agents including digoxin and beta blocker. These medications were held and these finding resolved. The metoprolol was restarted at a lower dose and digoxin was d/c. *hypernatermia - 3L free water deficit on admission. Was given D5W and Na followed until this resolved. Likely related to dehydration. Her Na has been stable for 72 hours. *atrial fibrillation - Rate controled on metoprololXL 50 mg qd now. per GI rec'may restart anitcoagulation. will restart coumadin at lower dose of 3mg qd and will check an INR in 3 days. will hold of restarting digoxin. Pt hdoes not have diastolic dysfunction on recent echo and does not need a second [**Doctor Last Name 360**] for rate control at this time. *Anemia- iron studies normal, likely due to blood loss, Transfuse to HCT<30. Medications on Admission: On transfer Neutra-Phos 1 PKT PO ONCE Potassium Chloride 20 mEq PO Calcium Carbonate 500 mg PO ONCE Metoprolol XL 50 mg PO Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea Digoxin 0.25 mg PO DAILY Pantoprazole 40 mg IV Q12H At home Allgera Lasix (dose [**Last Name (un) 5487**]-??????tiny little pill??????) Dig, metoprolo xl and coumadin. ASA Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal twice a day as needed for constipation. 3. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 4. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO once a day. Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Bleeding gastric ulcer Discharge Condition: Good Discharge Instructions: Please take all medicine as prescribed. Please call your primary care physician or go to the emergency department if you notice blood in your stool, dizzyness, chest pain, trouble breathing, or other concerning symptoms. Followup Instructions: Please see your PCP [**Last Name (NamePattern4) **].[**First Name8 (NamePattern2) 335**] [**Last Name (NamePattern1) 5351**] at [**Telephone/Fax (1) 608**] to schedule an appointment with in 7 days. Completed by:[**2167-11-4**]

531,285,427,428,276,401

{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,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: blood per rectum PRESENT ILLNESS: 85yo F with history of atrial fibrillation and CHF who presents to the ED with melena and orthostasis for one day. Patient denies nausea/vomiting/chest pain/shortness of breath/hemetemesis. Patient woke up feeling dizzy and has been lying in bed since then. Her health aide came to see her and found her lying in a pool of blood. Patient denies prior occurence. Patient does not know her INR monitoring schedule as it is done routinely by clinic and she would be notified only if there was something wrong. She has not been sick and has not been taking any antibiotics. She denies OTC drug/new medication/herbal medication. Patient denies taking extra coumadin but there could be possible mix up in dosing [**Name8 (MD) **] NP. In the ED, her vital signs were T96.4 P86 BP 121/72 R 16 100% on RA. Her initial BP at home was reported as 60/palp. NO intervention between home and ED. Physical exam in ED reveals frank melena and external hemorrhoid. Her initial INR was 6.5. She received 1U PRBC in ED although her Hct was 34 given that she has frank melena. She also received 2 units of FFP. CXR was normal. Pt was admitted to MICU and GI consulted with plan for a scope. She was found to be hypernatremic with a sodium of 150 and a 3L free water deficit. She was started on D5W at 75 cc an hour and Na is now 147. She received a total of 5 units of pRBCs since admission and her HCT still is hovering around 29%. This AM pt had episode of chest pain in the MICU. She describes it as a ??????chest twinge??????. Lasted only seconds. She has had these before and states ??????they are a signal for me to slow down??????. During this time her heart rate dropped into the 40s. No EKG changes seen and first set of cardiac enzymes negative. Scope is deferred while pt is ruled out for MI in the setting of GIB. MEDICAL HISTORY: Atrial fibrillation on coumadin (for 8-10yrs) Congestive heart failure ( [**7-/2160**] >55%) Symptomatic cholecystectomy status post laparoscopic cholecystectomy. [**2163**] hypertension OA of knees b/l (wheel chair bound) MEDICATION ON ADMISSION: On transfer Neutra-Phos 1 PKT PO ONCE Potassium Chloride 20 mEq PO Calcium Carbonate 500 mg PO ONCE Metoprolol XL 50 mg PO Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea Digoxin 0.25 mg PO DAILY Pantoprazole 40 mg IV Q12H ALLERGIES: Codeine PHYSICAL EXAM: Tm/c: 98.3 BP: 115/43 HR: 65 RR: 24 O2Sat.: 96% RA I/O: 1200/1180 FAMILY HISTORY: Mother ?????? Rhuematic heart disease contracted during WWI died from complications at age 68. Father with ??????[**Name2 (NI) **] heart?????? SOCIAL HISTORY: Patient denies alcohol or smoking. She is currently living with her husband. [**Name (NI) **] [**Name2 (NI) **] a Hx of CVA and is now at [**Last Name (un) 14101**] house while she is her. He was a school board member in [**Location (un) **] for many years and she worked at the high school as secretary in Adult education. They live in a single family home in [**Location (un) **] and have [**Hospital 14102**] home health aides ### Response: {'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension'}

CHIEF COMPLAINT: shortness of breath, productive cough x 7 days PRESENT ILLNESS: 55 y/o F with Obesity, Sleep Apnea on bipap, Pulm HTN, Right heart failure on home O2 presents with 7 days of shortness of breath, sputum production with likely pulm edema and left lower lobe infiltrate. Patient has had multiple admissions for CHF exacerbation including one three weeks prior to this admission. At baseline she is on 4L O2 with activity and 3L at a baseline at home. VBG from last admission 7.33/97/44 and 7.32/101/78, baseline bicarb 35-43. . ED: CXR done. Given lasix 40 iv x 1 and levofloxacin 500 x 1. ABG done pH 7.29 pCO2 109 pO2 91 HCO3 55 BaseXS 20 and she was placed on bipap. Although ABG not far from baseline, patient was somnolent in ED despite bipap and was intubated. MEDICAL HISTORY: )morbid obesity s/p hernia repair [**6-1**], 2)OSA on nocturnal BIPAP and 3-5L home O2, obesity hypoventilation syndrome, COPD, pul HTN (PAP 54) f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **] 3)SLE 4)R CHF 5)chronic anemia (bl 32), iron def anemia 6)asthma 7)restrictive lung dz 8)HTN 9)OA MEDICATION ON ADMISSION: Sildenafil 25 mg TID Fluticasone 110 mcg 2Puff [**Hospital1 **] Lasix 40 mg [**Hospital1 **] Toprol XL 50 mg QD Atrovent 18 mcg 2puffs Q6Hrs Albuterol 90 mcg 2puffs Q6hrs PRN Ferrous Sulfate 325 mg TID Oxygen BiPAP ALLERGIES: Penicillins / Clindamycin / Celery / Bee Sting Kit PHYSICAL EXAM: VS: Temp: HR 73 BP 90/77 RR 22 92% on AC 400x18/60%/5 GEN: obese, lightly sedated, somewhat agitated, intubated HEENT: PERRL, EOMI, anicteric, MMM, intubated Neck: obese, difficult to assess JVD RESP: bilateral crackles at bases - anteriorly CV: Distant S1, S2, RRR ABD: Normoactive bowel sounds, soft, obese, nontender to palpation. EXT: no c/c/e SKIN: no rashes/no jaundice NEURO: sedated and intubated FAMILY HISTORY: mother also uses BiPAP, and had breast ca SOCIAL HISTORY: denies tobacco, occ EtOH, no other drugs.

Acute respiratory failure,Pneumonia, organism unspecified,Diastolic heart failure, unspecified,Acidosis,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Iron deficiency anemia, unspecified,Other chronic pulmonary heart diseases,Obesity, unspecified

Acute respiratry failure,Pneumonia, organism NOS,Diastolc hrt failure NOS,Acidosis,Asthma NOS,Obstructive sleep apnea,Iron defic anemia NOS,Chr pulmon heart dis NEC,Obesity NOS

Admission Date: [**2121-7-29**] Discharge Date: [**2121-8-4**] Date of Birth: [**2065-11-22**] Sex: F Service: MEDICINE Allergies: Penicillins / Clindamycin / Celery / Bee Sting Kit Attending:[**First Name3 (LF) 348**] Chief Complaint: shortness of breath, productive cough x 7 days Major Surgical or Invasive Procedure: intubation on [**7-29**] History of Present Illness: 55 y/o F with Obesity, Sleep Apnea on bipap, Pulm HTN, Right heart failure on home O2 presents with 7 days of shortness of breath, sputum production with likely pulm edema and left lower lobe infiltrate. Patient has had multiple admissions for CHF exacerbation including one three weeks prior to this admission. At baseline she is on 4L O2 with activity and 3L at a baseline at home. VBG from last admission 7.33/97/44 and 7.32/101/78, baseline bicarb 35-43. . ED: CXR done. Given lasix 40 iv x 1 and levofloxacin 500 x 1. ABG done pH 7.29 pCO2 109 pO2 91 HCO3 55 BaseXS 20 and she was placed on bipap. Although ABG not far from baseline, patient was somnolent in ED despite bipap and was intubated. Past Medical History: )morbid obesity s/p hernia repair [**6-1**], 2)OSA on nocturnal BIPAP and 3-5L home O2, obesity hypoventilation syndrome, COPD, pul HTN (PAP 54) f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **] 3)SLE 4)R CHF 5)chronic anemia (bl 32), iron def anemia 6)asthma 7)restrictive lung dz 8)HTN 9)OA Social History: denies tobacco, occ EtOH, no other drugs. Family History: mother also uses BiPAP, and had breast ca Physical Exam: VS: Temp: HR 73 BP 90/77 RR 22 92% on AC 400x18/60%/5 GEN: obese, lightly sedated, somewhat agitated, intubated HEENT: PERRL, EOMI, anicteric, MMM, intubated Neck: obese, difficult to assess JVD RESP: bilateral crackles at bases - anteriorly CV: Distant S1, S2, RRR ABD: Normoactive bowel sounds, soft, obese, nontender to palpation. EXT: no c/c/e SKIN: no rashes/no jaundice NEURO: sedated and intubated Pertinent Results: [**2121-7-29**] WBC-13.9*# RBC-4.93 Hgb-14.0 Hct-44.2 MCV-90 MCH-28.4 MCHC-31.6 RDW-15.7* Plt Ct-311 Neuts-80.9* Lymphs-12.1* Monos-3.6 Eos-2.1 Baso-1.2 [**2121-7-29**] Glucose-130* UreaN-24* Creat-1.0 Na-146* K-4.1 Cl-99 HCO3-41* [**2121-7-29**] 04:42PM BLOOD TotProt-6.7 . [**2121-7-29**] 04:42PM BLOOD CK(CPK)-38 cTropnT-<0.01 . [**2121-7-29**] 09:07PM BLOOD Type-ART FiO2-100 O2 Flow-15 pO2-91 pCO2-109* pH-7.29* calTCO2-55* Base XS-20 AADO2-525 REQ O2-86 Comment-NON-REBREA . [**7-29**] CXR: Mild pulmonary vascular congestion that is worse compared to the previous study. Patchy left lower lobe opacity Brief Hospital Course: 1. Pneumonia/ Resp. failure: Ms. [**Known lastname **] has a h/o right heart failure and is on home O2. She presented with 7 days of shortness of breath, sputum production and pulmonary edema, and was found to have a left lower lobe infiltrate. she has recently been admitted for CHF exacerbations has had multiple admissions for CHF exacerbation including one three weeks prior to this admission. Pt. has a 4l o2 requirement at baseline with activity and 3L at rest. In the ED the patients SOB did not improve. An ABG was done (7.29/109/91 bicarp 41) and she was subsequently placed on bipap. However she became increasingly somnelent despite these measure, she was intubated and transfered to the MICU. In the MICU patient was continued on levofloxacin for presumed PNA. She was weaned off the vent and extubated on [**7-31**]. She was diuresed with lasix and ruled out for MI with 2 sets negative CEs. She developed a metabolic acidosis likely [**1-30**] to diuresis and was given acetazolamide to decrease bicarb so CO2 would not increase in response. 2. LLL PNA: After extubation the patient was continued on Levofloxacin and inhalers. . 3. Pulm HTN: Continued on Sildenafil. . 4. CHF exacerbation: A CXR should worsening pulmonary vascular congestion. She ws diuresed with lasix as needed. . 5. HTN: Continued metoprolol. Cardiac enzymes were negative for MI. Pt. was monitored on telemetry Medications on Admission: Sildenafil 25 mg TID Fluticasone 110 mcg 2Puff [**Hospital1 **] Lasix 40 mg [**Hospital1 **] Toprol XL 50 mg QD Atrovent 18 mcg 2puffs Q6Hrs Albuterol 90 mcg 2puffs Q6hrs PRN Ferrous Sulfate 325 mg TID Oxygen BiPAP Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Pneumonia CHF Exacerbation Secondary Diagnosis: Obesity Hypertension Sleep Apnea Pulmonary hypertension Discharge Condition: Stable on 3 L NC O2 Discharge Instructions: Please weigh yourself every morning, call your doctor if your weight increases by 3 lbs Please adhere to 2 gm sodium diet Please take your medications as prescribed. Please call your doctor or return to the ER if you have chest pain, shortness of breath, dizziness, fevers or other concerning symptoms. Followup Instructions: Please follow-up with your primary care doctor in [**12-30**] weeks. Please call [**Telephone/Fax (1) 250**] to make an appointment. Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 2664**] Date/Time:[**2121-8-7**] 10:30 Provider: [**First Name11 (Name Pattern1) 674**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. Date/Time:[**2121-9-16**] 11:00 Completed by:[**2121-8-5**]

518,486,428,276,493,327,280,416,278

{'Acute respiratory failure,Pneumonia, organism unspecified,Diastolic heart failure, unspecified,Acidosis,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Iron deficiency anemia, unspecified,Other chronic pulmonary heart diseases,Obesity, 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: shortness of breath, productive cough x 7 days PRESENT ILLNESS: 55 y/o F with Obesity, Sleep Apnea on bipap, Pulm HTN, Right heart failure on home O2 presents with 7 days of shortness of breath, sputum production with likely pulm edema and left lower lobe infiltrate. Patient has had multiple admissions for CHF exacerbation including one three weeks prior to this admission. At baseline she is on 4L O2 with activity and 3L at a baseline at home. VBG from last admission 7.33/97/44 and 7.32/101/78, baseline bicarb 35-43. . ED: CXR done. Given lasix 40 iv x 1 and levofloxacin 500 x 1. ABG done pH 7.29 pCO2 109 pO2 91 HCO3 55 BaseXS 20 and she was placed on bipap. Although ABG not far from baseline, patient was somnolent in ED despite bipap and was intubated. MEDICAL HISTORY: )morbid obesity s/p hernia repair [**6-1**], 2)OSA on nocturnal BIPAP and 3-5L home O2, obesity hypoventilation syndrome, COPD, pul HTN (PAP 54) f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **] 3)SLE 4)R CHF 5)chronic anemia (bl 32), iron def anemia 6)asthma 7)restrictive lung dz 8)HTN 9)OA MEDICATION ON ADMISSION: Sildenafil 25 mg TID Fluticasone 110 mcg 2Puff [**Hospital1 **] Lasix 40 mg [**Hospital1 **] Toprol XL 50 mg QD Atrovent 18 mcg 2puffs Q6Hrs Albuterol 90 mcg 2puffs Q6hrs PRN Ferrous Sulfate 325 mg TID Oxygen BiPAP ALLERGIES: Penicillins / Clindamycin / Celery / Bee Sting Kit PHYSICAL EXAM: VS: Temp: HR 73 BP 90/77 RR 22 92% on AC 400x18/60%/5 GEN: obese, lightly sedated, somewhat agitated, intubated HEENT: PERRL, EOMI, anicteric, MMM, intubated Neck: obese, difficult to assess JVD RESP: bilateral crackles at bases - anteriorly CV: Distant S1, S2, RRR ABD: Normoactive bowel sounds, soft, obese, nontender to palpation. EXT: no c/c/e SKIN: no rashes/no jaundice NEURO: sedated and intubated FAMILY HISTORY: mother also uses BiPAP, and had breast ca SOCIAL HISTORY: denies tobacco, occ EtOH, no other drugs. ### Response: {'Acute respiratory failure,Pneumonia, organism unspecified,Diastolic heart failure, unspecified,Acidosis,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Iron deficiency anemia, unspecified,Other chronic pulmonary heart diseases,Obesity, unspecified'}

CHIEF COMPLAINT: Unresponsive, hypotension PRESENT ILLNESS: 84F with h/o HepB, diabetes, C/O unresponsive episode at nursing home at 1100 am, found hypotensive in the 80's/sys and o2 was in the 70's. Upon ambulance arrival BP wnl and placed on non-rebreather. MEDICAL HISTORY: Diabetes hepatitis B, no known cirrhosis dementia HTN CKD? - a few months prior to admission BUN went from 20s to 38. reportedly cr is 1.0 OA with reported femoral neck frx in past MEDICATION ON ADMISSION: tylenol benicar 10mg daily glipizide 15mg daily megace 625mg/5mL omeprazole 20mg viread 300mg PO daily donepezil 10mg q day amenda 10mg [**Hospital1 **] cromolyn 4% instill 2 drops each eye TID Senna novolin 70/30 24U qAM 14U q5pm MVI ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On arrival to ICU FAMILY HISTORY: NC SOCIAL HISTORY: Pt lives in nursing home in [**Location (un) **], demented at baseline. She can feed herself and is interactive at baseline. As per son, she is alert and oriented to name only at baseline. Non-ambulatory and incontinent of stool and urine. No smoking or tobacco history

Unspecified septicemia,Septic shock,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Acidosis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Pressure ulcer, lower back,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dementia, unspecified, without behavioral disturbance,Severe sepsis,Diarrhea,Anemia in chronic kidney disease

Septicemia NOS,Septic shock,Toxic encephalopathy,Urin tract infection NOS,Acute kidney failure NOS,Acidosis,Hpt B chrn wo cm wo dlta,Pressure ulcer, low back,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,DMII wo cmp nt st uncntr,Demen NOS w/o behv dstrb,Severe sepsis,Diarrhea,Anemia in chr kidney dis

Admission Date: [**2161-6-4**] Discharge Date: [**2161-6-9**] Date of Birth: [**2077-3-24**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 896**] Chief Complaint: Unresponsive, hypotension Major Surgical or Invasive Procedure: 1. Arterial line 2. Right internal jugular triple lumen catheter 3. PICC placement History of Present Illness: 84F with h/o HepB, diabetes, C/O unresponsive episode at nursing home at 1100 am, found hypotensive in the 80's/sys and o2 was in the 70's. Upon ambulance arrival BP wnl and placed on non-rebreather. Pt was transferred to ED. In ED, blood pressure was 70/40 initially. A RIJ and two peripheral IVs were placed and fluid resuscitation was started as well as IV pressors with norepi at 2mcg/kg/min. A foley was placed and frank pus returned with + U/A. She was started on vancomycin and zosyn. Labs were significant for sodium of 150, BUN/Cr of 100/2.7, K of 6.3, lactate of 3.6 and ABG = 7.15/8/159/15. Imaging significant for head CT unremarkable, cxr with questionable retrocardiac opacity. On arrival to the MICU, patient's VS. 97.6, HR 91, SBP 89/37, rr=16, 96% RA. At time of arrival, she had received 3.5L NS and was on 0.1 of norepi. She is alert in NAD does not speak English, so cannot answer questions. Review of systems: cannot be obtained due to pt not responsive Past Medical History: Diabetes hepatitis B, no known cirrhosis dementia HTN CKD? - a few months prior to admission BUN went from 20s to 38. reportedly cr is 1.0 OA with reported femoral neck frx in past Social History: Pt lives in nursing home in [**Location (un) **], demented at baseline. She can feed herself and is interactive at baseline. As per son, she is alert and oriented to name only at baseline. Non-ambulatory and incontinent of stool and urine. No smoking or tobacco history Family History: NC Physical Exam: On arrival to ICU Vitals: 97.6, HR 91, SBP 89/37, rr=16, 96% RA. General: alert, not interacting does not speak english HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, cvp = 1, no LAD CV: rrr no mrg Lungs: ctab, no wrr Abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding GU: foley in place Ext: cold, clammy. pulse 1+ b/l in LE. She has a dry ulcer on lateral calcaneous of R foot. Back: she has 2 unstagable decubitis dry ulcers on back Neuro: PERRLA, exam is grossly intact. Pertinant discharge: BP 145/75, HR 86 General: Alert oriented to person. Knows she is in the hospital but does not know date Skin: 2 unstagable decubitis dry ulcers on buttocks and on each heal Pertinent Results: ADMISSION LABS: [**2161-6-4**] 12:00PM BLOOD WBC-15.9* RBC-4.39 Hgb-13.1 Hct-43.0 MCV-98 MCH-29.8 MCHC-30.4* RDW-16.9* Plt Ct-326 [**2161-6-4**] 12:00PM BLOOD Glucose-146* UreaN-121* Creat-2.7* Na-151* K-6.2* Cl-128* HCO3-8* AnGap-21* DISCHARGE LABS: [**2161-6-8**] 04:27AM BLOOD WBC-7.3 RBC-3.12* Hgb-9.5* Hct-29.1* MCV-93 MCH-30.5 MCHC-32.7 RDW-16.6* Plt Ct-216 [**2161-6-8**] 04:27AM BLOOD Glucose-213* UreaN-18 Creat-0.9 Na-141 K-3.7 Cl-116* HCO3-16* AnGap-13 URINE CULTURE ([**2161-6-4**]): KLEBSIELLA PNEUMONIAE | KLEBSIELLA PNEUMONIAE | | AMPICILLIN/SULBACTAM-- 8 S 8 S CEFAZOLIN------------- <=4 S <=4 S CEFEPIME-------------- <=1 S <=1 S CEFTAZIDIME----------- <=1 S <=1 S CEFTRIAXONE----------- <=1 S <=1 S CIPROFLOXACIN---------<=0.25 S <=0.25 S GENTAMICIN------------ <=1 S <=1 S MEROPENEM-------------<=0.25 S <=0.25 S NITROFURANTOIN-------- 64 I 64 I TOBRAMYCIN------------ <=1 S <=1 S TRIMETHOPRIM/SULFA---- <=1 S <=1 S C.DIFF NEGATIVE ([**2161-6-6**]) CT HEAD ([**2161-6-4**]): No acute intracranial process. CXR ([**2161-6-4**]): The lungs are clear, without focal airspace consolidation to suggest pneumonia. Linear atelectasis is seen at the left lung base. A right side IJ catheter tip terminates in the mid SVC. There is no pleural effusion or pneumothorax. Apical pleural thickening is seen. The heart size is normal. Calcifications are present within the aortic arch. RENAL U/S ([**2161-6-5**]): Normal renal echotexture without evidence of hydronephrosis. Brief Hospital Course: 1. Severe sepsis with shock (hypovolemic/septic): Initial SBP in the low 70s. When a foley was placed, it drained frank pus. She required pressor support with norepinephrine and vasopressin. After 7 Liters of NS, she was weaned off of pressor medications and after 12L her blood pressure, renal function and mental status improved. 2. Urinary tract infection: A renal ultrasound was done which did not show any signs of pyelonephritis. Urine cutlure grew out two types of Klebsiella, both sensitive to all antibiotics tested except for intermediate sensitivity to nitrofurantoin. Ceftriaxone was continued until the day of discharge with ciprofloxacin presribed to complete a 10-day course (through [**Date range (1) 112057**]). 3. Encephalopathy, toxic-metabolic: Likely related to UTI/sepsis. Improved throughout admission. Was oriented to name and "hospital" at discharge which her son reports as baseline. 4. Acute renal failure: Initial creatinine 2.7 with BUN in 100s. Improved with fluid resuscitation 5. Hyperkalemia: Potassium 6.2 on admission. As her renal failure improved, her potassium levels remained within normal limits. 6. Metabolic acidosis: Her metabolic acidosis was primarily nongap but she did have a significant gap acidosis most likely secondary to lactic acidosis and renal failure. Bicarb autocorrected throughout admission but had not completed normalized on last check. 7. Hypernatremia: Sodium 150 on admission with increase to 157 on arrival to ICU. Her free water deficit was corrected with 1/2NS in D5w. Over 24hrs her serum sodium corrected to 140s. Her serum sodium was within normal limits for remainder of hospital stay. 8. Diarrhea: Developed diarrhea while in the ICU. Cdiff assay was negative. 9. Pressure ulcers: Gluteal and heel. Wound care recommended: * Turn and reposition off back q 2 hours and prn * Limit sit time to 1 hour at a time using a pressure * Redistribution cushion * Cleanse wound with wound cleanser then pat dry then place sacral Mepilex border change every 3 days * Critic aid clear [**Hospital1 **] to reddened tissue including labial ulcer * No dressing needed to heel - aloe vesta daily for skin conditioning * Waffle boots 10. Diabetes mellitus type 2: Her glipizide was held during hospitalization but restarted at discharge. Long-acting insulin was also held with finger sticks in the 100-200 range. 11. Hypertension: Olmesartan was held in the setting of hypotension. On day of discharge BP was 140s/70s. CHRONIC ISSUES: 1. Dementia: Namenda was held during hospitalization as this is not a formulary medicatin. Restarted on discharge. 2. Hepatitis B, chronic: Tenofovir was continued, dosed for GFR TRANSITIONAL ISSUSE: 1. Antibiotics: ciprofloxacin presribed to complete a 10-day course (through [**Date range (1) 112057**]). 2. Held medications - Olmesartan: could be restarted if blood pressure remains elevated - 70/30 insulin: could be restrated if finger stick blood glucose remains elevated Medications on Admission: tylenol benicar 10mg daily glipizide 15mg daily megace 625mg/5mL omeprazole 20mg viread 300mg PO daily donepezil 10mg q day amenda 10mg [**Hospital1 **] cromolyn 4% instill 2 drops each eye TID Senna novolin 70/30 24U qAM 14U q5pm MVI Discharge Medications: 1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. tenofovir disoproxil fumarate 300 mg Tablet Sig: One (1) Tablet PO once a day. 4. donepezil 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. Namenda 10 mg Tablet Sig: One (1) Tablet PO twice a day. 6. cromolyn 4 % Drops Sig: Two (2) Ophthalmic three times a day. 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 8. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 6 days. 10. insulin lispro 100 unit/mL Solution Sig: as directed Subcutaneous ASDIR (AS DIRECTED). 11. glipizide 5 mg Tablet Sig: Three (3) Tablet PO once a day: 15 mg daily. 12. Megace ES 625 mg/5 mL Suspension Sig: One (1) PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital **] Healthcare Center - [**Location (un) **] Discharge Diagnosis: 1. Shock (septic and hypovolemic) 2. Urinary tract infection (klebsiella) 3. Acute renal failure 4. Encephalopathy, toxic-metabolic, with underlying dementia 5. Metabolic acidosis 6. Pressure ulcers (heal/buttock), unstageable 7. Diarrhea 8. Anemia 9. Hypertension 10. Diabetes type II 11. Hepatitis B, chronic Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: You were admitted for low blood pressure, which was from a combination of dehydration and a urinary tract infection. You improved with IV fluids and antibiotics. You should continue antibiotics to complete a course (through [**6-15**]). Followup Instructions: I spoke with your primary physician. [**Name10 (NameIs) **] will coordinate a visit to your nursing home.

038,785,349,599,584,276,070,707,403,585,250,294,995,787,285

{'Unspecified septicemia,Septic shock,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Acidosis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Pressure ulcer, lower back,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dementia, unspecified, without behavioral disturbance,Severe sepsis,Diarrhea,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: Unresponsive, hypotension PRESENT ILLNESS: 84F with h/o HepB, diabetes, C/O unresponsive episode at nursing home at 1100 am, found hypotensive in the 80's/sys and o2 was in the 70's. Upon ambulance arrival BP wnl and placed on non-rebreather. MEDICAL HISTORY: Diabetes hepatitis B, no known cirrhosis dementia HTN CKD? - a few months prior to admission BUN went from 20s to 38. reportedly cr is 1.0 OA with reported femoral neck frx in past MEDICATION ON ADMISSION: tylenol benicar 10mg daily glipizide 15mg daily megace 625mg/5mL omeprazole 20mg viread 300mg PO daily donepezil 10mg q day amenda 10mg [**Hospital1 **] cromolyn 4% instill 2 drops each eye TID Senna novolin 70/30 24U qAM 14U q5pm MVI ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On arrival to ICU FAMILY HISTORY: NC SOCIAL HISTORY: Pt lives in nursing home in [**Location (un) **], demented at baseline. She can feed herself and is interactive at baseline. As per son, she is alert and oriented to name only at baseline. Non-ambulatory and incontinent of stool and urine. No smoking or tobacco history ### Response: {'Unspecified septicemia,Septic shock,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Acidosis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Pressure ulcer, lower back,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dementia, unspecified, without behavioral disturbance,Severe sepsis,Diarrhea,Anemia in chronic kidney disease'}

CHIEF COMPLAINT: obesity, requesting surgical treatment PRESENT ILLNESS: The patient is a 35-year-old woman who complains of morbid obesity since being a teenager. She has been on multiple supervised diets with a maximum of a 40-pound weight loss and regain. She has been evaluated at [**Hospital1 **] Bariatric Program and deemed a good candidate for surgical weight loss. MEDICAL HISTORY: Diabetes Mellitus GERD Back Pain Retinal vein occlusion Morbid obesity MEDICATION ON ADMISSION: Insulin 40 units of NPH in the am, 30 units NPH in the evening, glucophage 1000mg [**Hospital1 **], elavil 25 qhs, lisinopril 45 qd, neurontin 300 mg tid, and aspirin and plavix (stopped prior to admission for procedure) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: obese female in NAD Head and Neck: Pupils equal round and reactive to light, neck supple trachea midline Cardiac: reglular rate rhythm with no murmurs rubs or gallops lungs: clear to auscultation bilaterally Abdomen: soft, Nontender and nondistended Extremities: no clubbing cyanosis or edema. Warm well perfused Neuro: alert and oriented times three FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, no children, previously worked as a surgical bed technologist. No alcohol or smoking

Morbid obesity,Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,Esophageal reflux

Morbid obesity,DMII ophth uncntrld,Diabetic retinopathy NOS,Esophageal reflux

Admission Date: [**2176-10-14**] Discharge Date: [**2176-10-17**] Date of Birth: [**2141-6-27**] Sex: F Service: [**Doctor First Name 147**] Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 301**] Chief Complaint: obesity, requesting surgical treatment Major Surgical or Invasive Procedure: Open gastric bypass History of Present Illness: The patient is a 35-year-old woman who complains of morbid obesity since being a teenager. She has been on multiple supervised diets with a maximum of a 40-pound weight loss and regain. She has been evaluated at [**Hospital1 **] Bariatric Program and deemed a good candidate for surgical weight loss. Past Medical History: Diabetes Mellitus GERD Back Pain Retinal vein occlusion Morbid obesity Social History: Married, no children, previously worked as a surgical bed technologist. No alcohol or smoking Family History: noncontributory Physical Exam: General: obese female in NAD Head and Neck: Pupils equal round and reactive to light, neck supple trachea midline Cardiac: reglular rate rhythm with no murmurs rubs or gallops lungs: clear to auscultation bilaterally Abdomen: soft, Nontender and nondistended Extremities: no clubbing cyanosis or edema. Warm well perfused Neuro: alert and oriented times three On discharge, the patient had a well healing midline incision with staples in place, the incision was clean dry and intact. The patients abdomen was soft, nontender, and nondistended Brief Hospital Course: The patient had an uneventful gastric bypass procedure, and was transferred to the PACU in stable condition. The patient was in some significant pain postoperatively on a PCA of 1.0 mg q 6 minutes with a max hourly limit of 10mg of morphine. The patient was awake and in considerable discomfort, and was maximally using the PCA. The patients dose was increased to 1.5 mg q6 hours with a hourly max of 15 mg. The patient 4 hours later had better pain control, was awake alert and oriented, but the patient continued to maximally use her PCA. 4 hours after that the nurse called a code blue because the patient was unresponvie and had labored breathing, and the patient was near apneic. The patient was masked venitlated and the patient was given narcan, and the vital signs were significant for decreased oxygen saturation and a blood pressure of 60/42. The patient regained consciouness and intbuation was not required as the patient was alert and answering questions. An ABG obtained during the episode was 7.26/46/76/22/-6, with a relatively normal PCO2. The patient had serial cardiac enzymes and ruled out for MI. She was transferred to the intensive care unit for close monitoring and placed on an insulin drip for aggressive blood glucose control. On post operative day 1 the patient remained hemodynamically stable, and was started on a stage I diet, and was ambulating without difficulty. ON post operative day 2 the patient was transferred to the surgical floor and tolerated advanced diet from stage II to stage III. She was started on oral pain medication and her home medications. The patient was ready for discharge on postoperative day 3, in good condition. Medications on Admission: Insulin 40 units of NPH in the am, 30 units NPH in the evening, glucophage 1000mg [**Hospital1 **], elavil 25 qhs, lisinopril 45 qd, neurontin 300 mg tid, and aspirin and plavix (stopped prior to admission for procedure) Discharge Medications: 1. Metformin HCl 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): crush pill before administering. Disp:*120 Tablet(s)* Refills:*2* 2. Amitriptyline HCl 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime): crush pill before administering. Disp:*30 Tablet(s)* Refills:*2* 3. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day: crush pill before administering . Disp:*30 Tablet(s)* Refills:*2* 4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day: crush pill before administering. Disp:*30 Tablet(s)* Refills:*2* 5. Gabapentin 250 mg/5 mL Solution Sig: Six (6) ml PO TID (3 times a day). Disp:*540 ml* Refills:*2* 6. Ranitidine HCl 15 mg/mL Syrup Sig: Ten (10) ml PO BID (2 times a day). Disp:*600 ml* Refills:*2* 7. Docusate Sodium 150 mg/15 mL Liquid Sig: Ten (10) ml PO BID (2 times a day). Disp:*600 ml* Refills:*2* 8. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs PO Q4-6H (every 4 to 6 hours) as needed. Disp:*250 ML(s)* Refills:*0* 9. Roxicet 5-325 mg/5 mL Solution Sig: [**6-10**] ml PO every [**5-7**] hours as needed for pain. Disp:*250 ml* Refills:*0* 10. Multivitamin with Iron-Mineral Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. Disp:*30 Tablet, Chewable(s)* Refills:*2* 11. Actigall 300 mg Capsule Sig: One (1) Capsule PO twice a day for 6 months. Disp:*360 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Morbid Obesity status post open gastric bypass Uncontrolled Diabetes Mellitus Hypertension Discharge Condition: Good Discharge Instructions: Stay on stage III until follow up. Do not self advance diet Do not drink out of a straw. Do not chew gum You may shower (no bathing or swimming) if no drainage from wound If Clear drainage, cover wound with clean dressing, stop showering No heavy lifting (greater than 10 pounds) lifting for 6 weeks If severe pain, persistent nausea vomiting, fevers >101.5, redness of wound, call surgeon You should resume taking your preoperative medications, but you must crush all of your pills. You should also resume taking the insulin dose you were taking at home. You should monitor your blood sugar frequently, since your diet has changed significantly and may change your insulin requirements Followup Instructions: You should follow up at [**Hospital 1560**] clinic [**Telephone/Fax (1) **] at 3 weeks (Do not call surgeon's office). You will need to get the staples removed at that time You should follow up with Dr. [**First Name8 (NamePattern2) 9241**] [**Last Name (NamePattern1) 9242**] at [**Doctor Last Name 9243**] Retina Association in order to assess your need to restart your plavix and aspirin Import Follow-up Instructions

278,250,362,530

{'Morbid obesity,Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,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: obesity, requesting surgical treatment PRESENT ILLNESS: The patient is a 35-year-old woman who complains of morbid obesity since being a teenager. She has been on multiple supervised diets with a maximum of a 40-pound weight loss and regain. She has been evaluated at [**Hospital1 **] Bariatric Program and deemed a good candidate for surgical weight loss. MEDICAL HISTORY: Diabetes Mellitus GERD Back Pain Retinal vein occlusion Morbid obesity MEDICATION ON ADMISSION: Insulin 40 units of NPH in the am, 30 units NPH in the evening, glucophage 1000mg [**Hospital1 **], elavil 25 qhs, lisinopril 45 qd, neurontin 300 mg tid, and aspirin and plavix (stopped prior to admission for procedure) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: obese female in NAD Head and Neck: Pupils equal round and reactive to light, neck supple trachea midline Cardiac: reglular rate rhythm with no murmurs rubs or gallops lungs: clear to auscultation bilaterally Abdomen: soft, Nontender and nondistended Extremities: no clubbing cyanosis or edema. Warm well perfused Neuro: alert and oriented times three FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, no children, previously worked as a surgical bed technologist. No alcohol or smoking ### Response: {'Morbid obesity,Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled,Background diabetic retinopathy,Esophageal reflux'}

CHIEF COMPLAINT: ACQUIRED DEFECT FROM BASAL CELL CARCINOMA RESECTION PRESENT ILLNESS: MS. [**Known lastname **] IS A 64-YEAR OLD, MENTALLY RETARDED, FEMALE WHO PRESENTED WITH AN AQUIRED DEFECT OF THE RIGHT NASAL ALA AND MEDIAL CHEEK REGION AFTER BASAL CELL CARCINOMA WAS RESECTED BY DERMATOLOGY. MEDICAL HISTORY: MENTAL RETARDATION DIABETES BIPOLAR DISORDER MEDICATION ON ADMISSION: ALLERGIES: Trazodone / Ambien / Sinequan PHYSICAL EXAM: ON PRESENTATION, PT WAS AFEBRILE WITH NORMAL VITAL SIGNS FAMILY HISTORY: SOCIAL HISTORY: LIVES IN A NURSING HOME, HAS A BROTHER WHO IS THE HEALTH CARE PROXY. NO [**Name2 (NI) 62913**], ETOH, OR REC DRUG USE.

Encounter for planned post-operative wound closure,Unspecified schizophrenia, unspecified,Hypovolemia,Acquired deformity of nose,Personal history of other malignant neoplasm of skin,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified intellectual disabilities

Encntr plnd po wnd clsr,Schizophrenia NOS-unspec,Hypovolemia,Acq nose deformity,Hx-skin malignancy NEC,Bipolor I current NOS,DMII wo cmp nt st uncntr,Intellect disability NOS

Admission Date: [**2111-11-5**] Discharge Date: [**2111-11-10**] Date of Birth: [**2047-7-1**] Sex: F Service: PLASTIC Allergies: Trazodone / Ambien / Sinequan Attending:[**First Name3 (LF) 16920**] Chief Complaint: ACQUIRED DEFECT FROM BASAL CELL CARCINOMA RESECTION Major Surgical or Invasive Procedure: RIGHT NOSE/ALA RECONSTRUCTION USING RIGHT CHEEK ADVANCEMENT AND FOREHEAD LOCAL FLAP History of Present Illness: MS. [**Known lastname **] IS A 64-YEAR OLD, MENTALLY RETARDED, FEMALE WHO PRESENTED WITH AN AQUIRED DEFECT OF THE RIGHT NASAL ALA AND MEDIAL CHEEK REGION AFTER BASAL CELL CARCINOMA WAS RESECTED BY DERMATOLOGY. Past Medical History: MENTAL RETARDATION DIABETES BIPOLAR DISORDER Social History: LIVES IN A NURSING HOME, HAS A BROTHER WHO IS THE HEALTH CARE PROXY. NO [**Name2 (NI) 62913**], ETOH, OR REC DRUG USE. Physical Exam: ON PRESENTATION, PT WAS AFEBRILE WITH NORMAL VITAL SIGNS GEN: NO ACUTE DISTRESS, ABLE TO COMMUNICATE AND FOLLOW ORDERS HEAD AND NECK: 5 CM CIRCULAR FULL THICKNESS DEFECT AT THE JUNCTION OF THE RIGHT ALA AND CHEEK HEART: REGULAR RATE AND RHYTHM LUNGS: CLEAR TO ASCULATION ABDOMEN: SOFT, NON-TENDER, NON-DISTENDED EXTREMITIES: NO EDEMA, CYANOSIS, FULL RANGE OF MOTION 1 Brief Hospital Course: UPON ADMISSION, THE PATIENT WAS PRE-OP'D AND MADE NPO/IVF. SHE WENT TO SURGERY THE NEXT MORNING AND TOLERATED THE SURGERY WELL. HOWEVER, SHE WAS SLOW TO AWAKE FROM ANESTHESIA, AND WAS ADMITTED TO THE MICU FOR OBSERVATION. SHE WAS TRANSFERED TO THE FLOOR POST-OP DAY 2 WHERE SHE HAD BEEN AFEBRILE WITH NORMAL VITALS, MAKING GOOD URINE, AND TOLERATING A REGULAR DIET. HER WOUND HAS REMAIND DRY AND CLOSED, WITHOUT EVIDENCE OF INFECTION OR BREAKDOWN. SHE HAS BEEN WATCHED BY A SITTER AT ALL TIMES. SHE WILL BE DISCHARGED TODAY BACK TO HER NURSING HOME IN GOOD CONDITION, ON PAIN MEDS, ANTIBIOTICS, AND WITH ANTICIPATED 1:1 WATCH. SHE WILL FOLLOW UP WITH DR. [**First Name (STitle) **] IN 1 WEEK. STAGE TWO OF HER SURGERY WILL BE DONE IN 3 WEEKS. Discharge Medications: 1. Paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO AM (). 2. Multivitamin Capsule Sig: One (1) Cap PO QAM (once a day (in the morning)). 3. Divalproex Sodium 500 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO QAM (once a day (in the morning)). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed: constipation. Disp:*30 Capsule(s)* Refills:*0* 5. Triamcinolone Acetonide 0.1 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). 6. Divalproex Sodium Oral 7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 8. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO QPM (once a day (in the evening)). 9. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours). Disp:*40 Tablet(s)* Refills:*0* 10. Bacitracin-Polymyxin-Neosp HC Ointment Sig: One (1) Topical three times a day. Disp:*1 500/gram* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: AQUIRED DEFORMITY OF THE RIGHT ALA/NOSE AND MEDIAL CHEEK FROM BASAL CELL CARCINOMA RESECTION Discharge Condition: GOOD Discharge Instructions: PLEASE GIVE PATIENT MEDICATIONS AS PRESCRIBED AND READ WARNING LABELS CAREFULLY. IF SIGNS AND SYMPTOMS OF INFECTION, SUCH AS FEVERS/CHILLS, PURULENT DISCHARGE FROM WOUND/INCISION SITE, INCREASED REDNESS, INCREASED PAIN, PLEASE CALL OR GO TO THE EMERGENCY ROOM. REMEMBER TO CALL TO SCHEDULE HER FOLLOW UP APPOINTMENT (BELOW). LIGHT ACTIVITIES UNTIL SEEN IN CLINIC. STAGE 2 OF THE SURGERY WILL BE DONE IN 3 WEEKS. [**Month (only) **] SHOWER--DAB DRY, DO NOT SCRUB. PLEASE CLEAN INCISION SITE WITH NORMAL SALINE OR CLEAN WATER THREE TIMES A DAY AND PLACE ANTIBIOTIC OINTMENT (GIVEN) ON TOP OF WOUND. PLEASE KEEP PATIENT AWAY FROM THE SUN. MOST IMPORTANTLY, THE PATIENT MUST BE WATCH ONE-ON-ONE SO THAT SHE DOES NOT PICK AT HER WOUND. Followup Instructions: PLEASE CALL DR.[**Doctor Last Name **] OFFICE FOR A FOLLOW UP([**Telephone/Fax (1) 62914**] [**Doctor First Name **] ([**Telephone/Fax (1) 2868**] Completed by:[**2111-11-10**]

V584,295,276,738,V108,296,250,319

{'Encounter for planned post-operative wound closure,Unspecified schizophrenia, unspecified,Hypovolemia,Acquired deformity of nose,Personal history of other malignant neoplasm of skin,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified intellectual disabilities'}

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: ACQUIRED DEFECT FROM BASAL CELL CARCINOMA RESECTION PRESENT ILLNESS: MS. [**Known lastname **] IS A 64-YEAR OLD, MENTALLY RETARDED, FEMALE WHO PRESENTED WITH AN AQUIRED DEFECT OF THE RIGHT NASAL ALA AND MEDIAL CHEEK REGION AFTER BASAL CELL CARCINOMA WAS RESECTED BY DERMATOLOGY. MEDICAL HISTORY: MENTAL RETARDATION DIABETES BIPOLAR DISORDER MEDICATION ON ADMISSION: ALLERGIES: Trazodone / Ambien / Sinequan PHYSICAL EXAM: ON PRESENTATION, PT WAS AFEBRILE WITH NORMAL VITAL SIGNS FAMILY HISTORY: SOCIAL HISTORY: LIVES IN A NURSING HOME, HAS A BROTHER WHO IS THE HEALTH CARE PROXY. NO [**Name2 (NI) 62913**], ETOH, OR REC DRUG USE. ### Response: {'Encounter for planned post-operative wound closure,Unspecified schizophrenia, unspecified,Hypovolemia,Acquired deformity of nose,Personal history of other malignant neoplasm of skin,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified intellectual disabilities'}

CHIEF COMPLAINT: new onset seizures, small SDH PRESENT ILLNESS: 44 yo woman with h/o EtOH and BZD use, was in her USOH until Friday [**2106-12-10**] when she was blow-drying her hair at 10am, and the next thing she new she awoke on the floor at 11:30am, no incontinence or tongue biting, thought she had just fallen asleep, feeling a little "groggy" but no headache, no bleeding. She went out to lunch with her father and children at a restaurant. Her son notes she began staring off while sitting and then her head and eyes went backwards, and she slumped onto her father, whole body shaking, duration of this event is unknown but likely on the order of minutes as the next thing she remembers is awakening in the ambulance, + tongue bite, no incontinence. She was taken to [**Location (un) **] [**Location (un) 1459**] where she had 2 more episodes of "seizures" (i.e. shaking, unresponsiveness), but there are no records from this hospital for review. Per our ED records, she received 2mg IV ativan after or during the 2nd event and was loaded with cerebrex. Had a CT head, found to have subdural hematoma and was transported here to [**Hospital1 18**] for neurosurgical eval. ETOH level at OSH is per report 14; our tox screen was negative ( but 2 days after initial presentation). Was to go to NSICU for monitering and neurchecks but no beds. Initially had been on labetolol gtt for BP. Nsurg recommended neurocheck, dilantin treatment. However, also on ddx included worsening subdural. On presentation to [**Name (NI) **], pt noted to be increasingly agitated-->concern for alcohol withdrawal. Because of agitation, pt required intubation and large amts of ativan for repeat CT, which was unchanged. NSurg did not intervene, recommended dilantin x 1 week and f/u 4-6 weeks with repeat head CT. Neuro was consulted once back on the floor and felt that pt's sz were [**1-5**] EtOH/BZD withdrawl and SDH resulted from fall. MEDICAL HISTORY: PMHx: Depression HTN scarlet fever as a child 2 c-sections endometriosis cyst removal from abdominal muscle MEDICATION ON ADMISSION: MEDS: @ home: zoloft 100, atenolol 100, klonopin but has not taken since Xmas @ MICU: valium 10mg IV q 6 hrs + prn CIWA, kcl and mag replacement, dilantin 100 tid, PPI, thiamine/folate/MVI IV, zoloft 100, metoprolol 50 [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VITALS: 99.5 101 142/67 23 99% RA GEN: mildly agitated, picking at O2sat monitor and tele leads. SKIN: no obvious HEENT: NC/AT - unable to appreciate any head bumps or lacs, anicteric sclera, mmm NECK: supple, no LAD, no pain to palp CHEST: CTA bilaterally CV: regular rate and rhythm without murmurs ABD: soft, nontender, nondistended EXTREM: no edema NEURO: CN 2-12 in tact. + nystagmus on lateral gaze bilaterally. moving all extremities well. FAMILY HISTORY: FamHx: parents/sister/2kids all alive and healthy. No h/o seizures or strokes. SOCIAL HISTORY: ALL: scallops, prozac makes her feel like she's on speed

Alcohol withdrawal,Other convulsions,Subdural hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute respiratory failure,Unspecified fall,Home accidents,Drug withdrawal,Sedative, hypnotic or anxiolytic dependence, unspecified,Alcohol abuse, unspecified,Nonspecific abnormal electroencephalogram [EEG],Personal history of noncompliance with medical treatment, presenting hazards to health,Anxiety state, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified

Alcohol withdrawal,Convulsions NEC,Subdural hem-brief coma,Acute respiratry failure,Fall NOS,Accident in home,Drug withdrawal,Sed,hyp,anxiolyt dep-NOS,Alcohol abuse-unspec,Abn electroencephalogram,Hx of past noncompliance,Anxiety state NOS,Hypertension NOS,Depressive disorder NEC

Admission Date: [**2106-12-11**] Discharge Date: [**2106-12-14**] Date of Birth: [**2062-2-11**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 613**] Chief Complaint: new onset seizures, small SDH Major Surgical or Invasive Procedure: None History of Present Illness: 44 yo woman with h/o EtOH and BZD use, was in her USOH until Friday [**2106-12-10**] when she was blow-drying her hair at 10am, and the next thing she new she awoke on the floor at 11:30am, no incontinence or tongue biting, thought she had just fallen asleep, feeling a little "groggy" but no headache, no bleeding. She went out to lunch with her father and children at a restaurant. Her son notes she began staring off while sitting and then her head and eyes went backwards, and she slumped onto her father, whole body shaking, duration of this event is unknown but likely on the order of minutes as the next thing she remembers is awakening in the ambulance, + tongue bite, no incontinence. She was taken to [**Location (un) **] [**Location (un) 1459**] where she had 2 more episodes of "seizures" (i.e. shaking, unresponsiveness), but there are no records from this hospital for review. Per our ED records, she received 2mg IV ativan after or during the 2nd event and was loaded with cerebrex. Had a CT head, found to have subdural hematoma and was transported here to [**Hospital1 18**] for neurosurgical eval. ETOH level at OSH is per report 14; our tox screen was negative ( but 2 days after initial presentation). Was to go to NSICU for monitering and neurchecks but no beds. Initially had been on labetolol gtt for BP. Nsurg recommended neurocheck, dilantin treatment. However, also on ddx included worsening subdural. On presentation to [**Name (NI) **], pt noted to be increasingly agitated-->concern for alcohol withdrawal. Because of agitation, pt required intubation and large amts of ativan for repeat CT, which was unchanged. NSurg did not intervene, recommended dilantin x 1 week and f/u 4-6 weeks with repeat head CT. Neuro was consulted once back on the floor and felt that pt's sz were [**1-5**] EtOH/BZD withdrawl and SDH resulted from fall. She has no previous history of seizures, etoh withdrawl seizures, febrile seizures as a child, ususual tastes or smells or out of body experiences. She did STOP taking klonopin (takes for depression/anxiety) just prior to Xmas as she ran out of her script and did not refill it. She states she drinks about [**1-6**] glasses of wine per night, but also admits to drinking up to a full bottle of wine during the day when she is home alone. She states she has been under more emotional stress recently with family issues. States her last drink was Wed [**2106-12-8**]. Her husbaand further expressed concern re:increased depression/EtOH consumption lately. NO fevers, chills, recent illenss,chest pain, does have occ palpitations but none with these episodes. No abdominal pain, dysuria, bleeding from the rectum Currently she feels quite good. Past Medical History: PMHx: Depression HTN scarlet fever as a child 2 c-sections endometriosis cyst removal from abdominal muscle no h/o strokes, seizures Social History: ALL: scallops, prozac makes her feel like she's on speed SHx: increased stressors at Xmas, drinks 2-3 glasses of wine a night, no tob, no drugs. Works as a plant [**Last Name (un) 58981**], 2 kids ages 18, 14. Family History: FamHx: parents/sister/2kids all alive and healthy. No h/o seizures or strokes. Physical Exam: VITALS: 99.5 101 142/67 23 99% RA GEN: mildly agitated, picking at O2sat monitor and tele leads. SKIN: no obvious HEENT: NC/AT - unable to appreciate any head bumps or lacs, anicteric sclera, mmm NECK: supple, no LAD, no pain to palp CHEST: CTA bilaterally CV: regular rate and rhythm without murmurs ABD: soft, nontender, nondistended EXTREM: no edema NEURO: CN 2-12 in tact. + nystagmus on lateral gaze bilaterally. moving all extremities well. Pertinent Results: MRA and MRV [**2106-12-11**]: Normal MRA and MRV of the head. MRI [**2106-12-11**]: Small right subdural hematoma. No mass effect, hydrocephalus or evidence of acute infarct. CT head [**2106-12-11**]: There is a stable small right temporal subdural hematoma exerting mild mass effect on the adjacent sulci. There is no shift of midline. The [**Doctor Last Name 352**]-white matter differentiation remains intact. There are no new areas of hemorrhage. The ventricles are stable in size. The osseous structures and paranasal sinuses are normal. IMPRESSION: Stable small right temporal subdural hematoma. CSpine [**2106-12-11**]: no fractures. [**2106-12-10**] 05:00PM BLOOD WBC-10.8 RBC-3.81* Hgb-12.3 Hct-37.0 MCV-97 MCH-32.3* MCHC-33.3 RDW-14.0 Plt Ct-222 [**2106-12-12**] 01:05AM BLOOD WBC-6.8 RBC-3.34* Hgb-10.9* Hct-31.6* MCV-95 MCH-32.6* MCHC-34.5 RDW-13.4 Plt Ct-180 [**2106-12-12**] 08:40AM BLOOD Hct-33.0* [**2106-12-10**] 05:00PM BLOOD Neuts-89.1* Lymphs-6.8* Monos-3.9 Eos-0.1 Baso-0.1 [**2106-12-12**] 01:05AM BLOOD Neuts-78.9* Lymphs-14.8* Monos-5.5 Eos-0.7 Baso-0.1 [**2106-12-10**] 07:00PM BLOOD PT-12.4 PTT-20.9* INR(PT)-1.0 [**2106-12-10**] 05:00PM BLOOD Glucose-138* UreaN-10 Creat-0.5 Na-138 K-3.5 Cl-103 HCO3-24 AnGap-15 [**2106-12-12**] 09:20AM BLOOD Glucose-138* UreaN-3* Creat-0.4 Na-141 K-3.8 Cl-110* HCO3-23 AnGap-12 [**2106-12-12**] 09:20AM BLOOD ALT-19 AST-24 LD(LDH)-181 AlkPhos-73 Amylase-36 TotBili-0.5 [**2106-12-12**] 09:20AM BLOOD Albumin-3.5 Calcium-8.0* Phos-2.9 Mg-2.3 UricAcd-1.8* [**2106-12-12**] 01:05AM BLOOD calTIBC-308 Ferritn-64 TRF-237 [**2106-12-12**] 09:20AM BLOOD TSH-0.82 [**2106-12-10**] 05:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2106-12-12**] 03:08AM BLOOD Lactate-0.7 Brief Hospital Course: 1. Seizures: Patient presented with LOC/concern for seizures times three episodes. After detailed history taking, it was felt that the pt had a seizure in the setting of EtOH/BZD withdrawal, and fell causing the subdural hemorrhage. She then later had two more seizures. The pt was initially monitored in the MICU after she was intubated for the repeat head CT. She came off of the ventilator easily and remained stable. She was started on phenytoin 100mg three times a day and labs showed that the level was therapeutic as adjusted for albumin. She had no further seizures while at [**Hospital1 18**]. EEG was performed but the results were not available at the time of discharge. The pt will continue on Dilantin until her follow up appointment with neurology in approx 1 month at which time she will have a repeat EEG and it will be discussed if she needs to continue on Dilantin. She should also have a head CT at this time to follow up on the resolution of her subdural hematoma. She was informed that according to Mass state law, she is prohibited from driving for 6 months after having had a seizure. 2. EtOH withdrawal: The pt remained extremely agitated both before intubation and after extubation. She was also tachycardic and had a mild tremor. This was felt to be [**1-5**] EtOH withdrawal primarily. She was maintained on standing doses of valium and kept on a CIWA scale until her symptoms improved. She was evaluated by psychiatry as well as being seen by [**First Name8 (NamePattern2) 2411**] [**Last Name (NamePattern1) 2412**], the substance abuse counselor. She will follow up with her psychologist and PCP and was also given the number for the psychiatry department here at [**Hospital1 18**]. 3. Subdural: The pt sustained a small subdural hemorrhage when she fell. This was eval'd by neurosurg and on repeat head CT was unchanged. She will follow up with neurology for a repeat exam and head CT in a few weeks as discussed above. 4. Depression and anxiety: As above, the pt was seen by psychiatry and was continued on Zoloft. After her EtOH withdrawal symptoms had resolved, she was restarted on klonopin 0.5mg [**Hospital1 **] for her anxiety. She was instructed to follow up with her PCP and psychiatry and to not stop this medication before talking with her doctors. She also had difficulty sleeping at night which was aided by ambien. She was given a prescription for 15 pills and she will further discuss this with her PCP. 5. HTN: The pt was continued on a BB for HR and BP control while in house. She was discharged with the same dose of atenolol as she had on admission -atenolol 100mg qd. Medications on Admission: MEDS: @ home: zoloft 100, atenolol 100, klonopin but has not taken since Xmas @ MICU: valium 10mg IV q 6 hrs + prn CIWA, kcl and mag replacement, dilantin 100 tid, PPI, thiamine/folate/MVI IV, zoloft 100, metoprolol 50 [**Hospital1 **] Discharge Medications: 1. Sertraline HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*2* 3. Atenolol 100 mg Tablet Sig: One (1) Tablet PO once a day. 4. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 5. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*0* 6. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. Disp:*15 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: subdural hematoma seizures EtOH withdrawal depression anxiety Discharge Condition: stable Discharge Instructions: Please follow up as described below. Continue taking all medications until you discuss with your physicians. Massachussetts state law prohibits you from driving for the next 6 months. You can discuss this further at your follow up neurology appointment. Followup Instructions: Please follow up with neurology in [**2-4**] weeks. Call ([**Telephone/Fax (1) 16617**] to schedule an appointment. You will need an EEG at this time. Please also follow up with a psychiatrist in the next few weeks. You can call ([**Telephone/Fax (1) 24780**] to schedule an appointment. Finally, please call your PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) **] for an appointment in the next 2 weeks at [**Telephone/Fax (1) 58982**] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

291,780,852,518,E888,E849,292,304,305,794,V158,300,401,311

{'Alcohol withdrawal,Other convulsions,Subdural hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute respiratory failure,Unspecified fall,Home accidents,Drug withdrawal,Sedative, hypnotic or anxiolytic dependence, unspecified,Alcohol abuse, unspecified,Nonspecific abnormal electroencephalogram [EEG],Personal history of noncompliance with medical treatment, presenting hazards to health,Anxiety state, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}

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: new onset seizures, small SDH PRESENT ILLNESS: 44 yo woman with h/o EtOH and BZD use, was in her USOH until Friday [**2106-12-10**] when she was blow-drying her hair at 10am, and the next thing she new she awoke on the floor at 11:30am, no incontinence or tongue biting, thought she had just fallen asleep, feeling a little "groggy" but no headache, no bleeding. She went out to lunch with her father and children at a restaurant. Her son notes she began staring off while sitting and then her head and eyes went backwards, and she slumped onto her father, whole body shaking, duration of this event is unknown but likely on the order of minutes as the next thing she remembers is awakening in the ambulance, + tongue bite, no incontinence. She was taken to [**Location (un) **] [**Location (un) 1459**] where she had 2 more episodes of "seizures" (i.e. shaking, unresponsiveness), but there are no records from this hospital for review. Per our ED records, she received 2mg IV ativan after or during the 2nd event and was loaded with cerebrex. Had a CT head, found to have subdural hematoma and was transported here to [**Hospital1 18**] for neurosurgical eval. ETOH level at OSH is per report 14; our tox screen was negative ( but 2 days after initial presentation). Was to go to NSICU for monitering and neurchecks but no beds. Initially had been on labetolol gtt for BP. Nsurg recommended neurocheck, dilantin treatment. However, also on ddx included worsening subdural. On presentation to [**Name (NI) **], pt noted to be increasingly agitated-->concern for alcohol withdrawal. Because of agitation, pt required intubation and large amts of ativan for repeat CT, which was unchanged. NSurg did not intervene, recommended dilantin x 1 week and f/u 4-6 weeks with repeat head CT. Neuro was consulted once back on the floor and felt that pt's sz were [**1-5**] EtOH/BZD withdrawl and SDH resulted from fall. MEDICAL HISTORY: PMHx: Depression HTN scarlet fever as a child 2 c-sections endometriosis cyst removal from abdominal muscle MEDICATION ON ADMISSION: MEDS: @ home: zoloft 100, atenolol 100, klonopin but has not taken since Xmas @ MICU: valium 10mg IV q 6 hrs + prn CIWA, kcl and mag replacement, dilantin 100 tid, PPI, thiamine/folate/MVI IV, zoloft 100, metoprolol 50 [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VITALS: 99.5 101 142/67 23 99% RA GEN: mildly agitated, picking at O2sat monitor and tele leads. SKIN: no obvious HEENT: NC/AT - unable to appreciate any head bumps or lacs, anicteric sclera, mmm NECK: supple, no LAD, no pain to palp CHEST: CTA bilaterally CV: regular rate and rhythm without murmurs ABD: soft, nontender, nondistended EXTREM: no edema NEURO: CN 2-12 in tact. + nystagmus on lateral gaze bilaterally. moving all extremities well. FAMILY HISTORY: FamHx: parents/sister/2kids all alive and healthy. No h/o seizures or strokes. SOCIAL HISTORY: ALL: scallops, prozac makes her feel like she's on speed ### Response: {'Alcohol withdrawal,Other convulsions,Subdural hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute respiratory failure,Unspecified fall,Home accidents,Drug withdrawal,Sedative, hypnotic or anxiolytic dependence, unspecified,Alcohol abuse, unspecified,Nonspecific abnormal electroencephalogram [EEG],Personal history of noncompliance with medical treatment, presenting hazards to health,Anxiety state, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}

CHIEF COMPLAINT: Fall PRESENT ILLNESS: The patient is a 71-year-old male status post a fall a month prior to admission. He came to our hospital with a CT scan that showed acute subdural hematoma. MEDICAL HISTORY: Hyperlipidemia, COPD, fem [**Doctor Last Name **] bypass 6 years ago, hip and knee replacements, smoker/drinker MEDICATION ON ADMISSION: Coumadin 5mg MWF, 7.5mg TuThSaSu Niacin 500mg qd Atrovent INH Tylenol prn headache ALLERGIES: Percocet PHYSICAL EXAM: On admission: Vital signs stable, afebrile. General- awake and alert HEENT- NCAT, PERRL, no otorrhea/rhinorrhea CV- RRR, nl S1S2, no M/G/R Pulm- Bibasilar expiratory wheezes Abd- +BS, soft, NTND Ext- warm, no C/C/E [**Name (NI) 298**] Pt awake, alert, and oriented x 3; PERRL; EOMI; facial sensation intact; slight flattening of nasal-labial fold on left side; tongue midline; speech clear and appropriate; no drift. Motor: Delt [**Hospital1 **] Tri IP Ham Quad AT G [**Last Name (un) 938**] Right 5 5 5 5 5 5 5 5 5 Left 4 5 4 5 5 5 4 5 4 FAMILY HISTORY: SOCIAL HISTORY: Widowed; 3 grown children +Tobacco, 1 ppd x 60 yrs +EtOH, 3 highballs per day

Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Alcohol withdrawal delirium,Atrial fibrillation,Abnormality of gait,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Long-term (current) use of anticoagulants,Other and unspecified alcohol dependence, unspecified,Peripheral vascular disease, unspecified

Subdural hemorrhage,Chr airway obstruct NEC,Delirium tremens,Atrial fibrillation,Abnormality of gait,Hyperlipidemia NEC/NOS,Tobacco use disorder,Joint replaced hip,Long-term use anticoagul,Alcoh dep NEC/NOS-unspec,Periph vascular dis NOS

Admission Date: [**2101-11-23**] Discharge Date: [**2101-12-2**] Date of Birth: [**2030-3-26**] Sex: M Service: NEUROSURGERY Allergies: Percocet Attending:[**First Name3 (LF) 1271**] Chief Complaint: Fall Major Surgical or Invasive Procedure: Burr hole Craniotomy History of Present Illness: The patient is a 71-year-old male status post a fall a month prior to admission. He came to our hospital with a CT scan that showed acute subdural hematoma. Past Medical History: Hyperlipidemia, COPD, fem [**Doctor Last Name **] bypass 6 years ago, hip and knee replacements, smoker/drinker Social History: Widowed; 3 grown children +Tobacco, 1 ppd x 60 yrs +EtOH, 3 highballs per day Physical Exam: On admission: Vital signs stable, afebrile. General- awake and alert HEENT- NCAT, PERRL, no otorrhea/rhinorrhea CV- RRR, nl S1S2, no M/G/R Pulm- Bibasilar expiratory wheezes Abd- +BS, soft, NTND Ext- warm, no C/C/E [**Name (NI) 298**] Pt awake, alert, and oriented x 3; PERRL; EOMI; facial sensation intact; slight flattening of nasal-labial fold on left side; tongue midline; speech clear and appropriate; no drift. Motor: Delt [**Hospital1 **] Tri IP Ham Quad AT G [**Last Name (un) 938**] Right 5 5 5 5 5 5 5 5 5 Left 4 5 4 5 5 5 4 5 4 Pertinent Results: [**2101-11-23**] 05:45PM GLUCOSE-94 UREA N-15 CREAT-0.9 SODIUM-143 POTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-22 ANION GAP-18 [**2101-11-23**] 05:45PM WBC-9.2 RBC-4.56* HGB-14.9 HCT-41.7 MCV-92# MCH-32.8* MCHC-35.9* RDW-15.3 [**2101-11-23**] 05:45PM NEUTS-67.4 LYMPHS-27.1 MONOS-3.8 EOS-1.5 BASOS-0.2 [**2101-11-23**] 05:45PM PLT COUNT-228 [**2101-11-23**] 05:45PM PT-26.4* PTT-35.4* INR(PT)-5.1 Brief Hospital Course: The patient was taken to the OR for an attempt to use a burr hole to evacuate the subdural hematoma. Unfortunately, multiple membranes were encountered and the repeat head CT did not show significant improvement of the subdural hematoma. Based on that and after discussion with the family, it was decided to take the patient back to the operating room to perform a large craniotomy for evacuation of the subdural and also removal of the subdural membranes. The patient was monitored in the ICU postoperatively, then transferred to the stepdown unit on post op day 1. He went into atrial fibrillation, Diltiazem was initiated, and he was transferred back to the ICU. He had one episode of a 3-second pause in the ICU. Diltiazem was discontinued and an Amiodarone drip started. He converted back to normal sinus rhythm. The patient was asymptomatic throughout this episode of dysrhythmia. A transthoracic echo revealed an EF 50-55%, [**1-9**]+ MR, mild symmetric LVH. The patient was given oral Amiodarone and he was transferred to the floor on post op day 3. Please evaluate pateint thyhroid function, liver functions, and eye exam periodically while on amiodarone.Coumadin can be started 2 weeks from surgery date on [**2101-11-25**]. He was evaluated by PT/OT who recommended discharge to rehabilitation. Medications on Admission: Coumadin 5mg MWF, 7.5mg TuThSaSu Niacin 500mg qd Atrovent INH Tylenol prn headache Discharge Medications: 1. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 5. Niacin 500 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 6. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day) for 1 months: Please discontinue after 1 month. Disp:*93 Capsule(s)* Refills:*0* 7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR Transdermal DAILY (Daily). 11. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED): Sliding scale. 12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day) for 5 days: Through [**12-4**]. 13. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO once a day for 7 days: [**12-5**] through [**12-11**]. 14. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day for 1 months: Beginning [**12-12**], discontinue after 1 month completed. 15. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 16. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Ativan 1 mg Tablet Sig: One (1) Tablet PO three times a day: wean to off over one week if patient tolerates. It was started post op for DT's. Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) 533**] [**Last Name (NamePattern1) **] for Extended Care - [**Location 1268**] Discharge Diagnosis: Chronic subdural hematoma Discharge Condition: neurologically Stable Discharge Instructions: PLEASE TAKE MEDICATIONS AS PRESCRIBED AND READ WARNING LABELS CAREFULLY. IF CONDITION WORSENS, SUCH AS DECREASED MOBILITY AND SENSATION, GO TO THE EMERGENCY ROOM IMMEDIATELY. IF SIGNS AND SYMPTOMS OF INFECTION, SUCH AS FEVERS/CHILLS, PURULENT DISCHARGE FROM WOUND/INCISION SITE, INCREASED REDNESS, INCREASED PAIN, PLEASE CALL OR GO TO THE EMERGENCY ROOM. REMEMBER TO CALL TO SCHEDULE YOUR FOLLOW UP APPOINTMENT (BELOW). LIGHT ACTIVITIES UNTIL SEEN IN CLINIC. [**Month (only) **] SPONGE BATH OR SHOWER, BUT KEEP WOUND/INCISION AS DRY AS POSSIBLE. can be Started on coumadin 2 weeks from [**2101-11-25**] which will be [**2101-12-9**]. Please wean ativan to off over one week if patient tolerates. Followup Instructions: Please have staples removed on Monday [**12-5**]. (Staples can be removed at the rehabilitation facility, by your primary care doctor, or on [**Hospital Ward Name 121**] 5 between 9am-12pm, 1-5pm.) Please see Dr. [**Last Name (STitle) 14667**] in 6 weeks, Please call [**Telephone/Fax (1) 3571**] for an appointment. [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**] Completed by:[**2101-12-2**]

432,496,291,427,781,272,305,V436,V586,303,443

{'Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Alcohol withdrawal delirium,Atrial fibrillation,Abnormality of gait,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Long-term (current) use of anticoagulants,Other and unspecified alcohol dependence, unspecified,Peripheral vascular disease, 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: Fall PRESENT ILLNESS: The patient is a 71-year-old male status post a fall a month prior to admission. He came to our hospital with a CT scan that showed acute subdural hematoma. MEDICAL HISTORY: Hyperlipidemia, COPD, fem [**Doctor Last Name **] bypass 6 years ago, hip and knee replacements, smoker/drinker MEDICATION ON ADMISSION: Coumadin 5mg MWF, 7.5mg TuThSaSu Niacin 500mg qd Atrovent INH Tylenol prn headache ALLERGIES: Percocet PHYSICAL EXAM: On admission: Vital signs stable, afebrile. General- awake and alert HEENT- NCAT, PERRL, no otorrhea/rhinorrhea CV- RRR, nl S1S2, no M/G/R Pulm- Bibasilar expiratory wheezes Abd- +BS, soft, NTND Ext- warm, no C/C/E [**Name (NI) 298**] Pt awake, alert, and oriented x 3; PERRL; EOMI; facial sensation intact; slight flattening of nasal-labial fold on left side; tongue midline; speech clear and appropriate; no drift. Motor: Delt [**Hospital1 **] Tri IP Ham Quad AT G [**Last Name (un) 938**] Right 5 5 5 5 5 5 5 5 5 Left 4 5 4 5 5 5 4 5 4 FAMILY HISTORY: SOCIAL HISTORY: Widowed; 3 grown children +Tobacco, 1 ppd x 60 yrs +EtOH, 3 highballs per day ### Response: {'Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Alcohol withdrawal delirium,Atrial fibrillation,Abnormality of gait,Other and unspecified hyperlipidemia,Tobacco use disorder,Hip joint replacement,Long-term (current) use of anticoagulants,Other and unspecified alcohol dependence, unspecified,Peripheral vascular disease, unspecified'}

CHIEF COMPLAINT: Requesting pain medications PRESENT ILLNESS: 50 y/o F with MMP including h/o gastric bypass, DVT/PE s/p IVC filter [**11-23**], SLE on chronic prednisone, hypothyroidism, chronic hypoventilation with PCO2 60s, adrenal insufficiency presents to ED today for request of pain meds. Pt was recently admitted to [**Hospital 4199**] hospital from [**Date range (1) 33651**] after presenting with unresponsiveness and respiratory failure requiring intubation. Per d/c summary from [**Name (NI) 4199**], pt was admitted with resp failure, intubated, admitted to the ICU, and then quickly extubated. She was treated for COPD with IV antibiotics, IV solumedrol, and nebulizer treatments. The pt had attributed her respiratory failure to seroquel and thus, seroquel was discontinued. The patient was discharged on only Klonapin 0.5 PO BID, and per d/c summary, was strongly recommended not to have extra pain and anti-anxiety medications pescribed since they have caused significant lethargy and loss of respiratory drive. During her hospital stay, pt was found to have a UTI on [**10-21**] (d/c summary does not state what she was treated with), resp cx with +MRSA (unclear if this was treated or thought to be colonized), blood cxs NGTD. Pt was also placed on steroid taper of Prednisone 20 mg to continue for one week and then plan was to taper to 10 mg daily (unclear when IV solumedrol was d/ced at OSH, ?[**10-27**]). . Pt presents to ED today for request of pain and anxiety medications for abdominal pain and anxiety. Pt reports that her doctor took all of her pain medications and that she has been having "wicked" pain since then with increased anxiety. Pt also reports throat pain/soreness after recent intubation and extubations. Denies fevers/chills, headache, chest pain, shortness of breath, abd pain, dysuria, no change in BMs, no LE swelling. Of note, pt has been having continual oozing from G tube site which has been out for last 2 months per last note from GI. . In [**Last Name (LF) **], [**First Name3 (LF) **] staff had discussion with PCP [**Last Name (NamePattern4) **]: chronic pain issues and after discussion with PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 6431**] as well as NH physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], it was decided that pt could be re-started on Klonapin 0.5 mg [**Hospital1 **] as well as Methadone 5 mg TID. Labs in ED were drawn and found to have Na of 127 (baseline 133-136 on last d/c, although has been as low as 127) and K of 5.7, repeat 5.8. EKG with NSR at 96 bpm and +peaked T waves. Pt was given 10 units regular insulin IV +1 amp D50, Kayexylate 30 gm PO, Ca gluconate 2 gm IV x 1, also hydrated with 1 L NS. Also given Klonapin 0.5 mg PO and Methadone 5 mg PO, tums. Repeat EKG at 6 pm with still peaked T waves. Pt was then admitted to medicine service for further treatment of hyperkalemia. MEDICAL HISTORY: 1. S/p gastric bypass in [**2099**] for weight loss, very complicated course including chronic malnutrition s/p J-tube 2. DVT/PE [**10-23**] IVC filter placed on [**2111-11-23**]. 3. SLE with dermatologic involvement, treated with low dose chronic prednisone for several yrs. s/p biopsy. 4. Hypothyroidism, treated with levothyroxine. 5. Hypoventilation syndrome with CO2 in 60s s/p multiple intubations/ICU stays 6. Osteoporosis 7. Barretts esophagus and esophageal stricture. 8. Peripheral neuropathy. 9. H/O tachycardia, ? MAT 10. Anxiety and depression. 11. Chronic malnutrition s/p J- tube 12. h/o thigh hematomas while on coumadin therapy X 2 occassions (right and left) 13. orthostatic hypotension 14. Migraine headache 15. Asthma 16. Adrenal Insufficiency 17. Small left frontal cortical bleed and frontal scalp hematoma s/p [**2111**]8. Status post cholecystectomy [**27**]. History of seizures MEDICATION ON ADMISSION: 1. Albuterol IH 2 puffs qid 2. Levoxyl 75 mcg PO daily 3. Plaquenil 200 mg daily 4. Prednisone 20 mg daily x 1 week (?beg [**10-31**]), then taper to 10 mg daily (previously on 7.5 mg QMWF alternating with 9.5 mg QTues/Thurs/Sat per last d/c summary [**8-25**]) 5. Klonopin 0.5 mg [**Hospital1 **] 6. Neurontin 600 mg TID 7. Protonix 40 mg daily 8. Tylenol 650 mg q4hr prn 9. MOM 30 cc PO daily prn 10. Mylanta 30 cc PO q4hr prn 11. Albuterol nebs q4hr prn 12. ?Sorionate 25 mg daily ALLERGIES: Sulfonamides / Zithromax / Floxin / Penicillins / Demerol / Morphine Sulfate / Dilaudid / Bactrim PHYSICAL EXAM: T 98.7 BP 130/90 P 103 P18 Sat 99%RA wt 97 lbs Gen: A+O x 3, cachectic female, lying comfortably, NAD HEENT: PERRL, EOMI, OP clear with MMM Neck: supple, NT, no LAD Pulm: CTA bilat CV: reg rhythm, tachy, no m/r/g Abd: s/nt/nd +BS; G tube slightly oozing (pt states chronic) and mild erythema around site (also been present >1 month per pt) [**Name (NI) **]: thin, no edema, no CT, +2 DP bilat; R heel: small abrasion with eschar, no erythema, no tenderness Neuro: CN 2-12 intact, DTRs 2+throughout FAMILY HISTORY: Father died on MI, had diabetes; mother died of MI SOCIAL HISTORY: 75 pack year smoking history and quit few months ago. She denies any alcohol consumption. She lives in a nursing home at the [**Location (un) 29393**] in [**Location (un) 2251**].

Hyperpotassemia,Systemic lupus erythematosus,Acute and chronic respiratory failure,Chronic obstructive asthma, unspecified,Bacteremia,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Long-term (current) use of steroids,Intestinal bypass or anastomosis status,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Methadone causing averse effects in therapeutic use,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use

Hyperpotassemia,Syst lupus erythematosus,Acute & chronc resp fail,Chronic obst asthma NOS,Bacteremia,Protein-cal malnutr NOS,Urin tract infection NOS,Long-term use steroids,Intestinal bypass status,Osteoporosis NOS,Hypothyroidism NOS,Other staphylococcus,Adv eff methadone,Adv eff benzodiaz tranq

Admission Date: [**2113-11-1**] Discharge Date: [**2113-11-12**] Date of Birth: [**2063-4-17**] Sex: F Service: MEDICINE Allergies: Sulfonamides / Zithromax / Floxin / Penicillins / Demerol / Morphine Sulfate / Dilaudid / Bactrim Attending:[**First Name3 (LF) 689**] Chief Complaint: Requesting pain medications Major Surgical or Invasive Procedure: Intubation History of Present Illness: 50 y/o F with MMP including h/o gastric bypass, DVT/PE s/p IVC filter [**11-23**], SLE on chronic prednisone, hypothyroidism, chronic hypoventilation with PCO2 60s, adrenal insufficiency presents to ED today for request of pain meds. Pt was recently admitted to [**Hospital 4199**] hospital from [**Date range (1) 33651**] after presenting with unresponsiveness and respiratory failure requiring intubation. Per d/c summary from [**Name (NI) 4199**], pt was admitted with resp failure, intubated, admitted to the ICU, and then quickly extubated. She was treated for COPD with IV antibiotics, IV solumedrol, and nebulizer treatments. The pt had attributed her respiratory failure to seroquel and thus, seroquel was discontinued. The patient was discharged on only Klonapin 0.5 PO BID, and per d/c summary, was strongly recommended not to have extra pain and anti-anxiety medications pescribed since they have caused significant lethargy and loss of respiratory drive. During her hospital stay, pt was found to have a UTI on [**10-21**] (d/c summary does not state what she was treated with), resp cx with +MRSA (unclear if this was treated or thought to be colonized), blood cxs NGTD. Pt was also placed on steroid taper of Prednisone 20 mg to continue for one week and then plan was to taper to 10 mg daily (unclear when IV solumedrol was d/ced at OSH, ?[**10-27**]). . Pt presents to ED today for request of pain and anxiety medications for abdominal pain and anxiety. Pt reports that her doctor took all of her pain medications and that she has been having "wicked" pain since then with increased anxiety. Pt also reports throat pain/soreness after recent intubation and extubations. Denies fevers/chills, headache, chest pain, shortness of breath, abd pain, dysuria, no change in BMs, no LE swelling. Of note, pt has been having continual oozing from G tube site which has been out for last 2 months per last note from GI. . In [**Last Name (LF) **], [**First Name3 (LF) **] staff had discussion with PCP [**Last Name (NamePattern4) **]: chronic pain issues and after discussion with PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 6431**] as well as NH physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], it was decided that pt could be re-started on Klonapin 0.5 mg [**Hospital1 **] as well as Methadone 5 mg TID. Labs in ED were drawn and found to have Na of 127 (baseline 133-136 on last d/c, although has been as low as 127) and K of 5.7, repeat 5.8. EKG with NSR at 96 bpm and +peaked T waves. Pt was given 10 units regular insulin IV +1 amp D50, Kayexylate 30 gm PO, Ca gluconate 2 gm IV x 1, also hydrated with 1 L NS. Also given Klonapin 0.5 mg PO and Methadone 5 mg PO, tums. Repeat EKG at 6 pm with still peaked T waves. Pt was then admitted to medicine service for further treatment of hyperkalemia. Past Medical History: 1. S/p gastric bypass in [**2099**] for weight loss, very complicated course including chronic malnutrition s/p J-tube 2. DVT/PE [**10-23**] IVC filter placed on [**2111-11-23**]. 3. SLE with dermatologic involvement, treated with low dose chronic prednisone for several yrs. s/p biopsy. 4. Hypothyroidism, treated with levothyroxine. 5. Hypoventilation syndrome with CO2 in 60s s/p multiple intubations/ICU stays 6. Osteoporosis 7. Barretts esophagus and esophageal stricture. 8. Peripheral neuropathy. 9. H/O tachycardia, ? MAT 10. Anxiety and depression. 11. Chronic malnutrition s/p J- tube 12. h/o thigh hematomas while on coumadin therapy X 2 occassions (right and left) 13. orthostatic hypotension 14. Migraine headache 15. Asthma 16. Adrenal Insufficiency 17. Small left frontal cortical bleed and frontal scalp hematoma s/p [**2111**]8. Status post cholecystectomy [**27**]. History of seizures Social History: 75 pack year smoking history and quit few months ago. She denies any alcohol consumption. She lives in a nursing home at the [**Location (un) 29393**] in [**Location (un) 2251**]. Family History: Father died on MI, had diabetes; mother died of MI Physical Exam: T 98.7 BP 130/90 P 103 P18 Sat 99%RA wt 97 lbs Gen: A+O x 3, cachectic female, lying comfortably, NAD HEENT: PERRL, EOMI, OP clear with MMM Neck: supple, NT, no LAD Pulm: CTA bilat CV: reg rhythm, tachy, no m/r/g Abd: s/nt/nd +BS; G tube slightly oozing (pt states chronic) and mild erythema around site (also been present >1 month per pt) [**Name (NI) **]: thin, no edema, no CT, +2 DP bilat; R heel: small abrasion with eschar, no erythema, no tenderness Neuro: CN 2-12 intact, DTRs 2+throughout Pertinent Results: [**2113-11-1**] 02:35PM WBC-10.4# RBC-3.88* HGB-13.0 HCT-42.0 MCV-108* MCH-33.5* MCHC-31.0 RDW-14.2 [**2113-11-1**] 02:35PM NEUTS-92.9* BANDS-0 LYMPHS-4.3* MONOS-2.1 EOS-0.5 BASOS-0.1 [**2113-11-1**] 02:35PM PLT SMR-HIGH PLT COUNT-506*# [**2113-11-1**] 02:35PM GLUCOSE-105 UREA N-11 CREAT-0.5 SODIUM-127* POTASSIUM-5.8* CHLORIDE-85* TOTAL CO2-32 ANION GAP-16 [**2113-11-1**] 02:40PM K+-5.7* U/A: [**2113-11-1**] 02:35PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.009 [**2113-11-1**] 02:35PM URINE BLOOD-TR NITRITE-POS PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG CXR:no infiltrate; dilated bowel in LUQ but seen on prev CXR Brief Hospital Course: A/P: 50 y/o female with MMP including chronic pain, COPD s/p recent intubation for ?hypercarbic respiratory failure attributed to benzo/narcotic use, SLE on chronic prednisone, remote h/o adrenal insufficiency, depression/anxiety, h/o DVT/PE with IVC filter presenting with hyperkalemia, EKG changes, hyponatremia. The patient was initially admitted to the medical service who, in discussion with the ED and the patient's PCP, [**Name10 (NameIs) **] the patient on Methadone 5 TID and Klonopin 0.5. The patient recieved a total of methadone 10 and klonopin 0.5 when she had a respiratory arrest with a max PCO2 of 132. She was emergently intubated and sent to the MICU. There, she was slightly hypotensiove requiring a small amount of dopamine. She was weaned off the vent, and transfred to the floor on no narcotics or benzos. . Hypercarbic respiratory failure: She has a baseline hypercarbia secondary to likely COPD (although past PFT's unrevealing with poor effort) with extensive smoking history, but also has diagnosis of hypoventilation sydrome. She had an acute on chronic exacerbation of this hypercarbic respiratory failure, most likely secondary to hypoventilation, as she had normal A-a gradient and clinical syndrome of decreased level of consciousness and bradypnea in the setting of re-initiating her methadone and clonopin. She will follow up in pulmonary clinic to have a outpainett sleep study since she may have central sleep apnea. She was also started on BiPap overnight at 8/5 and tolerated it well. Recommend to avoid ALL BENZOS AND PAIN MEDS!! Hyperkalemia on admission: unclear etiology; no K sparing medications. No renal insufficency. Possibly adrenal insufficiency in her clinical context. She was given insulin/d50/calcium/kayexalate in ED for K of 5.8 and peaked T waves. Her potassium is now normal. She recevied stress dose steroids in the MICU and then was changed to her standing prednisone 20mg po qd. Methicillin Resistent Staph Epi Bacteremia: Unclear where the source is from. Blood cultures positive for MRSE on [**11-4**]. She was started on Vancomycin. ESR is only 3 so unlikely endocarditis or osteomyelitis. TTE negative for vegetetations. Vancomycin iv per PICC line x 14 day course started on [**11-4**]. EColi Urinary Tract Infection. Sensitive to bactrim, but patient is allergic. Treated with Macrobid x 7 days. Chronic Abdominal pain and anxiety: Psychiatry saw the patient for anxiety. We held all narcotics and benzodiazepines given the recent intubation. Started her on seroquel and titrated up as this allievates some of her anxiety. She was started on standing APAP, lidocaine patches and Ibuprofen with some relief of her pain. She understands that she may never be pain-free as narcotics are not an option given her intubations in the past. SLE, chronic steroids/immunosuppression: Recieved stress dose steroids in the MICU and then was dropped to Prednisone 20mg qday Fluids/Electrolytes/Nutrition - She is very malnurouished after a gastric bypass. [**Last Name (un) 1372**]-jejunal tube placed underfouroscopic guidance. She was started on tube feeds. B12 injection was given as patient has been deficient in the past and currently macrocytic. Plan is for her to follow up with Dr. [**Last Name (STitle) **] of surgery and Dr. [**Last Name (STitle) 12590**] of GI to plan for percutaneous J tube once her bacteremia has resolved. Hyponatermia. Was planning to discharge her on [**11-10**] but then her am Na returned at 125. She was somewhat volume depleted and so she was started on NS x 1.5L. There was also concern that this could be SiADH and so her celexa was held. Urine lytes show Na 15, which shows dilute urine, which is NOT c/w with siADH. Most likely due to volume depletion. On day of discharge Na was ... Code: Full Code Access: Single lumen PICC Dispo: To rehabiliation for iv antibiotics Medications on Admission: 1. Albuterol IH 2 puffs qid 2. Levoxyl 75 mcg PO daily 3. Plaquenil 200 mg daily 4. Prednisone 20 mg daily x 1 week (?beg [**10-31**]), then taper to 10 mg daily (previously on 7.5 mg QMWF alternating with 9.5 mg QTues/Thurs/Sat per last d/c summary [**8-25**]) 5. Klonopin 0.5 mg [**Hospital1 **] 6. Neurontin 600 mg TID 7. Protonix 40 mg daily 8. Tylenol 650 mg q4hr prn 9. MOM 30 cc PO daily prn 10. Mylanta 30 cc PO q4hr prn 11. Albuterol nebs q4hr prn 12. ?Sorionate 25 mg daily Discharge Medications: 1. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed. 2. Levothyroxine Sodium 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO DAILY (Daily) as needed. 5. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig: 15-30 MLs PO QID (4 times a day) as needed. 6. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). 7. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 8. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours). 9. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed. 10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 11. Lidocaine HCl 2 % Solution Sig: Twenty (20) ML Mucous membrane TID (3 times a day) as needed for sore throat. 12. Beclomethasone Diprop Monohyd 0.042 % Aerosol, Spray Sig: Two (2) Spray Nasal [**Hospital1 **] (2 times a day). 13. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). 15. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 16. Quetiapine 100 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 17. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO PRN (as needed). 18. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: Four (4) Adhesive Patch, Medicated Topical QD (). 19. Quetiapine 25 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day) as needed for anxiety. 20. Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea 21. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) g Intravenous Q 12H (Every 12 Hours) for 7 days. 22. Vitamin B12-Vitamin B1 100-1 mg/mL Solution Sig: One (1) mL Intramuscular once a month. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Methicillin-Resistent Staph Epi Bacteremia EColi UTI Hypercarbic respiratory failure Malnutrition Hyperkalemia, Resolved Discharge Condition: Good Discharge Instructions: Follow up as below Followup Instructions: Please call Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] (Surgeon), M.D.([**Telephone/Fax (1) 2363**] for an appointment within the next month for a consultation regarding your feeding tube. Call Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] (Gastroenterology)([**Telephone/Fax (1) 8892**] for an appointment to follow up in [**1-22**] weeks after discharge Call Dr. [**First Name (STitle) **] [**Name (STitle) **] (Pulmonary) at ([**Telephone/Fax (1) 513**] for an appointment in [**1-22**] weeks after discharge Call your primary care doctor [**First Name (Titles) 33652**] [**Last Name (Titles) **] for an appointment [**1-22**] weeks after discharge [**Telephone/Fax (1) 33653**]. Provider: [**First Name11 (Name Pattern1) 2890**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 2226**] Date/Time:[**2113-11-24**] 11:00 Provider: [**First Name4 (NamePattern1) 8990**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2113-12-18**] 1:30

276,710,518,493,790,263,599,V586,V453,733,244,041,E935,E939

{'Hyperpotassemia,Systemic lupus erythematosus,Acute and chronic respiratory failure,Chronic obstructive asthma, unspecified,Bacteremia,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Long-term (current) use of steroids,Intestinal bypass or anastomosis status,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Methadone causing averse effects in therapeutic use,Benzodiazepine-based tranquilizers 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: Requesting pain medications PRESENT ILLNESS: 50 y/o F with MMP including h/o gastric bypass, DVT/PE s/p IVC filter [**11-23**], SLE on chronic prednisone, hypothyroidism, chronic hypoventilation with PCO2 60s, adrenal insufficiency presents to ED today for request of pain meds. Pt was recently admitted to [**Hospital 4199**] hospital from [**Date range (1) 33651**] after presenting with unresponsiveness and respiratory failure requiring intubation. Per d/c summary from [**Name (NI) 4199**], pt was admitted with resp failure, intubated, admitted to the ICU, and then quickly extubated. She was treated for COPD with IV antibiotics, IV solumedrol, and nebulizer treatments. The pt had attributed her respiratory failure to seroquel and thus, seroquel was discontinued. The patient was discharged on only Klonapin 0.5 PO BID, and per d/c summary, was strongly recommended not to have extra pain and anti-anxiety medications pescribed since they have caused significant lethargy and loss of respiratory drive. During her hospital stay, pt was found to have a UTI on [**10-21**] (d/c summary does not state what she was treated with), resp cx with +MRSA (unclear if this was treated or thought to be colonized), blood cxs NGTD. Pt was also placed on steroid taper of Prednisone 20 mg to continue for one week and then plan was to taper to 10 mg daily (unclear when IV solumedrol was d/ced at OSH, ?[**10-27**]). . Pt presents to ED today for request of pain and anxiety medications for abdominal pain and anxiety. Pt reports that her doctor took all of her pain medications and that she has been having "wicked" pain since then with increased anxiety. Pt also reports throat pain/soreness after recent intubation and extubations. Denies fevers/chills, headache, chest pain, shortness of breath, abd pain, dysuria, no change in BMs, no LE swelling. Of note, pt has been having continual oozing from G tube site which has been out for last 2 months per last note from GI. . In [**Last Name (LF) **], [**First Name3 (LF) **] staff had discussion with PCP [**Last Name (NamePattern4) **]: chronic pain issues and after discussion with PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 6431**] as well as NH physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], it was decided that pt could be re-started on Klonapin 0.5 mg [**Hospital1 **] as well as Methadone 5 mg TID. Labs in ED were drawn and found to have Na of 127 (baseline 133-136 on last d/c, although has been as low as 127) and K of 5.7, repeat 5.8. EKG with NSR at 96 bpm and +peaked T waves. Pt was given 10 units regular insulin IV +1 amp D50, Kayexylate 30 gm PO, Ca gluconate 2 gm IV x 1, also hydrated with 1 L NS. Also given Klonapin 0.5 mg PO and Methadone 5 mg PO, tums. Repeat EKG at 6 pm with still peaked T waves. Pt was then admitted to medicine service for further treatment of hyperkalemia. MEDICAL HISTORY: 1. S/p gastric bypass in [**2099**] for weight loss, very complicated course including chronic malnutrition s/p J-tube 2. DVT/PE [**10-23**] IVC filter placed on [**2111-11-23**]. 3. SLE with dermatologic involvement, treated with low dose chronic prednisone for several yrs. s/p biopsy. 4. Hypothyroidism, treated with levothyroxine. 5. Hypoventilation syndrome with CO2 in 60s s/p multiple intubations/ICU stays 6. Osteoporosis 7. Barretts esophagus and esophageal stricture. 8. Peripheral neuropathy. 9. H/O tachycardia, ? MAT 10. Anxiety and depression. 11. Chronic malnutrition s/p J- tube 12. h/o thigh hematomas while on coumadin therapy X 2 occassions (right and left) 13. orthostatic hypotension 14. Migraine headache 15. Asthma 16. Adrenal Insufficiency 17. Small left frontal cortical bleed and frontal scalp hematoma s/p [**2111**]8. Status post cholecystectomy [**27**]. History of seizures MEDICATION ON ADMISSION: 1. Albuterol IH 2 puffs qid 2. Levoxyl 75 mcg PO daily 3. Plaquenil 200 mg daily 4. Prednisone 20 mg daily x 1 week (?beg [**10-31**]), then taper to 10 mg daily (previously on 7.5 mg QMWF alternating with 9.5 mg QTues/Thurs/Sat per last d/c summary [**8-25**]) 5. Klonopin 0.5 mg [**Hospital1 **] 6. Neurontin 600 mg TID 7. Protonix 40 mg daily 8. Tylenol 650 mg q4hr prn 9. MOM 30 cc PO daily prn 10. Mylanta 30 cc PO q4hr prn 11. Albuterol nebs q4hr prn 12. ?Sorionate 25 mg daily ALLERGIES: Sulfonamides / Zithromax / Floxin / Penicillins / Demerol / Morphine Sulfate / Dilaudid / Bactrim PHYSICAL EXAM: T 98.7 BP 130/90 P 103 P18 Sat 99%RA wt 97 lbs Gen: A+O x 3, cachectic female, lying comfortably, NAD HEENT: PERRL, EOMI, OP clear with MMM Neck: supple, NT, no LAD Pulm: CTA bilat CV: reg rhythm, tachy, no m/r/g Abd: s/nt/nd +BS; G tube slightly oozing (pt states chronic) and mild erythema around site (also been present >1 month per pt) [**Name (NI) **]: thin, no edema, no CT, +2 DP bilat; R heel: small abrasion with eschar, no erythema, no tenderness Neuro: CN 2-12 intact, DTRs 2+throughout FAMILY HISTORY: Father died on MI, had diabetes; mother died of MI SOCIAL HISTORY: 75 pack year smoking history and quit few months ago. She denies any alcohol consumption. She lives in a nursing home at the [**Location (un) 29393**] in [**Location (un) 2251**]. ### Response: {'Hyperpotassemia,Systemic lupus erythematosus,Acute and chronic respiratory failure,Chronic obstructive asthma, unspecified,Bacteremia,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Long-term (current) use of steroids,Intestinal bypass or anastomosis status,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Methadone causing averse effects in therapeutic use,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: hematemesis PRESENT ILLNESS: 59 yo old gentleman with alcoholic cirrhosis transfered from [**Hospital 8641**] hospital, NH for hematemesis from Esophageal and gastric varices. Reports drinking 2 cases of beer daily and last bleed [**4-1**] with banding. He states he had increased fatigue over the course of ten days without nausea, vomiting, abdominal pain, hematemesis, melena hematochezia. Day of admission to [**Location (un) 8641**] [**4-21**] patient with hematemesis. This was the patients third admission in recent months. Banding performed in [**Month (only) 956**] admission only. While admitted, it appears from review of the records that his hematocrit remained stable and he did not receive any blood products. EGD revealed grade I-II varices in Esophagus and gastrocardiac junction without stigmata of recent hemorrhage. No evidence of banding. He was maintained on an IV PPI, no octreotide nor antibiotics were administered. Patient was transferred for further evaluation and potential TIPS. Several episodes of encephalopathy in the setting of bleed in the past. . The patient reports that he continues to have small episodes of hematemesis as recently as this morning. He has abdominal pain, chronic back/leg pain and a headache that has lasted several days. Has loose, non-melanotic guaiac positive stools. . VS on admission to the floor: 98.7 158/60 61 18 96%RA. Patient was transferred to MICU for closer monitoring and potential EGD. . MEDICAL HISTORY: Alcoholic Cirrhosis Chronic Alcohol abuse, last drink "was the superbowl" Portal Hypertension Gastric/Esophageal Varices COPD Hypothyroidism Chronic Back pain MEDICATION ON ADMISSION: Oxycontin 30mg PO Q8 Oxycodone 5mg PO Q6H PRN Ativan 1mg IV/PO Q4h PRN Anxiety Albuterol Q2h PRN Wheezing/Dyspnea Duoneb QID Pantoprazole 40mg IV BID Celexa 60mg PO Daily Aldactone 100mg PO Daily MVI PO Daily Nadolol (Both 20 & 40 listed)mg PO Daily Vit D3 1000 Units daily Nicotine 21mg TP ALLERGIES: Nsaids / Acetaminophen PHYSICAL EXAM: Vitals: T: 98.2 BP:115/57 P:59 R: 11 O2: 97% on RA General: Arousable, ill appearing. 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, distended, non-tender, bowel sounds present, no rebound tenderness or guarding. Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox0. No asterixis. Non focal. skin: palmar erythema, numerous tatoos, telangiectasia. No caput FAMILY HISTORY: Father died from unknown CA @ 77, brother died, age unknown from esophageal Ca. SOCIAL HISTORY: Lives alone. History of ETOH Abuse. 70pkyr history, (current 1.5ppd). Unable to obtain other illicity use

Alcoholic cirrhosis of liver,Hepatic encephalopathy,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Other and unspecified alcohol dependence, unspecified,Other specified disorders of circulatory system,Other chronic pulmonary heart diseases,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Backache, unspecified

Alcohol cirrhosis liver,Hepatic encephalopathy,Bleed esoph var oth dis,Food/vomit pneumonitis,Chr airway obstruct NEC,Aortic valve disorder,Alcoh dep NEC/NOS-unspec,Circulatory disease NEC,Chr pulmon heart dis NEC,Hypothyroidism NOS,Esophageal reflux,History of tobacco use,Backache NOS

Admission Date: [**2109-4-25**] Discharge Date: [**2109-5-2**] Date of Birth: [**2050-11-8**] Sex: M Service: MEDICINE Allergies: Nsaids / Acetaminophen Attending:[**Male First Name (un) 5282**] Chief Complaint: hematemesis Major Surgical or Invasive Procedure: EGD, TIPS History of Present Illness: 59 yo old gentleman with alcoholic cirrhosis transfered from [**Hospital 8641**] hospital, NH for hematemesis from Esophageal and gastric varices. Reports drinking 2 cases of beer daily and last bleed [**4-1**] with banding. He states he had increased fatigue over the course of ten days without nausea, vomiting, abdominal pain, hematemesis, melena hematochezia. Day of admission to [**Location (un) 8641**] [**4-21**] patient with hematemesis. This was the patients third admission in recent months. Banding performed in [**Month (only) 956**] admission only. While admitted, it appears from review of the records that his hematocrit remained stable and he did not receive any blood products. EGD revealed grade I-II varices in Esophagus and gastrocardiac junction without stigmata of recent hemorrhage. No evidence of banding. He was maintained on an IV PPI, no octreotide nor antibiotics were administered. Patient was transferred for further evaluation and potential TIPS. Several episodes of encephalopathy in the setting of bleed in the past. . The patient reports that he continues to have small episodes of hematemesis as recently as this morning. He has abdominal pain, chronic back/leg pain and a headache that has lasted several days. Has loose, non-melanotic guaiac positive stools. . VS on admission to the floor: 98.7 158/60 61 18 96%RA. Patient was transferred to MICU for closer monitoring and potential EGD. . Past Medical History: Alcoholic Cirrhosis Chronic Alcohol abuse, last drink "was the superbowl" Portal Hypertension Gastric/Esophageal Varices COPD Hypothyroidism Chronic Back pain Social History: Lives alone. History of ETOH Abuse. 70pkyr history, (current 1.5ppd). Unable to obtain other illicity use Family History: Father died from unknown CA @ 77, brother died, age unknown from esophageal Ca. Physical Exam: Vitals: T: 98.2 BP:115/57 P:59 R: 11 O2: 97% on RA General: Arousable, ill appearing. 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, distended, non-tender, bowel sounds present, no rebound tenderness or guarding. Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox0. No asterixis. Non focal. skin: palmar erythema, numerous tatoos, telangiectasia. No caput Pertinent Results: - CXR 1V ([**2109-4-29**]): Pulmonary vascular congestion which improved between [**4-26**] and [**4-27**] has returned suggesting a borderline cardiac decompensation. Right basal consolidation is most consistent with pneumonia, while left basal abnormality which has improved since [**4-27**] is probably resolving atelectasis, although it may be related to aspiration. Heart size is normal. Lateral aspect of the right lower chest is excluded from the examination. The other pleural surfaces are normal. Right jugular sheath ends just above the junction with the right subclavian vein. Nasogastric tube passes into the stomach and out of view. - TIPS ([**2109-4-26**]) - RUQ ultrasound ([**2109-4-26**]): Limited Doppler examination due to the covered TIPS shunt is causing acoustic shadowing and preventing Doppler examination of the flow within the TIPS shunt itself. Indirect evidence suggests TIPS patency with appropriate direction based on the flow in the main, anterior right common and left portal veins. Followup ultrasound in one week is recommended when the TIPS shunt may be interrogated with ultrasound. - TIPS ([**2109-4-25**]) - TTE ([**2109-4-25**]): The left atrium is mildly dilated. 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 mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Moderate (2+) aortic regurgitation is seen, secondary to incomplete central leaflet coaptation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Normal global and regional biventricular systolic function. Moderate aortic regurgitation. Mild pulmonary hypertension. - EGD ([**2109-4-25**]): Varices at the lower third of the esophagus (4 cords of grade I-II varices); varices at the cardia, injected; otherwise normal EGD to third part of the duodenum and stomach antrum. [**2109-4-29**] WBC-10.3 Hgb-11.0* Hct-31.0* MCV-88 Plt Ct-71* PT-17.6* PTT-35.0 INR(PT)-1.6* Glucose-115* UreaN-22* Creat-0.5 Na-143 K-2.9* Cl-109* HCO3-25 Calcium-8.6 Phos-1.9* Mg-1.8 ALT-492* AST-498* LD(LDH)-289* AlkPhos-113 TotBili-5.0* Brief Hospital Course: 58 year-old male with cirrhosis secondary to alcohol complicated by esophageal and gastric varices s/p banding in [**2109-1-27**] transferred from outside hospital on [**2109-4-25**] with hematemesis. Patient was admitted directly to the MICU, and transferred to the medical [**Hospital1 **] on [**2109-4-30**]. Hospital course was as follows. Hematemesis was most likely secondary to variceal bleeding. Patient was started on an ocretotide gtt, IV PPI, Ciprofloxacin, and transfused to keep HCT > 25. Nadolol and Spironolactone were held in the setting of acute GI bleed. Patient was kept NPO during admission. Liver team was consulted. They performed an EGD on the night of admission. EGD revealed large gastric varix, which was injected 2cc, 6cc, with bleeding (hematemesis). Bleeding appeared to stop. However NG tube with dark blood, clots. Patient looked unwell. BP transiently dropped to 80's. Patient was typed and cross matched and received 2 units of blood. IR was contact[**Name (NI) **] for urgent TIPS. He was intubated prior to TIPS, with permission from daughter, his health care proxy. In procedure, initial porto-systemic gradient of 22. Brought down to 6 after TIPS. Saw esophageal varices. Pre-TIPS saw splenorenal shunt. Slower filling after TIPS. They did not perform any embolization on initial TIPS. The following morning [**4-26**], patient had a second episode of hematemesis, 200cc. Vital signs and HCT were stable. IR performed a redo of TIPS procedure. Patient was extubated on [**4-27**]. On [**4-28**] patient was started on Ceftriaxone and Flagyl for aspiration pneumonia seen on chest x-ray. The following day a meeting was held with the [**Hospital 228**] health care proxy and the MICU team. The daughter concluded that the patient should have no more care other than treating his hepatic encephalopathy (i.e. continuing lactulose, rifaximin, but discontinuing all antibiotics). Central lines were discontinued, and one peripheral IV was placed. She did not want further antibiotics, lab draws, blood products, intubation, or resusitation. Patient was made CMO, with the exception of treating hepatic encephalopathy in the event that mental status clears and the patient does not continue to bleed. On transfer to the medical service, patient's NG tube fell out. Per discussion with daughter, the patient would not want tube replaced. She reported that this was based on lengthy discussions with her father following recent hospitalizations. Patient received one dose of lactulose PR. Pain was controlled with morphine PO; agitation with olanzapine. Patient required the use of restraints given danger to himself; he made repeated attempts to get out of bed, and was at risk of falling. He was alert at times although with limited interaction; he was not oriented to place or time on discharge. He was hemodynamically stable on discharge. Medications on Admission: Oxycontin 30mg PO Q8 Oxycodone 5mg PO Q6H PRN Ativan 1mg IV/PO Q4h PRN Anxiety Albuterol Q2h PRN Wheezing/Dyspnea Duoneb QID Pantoprazole 40mg IV BID Celexa 60mg PO Daily Aldactone 100mg PO Daily MVI PO Daily Nadolol (Both 20 & 40 listed)mg PO Daily Vit D3 1000 Units daily Nicotine 21mg TP Discharge Medications: 1. Morphine Concentrate 20 mg/mL Solution Sig: 0.5 mL PO Q8H (every 8 hours): Hold for sedation or RR<12. 2. Morphine Concentrate 20 mg/mL Solution Sig: 0.25 to 0.5 mL PO Q4H (every 4 hours) as needed for Pain: Hold for sedation or RR<12. 3. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 2.5 to 5 mg PO Q4H (every 4 hours) as needed for Agitation. Discharge Disposition: Extended Care Facility: [**Last Name (un) **] family hospice house Discharge Diagnosis: Gastric varices Esophageal varices Hepatic encephalopathy Alcoholic cirrhosis Aspiration pneumonia Discharge Condition: Hemodynamically stable. Encephalopathic. Arousable, but unable to interact. Not orient to place or time. Discharge Instructions: You were admitted to [**Hospital1 69**] on [**2109-4-25**] with variceal bleeding. The liver team was consulted. You were initially treated with ocreotide, proton pump inhibitor, ciprofloxacin, IV fluids, and blood transfusions. An EGD was performed on the night of admission, which revealed esophageal varices, and a bleeding gastric varix. You subsequently had hematemesis (vomiting blood), and had an emergent TIPS performed. You were intubated for this procedure. The following morning, you had repeat hematemesis and a redo tips procedure. After a family meeting with you daughter, your health care proxy, it was decided to withdraw further interventions. This included no further blood products, no ventilation or rescusitations, no lab draws, no IV fluids for rescusitation. You were initially treated for hepatic encephalopathy with lactulose and rifaximin, although your nasogastric tube fell out and was not replaced and after discussion with your daughter. You will be going to [**Last Name (un) 59614**] Family Hospice House in New [**Location (un) **]. Followup Instructions: You will be cared for at [**Last Name (un) 59614**] Family Hospice House. Completed by:[**2109-5-2**]

571,572,456,507,496,424,303,459,416,244,530,V158,724

{'Alcoholic cirrhosis of liver,Hepatic encephalopathy,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Other and unspecified alcohol dependence, unspecified,Other specified disorders of circulatory system,Other chronic pulmonary heart diseases,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Backache, 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: hematemesis PRESENT ILLNESS: 59 yo old gentleman with alcoholic cirrhosis transfered from [**Hospital 8641**] hospital, NH for hematemesis from Esophageal and gastric varices. Reports drinking 2 cases of beer daily and last bleed [**4-1**] with banding. He states he had increased fatigue over the course of ten days without nausea, vomiting, abdominal pain, hematemesis, melena hematochezia. Day of admission to [**Location (un) 8641**] [**4-21**] patient with hematemesis. This was the patients third admission in recent months. Banding performed in [**Month (only) 956**] admission only. While admitted, it appears from review of the records that his hematocrit remained stable and he did not receive any blood products. EGD revealed grade I-II varices in Esophagus and gastrocardiac junction without stigmata of recent hemorrhage. No evidence of banding. He was maintained on an IV PPI, no octreotide nor antibiotics were administered. Patient was transferred for further evaluation and potential TIPS. Several episodes of encephalopathy in the setting of bleed in the past. . The patient reports that he continues to have small episodes of hematemesis as recently as this morning. He has abdominal pain, chronic back/leg pain and a headache that has lasted several days. Has loose, non-melanotic guaiac positive stools. . VS on admission to the floor: 98.7 158/60 61 18 96%RA. Patient was transferred to MICU for closer monitoring and potential EGD. . MEDICAL HISTORY: Alcoholic Cirrhosis Chronic Alcohol abuse, last drink "was the superbowl" Portal Hypertension Gastric/Esophageal Varices COPD Hypothyroidism Chronic Back pain MEDICATION ON ADMISSION: Oxycontin 30mg PO Q8 Oxycodone 5mg PO Q6H PRN Ativan 1mg IV/PO Q4h PRN Anxiety Albuterol Q2h PRN Wheezing/Dyspnea Duoneb QID Pantoprazole 40mg IV BID Celexa 60mg PO Daily Aldactone 100mg PO Daily MVI PO Daily Nadolol (Both 20 & 40 listed)mg PO Daily Vit D3 1000 Units daily Nicotine 21mg TP ALLERGIES: Nsaids / Acetaminophen PHYSICAL EXAM: Vitals: T: 98.2 BP:115/57 P:59 R: 11 O2: 97% on RA General: Arousable, ill appearing. 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, distended, non-tender, bowel sounds present, no rebound tenderness or guarding. Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox0. No asterixis. Non focal. skin: palmar erythema, numerous tatoos, telangiectasia. No caput FAMILY HISTORY: Father died from unknown CA @ 77, brother died, age unknown from esophageal Ca. SOCIAL HISTORY: Lives alone. History of ETOH Abuse. 70pkyr history, (current 1.5ppd). Unable to obtain other illicity use ### Response: {'Alcoholic cirrhosis of liver,Hepatic encephalopathy,Esophageal varices in diseases classified elsewhere, with bleeding,Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Other and unspecified alcohol dependence, unspecified,Other specified disorders of circulatory system,Other chronic pulmonary heart diseases,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Backache, unspecified'}

CHIEF COMPLAINT: Fevers, low blood pressure, abdominal pain PRESENT ILLNESS: 65M with chronic pancreatitis, several intra-abdominal abscesses p/w with 3 d of severe low back pain. Patient has been to ED 3 times in the past 3 days with no resolution of symptoms. He reports that he can not move or walk due to the pain, worst with standing up, no radiation. He spoke with his PCP today, who was concerned about osteomyelitis given low back pain with history of intraabdominal abscesses and elevated white count. He recommended he come to the ED for evaluation. . In the ED, initial VS were: 98.1 79 100/64 20. Physical exam showed tenderness to palpation adjacent to spine. Labs were remarkable for elevated alk phos and WBC 14.2. He was given hydromorphone 2mg po q8h for pain control and started on IV vancomycin and ceftriaxone, no blood cultures were drawn prior. No imaging obtained in the ED. Admitted to medicine for evaluation of osteomyelitis. Vitals prior to transfer were 98.4 87 116/83 16 95% room air. . On arrival to the floor, the patient was found to be hypotensive to the 70s sytolic, tachycardic to the 130s, febrile to 102. He was given 3L NS, blood cultures were drawn. Labs were redrawn and WBC had risen to 25.5 (from 14.2 6h earlier), lactate 4.0. Given daptomycin to cover VRE, given his hx of VRE bacteremia in the past. He was transfered to the MICU for sepsis. . On arrival to the MICU, he is lying in bed complaining of pain in his back but otherwise doing well. Awake and interactive, able to give the HPI. MEDICAL HISTORY: 1. Multiple polymicrobial fluid collections, status post multiple drain procedures over the past several years. Most recently MRSA in new L flank abscess in [**2188-6-6**], past h/o psoas abscess, retroperitoneal abscess, enterocutaneous fistula. 2. Ventral hernia repair complicated by severe pancreatitis, leading to a nearly yearlong hospitalization starting [**2185-4-7**] at [**Hospital6 10353**] and at the [**Hospital1 2177**] to rehabilitation ending [**2186-1-8**]. 3. Pancreatic mass per GI notes. Endoscopic ultrasound performed twice, most recently [**2187-1-8**] showing 2 x 3 cm ill-defined mass to the pancreas. FNA was performed. No malignancy was found. 4. CAD status post MI [**2185**] 5. Diverticulosis. 6. Anxiety. 7. Hypothyroidism. 8. Hypertension. 9. Lower extremity DVT status post IVC filter ([**2185**] or [**2186**]) 10. Portal vein thrombosis. 11. Status post fundoplication 16 plus years ago complicated by splenic injury requiring splenectomy. 12. BPH. 13. Vitamin D deficiency. 14. Abnormal LFTs intermittently, most recently thought due to Augmentin. 15. Gynecomastia. 16. Cirrhosis - dx in [**2186**] MEDICATION ON ADMISSION: FLUCONAZOLE - 200 mg Tablet - 1 Tablet(s) by mouth daily FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth Monday/Wednesday/Friday HYDROMORPHONE - 2 mg Tablet - 1 Tablet(s) by mouth every 8 hours Do not drive while taking this medication. LEVOTHYROXINE - 25 mcg Tablet - 1 Tablet(s) by mouth qday LIPASE-PROTEASE-AMYLASE [CREON] - 24,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000 unit Capsule, Delayed Release(E.C.) - 2 Capsule(s) by mouth with meals 1 capsule with snac - No Substitution METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth every 6 hours as needed for nausea MOXIFLOXACIN [AVELOX] - 400 mg Tablet - 1 Tablet(s) by mouth qdaily OMEPRAZOLE - (Prescribed by Other Provider) - 40 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth daily SODIUM POLYSTYRENE SULFONATE [KAYEXALATE] - Powder - 30Gm dose by mouth once as directed as needed for then call for instructions CVS will dispense the suspension; 15Gm/60mL TAMSULOSIN - 0.4 mg Capsule, Ext Release 24 hr - 1 Capsule(s) by mouth daily TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime as needed for insomnia ASPIRIN [ASPERDRINK] - 81 mg Tablet, Effervescent - 1 Tablet(s) by mouth daily CHOLECALCIFEROL (VITAMIN D3) - 1,000 unit Capsule - 1 Capsule(s) by mouth daily DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a day MICONAZOLE NITRATE [MICRO-GUARD] - 2 % Powder - please place along wound area three times a day as needed for moisture accumulation MULTIVITAMIN WITH MINERALS - (Prescribed by Other Provider) - Tablet - 1 Tablet(s) by mouth daily ALLERGIES: Clotrimazole / Augmentin PHYSICAL EXAM: On Admission: Vitals: T: 96.7 BP: 97/66 P: 99 R: 18 O2: 98% on 3L General: Alert, oriented to place and situation but not time. In no acute distress unless being turned/moved (severe pain) HEENT: PERRL, sclera anicteric, dry mucous membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: diminished breath sounds in bases bilaterally, no wheezes, rales, ronchi Abdomen: BS+, distended, caput medusa seen, soft, moderately tender to palpation of RUQ and left flank. Protrusion seen below ribs on right side. Some voluntary guarding, but no rebound GU: foley draining clear yellow urine Back: pain to palpation of spine at L3-L5 levels, no paraspinous tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNs II-[**Doctor First Name 81**] intact, strength 4+/5 and symmetric in UE, stength [**2-9**] in hip flexors and [**3-11**] knee extensors, [**4-10**] in other LE muscle groups. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives in [**Location (un) 7913**] with [**Doctor First Name 1258**] his wife. [**Name (NI) **] is unemployed. - Tobacco: smoked <1 PPD for 1 year in the past - Alcohol: denies - Illicits: denies

Methicillin resistant Staphylococcus aureus septicemia,Peritoneal abscess,Acute respiratory failure,Encephalopathy, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic pancreatitis,Hydronephrosis,Paralytic ileus,Hematemesis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Severe sepsis,Cirrhosis of liver without mention of alcohol,Lumbosacral spondylosis without myelopathy,Coronary atherosclerosis of native coronary artery,Diverticulosis of colon (without mention of hemorrhage),Anxiety state, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Other specified disorders of biliary tract,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyperpotassemia,Hypertrophy of breast,Anemia, unspecified,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Do not resuscitate status,Penicillins causing adverse effects in therapeutic use

MRSA septicemia,Peritoneal abscess,Acute respiratry failure,Encephalopathy NOS,Ac kidny fail, tubr necr,Chronic pancreatitis,Hydronephrosis,Paralytic ileus,Hematemesis,Enterococcus group d,Severe sepsis,Cirrhosis of liver NOS,Lumbosacral spondylosis,Crnry athrscl natve vssl,Dvrtclo colon w/o hmrhg,Anxiety state NOS,Hypothyroidism NOS,Vitamin D deficiency NOS,Dis of biliary tract NEC,BPH w/o urinary obs/LUTS,Hyperpotassemia,Hypertrophy of breast,Anemia NOS,Old myocardial infarct,Hypertension NOS,Hx-ven thrombosis/embols,Do not resusctate status,Adv eff penicillins

Admission Date: [**2188-8-25**] Discharge Date: [**2188-9-18**] Date of Birth: [**2123-6-24**] Sex: M Service: MEDICINE Allergies: Clotrimazole / Augmentin Attending:[**First Name3 (LF) 4095**] Chief Complaint: Fevers, low blood pressure, abdominal pain Major Surgical or Invasive Procedure: CT guided drainage of peri-hepatic abscess with placement of a pig-tail drain. ERCP with placement of CBD stent Ultrasound guided PICC placement History of Present Illness: 65M with chronic pancreatitis, several intra-abdominal abscesses p/w with 3 d of severe low back pain. Patient has been to ED 3 times in the past 3 days with no resolution of symptoms. He reports that he can not move or walk due to the pain, worst with standing up, no radiation. He spoke with his PCP today, who was concerned about osteomyelitis given low back pain with history of intraabdominal abscesses and elevated white count. He recommended he come to the ED for evaluation. . In the ED, initial VS were: 98.1 79 100/64 20. Physical exam showed tenderness to palpation adjacent to spine. Labs were remarkable for elevated alk phos and WBC 14.2. He was given hydromorphone 2mg po q8h for pain control and started on IV vancomycin and ceftriaxone, no blood cultures were drawn prior. No imaging obtained in the ED. Admitted to medicine for evaluation of osteomyelitis. Vitals prior to transfer were 98.4 87 116/83 16 95% room air. . On arrival to the floor, the patient was found to be hypotensive to the 70s sytolic, tachycardic to the 130s, febrile to 102. He was given 3L NS, blood cultures were drawn. Labs were redrawn and WBC had risen to 25.5 (from 14.2 6h earlier), lactate 4.0. Given daptomycin to cover VRE, given his hx of VRE bacteremia in the past. He was transfered to the MICU for sepsis. . On arrival to the MICU, he is lying in bed complaining of pain in his back but otherwise doing well. Awake and interactive, able to give the HPI. Past Medical History: 1. Multiple polymicrobial fluid collections, status post multiple drain procedures over the past several years. Most recently MRSA in new L flank abscess in [**2188-6-6**], past h/o psoas abscess, retroperitoneal abscess, enterocutaneous fistula. 2. Ventral hernia repair complicated by severe pancreatitis, leading to a nearly yearlong hospitalization starting [**2185-4-7**] at [**Hospital6 10353**] and at the [**Hospital1 2177**] to rehabilitation ending [**2186-1-8**]. 3. Pancreatic mass per GI notes. Endoscopic ultrasound performed twice, most recently [**2187-1-8**] showing 2 x 3 cm ill-defined mass to the pancreas. FNA was performed. No malignancy was found. 4. CAD status post MI [**2185**] 5. Diverticulosis. 6. Anxiety. 7. Hypothyroidism. 8. Hypertension. 9. Lower extremity DVT status post IVC filter ([**2185**] or [**2186**]) 10. Portal vein thrombosis. 11. Status post fundoplication 16 plus years ago complicated by splenic injury requiring splenectomy. 12. BPH. 13. Vitamin D deficiency. 14. Abnormal LFTs intermittently, most recently thought due to Augmentin. 15. Gynecomastia. 16. Cirrhosis - dx in [**2186**] Social History: Lives in [**Location (un) 7913**] with [**Doctor First Name 1258**] his wife. [**Name (NI) **] is unemployed. - Tobacco: smoked <1 PPD for 1 year in the past - Alcohol: denies - Illicits: denies Family History: Non-contributory. Physical Exam: On Admission: Vitals: T: 96.7 BP: 97/66 P: 99 R: 18 O2: 98% on 3L General: Alert, oriented to place and situation but not time. In no acute distress unless being turned/moved (severe pain) HEENT: PERRL, sclera anicteric, dry mucous membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: diminished breath sounds in bases bilaterally, no wheezes, rales, ronchi Abdomen: BS+, distended, caput medusa seen, soft, moderately tender to palpation of RUQ and left flank. Protrusion seen below ribs on right side. Some voluntary guarding, but no rebound GU: foley draining clear yellow urine Back: pain to palpation of spine at L3-L5 levels, no paraspinous tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNs II-[**Doctor First Name 81**] intact, strength 4+/5 and symmetric in UE, stength [**2-9**] in hip flexors and [**3-11**] knee extensors, [**4-10**] in other LE muscle groups. Discharge: VS: 98.7, 116/80, 85, 16, 97% RA. Gen: Resting comfortably in bed; appropriate conversation HEENT: PERRLA, EOMI Lungs: CTA bilat, no r/rh/wh CVS: RRR, no MRG, nl S1/S2 Abd: nontender to palpation in all four quadrants and flank. Mildly distended, bs x 4, no masses, dilated superficial epigastric veins; RUQ drain w/ scant green bilious fluid Ext: warm, perfused, 2+ edema b/l; PICC in place Skin: no rashes Neuro: CNIII-XII intact, strength 5/5 throughout, sensation grossly intact b/l UE/LE, gait not tested. . Pertinent Results: [**2188-8-24**] 07:00PM BLOOD WBC-16.1* RBC-4.23* Hgb-12.0* Hct-36.6* MCV-87 MCH-28.5 MCHC-32.9 RDW-15.2 Plt Ct-765* [**2188-8-24**] 07:00PM BLOOD Neuts-85.6* Lymphs-6.5* Monos-5.8 Eos-1.1 Baso-0.8 [**2188-8-24**] 07:00PM BLOOD PT-14.2* PTT-27.2 INR(PT)-1.2* [**2188-8-25**] 06:45PM BLOOD ESR-56* [**2188-8-24**] 07:00PM BLOOD Glucose-74 UreaN-12 Creat-0.6 Na-138 K-4.9 Cl-105 HCO3-25 AnGap-13 [**2188-8-25**] 06:45PM BLOOD ALT-19 AST-38 AlkPhos-304* TotBili-0.3 [**2188-8-25**] 06:45PM BLOOD Lipase-31 [**2188-8-25**] 06:45PM BLOOD Albumin-2.1* [**2188-8-25**] 06:45PM BLOOD CRP-188.3* [**2188-8-26**] 02:26AM BLOOD Lactate-4.0* calHCO3-19* . [**2188-9-18**] 07:25AM BLOOD WBC-9.9 RBC-3.36* Hgb-10.2* Hct-31.0* MCV-92 MCH-30.4 MCHC-33.0 RDW-18.1* Plt Ct-596* [**2188-9-13**] 10:00AM BLOOD Neuts-73* Bands-0 Lymphs-16* Monos-7 Eos-3 Baso-1 Atyps-0 Metas-0 Myelos-0 [**2188-9-18**] 07:25AM BLOOD Glucose-78 UreaN-37* Creat-3.4* Na-141 K-4.4 Cl-110* HCO3-22 AnGap-13 [**2188-9-16**] 09:30AM BLOOD ALT-11 AST-37 LD(LDH)-165 AlkPhos-219* TotBili-0.4 [**2188-9-16**] 09:00AM BLOOD CK(CPK)-18* [**2188-9-15**] 04:05AM BLOOD Lipase-20 [**2188-9-16**] 09:00AM BLOOD CK-MB-2 cTropnT-0.03* [**2188-9-18**] 07:25AM BLOOD Calcium-8.3* Phos-4.6* Mg-1.9 [**2188-9-9**] 06:10AM BLOOD CEA-1.4 AFP-2.7 . [**8-23**] CT Abdomen: 1. A longstanding fluid collection adjacent to the right hepatic lobe and the gallbladder persists, and shows mild increase in size since [**Month (only) 205**]. This most likely represents a pseudocyst, though abscess or superinfection cannot be excluded. Note is made of an equivocal communication to the gallbladder/cystic duct. This could be further assessed with HIDA on a nonurgent basis. 2. No additional sites of new or worsening fluid collections. 3. Unchanged appearance to intra- and extra-hepatic biliary ductal dilatation, foci of free air adjacent to the liver and pancreatic head, extensive inflammatory and fibrotic change in the region of pancreatic head along with cavernous circulation transformation of the portal vein, all consistent with changes of prior/chronic pancreatitis. . [**8-27**] MR [**Name13 (STitle) **]: TECHNIQUE: Sagittal T1, T2 STIR and axial T1- and T2-weighted images were obtained through the lumbar spine. Following administration of intravenous contrast, sagittal and axial T1-weighted images were obtained. . FINDINGS: Lumbar vertebrae reveal normal height and signal intensities. There is grade 1 retrolisthesis at L5-S1. The spinal cord terminates at the upper border of L1. Conus medullaris and cauda equina has normal morphology and signal intensities. . At T12-L1, L1-L2, there is no significant disc herniation, spinal canal or neural foraminal narrowing. . At L2-L3, there is mild disc bulge with no significant canal or neural foraminal narrowing. . At L3-L4, there is disc desiccation with diffuse disc bulge, but no significant canal or neural foraminal narrowing. . At L4-L5 there is disc desiccation with diffuse disc bulge and posterior annular tear causing mild narrowing of bilateral neural foramina but no significant nerve root impingement is seen. . At L5-S1 there is grade 1 retrolisthesis with type 2 endplate changes. There is a posterior disc protrusion predominantly to the left of the midline touching the traversing left S1 nerve root. . Post-contrast scans reveal no abnormal enhancement. Subtle signal alteration in bilateral psoas muscles, likely secondary to inflammatory changes in the retroperitoneum. There is no evidence of epidural abscess. . IMPRESSION: 1. Degenerative changes in the lumbar spine, most prominent at L5-S1 where there is grade 1 retrolisthesis with discogenic endplate marrow changes. No evidence of epidural abscess. . 2. Subtle signal alteration in bilateral psoas muscles, likely secondary to inflammatory changes in the retroperitoneum. No drainable collection is seen. . [**2188-8-31**] MRCP: MR ABDOMEN WITH MRCP . CLINICAL HISTORY: A 65-year-old man with history of chronic pancreatitis and several intraabdominal masses, presents with sepsis. Evaluation prior to ERCP. . TECHNIQUE: Multiplanar T1 and T2-weighted images of the abdomen were obtained both pre- and post-administration of 15 cc of gadolinium DTPA. The patient was also given 75 cc of distilled water mixed with 5 cc of gadolinium orally. . A prior CT study of the abdomen and pelvis dated [**2188-8-23**] was available for comparison. . FINDINGS: . LUNG BASES: Lung bases are included and show a small left-sided pleural effusion which is new in comparison with the prior study. . ABDOMEN: The patient is status post splenectomy. Few splenosis nodules are identified in the splenic bed. The liver is normal in size. No focal hepatic lesions are identified. There is persistent moderate dilation of the intra- and extrahepatic biliary system with tapering of the common bile duct at the level of the head of the pancreas. There is also stable persistent dilation of the main pancreatic ducts also tapering within the head of the pancreas. There is stable-appearing inflammation in the head of the pancreas and the duodenal sweep consistent with the patient's known diagnosis of chronic pancreatitis. An air-fluid level is identified in the cystic duct stump. There is also stable mild right-sided hydronephrosis, most likely due to the presence of inflammation adjacent to the right renal pelvis. There is an extensive anasarca in the subcutaneous tissues. Few small renal cysts that are stable are identified in the right kidney measuring up to 10 mm. A small amount of fluid is identified surrounding the pancreatic glands, unchanged in comparison to the prior study. Following administration of contrast material, there is marked cavernous transformation of the portal vein with presence of numerous venous collaterals in the hepatico-duodenal ligament encircling the biliary system. This is not significantly changed from the prior study. . IMPRESSION: . 1. Small new left pleural effusion. . 2. Persistent moderate dilation of the intra- and extrahepatic bile ducts with tapering of the CBD at the level of the pancreatic head, most likely due to combination of the patient's known chronic pancreatitis and peri-biliary varices formation following cavernous transformation of the portal vein. . 3. Status post splenectomy with splenosis nodule in the left upper quadrant. . 4. Moderate dilation of the pancreatic duct which is also tapering in the pancreatic head region due to the patient's known chronic pancreatitis with associated inflammation. . 5. Stable mild right hydronephrosis, also induced by the inflammatory process in the retroperitoneum. . 6. Significant subcutaneous edema. . [**2188-9-6**] RENAL ULTRASOUND: . The right kidney measures 11.5, the left kidney measures 11.2 cm. There is mild right-sided hydronephrosis without evidence of obstructing stones in the kidney or the right ureter; however, CT is more sensitive for assessment of the renal or ureteral stones. . There is no evidence of hydronephrosis or masses of the left kidney. . A Foley catheter is seen in empty urinary bladder. . IMPRESSION: Mild right hydronephrosis, unchanged since [**8-23**], [**2187**]. No evidence of obstructing stones. . [**2188-9-8**] LIVER/BILLIARY HIDA SCAN: . RADIOPHARMACEUTICAL DATA: 4.4 mCi Tc-[**Age over 90 **]m DISIDA ([**2188-9-8**]); HISTORY: perihepatic infected fluid collection . DECISION: gallbladder scan followed by 18 hour delayed scan . INTERPRETATION: Serial images over the abdomen show delay in uptake and excretion of the tracer into the hepatic parenchyma. Activity was seen within the small bowel at 55 minutes and then within the gallbladder at 90 minutes. which is delayed in comparison to normal. . The patient returned the morning following tracer administration and there was intense tracer activity within the large bowel. There was no evidence of a leak. . IMPRESSION: 1. No evidence of biliary leak. 2. Delayed hepatic and gallbladder uptake. . [**2188-9-15**] Abdominal Xray: . A pigtail catheter is seen projected over the right upper quadrant. Biliary stent is present. Gas pattern is normal. I see no evidence of free air. Gas is noted in the biliary tree which is not unexpected given the biliary stent. . IMPRESSION: No evidence of obstruction. . [**2188-9-16**] Abdominal Ultrasound: . FINDINGS: Note is made that this is a very limited ultrasound due to the limited acoustic window. Pneumobilia is seen within the intrahepatic bile ducts. No biliary dilatation is identified. Linear echogenic structures in the right upper quadrant are consistent with the patient's known drainage catheter. The visualization of the prior right upper quadrant collection is very limited, but appears to be partially resolved. . No hydronephrosis is seen on limited views of the kidneys. No fluid collections are seen within the intra-abdominal space. There are edematous soft tissues seen in the subcutaneous space along the left flank. These edematous structures correspond to the patient's area of discomfort. No discrete collection is identified. The portal vein is patent with hepatopetal flow. . IMPRESSION: Edematous soft tissues consistent with cellulitis seen along the left flank in a location that corresponds with the patient's discomfort. No discrete collection identified. . Brief Hospital Course: 65M with chronic pancreatitis, complicated history w/ multiple past intra-abdominal abscesses presented w/ 3 days of severe low back pain, was septic on admission, transferred to the ICU, had IR drainage of perihepatic fluid collection, transferred to the floor on [**8-29**] from the MICU. Had ERCP/biliary stent placed for biliary leak - perihepatic drain still draining bilious fluid, but at decreasing cc/day rate. Now in acute renal failure, but slowly trending downward (Cre 3.4 on discharge). New development of heme+ emesis [**2187-9-15**] w/o corresponding HCT drop, but no other episodes. New left abdominal wall pain/tenderness w/ u/s showing abominal wall soft tissue swelling, but pain/tenderness has since resolved. [**Last Name (un) **] [**1-9**] vancomycin and perhaps due to zosyn as well is now resolving with downtrending Cre. Patient broadly covered on multiple antibiotic regimens and will be discharged on daptomycin, moxifloxacin, and fluconazole. # Sepsis: Patient was hypotensive but responsive to fluid boluses and did not need pressors. Blood culture postive for MRSA. IR guided drainage of perihepatic fluid collection showed polymicrobial infection (+ MRSA and vanc-sensitive enterococcus). TTE showed no vegetations. Lactate originally 4.0, but returned to [**Location 213**] with fluids. Patient originally on zosyn, fluconazole, and daptomycin. Zosyn discharged due to suspicion of causing [**Last Name (un) **] and cipro/flagyl started. Daptomycin stopped and vancomycin started, but then vancomycin stopped as well do to [**First Name9 (NamePattern2) 19040**] [**Last Name (un) **] and suspicion that vancomycin may be contributing factor. At time of discharge, all BCx negative. Will discharge on daptomycin, moxifloxacin, and fluconazole. PICC successfully placed on [**9-18**]. . #Biliary Leak: At time of discharge, continues to drain small amounts bilious fluid from perihepatic drain. ERCP showed no biliary leak or strictures but stent was placed and will need to be removed AFTER surgery evals as outpatient. HIDA scan ([**9-9**]) was noncontributory and did not show an active leak. Fluid cc/day has recently decreased markedly since original placement and only ~ 5 - 10 cc/day at time of discharge. . # Back pain: Likely musculoskeletal, no abcess on MRI but a lot of DJD and retrolisthesis at L5-S1. Pain controlled on prn oxyxcodone and daily lidocaine patch. . # Chronic pancreatitis: no signs of acute flare at this time. Home pancrease replacement meds as per outpatient regimen. . # CAD s/p MI: last echo in [**1-/2188**] shows normal EF (>55%), no suggestion that there is a cardiogenic component to his hypotension. TTE ECHO here showed EF >55%, normal valves except "trivial" MR. [**Name13 (STitle) **] signs of vegetations or abscesses, home ASA regimen continued. . # Cirrhosis vs. Fatty Liver Disease: RUQ US and CT in [**2186**] shows echogenicity c/w cirrhosis vs. fatty liver disease. Very low concern for HRS given this picture. . #Left abdominal wall tenderness: patient has tenderness to minimal palpation of left lower quadrant onto left flank on [**9-16**]. Pain has since resolved. Abdominal u/s shows soft tissue edema of left abdominal wall that was concerning for cellulitis, but there are no clinically correlated signs or symptoms. Patient is being covered for gram (+) with daptomycin. . #Acute renal failure: Unclear etiology of this acute kidney injury but our suspicion is secondary to zosyn. Then, patient was found to have supratherapeutic levels of vancomycin which may represent a second insult to this patient's kidneys. Cre peaked at 4.8 and now downtrending. 3.4 at time of discharge. During the admission, patient's potassium was intermittently elevated in the setting of [**Last Name (un) **]. K+ peaked at 6.3. Kayexalate brought potassium into normal limits. Since Cre has been downtrending, patient has not required the use of kayexalate. He has been maintained on a low potassium diet of less than 1 mEq of potassium daily. . # Heme+ coffee ground emesis. On [**9-13**], patient had heme positive emesis with no other symptoms except for some nausea. This episode resolved spontaneously and there have been no repeat episodes or concerning signs/symptoms since. . Medications on Admission: FLUCONAZOLE - 200 mg Tablet - 1 Tablet(s) by mouth daily FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth Monday/Wednesday/Friday HYDROMORPHONE - 2 mg Tablet - 1 Tablet(s) by mouth every 8 hours Do not drive while taking this medication. LEVOTHYROXINE - 25 mcg Tablet - 1 Tablet(s) by mouth qday LIPASE-PROTEASE-AMYLASE [CREON] - 24,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000 unit Capsule, Delayed Release(E.C.) - 2 Capsule(s) by mouth with meals 1 capsule with snac - No Substitution METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth every 6 hours as needed for nausea MOXIFLOXACIN [AVELOX] - 400 mg Tablet - 1 Tablet(s) by mouth qdaily OMEPRAZOLE - (Prescribed by Other Provider) - 40 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth daily SODIUM POLYSTYRENE SULFONATE [KAYEXALATE] - Powder - 30Gm dose by mouth once as directed as needed for then call for instructions CVS will dispense the suspension; 15Gm/60mL TAMSULOSIN - 0.4 mg Capsule, Ext Release 24 hr - 1 Capsule(s) by mouth daily TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime as needed for insomnia ASPIRIN [ASPERDRINK] - 81 mg Tablet, Effervescent - 1 Tablet(s) by mouth daily CHOLECALCIFEROL (VITAMIN D3) - 1,000 unit Capsule - 1 Capsule(s) by mouth daily DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a day MICONAZOLE NITRATE [MICRO-GUARD] - 2 % Powder - please place along wound area three times a day as needed for moisture accumulation MULTIVITAMIN WITH MINERALS - (Prescribed by Other Provider) - Tablet - 1 Tablet(s) by mouth daily Discharge Medications: 1. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. lipase-protease-amylase 5,000-17,000 -27,000 unit Capsule, Delayed Release(E.C.) Sig: Two (2) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*180 Cap(s)* Refills:*2* 3. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed for moisture accumulation. Disp:*90 applications* Refills:*0* 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 5. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): 12 hours on; 12 hours off. Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2* 6. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day) as needed for pain: Do not give more than 2 grams within any 24 hour window. Disp:*120 Tablet(s)* Refills:*0* 7. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*180 Tablet(s)* Refills:*2* 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. Disp:*60 Capsule(s)* Refills:*0* 9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*60 Tablet(s)* Refills:*0* 10. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 11. daptomycin 500 mg Recon Soln Sig: Four Hundred (400) mg Intravenous Q48H (every 48 hours). Disp:*6000 mg* Refills:*2* 12. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 13. moxifloxacin 400 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 14. fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Sepsis due to MRSA bacteremia Perihepatic fluid collection Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname **], . We appreciated the opportunity to participate in your care at [**Hospital1 18**]. . You were admitted for an infection of your bloodstream with a bacteria called MRSA. We also found that you had a large collection of fluid near your liver which was also infected with MRSA and another bacteria called enterococcus. Antibiotics were started to treat the infection, and a drain was placed in the fluid collection. Because the fluid collection contained bile, you underwent a procedure called an ERCP to place a stent in your bile ducts to help relieve possible pressure in the ducts that might have contributed to the leaking bile. While you still a very small amount of bile leaking from the drain, this has slowed considerably since your admission. You have an upcoming appointment with your surgeon, Dr. [**Last Name (STitle) 468**]. At this appointment, it will be determined if the drain can be removed or not. In the meantime, we would like you to keep a record of how much fluid collects in the drain each day. Also make a daily note of what that fluid looks like. . During your admission, you also suffered an injury to your kidneys. This may have been due to an antibiotic you were getting called vancomycin. You are no longer on vancomycin and you should avoid taking vancomycin in the future. Your kidneys have not completely returned to their previous level of functioning, but we are hopeful that they will heal on their own with some time. Your doctors [**Name5 (PTitle) **] [**Name5 (PTitle) 4169**] a blood test called Creatinine to see how they are functioning. Until they have returned to [**Location 213**], you should maintain a low potassium diet and try not to become dehydrated by drinking plenty of fluids. . You are being sent home on daptomycin, fluconazole, and moxifloxacin which you will need to take indefinitely until your infectious disease doctor thinks it is safe for you to come off these medications. We have made arrangements for your rehab facillity to help manage and administer these antibiotics until your course is complete. . START taking the following medications: - Daptomycin 400mg IV every 48 hours. This dose will be adjusted as your renal function gets better. - Sevelemer three times a day with meals - You may place a lidocaine patch once daily on any area where you are having pain . STOP taking the following medications: - Vancomycin - Lasix (furosamide), the doctors at rehab [**Name5 (PTitle) **] restart this when your kidney function is better. - hydromorphone (Dilaudid), ask the rehab doctors if [**Name5 (PTitle) **] need additional pain medicine - metrochlopramide (Reglan), please alert the doctors if [**Name5 (PTitle) **] are having nausea . Followup Instructions: Department: RADIOLOGY When: MONDAY [**2188-9-29**] at 9:00 AM With: CAT SCAN [**Telephone/Fax (1) 327**] Building: [**Hospital6 29**] [**Location (un) 861**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Department: SURGICAL SPECIALTIES When: MONDAY [**2188-9-29**] at 10:30 AM With: [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 2835**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Department: INFECTIOUS DISEASE When: WEDNESDAY [**2188-10-8**] at 9:30 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13896**], MD [**Telephone/Fax (1) 457**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Hospital 1422**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Completed by:[**2188-9-21**]

038,567,518,348,584,577,591,560,578,041,995,571,721,414,562,300,244,268,576,600,276,611,285,412,401,V125,V498,E930

{'Methicillin resistant Staphylococcus aureus septicemia,Peritoneal abscess,Acute respiratory failure,Encephalopathy, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic pancreatitis,Hydronephrosis,Paralytic ileus,Hematemesis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Severe sepsis,Cirrhosis of liver without mention of alcohol,Lumbosacral spondylosis without myelopathy,Coronary atherosclerosis of native coronary artery,Diverticulosis of colon (without mention of hemorrhage),Anxiety state, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Other specified disorders of biliary tract,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyperpotassemia,Hypertrophy of breast,Anemia, unspecified,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Do not resuscitate status,Penicillins 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: Fevers, low blood pressure, abdominal pain PRESENT ILLNESS: 65M with chronic pancreatitis, several intra-abdominal abscesses p/w with 3 d of severe low back pain. Patient has been to ED 3 times in the past 3 days with no resolution of symptoms. He reports that he can not move or walk due to the pain, worst with standing up, no radiation. He spoke with his PCP today, who was concerned about osteomyelitis given low back pain with history of intraabdominal abscesses and elevated white count. He recommended he come to the ED for evaluation. . In the ED, initial VS were: 98.1 79 100/64 20. Physical exam showed tenderness to palpation adjacent to spine. Labs were remarkable for elevated alk phos and WBC 14.2. He was given hydromorphone 2mg po q8h for pain control and started on IV vancomycin and ceftriaxone, no blood cultures were drawn prior. No imaging obtained in the ED. Admitted to medicine for evaluation of osteomyelitis. Vitals prior to transfer were 98.4 87 116/83 16 95% room air. . On arrival to the floor, the patient was found to be hypotensive to the 70s sytolic, tachycardic to the 130s, febrile to 102. He was given 3L NS, blood cultures were drawn. Labs were redrawn and WBC had risen to 25.5 (from 14.2 6h earlier), lactate 4.0. Given daptomycin to cover VRE, given his hx of VRE bacteremia in the past. He was transfered to the MICU for sepsis. . On arrival to the MICU, he is lying in bed complaining of pain in his back but otherwise doing well. Awake and interactive, able to give the HPI. MEDICAL HISTORY: 1. Multiple polymicrobial fluid collections, status post multiple drain procedures over the past several years. Most recently MRSA in new L flank abscess in [**2188-6-6**], past h/o psoas abscess, retroperitoneal abscess, enterocutaneous fistula. 2. Ventral hernia repair complicated by severe pancreatitis, leading to a nearly yearlong hospitalization starting [**2185-4-7**] at [**Hospital6 10353**] and at the [**Hospital1 2177**] to rehabilitation ending [**2186-1-8**]. 3. Pancreatic mass per GI notes. Endoscopic ultrasound performed twice, most recently [**2187-1-8**] showing 2 x 3 cm ill-defined mass to the pancreas. FNA was performed. No malignancy was found. 4. CAD status post MI [**2185**] 5. Diverticulosis. 6. Anxiety. 7. Hypothyroidism. 8. Hypertension. 9. Lower extremity DVT status post IVC filter ([**2185**] or [**2186**]) 10. Portal vein thrombosis. 11. Status post fundoplication 16 plus years ago complicated by splenic injury requiring splenectomy. 12. BPH. 13. Vitamin D deficiency. 14. Abnormal LFTs intermittently, most recently thought due to Augmentin. 15. Gynecomastia. 16. Cirrhosis - dx in [**2186**] MEDICATION ON ADMISSION: FLUCONAZOLE - 200 mg Tablet - 1 Tablet(s) by mouth daily FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth Monday/Wednesday/Friday HYDROMORPHONE - 2 mg Tablet - 1 Tablet(s) by mouth every 8 hours Do not drive while taking this medication. LEVOTHYROXINE - 25 mcg Tablet - 1 Tablet(s) by mouth qday LIPASE-PROTEASE-AMYLASE [CREON] - 24,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000 unit Capsule, Delayed Release(E.C.) - 2 Capsule(s) by mouth with meals 1 capsule with snac - No Substitution METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth every 6 hours as needed for nausea MOXIFLOXACIN [AVELOX] - 400 mg Tablet - 1 Tablet(s) by mouth qdaily OMEPRAZOLE - (Prescribed by Other Provider) - 40 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth daily SODIUM POLYSTYRENE SULFONATE [KAYEXALATE] - Powder - 30Gm dose by mouth once as directed as needed for then call for instructions CVS will dispense the suspension; 15Gm/60mL TAMSULOSIN - 0.4 mg Capsule, Ext Release 24 hr - 1 Capsule(s) by mouth daily TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime as needed for insomnia ASPIRIN [ASPERDRINK] - 81 mg Tablet, Effervescent - 1 Tablet(s) by mouth daily CHOLECALCIFEROL (VITAMIN D3) - 1,000 unit Capsule - 1 Capsule(s) by mouth daily DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a day MICONAZOLE NITRATE [MICRO-GUARD] - 2 % Powder - please place along wound area three times a day as needed for moisture accumulation MULTIVITAMIN WITH MINERALS - (Prescribed by Other Provider) - Tablet - 1 Tablet(s) by mouth daily ALLERGIES: Clotrimazole / Augmentin PHYSICAL EXAM: On Admission: Vitals: T: 96.7 BP: 97/66 P: 99 R: 18 O2: 98% on 3L General: Alert, oriented to place and situation but not time. In no acute distress unless being turned/moved (severe pain) HEENT: PERRL, sclera anicteric, dry mucous membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: diminished breath sounds in bases bilaterally, no wheezes, rales, ronchi Abdomen: BS+, distended, caput medusa seen, soft, moderately tender to palpation of RUQ and left flank. Protrusion seen below ribs on right side. Some voluntary guarding, but no rebound GU: foley draining clear yellow urine Back: pain to palpation of spine at L3-L5 levels, no paraspinous tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNs II-[**Doctor First Name 81**] intact, strength 4+/5 and symmetric in UE, stength [**2-9**] in hip flexors and [**3-11**] knee extensors, [**4-10**] in other LE muscle groups. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives in [**Location (un) 7913**] with [**Doctor First Name 1258**] his wife. [**Name (NI) **] is unemployed. - Tobacco: smoked <1 PPD for 1 year in the past - Alcohol: denies - Illicits: denies ### Response: {'Methicillin resistant Staphylococcus aureus septicemia,Peritoneal abscess,Acute respiratory failure,Encephalopathy, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic pancreatitis,Hydronephrosis,Paralytic ileus,Hematemesis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Severe sepsis,Cirrhosis of liver without mention of alcohol,Lumbosacral spondylosis without myelopathy,Coronary atherosclerosis of native coronary artery,Diverticulosis of colon (without mention of hemorrhage),Anxiety state, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Other specified disorders of biliary tract,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Hyperpotassemia,Hypertrophy of breast,Anemia, unspecified,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Do not resuscitate status,Penicillins causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 50 year old male with history of HPV and HCC who presents for liver transplantation. The patient underwent EXLAP [**6-/2116**] for his HCC and at that time was unresectable. He then underwent chemo-embolization/RFA, which significantly reduced the tumor. The patient is currently a good transplant candidate. Interpreter was present for both history on [**2117-9-4**] and on [**2117-9-13**]. All the history from [**2117-9-4**] has not changed. The patient currently has no fevers, chills, nausea, vomiting, and no abdominal pain. The last time the patient ate on [**2117-9-13**] was at 7:00 am. MEDICAL HISTORY: HPV, HCC, post-traumatic stress disorder/depression, question alcohol abuse, quit five years ago. MEDICATION ON ADMISSION: Wellbutrin 75 mg once a day Amitriptyline 75 mg q.day Epivir 150 mg q.day ALLERGIES: Motrin, which gives him hives. PHYSICAL EXAM: FAMILY HISTORY: Patient has six daughters, alive and healthy, seven siblings, healthy until killed in [**Country 3992**] War. SOCIAL HISTORY: Married times 30 years. History of tobacco, quit 10 years ago. History of alcohol abuse, quit 5 years ago. No I.V. drug abuse.

Malignant neoplasm of intrahepatic bile ducts,Cirrhosis of liver without mention of alcohol,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Atrial fibrillation,Posttraumatic stress disorder

Mal neo intrahepat ducts,Cirrhosis of liver NOS,Hpt B chrn wo cm wo dlta,Atrial fibrillation,Posttraumatic stress dis

Admission Date: [**2117-9-13**] Discharge Date: [**2117-9-22**] Date of Birth: [**2067-11-26**] Sex: M Service: [**Last Name (un) **] ADMITTING DIAGNOSES: Post necrotic cirrhosis, awaiting liver transplant. HISTORY OF PRESENT ILLNESS: The patient is a 50 year old male with history of HPV and HCC who presents for liver transplantation. The patient underwent EXLAP [**6-/2116**] for his HCC and at that time was unresectable. He then underwent chemo-embolization/RFA, which significantly reduced the tumor. The patient is currently a good transplant candidate. Interpreter was present for both history on [**2117-9-4**] and on [**2117-9-13**]. All the history from [**2117-9-4**] has not changed. The patient currently has no fevers, chills, nausea, vomiting, and no abdominal pain. The last time the patient ate on [**2117-9-13**] was at 7:00 am. PAST MEDICAL HISTORY: HPV, HCC, post-traumatic stress disorder/depression, question alcohol abuse, quit five years ago. PAST SURGICAL HISTORY: EXLAP, [**6-/2116**] for liver biopsy of tumor. Left upper extremity war wound. Status post chemo- embolization/RFA in [**2106**]. ALLERGIES: Motrin, which gives him hives. MEDICATIONS ON ADMISSION: Wellbutrin 75 mg once a day Amitriptyline 75 mg q.day Epivir 150 mg q.day SOCIAL HISTORY: Married times 30 years. History of tobacco, quit 10 years ago. History of alcohol abuse, quit 5 years ago. No I.V. drug abuse. FAMILY HISTORY: Patient has six daughters, alive and healthy, seven siblings, healthy until killed in [**Country 3992**] War. PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 99.4, blood pressure 146/90, heart rate 90, respirations 20, 90 percent on room air, weight 77.3. GENERAL: In no acute distress well-appearing male. HEENT: Atraumatic, normocephalic. Pupils are equal, round, react to light. EOMs are full. Mouth: Poor dentition. Tongue midline. No exudates. NECK: Supple. No palpable nodes. No thyromegaly. No carotid bruits. Lungs clear to auscultation and percussion bilaterally. CV: Regular rate and rhythm. Normal S1 and S2 without murmurs or rubs. ABDOMEN: Well-healed abdominal scar, slightly distended but soft. Positive bowel sounds, nontender. Slight left upper quadrant tenderness. No rebound. EXTREMITIES: No C/C/E. Left upper extremity deformity secondary to injury. NEURO: Awake, alert, oriented times three. Cranial nerves II - XII intact. Motor in upper extremity 5 out of 5 bilaterally, no drift. LABORATORY DATA: [**2117-9-13**]: WBC 5.8, hematocrit of 44.7, platelets 200, sodium 140, 4.2, 104, 27, BUN/creatinine 13 and 1.0. Platelets 108. ALT 40, AST 26, alk phos 64, serum bili 0.6, PT 12.9, PTT 22.7, INR 1.1. EKG: Normal sinus rhythm. No ST wave changes. Chest x-ray from [**9-13**]: Lungs clear, no infiltrate. The patient was typed and crossed for 10 units of FFP, packed red blood cells, cryo, and platelets. The patient was currently NPO, pre-meds ordered, consent on the chart. Reviewed information with Dr. [**First Name8 (NamePattern2) 3825**] [**Last Name (NamePattern1) 3826**]. Patient went to surgery on [**9-13**]/;[**2116**] with preoperative diagnosis of chronic Hep B and hepatoma, the suture, backtable bench of a deceased donor liver performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Please see detailed note regarding surgery. Also the patient had a piggyback cadaveric liver transplant, portal vein to portal vein anastomosis, common hepatic artery to hepatic artery branch patch anastomosis, bile duct to bile duct, performed by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 816**]. Again, please see detailed surgery note for more information. Postoperatively, the patient went to the SICU. The patient received ganciclovir, Hep B immunoglobulin, lamivudine was started. Methylprednisone, Bactrim and Unasyn were started. Morphine sulfate was started for pain management. Duplex ultrasound of the liver was obtained on [**2117-9-14**], demonstrating normal son[**Name (NI) 493**] appearance of the liver and hepatic duct. Flow in hepatic veins is normal. Portal vein is hepatopetal with peak velocity approximately 20 cm/second. The main hepatic artery demonstrates brisk upstroke with a resistive index of 0.46; similar brisk upstroke is seen on the left and right hepatic arteries. On the postoperative day, the patient was intubated, sedated. The patient had two JPs, a T-tube. The patient was extubated on [**2117-9-15**], continued on Neomycin, Bactrim, lamivudine, Valcyte, ganciclovir. Right IJ was placed postoperatively and chest x- ray confirmed placement, demonstrating bilateral effusions, no pneumothorax. On [**2117-9-16**], cardiology was consulted for Afib, suggested rate control with Lopressor, aspirin as necessary, if surgically accepted. It was demonstrated that platelets were slightly low at 67. Blood tests were sent off, which were unremarkable. Patient was transferred from SICU to FAR-10 on [**2117-9-17**]. While in the ICU, one of the JPs were removed, [**9-21**] T-tube to drainage and another JP drain. PT and OT were consulted. Continued to be afebrile, vital signs stable. Continued on SK 0.2, MMF, Solu-Medrol, prednisone was started 20 mg q.day on [**2117-9-19**]. Foley was removed on [**2117-9-19**]. Cholangiogram was obtained on [**2117-9-18**], demonstrating no intra- or extrahepatic biliary dilatations, narrowing of the common duct, T-tube insertion. Pre-contrast to the extrahepatic duct into small bowel. Since surgery, all his LFTs have been dropping slowly except for the alk phos which slowly increased. On [**2117-9-15**], ALT was 697, AST 473, alk phos 56, total bili 0.5. On [**2117-9-20**], ALT was 298, AST 74, alk phos 206, total bili 1.2. Of note, when cardiology was consulted, troponins were obtained and on [**2117-9-15**], troponin was 0.025 and on [**2117-9-16**], troponin was 0.02, and on [**2117-9-16**] the troponin was less than 0.01, which would rule out patient having myocardial infarction. On [**2117-9-20**], T-tube was capped. The patient had stool cultures sent off for C-diff on [**2117-9-19**], [**2117-9-21**], because loose/borderline diarrhea, which demonstrated that both of those cultures were negative. On [**2117-9-20**], hepatology was consulted, had recommended DC-ing lamivudine, instead put patient on adefovir 10 mg q.day. On [**2117-9-20**], the patient did receive another dose of Hep-_____ and prior to receiving the dose, quantitative HPV of antigen and antibody was obtained. On [**2117-9-20**], quantitative hepatitis antigen was negative and quantitative hepatitis antibody was positive, greater than 150 miu/ml. The patient continues to do well with no complaints, ambulating a regular diet, awaiting medication teaching. Continues to be afebrile. Vital signs stable. Good I&Os. Labs on [**2117-9-22**] are the following: WBC 10.8, hematocrit of 36.3, platelets 62, sodium 135, 4.4, chloride 100, bicarb 22, BUN/creatinine of 31, 1.0, with glucose 154, ALT 220, AST 36, alk phos 199, total bili 0.9. FT level on Herpsera was 11.8. The patient is going to be going home tomorrow with services after patient has been taught how to administer insulin. The patient will be going home on the following medications. DISCHARGE MEDICATIONS: Tylenol 325 to 650 mg p.r.n. Dulcolax 10 mg q.h.s. p.r.n. Fluconazole 400 mg q.24 Hepsera 10 mg q.day Lopressor 75 mg b.i.d. MMS 500 q.i.d. Oxycodone 4 mg q.4-6 hours p.r.n. Prednisone 20 mg q.day. Bactrim SS one tab q.day Regular insulin, sliding scale, fingersticks q.i.d. Prevacid 30 mg q.day. Tacrolimus 4 mg b.i.d. Ganciclovir 900 mg q.day. The patient is to follow up with Dr. [**Last Name (STitle) 497**] on [**2117-9-24**] at 11:00 a.m. Telephone number is [**Telephone/Fax (1) 2422**]. Also please arrange an appointment with [**Doctor First Name 2398**], who is the coordinator, for followup appointment next week, [**Telephone/Fax (1) 673**], if [**Doctor First Name 2398**] has not made an appointment for patient. Please make sure that patient has an interpreter for followup appointment. Also please instruct the patient that he should call [**Telephone/Fax (1) 30335**] if any fevers, chills, nausea, vomiting, inability to take medications, abdominal pain, jaundice, lethargy, lower extremity edema or any problems drinking or taking any foods by mouth. The patient should have labs every Monday and Thursday for CBC, chem-10, AST, ALT, alk phos, total bili, albumin and a Prograf trough level. The results of those lab tests should be faxed to the [**Hospital1 18**] Transplant Office, at [**Telephone/Fax (1) 21087**]. The patient should not be driving while taking pain medications. The patient may shower, no heavy lifting. Discharge is to home with services. FINAL DIAGNOSES: Hepatitis B and hepatocellular carcinoma, status post liver transplant [**2117-9-13**]. DISCHARGE CONDITION: Stable. [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 4841**] Dictated By:[**Last Name (NamePattern1) 4835**] MEDQUIST36 D: [**2117-9-22**] 19:51:40 T: [**2117-9-22**] 23:06:13 Job#: [**Job Number 53815**]

155,571,070,427,309

{'Malignant neoplasm of intrahepatic bile ducts,Cirrhosis of liver without mention of alcohol,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Atrial fibrillation,Posttraumatic stress 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 50 year old male with history of HPV and HCC who presents for liver transplantation. The patient underwent EXLAP [**6-/2116**] for his HCC and at that time was unresectable. He then underwent chemo-embolization/RFA, which significantly reduced the tumor. The patient is currently a good transplant candidate. Interpreter was present for both history on [**2117-9-4**] and on [**2117-9-13**]. All the history from [**2117-9-4**] has not changed. The patient currently has no fevers, chills, nausea, vomiting, and no abdominal pain. The last time the patient ate on [**2117-9-13**] was at 7:00 am. MEDICAL HISTORY: HPV, HCC, post-traumatic stress disorder/depression, question alcohol abuse, quit five years ago. MEDICATION ON ADMISSION: Wellbutrin 75 mg once a day Amitriptyline 75 mg q.day Epivir 150 mg q.day ALLERGIES: Motrin, which gives him hives. PHYSICAL EXAM: FAMILY HISTORY: Patient has six daughters, alive and healthy, seven siblings, healthy until killed in [**Country 3992**] War. SOCIAL HISTORY: Married times 30 years. History of tobacco, quit 10 years ago. History of alcohol abuse, quit 5 years ago. No I.V. drug abuse. ### Response: {'Malignant neoplasm of intrahepatic bile ducts,Cirrhosis of liver without mention of alcohol,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Atrial fibrillation,Posttraumatic stress disorder'}

CHIEF COMPLAINT: abdominal pains PRESENT ILLNESS: Mr. [**Known lastname 487**] is a 54yo M with PMH s/f cocaine abuse, ETOH-ism, and tobacco use who presents with acute on chronic abdominal pains. MEDICAL HISTORY: -ETOH abuse (states last drink 3 months ago) -chronic abdominal pains -crack cocaine use /last used yesturday (using 2x week) -s/p CCY -s/p appendectomy -told his liver was "enlarged" in past -smoking tobacco . MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.7F, BP=100/66, HR=84,RR=20, O2=97% RA PHYSICAL EXAM GENERAL: Pleasant, thin appearing male in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: RRR, Normal S1/S2. No murmurs, rubs or [**Last Name (un) 549**]. JVP=8cm FAMILY HISTORY: Mother died of lung CA, no GI cancers in family and no other GI diseases per patient. SOCIAL HISTORY: He is currently collecting unemployment and he lives in [**Location 2251**] with his daughter. [**Name (NI) **] smokes about 1PPD x 32 years. Drinking 8 beers a day until 3 months ago and using crack cocaine 2x week.

Neoplasm of unspecified nature of digestive system,Acute pancreatitis,Blood in stool,Cocaine dependence, continuous,Phlebitis and thrombophlebitis of deep veins of upper extremities,Hemangioma of intra-abdominal structures,Iron deficiency anemia, unspecified,Acquired spondylolisthesis,Tobacco use disorder,Barrett's esophagus,Benign neoplasm of rectum and anal canal,Other and unspecified alcohol dependence, unspecified

Digestive neoplasm NOS,Acute pancreatitis,Blood in stool,Cocaine depend-contin,Phlbts deep vn up extrm,Hemangioma intra-abdom,Iron defic anemia NOS,Acq spondylolisthesis,Tobacco use disorder,Barrett's esophagus,Benign neopl rectum/anus,Alcoh dep NEC/NOS-unspec

Admission Date: [**2125-12-6**] Discharge Date: [**2125-12-19**] Date of Birth: [**2071-1-20**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 800**] Chief Complaint: abdominal pains Major Surgical or Invasive Procedure: EGD with biosy Colonoscopy with polypectomy ERCP with FNA of pancreatic mass History of Present Illness: Mr. [**Known lastname 487**] is a 54yo M with PMH s/f cocaine abuse, ETOH-ism, and tobacco use who presents with acute on chronic abdominal pains. He describes his abdominal pain as being worse with eating and his pain is worse around epigastric region with radiatiion towards back and lower left chest at times. He reports 1 week of "black-ish" and dark stools and a few drops of BRB in toilet 2 days ago after BM. last BM was this morning. No recent diarrhea, no hematemesis or overt melena. Minimal intermittent nausea but no emesis. He explains that he has been seen at [**Hospital1 2025**] multiple times in past for similar abdominal pains over last year but only given Maalox with limited workup. Never had an EGD or colonscopy. In terms of his polysubstance abuse issues, he states he stopped using alcohol 3 months ago but last used crack cocaine yesturday (using 2x week). . Initial vitals in ED were: T 98.9F, BP 132/45, HR 109, RR 16 and O2 sats 100% RA. On rectal exam he was guaiac positive with Hct of 25.5 (unknown baseline) and elvated lipase 161. GI fellow was consulted from ED and advised admission with IV PPI, CT abdomen and IVFs with plan for a.m. GI consult follow-up as well. Prelim read of abdominal CT showed pancreatitic duct dilitation/stranding and multiple liver lesions. In ED he was given IV pantoprazole 40mg, 2L NS IVFs, 4mg IV morphine, IVFs and kept NPO. . Vitals on transfer to floor were: 98F, BP 132/88, HR 92, RR 18, sat 98% RA. On arrival to medical floor he appeared to be in no apparent distress but complaining of poor appetite and limited PO over last 2 days which has left him feeling "empty". . Past Medical History: -ETOH abuse (states last drink 3 months ago) -chronic abdominal pains -crack cocaine use /last used yesturday (using 2x week) -s/p CCY -s/p appendectomy -told his liver was "enlarged" in past -smoking tobacco . Social History: He is currently collecting unemployment and he lives in [**Location 2251**] with his daughter. [**Name (NI) **] smokes about 1PPD x 32 years. Drinking 8 beers a day until 3 months ago and using crack cocaine 2x week. Family History: Mother died of lung CA, no GI cancers in family and no other GI diseases per patient. Physical Exam: 97.7F, BP=100/66, HR=84,RR=20, O2=97% RA PHYSICAL EXAM GENERAL: Pleasant, thin appearing male in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: RRR, Normal S1/S2. No murmurs, rubs or [**Last Name (un) 549**]. JVP=8cm LUNGS: CTA at mid and upper lung fields but scattered wheezes at bases. . ABDOMEN: + TTP at umbilical area/epigastic region, NABS, Soft, ND, liver edge right at lower costal margin. No overt splenomegaly noted. No rebound. 2 well healed scars from appy and CCY. EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. SKIN: No rashes/lesions, ecchymoses. Multiple dysplastic appearing nevi over back and shoulders. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**1-5**]+ reflexes, equal BL. Normal coordination. Gait assessment WNL . Pertinent Results: Admit Labs: [**2125-12-6**] 08:00PM BLOOD WBC-9.8 RBC-2.92* Hgb-8.5* Hct-25.5* MCV-87 MCH-28.9 MCHC-33.2 RDW-13.5 Plt Ct-522* [**2125-12-6**] 08:00PM BLOOD WBC-9.8 RBC-2.92* Hgb-8.5* Hct-25.5* MCV-87 MCH-28.9 MCHC-33.2 RDW-13.5 Plt Ct-522* [**2125-12-6**] 08:00PM BLOOD PT-11.1 PTT-25.1 INR(PT)-0.9 [**2125-12-6**] 08:00PM BLOOD Glucose-108* UreaN-20 Creat-0.8 Na-138 K-4.3 Cl-101 HCO3-23 AnGap-18 [**2125-12-6**] 08:00PM BLOOD ALT-27 AST-21 TotBili-0.2 [**2125-12-6**] 08:00PM BLOOD Lipase-161* [**2125-12-6**] 08:00PM BLOOD Calcium-9.4 Phos-5.0* Mg-2.2 [**2125-12-7**] 07:15AM BLOOD calTIBC-304 VitB12-293 Folate-10.3 Ferritn-13* TRF-234 [**2125-12-7**] 07:15AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2125-12-12**] 07:10AM BLOOD CA [**35**]-9 -Test 1314 H . CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST [**2125-12-6**]: Visualized portion of the cardiac apex and lung bases are clear. The stomach, duodenum, spleen, adrenal glands are unremarkable. The kidneys enhance and excrete contrast in a symmetric fashion and are also notable for bilateral hypodensities, the largest of which is in the left upper pole and consistent with a simple cyst, others of which are too small to characterize. The pancreas is notable for diffuse ductal dilation, measuring approximately 6 mm on this single phase of contrast, there is no definite pancreatic mass and equivocal stranding adjacent to the pancreatic head. The liver contains a heterogeneous area of relative [**Name (NI) 39862**] near the dome in the left lobe which measures in total approximately 23 x 15 mm, possibly a hemangioma. A similar right lobe lesion (2:29) also is likely a hemangioma. In addition,there are numerous hypodense lesions seen throughout the right lobe. No intrahepatic biliary dilatation noted. Regional vascular structures are notable for scattered atherosclerotic calcification of the aorta, in the absence of aneurysmal dilation. Scattered prominent nodes are visualized including a node interposed between the aorta and IVC measuring 9 mm in shortest cross-sectional diameter. A portacaval node is also borderline measuring 9 mm in shortest cross-sectional diameter. There is no free gas or fluid in the abdomen. CT PELVIS WITH CONTRAST: The urinary bladder, distal ureters, prostate, seminal vesicles, rectum and colon are unremarkable. There is no free gas or fluid in the pelvis and there is no pelvic sidewall lymphadenopathy. OSSEOUS FINDINGS: There is no suspicious sclerotic or lytic osseous lesion. There is bilateral spondylolysis with spondylolisthesis of L5 over S1, measuring approximately 8 mm. IMPRESSION: 1. Pancreatic ductal dilation and minimal peripancreatic stranding. In addition there are numerous hypodense hepatic lesions and borderline adjacent lymph nodes. Overall, this is nonspecific. Considerations include focal pancreatic head pancreatitis, in which the case the hepatic lesions are incidental. Alternatively a pancreatic head mass may be occult with metastatic hepatic lesions. Correlation to history and laboratory values is recommended and an MRI would best evaluate the hepatic lesions and the etiology of the pancreatic ductal dilation. 2. Bilateral spondylolysis and spondylolisthesis of L5. . MR 3D RENDERING W/POST PROCESSING ON INDEPENDENT WS [**2125-12-10**]: 1. Diffuse distal pancreatic ductal dilatation with segmental stricture in the pancreatic head, surrounded by abnormal pancreatic tissue, could represent focal mass-like changes from prior pancreatitis or neoplasm such as pancreatic adenocarcinoma. Tiny intraluminal air pocket, unchanged from prior CT, of unclear etiology, possibly from prior ERCP, though none is documented in OMR. Recommend ERCP to evaluate this focal pancreatic ductal stricture and to obtain brush samples. 2. Two subcentimeter pancreatic cystic lesions, one in the head and the other in the tail. 3. Hepatic hemangiomas and cysts as described above. No suspicious hepatic lesions. Mild intrahepatic ductal dilatation. Status post cholecystectomy. 4. 9-mm left adrenal nodule, incompletely assessed, but possibly an adrenal adenoma. . UNILAT UP EXT VEINS US LEFT [**2125-12-10**]: Acute thrombus in the left radial vein, not propagating to the deep veins of the left upper extremity. . Pathology [**2125-12-11**]: Sigmoid colon polyp #1, biopsy (A): Adenoma. Sigmoid colon polyp #2, biopsy (B): Hyperplastic polyp. Sigmoid colon, thickened fold, biopsy (C): Colonic mucosa with no diagnostic abnormality (see note). Gastroesophageal junction, biopsy (D): - Cardia-type mucosa with intestinal metaplasia, consistent with Barrett's esophagus; no dysplasia identified. - No squamous epithelium present. Duodenum, second part, biopsy (E): Scant superficial fragments of small intestinal mucosa with no diagnostic abnormality (see note). . CTA ABD W&W/O C & RECONS [**2125-12-13**]: Pancreatic Tumor Table: I: Pancreatic tumor present: Possible yes. a) Location: Head. b) Size: 18 x 20 mm. c) Enhancement relative to pancreas: Hypo. d) Confined to pancreas with clear fat planes (duodenum and IVC do not apply): Yes. e) Remaining pancreas: Atrophic with a dilated duct. II. Adenopathy present: Yes. a) Size and location of largest lymph node: Portocaval measuring 17 x 23 mm b) Necrosis in lymph nodes: Yes. c) Size of gastroduodenal artery node, "node of importance": Not present III. Metastatic disease, definitely present: Possibly although an ultrasound is recommended to evaluate possible metastasis within the liver. IV: Ascites/peripancreatic fluid: Yes. Pancreatic Vascular Table I: Vascular Tumor Involvement: No. a) Celiac involvement: No. b) SMA involvement: No. c) SMV involvement and percent encasement: No. d) Less than 1 cm SMV between tumor and first major SMV branch: No. e) Portal vein involvement: No. g) Splenic vein involvement: No h) Splenic artery involvement and distance from tumor to celiac artery bifurcation: 4 cm. i) Vascular Involvement, Other: No. II: Thrombosis, any vessel: No. III: Aberrant Anatomy: No. a) Replaced right hepatic artery: No. The visualized small and large bowel appears minimally distended although no obvious areas of obstruction are seen. Multiple small lymph nodes within the retroperitoneal area, which are not enlarged by CT criteria. The left adrenal again appears thickened measuring 11 Hounsfield units on the non-contrast study consistent with an adrenal adenoma. IMPRESSION: 1. Pancreatic head mass is separated from vessels as above. 2. Liver hemangioma and multiple peripherally enhancing hypodense hepatic lesions which might represent metastases versus hepatic cysts. An ultrasound is recommended for further evaluation of these lesions. 3. Enhancing portion of the duodenum wall concerning for malignancy. An endoscopy may be considered to evaluate this finding. . EGD [**2125-12-11**]: Impression: Small hiatal hernia Salmon colored in the gastroesophageal junction compatible with Barrett's esophagus (biopsy) Deformity of the second part of the duodenum (biopsy) Otherwise normal EGD to third part of the duodenum Recommendations: Please follow with biopsy Please consult ERCP team for EUS Please proceed with surgery consult . Colonoscopy [**2125-12-11**]: Impression: Polyps at a distance between 15 cm and 20 cm in the sigmoid colon (biopsy, biopsy) Thickened fold with induration on top in the sigmoid colon (biopsy) Biopsy taken for polyps, polypectomy NOT performed due to recent GI bleed. Otherwise normal colonoscopy to cecum Recommendations: Please follow biopsy results Biopsy taken for polyps, polypectomy NOT performed due to recent GI bleed. Pt needs to have colonoscopy repeated for polypectomy. . ERCP [**2125-12-13**]: Impression: Limited examination of the esophagus and stomach were normal Due to the presence of an ulcer in the duodeum, the scope was not advanced beyond the duodenal bulb A 2.6 cm X 1.8 cm ill-defined mass was noted in the head of the pancreas - FNA was performed. Recommendations: Follow-up with Dr. [**Last Name (STitle) **] [**Name (STitle) **] cytology results. Colonoscopy [**2125-12-19**]: Impression: Polyp in the sigmoid colon (polypectomy) Polyp in the sigmoid colon (polypectomy) Polyps in the rectum (polypectomy, polypectomy) Otherwise normal colonoscopy to transverse colon Recommendations: Please follow biopsy results Consider a repeat colonoscopy in 1 year if patients over all clinical condition permits - to be scheduled through primary care physician's office . Discharge Labs: HCT 34.8 Brief Hospital Course: 54 y/o with PMH significant for heavy ETOH abuse, cocaine use, who presents now with acute on chronic abdominal pain alongside low Hct and positive guaiac concerning for GIB. Now has pancreatic head mass concerning for malignancy. . #. Pancreatic head mass/liver mass: He was found to have pancreatic head mass during the workup for his anemia. He has multiple imaging and procedures to better evaluate the mass. This mass is concerning for malignancy esp with CA [**35**]-9 at 1314. FNA by ERCP prelim results show atypical changes. However they were not able to differentiate between malignancy vs. severe pancreastitis. Liver mass found in CT were identified as hemangiomas on MRCP. We appreciated surgery recommendations. Dr[**Doctor Last Name **] team is arranging for surgical removal of the mass in two weeks. We aprreciated oncology recommendations. . #.Anemia / GI bleed: Patient's history and exam were consistent with chronic GI bleed. He recieved 3 u PRBC on [**12-7**] and his hematocrit has been stable since then. His blood pressure usually runs as low as SBP in mid 80s with heart rate in 70s without symptoms. EGD/[**Last Name (un) **] on [**12-11**] showed mass with stricture in second part of the duodenum, biopsy shows small intestinal mucusa. ERCP on [**12-13**] showed duodenal ulcer. He also has polyps and thickened fold in sigmoid colon and biopsy showed adenoma/hyperplasia. Patient underwent another colonoscopy on [**12-19**] for polypectomy priot to discharge as the initial procedure was focussed on finding a source of bleed. . #.Abdominal Pain: Chronic pancreatitis with acute component. Also has duodenal ulcers. Also concern for malignancy as above. He was treated with IV hydration and IV morphine. His pain meds were switched to oxycodone at discharge. We appreciated gastroenterologist, surgery and ERCP recommendations. . #.Left superficial thrombophlebitis: Patient was found to have left superficial thrombophlebitis during this admission. His symtpoms resolved with warm compression. . #.Polysubstance abuse: Recently stopped ETOH use 3 months ago after 8-9 beers/day, using cocaine now, and also smoking 1PPD. Serum tox was negative on admission. We appreciated social worker recommendations and resources. He recieved multivitamin, thaimine and folate during this admission. . #.Multiple nevi: Patient will benefit from dermatology referal as out patient. . # Patient had pneumoboots for DVT prophylaxis given GI bleed. . Medications on Admission: None Discharge Medications: 1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Oxycodone 5 mg Capsule Sig: One (1) Capsule PO twice a day as needed for pain for 10 days. Disp:*20 Capsule(s)* Refills:*0* 3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. Disp:*30 Capsule(s)* Refills:*0* 4. Multivitamin Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Acute on chronic pancreatitis Pancreatic head mass concerning for malignancy Liver hemangioma Chronic GI bleed Colonic polyps Duodenal ulcer Discharge Condition: Asymptomatic and hemodynamically stable Alert and oriented x 3 Ambulating without difficulty Discharge Instructions: Dear Mr.[**Known lastname 487**], You were admitted to [**Hospital1 69**] with abdominal pain. You were found to have pancreatitis. You also had slow gastrointestinal bleed. You recieved blood transfusion and your blood levels increased after that. During your workup here, you were found to have a mass in the pancreas which is concerning for cancer. You underwent a procedure called ERCP with sampling of the mass. The results are still pending. You also had colonoscopy with removal of polyps and the results of these are still pending. Surgeon, Dr.[**Last Name (STitle) 28529**], saw you here and recommended that you have a surgical procedure to remove the mass in pancreas. Dr[**Last Name (un) 84068**] office is arranging for the date of the surgery to be done in two weeks. The following changes were made to your medications: START Pantoprazole START Oxycodone START Colace START Multivitamin Followup Instructions: Primary care doctor appointment: Provider: [**First Name4 (NamePattern1) 2353**] [**Last Name (NamePattern1) 2354**], MD Phone:[**Telephone/Fax (1) 1144**] Date/Time:[**2126-1-15**] 9:10. Please ask your primary care doctor to refer you to a dermatologist (skin doctor). They should look at the moles on your back and ensure you do not have any skin cancers. . Surgery follow up: Dr[**Last Name (un) 84068**] office will be contacting you about an appointment for surgery in two weeks. If you do not hear from them in the next two days, please call Dr.[**Name (NI) 2829**] office at ([**Telephone/Fax (1) 15807**] and request for the date and time of the surgery. Please ask Dr.[**Last Name (STitle) **] to schedule an appointment with Oncology (Cancer specialist) clinic after the surgery. . Gastroenterology: Provider: [**Name10 (NameIs) 81**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2126-1-29**] 1:30 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**] Completed by:[**2125-12-19**]

239,577,578,304,451,228,280,738,305,530,211,303

{"Neoplasm of unspecified nature of digestive system,Acute pancreatitis,Blood in stool,Cocaine dependence, continuous,Phlebitis and thrombophlebitis of deep veins of upper extremities,Hemangioma of intra-abdominal structures,Iron deficiency anemia, unspecified,Acquired spondylolisthesis,Tobacco use disorder,Barrett's esophagus,Benign neoplasm of rectum and anal canal,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: abdominal pains PRESENT ILLNESS: Mr. [**Known lastname 487**] is a 54yo M with PMH s/f cocaine abuse, ETOH-ism, and tobacco use who presents with acute on chronic abdominal pains. MEDICAL HISTORY: -ETOH abuse (states last drink 3 months ago) -chronic abdominal pains -crack cocaine use /last used yesturday (using 2x week) -s/p CCY -s/p appendectomy -told his liver was "enlarged" in past -smoking tobacco . MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.7F, BP=100/66, HR=84,RR=20, O2=97% RA PHYSICAL EXAM GENERAL: Pleasant, thin appearing male in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: RRR, Normal S1/S2. No murmurs, rubs or [**Last Name (un) 549**]. JVP=8cm FAMILY HISTORY: Mother died of lung CA, no GI cancers in family and no other GI diseases per patient. SOCIAL HISTORY: He is currently collecting unemployment and he lives in [**Location 2251**] with his daughter. [**Name (NI) **] smokes about 1PPD x 32 years. Drinking 8 beers a day until 3 months ago and using crack cocaine 2x week. ### Response: {"Neoplasm of unspecified nature of digestive system,Acute pancreatitis,Blood in stool,Cocaine dependence, continuous,Phlebitis and thrombophlebitis of deep veins of upper extremities,Hemangioma of intra-abdominal structures,Iron deficiency anemia, unspecified,Acquired spondylolisthesis,Tobacco use disorder,Barrett's esophagus,Benign neoplasm of rectum and anal canal,Other and unspecified alcohol dependence, unspecified"}

CHIEF COMPLAINT: tylenol, seroquel, klonipin, and prozac ingestion PRESENT ILLNESS: History of Present Illness: 18F PMH depression and multiple suicide attempts, last [**1-/2149**] per patient, presenting after suicide attempt with tylenol overdose. The patient states that at 22:30 the night prior to admission she took tylenol ES x 10 (5 gram acetaminophen) in addition to two times the amounts of her normal psychiatric medications: total seroquel 100 mg, klonapin 1 mg, and prozac 40 mg with "swigs of vodka." . In the ED, VS 98 100 85/58 28 100%RA. The patient received charcoal 60 gm and NAC 8.4 gm PO x 1 (140 mg/kg). Tylenol level two hours after ingestion was 98.0 and four hours post-ingestion 54.8. Of note, LFTs not sent in ED. . Review of systems: Negative for change in vision, dizziness, somnulence, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, constipation, melena, BRBPR. ROS otherwise negative in detail MEDICAL HISTORY: Depression - patient is new to [**Location (un) 86**] and needs a psychiatrist Multiple past suicide attempts MEDICATION ON ADMISSION: Seroquel 50 mg daily Prozac 20 mg daily Klonapin 0.5 mg as needed ALLERGIES: Penicillins PHYSICAL EXAM: On Admit: Vital signs: 97.3 72 102/48 19 97%RA General: Young female in NAD HEENT: Sclera anicteric, PERRL, EOMI, MM dry Heart: RRR, no MRG Lungs: CTAB Abdomen: NABS, soft, NTND, no HSM Extremities: No CCE Skin: No jaundice Neurologic: AAOx3, CN II-XII intact, no asterixis FAMILY HISTORY: non-contrib SOCIAL HISTORY: Patient is a freshman/sophomore at [**Last Name (NamePattern1) 74733**]after spending one year at RI college in [**Hospital1 789**]. She lives in a dorm. She smokes [**2-11**] ppd x 1 year. She denies alcohol use other than the vodka she took with the overdose as above. Rare marijuana use. No IV drug use.

Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Toxic effect of ethyl alcohol,Accidents occurring in residential institution,Poisoning by benzodiazepine-based tranquilizers

Pois-arom analgesics NEC,Poison-analgesics,Depressive disorder NEC,Toxic eff ethyl alcohol,Accid in resident instit,Pois-benzodiazepine tran

Admission Date: [**2149-11-2**] Discharge Date: [**2149-11-3**] Date of Birth: [**2130-12-11**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 3556**] Chief Complaint: tylenol, seroquel, klonipin, and prozac ingestion Major Surgical or Invasive Procedure: none History of Present Illness: History of Present Illness: 18F PMH depression and multiple suicide attempts, last [**1-/2149**] per patient, presenting after suicide attempt with tylenol overdose. The patient states that at 22:30 the night prior to admission she took tylenol ES x 10 (5 gram acetaminophen) in addition to two times the amounts of her normal psychiatric medications: total seroquel 100 mg, klonapin 1 mg, and prozac 40 mg with "swigs of vodka." . In the ED, VS 98 100 85/58 28 100%RA. The patient received charcoal 60 gm and NAC 8.4 gm PO x 1 (140 mg/kg). Tylenol level two hours after ingestion was 98.0 and four hours post-ingestion 54.8. Of note, LFTs not sent in ED. . Review of systems: Negative for change in vision, dizziness, somnulence, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, constipation, melena, BRBPR. ROS otherwise negative in detail Past Medical History: Depression - patient is new to [**Location (un) 86**] and needs a psychiatrist Multiple past suicide attempts Social History: Patient is a freshman/sophomore at [**Last Name (NamePattern1) 74733**]after spending one year at RI college in [**Hospital1 789**]. She lives in a dorm. She smokes [**2-11**] ppd x 1 year. She denies alcohol use other than the vodka she took with the overdose as above. Rare marijuana use. No IV drug use. Family History: non-contrib Physical Exam: On Admit: Vital signs: 97.3 72 102/48 19 97%RA General: Young female in NAD HEENT: Sclera anicteric, PERRL, EOMI, MM dry Heart: RRR, no MRG Lungs: CTAB Abdomen: NABS, soft, NTND, no HSM Extremities: No CCE Skin: No jaundice Neurologic: AAOx3, CN II-XII intact, no asterixis Pertinent Results: [**2149-11-2**] 12:25AM BLOOD WBC-8.0 RBC-4.20 Hgb-13.2 Hct-38.2 MCV-91 MCH-31.3 MCHC-34.5 RDW-13.1 Plt Ct-227 [**2149-11-3**] 03:50AM BLOOD WBC-8.5 RBC-4.01* Hgb-13.1 Hct-37.1 MCV-93 MCH-32.5* MCHC-35.2* RDW-13.4 Plt Ct-217 [**2149-11-2**] 12:25AM BLOOD Neuts-60.3 Lymphs-33.0 Monos-5.1 Eos-1.3 Baso-0.4 [**2149-11-3**] 03:50AM BLOOD Plt Ct-217 [**2149-11-3**] 03:50AM BLOOD PT-12.8 PTT-47.5* INR(PT)-1.1 [**2149-11-2**] 12:25AM BLOOD Glucose-90 UreaN-18 Creat-0.8 Na-139 K-3.6 Cl-101 HCO3-25 AnGap-17 [**2149-11-3**] 03:50AM BLOOD Glucose-91 UreaN-14 Creat-0.8 Na-140 K-3.5 Cl-107 HCO3-26 AnGap-11 [**2149-11-2**] 06:33AM BLOOD ALT-14 AST-16 LD(LDH)-150 AlkPhos-58 TotBili-0.2 [**2149-11-3**] 03:50AM BLOOD ALT-14 AST-15 AlkPhos-69 TotBili-0.2 [**2149-11-3**] 03:50AM BLOOD Calcium-8.6 Phos-3.6 Mg-2.0 [**2149-11-2**] 12:25AM BLOOD ASA-NEG Ethanol-46* Acetmnp-98.4* Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2149-11-2**] 02:45AM BLOOD Acetmnp-54.8* [**2149-11-2**] 06:33AM BLOOD Acetmnp-12.6 [**2149-11-2**] 05:32AM BLOOD Type-ART Temp-36.1 pO2-99 pCO2-42 pH-7.35 calTCO2-24 Base XS--2 Intubat-NOT INTUBA [**2149-11-3**] 02:10PM BLOOD PT-12.6 PTT-28.8 INR(PT)-1.1 Brief Hospital Course: 18F w/PMH significant for depression and multiple suicide attempts, last [**1-/2149**] per patient, presenting after suicide attempt with tylenol 5 grams. . # Acetaminophen overdose: Per history the patient took 5 grams tylenol and does not have a history of liver disease or chronic alcohol abuse. Tylenol level two hours after ingestion was 98.0 and four hours post-ingestion 54.8, which fall in the "no hepatic toxicity" range of the Rumack-[**Doctor First Name **] nomogram. Her acute alcohol ingestion is also protective by competing with acetaminophen for CYP2E1 and, thereby, decreasing the amount of NAPQI produced. Her other medications do not affect CYP2E1. Tox screens otherwise negative. - Patient given charcoal in ED - Patient loaded with NAC 140 mg/kg PO in ED; no need for further NAC as total dose of ingestion less than 7.5 grams and the above tylenol levels are low risk - Toxicology following; appreciate - 1:1 sitter - Psychiatry consult -> section 12 and will need psych admit once medically clear - SW consult - Monitor LFTs -> normal - PTT slightly elevated am [**11-3**] -> d/c heparin subcutaneous and recheck PTT -> 28.8 -> with normal LFTs and isolated elevated PTT this is unlikely to be related to the tylenol ingestion -> no need for further monitoring - No need for transplant surgery consult at this time . # Seroquel, klonapin, prozac use: The above doses are unlikely to cause toxicity. - QTc 434 on EKG - Ok to restart Klonapin as of [**2149-11-2**] per psych - consider restarting soon . # Alcohol use: EtOH level 46 on admission. No history of chronic alcohol abuse. - SW consult . # Psychiatric: Patient is new to [**Location (un) 86**] and needs psychiatry follow-up. - Holding above medications for now - Psychiatry consult -> pt. on section 12 and will need psych admit once medically clear . # FEN: - tolerating regular diet . # Prophy: - bowel regimen . # Access: - PIV . # Code: - Full . # Dispo: - once medically cleared pt. will need psych admission as she is on section 12 - consider call-out to floor with 1:1 sitter until psych bed ready Medications on Admission: Seroquel 50 mg daily Prozac 20 mg daily Klonapin 0.5 mg as needed Discharge Medications: - holding psych medications for now - inpatient psychiatry facility will evaluated patient and adjust / start medications as they see fit Discharge Disposition: Extended Care Facility: [**Hospital3 44097**] Discharge Diagnosis: - suicide attempt by ingestion of tylenol, klonipin, seroquel, and prozac - depression Discharge Condition: good Discharge Instructions: - you have been evaluated by the psychiatry department and will transition care to a psych facility - you need to continue taking your medications as instructed - [**Name8 (MD) 138**] MD or return to ED if T>101.5, chills, nausea, vomiting, chest pain, shortness of breath, depression, increasing sadness, feelings of dispair, thoughts of suicidial ideation, homicidial ideation, or any other concern. Followup Instructions: - you will need to follow-up with your primary care doctor once you have completed your acute psychiatric care. Please call their office to schedule a post-hospitalization visit. - you will need to have close follow-up with a psychiatrist -> initially you are going to an inpatient facility -> your doctor will set up follow-up for you once you have completed the acute phase of your treatment [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]

965,E950,311,980,E849,969

{'Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Toxic effect of ethyl alcohol,Accidents occurring in residential institution,Poisoning by benzodiazepine-based tranquilizers'}

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, seroquel, klonipin, and prozac ingestion PRESENT ILLNESS: History of Present Illness: 18F PMH depression and multiple suicide attempts, last [**1-/2149**] per patient, presenting after suicide attempt with tylenol overdose. The patient states that at 22:30 the night prior to admission she took tylenol ES x 10 (5 gram acetaminophen) in addition to two times the amounts of her normal psychiatric medications: total seroquel 100 mg, klonapin 1 mg, and prozac 40 mg with "swigs of vodka." . In the ED, VS 98 100 85/58 28 100%RA. The patient received charcoal 60 gm and NAC 8.4 gm PO x 1 (140 mg/kg). Tylenol level two hours after ingestion was 98.0 and four hours post-ingestion 54.8. Of note, LFTs not sent in ED. . Review of systems: Negative for change in vision, dizziness, somnulence, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, constipation, melena, BRBPR. ROS otherwise negative in detail MEDICAL HISTORY: Depression - patient is new to [**Location (un) 86**] and needs a psychiatrist Multiple past suicide attempts MEDICATION ON ADMISSION: Seroquel 50 mg daily Prozac 20 mg daily Klonapin 0.5 mg as needed ALLERGIES: Penicillins PHYSICAL EXAM: On Admit: Vital signs: 97.3 72 102/48 19 97%RA General: Young female in NAD HEENT: Sclera anicteric, PERRL, EOMI, MM dry Heart: RRR, no MRG Lungs: CTAB Abdomen: NABS, soft, NTND, no HSM Extremities: No CCE Skin: No jaundice Neurologic: AAOx3, CN II-XII intact, no asterixis FAMILY HISTORY: non-contrib SOCIAL HISTORY: Patient is a freshman/sophomore at [**Last Name (NamePattern1) 74733**]after spending one year at RI college in [**Hospital1 789**]. She lives in a dorm. She smokes [**2-11**] ppd x 1 year. She denies alcohol use other than the vodka she took with the overdose as above. Rare marijuana use. No IV drug use. ### Response: {'Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Toxic effect of ethyl alcohol,Accidents occurring in residential institution,Poisoning by benzodiazepine-based tranquilizers'}

CHIEF COMPLAINT: SOB PRESENT ILLNESS: 57 y.o. female with hx asthma, CAD, DM II, hypothyroidism, anxiety/agarophobia and depression, who presented to the ED today with SOB and agitation. Patient is unable to provide history as she is intubated at this time. History is obtained from patient's daughter who does not live with the patient. According to the patient's daughter the patient has been in her USOH until a few days ago when she started complaining of SOB initially relieved with Albuterol inhaler. Daughter reports speaking with pt on the phone day prior to admission and pt has not mentioned any complaints to her. Her SOB has been getting progressively worse and this morning she developed increased WOB and had to come in to the ED. In the ED, the patient was noted to have increased WOB and was very agitated. ED initial vitals 98.3 108 207/78 20 100% on NRB and 88% on RAHer lung exam was described as having bilateraly wheezing and crackles. She was given nebs, 125 mg of Solumedrol IV, Levofloxacin for presumed UTI, 5 units of insulin, a total of 3 mg of Ativan and Valium 5 mg for anxiety, and was placed on oxygen. She then was noted to be somnolent and difficult to arouse. Patient was intubated and placed on AC 500x15; peep 5; FiO2 100%. ABG was checked post-intubation and was 7.06/98/374. CXR and CTA done (see below). . Per family, no fevers, chills recently. No cough. No ill contacts. Bloody stools recorded in ED record. Patient's SO reports that she ran out of Levothyroxine x 2 wks recently. . Of note, the patient was recently seen in PCP's office. Her TSH was noted to be 9 and Levothyroxine dose was increased. She was also started on Bactrim for presumed UTI. . Called out to floor on [**2158-6-10**] - patient reports that she is feeling well. SOB is significantly improved, no cough. No chest pain, abdominal pain. Eating well. Urinating without difficulty after removal of foley. MEDICAL HISTORY: 1. Diabetes Type II on NPH and SS at home, last HgbA1C 9.4% ([**5-11**]) 2. HTN 3. Hypothyroidism, last TSH 9.3 ([**5-11**]) 4. Major depressive disorder 5. Anxiety with agoraphobia 6. CAD, s/p stent in [**2153**] mid LCx, mid and distal RCA and LVEF 58% LV-gram 7. Two prior episodes of confusion with abnormal EEG findings (evidence of focal irritability). She was started on Tegretol [**9-/2157**] and recent level was 6.2. 8. Asthma. On Flovent and Albulterol at home. No PFTs on record. Never hospitalized for asthma exacerbation. Never intubated. 9. s/p hysterectomy MEDICATION ON ADMISSION: ALBUTEROL inh 1 puff qid prn wheezes ASPIRIN 325MG every day ATENOLOL 50MG every day ATORVASTATIN CALCIUM 10 MG daily CARBAMAZEPINE XR 400 MG daily DIAZEPAM 5 MG qhs FLOVENT 2 puff twice a day Insulin KLONOPIN 0.5MG [**Hospital1 **] prn LEVOTHYROXINE SODIUM 150 mcg daily LISINOPRIL 10 MG po daily Nortriptyline 50 mg po qhs PAXIL 20 mg po qd Bactrim (started [**6-4**]) x 7 days ALLERGIES: Codeine / Demerol / Plavix / Percocet PHYSICAL EXAM: VS: 97.8 78 (78-80) 145/65 92% on a vent current vent AC 500x20; PEEP of 5; FiO2 30% GENERAL: intubated, sedated, follows some simple commands, does not appear to focus HEENT: NC, AT, PER sluggishly reactive from 3 mm to 2 mm, no scleral icterus, MM sl dry NECK: supple, no elevated JVP appreciated CV: regular, nl S1S2, no m/r/g PULM: soft crackles bilterally ABD: + BS, soft, obese, NT, ND, well healed vertical midline scar c/w prior C-section EXT: trace LE edema, no pretibial myxedema, extremities are cool to touch NEURO: moving all 4 xtr; lightly sedated SKIN: maculopapular rash with excoriated papules on abdomen and arms FAMILY HISTORY: FX of DM II and heart disease, no asthma hx known of relatives SOCIAL HISTORY: Widow. Lives at home with boyfriend. [**Name (NI) 1403**] as a secretary at a red cross. Has a daughter. Alcohol: occasionally. Tobacco: a few cigs/day. Has smoked x 35 years and "much more" than just a few cigs in past.

Acute respiratory failure,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Unspecified pleural effusion,Panic disorder without agoraphobia,Major depressive affective disorder, single episode, unspecified,Tobacco use disorder

Acute respiratry failure,DMII unspf uncntrld,Chronic obst asthma NOS,CHF NOS,Pleural effusion NOS,Panic dis w/o agorphobia,Depress psychosis-unspec,Tobacco use disorder

Admission Date: [**2158-6-8**] Discharge Date: [**2158-6-12**] Date of Birth: [**2100-10-3**] Sex: F Service: MEDICINE Allergies: Codeine / Demerol / Plavix / Percocet Attending:[**First Name3 (LF) 6195**] Chief Complaint: SOB Major Surgical or Invasive Procedure: intubation History of Present Illness: 57 y.o. female with hx asthma, CAD, DM II, hypothyroidism, anxiety/agarophobia and depression, who presented to the ED today with SOB and agitation. Patient is unable to provide history as she is intubated at this time. History is obtained from patient's daughter who does not live with the patient. According to the patient's daughter the patient has been in her USOH until a few days ago when she started complaining of SOB initially relieved with Albuterol inhaler. Daughter reports speaking with pt on the phone day prior to admission and pt has not mentioned any complaints to her. Her SOB has been getting progressively worse and this morning she developed increased WOB and had to come in to the ED. In the ED, the patient was noted to have increased WOB and was very agitated. ED initial vitals 98.3 108 207/78 20 100% on NRB and 88% on RAHer lung exam was described as having bilateraly wheezing and crackles. She was given nebs, 125 mg of Solumedrol IV, Levofloxacin for presumed UTI, 5 units of insulin, a total of 3 mg of Ativan and Valium 5 mg for anxiety, and was placed on oxygen. She then was noted to be somnolent and difficult to arouse. Patient was intubated and placed on AC 500x15; peep 5; FiO2 100%. ABG was checked post-intubation and was 7.06/98/374. CXR and CTA done (see below). . Per family, no fevers, chills recently. No cough. No ill contacts. Bloody stools recorded in ED record. Patient's SO reports that she ran out of Levothyroxine x 2 wks recently. . Of note, the patient was recently seen in PCP's office. Her TSH was noted to be 9 and Levothyroxine dose was increased. She was also started on Bactrim for presumed UTI. . Called out to floor on [**2158-6-10**] - patient reports that she is feeling well. SOB is significantly improved, no cough. No chest pain, abdominal pain. Eating well. Urinating without difficulty after removal of foley. Past Medical History: 1. Diabetes Type II on NPH and SS at home, last HgbA1C 9.4% ([**5-11**]) 2. HTN 3. Hypothyroidism, last TSH 9.3 ([**5-11**]) 4. Major depressive disorder 5. Anxiety with agoraphobia 6. CAD, s/p stent in [**2153**] mid LCx, mid and distal RCA and LVEF 58% LV-gram 7. Two prior episodes of confusion with abnormal EEG findings (evidence of focal irritability). She was started on Tegretol [**9-/2157**] and recent level was 6.2. 8. Asthma. On Flovent and Albulterol at home. No PFTs on record. Never hospitalized for asthma exacerbation. Never intubated. 9. s/p hysterectomy Social History: Widow. Lives at home with boyfriend. [**Name (NI) 1403**] as a secretary at a red cross. Has a daughter. Alcohol: occasionally. Tobacco: a few cigs/day. Has smoked x 35 years and "much more" than just a few cigs in past. Family History: FX of DM II and heart disease, no asthma hx known of relatives Physical Exam: VS: 97.8 78 (78-80) 145/65 92% on a vent current vent AC 500x20; PEEP of 5; FiO2 30% GENERAL: intubated, sedated, follows some simple commands, does not appear to focus HEENT: NC, AT, PER sluggishly reactive from 3 mm to 2 mm, no scleral icterus, MM sl dry NECK: supple, no elevated JVP appreciated CV: regular, nl S1S2, no m/r/g PULM: soft crackles bilterally ABD: + BS, soft, obese, NT, ND, well healed vertical midline scar c/w prior C-section EXT: trace LE edema, no pretibial myxedema, extremities are cool to touch NEURO: moving all 4 xtr; lightly sedated SKIN: maculopapular rash with excoriated papules on abdomen and arms Pertinent Results: EKG: sinus rate 116, ST depressions in V4-V6 and II, III, aVF (new c/w prior). . CXR [**2158-6-8**]: Persistent bilateral interstitial pattern. This could represent recurrent interstitial pulmonary edema, but differential diagnosis includes interstitial infection and a more chronic interstitial infiltrative process. If there is clinical evidence of volume overload, initial evaluation with follow up chest x-rays after diuresis would be suggested. If persistent, high-resolution CT may be helpful for better characterization if warranted clinically . CTA [**2158-6-8**]: 1. No evidence of pulmonary embolism or aortic dissection. 2. Focal opacity seen at the anterior aspect of the left and right lungs, possibly representing focal area of atelectasis versus infection. . PRIOR STUDIES: Exercise-MIBI [**12/2157**]: 4.8 Mets Probable reversible defect involving the basal inferior wall. Moderately depressed left ventricular function with inferior hypokinesis. . Brief Hospital Course: 1. Hypercarbic respiratory failure: Etiology is not entirely clear - ? CHF exacerbation and/or asthma causing development of initial respiratory symptoms, further exacerbated by multiple doses of benzodiazepines given for anxiety in the ED. Also has history of hypothyroidism - abnormal TFTs but no bradycardia, hypothermia, or other symptoms that suggest myxedema coma. CXR with interstitial infiltrate vs. pulmonary edema. Patient required intubation in the ED for respiratory distress. She was able to be extubated on hospital day 2 and was transferred to the floor. Asthma exacerbation was treated with Solu-Medrol and then was switched to a prednisone taper. Patient received albuterol and ipratropium inhalers. She was also started on Levofloxacin and Azithromycin empirically to cover for a URI. A nasopharyngeal aspirate for viral pathogens was negative. Patient was started on furosemide and diuresed. WBC elevated during her stay although most likely secondary to steroids - WBC were WNL on admit, increased after getting Solu-Medrol, and trended down as steroid dose was decreased. Antibiotics were discontinued. On discharge patient was continued on albuterol and ipratropium, a prednisone taper, and furosemide. . 2. Pleural effusions: Etiology unclear. [**Name2 (NI) **] fevers, chills to suggest infection. Profound hypothyroidism may results in pleural effusion but unlikely to be the case here. Most likely can be attributed to her CHF. ECHO on [**2158-6-9**] with EF of 40 % (this is unchanged from exercise mibi in [**12-10**] with calculated EF of 40%). Patient will be discharged on standing furosemide. She will follow-up with her PCP next week who will repeat her CXR and adjust her furosemide dose as necessary. She should also have her electrolytes checked at that time. . 3. Anemia: Acute HCT drop from 35.8 on admission to 28. ED chart has documented blood in stool. Recent colonoscopy negative. No bowel movements during admission. No obvious source of bleeding. Gastric lavage was negative. No recent instrumentation to be concerned about retroperitoneal bleed. Bilateral pneumothoraces unlikely. HCT stable since admission. Coags WNL. No transfusions during this admission. Anemia may be related to hypothyroidism and should be followed up in out-patient setting. . 4. CAD s/p stents: ST depressions in lateral and inferior leads on EKG changes. CK slightly elevated, but MB and trop negative. Patient with recent stress mibi in [**12-10**] and seen by cardiology in [**4-10**], recommended ongoing medical management. No chest pain during this admission. Patient was continued on ASA, atorvastatin, metoprolol and lisinopril. . 5. UTI: Treated with a course of levofloxacin. . 6. Hypothyroidism: TSH up to 17 from 9.4 recently. Discussed with endocrine fellow: no indications for T3 at this time. Levothyroxine 150 mcg po daily, per endocrine - recheck TFTs in one month. . 7. DM: Poorly controlled, was initially on insulin gtt when on the ICU. Seen by endocrine who made recommendations for a home regimen of NPH and a regular insulin sliding scale. Patient was discharged on NPH and regular insulin. . 8. Depression/anxiety/psych: Continued on home regimen of Paxil, Klonopin, and Valium. Medications on Admission: ALBUTEROL inh 1 puff qid prn wheezes ASPIRIN 325MG every day ATENOLOL 50MG every day ATORVASTATIN CALCIUM 10 MG daily CARBAMAZEPINE XR 400 MG daily DIAZEPAM 5 MG qhs FLOVENT 2 puff twice a day Insulin KLONOPIN 0.5MG [**Hospital1 **] prn LEVOTHYROXINE SODIUM 150 mcg daily LISINOPRIL 10 MG po daily Nortriptyline 50 mg po qhs PAXIL 20 mg po qd Bactrim (started [**6-4**]) x 7 days Discharge Medications: 1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Nortriptyline 25 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime). Disp:*60 Capsule(s)* Refills:*2* 5. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO DAILY (Daily) as needed for constipation. Disp:*60 Tablet(s)* Refills:*3* 6. Carbamazepine 100 mg/5 mL Suspension Sig: Two (2) PO BID (2 times a day). Disp:*qs qs* Refills:*2* 7. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day) as needed for constipation. Disp:*qs qs* Refills:*3* 8. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. 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:*2* 10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). Disp:*qs qs* Refills:*2* 11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 12. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. Disp:*qs qs* Refills:*3* 13. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). Disp:*qs qs* Refills:*2* 14. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 15. Prednisone 10 mg Tablet Sig: Five (5) Tablet PO once a day: take 50 mg (5 pills)on [**6-13**] mg (4 pills)on [**6-14**] mg (3 pills)on [**6-15**] - you should discuss further dosing with your PCP [**Last Name (NamePattern4) **] [**6-15**]. Disp:*30 Tablet(s)* Refills:*2* 16. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 17. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: 40 units in AM, 20units at bedtime Subcutaneous QAM and QHS. Disp:*qs qs* Refills:*2* 18. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: per sliding scale Subcutaneous 4 x daily per sliding scale: sliding scale as recommended by the endocrinologist will be provided in your discharge paperwork. Disp:*qs qs* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses congestive heart failure asthma exacerbation * Secondary diagnoses coronary artery diease hypothyroidism depression anxiety Discharge Condition: good Discharge Instructions: Please take all of your medications as prescribed. You were started on a new medication called furosemide (Lasix) - your PCP will adjust the dosage of this as needed. You were also given a prescription for prednisone. You should take this as prescibed until your see your PCP in clinic. He will then advise when to stop the prednisone. . Please call your doctor or return to the emergency department if you develop chest pain, shortness of breath, if you cannot eat, drink, or take your medications, or you develop any other symptoms that are concerning to you. Followup Instructions: Please follow-up with your PCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (PRE) **].D. on Thursday [**2158-6-15**] - please call to confirm your appointment [**Telephone/Fax (1) 250**]. You should have your electolytes checked then, and you should have your thyroid function checked again in two weeks. * You also have the following apointments coming up: 1. Provider: [**Name10 (NameIs) 19240**],[**Name11 (NameIs) 19241**] PSYCHIATRY OPD Phone:[**Telephone/Fax (1) 1387**] Date/Time:[**2158-6-27**] 5:00 . 2. Provider: [**Name10 (NameIs) 19240**],[**Name11 (NameIs) 19241**] PSYCHIATRY OPD Phone:[**Telephone/Fax (1) 1387**] Date/Time:[**2158-7-18**] 5:00 . 3. Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 540**], MD Phone:[**Telephone/Fax (1) 8302**] Date/Time:[**2158-7-20**] 3:15 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6198**] MD, [**MD Number(3) 6199**]

518,250,493,428,511,300,296,305

{'Acute respiratory failure,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Unspecified pleural effusion,Panic disorder without agoraphobia,Major depressive affective disorder, single episode, unspecified,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: SOB PRESENT ILLNESS: 57 y.o. female with hx asthma, CAD, DM II, hypothyroidism, anxiety/agarophobia and depression, who presented to the ED today with SOB and agitation. Patient is unable to provide history as she is intubated at this time. History is obtained from patient's daughter who does not live with the patient. According to the patient's daughter the patient has been in her USOH until a few days ago when she started complaining of SOB initially relieved with Albuterol inhaler. Daughter reports speaking with pt on the phone day prior to admission and pt has not mentioned any complaints to her. Her SOB has been getting progressively worse and this morning she developed increased WOB and had to come in to the ED. In the ED, the patient was noted to have increased WOB and was very agitated. ED initial vitals 98.3 108 207/78 20 100% on NRB and 88% on RAHer lung exam was described as having bilateraly wheezing and crackles. She was given nebs, 125 mg of Solumedrol IV, Levofloxacin for presumed UTI, 5 units of insulin, a total of 3 mg of Ativan and Valium 5 mg for anxiety, and was placed on oxygen. She then was noted to be somnolent and difficult to arouse. Patient was intubated and placed on AC 500x15; peep 5; FiO2 100%. ABG was checked post-intubation and was 7.06/98/374. CXR and CTA done (see below). . Per family, no fevers, chills recently. No cough. No ill contacts. Bloody stools recorded in ED record. Patient's SO reports that she ran out of Levothyroxine x 2 wks recently. . Of note, the patient was recently seen in PCP's office. Her TSH was noted to be 9 and Levothyroxine dose was increased. She was also started on Bactrim for presumed UTI. . Called out to floor on [**2158-6-10**] - patient reports that she is feeling well. SOB is significantly improved, no cough. No chest pain, abdominal pain. Eating well. Urinating without difficulty after removal of foley. MEDICAL HISTORY: 1. Diabetes Type II on NPH and SS at home, last HgbA1C 9.4% ([**5-11**]) 2. HTN 3. Hypothyroidism, last TSH 9.3 ([**5-11**]) 4. Major depressive disorder 5. Anxiety with agoraphobia 6. CAD, s/p stent in [**2153**] mid LCx, mid and distal RCA and LVEF 58% LV-gram 7. Two prior episodes of confusion with abnormal EEG findings (evidence of focal irritability). She was started on Tegretol [**9-/2157**] and recent level was 6.2. 8. Asthma. On Flovent and Albulterol at home. No PFTs on record. Never hospitalized for asthma exacerbation. Never intubated. 9. s/p hysterectomy MEDICATION ON ADMISSION: ALBUTEROL inh 1 puff qid prn wheezes ASPIRIN 325MG every day ATENOLOL 50MG every day ATORVASTATIN CALCIUM 10 MG daily CARBAMAZEPINE XR 400 MG daily DIAZEPAM 5 MG qhs FLOVENT 2 puff twice a day Insulin KLONOPIN 0.5MG [**Hospital1 **] prn LEVOTHYROXINE SODIUM 150 mcg daily LISINOPRIL 10 MG po daily Nortriptyline 50 mg po qhs PAXIL 20 mg po qd Bactrim (started [**6-4**]) x 7 days ALLERGIES: Codeine / Demerol / Plavix / Percocet PHYSICAL EXAM: VS: 97.8 78 (78-80) 145/65 92% on a vent current vent AC 500x20; PEEP of 5; FiO2 30% GENERAL: intubated, sedated, follows some simple commands, does not appear to focus HEENT: NC, AT, PER sluggishly reactive from 3 mm to 2 mm, no scleral icterus, MM sl dry NECK: supple, no elevated JVP appreciated CV: regular, nl S1S2, no m/r/g PULM: soft crackles bilterally ABD: + BS, soft, obese, NT, ND, well healed vertical midline scar c/w prior C-section EXT: trace LE edema, no pretibial myxedema, extremities are cool to touch NEURO: moving all 4 xtr; lightly sedated SKIN: maculopapular rash with excoriated papules on abdomen and arms FAMILY HISTORY: FX of DM II and heart disease, no asthma hx known of relatives SOCIAL HISTORY: Widow. Lives at home with boyfriend. [**Name (NI) 1403**] as a secretary at a red cross. Has a daughter. Alcohol: occasionally. Tobacco: a few cigs/day. Has smoked x 35 years and "much more" than just a few cigs in past. ### Response: {'Acute respiratory failure,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Unspecified pleural effusion,Panic disorder without agoraphobia,Major depressive affective disorder, single episode, unspecified,Tobacco use disorder'}

CHIEF COMPLAINT: Question overdose/unresponsiveness. PRESENT ILLNESS: The patient is a 40-year-old female with a history of depression, hypertension, asthma, and question of prior suicide attempts who presented after being witnessed taking an intentional overdose. Emergency Medical Service found her with four bottles, including Norvasc, Doxepin, clonidine, and Prozac; only the clonidine bottle was empty (by report). MEDICAL HISTORY: 1. Depression, with recent discharge from [**Hospital6 **] for cocaine overdose and depression. 2. Asthma. 3. Hypertension. 4. Ovarian venous thrombosis, for which the patient was started on Coumadin; however, never followed up for further workup and was noncompliant with the medication. MEDICATION ON ADMISSION: Per primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] (telephone number [**Telephone/Fax (1) 1792**]) the patient is supposed to be taking Doxepin 50 mg p.o. q.h.s., Norvasc 2.5 mg p.o. q.d., Prozac 20 mg p.o. q.h.s., Prilosec 20 mg p.o., Ventolin 2 puffs q.i.d., Azmacort 2 puffs t.i.d., hydrochlorothiazide 25 mg p.o. q.d., Neurontin, Accolate. ALLERGIES: NONSTEROIDAL ANTIINFLAMMATORY DRUGS causing rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Unable to obtain social history on arrival; per old record and primary care physician, [**Name10 (NameIs) **] patient is married and lives with her husband and two children. She is under a significant number of stressors at home. She actively uses cocaine. One of her family members is a drug dealer, given the patient free access to the cocaine.

Poisoning by other specified drugs and medicinal substances,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Other pulmonary insufficiency, not elsewhere classified,Cocaine abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Vomiting alone,Asthma, unspecified type, unspecified

Poison-medicinal agt NEC,Rec depr psych-psychotic,Other pulmonary insuff,Cocaine abuse-unspec,Poison-psychotropic agt,Vomiting alone,Asthma NOS

Admission Date: [**2145-2-9**] Discharge Date: [**2145-2-11**] Date of Birth: [**2104-3-29**] Sex: F Service: MEDICAL INTENSIVE CARE UNIT CHIEF COMPLAINT: Question overdose/unresponsiveness. HISTORY OF PRESENT ILLNESS: The patient is a 40-year-old female with a history of depression, hypertension, asthma, and question of prior suicide attempts who presented after being witnessed taking an intentional overdose. Emergency Medical Service found her with four bottles, including Norvasc, Doxepin, clonidine, and Prozac; only the clonidine bottle was empty (by report). The patient was a apparently awake and alert on arrival to the Emergency Department. However, she was found in respiratory distress (by report), tachypneic, also tachycardic with blood pressures as high as 229/141, and a heart rate in the 108 range to 132 range. By report, the patient became unresponsive and was intubated for airway protection. Due to significant agitation, the patient was given multiple doses of Versed and four separate doses of pancuronium. A head CT was negative for intracranial bleed. She was given hydralazine 20 mg intravenously with a decrease in her blood pressure to the 170s. For her ingestion, she received 70 g of charcoal in the Emergency Department. On arrival to the Intensive Care Unit, the patient was intubated and paralyzed status post dose of paralytic just prior to leaving the Emergency Room. PAST MEDICAL HISTORY: 1. Depression, with recent discharge from [**Hospital6 **] for cocaine overdose and depression. 2. Asthma. 3. Hypertension. 4. Ovarian venous thrombosis, for which the patient was started on Coumadin; however, never followed up for further workup and was noncompliant with the medication. ALLERGIES: NONSTEROIDAL ANTIINFLAMMATORY DRUGS causing rash. MEDICATIONS ON ADMISSION: Per primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] (telephone number [**Telephone/Fax (1) 1792**]) the patient is supposed to be taking Doxepin 50 mg p.o. q.h.s., Norvasc 2.5 mg p.o. q.d., Prozac 20 mg p.o. q.h.s., Prilosec 20 mg p.o., Ventolin 2 puffs q.i.d., Azmacort 2 puffs t.i.d., hydrochlorothiazide 25 mg p.o. q.d., Neurontin, Accolate. SOCIAL HISTORY: Unable to obtain social history on arrival; per old record and primary care physician, [**Name10 (NameIs) **] patient is married and lives with her husband and two children. She is under a significant number of stressors at home. She actively uses cocaine. One of her family members is a drug dealer, given the patient free access to the cocaine. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination on admission revealed temperature of 98.4, blood pressure of 172/90, pulse of 116, respiratory rate of 12, oxygen saturation of 100%, paralyzed, on the ventilator, setting at AC 700 X 12, FIO2 of 100%, and a positive end-expiratory pressure of 5. Head, eyes, ears, nose, and throat revealed mucous membranes were moist. Pupils were 5 mm and reactive to light. Perforated nasal septum. Lungs were clear to auscultation. Heart was tachycardic but regular. No murmurs, rubs or gallops. Abdomen was soft, obese, nontender and nondistended, good bowel sounds. Extremities revealed no cyanosis, clubbing or edema. Scattered round papular scar-type lesions on the legs and arms. Multiple ecchymoses, especially on the right hand, and question right temple of the face. PERTINENT LABORATORY DATA ON PRESENTATION: Laboratory findings on admission revealed a white blood cell count of 13.8 (with a differential of 81 neutrophils, 13 lymphocytes, 4 monocytes, 0.5 eosinophils, 0.7 basophils), hematocrit of 38.5, platelet count of 483. Chem-7 revealed sodium of 135, potassium of 3.5, chloride of 98, bicarbonate of 22, blood urea nitrogen of 17, creatinine of 0.9, blood sugar of 158. Creatine kinase was 120, with a MB of 3. Urinalysis showed yellow/clear urine, with a specific gravity of 1.02, 30 protein, 15 ketones, pH of 9, 325 white blood cells, occasional bacteria, 3 to 5 epithelial cells. Urine culture was pending. Serum drug screen was positive for benzodiazepines. Urine drug screen was positive for benzodiazepines and cocaine. RADIOLOGY/IMAGING: Electrocardiogram showed tachycardic, sinus rhythm, normal axis, normal intervals. There was right atrial enlargement and poor R wave progression. There were no changes when compared with prior. Chest x-ray showed no pneumonia, ETT tube at 2.9 cm above groin with nasogastric tube well positioned in stomach. Head CT showed no intracranial hemorrhage. There was slight thickening of the sinuses. HOSPITAL COURSE: The patient was admitted to the Medical Intensive Care Unit for further management after intubation in the Emergency Department. 1. AIRWAYS: The patient's sedation as well as paralysis was allowed to wear off with plan for extubation. However, the patient was extubated within one hour of arriving to the Medical Intensive Care Unit. She was able to maintain her airway, oxygenate, and ventilate well; and the decision was made not to reintubate. 2. OVERDOSE: It was unclear which medications the patient ingested. Once extubated, with the help of a Spanish interpreter, the patient was interviewed and insisted that she wanted to take some medication just to sleep. Her electrocardiogram was followed for QT prolongation in case one of the medications she ingested was a tricyclic antidepressant. She was placed on a CIWA scale in case part of her agitation was due to alcohol withdrawal. The Ativan was stopped once further information became available, and the patient was confirmed not to have significant alcohol history. 3. CARDIOVASCULAR: Upon presentation the patient was tachycardic and hypertensive with a blood pressure of up to 230/140. She initially received hydralazine with improvement in her blood pressure to 170/90. Intravenous hydralazine was continued during her Medical Intensive Care Unit stay. Due to positive cocaine screen, Lopressor and labetalol were avoided. The patient was ruled out for myocardial infarction with serial troponins, since she received intramuscular injections. Due to nonsteroidal antiinflammatory drugs allergy, aspirin was held. 4. AGITATION: Following self-extubation, the patient became increasingly more agitated and combative. Per Spanish interpreter, the patient was aware of herself, her location, and time, and date. She was noted to induce emesis by placing her fingers in her mouth. Due to the progressive increase in agitation and [**Last Name (LF) 29399**], [**First Name3 (LF) **] emergent Psychiatry evaluation was obtained. The patient was judged to be a danger to self as well as others, and restraints were indicated. Neither soft nor leather restraints were able to restrain the patient, and chemical restraint was recommended by Psychiatry. The patient received a cocktail of Haldol, Ativan and Cogentin leading to a decrease in her agitation. The next day, the patient woke up much more cooperative and not agitated. 5. PROPHYLAXIS: For prophylaxis, the patient was maintained on subcutaneous heparin and Prevacid through the nasogastric tube. DISCHARGE STATUS: The patient was to be discharged to [**Hospital6 18075**] for psychiatric hospitalization. MEDICATIONS ON DISCHARGE: (Her medications on discharge included) 1. Norvasc 2.5 mg p.o. q.d. 2. Azmacort inhaler 2 puffs b.i.d. 3. Hydrochlorothiazide 25 mg p.o. q.d. 4. Singulair 10 mg p.o. q.d. 5. Albuterol meter-dosed inhaler 2 puffs q.4h. p.r.n. 6. Thiamine 100 mg p.o. q.d. 7. Multivitamin one tablet p.o. q.d. 8. Folate 1 mg p.o. q.d. 9. Compazine 5 mg p.o./p.r. p.r.n. for nausea. CONDITION AT DISCHARGE: Medically stable. [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D. [**MD Number(1) 8285**] Dictated By:[**Last Name (NamePattern1) 1762**] MEDQUIST36 D: [**2145-2-11**] 13:19 T: [**2145-2-13**] 06:13 JOB#: [**Job Number 29400**]

977,296,518,305,E950,787,493

{'Poisoning by other specified drugs and medicinal substances,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Other pulmonary insufficiency, not elsewhere classified,Cocaine abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Vomiting alone,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: Question overdose/unresponsiveness. PRESENT ILLNESS: The patient is a 40-year-old female with a history of depression, hypertension, asthma, and question of prior suicide attempts who presented after being witnessed taking an intentional overdose. Emergency Medical Service found her with four bottles, including Norvasc, Doxepin, clonidine, and Prozac; only the clonidine bottle was empty (by report). MEDICAL HISTORY: 1. Depression, with recent discharge from [**Hospital6 **] for cocaine overdose and depression. 2. Asthma. 3. Hypertension. 4. Ovarian venous thrombosis, for which the patient was started on Coumadin; however, never followed up for further workup and was noncompliant with the medication. MEDICATION ON ADMISSION: Per primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] (telephone number [**Telephone/Fax (1) 1792**]) the patient is supposed to be taking Doxepin 50 mg p.o. q.h.s., Norvasc 2.5 mg p.o. q.d., Prozac 20 mg p.o. q.h.s., Prilosec 20 mg p.o., Ventolin 2 puffs q.i.d., Azmacort 2 puffs t.i.d., hydrochlorothiazide 25 mg p.o. q.d., Neurontin, Accolate. ALLERGIES: NONSTEROIDAL ANTIINFLAMMATORY DRUGS causing rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Unable to obtain social history on arrival; per old record and primary care physician, [**Name10 (NameIs) **] patient is married and lives with her husband and two children. She is under a significant number of stressors at home. She actively uses cocaine. One of her family members is a drug dealer, given the patient free access to the cocaine. ### Response: {'Poisoning by other specified drugs and medicinal substances,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Other pulmonary insufficiency, not elsewhere classified,Cocaine abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Vomiting alone,Asthma, unspecified type, unspecified'}

CHIEF COMPLAINT: bilateral saddle pulmonary emboli PRESENT ILLNESS: 44 yo F with no previous medical history who is transferred from an OSH for bilateral saddle pulmonary emboli who is now s/p percutaneous thrombectomy. She presented to [**Hospital 5279**] Hospital this am complaining of anxiety with hyperventiliation as well as mid back pain with leaning forward. The pt was noted to be anxious on exam and breathing in a paper bag and was given 1 mg IV ativan. An EKG was significant for sinus tachycardia with a S1Q3T3 and RV strain. An ABG was 7.12/25/120/8/97.8 on a NRB and the pt was intubated. This was then followed by HR 32 and the pt was given atropine with improvement in HR to the 50s. A stat chest CTA was significant for bilateral saddle pulmonary emboli with thrombus also seen in the more distal branches of the bilateral pulmonary arteries. Shortly thereafter, the pt was started on levophed at 4 mcg/kg/hr which was titrated up to 20 mcg/kg/hr and vasopressin 0.04 units/hr for SBPs in the 40s. A HCO3 gtt was also started at 200 cc/hr for severe respiratory acidosis on a rpt ABG. She was given 10 units retaplase IV X 1 prior to being transferred to [**Hospital1 18**]. . On arrival, labs were significant for Hct 34.2 and ABG 7.03/69/90/20 with lactate of 6.3. The pt was sent immediately to the OR for percutaneous tPA and thrombectomy. In the OR, a TEE was significant for massive clot burden in the main PA, R PA, and L PA with some flow distally. A percutaneous thrombectomy was performed of the main PA and right PA with residual clot but flow visualized in the right PA. Levophed and vasopressin were shut off and she was started on neo at 2 mcg/kg/min and epi gtt at 0.04. She was also given 100 meq HCO3 and was then transferred to the CCU for further management. . ROS unable to be performed as pt sedated and intubated. Per her family, the pt has not had any recent travel and has not complained recently of shortness of breath, chest pain, or leg swelling/pain. Of note, the family reports that she is a heavy smoker and is on OCPs. MEDICAL HISTORY: Anxiety s/p CCY MEDICATION ON ADMISSION: Aspirin 162 mg po daily Cilostazol 100 mg [**Hospital1 **] Metoprolol Tartrate 75 mg [**Hospital1 **] Pantoprazole 40 mg daily Warfarin 1 mg daily Nitroglycerin 0.4 mg SL prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: (on admission) VS: T 93.5 oral, BP 125/94, HR 114, RR 24, O2 100% on AC FiO2 100%, PEEP 10, TV 600, RR set at 24 Gen: obese female, sedated and intubated. [**Doctor Last Name 13674**] hugger in place. HEENT: pupils dilated and fixed, NGT in L nare, sanguinous fluid draining from R nare, ETT tube in place Neck: RIJ present with area of diffuse ecchymoses and 3X4 palpable hematoma. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. no murmurs appreciated Chest: No chest wall deformities, scoliosis or kyphosis. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. Ext: No c/c/e. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: No family history of blood clots. SOCIAL HISTORY: No alcohol or illicits. 1 PPD X 20 yrs.

Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Acidosis,Cardiogenic shock,Tobacco use disorder

Pulm embol/infarct NEC,Acute kidney failure NOS,Ac DVT/emb prox low ext,Acidosis,Cardiogenic shock,Tobacco use disorder

Admission Date: [**2123-11-23**] Discharge Date: [**2123-11-26**] Date of Birth: [**2079-7-28**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: bilateral saddle pulmonary emboli Major Surgical or Invasive Procedure: percutaneous thrombectomy x2 History of Present Illness: 44 yo F with no previous medical history who is transferred from an OSH for bilateral saddle pulmonary emboli who is now s/p percutaneous thrombectomy. She presented to [**Hospital 5279**] Hospital this am complaining of anxiety with hyperventiliation as well as mid back pain with leaning forward. The pt was noted to be anxious on exam and breathing in a paper bag and was given 1 mg IV ativan. An EKG was significant for sinus tachycardia with a S1Q3T3 and RV strain. An ABG was 7.12/25/120/8/97.8 on a NRB and the pt was intubated. This was then followed by HR 32 and the pt was given atropine with improvement in HR to the 50s. A stat chest CTA was significant for bilateral saddle pulmonary emboli with thrombus also seen in the more distal branches of the bilateral pulmonary arteries. Shortly thereafter, the pt was started on levophed at 4 mcg/kg/hr which was titrated up to 20 mcg/kg/hr and vasopressin 0.04 units/hr for SBPs in the 40s. A HCO3 gtt was also started at 200 cc/hr for severe respiratory acidosis on a rpt ABG. She was given 10 units retaplase IV X 1 prior to being transferred to [**Hospital1 18**]. . On arrival, labs were significant for Hct 34.2 and ABG 7.03/69/90/20 with lactate of 6.3. The pt was sent immediately to the OR for percutaneous tPA and thrombectomy. In the OR, a TEE was significant for massive clot burden in the main PA, R PA, and L PA with some flow distally. A percutaneous thrombectomy was performed of the main PA and right PA with residual clot but flow visualized in the right PA. Levophed and vasopressin were shut off and she was started on neo at 2 mcg/kg/min and epi gtt at 0.04. She was also given 100 meq HCO3 and was then transferred to the CCU for further management. . ROS unable to be performed as pt sedated and intubated. Per her family, the pt has not had any recent travel and has not complained recently of shortness of breath, chest pain, or leg swelling/pain. Of note, the family reports that she is a heavy smoker and is on OCPs. Past Medical History: Anxiety s/p CCY Social History: No alcohol or illicits. 1 PPD X 20 yrs. Family History: No family history of blood clots. Physical Exam: (on admission) VS: T 93.5 oral, BP 125/94, HR 114, RR 24, O2 100% on AC FiO2 100%, PEEP 10, TV 600, RR set at 24 Gen: obese female, sedated and intubated. [**Doctor Last Name 13674**] hugger in place. HEENT: pupils dilated and fixed, NGT in L nare, sanguinous fluid draining from R nare, ETT tube in place Neck: RIJ present with area of diffuse ecchymoses and 3X4 palpable hematoma. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. no murmurs appreciated Chest: No chest wall deformities, scoliosis or kyphosis. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. Ext: No c/c/e. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Foley draining grossly bloody urine Neurologic: sedated, pupils dilated and fixed bilaterally, does not withdraw to pain, does not move extremities spontaneously, slightly decreased motor tone b/l, unable to perform motor strength or sensation testing, +1 DTRs b/l, babinski equivocal b/l, twitch test performed by neurology resident at bedside negative. Pertinent Results: Port CXR [**11-23**] - underinflation with elevation of R diaphragm and bibasilar atelectasis. Cardiomediastinal silhouette and pulmonary vascularity are grossly unremarkable. ETT present in the trachea above the carina. . Chest CTA [**11-23**] - large central saddle pulmonary embolism present with thrombus seen beyond this central saddle embolus in the central and more distal branches of both pulmonary arteries. Scatterred areas of ground glass opacification in both lungs with some pleural thickening on the right. 3 cm long stenotic semenet of hte R common iliac artery on the order of 70% with less than 50% segmental stenosis of the L common iliac artery. . TEE [**11-23**] - Pre-pulmonary angiography: 1. The left atrium is normal in size. 2. Overall left ventricular systolic function is normal (LVEF>55%). 3. The right ventricular cavity is moderately dilated. There is moderate global right ventricular free wall hypokinesis. 4. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. 5. The mitral valve appears structurally normal with trivial mitral regurgitation. 6. Moderate [2+] tricuspid regurgitation is seen. 7. Significant pulmonic regurgitation is seen. The main pulmonary artery is dilated. There is an area of echogenicity in the right pulmonary artery consistent of pulmonary embolism. There is limited flow across this area. An area of echogenicity in the main pulmonary artery cannot be excluded. Unable to visualize the left pulmonary artery. 8. IVC is dilated. Post-pulmonary angiography: 1. The area of echogenicity in the right pulmonary artery has decreased and there is an improvement of flow along the right pulmonary artery. There is flow along the main pulmonary artery. The left pulmonary artery remains difficult to visualize. . BILATERAL LOWER EXTREMITY ULTRASOUND ([**11-23**]): Thrombus is identified within the right popliteal vein extending proximally. However, the superficial femoral vein on the right appears patent with normal compressibility, waveforms, and augmentation. Partially occlusive thrombus is identified within the right common femoral vein. On the left, partially occlusive thrombus identified within the left popliteal vein. Otherwise, the left superficial femoral and common femoral veins appear patent with normal compressibility, waveforms, and augmentation. IMPRESSION: Thrombus identified within the right popliteal vein with non- occlusive thrombus within the right common femoral vein. Likely thrombus identified within the left popliteal vein. . CTA [**11-24**]: Bilateral pulmonary embolism as described above. Multifocal opacities/nodular opacities/ and consolidation in the lungs. Notably, the area of consolidation in the right lower lobe appears to have components of ischemia/infarction; less likely would be a component of pneumonia. Recommend follow up after clinical treatment to demonstrate resolution of these findings. Soft tissue stranding in the anterior superior chest, surrounding the trachea in the superior mediastinum, and supraclavicular regions. . Echo [**11-24**]: LV unusually small. RV markedly dilated. severe global RV free wall hypokinesis. abnormal diastolic septal motion/position consistent with RV volume overload. no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Suboptimal images due to patient being intubated. The right ventricle appears markedly dilated and moderately to severely hypokinetic. Pressure overload of the right ventricle. LV cavity appears small, probably due to compressive effect of the large RV. LV function appears normal/hyperdynamic. Brief Hospital Course: As mentioned above, on arrival to BIMDC labs were significant for Hct 34.2 and ABG 7.03/69/90/20 with lactate of 6.3. The pt was sent immediately to the OR for percutaneous tPA and thrombectomy. In the OR, a TEE was significant for massive clot burden in the main PA, R PA, and L PA with some flow distally. A percutaneous thrombectomy was performed of the main PA and right PA with residual clot but flow visualized in the right PA. Pt was brought up to the CCU where she was very tenuous with hypotension requiring quadruple pressors, and multisystem organ failure including renal, liver, GI tract, endocrine, neurological systems [**2-5**] the bilateral saddle pulmonary embolism and subsequent hypotension (and possibly to to embolisms to other organs other than lung). Pt had a lactate at 11.1 that evantually peaked at 17 requiring nuumerous amps of bicarb. She received blood transfusions for oozing from several sites and for coffee ground, bloody drainage from upper GI tract throught the NGT. A STAT CT scan of the head was negative for intracranial bleed on admission. Pt had no risk factors for PE other than being on OCPs and smoker. With signs of RV strain and dilatation on initial EKG and echos. Once PTT was at goal, the heparin was restarted and continued. LENIS were positive for bilteral DVTs that were compressible suggesting fresh clots. Pt was seen by neuro who thought but had little brain and brain stem fn but given young, there was still a small hope she would recover some function if surviving the first 24 hrs. Pt managed to make it through the first night and then when weaned off sedation there was a question from neuro about weather she had recovery of her function to some extent; therefore she was taken back to have another percutaneous thrombectomy and placement of an IVC filter. Despite this pt continued to require 4 pressors with worsening multisystem organ failure. Her neuro exam was relevant for absent gag reflex, corneal reflex, with sluggish pupillary response and only response to pain was decortication. The prognosis was thought to be exceedingly poor at this time since it had been >72 hrs since first presenting at the OSH. After discussion with the family including the HCP [**Name (NI) **] [**Name (NI) 75456**] on [**2123-11-26**], the decision was made to make the pt cmo. Pt expired soon thereafter and was pronounced at 17:12 on [**11-26**]. Medications on Admission: Aspirin 162 mg po daily Cilostazol 100 mg [**Hospital1 **] Metoprolol Tartrate 75 mg [**Hospital1 **] Pantoprazole 40 mg daily Warfarin 1 mg daily Nitroglycerin 0.4 mg SL prn Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Saddle embolus/pulmonary embolism Multisystem organ failure Cardiopulmonary arrest Discharge Condition: Expired Discharge Instructions: N/A Followup Instructions: N/A

415,584,453,276,785,305

{'Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Acidosis,Cardiogenic shock,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: bilateral saddle pulmonary emboli PRESENT ILLNESS: 44 yo F with no previous medical history who is transferred from an OSH for bilateral saddle pulmonary emboli who is now s/p percutaneous thrombectomy. She presented to [**Hospital 5279**] Hospital this am complaining of anxiety with hyperventiliation as well as mid back pain with leaning forward. The pt was noted to be anxious on exam and breathing in a paper bag and was given 1 mg IV ativan. An EKG was significant for sinus tachycardia with a S1Q3T3 and RV strain. An ABG was 7.12/25/120/8/97.8 on a NRB and the pt was intubated. This was then followed by HR 32 and the pt was given atropine with improvement in HR to the 50s. A stat chest CTA was significant for bilateral saddle pulmonary emboli with thrombus also seen in the more distal branches of the bilateral pulmonary arteries. Shortly thereafter, the pt was started on levophed at 4 mcg/kg/hr which was titrated up to 20 mcg/kg/hr and vasopressin 0.04 units/hr for SBPs in the 40s. A HCO3 gtt was also started at 200 cc/hr for severe respiratory acidosis on a rpt ABG. She was given 10 units retaplase IV X 1 prior to being transferred to [**Hospital1 18**]. . On arrival, labs were significant for Hct 34.2 and ABG 7.03/69/90/20 with lactate of 6.3. The pt was sent immediately to the OR for percutaneous tPA and thrombectomy. In the OR, a TEE was significant for massive clot burden in the main PA, R PA, and L PA with some flow distally. A percutaneous thrombectomy was performed of the main PA and right PA with residual clot but flow visualized in the right PA. Levophed and vasopressin were shut off and she was started on neo at 2 mcg/kg/min and epi gtt at 0.04. She was also given 100 meq HCO3 and was then transferred to the CCU for further management. . ROS unable to be performed as pt sedated and intubated. Per her family, the pt has not had any recent travel and has not complained recently of shortness of breath, chest pain, or leg swelling/pain. Of note, the family reports that she is a heavy smoker and is on OCPs. MEDICAL HISTORY: Anxiety s/p CCY MEDICATION ON ADMISSION: Aspirin 162 mg po daily Cilostazol 100 mg [**Hospital1 **] Metoprolol Tartrate 75 mg [**Hospital1 **] Pantoprazole 40 mg daily Warfarin 1 mg daily Nitroglycerin 0.4 mg SL prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: (on admission) VS: T 93.5 oral, BP 125/94, HR 114, RR 24, O2 100% on AC FiO2 100%, PEEP 10, TV 600, RR set at 24 Gen: obese female, sedated and intubated. [**Doctor Last Name 13674**] hugger in place. HEENT: pupils dilated and fixed, NGT in L nare, sanguinous fluid draining from R nare, ETT tube in place Neck: RIJ present with area of diffuse ecchymoses and 3X4 palpable hematoma. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. no murmurs appreciated Chest: No chest wall deformities, scoliosis or kyphosis. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. Ext: No c/c/e. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: No family history of blood clots. SOCIAL HISTORY: No alcohol or illicits. 1 PPD X 20 yrs. ### Response: {'Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Acidosis,Cardiogenic shock,Tobacco use disorder'}

CHIEF COMPLAINT: Chest pain and Shortness of Breath PRESENT ILLNESS: History of Present Illness: 76 yo male history of anoxic brain injury s/p likely vfib arrest, ESRD on HD MWF, HTN, and DMII presenting from rehab with SOB. Per report, patient awoke with substernal chest pain and shortness of breath around 11:30 AM. MEDICAL HISTORY: Anoxic brain injury s/p likely VF arrest in the setting of hyperkalemia CKD stage V, on HD MWF at [**Hospital **] hospital HTN DM II Severe peripheral neuropathy Glaucoma Depression MEDICATION ON ADMISSION: 1. Amlodipine 10 mg PO DAILY Hold for SBP<100 2. Omeprazole 20 mg PO DAILY 3. Finasteride 5 mg PO DAILY 4. Nephrocaps 1 CAP PO DAILY 5. brimonidine *NF* 0.2 % OU [**Hospital1 **] 6. Senna 1 TAB PO BID 7. Levobunolol 0.25% 1 DROP BOTH EYES [**Hospital1 **] 8. Docusate Sodium 100 mg PO BID 9. Calcium Acetate 667 mg PO TID W/MEALS 10. Pilocarpine 1% 1 DROP RIGHT EYE QID 11. Acetaminophen 500 mg PO QOD HS 12. Gabapentin 400 mg PO HS 13. Carvedilol 12.5 mg PO BID Hold for SBP<100, HR<60 14. Lisinopril 40 mg PO DAILY Hold for SBP<100 15. Guaifenesin 20 mL PO TID cough 16. Loperamide 2 mg PO QID:PRN diarrhea 17. Polyethylene Glycol 17 g PO BID:PRN constipation 18. Epoetin Alfa 0.6 mL SC M,W,F AT HD 19. Lidocaine 5% Patch 1 PTCH TD DAILY 20. Isosorbide Mononitrate 30 mg PO QAM Hold for SBP<120 21. Loratadine *NF* 10 mg Oral qd itching, allergic rash 22. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 23. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin ALLERGIES: Lovenox / aspirin PHYSICAL EXAM: ADMIT EXAM: Vitals: T 97.6, HR 81, BP 196/93, RR 22, satting 99% ON 3L General: Alert, oriented, appears uncomfortable HEENT: Sclera anicteric, MMM, oropharynx clear with poor dentition, EOMI, PERRL Neck: supple, no LAD CV: Regular rate and rhythm, normal S1 + S2, pansystolic murmur as well as [**4-4**] crescendo descrescendo murmur best auscultated parasternally. No rubs, gallops Lungs: Diffuse crackles with wheezes. Abdomen: soft, mild tenderness to palpation in epigastric region. Non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused,1+ pulses, no clubbing, cyanosis or edema. Fistula with palpable thrill and auscultated bruit in LUE. Neuro: Alert and oriented to person and place. CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred. FAMILY HISTORY: No history of cardiac disease, diabetes. SOCIAL HISTORY: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043 - Tobacco: None - Alcohol: None - Illicits: None

End stage renal disease,Acute on chronic systolic heart failure,Anoxic brain damage,Other acute and subacute forms of ischemic heart disease, other,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,Other fluid overload,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Renal dialysis status,Leukocytopenia, unspecified,Polyneuropathy in diabetes,Unspecified glaucoma,Anemia, unspecified,Depressive disorder, not elsewhere classified,Personal history of sudden cardiac arrest,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin

End stage renal disease,Ac on chr syst hrt fail,Anoxic brain damage,Ac ischemic hrt dis NEC,Hyp ht/kd NOS st V w hf,Fluid overload NEC,DMII renl nt st uncntrld,Nephritis NOS in oth dis,Renal dialysis status,Leukocytopenia NOS,Neuropathy in diabetes,Glaucoma NOS,Anemia NOS,Depressive disorder NEC,Hx sudden cardiac arrest,Crnry athrscl natve vssl,Long-term use of insulin

Admission Date: [**2141-9-4**] Discharge Date: [**2141-9-5**] Date of Birth: [**2064-11-4**] Sex: M Service: MEDICINE Allergies: Lovenox / aspirin Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Chest pain and Shortness of Breath Major Surgical or Invasive Procedure: Hemodialysis (Monday, Wednesday, Friday each week) History of Present Illness: History of Present Illness: 76 yo male history of anoxic brain injury s/p likely vfib arrest, ESRD on HD MWF, HTN, and DMII presenting from rehab with SOB. Per report, patient awoke with substernal chest pain and shortness of breath around 11:30 AM. In the ED, initial VS were: T97.4, HR87 BP190/87 RR22 satting 100% on NRB. Labs showed CBC with HCT of 39, otherwise rest of CBC WNL, pro BNP of [**Numeric Identifier **], Normal LFTs except for an AP of 135, and a CMP showing hyponatremia with Na of 129, hyperkalemia of 5.5, CL of 95, BUN 54, Cr of 6.9 and glucose of 251. Troponins were checked with a Trop of 0.34 with baseline in the 0.25 to 0.4 region. EKG performed showed sinus rhythm with peaked TW in the anterior leads, as well as TWI in AVL and V1. LVH present as well as LAE. No other ST/ischemic changes were noted. CXR showed bilateral infiltrates with superimposed fluid overload. Patient was provided with IV vancomycin and levofloxacin for empiric tx of PNA. In the ICU patient is complaining of [**8-8**] chest/belly pain Past Medical History: Anoxic brain injury s/p likely VF arrest in the setting of hyperkalemia CKD stage V, on HD MWF at [**Hospital **] hospital HTN DM II Severe peripheral neuropathy Glaucoma Depression Social History: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043 - Tobacco: None - Alcohol: None - Illicits: None Family History: No history of cardiac disease, diabetes. Physical Exam: ADMIT EXAM: Vitals: T 97.6, HR 81, BP 196/93, RR 22, satting 99% ON 3L General: Alert, oriented, appears uncomfortable HEENT: Sclera anicteric, MMM, oropharynx clear with poor dentition, EOMI, PERRL Neck: supple, no LAD CV: Regular rate and rhythm, normal S1 + S2, pansystolic murmur as well as [**4-4**] crescendo descrescendo murmur best auscultated parasternally. No rubs, gallops Lungs: Diffuse crackles with wheezes. Abdomen: soft, mild tenderness to palpation in epigastric region. Non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused,1+ pulses, no clubbing, cyanosis or edema. Fistula with palpable thrill and auscultated bruit in LUE. Neuro: Alert and oriented to person and place. CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred. DISCHARGE EXAM: Pertinent Results: IMAGING: CXR [**2141-9-4**] - FINDINGS: Diffuse parenchymal opacities with areas of increased interstitial markings are consistent with development of moderate pulmonary edema. No pneumothorax is seen. There is mild cardiomegaly. There may be small pleural effusions. Surgical clips are noted in the region of the gastroesophageal junction. MICRO/PATH: ADMIT LABS: [**2141-9-4**] 12:30AM BLOOD WBC-6.3 RBC-5.03 Hgb-11.4* Hct-39.0* MCV-78* MCH-22.7* MCHC-29.2* RDW-17.1* Plt Ct-176 [**2141-9-4**] 12:30AM BLOOD Neuts-77.2* Lymphs-15.2* Monos-5.5 Eos-1.7 Baso-0.4 [**2141-9-4**] 12:30AM BLOOD Plt Ct-176 [**2141-9-4**] 04:39AM BLOOD PT-10.1 PTT-32.5 INR(PT)-0.9 [**2141-9-4**] 12:30AM BLOOD Glucose-251* UreaN-54* Creat-6.9*# Na-129* K-5.5* Cl-95* HCO3-23 AnGap-17 [**2141-9-4**] 12:30AM BLOOD ALT-27 AST-27 AlkPhos-135* [**2141-9-4**] 12:30AM BLOOD proBNP-[**Numeric Identifier **]* [**2141-9-4**] 12:30AM BLOOD cTropnT-0.34* [**2141-9-4**] 12:30AM BLOOD Albumin-4.1 Calcium-9.1 Phos-4.5# Mg-2.7* [**2141-9-4**] 04:50AM BLOOD Type-[**Last Name (un) **] pO2-44* pCO2-52* pH-7.29* calTCO2-26 Base XS--1 [**2141-9-4**] 12:40AM BLOOD Lactate-0.8 K-5.3* RELEVENT LABS: [**2141-9-4**] 04:39AM BLOOD WBC-5.2 RBC-4.87 Hgb-11.1* Hct-37.9* MCV-78* MCH-22.9* MCHC-29.4* RDW-17.0* Plt Ct-155 [**2141-9-4**] 04:39AM BLOOD Plt Ct-155 [**2141-9-4**] 04:39AM BLOOD Glucose-314* UreaN-52* Creat-6.5* Na-129* K-5.1 Cl-96 HCO3-23 AnGap-15 Brief Hospital Course: 76 year old male with anoxic brain injury s/p likely vfib arrest, end stage renal disease on hemodialysis three times a week (monday, wednesday, friday), hypertension, and type two presenting from rehab with shortness of breath and chest pain. # Chest Pain: Intial chest xray shows bilateral multiple inflitrates concerning for fluid overload from flash pulmonary edema. While acute coronary syndrome was a concern, troponins were initially around baseline without evidence of EKG changes. While in the MICU he was treated with a nitroprusside drip given his hypertension to 220's systolic and underwent hemodialysis with the removal of 3.3 liters. His chest pain and shortness of breath resolved. Repeat EKG's and cardiac markers were unconcerning for a cardiac etiology. # Respiratory distress: Pt likely volume overloaded from renal failure and superimposed congestive heart failure exacerbation given elevated BNP, appearance of CXR, hypertension and history of similar episodes. His respiratory status improved with hemodialysis and nebulizers of albuterol and ipratropium. On day of discharge, he was dialyzed and 1.8L were removed. It appears that this is a recurrent process which may be related to inability to fully ultrafiltrate patient because BPs tend to fall. ****It is important that patient receive antihypertensives after dialysis sessions.**** [**Hospital1 **] Dialysis team will communicate with outpatient nephrologist. # End Stage Renal Disease: On hemodialysis monday, wednesday, and friday. While in the MICU we renally dosed his medication and treated him with Nephrocaps, calcium acetate, Vitamin D. On day of discharge, 1.9L were dialyzed off. For further comments see above. # Hypertension: Pt was hypertensive to systolic blood pressure of 220s on admission. Initially he was started on a nitroglycerin drip to drop pre-load and underwent dialysis for volume removal as above. He was continued on his home amlodipine, lisinopril, and carvedilol. His pulse pressure remained high, likely secondary to his fistula. # Coronary Artery Disease and Systolic Congestive Heart Failure: No evidence of acute coronary syndrome on EKG. Tropnin leak likely secondary to demand ischemia. He was constinued on his [**Last Name (un) **] medications one dialysis was complete. His BNP was elevated suggesting a acute CHF exacerbation. Unclear etiology. [**Month (only) 116**] be dietary indiscrestion or underlaying infection or inadequate fluid removal during dialysis. #Diabetes Mellitus: Chronic issue. Placed on insulin sliding scale. #Glaucoma: Chronic issue. Continued outpatient eyedrops. Transitional Issues: 1) Please check CBC on Wednseday [**9-6**] to follow up on mild leukopenia. 2) Please be sure to give antihypertensives after diaylsis sessions per renal recommendations. Medications on Admission: 1. Amlodipine 10 mg PO DAILY Hold for SBP<100 2. Omeprazole 20 mg PO DAILY 3. Finasteride 5 mg PO DAILY 4. Nephrocaps 1 CAP PO DAILY 5. brimonidine *NF* 0.2 % OU [**Hospital1 **] 6. Senna 1 TAB PO BID 7. Levobunolol 0.25% 1 DROP BOTH EYES [**Hospital1 **] 8. Docusate Sodium 100 mg PO BID 9. Calcium Acetate 667 mg PO TID W/MEALS 10. Pilocarpine 1% 1 DROP RIGHT EYE QID 11. Acetaminophen 500 mg PO QOD HS 12. Gabapentin 400 mg PO HS 13. Carvedilol 12.5 mg PO BID Hold for SBP<100, HR<60 14. Lisinopril 40 mg PO DAILY Hold for SBP<100 15. Guaifenesin 20 mL PO TID cough 16. Loperamide 2 mg PO QID:PRN diarrhea 17. Polyethylene Glycol 17 g PO BID:PRN constipation 18. Epoetin Alfa 0.6 mL SC M,W,F AT HD 19. Lidocaine 5% Patch 1 PTCH TD DAILY 20. Isosorbide Mononitrate 30 mg PO QAM Hold for SBP<120 21. Loratadine *NF* 10 mg Oral qd itching, allergic rash 22. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 23. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Medications: 1. Amlodipine 10 mg PO DAILY 2. Omeprazole 20 mg PO DAILY 3. Finasteride 5 mg PO DAILY 4. Nephrocaps 1 CAP PO DAILY 5. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES [**Hospital1 **] 6. Senna 1 TAB PO BID:PRN constipation 7. Levobunolol 0.25% 1 DROP BOTH EYES [**Hospital1 **] 8. Docusate Sodium 100 mg PO BID 9. Calcium Acetate 667 mg PO TID W/MEALS 10. Pilocarpine 1% 1 DROP RIGHT EYE Q6H 11. Acetaminophen 500 mg PO Q6H:PRN pain 12. Gabapentin 400 mg PO HS 13. Carvedilol 12.5 mg PO BID 14. Lisinopril 40 mg PO DAILY 15. Guaifenesin 20 mL PO TID cough 16. Epoetin Alfa 0.6 ml SC M,W,F AT HD 17. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 18. Lidocaine 5% Patch 1 PTCH TD DAILY 19. Loperamide 2 mg PO QID:PRN diarrhea 20. Loratadine *NF* 10 mg Oral qday:prn itching 21. Polyethylene Glycol 17 g PO BID:PRN constipation 22. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 23. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Extended Care Facility: [**Hospital3 537**]- [**Location (un) 538**] Discharge Diagnosis: Hypertensive urgency Pulmonary edema Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Mr. [**Known lastname 1058**], You were admitted to the hospital when you were short of breath and had a high blood pressure. You required care in the intensive care unit for your blood pressure and you needed an extra course of dialysis to get fluid off of your lungs. It is unclear exactly why your blood pressure went so high. You were stable after this and are now safe to go back to your rehab facility. No medication changes were made **Your white blood cell count was a little low at the time of discharge and this will need to be rechecked at rehab on [**2141-9-6**]** Followup Instructions: Department: SURGICAL SPECIALTIES When: TUESDAY [**2141-10-17**] at 2:45 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 11307**], MD [**Telephone/Fax (1) 3752**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 1935**] CENTER When: THURSDAY [**2141-11-16**] at 1:45 PM With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

585,428,348,411,404,276,250,583,V451,288,357,365,285,311,V125,414,V586

{'End stage renal disease,Acute on chronic systolic heart failure,Anoxic brain damage,Other acute and subacute forms of ischemic heart disease, other,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,Other fluid overload,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Renal dialysis status,Leukocytopenia, unspecified,Polyneuropathy in diabetes,Unspecified glaucoma,Anemia, unspecified,Depressive disorder, not elsewhere classified,Personal history of sudden cardiac arrest,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin'}

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 and Shortness of Breath PRESENT ILLNESS: History of Present Illness: 76 yo male history of anoxic brain injury s/p likely vfib arrest, ESRD on HD MWF, HTN, and DMII presenting from rehab with SOB. Per report, patient awoke with substernal chest pain and shortness of breath around 11:30 AM. MEDICAL HISTORY: Anoxic brain injury s/p likely VF arrest in the setting of hyperkalemia CKD stage V, on HD MWF at [**Hospital **] hospital HTN DM II Severe peripheral neuropathy Glaucoma Depression MEDICATION ON ADMISSION: 1. Amlodipine 10 mg PO DAILY Hold for SBP<100 2. Omeprazole 20 mg PO DAILY 3. Finasteride 5 mg PO DAILY 4. Nephrocaps 1 CAP PO DAILY 5. brimonidine *NF* 0.2 % OU [**Hospital1 **] 6. Senna 1 TAB PO BID 7. Levobunolol 0.25% 1 DROP BOTH EYES [**Hospital1 **] 8. Docusate Sodium 100 mg PO BID 9. Calcium Acetate 667 mg PO TID W/MEALS 10. Pilocarpine 1% 1 DROP RIGHT EYE QID 11. Acetaminophen 500 mg PO QOD HS 12. Gabapentin 400 mg PO HS 13. Carvedilol 12.5 mg PO BID Hold for SBP<100, HR<60 14. Lisinopril 40 mg PO DAILY Hold for SBP<100 15. Guaifenesin 20 mL PO TID cough 16. Loperamide 2 mg PO QID:PRN diarrhea 17. Polyethylene Glycol 17 g PO BID:PRN constipation 18. Epoetin Alfa 0.6 mL SC M,W,F AT HD 19. Lidocaine 5% Patch 1 PTCH TD DAILY 20. Isosorbide Mononitrate 30 mg PO QAM Hold for SBP<120 21. Loratadine *NF* 10 mg Oral qd itching, allergic rash 22. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 23. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin ALLERGIES: Lovenox / aspirin PHYSICAL EXAM: ADMIT EXAM: Vitals: T 97.6, HR 81, BP 196/93, RR 22, satting 99% ON 3L General: Alert, oriented, appears uncomfortable HEENT: Sclera anicteric, MMM, oropharynx clear with poor dentition, EOMI, PERRL Neck: supple, no LAD CV: Regular rate and rhythm, normal S1 + S2, pansystolic murmur as well as [**4-4**] crescendo descrescendo murmur best auscultated parasternally. No rubs, gallops Lungs: Diffuse crackles with wheezes. Abdomen: soft, mild tenderness to palpation in epigastric region. Non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused,1+ pulses, no clubbing, cyanosis or edema. Fistula with palpable thrill and auscultated bruit in LUE. Neuro: Alert and oriented to person and place. CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred. FAMILY HISTORY: No history of cardiac disease, diabetes. SOCIAL HISTORY: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043 - Tobacco: None - Alcohol: None - Illicits: None ### Response: {'End stage renal disease,Acute on chronic systolic heart failure,Anoxic brain damage,Other acute and subacute forms of ischemic heart disease, other,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,Other fluid overload,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Renal dialysis status,Leukocytopenia, unspecified,Polyneuropathy in diabetes,Unspecified glaucoma,Anemia, unspecified,Depressive disorder, not elsewhere classified,Personal history of sudden cardiac arrest,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 55-year-old male with a history of alcohol abuse, who is admitted on [**4-15**] after being found down and having a generalized tonoclonic seizure. He was admitted to the MICU after being intubated for mental status. His MICU course was significant for an upper endoscopy showing Grade I varices with erosions in the stomach and esophagus as well as duodenitis. The patient also had paracentesis which was bloody, but ultimately was not a surgical abdomen. He was also diagnosed with spontaneous bacterial peritonitis and treated with IV ceftriaxone. MEDICAL HISTORY: 1. Alcohol abuse. 2. End-stage liver disease. 3. Posttraumatic stress disorder with suicidal ideation. 4. History of falls. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Significant for mother who died of end-stage liver disease and hepatoma. SOCIAL HISTORY: The patient is estranged from his family and really only has contact with the local friend.

Hepatic encephalopathy,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Other convulsions,Hemoperitoneum (nontraumatic),Hyperosmolality and/or hypernatremia,Alcohol withdrawal,Esophageal varices in diseases classified elsewhere, with bleeding

Hepatic encephalopathy,Alcohol cirrhosis liver,Alcoh dep NEC/NOS-contin,Convulsions NEC,Hemoperitoneum,Hyperosmolality,Alcohol withdrawal,Bleed esoph var oth dis

Admission Date: [**2190-4-15**] Discharge Date: [**2190-5-5**] Date of Birth: [**2134-11-3**] Sex: M Service: [**Company 191**] MEDICINE REASON FOR ADMISSION: Tonoclonic seizure, encephalopathy. HISTORY OF PRESENT ILLNESS: This is a 55-year-old male with a history of alcohol abuse, who is admitted on [**4-15**] after being found down and having a generalized tonoclonic seizure. He was admitted to the MICU after being intubated for mental status. His MICU course was significant for an upper endoscopy showing Grade I varices with erosions in the stomach and esophagus as well as duodenitis. The patient also had paracentesis which was bloody, but ultimately was not a surgical abdomen. He was also diagnosed with spontaneous bacterial peritonitis and treated with IV ceftriaxone. He also developed transfusion related lung injury related to his fresh-frozen plasma transfusions. He was extubated five days prior to transfer to the [**Company 191**] Medicine service and has had a decreasing oxygen requirement. He had been treated for hepatic encephalopathy with lactulose with some clinical improvement. He was now transferred to the [**Company 191**] Medicine Service since he no longer needed Intensive Care Unit care. PAST MEDICAL HISTORY: 1. Alcohol abuse. 2. End-stage liver disease. 3. Posttraumatic stress disorder with suicidal ideation. 4. History of falls. MEDICATIONS UPON TRANSFER: 1. Lacrilube. 2. Artificial Tears. 3. Vitamin K 10 mg subQ q day. 4. Multivitamins 5 mL np/NG tube q day. 5. Lansoprazole 30 mg/NG tube q day. 6. Vitamin B12 15 mcg/NG tube q day. 7. Furosemide 40 mg nasogastric tube [**Hospital1 **]. 8. Metronidazole 500 mg nasogastric tube tid. 9. Folic acid 1 mg nasogastric tube q day. 10. Thiamine 100 mcg nasogastric tube q day. 11. Ceftriaxone 1 mg IV bid. 12. Lactulose 30 mL nasogastric tube tid to produce [**3-8**] bowel movements. 13. Nadolol 20 mg nasogastric tube q day. 14. Spironolactone 100 mg nasogastric tube q day. 15. Ursodiol 300 mg nasogastric tube tid. SOCIAL HISTORY: The patient is estranged from his family and really only has contact with the local friend. FAMILY HISTORY: Significant for mother who died of end-stage liver disease and hepatoma. EXAM UPON PRESENTATION: Temperature 98.8 axillary, blood pressure 110/68, heart rate 95, respiratory rate 22, and O2 saturation is 96% on 2 liters. In general, he is jaundiced and alert, but mumbling indistinct words. His HEENT examination reveals a nasogastric tube in place with dry mucous membranes. His lungs revealed diffuse crackles bilaterally in the anterior portions. Cardiovascular examination reveals a regular, rate, and rhythm without murmurs, rubs, or gallops. His abdomen is protuberant and tense. It seemed slightly tender diffusely. There are diminished bowel sounds. Extremities show no pedal edema and warm to the touch. Neurologic examination reveals a patient who can follow simple one step commands such as stick out your tongue and close your eyes. He is able to say his name and perseverates on the word [**Known lastname **]. He moves all four extremities and there is no facial asymmetry. LABORATORIES UPON TRANSFER: White count 17.1, hematocrit 36.3, platelets 177 with a MCV of 103. The Chem-7 is unremarkable. The LFTs show an ALT of 31, AST of 110, alkaline phosphatase of 258, total bilirubin of 27, albumin is 2.5, INR is 3.9, PT 24.2, PTT 42.9. IMAGING: CT scan of the abdomen done on [**2190-4-14**] showed multiple nodules in the liver with moderate ascites and thickening of the right colon wall. Chest x-ray done on [**2190-4-24**] show bilateral parenchymal opacities greater on the left than on the right. HOSPITAL COURSE BY PROBLEMS: 1. Liver disease: The patient was clearly in decompensated liver disease and had radiographic evidence of hepatoma as a complication of end-stage cirrhotic liver. The Liver Service was consulted for help with management with this patient. They recommended lactulose and ursodiol as well as albumin postparacentesis. They continued to follow the patient, and given the patient's extremely high bilirubin and mental status which was not improving with daily lactulose 3x a day as well as evidence of a severe coagulopathy, they recommended comfort measures only. During this time, it was difficult to find next of [**Doctor First Name **] for the patient. Eventually, the patient's brother, [**Name (NI) **] [**Name (NI) **], was contact[**Name (NI) **]. [**Name2 (NI) **] was explained the situation regarding the patient's irreversible medical disease and explained the risks and benefits of changing the code status of do not resuscitate and do not intubate. The patient's brother agreed to the do not resuscitate and do not intubate order given the irreversible nature of this patient's disease. In addition, as the patient remained on the floor with supportive measures, it was also approached with the brother whether or not comfort measures should be taken for this patient including removal of the nasogastric tube. This was explained to the brother, who considered it and decided to make the patient comfort measures only. The nasogastric tube was pulled and only Morphine and Artificial Tears remained on the patient's medication record for comfort only. The patient passed away shortly after making him comfort measures only. He appeared to have significant epistaxis and underwent respiratory failure subsequent to that, and he was declared dead on [**5-5**] at approximately 8:09 am. A postmortem examination was declined. Family members including the brother of the patient as well as the daughter of the patient were notified of his death. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. Dictated By:[**Name8 (MD) 4064**] MEDQUIST36 D: [**2190-5-12**] 19:48 T: [**2190-5-13**] 07:12 JOB#: [**Job Number 49272**]

572,571,303,780,568,276,291,456

{'Hepatic encephalopathy,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Other convulsions,Hemoperitoneum (nontraumatic),Hyperosmolality and/or hypernatremia,Alcohol withdrawal,Esophageal varices in diseases classified elsewhere, with bleeding'}

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 55-year-old male with a history of alcohol abuse, who is admitted on [**4-15**] after being found down and having a generalized tonoclonic seizure. He was admitted to the MICU after being intubated for mental status. His MICU course was significant for an upper endoscopy showing Grade I varices with erosions in the stomach and esophagus as well as duodenitis. The patient also had paracentesis which was bloody, but ultimately was not a surgical abdomen. He was also diagnosed with spontaneous bacterial peritonitis and treated with IV ceftriaxone. MEDICAL HISTORY: 1. Alcohol abuse. 2. End-stage liver disease. 3. Posttraumatic stress disorder with suicidal ideation. 4. History of falls. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Significant for mother who died of end-stage liver disease and hepatoma. SOCIAL HISTORY: The patient is estranged from his family and really only has contact with the local friend. ### Response: {'Hepatic encephalopathy,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Other convulsions,Hemoperitoneum (nontraumatic),Hyperosmolality and/or hypernatremia,Alcohol withdrawal,Esophageal varices in diseases classified elsewhere, with bleeding'}

CHIEF COMPLAINT: Bright red blood per rectum. PRESENT ILLNESS: Mr. [**Known lastname 7710**] is a 65 yo male with a history of metastatic renal cell carcinoma on Sutent, CAD, DM who presented with BRBPR rectum on [**5-27**]. This had been going on for two days. Yesterday morning he went to clinic where hct was found to be 19,with sbp in the 90's and he was sent to the ER. . In the ED, patient's hct was found to be 17. His pulse was 79, and bp was 160's/70's. He was transfused one unit prbc. GI was made aware. He was sent to the MICU for further monitoring. . In the MICU the patient was tranfused 2 additional units and hct was 25.8 this AM. Did not have any episodes of BRBPR since being in the ER. Was seen by GI today who took him for EGD/colonoscopy as well as ERCP b/c his Tbili rose rapidly. Results are still pending. Patient did have some lightheadedness this yesterday but denied upon arrival to the MICU. He denies n/v/chest pain/sob MEDICAL HISTORY: PMH: Onc hx as of [**12-24**]: Mr. [**Known lastname 7710**] presented in [**2176-10-19**] with urinary retention, ultrasound revealing a mass in the right kidney, surgery was delayed, but he underwent right nephrectomy on [**2177-3-14**], revealing a 10-cm tumor clear cell pathology, [**Last Name (un) 9951**] grade 3 to 4, with tumor extension into the perinephric tissues. The patient was staged as a T3. Two lymph nodes were involved. However, at the time of diagnosis, there was no evidence of distant metastatic disease. The patient was enrolled in the ARISER clinical trial randomized phase III double blind adjuvant study involving cG250 versus placebo, received twelve weeks of therapy, at which point, a CAT scan demonstrating increased retroperitoneal lymph nodes suggestive of metastatic disease. He underwent a cardiac catheterization with stent placement for symptoms of angina on [**2177-7-30**], to the RCA. He has been asymptomatic since then from a cardiac standpoint. Followup CT in mid [**Month (only) 216**] revealed slight increase in size of retroperitoneal lymph nodes, and since then the patient has intermittent history of abdominal pain, which has become progressive in nature. High-dose IL-2 was initiated on the high-dose IL-2 select trial on [**2177-12-22**]. He received 11 out of 14 doses and was stopped secondary to neurotoxicity. His last treatment was delayed in the setting of the elevated creatinine MEDICATION ON ADMISSION: Aspirin 81 Humalog SS HYTRIN 2 mg daily Lantus Lipitor 20mg Levothyroxine 100 mcg daily Oxycodone 20 mg--1 tablet(s) by mouth twice a day Prilosec SUTENT 12.5 mg--3 capsule(s) by mouth once a day total of 37.5mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T 100.6 P 80 BP 156/72 O2 100% RA Wt 77 KG GEN: awake, nad, pale HEENT: PERRLA/EOMI Lungs: CTA x 2 CV: RRR, s1 s2 Abd: soft, diffusely mildly tender, indwelling foley, no r/g Ext: no c/c/e Rectal with brown stool with brbpr in ed FAMILY HISTORY: father with lung ca SOCIAL HISTORY: quit smoking 25 yrs ago, no etoh, no drugs. Works in construction-office job has not worked since [**Month (only) **]. Lives alone. Has wife with 3 kids. Wants daughter to be hcp if any emergency.

Malignant neoplasm of liver, secondary,Hemorrhage of gastrointestinal tract, unspecified,Other specified retention of urine,Other venous embolism and thrombosis of inferior vena cava,Hepatitis, unspecified,Personal history of malignant neoplasm of kidney,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstruction of bile duct,Internal hemorrhoids without mention of complication,Esophageal reflux,Anemia, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)

Second malig neo liver,Gastrointest hemorr NOS,Oth spcf retention urine,Oth inf vena cava thromb,Hepatitis NOS,Hx of kidney malignancy,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Hypothyroidism NOS,Obstruction of bile duct,Int hemorrhoid w/o compl,Esophageal reflux,Anemia NOS,BPH w urinary obs/LUTS

Admission Date: [**2178-5-27**] Discharge Date: [**2178-5-30**] Date of Birth: [**2113-1-4**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 18369**] Chief Complaint: Bright red blood per rectum. Major Surgical or Invasive Procedure: EGD, colonoscopy, ERCP with common bile duct stent placement. History of Present Illness: Mr. [**Known lastname 7710**] is a 65 yo male with a history of metastatic renal cell carcinoma on Sutent, CAD, DM who presented with BRBPR rectum on [**5-27**]. This had been going on for two days. Yesterday morning he went to clinic where hct was found to be 19,with sbp in the 90's and he was sent to the ER. . In the ED, patient's hct was found to be 17. His pulse was 79, and bp was 160's/70's. He was transfused one unit prbc. GI was made aware. He was sent to the MICU for further monitoring. . In the MICU the patient was tranfused 2 additional units and hct was 25.8 this AM. Did not have any episodes of BRBPR since being in the ER. Was seen by GI today who took him for EGD/colonoscopy as well as ERCP b/c his Tbili rose rapidly. Results are still pending. Patient did have some lightheadedness this yesterday but denied upon arrival to the MICU. He denies n/v/chest pain/sob Past Medical History: PMH: Onc hx as of [**12-24**]: Mr. [**Known lastname 7710**] presented in [**2176-10-19**] with urinary retention, ultrasound revealing a mass in the right kidney, surgery was delayed, but he underwent right nephrectomy on [**2177-3-14**], revealing a 10-cm tumor clear cell pathology, [**Last Name (un) 9951**] grade 3 to 4, with tumor extension into the perinephric tissues. The patient was staged as a T3. Two lymph nodes were involved. However, at the time of diagnosis, there was no evidence of distant metastatic disease. The patient was enrolled in the ARISER clinical trial randomized phase III double blind adjuvant study involving cG250 versus placebo, received twelve weeks of therapy, at which point, a CAT scan demonstrating increased retroperitoneal lymph nodes suggestive of metastatic disease. He underwent a cardiac catheterization with stent placement for symptoms of angina on [**2177-7-30**], to the RCA. He has been asymptomatic since then from a cardiac standpoint. Followup CT in mid [**Month (only) 216**] revealed slight increase in size of retroperitoneal lymph nodes, and since then the patient has intermittent history of abdominal pain, which has become progressive in nature. High-dose IL-2 was initiated on the high-dose IL-2 select trial on [**2177-12-22**]. He received 11 out of 14 doses and was stopped secondary to neurotoxicity. His last treatment was delayed in the setting of the elevated creatinine and urinary retention on [**2178-1-5**]. He underwent his last cycle of therapy from [**2178-1-20**] through [**2178-1-27**]. He has been on Sutent since [**2-24**]. . PMH: 1)metastatic renal cell ca with known large mesenteric metastasis, and liver mets on sutent as above 2)CAD s/p RCA [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 5175**] [**7-/2177**] - cath [**7-24**]: LCX 75% stenosis, OM1 50% stenosis, RCA 90% stenosis 3)Diabetes 4)GERD 5)HTN 6)Hypothyroid 7)Hyperlipidemia 8)BPH retention - indwelling foley with failed voiding trial- no turp due to hematuria. Urologist Dr. [**Last Name (STitle) 770**] 9) s/p appy 10) s/p tonsillectomy Social History: quit smoking 25 yrs ago, no etoh, no drugs. Works in construction-office job has not worked since [**Month (only) **]. Lives alone. Has wife with 3 kids. Wants daughter to be hcp if any emergency. Family History: father with lung ca Physical Exam: PE: T 100.6 P 80 BP 156/72 O2 100% RA Wt 77 KG GEN: awake, nad, pale HEENT: PERRLA/EOMI Lungs: CTA x 2 CV: RRR, s1 s2 Abd: soft, diffusely mildly tender, indwelling foley, no r/g Ext: no c/c/e Rectal with brown stool with brbpr in ed Pertinent Results: Admission labs: 136 102 23 ------------<93 4.6 27 1.4 estGFR: 51/62 (click for details) Ca: 8.8 Mg: 2.1 P: 3.4 ALT: 46 AP: 2447 Tbili: 1.1 AST: 40 [**Doctor First Name **]: 60 Lip: 63 . 5.2 6.0>---<507 17.4 N:71.3 L:21.8 M:3.6 E:2.9 Bas:0.5 . PT: 12.1 PTT: 29.9 INR: 1.0 . Ca: 9.0 Mg: 2.0 P: 3.0 ALT: 44 AP: [**2160**] Tbili: 0.9 Alb: 2.5 AST: 35 Dbili: 0.5 . PT: 12.5 PTT: 28.9 INR: 1.1 . 5.6 7.4>---< 591 19.8 Gran-Ct: 5580 . ERCP [**2178-5-28**]: 1. Extrinsic compression of the CBD due to mass in the porta hepatis. Dilatation of the upper one third of the CBD and intrahepatic biliary ducts. Status post placement of biliary stent. 2. Diffuse fold thickening within the duodenum may be related to patient's known IVC and SMV thrombosis. . CT torso [**2178-5-29**]: 1. Interval decrease in the size of metastatic disease including multiple liver lesions and the large retroperitoneal mass anterior to the nephrectomy bed and mesenteric lymphadenopathy. 2. Unchanged IVC thrombosis with extension of the thrombosis to the left iliac vein. 3. Unchanged appearance of thrombosis of the proximal segment of the SMV. 4. Status post placement of CBD stent with interval decrease in the amount of intra and extrahepatic bile duct dilatation. 5. Unchanged appearance of L2 lytic lesion with focal compression. 6. Unchanged appearance of multiple small pulmonary nodule that measure 3 mm in greatest dimension. 7. Right fluid containing inguinal hernia. 8. Interval development of mild ascites within the abdomen and pelvis. . Brief Hospital Course: A/P: Pt is a 65 yo m with metastatic renal cell who presented with a hct of 17 thought likely [**2-20**] to a lower GI bleed. . 1) Anemia: Pt presented with hct of 17, thought due to lower GIB vs. AVM vs. hemorrhoids given BRBPR. Hct one week PTA was 27, so this was an acute drop. Counts improved come up with 3 units PRBCs. He had EGD and colonoscopy which revealed friable mucosa in the duodenum but no active bleeding, adherent clot of visible vessel. He was maintained on pantoprazole [**Hospital1 **]. He was transfussed an additional 2 units pRBC's for a hct slowly trending down but found to be stable for discharge. . 2) Elevated LFTs: AST and ALT were slightly elevated but T bili jumped up to 5 after admission and alk phos is in the [**2171**]. This was thought possibly [**2-20**] obstruction, LDH was nl. ERCP was done and demonstrated metastatic renal cell mass compressing the biliary tree likely causing obstruction. He had a stent placed in his CBD after which the LFT's began steadily trending down. Given high risk for post-ERCP cholangitis he was treated with ciprofloxacin 500mg [**Hospital1 **] po for 4 day course. . 3) Metastatic renal cell carcinoma: To peritoneum, on sutent on admit. This medication was stopped on admit given increased propensity for GIB it causes. CT scan noted interval decrease in size of metastises. He will follow-up as an outpatient for further treatment. . 4) CAD- 2 sets CEs negative on admission that were sent after slight change in V2 noted on admission ECG. No symptoms were noted during his hospital course. He had a cypher stent placed [**7-24**] but aspirin was held given bleeding. He was discharged off this medication. . 5) Renal insufficiency (recent baseline appears to be 1.4-1.6). This was noted to be at his baseline. He was given bicarb and mucomyst for renal protection for CT w/contrast [**5-29**]. . 6) HTN- Started metoprolol 25mg [**Hospital1 **] for SBP 160-180. . 7) DM- Continued on lantus and humalog ss. . 8) Hypothyroid- Continued on levothyroxine. Medications on Admission: Aspirin 81 Humalog SS HYTRIN 2 mg daily Lantus Lipitor 20mg Levothyroxine 100 mcg daily Oxycodone 20 mg--1 tablet(s) by mouth twice a day Prilosec SUTENT 12.5 mg--3 capsule(s) by mouth once a day total of 37.5mg daily Discharge Medications: 1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1) Tablet Sustained Release 12 hr PO Q12H (every 12 hours). 3. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Terazosin 1 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime). Disp:*60 Capsule(s)* Refills:*2* 5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 8. Lantus 100 unit/mL Cartridge Sig: One (1) Subcutaneous once a day: as directed by [**Hospital 387**] clinic. 9. Humalog 100 unit/mL Cartridge Sig: One (1) Subcutaneous four times a day: as directed by [**Hospital 387**] clinic. Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: Gastrointestinal bleed, common bile duct obstruction with hepatitis. . Renal cell carcinoma, hypertension, diabetes melitus, coronary artery disease. Discharge Condition: Good, no signs of bleeding, hematocrit stable at 28% Discharge Instructions: Please take all medications as prescribed. Please keep all follow-up appointments. Please notify your primary care physician or Dr. [**Last Name (STitle) **] if you experience fevers, chills, abdominal pain, nausea, vomitting, constipaiton, diarrhea, chest pain, dizziness, further bleeding, or any symptoms that concern you. Followup Instructions: You will be meeting with Dr. [**First Name8 (NamePattern2) 553**] [**Last Name (NamePattern1) **] on Monday at 1 pm.

197,578,788,453,573,V105,414,250,401,244,576,455,530,285,600

{'Malignant neoplasm of liver, secondary,Hemorrhage of gastrointestinal tract, unspecified,Other specified retention of urine,Other venous embolism and thrombosis of inferior vena cava,Hepatitis, unspecified,Personal history of malignant neoplasm of kidney,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstruction of bile duct,Internal hemorrhoids without mention of complication,Esophageal reflux,Anemia, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (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: Bright red blood per rectum. PRESENT ILLNESS: Mr. [**Known lastname 7710**] is a 65 yo male with a history of metastatic renal cell carcinoma on Sutent, CAD, DM who presented with BRBPR rectum on [**5-27**]. This had been going on for two days. Yesterday morning he went to clinic where hct was found to be 19,with sbp in the 90's and he was sent to the ER. . In the ED, patient's hct was found to be 17. His pulse was 79, and bp was 160's/70's. He was transfused one unit prbc. GI was made aware. He was sent to the MICU for further monitoring. . In the MICU the patient was tranfused 2 additional units and hct was 25.8 this AM. Did not have any episodes of BRBPR since being in the ER. Was seen by GI today who took him for EGD/colonoscopy as well as ERCP b/c his Tbili rose rapidly. Results are still pending. Patient did have some lightheadedness this yesterday but denied upon arrival to the MICU. He denies n/v/chest pain/sob MEDICAL HISTORY: PMH: Onc hx as of [**12-24**]: Mr. [**Known lastname 7710**] presented in [**2176-10-19**] with urinary retention, ultrasound revealing a mass in the right kidney, surgery was delayed, but he underwent right nephrectomy on [**2177-3-14**], revealing a 10-cm tumor clear cell pathology, [**Last Name (un) 9951**] grade 3 to 4, with tumor extension into the perinephric tissues. The patient was staged as a T3. Two lymph nodes were involved. However, at the time of diagnosis, there was no evidence of distant metastatic disease. The patient was enrolled in the ARISER clinical trial randomized phase III double blind adjuvant study involving cG250 versus placebo, received twelve weeks of therapy, at which point, a CAT scan demonstrating increased retroperitoneal lymph nodes suggestive of metastatic disease. He underwent a cardiac catheterization with stent placement for symptoms of angina on [**2177-7-30**], to the RCA. He has been asymptomatic since then from a cardiac standpoint. Followup CT in mid [**Month (only) 216**] revealed slight increase in size of retroperitoneal lymph nodes, and since then the patient has intermittent history of abdominal pain, which has become progressive in nature. High-dose IL-2 was initiated on the high-dose IL-2 select trial on [**2177-12-22**]. He received 11 out of 14 doses and was stopped secondary to neurotoxicity. His last treatment was delayed in the setting of the elevated creatinine MEDICATION ON ADMISSION: Aspirin 81 Humalog SS HYTRIN 2 mg daily Lantus Lipitor 20mg Levothyroxine 100 mcg daily Oxycodone 20 mg--1 tablet(s) by mouth twice a day Prilosec SUTENT 12.5 mg--3 capsule(s) by mouth once a day total of 37.5mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T 100.6 P 80 BP 156/72 O2 100% RA Wt 77 KG GEN: awake, nad, pale HEENT: PERRLA/EOMI Lungs: CTA x 2 CV: RRR, s1 s2 Abd: soft, diffusely mildly tender, indwelling foley, no r/g Ext: no c/c/e Rectal with brown stool with brbpr in ed FAMILY HISTORY: father with lung ca SOCIAL HISTORY: quit smoking 25 yrs ago, no etoh, no drugs. Works in construction-office job has not worked since [**Month (only) **]. Lives alone. Has wife with 3 kids. Wants daughter to be hcp if any emergency. ### Response: {'Malignant neoplasm of liver, secondary,Hemorrhage of gastrointestinal tract, unspecified,Other specified retention of urine,Other venous embolism and thrombosis of inferior vena cava,Hepatitis, unspecified,Personal history of malignant neoplasm of kidney,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Obstruction of bile duct,Internal hemorrhoids without mention of complication,Esophageal reflux,Anemia, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 69-year-old female who presented to the Emergency Department with mental status changes, confusion and not speaking. The patient was discharged from the hospital yesterday after a two day admission for pain control of left nephrolithiasis and hydronephrosis. She was discharged on Motrin for further pain control and returned on the morning of admission with worsening pain, vomiting and confusion. MEDICAL HISTORY: Breast cancer diagnosed in [**2085**], locally metastatic to the chest wall, status post chemotherapy. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of other specified sites,Aphasia,Personal history of malignant neoplasm of breast

Intracerebral hemorrhage,Hyposmolality,Secondary malig neo NEC,Aphasia,Hx of breast malignancy

Admission Date: [**2103-3-8**] Discharge Date: [**2103-3-13**] Date of Birth: [**2033-6-27**] Sex: F Service: HISTORY OF PRESENT ILLNESS: The patient is a 69-year-old female who presented to the Emergency Department with mental status changes, confusion and not speaking. The patient was discharged from the hospital yesterday after a two day admission for pain control of left nephrolithiasis and hydronephrosis. She was discharged on Motrin for further pain control and returned on the morning of admission with worsening pain, vomiting and confusion. PAST MEDICAL HISTORY: Breast cancer diagnosed in [**2085**], locally metastatic to the chest wall, status post chemotherapy. MEDICATIONS: Motrin, Herceptin, Velban. In the emergency room, the patient had difficulty finding words. She was alert and moving all extremities. She had a blood pressure of 165/93 with a heart rate of 96. Temperature was 96.4. She was found to have a sodium of 120. She was treated with hypotonic saline and urine lytes were sent. The patient became more confusion after her sodium came up to 126, and a head CT was obtained showing a left temporal intraparenchymal hemorrhage of 3 cm. On physical examination, the patient was confused but answering some questions. Pupils were equal, round and reactive to light. Extraocular movements were intact. Chest: Clear to auscultation. Cardiovascular: Regular rate and rhythm. Abdomen: Soft, non-tender and non-distended with positive bowel sounds. Neurologic: Cranial nerves II-XII intact. Moving all extremities. Uncooperative. Skin: Very dry. Rash on the chest. LABORATORIES ON ADMISSION: White count 5.9, hematocrit 30.5, platelets 201. PT 12.8, PTT 29, INR 1.1. Sodium 126, potassium 3.2, chloride 91, CO2 23, BUN 8, creatinine .5, glucose 151. The patient had a MRI scan which was positive for the intraparenchymal hemorrhage and possible metastatic tumor. HOSPITAL COURSE: The patient was admitted to the Intensive Care Unit where she was monitored closely regarding her neurologic status. She was taken to the operating room on [**2103-3-8**] and had a left temporoparietal craniotomy for resection of the hemorrhagic lesion which was sent for pathology. Postoperatively, the patient was awake and attentive. She knows her name and smiles on command. Smile is equal and symmetric. Moving all four extremities with good range of motion and strength. Repeats certain questions. Attempts to answer to her name. Continues to have difficulty with receptive and expressive aphasia. The patient was seen by the Speech and Swallow Service who found her capable of tolerating a regular diet p.o. A repeat head CT on the 19th showed the left temporoparietal craniotomy with a hypo-dense area posterior to the bleed which was possibly consistent with edema. The patient was seen by Physical Therapy and Occupational Therapy and found to require rehabilitation. She was transferred to the floor on postoperative day #1 where she remained neurologically stable with stable vital signs. MEDICATIONS ON DISCHARGE: Senna p.o. b.i.d. p.r.n., Protonix 40 mg p.o. q24 hours, Dilantin 100 mg p.o. t.i.d., Decadron to wean to 2 b.i.d. over a week, Percocet 1-2 tabs p.o. q4 hours p.r.n., Colace 100 mg p.o. b.i.d., Dulcolax 10 mg p.r. q h.s. p.r.n., Tylenol 650 mg p.o. q4 hours p.r.n. The patient's condition was stable at the time of discharge. She will follow up in the Brain [**Hospital 341**] Clinic in one week, and she will have her staples removed at that time. [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D. [**MD Number(1) 1341**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2103-3-12**] 08:41 T: [**2103-3-12**] 08:44 JOB#: [**Job Number **]

431,276,198,784,V103

{'Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of other specified sites,Aphasia,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: PRESENT ILLNESS: The patient is a 69-year-old female who presented to the Emergency Department with mental status changes, confusion and not speaking. The patient was discharged from the hospital yesterday after a two day admission for pain control of left nephrolithiasis and hydronephrosis. She was discharged on Motrin for further pain control and returned on the morning of admission with worsening pain, vomiting and confusion. MEDICAL HISTORY: Breast cancer diagnosed in [**2085**], locally metastatic to the chest wall, status post chemotherapy. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of other specified sites,Aphasia,Personal history of malignant neoplasm of breast'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 76-year-old woman with past medical history significant for aortic stenosis and patent foramen ovale status post atrial septal defect repair and aortic valve replacement in [**2117-8-6**], that presents to the emergency room with complaint of abdominal pain and report of free intraperitoneal air on x-ray at her rehabilitation facility, [**Hospital2 57361**] [**Hospital3 **]. MEDICAL HISTORY: Hypercholesterolemia, peripheral vascular disease, chronic obstructive pulmonary disease, right iliac artery disease, lung cancer, malignant pericardial and pleural effusions, pacemaker in situ, left carotid endarterectomy, hysterectomy, pericardial window, tonsillectomy, mitral regurgitation, aortic stenosis, patent foramen ovale, and coronary artery disease. MEDICATION ON ADMISSION: ALLERGIES: Augmentin PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other specified disorders of peritoneum,Malignant neoplasm of lower lobe, bronchus or lung,Heart valve replaced by transplant,Chronic airway obstruction, not elsewhere classified,Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum,Anemia, unspecified,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Tracheostomy status,Gastrostomy status,Personal history of other diseases of circulatory system,Cardiac pacemaker in situ

Peritoneal disorder NEC,Mal neo lower lobe lung,Heart valve transplant,Chr airway obstruct NEC,Nonsp abn fnd-abdom area,Anemia NOS,Hyperlipidemia NEC/NOS,Periph vascular dis NOS,Tracheostomy status,Gastrostomy status,Hx-circulatory dis NEC,Status cardiac pacemaker

Admission Date: [**2117-9-10**] Discharge Date: [**2117-9-16**] Date of Birth: [**2041-8-18**] Sex: F Service: [**Last Name (un) **] HISTORY OF PRESENT ILLNESS: This is a 76-year-old woman with past medical history significant for aortic stenosis and patent foramen ovale status post atrial septal defect repair and aortic valve replacement in [**2117-8-6**], that presents to the emergency room with complaint of abdominal pain and report of free intraperitoneal air on x-ray at her rehabilitation facility, [**Hospital2 57361**] [**Hospital3 **]. Briefly, this is a 76-year-old female who has multiple medical problems as described above, including hypercholesterolemia, peripheral vascular disease, chronic obstructive pulmonary disease, and known lung cancer, that was recently discharged 2 days prior to [**Hospital1 57361**] Rehabilitation facility after a lengthy hospital course in which she underwent an aortic valve replacement and an atrial septal defect closure. She was taken after this point to the surgical intensive care unit for monitoring, however, had developed respiratory distress that required intubation. She required tracheostomy, as well, during this prior stay and was noted to be doing well at the rehabilitation facility in terms of her respiratory status up to this point. Also of note, she also received before her prior discharge a percutaneous endoscopic gastrostomy tube placed by the general surgery service. This was done on [**2117-9-1**], seven days before discharge to the rehabilitation facility. Of note, the patient continued to have free intra-abdominal air during her stay in the intensive care unit before her discharge. However, her abdominal pain resolved, and she was able to resume her tube feeds per recommendation of the general surgery service. Upon discharge she was sent to the [**Hospital1 57361**] rehabilitation facility, where she was noted to be progressing well until her 3rd day when she noted abdominal pain. At this time a kidney/ureter/bladder x-ray was performed that revealed significant right- and left-sided intraperitoneal free air. The patient was then sent back to the [**Hospital1 190**] for further evaluation and treatment. PAST MEDICAL HISTORY: Hypercholesterolemia, peripheral vascular disease, chronic obstructive pulmonary disease, right iliac artery disease, lung cancer, malignant pericardial and pleural effusions, pacemaker in situ, left carotid endarterectomy, hysterectomy, pericardial window, tonsillectomy, mitral regurgitation, aortic stenosis, patent foramen ovale, and coronary artery disease. MEDICATIONS: Amiodarone, Lipitor, Warfarin, furosemide, lansoprazole, digoxin, aspirin, fluconazole, and vancomycin. Vancomycin was for a methicillin-resistant Staphylococcus aureus that was growing out of her sputum prior to her previous discharge. PHYSICAL EXAMINATION ON ADMISSION: Temperature 97.8 F, heart rate 81 in sinus rhythm, blood pressure 148/71, respiratory rate 18, 100 % on room air. She is generally comfortably appearing and is sitting up in bed at this time. Her tracheostomy is noted to be in place without drainage or erythema around the site. Her lungs are clear to auscultation bilaterally with some coarse breath sounds reported. Her incision is noted to be well healed with Steri-Strips beginning to slough off. There is no drainage or erythema around the sternal wound. Her heart is in regular rate and rhythm. Without murmurs, rubs, or gallops at this time. Her abdomen is noted to be slightly distended with slightly hypoactive bowel sounds. Soft. Minimally tender throughout. No signs of rebound or guarding at this time. Her extremities are warm and well perfused. Distal pulses are 2+ with no clubbing, cyanosis, or edema. HOSPITAL COURSE: Thus, at this time the patient was admitted to the [**Hospital1 69**] for further evaluation and treatment. This 75-year-old female recently discharged with an aortic valve replacement and atrial septal defect repair was brought back into the hospital for further evaluation of persistent intraperitoneal free air status post percutaneous endoscopic gastrostomy tube placement on [**2117-9-1**], nine days prior to this at readmission. The question at this point was whether there was an active leak from the percutaneous endoscopic gastrostomy tube. A CAT scan was performed at this time that revealed no extravasation, though this did not satisfy our curiosity in regard to the possibility of anterior leak of the percutaneous endoscopic gastrostomy tube. The patient was noted to be stable, was afebrile, with a leukocyte count that was within normal limits and unchanged from 5 days previously. The plan at this time was to do a water-soluble contrast study through this PEG tube and to assess the patient in the prone position for possible anterior leak. On hospital day #3 the patient began to feel better, with less abdominal pain and less distention at this time. Patient continued to remain afebrile and to remain hemodynamically stable. There were no sudden rises in the leukocyte count, as well. The rest of her laboratories was within normal limits. We placed her PEG tube to gravity at this time with the plan to have a prone study performed the following day, and to continue to hold tube feeds at this time. In addition, Clostridium difficile toxin was sent off which came back negative. It was also notable that the patient was passing gas and having bowel movements at this time. On hospital day #4 the patient continued to progress well and was noted to be comfortable and did receive 1 unit of packed red blood cells at this time for a hematocrit of 25.6, noted to be down from 28 the previous day. The patient then had a follow up portable abdominal x-ray on Tuesday, [**9-14**], hospital day #5, that continued to show persistent large amount of free intraperitoneal air. There was retained contrast present in the colon, but there was, again, no sign of any sort of leak at this time. Thus, throughout the hospital course there was, at no point, that we could locate a definitive leak of contrast due to the percutaneous endoscopic gastrostomy tube. It was determined that the patient could have her tube feeds resumed. On hospital day #5 these tube feeds were resumed, indeed, and the patient tolerated them well and was slowly increased to her goal rate of 50 mL per hour of ProBalance with fiber. Also at this time, the patient received a PICC line on the right side that was placed under interventional radiology due to her presence of a permanent pacemaker on the left side. The patient also had a study of the venous system in the left upper extremity that revealed thrombosis of the left subclavian vein. This venous catheter was removed after the procedure and the port remained in place in the left antebrachial area. Then, on hospital day #6, the patient was evaluated again and had been continued on her tube feeds at this time. She was noted to be tolerating these well and was noticeably less distended on examination. She was spending significant amounts of time in her chair and was tolerating a tracheostomy mask at this time with continued plan for her to rest at night on the ventilator. On hospital day #6, it was determined the patient was fit for discharge to rehabilitation facility on continued tube feeds. The patient was to receive 1 more week of vancomycin for positive blood culture and yeast in sputum. The patient was to continue on tracheostomy mask during the day as needed and to be placed on the ventilator as needed at night so that she could rest. Fluconazole was not given necessary upon discharge. ER[**Last Name (STitle) 57362**]ving any increasing pains, fevers, chills, nausea, vomiting, shortness of breath, chest pain, redness or drainage about the wounds, or if there are any questions or concerns or signs of any events there untoward. Patient to continue on continuous positive airway pressure and pressure support for 12-14 hours a day goal and to receive assist control at night for rest. Patient to have International Normalized Ratio checked daily with goal of 2.0-2.5. Patient to receive tube feedings of ProBalance full strength at 50 mL per hour with checks every 4 hours for residuals, and tube feeds to be held for any residual greater than 100 mL. Patient to have an appointment with Dr. [**Last Name (Prefixes) **] scheduled upon discharge from rehabilitation facility. DISCHARGE DIAGNOSES: 1. Intraperitoneal free air in abdomen. 2. Status post aortic valve replacement. 3. Status post atrial septal defect repair. 4. Status post tracheostomy. 5. Status post percutaneous endoscopic gastrostomy. 6. Status post stage 3 lung cancer treatment. 7. Methicillin-resistant Staphylococcus aureus of the sputum. 8. Aortic stenosis. 9. Patent foramen ovale. 10. Chronic obstructive pulmonary disease. 11. Respiratory failure. 12. Cerebrovascular accident. 13. Hyperlipidemia. 14. Hypertension. 15. Peripheral vascular disease. 16. Status post permanent pacemaker in situ. 17. Status post left port placement [**2110**]. DISCHARGE MEDICATIONS: 1. Fluticasone 110 mcg 2. Actuation aerosol 2 puffs inhalation b.i.d. 3. Digoxin 125 mcg tablets 1 tablet p.o. once daily 4. Furosemide 20 mg p.o. once daily 5. Amiodarone 200 mg 0.5 tablets p.o. once daily for a total of 100 mg per day. 6. Lansoprazole 30 mg suspension delayed release 1 p.o. once daily. 7. Atorvastatin calcium 20 mg p.o. once daily. 8. Azintamide 10 mg p.o. once daily. 9. Albuterol ipratropium. 10. Actuation 103/18 mcg 6-8 puffs inhalation q.4 hours. 11. Aspirin 81 mg chewable p.o. once daily. 12. Vancomycin 1 g q.24 hours for 7 days intravenously. 13. Potassium chloride 20 mEq as needed for potassium less than 4.0. 14. Acetaminophen 325 mg 1-2 tablets p.o. q.4-6 hours as needed for pain. DISPOSITION: Stable and to be discharged to rehabilitation facility, [**Hospital2 57361**] [**Hospital3 **], on [**2117-9-16**]. [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**] Dictated By:[**Last Name (NamePattern1) 15912**] MEDQUIST36 D: [**2117-9-15**] 17:25:52 T: [**2117-9-15**] 20:43:05 Job#: [**Job Number 57363**] Name: [**Known lastname 5160**],[**Known firstname 2219**] Unit No: [**Numeric Identifier 10616**] Admission Date: [**2117-9-10**] Discharge Date: [**2117-9-16**] Date of Birth: [**2041-8-18**] Sex: F Service: CARDIOTHORACIC Allergies: Augmentin Attending:[**First Name3 (LF) 674**] Addendum: Pt. is on goal TF and tolerating it well. She has been on coumadin for afib and a clot in her L subclavian vein. Her INR was 1.5 today and she was restarted on heparin. Discharge Medications: 1. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Amiodarone 200 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 5. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY (Daily). 6. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**7-14**] Puffs Inhalation Q4H (every 4 hours). 9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) Intravenous Q 24H (Every 24 Hours) for 7 days. 11. Potassium Chloride 20 mEq/50 mL Piggyback Sig: One (1) Intravenous PRN (as needed) as needed for K < 4.0. 12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 13. Reglan 10 mg Tablet Sig: One (1) Tablet PO four times a day. 14. Heparin (Porcine) in NS 2 unit/mL Parenteral Solution Sig: Four Hundred (400) units Intravenous per hour: PTT goal 40-60. 15. Coumadin 1 mg Tablet Sig: One (1) Tablet PO tonight: INR goal 2-2.5. Discharge Disposition: Extended Care Facility: [**Hospital3 14**] & Rehab Center - [**Hospital1 15**] [**Doctor Last Name **] [**Last Name (Prefixes) **] MD [**MD Number(1) 681**] Completed by:[**2117-9-16**]

568,162,V422,496,793,285,272,443,V440,V441,V125,V450

{'Other specified disorders of peritoneum,Malignant neoplasm of lower lobe, bronchus or lung,Heart valve replaced by transplant,Chronic airway obstruction, not elsewhere classified,Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum,Anemia, unspecified,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Tracheostomy status,Gastrostomy status,Personal history of other diseases of circulatory system,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: PRESENT ILLNESS: This is a 76-year-old woman with past medical history significant for aortic stenosis and patent foramen ovale status post atrial septal defect repair and aortic valve replacement in [**2117-8-6**], that presents to the emergency room with complaint of abdominal pain and report of free intraperitoneal air on x-ray at her rehabilitation facility, [**Hospital2 57361**] [**Hospital3 **]. MEDICAL HISTORY: Hypercholesterolemia, peripheral vascular disease, chronic obstructive pulmonary disease, right iliac artery disease, lung cancer, malignant pericardial and pleural effusions, pacemaker in situ, left carotid endarterectomy, hysterectomy, pericardial window, tonsillectomy, mitral regurgitation, aortic stenosis, patent foramen ovale, and coronary artery disease. MEDICATION ON ADMISSION: ALLERGIES: Augmentin PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other specified disorders of peritoneum,Malignant neoplasm of lower lobe, bronchus or lung,Heart valve replaced by transplant,Chronic airway obstruction, not elsewhere classified,Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum,Anemia, unspecified,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Tracheostomy status,Gastrostomy status,Personal history of other diseases of circulatory system,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: [**Hospital **] transferred to [**Hospital1 18**] for cardiac catheteriztion/CABG PRESENT ILLNESS: 78 yo f s/p L CEA on [**2-1**] (discharged on [**2-2**]) felt gradually worsening SOB the night of discharge from hospital. She denied chest, arm, or jaw pain. She awoke from sleep with increased SOB, and had episode of syncope after using the bathroom. Directly before syncopal episode, she denied CP, palpitations, urinary/stool incontinence, and weakness, confusion, or paresthesias afterwards. She was heard by her family moaning in the bathroom and was brought to OSH. At the OSH, EKG showed sinus tachycardia @ 98bpm, TWI in V6, and STE in I, AvL, V5, and V6. STD was observed in inferior leads. CEs revealed troponin I 0.89, D-dimer 3.52, and BNP 920. PE revealed crackles. She was treated with ASA/NG/BB/plavix/heparin for STEMI. She was also given 20mg IV lasix for reduction of pulm edema. She was transferred to [**Hospital1 18**] for cardiac catherization. MEDICAL HISTORY: CAD s/p MI ~9 yrs ago (unknown hx) HTN Hypercholesterolemia Carotid stenosis s/p L CEA [**2-1**] R knee replacement MEDICATION ON ADMISSION: Lisinopril 10mg QD ASA 325mg QD Zocor 5mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: afebrile 127/53 75 20 100% on 2L NC Gen: well appearing, NAD, conversant HEENT: NC/AT, PERRL Neck: no JVP on R, cannot assess on L COR: S1 S2, RRR. [**2-18**] blowing systolic murmur radiating to axilla. no S3 or S4. Pulm: bibasilar crackles to [**12-17**] assessed supine Abd: soft, mild suprapubic tenderness, no guarding, no rebound. + BS. no bruits auscultated Ext: R cath site with art and venous sheaths removed. WWP bil, with 2+ DP L and 1+ DP R. Neuro: A/O x 3. FAMILY HISTORY: Mother and sister had MI in early 70s, father had MI in late 60s. SOCIAL HISTORY: Lives in her daughter's home in [**Location (un) 1110**], MA. Has several children who are well and involved in care.

Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Atrioventricular block, complete,Mitral valve disorders,Combined systolic and diastolic heart failure, unspecified,Pneumonia due to Pseudomonas,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Old myocardial infarction,Other and unspecified hyperlipidemia

Surg compl-heart,AMI anterolateral, init,Atriovent block complete,Mitral valve disorder,Syst/diast hrt fail NOS,Pseudomonal pneumonia,Atrial fibrillation,Crnry athrscl natve vssl,Urin tract infection NOS,Thrombocytopenia NOS,Hypertension NOS,Old myocardial infarct,Hyperlipidemia NEC/NOS

Admission Date: [**2182-2-3**] Discharge Date: [**2182-3-4**] Date of Birth: [**2103-4-18**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1267**] Chief Complaint: [**Hospital **] transferred to [**Hospital1 18**] for cardiac catheteriztion/CABG Major Surgical or Invasive Procedure: Cardiac Catheterization MVR (#27 Mosaic porcine), CABG X 3 (LIMA > LAD, SVG > OM, SVG > PLV) on [**2182-2-5**] Tracheostomy on 3/0/06 History of Present Illness: 78 yo f s/p L CEA on [**2-1**] (discharged on [**2-2**]) felt gradually worsening SOB the night of discharge from hospital. She denied chest, arm, or jaw pain. She awoke from sleep with increased SOB, and had episode of syncope after using the bathroom. Directly before syncopal episode, she denied CP, palpitations, urinary/stool incontinence, and weakness, confusion, or paresthesias afterwards. She was heard by her family moaning in the bathroom and was brought to OSH. At the OSH, EKG showed sinus tachycardia @ 98bpm, TWI in V6, and STE in I, AvL, V5, and V6. STD was observed in inferior leads. CEs revealed troponin I 0.89, D-dimer 3.52, and BNP 920. PE revealed crackles. She was treated with ASA/NG/BB/plavix/heparin for STEMI. She was also given 20mg IV lasix for reduction of pulm edema. She was transferred to [**Hospital1 18**] for cardiac catherization. Past Medical History: CAD s/p MI ~9 yrs ago (unknown hx) HTN Hypercholesterolemia Carotid stenosis s/p L CEA [**2-1**] R knee replacement Social History: Lives in her daughter's home in [**Location (un) 1110**], MA. Has several children who are well and involved in care. Family History: Mother and sister had MI in early 70s, father had MI in late 60s. Physical Exam: VS: afebrile 127/53 75 20 100% on 2L NC Gen: well appearing, NAD, conversant HEENT: NC/AT, PERRL Neck: no JVP on R, cannot assess on L COR: S1 S2, RRR. [**2-18**] blowing systolic murmur radiating to axilla. no S3 or S4. Pulm: bibasilar crackles to [**12-17**] assessed supine Abd: soft, mild suprapubic tenderness, no guarding, no rebound. + BS. no bruits auscultated Ext: R cath site with art and venous sheaths removed. WWP bil, with 2+ DP L and 1+ DP R. Neuro: A/O x 3. Pertinent Results: [**2182-3-4**] 02:49AM BLOOD WBC-7.1 RBC-2.90* Hgb-8.7* Hct-26.0* MCV-90 MCH-30.1 MCHC-33.5 RDW-15.5 Plt Ct-160 [**2182-3-4**] 02:49AM BLOOD PT-13.3* PTT-30.5 INR(PT)-1.2* [**2182-3-3**] 03:26AM BLOOD Glucose-113* UreaN-57* Creat-0.7 Na-145 K-4.1 Cl-114* HCO3-22 AnGap-13 [**2182-3-1**] 03:18AM BLOOD ALT-64* AST-40 AlkPhos-46 Amylase-58 TotBili-0.3 [**2182-3-4**] 02:59AM BLOOD Type-ART pO2-125* pCO2-36 pH-7.45 calHCO3-26 Base XS-2 Brief Hospital Course: At the OSH on [**2-2**], EKG showed findings c/w anterolateral STEMI. Cardiac enzymes were elevated. At the OSH she was treated with ASA/NG/BB/plavix/heparin, and after treatment her ST segment elevations resolved. At [**Hospital1 18**], cardiac catheterization revealed significant occlusion in the LCx, RCA, and LAD, as well as moderate 2+ MR. In the CCU, the patient was managed on a medical regimen including ASA/BB/nitro gtt/ACEi/heparin/high dose statin. She was evaluated for CABG +/- MVR. On [**2-3**], her nitro gtt was discontinued given lack of symptoms and stable BP. On [**2-4**], an echocardiogram was done, showing small secundum atrial septal defect; mild regional left ventricular systolic dysfunction with focal severe hypokinesis of the distal septum, distal anterior and distal inferior walls; mild dyskinetic/aneurysm at apex; normal RV free wall motion; moderate (2+) mitral regurgitation with an eccentric, inferiorly directed jet. She was taken to the OR on [**2182-2-5**] where she underwent an MVR (27mm tissue valve) and CABG X 3 (LIMA > LAD, SVG > OM, SVG > PLV). She was taken to the cardiac surgery recovery unit on NTG & Epi drips. She went into rapid AFib on POD # 1, requiring cardioversion, amiodarone started. She subsequently had some heart block, requiring temporary pacing, and her native conduction recovered in the next few days. On [**2-11**], she was extubated, but required re-intubaltio for tachypnea and hypoxia. Several more attempts were made at weaning her from the ventilator, but each time she was weaned to minimal support, she again became tachypneic and hypoxic. She underwent tracheostomy on [**2182-2-18**]. She continued with supportive care, and slow ventilator weaning. On [**2182-2-25**], an infectious disease consult was obtained for fevers to 102. Sputum and urine cultures revealed pseudomonas. There was 1 positive blood culture (out of bottles) for coag. negative staph. Central line culture was negative. Chest & sinus CT scans were negative, as was her lower extremity doppler. The recommendation was to place her on antibiotics for 7-10 days for presumed pseudomonas pneumonia. A midline catheter was placed for antibiotics. She has now remained afebrile since [**2182-2-28**], and has been off the ventilator on a trach collar since [**2182-3-1**]. She has intermittantly used a Passey Muir valve for speech. She remains hemodynamically stable, and is ready for transfer to rehab for continued speech, respiratory, and physical therapy. Medications on Admission: Lisinopril 10mg QD ASA 325mg QD Zocor 5mg QD Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) 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 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day). 4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q4H (every 4 hours) as needed. 5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 6. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours). 7. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 9. Simvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 10. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 11. Ferrous Sulfate 300 mg/5 mL Liquid Sig: Five (5) ml PO DAILY (Daily). 12. Ascorbic Acid 90 mg/mL Drops Sig: Five (5) ml PO BID (2 times a day). 13. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Ceftazidime-Dextrose (Iso-osm) 2 g/50 mL Piggyback Sig: Two (2) Gm Intravenous Q8H (every 8 hours) for 5 days. Discharge Disposition: Extended Care Facility: [**Hospital3 **] northeast Discharge Diagnosis: MR CAD post-op AFib post-op respiratory failure pseudomonas tracheobronchitis Discharge Condition: Good Discharge Instructions: patient may shower when able, no bathing for 1 month no creams, lotions or powders to any incisions No lifting > 10# for 10 weeks Followup Instructions: with Dr. [**Last Name (STitle) **] upon discharge from rehab with Dr. [**Last Name (STitle) **] in [**1-18**] weeks Completed by:[**2182-3-4**]

997,410,426,424,428,482,427,414,599,287,401,412,272

{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Atrioventricular block, complete,Mitral valve disorders,Combined systolic and diastolic heart failure, unspecified,Pneumonia due to Pseudomonas,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Old myocardial infarction,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: [**Hospital **] transferred to [**Hospital1 18**] for cardiac catheteriztion/CABG PRESENT ILLNESS: 78 yo f s/p L CEA on [**2-1**] (discharged on [**2-2**]) felt gradually worsening SOB the night of discharge from hospital. She denied chest, arm, or jaw pain. She awoke from sleep with increased SOB, and had episode of syncope after using the bathroom. Directly before syncopal episode, she denied CP, palpitations, urinary/stool incontinence, and weakness, confusion, or paresthesias afterwards. She was heard by her family moaning in the bathroom and was brought to OSH. At the OSH, EKG showed sinus tachycardia @ 98bpm, TWI in V6, and STE in I, AvL, V5, and V6. STD was observed in inferior leads. CEs revealed troponin I 0.89, D-dimer 3.52, and BNP 920. PE revealed crackles. She was treated with ASA/NG/BB/plavix/heparin for STEMI. She was also given 20mg IV lasix for reduction of pulm edema. She was transferred to [**Hospital1 18**] for cardiac catherization. MEDICAL HISTORY: CAD s/p MI ~9 yrs ago (unknown hx) HTN Hypercholesterolemia Carotid stenosis s/p L CEA [**2-1**] R knee replacement MEDICATION ON ADMISSION: Lisinopril 10mg QD ASA 325mg QD Zocor 5mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: afebrile 127/53 75 20 100% on 2L NC Gen: well appearing, NAD, conversant HEENT: NC/AT, PERRL Neck: no JVP on R, cannot assess on L COR: S1 S2, RRR. [**2-18**] blowing systolic murmur radiating to axilla. no S3 or S4. Pulm: bibasilar crackles to [**12-17**] assessed supine Abd: soft, mild suprapubic tenderness, no guarding, no rebound. + BS. no bruits auscultated Ext: R cath site with art and venous sheaths removed. WWP bil, with 2+ DP L and 1+ DP R. Neuro: A/O x 3. FAMILY HISTORY: Mother and sister had MI in early 70s, father had MI in late 60s. SOCIAL HISTORY: Lives in her daughter's home in [**Location (un) 1110**], MA. Has several children who are well and involved in care. ### Response: {'Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Atrioventricular block, complete,Mitral valve disorders,Combined systolic and diastolic heart failure, unspecified,Pneumonia due to Pseudomonas,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Old myocardial infarction,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: fatigue, shortness of breath, melena PRESENT ILLNESS: Mr [**Known lastname 39221**] is a 63 year old male with CAD s/p STEMI ([**2112-1-29**]) with DESx2 to LAD on Aspirin and Clopidogrel, achalasia with history of GI bleeding with unclear source requiring ICU admission ([**3-/2112**]) who presents to the ED with one day of non-specific malaise. Patient reports not feeling well with lightheadedness/orthostasis, nausea fatigue, shortness of breath since yesterday. He denies any associated chest pain, palpitations, cough, vomiting, abdominal pain, melana, BRBPR. He does report noting dark stools. Given known h/o GIB patient called daughter today and reported not feeling well so she urged him to come to ED. MEDICAL HISTORY: # CAD: s/p anterior STEMI ([**2112-1-29**]) -- s/p DESx2 to LAD, angioplasty with clot retrieval of Diagonal MEDICATION ON ADMISSION: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Examination Vitals: 98.6 82 82/46 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, pale conjunctiva, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, 1+ edema at ankles bilaterally Neuro: grossly intact FAMILY HISTORY: Family History: (per records) # Mother: MI, CVA, and DVT # Father: DVT # Brother: Congenital heart disease # Daughter: Achalasia SOCIAL HISTORY: # Home: Divorced and lives alone. Does not have HHA or VNA. Daughter is HCP - [**Name (NI) **] - Pharmacist at [**Name (NI) 112**]. # Work: Works at Arsenal Mall at photography kiosk. # Tobacco: None # Alcohol: None # Drugs: None

Esophageal hemorrhage,Acute posthemorrhagic anemia,Hypotension, unspecified,Old myocardial infarction,Hypovolemia,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia secondary to blood loss (chronic)

Esophageal hemorrhage,Ac posthemorrhag anemia,Hypotension NOS,Old myocardial infarct,Hypovolemia,Hyperlipidemia NEC/NOS,BPH w/o urinary obs/LUTS,Status-post ptca,Chr blood loss anemia

Admission Date: [**2112-7-20**] Discharge Date: [**2112-7-24**] Date of Birth: [**2049-2-23**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4891**] Chief Complaint: fatigue, shortness of breath, melena Major Surgical or Invasive Procedure: # EGD # capsule endoscopy (results pending at discharge) History of Present Illness: Mr [**Known lastname 39221**] is a 63 year old male with CAD s/p STEMI ([**2112-1-29**]) with DESx2 to LAD on Aspirin and Clopidogrel, achalasia with history of GI bleeding with unclear source requiring ICU admission ([**3-/2112**]) who presents to the ED with one day of non-specific malaise. Patient reports not feeling well with lightheadedness/orthostasis, nausea fatigue, shortness of breath since yesterday. He denies any associated chest pain, palpitations, cough, vomiting, abdominal pain, melana, BRBPR. He does report noting dark stools. Given known h/o GIB patient called daughter today and reported not feeling well so she urged him to come to ED. In the ED, initial VS were: 99.6 118 121/47 18 100% RA. His blood pressure dropped to the 90s. Patient was given 3L NS with SBPs persistently in low 90s. Exam was significant for black tarry guiac positive stools. Labs were significant for HCT of 22.8 down from 28 on [**6-26**], WBC of 24, and BUN of 43. NG lavage was not performed. His CXR revealed clear lung fields and EKG was stable from prior. Patient was type and crossed, started on IV PPI and transferred to the ICU. Vitals prior to transfer were: Pulse 90. Respiratory Rate 19. Blood Pressure 91/52. O2 Saturation 99. Of note, patient has had multiple admissions for GIB, most recently in 20/[**2112**], during which he was admitted to the ICU for hypotension on presentation. He was stabalized with blood products. Negative NG lavage and +stool guiacs were concerning for small bowel bleed. Evaluation with MRE and capsule endoscopy were ultimately non-revealing. He was discharged on PPI once he was HD stable with resolution of melana. Patient was subsequently seen by GI in [**Month (only) 958**] at which time it was recommended that he undergo endoscopy with endoscopic placement of capsule in the event of repeat bleed. On arrival to the MICU, the patient's VS were: 98.6 82 82/46 97%RA. He denied shortness of breath and reported feeling better. Review of systems: (+) Per HPI (-) Denies fever, cough, chest pain, chest pressure, palpitations, vomiting, diarrhea, constipation, abdominal pain, dysuria. Past Medical History: # CAD: s/p anterior STEMI ([**2112-1-29**]) -- s/p DESx2 to LAD, angioplasty with clot retrieval of Diagonal -- Post MI had LVEF 30% with apical akinesis -- Last TTE ([**2112-3-8**]) with LVEF 55-60% and apical hypokinesis # Dyslipidemia # Achalasia: massively dilated on recent EGD ([**2112-2-26**]) -- Balloon dilatation ([**2094**]) -- s/p Laparoscopic [**Doctor Last Name **] myotomy ([**2111-12-8**]) # GI Bleeding -- BRBPR with admission ([**2112-2-20**]) no source found -- Melena with ICU admission ([**2112-3-4**]) no source found # Phimosis # BPH Social History: # Home: Divorced and lives alone. Does not have HHA or VNA. Daughter is HCP - [**Name (NI) **] - Pharmacist at [**Name (NI) 112**]. # Work: Works at Arsenal Mall at photography kiosk. # Tobacco: None # Alcohol: None # Drugs: None Family History: Family History: (per records) # Mother: MI, CVA, and DVT # Father: DVT # Brother: Congenital heart disease # Daughter: Achalasia Physical Exam: Admission Examination Vitals: 98.6 82 82/46 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, pale conjunctiva, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, 1+ edema at ankles bilaterally Neuro: grossly intact Pertinent findings at discharge: BP remains borderline low, with SBPs 98-120 on day of discharge No Tachycardia (off BP medications) No rales or rhonchi on lung exam No LE or peripheral pitting edema Pertinent Results: ADMISSION . [**2112-7-20**] 07:45PM BLOOD WBC-24.5*# RBC-2.66*# Hgb-7.0* Hct-22.8* MCV-86# MCH-26.4*# MCHC-30.8*# RDW-23.2* Plt Ct-326 [**2112-7-20**] 07:45PM BLOOD Neuts-90.0* Lymphs-7.2* Monos-2.7 Eos-0 Baso-0.1 [**2112-7-20**] 07:45PM BLOOD PT-10.5 PTT-20.4* INR(PT)-1.0 [**2112-7-20**] 07:45PM BLOOD Glucose-164* UreaN-43* Creat-0.8 Na-136 K-4.0 Cl-103 HCO3-23 AnGap-14 [**2112-7-20**] 07:53PM BLOOD Lactate-4.8* [**2112-7-20**] 08:31PM BLOOD Lactate-3.7* [**2112-7-20**] 11:05PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020 [**2112-7-20**] 11:05PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG . CXR [**7-20**] FINDINGS: AP upright and lateral views of the chest were provided. In this patient with known achalasia and dilated esophagus, there is no change in the appearance of the dilated distal esophagus which contains ingested debris. There is no sign of aspiration. Heart size cannot be readily assessed. No large pleural effusion. No pneumothorax. Bony structures intact. IMPRESSION: Dilated distal esophagus as seen previously containing ingested food contents. No signs of aspiration. Please refer to prior CT torso for full descriptive details of esophageal abnormalities. . EKG: NSR, flattening of TWs in lateral leads not very significant when compared to prior EKG from [**5-/2112**] . Discharge: **EGD with small bowel enteroscopy: Mucosal laceration with contact bleeding was noted in the lower third of the esophagus. Evidence of free sloughing of epithelium and contact bleeding was seen at the lower esophagus. Tortuous and massively dilated esophagus; moderate amount of liquid and solid food found in the mid to lower esophagus. Friability, contact bleeding, and mucosal sloughing were noted in the lower third of the esophagus. This may be reflective of underling esophagitis in setting of chemical/acid irritation from fluid retention within esphagus, and may be a contributing factor to bleeding. **A capsule endoscope was synchronized. It was loaded on the scope by grabbing with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] net. It was inserted and successfully released in duodenum. . [**2112-7-24**] WBC-6.3 RBC-3.62* Hgb-9.9* Hct-30.2* MCV-83 MCH-27.5 MCHC-32.9 RDW-22.4* Plt Ct-298 [**2112-7-20**] Ret Man-4.9* [**2112-7-23**] Glucose-118* UreaN-10 Creat-0.7 Na-141 K-3.4 Cl-108 HCO3-28 [**2112-7-21**] Albumin-2.7* Calcium-7.5* Phos-3.1 Mg-2.1 Brief Hospital Course: Mr [**Known lastname 39221**] is a 63 year old male with CAD s/p STEMI ([**2112-1-29**]) with DESx2 to LAD on Aspirin and Clopidogrel, achalasia with history of GI bleeding with unclear source requiring ICU admission ([**3-/2112**]), who presents to the ED with fatigue, shortness of breath and found to have significant anemia with associated guaiac + stools and hypotension. # UGI Bleed Patient has h/o recurrent GIB with multiple admissions, including recent ICU admission. Previous work-up, including EGD, colonoscopy, MRE and capsule endoscopy have been unable to localize source of bleed. Presents with with HCT of 22 and hypotension with documented melenic guaiac positive stools and elevated BUN concerning for upper GI source of bleeding. He was treatd with IV PPI. The patient [**Year (4 digits) 1834**] EGD on [**7-21**] which showed a mucosal laceration with contact bleeding in the lower third of the esophagus. There was a small amount of bright red blood oozing from the underlying tissue. Given suboptimal study with copious food/fluid in the whole esophagus and proximal stomach, the patient was placed on a clear liquid diet with plan for repeat enteroscopy attempt and capsule placement. He was treated with IV PPI. He received 3 units of PRBCs and about 4L of fluid during the first 24hours of his [**Hospital Unit Name 153**] course with HCT increase from 22 to 27. His hematocrit thereafter remained stable. Capsule endoscopy was initiated on [**7-22**], and he remained clinically stable. He was transferred to the medical floor on [**7-23**]. He was started on a clear liquid diet, which he tolerated well. PPI was switched to po, and Hct remained stable around 28-30. The capsule endoscopy will be read on [**7-25**] and the patient and his daughter are aware that they should expect a phone call from the GI clinician [**Location (un) 1131**] the scan at that time. The patient provided his information at work, including his telephone number and availability on Monday [**7-25**], which was passed along to the GI team. Tel: [**Telephone/Fax (1) 39222**]. # Hypotension Baseline from previous records: 110-130 sbps. Patient with SBP in 90s s/p 3L NS. Hypotension is secondary to hypovolemia in setting of acute blood loss. In addition, patient took his antihypertensives on the morning of admission. Patient does have elevated WBC but suspicion for infection is very low at this time. BP improved with blood transfusion in addition to isotonic IVF. On the medical floor, his antihypertensives were not reintroduced prior to discharge, given persistent borderline to low BPs. He was instructed to see his internist, Dr [**Last Name (STitle) **], within several days following discharge, as we suspect as he heals these medications will again be needed. # Acute blood loss anemia Patient with HCT 40 baseline in [**12/2111**] prior to onset of GIB. Baseline since then ranges in 26-30, presumably all secondary to blood loss. Found to have significant iron deficiency with ferritin of 5 on [**6-25**]. Patient now receiving IV iron infusions ([**2112-6-30**] and [**2112-7-8**]) in outpatient setting. As noted above, he was transfused a total of 3U PRBCs in the [**Hospital Unit Name 153**], and Hct stabilized around 27. On the medical floor, Hct remained stable around 28-30. # Leukocytosis Patient with WBC or 24.5 on admission. He is afebrile with no localizing symptoms of infection. His CXR and u/a are within normal limits. No indication at this time to start empiric antibiotics. Likely secondary to stress response to anemia/ acute GIB. # CAD Patient with h/o STEMI ([**2112-1-29**]) s/p DESx2 to LAD, angioplasty with clot retrieval from Diagonal. Post-MI LVEF 30% with apical akinesis, but recent TTE in [**2112-3-8**] with LVEF 55-60% and apical hypokinesis. Patient currently on clopidogrel and ASA. No concerning EKG changes or symptoms. As he had no large volume GIB overnight, he was continued on ASA 81mg and clopidogrel 75mg daily. # HTN Home regimen of lisinopril 5mg daily and metoprolol ER 50mg daily were held in the [**Hospital Unit Name 153**] due to hypotension and acute GIB. On the medical floor, they were not reintroduced prior to discharge, as noted above. His SBP was 98-120 on the day of discharge without evidence or symptoms of orthostasis or chest discomfort. His tamsulosin was also held due to low blood pressures. # Achalasia: increased pantoprazole to [**Hospital1 **]. Evidence of esophagitis on evaluation, s/p prior myomectomy. # Hyperlipidemia: Statin was held while NPO in [**Hospital Unit Name 153**]. Atorvastatin 80mg was resumed at the time of discharge. # BPH: Tamsulosin and finasteride were held in [**Hospital Unit Name 153**] in setting of hypotension. On the medical floor finasteride was restarted, but the tamsulosin was not, given above-noted relative hypotension. [**Name2 (NI) **] noted no difficulty with urination during the admission. # CODE STATUS: full code # Communication: Patient and daughter/HCP: [**Telephone/Fax (1) 39223**]. Discharge instructions reviewed with daughter at bedside, and with patient earlier with assistance of a russian interpreter via phone as bedside interpreters were not available. The patient expressed understanding of the important role that his oral intake including coffee and hard or spicy foods might play in his esophageal irritation. He was also aware of the central importance of close follow-up of his medical issues. Medications on Admission: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 8. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily) as needed for constipation. 9. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 10. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. clopidogrel 75 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 twice a day: This is increased from once daily prior to admission. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 4. finasteride 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day: Per your home routine. Held at discharge, to be restarted in follow-up: (as noted to patient) Metoprolol ER 50mg daily Lisinopril 5mg daily Tamsulosin 0.4mg qhs Patient reports not taking bowel regimen, so medications not restarted. Discharge Disposition: Home Discharge Diagnosis: Primary: #Acute upper GI bleed due to esophageal irritation #Acute blood loss anemia #h/o Achalasia s/p myomectomy Secondary: Coronary artery disease, s/p STEMI [**12/2111**] Hyperlipidemia BPH Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: It was a pleasure to care for you during your admission. As you know, you were admitted due to a low blood count that we feel is related to irritation in your esophagus. While this is not directly related to your prior surgery, it is likely that increased acid levels with reflux to your esophagus will continue to make this worse. ***We have increased your acid blocking [**Doctor Last Name 360**] due to the irritation seen in your esophagus, and it is very important that you take the higher dose until your GI doctor tells you to decrease back down to once a day.*** It is also important that you avoid foods that make you have your discomfort in your chest/esophagus, as you noted to us. These foods are likely increasing the irritation, and can put you at increased risk of having another bleeding episode. Changes to your medications: -Increase your pantoprazole from once to twice daily -Please HOLD your blood pressure medications lisinopril and metoprolol until you see Dr [**Last Name (STitle) **] due to low blood pressures (100s) while you were in the hospital. You should see Dr [**Last Name (STitle) **] within 2-4 days of discharge as we expect you will need these medications restarted soon. -Please HOLD your tamsulosin until you see Dr [**Last Name (STitle) **], due to the same low blood pressures while you were in the hospital. Continue taking your aspirin and clopidogrel as you were doing prior to this admission. These are for your stents and heart disease. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please see Dr [**Last Name (STitle) **] within one week from discharge, and he should check your blood count. We were not able to schedule this appointment for you because you were discharged over the weekend, so please call Monday morning to his office to schedule an appointment. Department: CARDIAC SERVICES When: MONDAY [**2112-8-8**] at 2:00 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Gastroenterology: We were unable to make you an appointment before you left, but someone from GI will call you to schedule an appointment. In addition, you should receive a call tomorrow, MONDAY [**7-25**] with the results of your capsule study. You will be called either with the Russian Interpreter, or someone will call your daughter [**Name (NI) **] to give her the results. Please continue with your previously scheduled appointments: Department: SURGICAL SPECIALTIES When: FRIDAY [**2112-9-16**] at 1 PM With: PELVIC FLOOR UNIT [**Telephone/Fax (1) 274**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

530,285,458,412,276,272,600,V458,280

{'Esophageal hemorrhage,Acute posthemorrhagic anemia,Hypotension, unspecified,Old myocardial infarction,Hypovolemia,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia secondary to blood loss (chronic)'}

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: fatigue, shortness of breath, melena PRESENT ILLNESS: Mr [**Known lastname 39221**] is a 63 year old male with CAD s/p STEMI ([**2112-1-29**]) with DESx2 to LAD on Aspirin and Clopidogrel, achalasia with history of GI bleeding with unclear source requiring ICU admission ([**3-/2112**]) who presents to the ED with one day of non-specific malaise. Patient reports not feeling well with lightheadedness/orthostasis, nausea fatigue, shortness of breath since yesterday. He denies any associated chest pain, palpitations, cough, vomiting, abdominal pain, melana, BRBPR. He does report noting dark stools. Given known h/o GIB patient called daughter today and reported not feeling well so she urged him to come to ED. MEDICAL HISTORY: # CAD: s/p anterior STEMI ([**2112-1-29**]) -- s/p DESx2 to LAD, angioplasty with clot retrieval of Diagonal MEDICATION ON ADMISSION: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Examination Vitals: 98.6 82 82/46 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, pale conjunctiva, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, 1+ edema at ankles bilaterally Neuro: grossly intact FAMILY HISTORY: Family History: (per records) # Mother: MI, CVA, and DVT # Father: DVT # Brother: Congenital heart disease # Daughter: Achalasia SOCIAL HISTORY: # Home: Divorced and lives alone. Does not have HHA or VNA. Daughter is HCP - [**Name (NI) **] - Pharmacist at [**Name (NI) 112**]. # Work: Works at Arsenal Mall at photography kiosk. # Tobacco: None # Alcohol: None # Drugs: None ### Response: {'Esophageal hemorrhage,Acute posthemorrhagic anemia,Hypotension, unspecified,Old myocardial infarction,Hypovolemia,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia secondary to blood loss (chronic)'}

CHIEF COMPLAINT: change in mental status PRESENT ILLNESS: 83 y/o M admitted with several day history of lethargy, confusion and hypoxia in psychiatrist office to 85%. Per wife, the patient had had increased lethargy, chills and cloudy urine, as well as increased swelling in his LUE and LLE in the days prior to admission. MEDICAL HISTORY: CAD s/p CABG in [**12-16**] Mitral Regurg s/p MVR with bioprosthetic valve in [**12-16**] atrial fibrillation OSA (long standing and untreated) BPH s/p TURP Indwelling Foley for last 4 months scoliosis HTN MEDICATION ON ADMISSION: ASA 325 mg daily Coumadin 1-2mg daily Lansoprazole 30mg daily Lasix 40mg daily (recently decreased from 40qam 60qpm) MVI Mirtazapine 30mg hs Finasteride 5mg daily Lisinopril 10mg daily Atrovent as needed Lopressor 75mg [**Hospital1 **] ALLERGIES: Procardia PHYSICAL EXAM: T:96.7 HR:102 BP:92/64 RR:16 SaO2:89%RA and 96%on 2L Gen:lethargic but answering questions appropriately, mildly confused Neck: JVD not noted Chest: decr BS at the L base and bibasilar crackles CV: tachy, irreg, irreg Abd:soft, NT/ND hypoactive BS Extr:cool, 2+edema in LUE and LLE, tr edema RLE Neuro: CN intact, Bilateral hip flexor [**4-16**] but symmetric UE strength symmetric FAMILY HISTORY: non-contributory SOCIAL HISTORY: Retired manufacturer. Lives with his wife and has several children. No tobacco, no EtOH, no drug use.

Infection and inflammatory reaction due to indwelling urinary catheter,Other septicemia due to gram-negative organisms,Sepsis,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Atrial fibrillation,Retention of urine, unspecified,Heart valve replaced by transplant,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Iron deficiency anemia, unspecified,Unspecified sleep apnea,Long-term (current) use of anticoagulants

React-indwell urin cath,Gram-neg septicemia NEC,Sepsis,Int inf clstrdium dfcile,Systolic hrt failure NOS,Atrial fibrillation,Retention urine NOS,Heart valve transplant,Klebsiella pneumoniae,Iron defic anemia NOS,Sleep apnea NOS,Long-term use anticoagul

Admission Date: [**2135-4-27**] Discharge Date: [**2135-5-13**] Service: MEDICINE Allergies: Procardia Attending:[**First Name3 (LF) 4980**] Chief Complaint: change in mental status Major Surgical or Invasive Procedure: none History of Present Illness: 83 y/o M admitted with several day history of lethargy, confusion and hypoxia in psychiatrist office to 85%. Per wife, the patient had had increased lethargy, chills and cloudy urine, as well as increased swelling in his LUE and LLE in the days prior to admission. In [**Name (NI) **] pt found to have WBC 16, evidence of UTI in foley sample, LLL infiltrate on CXR. Thought to be likely volume depleted, but given LE edema and CXR with possible upper lobe redistribution and left-sided pleural effusion. Pt complained of fatigue but denied shortness of breath, cough, chest pain, abdominal pain, headache or fever. Past Medical History: CAD s/p CABG in [**12-16**] Mitral Regurg s/p MVR with bioprosthetic valve in [**12-16**] atrial fibrillation OSA (long standing and untreated) BPH s/p TURP Indwelling Foley for last 4 months scoliosis HTN Social History: Retired manufacturer. Lives with his wife and has several children. No tobacco, no EtOH, no drug use. Family History: non-contributory Physical Exam: T:96.7 HR:102 BP:92/64 RR:16 SaO2:89%RA and 96%on 2L Gen:lethargic but answering questions appropriately, mildly confused Neck: JVD not noted Chest: decr BS at the L base and bibasilar crackles CV: tachy, irreg, irreg Abd:soft, NT/ND hypoactive BS Extr:cool, 2+edema in LUE and LLE, tr edema RLE Neuro: CN intact, Bilateral hip flexor [**4-16**] but symmetric UE strength symmetric Pertinent Results: [**2135-4-27**] 10:22PM URINE HOURS-RANDOM SODIUM-LESS THAN [**2135-4-27**] 10:22PM URINE OSMOLAL-529 [**2135-4-27**] 05:20PM URINE COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.014 [**2135-4-27**] 05:20PM URINE BLOOD-LG NITRITE-NEG PROTEIN-500 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-MOD [**2135-4-27**] 05:20PM URINE RBC->50 WBC-[**1-1**]* BACTERIA-FEW YEAST-NONE EPI-<1 [**2135-4-27**] 05:20PM URINE COMMENT-ABN URINE COLOR INTERPRET DIPSTICK W/ CAUTION [**2135-4-27**] 03:41PM K+-5.1 [**2135-4-27**] 03:41PM HGB-13.0* calcHCT-39 [**2135-4-27**] 03:30PM GLUCOSE-81 UREA N-22* CREAT-0.9 SODIUM-126* POTASSIUM-5.3* CHLORIDE-85* TOTAL CO2-35* ANION GAP-11 [**2135-4-27**] 03:30PM CK(CPK)-59 [**2135-4-27**] 03:30PM CK-MB-NotDone cTropnT-0.01 [**2135-4-27**] 03:30PM ALBUMIN-3.7 CALCIUM-9.2 PHOSPHATE-4.0 MAGNESIUM-2.0 [**2135-4-27**] 03:30PM OSMOLAL-262* [**2135-4-27**] 03:30PM WBC-16.6*# RBC-5.11 HGB-13.4* HCT-41.4 MCV-81* MCH-26.1* MCHC-32.3 RDW-14.9 [**2135-4-27**] 03:30PM NEUTS-84.7* LYMPHS-9.7* MONOS-4.5 EOS-0.8 BASOS-0.2 [**2135-4-27**] 03:30PM PT-18.4* PTT-30.2 INR(PT)-2.1 Brief Hospital Course: A/P: 83 yo M with multiple medical problems, presenting with altered mental status, hypotension,hypoxia, and urinary tract infection. 1)Hypotension: Initial impression was that pt had urosepsis and was intravascularly deplete (though total body overloaded). He was hydrated gently overnight with some improvement in his blood pressure. Attempts were then made to diurese the patient which resulted in hypotension that necessitated a brief stay in the MICU. In the MICU the patient was given 3L of fluid with improvement in his blood pressures. Adrenal insufficiency was considered, but the patient's am cortisol was 18, inconsistent with this diagnosis. Thereafter, the patient had stable blood pressures, however he has required fluid bolusing to maintain urine output due to periods of decreased PO intake and overdiuresis. 2)Hypoxia:Pt cxr on admission consistent with pulmonary edema, as well as L sided pleural effusion. In the setting of urosepsis, the edema was likely due to capillary leak, rather than diminished cardiac output. The patient continued to require oxygen through out his stay, and had at times a recurrent L pleural effusion (see below). At the time of discharge, pt is being diuresed with goal of negative 500cc to 1L per day. 3)Atrial Fibrillation:Mr. [**Known lastname 12166**] had episodes of rapid atrial fibrillation while hospitalized. His rate was difficult to control during his hypotension and volume depletion--digitalization was attempted but unsuccessful. As the patient's beta blocker was restarted, he had improved rate control with HR in the 70s-90s. Mr. [**Known lastname 12166**] was continued on coumadin and his INR was therapeutic at the time of discharge, but should be followed closely while he is on levofloxacin. 4)CHF: The pateint presented with signs of volume overload. As discussed above, this was most likely due to capillary leak in the setting of sepsis than frank CHF. After fluid rescusitation, however the patient had persistent vascular congestion and a recurrent L pleural effusion. A cardiac echo was obtained to assess the patient's valve patency and ejection fraction. This showed his mitral valve prosthesis to be functioning well, and that his EF is 40%. As the patient's urosepsis resolved and his blood pressure improved, gentle diuresis was initiated. Brisk diuresis was avoided due to fear of volume contraction resulting in metabolic alkalosis, as earlier in the [**Hospital 228**] hospital course he became somnolent with an elevated pCO2 in response to brisk diuresis. As pt was diuresed, acetazolamide was added to attenuate further elevation in his bicarbonate and to increase his respiratory drive, this was eventually held due to concern that it might be contributing to the pt's lethargy. At present, pt lasix is on hold due to his low PO intake and the feeling that he is intravascularly depleted. 5)L pleural effusion:this was noted on admission CXR. Consideration was given to thoracentesis as this effusion was not noted on previous CXR, however the attending felt that this was most likely due to CHF. After the patient was transferred to the ICU service, an attempt to access the fluid with ultrasound guided thoracentesis was undertaken. At the time of the proceedure, there was not enough fluid to tap. OVer the next two days, however, the patient's CXR appeared to have a L sided effusion, thus a chest CT was obtained on [**5-5**] which confirmed the presence of a large L sided loculated pleural effusion. One pocket of this effusion was tapped on [**2135-5-7**], 500cc of transudative fluid was removed. The pulmonary service saw this patient and felt that the etiology of the effusion was most likely post-operative, and that given his lack of temp or of elevated WBC count, he did not require definative drainage of the loculations via VATS. 6)Obstructive Sleep Apnea: Mr. [**Known lastname 12166**] has many years of untreated sleep apnea which (combined with his scoliosis)has led to chronic CO2 retention. His Bicarbonate is chronically around 35, suggesting that his baseline CO2 is likely in the 60s. In the setting of aggressive diuresis, Mr. [**Known lastname 12166**] developed volume contraction and a metabolic alkalosis (bicarbonate around 40) which caused him to be acutely somnolent with a pCO2 near 80. This resolved with hydration and resolution of volume contraction. Mr. [**Known lastname 12166**] continues to display daytime fatigue and frequently falls asleep--this is likely due to his untreated sleep apnea. The hope is that Mr. [**Known lastname 12166**] can be transferred to a facility that will allow him to use nasal pillow CPAP as he has not been able to tolerate the nasal mask or the face mask. Treatment of his Sleep apnea would no doubt greatly improve his heart failure as well. 7)Urinary tract infection: Pt urine culture grew two strains of pan-sensitive klebsiella. He was treated with Levofloxacin and finished a 14d course on [**5-10**]. 8)Indwelling foley:Since his CABG/MVR, Mr. [**Known lastname 12166**] has had an indwelling foley. Multiple attempts to remove the foley have only resulted in reinsertion. According to the patient, his urologist (Dr. [**Last Name (STitle) 770**] told him that "a proceedure" would be necessary to ensure that he could urinate on his own when the foley was removed. Attempts to reach Dr. [**Last Name (STitle) 770**] were unsuccessful as he was out of town during the patient's hospitalization. The urology service was consulted and noted that Dr. [**Last Name (STitle) 770**] had performed urodyamics in the office and that the only options for the patient at present were intermittent clean cathing or indwelling foley. Mr. [**Known lastname 12166**] [**Last Name (Titles) 104978**] his foley while walking and had resulting hematuria with clots. This resolved after irrigation and placement of a 20Fr 3way foley. 9)Anemia:Mr. [**Known lastname 12166**] was found to be both iron deficient and B12 deficient. He was thus started on iron and B12 replacement. His stool was guaiac negative and his hematocrit was stable, thus colonoscopy was deferred to the outpatient setting. 10)Mental Status: Mr. [**Known lastname 12166**] was frankly delerious on admission, which improved over the course of the next few days. He did have an episode of somnolence due to hypercarbia, probably precipitated by overdiuresis. This resolved with aggressive fluid to counteract his metabolic alkalosis. Mr. [**Known lastname 12166**] did well for several days after this, remaining alert , oriented and appropriate. In the setting of his C.diff diarrhea, he again began to have problems with lethargy and fatigue, diamox was stopped due this issue. 10)C.Diff:Mr. [**Known lastname 12166**] developed diarrhea on levofloxacin which was positive for C.Diff. He was started on a 7d course of Flagyl on [**5-11**]. Medications on Admission: ASA 325 mg daily Coumadin 1-2mg daily Lansoprazole 30mg daily Lasix 40mg daily (recently decreased from 40qam 60qpm) MVI Mirtazapine 30mg hs Finasteride 5mg daily Lisinopril 10mg daily Atrovent as needed Lopressor 75mg [**Hospital1 **] Discharge Medications: 1. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 2. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 3. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). 4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Warfarin Sodium 1 mg Tablet Sig: 1-2 Tablets PO HS (at bedtime). 7. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 8. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO three times a day. 9. Fluoxetine HCl 20 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 10. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. 11. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO ONCE (once). 13. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 7 days. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - Acute Rehab Discharge Diagnosis: Urosepsis c. diff colitis congestive heart failure Atrial fibrillation with RVR L sided pleural effusion Iron Deficiency B12 deficiency Anemia Bioprosthetic heart valve Obstructive sleep apnea Discharge Condition: fair Discharge Instructions: Please follow up with Dr. [**Last Name (STitle) **] after your discharge from Rehab. You should have a colonoscopy as an outpatient. Followup Instructions: Pt will need an outpatient colonoscopy. PT should follow up with Dr. [**Last Name (STitle) **] after discharge

996,038,995,008,428,427,788,V422,041,280,780,V586

{"Infection and inflammatory reaction due to indwelling urinary catheter,Other septicemia due to gram-negative organisms,Sepsis,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Atrial fibrillation,Retention of urine, unspecified,Heart valve replaced by transplant,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Iron deficiency anemia, unspecified,Unspecified sleep apnea,Long-term (current) use of anticoagulants"}

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 PRESENT ILLNESS: 83 y/o M admitted with several day history of lethargy, confusion and hypoxia in psychiatrist office to 85%. Per wife, the patient had had increased lethargy, chills and cloudy urine, as well as increased swelling in his LUE and LLE in the days prior to admission. MEDICAL HISTORY: CAD s/p CABG in [**12-16**] Mitral Regurg s/p MVR with bioprosthetic valve in [**12-16**] atrial fibrillation OSA (long standing and untreated) BPH s/p TURP Indwelling Foley for last 4 months scoliosis HTN MEDICATION ON ADMISSION: ASA 325 mg daily Coumadin 1-2mg daily Lansoprazole 30mg daily Lasix 40mg daily (recently decreased from 40qam 60qpm) MVI Mirtazapine 30mg hs Finasteride 5mg daily Lisinopril 10mg daily Atrovent as needed Lopressor 75mg [**Hospital1 **] ALLERGIES: Procardia PHYSICAL EXAM: T:96.7 HR:102 BP:92/64 RR:16 SaO2:89%RA and 96%on 2L Gen:lethargic but answering questions appropriately, mildly confused Neck: JVD not noted Chest: decr BS at the L base and bibasilar crackles CV: tachy, irreg, irreg Abd:soft, NT/ND hypoactive BS Extr:cool, 2+edema in LUE and LLE, tr edema RLE Neuro: CN intact, Bilateral hip flexor [**4-16**] but symmetric UE strength symmetric FAMILY HISTORY: non-contributory SOCIAL HISTORY: Retired manufacturer. Lives with his wife and has several children. No tobacco, no EtOH, no drug use. ### Response: {"Infection and inflammatory reaction due to indwelling urinary catheter,Other septicemia due to gram-negative organisms,Sepsis,Intestinal infection due to Clostridium difficile,Systolic heart failure, unspecified,Atrial fibrillation,Retention of urine, unspecified,Heart valve replaced by transplant,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Iron deficiency anemia, unspecified,Unspecified sleep apnea,Long-term (current) use of anticoagulants"}

CHIEF COMPLAINT: Chest pain and abdominal pain PRESENT ILLNESS: This is a 73 year old male with past medical history significant for CAD s/p CABG and PCI to LCx, aortic stenosis, VT/VF arrest s/p ICD, CHF (EF 20%) s/p BiV pacer, afib on coumadin, CRI and diverticulosis who presents with 1 hour of chest pain similar to anginal equivalent that radiated to abd and back. Assocated with nausea. Took ntg tab w/o relief. No pleuritic chest pain. The abd pain is LLQ predominant w/o radiation. He states that he has had black stools on both of the last 2 days associated with changed smell of the stools. He has had no bloody stool. The abd pain usually is better after eating. There have been no new foods and no sick contacts. . Of note the patient was recently in the [**Hospital1 18**] for abdominal pain in [**1-20**]. At which time his labs were unremarkable. A CT abd showed no acute pathology to explain his pain. He received IV fluids and slowly advanced his diet to normal prior to discharge. . In ED, initial vitals were 97.8 120/70 100 14 100%RA. Stools brown and OB negative. ECG was V-paced at 85bpm, cardiac enzymes were negative. Patient given aspirin, nitro tabs, morphine. . On floor, patient was with decreasing chest pain but still with nausea. The abdominal pain is also improved. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. his weight has been stable at 222-223pounds. His baseline function is 1 flight of stairs. All of the other review of systems were negative. . Cardiac review of systems is notable for paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . MEDICAL HISTORY: CAD status post CABG with simultaneous aortic aneurysm repair in [**2133**], history of stenting of the left circumflex artery [**2135**] s/p VT/VF arrest, s/p ICD placement in [**2135**] iCMP (EF 20%) s/p BiV pacer [**10-18**] Chest wall cellulitis over pacer site [**3-19**] vs. ICD pacer pocket infection AFib (not anti-coagulated due to recurrent GI bleeds) CKD Stage III b/l Cr. ~1.6 Hyperlipidemia Asthma Anxiety Alzheimer's dementia Hypothyroidism Diverticulosis GERD s/p cholecystectomy . CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: Sotalol 80 mg [**Hospital1 **] Levothyroxine 112 mcg daily Citalopram 60 mg daily Quetiapine 50 mg QAM Quetiapine 25 mg daily at noon Quetiapine 75 mg QHS Sucralfate 1 gram QID Mexiletine 150 mg Q8H Pantoprazole 40 mg Q12 Atorvastatin 20 mg daily Fluticasone-Salmeterol 250-50 mc 2 puffs [**Hospital1 **] Donepezil 5 mg QHS Metoprolol Succinate 50 mg QHS Furosemide 40 mg daily Spironolactone 12.5 mg daily Nitroglycerin 0.3 mg PRN (as needed) as needed for chest pain. Clonazepam 0.5 mg TID (3 times a day) as needed for anxiety. Trazodone 50 mg qhs:prn insomnia Metoclopramide 25 mg q8 prn Digoxin 0.0625 mcg daily Albuterol 90 mcg prn Aspirin 81 mg daily K-Dur 20 mEq daily . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission- VS: 98.5 100/71 82 16 99%2L wt. 222 lbs GENERAL: WDWN obese male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 8 cm. CARDIAC: PMI laterally displaced. RR, normal S1, S2. [**2-17**] systolic murmur at RUSB c/w AS. No r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, minimal tender to LLSB. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. guiaiac negative brown stool. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Neuro: -MS alert and oriented x3. coherent response to interview -CN II-XII intact -Motor moving all 4 extremities symmetrically. -[**Last Name (un) **] light touch intact to face/hands/feet FAMILY HISTORY: No family history of early MI, otherwise non-contributory. SOCIAL HISTORY: married, lives with wife. [**Name (NI) **] originally from [**Country 4754**]. No history of smoking. Patient was a heavy drinker until 20 years ago. No history of illicit drugs

Acute pancreatitis,Cardiac arrest,Chronic systolic heart failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, Stage III (moderate),Aortocoronary bypass status,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diverticulosis of colon (without mention of hemorrhage),Fitting and adjustment of automatic implantable cardiac defibrillator

Acute pancreatitis,Cardiac arrest,Chr systolic hrt failure,Meth res pneu d/t Staph,Urin tract infection NOS,Ac kidny fail, tubr necr,Aortic valve disorder,Chr ischemic hrt dis NEC,Long-term use anticoagul,Asthma NOS,Hyperlipidemia NEC/NOS,Chr kidney dis stage III,Aortocoronary bypass,Alzheimer's disease,Dementia w/o behav dist,Hypothyroidism NOS,Dvrtclo colon w/o hmrhg,Ftng autmtc dfibrillator

Admission Date: [**2141-3-8**] Discharge Date: [**2141-3-30**] Date of Birth: [**2068-2-28**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: Chest pain and abdominal pain Major Surgical or Invasive Procedure: none History of Present Illness: This is a 73 year old male with past medical history significant for CAD s/p CABG and PCI to LCx, aortic stenosis, VT/VF arrest s/p ICD, CHF (EF 20%) s/p BiV pacer, afib on coumadin, CRI and diverticulosis who presents with 1 hour of chest pain similar to anginal equivalent that radiated to abd and back. Assocated with nausea. Took ntg tab w/o relief. No pleuritic chest pain. The abd pain is LLQ predominant w/o radiation. He states that he has had black stools on both of the last 2 days associated with changed smell of the stools. He has had no bloody stool. The abd pain usually is better after eating. There have been no new foods and no sick contacts. . Of note the patient was recently in the [**Hospital1 18**] for abdominal pain in [**1-20**]. At which time his labs were unremarkable. A CT abd showed no acute pathology to explain his pain. He received IV fluids and slowly advanced his diet to normal prior to discharge. . In ED, initial vitals were 97.8 120/70 100 14 100%RA. Stools brown and OB negative. ECG was V-paced at 85bpm, cardiac enzymes were negative. Patient given aspirin, nitro tabs, morphine. . On floor, patient was with decreasing chest pain but still with nausea. The abdominal pain is also improved. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. his weight has been stable at 222-223pounds. His baseline function is 1 flight of stairs. All of the other review of systems were negative. . Cardiac review of systems is notable for paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . Past Medical History: CAD status post CABG with simultaneous aortic aneurysm repair in [**2133**], history of stenting of the left circumflex artery [**2135**] s/p VT/VF arrest, s/p ICD placement in [**2135**] iCMP (EF 20%) s/p BiV pacer [**10-18**] Chest wall cellulitis over pacer site [**3-19**] vs. ICD pacer pocket infection AFib (not anti-coagulated due to recurrent GI bleeds) CKD Stage III b/l Cr. ~1.6 Hyperlipidemia Asthma Anxiety Alzheimer's dementia Hypothyroidism Diverticulosis GERD s/p cholecystectomy . CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension Social History: married, lives with wife. [**Name (NI) **] originally from [**Country 4754**]. No history of smoking. Patient was a heavy drinker until 20 years ago. No history of illicit drugs Family History: No family history of early MI, otherwise non-contributory. Physical Exam: On admission- VS: 98.5 100/71 82 16 99%2L wt. 222 lbs GENERAL: WDWN obese male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 8 cm. CARDIAC: PMI laterally displaced. RR, normal S1, S2. [**2-17**] systolic murmur at RUSB c/w AS. No r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, minimal tender to LLSB. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. guiaiac negative brown stool. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Neuro: -MS alert and oriented x3. coherent response to interview -CN II-XII intact -Motor moving all 4 extremities symmetrically. -[**Last Name (un) **] light touch intact to face/hands/feet Pertinent Results: ======== Labs ======== [**2141-3-30**] 11:51AM BLOOD Hct-27.8* [**2141-3-30**] 11:51AM BLOOD PT-22.2* PTT-91.8* INR(PT)-2.1* [**2141-3-30**] 04:09AM BLOOD WBC-9.2 RBC-2.92* Hgb-8.4* Hct-26.2* MCV-90 MCH-28.8 MCHC-32.1 RDW-15.5 Plt Ct-255 [**2141-3-30**] 04:09AM BLOOD Glucose-193* UreaN-31* Creat-2.0* Na-132* K-4.5 Cl-97 HCO3-27 AnGap-13 [**2141-3-11**] 06:37AM BLOOD WBC-6.5 RBC-4.10* Hgb-11.9* Hct-35.6* MCV-87 MCH-29.1 MCHC-33.5 RDW-14.6 Plt Ct-144* [**2141-3-10**] 05:15AM BLOOD WBC-7.4 RBC-4.16* Hgb-12.2* Hct-35.8* MCV-86 MCH-29.2 MCHC-34.0 RDW-14.7 Plt Ct-136* [**2141-3-9**] 05:15AM BLOOD WBC-8.7 RBC-4.14* Hgb-12.3* Hct-35.7* MCV-86 MCH-29.7 MCHC-34.5 RDW-14.5 Plt Ct-145* [**2141-3-8**] 06:45PM BLOOD WBC-9.2 RBC-4.44* Hgb-13.0* Hct-38.5* MCV-87 MCH-29.2 MCHC-33.7 RDW-14.5 Plt Ct-193 [**2141-3-11**] 06:37AM BLOOD Glucose-86 UreaN-17 Creat-1.6* Na-140 K-4.0 Cl-103 HCO3-27 AnGap-14 [**2141-3-10**] 05:15AM BLOOD Glucose-72 UreaN-20 Creat-1.5* Na-138 K-3.8 Cl-103 HCO3-27 AnGap-12 [**2141-3-9**] 05:15AM BLOOD Glucose-86 UreaN-25* Creat-1.6* Na-140 K-4.4 Cl-102 HCO3-29 AnGap-13 [**2141-3-8**] 06:45PM BLOOD Glucose-95 UreaN-26* Creat-1.7* Na-138 K-4.3 Cl-100 HCO3-31 AnGap-11 [**2141-3-10**] 05:15AM BLOOD ALT-42* AST-47* AlkPhos-132* Amylase-112* [**2141-3-9**] 05:15AM BLOOD LD(LDH)-276* CK(CPK)-86 Amylase-208* [**2141-3-8**] 06:45PM BLOOD ALT-20 AST-30 CK(CPK)-96 AlkPhos-92 Amylase-137* TotBili-0.3 [**2141-3-11**] 06:37AM BLOOD Lipase-33 [**2141-3-10**] 05:15AM BLOOD Lipase-46 [**2141-3-9**] 04:05PM BLOOD Lipase-58 [**2141-3-9**] 05:15AM BLOOD Lipase-164* [**2141-3-8**] 06:45PM BLOOD Lipase-124* [**2141-3-9**] 05:15AM BLOOD CK-MB-NotDone cTropnT-0.01 [**2141-3-8**] 06:45PM BLOOD cTropnT-<0.01 [**2141-3-8**] 06:45PM BLOOD Digoxin-0.7* . ========= Radiology ========= CXR [**3-8**] FINDINGS: PA and lateral views of the chest are obtained. Three-lead pacer device is unchanged with lead tips positioned in the expected location. Midline sternotomy wires are unchanged. Cardiomegaly is stable. There is no CHF or evidence of pneumonia. No pleural effusion or pneumothorax is seen. Osseous structures are intact. IMPRESSION: No significant change with persistent cardiomegaly and no evidence of CHF or pneumonia. . RUQ U/S [**3-9**] RIGHT UPPER QUADRANT ULTRASOUND: The liver appears unremarkable in echotexture and architecture, without focal liver lesion seen. Flow in the main portal vein is in normal hepatopetal direction. No intra- or extra- hepatic biliary ductal dilatation is noted, with the common duct measuring 5 mm. Again the gallbladder is absent, consistent with prior cholecystectomy. Visualization of the pancreatic tail is slightly limited due to overlying bowel gas however the visualized pancreas appears unremarkable and unchanged. No pancreatic ductal dilatation is noted. No ascites is seen. The spleen is enlarged, measuring 13.8 cm. IMPRESSION: 1. Patient is status post cholecystectomy. No intra- or extra-hepatic biliary ductal dilatation is noted. No choledocholithiasis seen. 2. Incidentally noted splenomegaly. . =========== Cardiology =========== TTE [**3-9**] Conclusions The left atrium is moderately dilated. The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is severely dilated. Overall left ventricular systolic function is severely depressed (LVEF= 20 %). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is no ventricular septal defect. Right ventricular chamber size is normal. with borderline normal free wall function. with focal hypokinesis of the apical free wall. The aortic root is mildly dilated at the sinus level. There are focal calcifications in the aortic arch. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are severely thickened/deformed. There is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. The main pulmonary artery is dilated. The branch pulmonary arteries are dilated. Compared with the findings of the prior study (images reviewed) of [**2140-10-12**], no major change is evident. . Myocardial perfusion study [**3-11**] IMPRESSION: 1) Severe left ventricular enlargment 2) Probably some viability within an inferior wall defect. TTE [**2141-3-14**] The left ventricular cavity is dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is severely depressed (LVEF= 20 %). The right ventricular cavity is mildly dilated with normal free wall contractility. The aortic valve leaflets are mildly thickened. The mitral valve leaflets are mildly thickened. Mild to moderate ([**1-13**]+) mitral regurgitation is seen. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Focused views. Severe left ventricular sysolic dysfunction. Mild to moderate mitral regurgitation. Compared with the prior study (images reviewed) of [**2141-3-9**], this is a limited/emergent/focused study and direct comparison cannot be made. Cardiac Cath [**2141-3-20**] COMMENTS: 1. Coronary angiography of this right dominant system demonstrated no angiographically apparent flow-limiting coronary artery disease. 2. Non-selective arteriography of the LIMA-LAD showed no apparent flow-limiting disease. 3. Limited resting hemodynamics revealed a central aortic pressure of 134/92 mmHg. FINAL DIAGNOSIS: 1. No angiographically apparent flow-limiting coronary artery disease. 2. Patent LIMA-LAD. [**2141-3-26**] LEFT UPPER EXTREMITY VENOUS ULTRASOUND: [**Doctor Last Name **]-scale and color and pulsed wave Doppler examination was performed over the right subclavian vein as well as the left internal jugular, subclavian, axillary, brachial, basilic, and cephalic veins. Note is made of nearly occlusive thrombosis of the left cephalic, basilic, brachial, and axillary veins. Flow is demonstrated in the left and right subclavian veins. More proximally, note is made of likely pacemaker wire entering the left subclavian vein. The internal jugular vein demonstrates normal compressibility and flow. IMPRESSION: Left upper extremity DVT extending from the superficial cephalic and basilic veins into the brachial and axillary deep veins. CXRs: [**2141-3-28**] PORTABLE SEMI-UPRIGHT RADIOGRAPH OF THE CHEST: The distal tip of right PICC projects in the mid SVC. There has been interval removal of the endotracheal tube and NG tube. The remainder of the study including the position of the AICD leads and the cardiopulmonary status appear unchanged. IMPRESSION: Standard position of the right PICC with no complication. Pertinent Micro data [**2141-3-22**] 2:00 pm URINE Source: Catheter. **FINAL REPORT [**2141-3-24**]** URINE CULTURE (Final [**2141-3-24**]): ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S GRAM STAIN (Final [**2141-3-21**]): >25 PMNs and <10 epithelial cells/100X field. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S). RESPIRATORY CULTURE (Final [**2141-3-24**]): MODERATE GROWTH OROPHARYNGEAL FLORA. STAPH AUREUS COAG +. MODERATE GROWTH. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. Rifampin should not be used alone for therapy. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | CLINDAMYCIN----------- =>8 R ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- =>8 R OXACILLIN------------- =>4 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- 2 S TRIMETHOPRIM/SULFA---- <=0.5 S VANCOMYCIN------------ <=1 S C diff negative Blood cx ngtd Brief Hospital Course: # VT: Initially on home meds of mexilitine and sotalol. On the floor, had an episode VT on telemetry and lost pulses. He [**Month/Day/Year 1834**] CPR, receiving a total of 4 shocks, 4mg of epinephrine, amiodarone 150mg x 2, Lidocaine 100mg x 1, magnesium 2mg, bicarb 1 amp, and calcium. Pacer interrogation showed his VT was below the rate of detection. He was manually paced out of VT several times but with return to VT each time. Finally, lidocaine and amiodarone gtts were started and the patient was successfully converted back to a paced rhythm. His mexilitine and sotalol were held. He was intubated during the code, but rapidly extubated afterward. From [**3-15**] to [**3-21**], he had repeated episodes of VT, receiving multiple ICD shocks each time, with conversion to a paced rhythm. The first of these episodes was associated with hypotension, but subsequent episodes showed good BP. He was given ativan for sedation due to the multiple shocks, and was reintubated [**3-19**] for airway protection from sedation. Over the course of these several episodes, he received multiple amiodarone and lidocaine boluses, and was variably on and off drips of these medications. On [**3-21**], he had an EP study and had 1 circuit ablated and an epicardial circuit interrupted. He was transitioned to a final regimen of oral mexilitene alone. After the study, he was kept sedated and initially required phenylephrine and vasopressin. He had multiple VT episodes on [**3-22**], but successfully paced out without shocks. He was weaned off pressors and extubated, and subsequently started on metoprolol, which was uptitrated to 25mg TID. His only further VT was on [**3-28**], and he was successsfully paced out. EP recommends that he continue on telemetry monitoring for 48 hours after discharge. # Chest pain: Has a history of CAD, although cardiac cath done during admission was clean and biomarkers on admission for chest pain in the ER were negative. After CPR, patient had significant reproducible chest wall tenderness that was due to the direct trauma of chest compressions. This pain was not felt to be ischemia. He was treated initially with IV morphine and hydromorphone, but received better pain control after transitioning to oral MS contin. He is also on [**Month/Year (2) 1988**] tylenol and a lidocaine patch. # Anxiety: Patient has known anxiety, and this was significantly worsened in the setting of recurrent VT and receiving many ICD shocks. Psychiatry was consulted and advised seroquel PRN in addition to his standing doses. He was also continued on citalopram and low dose clonazepam. Despite this, he continued to have significant anxiety; he would have episodes of lightheadedness and palpitations, despite normal vital signs and no telemetry changes. Also, he at times thought his ICD had fired, but review of telemetry showed this was not the case. He also becomes diaphoretic, but per patient and wife, this is long-standing and his baseline. # Abdominal pain: Presented with nausea, vomiting, abdominal pain and elevated lipase, otherwise normal LFTs. No cholethiasis on abdominal u/s. He was ruled out for acute cardiac event. He was treated with bowel rest and his diet was slowly advanced as tolerated. # DVT: LUE had swelling and ultrasound was positive. He was started on a heparin drip and bridged to warfarin before discharge. Continued on PPI and sucralfate given history of GI bleeds and ASA was lowered from 325mg to 81mg daily. He will need a follow up ultrasound in [**3-15**] mos. # Pump: LVEF 20% on TTE [**10-19**]. Also has known AS, although during admission patient was refusing AVR and valvuloplasty. He became hypervolemic around [**3-18**], requiring a lasix gtt. His volume status improved and he was transitioned to his home dose of lasix 40mg PO daily. His digoxin was stopped due to arrhythmogenic concerns. Beta blocker continued as above. Spironolactone was increased from 12.5 to 25mg daily. # CKD: Baseline Cr around 1.6. Prior to discharge, his creatinine trended up to 2.0 in the setting of increased ACE-I and restarting furosemide. Per discussion with his outpatient cardiologist, this is acceptable for now and can be followed after discharge, with med changes made as needed. # MRSA Pneumonia: Pt developed MRSA pneumonia with sputum growing MRSA. He was treated with Vancomycin 8 day course which he completed on [**2141-3-29**] # UTI: Pt had E coli UTI. He was initially on pip-tazo for empiric pneumonia coverage, but changed to ceftriaxone once sensitivities returned. He completed a 7 day course of antibiotics. # CODE: Code status had been changed to 1 externmal shock if neccessary but no compressions. This was reversed on [**2141-3-28**] when patient expressed desire to be full code. Medications on Admission: Sotalol 80 mg [**Hospital1 **] Levothyroxine 112 mcg daily Citalopram 60 mg daily Quetiapine 50 mg QAM Quetiapine 25 mg daily at noon Quetiapine 75 mg QHS Sucralfate 1 gram QID Mexiletine 150 mg Q8H Pantoprazole 40 mg Q12 Atorvastatin 20 mg daily Fluticasone-Salmeterol 250-50 mc 2 puffs [**Hospital1 **] Donepezil 5 mg QHS Metoprolol Succinate 50 mg QHS Furosemide 40 mg daily Spironolactone 12.5 mg daily Nitroglycerin 0.3 mg PRN (as needed) as needed for chest pain. Clonazepam 0.5 mg TID (3 times a day) as needed for anxiety. Trazodone 50 mg qhs:prn insomnia Metoclopramide 25 mg q8 prn Digoxin 0.0625 mcg daily Albuterol 90 mcg prn Aspirin 81 mg daily K-Dur 20 mEq daily . Discharge Medications: 1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 3. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 6. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Mexiletine 150 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours). 8. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. 9. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): at noon. 10. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO QAM (once a day (in the morning)). 11. Quetiapine 25 mg Tablet Sig: Three (3) Tablet PO HS (at bedtime). 12. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 13. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 14. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day: Hold for loose stools. 15. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed. 17. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day) as needed for anxiety. 18. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 19. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 20. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 21. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO four times a day. 22. 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. 23. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Hold SBP< 90. 24. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 25. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush Temporary Central Access-ICU: Flush with 10mL Normal Saline daily and PRN. 26. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 27. FerrouSul 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO once a day. 28. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO once a day. 29. Morphine 15 mg Tablet Sustained Release Sig: [**1-13**] Tablet Sustained Releases PO every eight (8) hours as needed for chest pain. 30. Digoxin 125 mcg Tablet Sig: 0.5 Tablet PO once a day. 31. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM: check INR on [**2141-4-1**]. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: Primary: Pancreatitis, Ventricular Tachycardia, Hypotension, Pneumonia Secondary: Aortic stenosis, Coronary artery disease Discharge Condition: stable, tolerating oral intake Discharge Instructions: You presented to the hospital with chest pain and abdominal pain. There was some initial concern that you were having a heart attack, but this was ruled out by basic lab work. Your chest pain resolved in the emergency room and you were chest pain free on the cardiology floor. It was recommended that you consider valvuloplasy and angioplasty for your tight aortic valve in your heart and your blocked blood vessels in your heart, but you refused this intervention. Your abdominal pain was felt to be due to inflammation in the pancreas. An ultrasound of your abdomen did not reveal any stones as the cause of this inflammation. Your pancreas improved with gently hydration. While you were in the hospital, you also developed worsening of your abnormal heart rhythm, requiring many shocks by your ICD. You were kept sedated and with a breathing tube since the shocks were so uncomfortable. You [**Location (un) 1834**] a procedure to help improve your heart rhythm, and this helped your heart rhythm considerably. You also developed pneumonia while you were in the hospital, and we are treating you with antibiotics. We have made several medication changes as listed below. . We made the following changes to your medications: - sotalol - we discontinued this medication - trazodone - we discontinued this medication - spironolactone - we increased this medication from 12.5mg once a day to 25mg daily. - reglan - we have decreased this medication from 25mg three times a day as you need it to 10mg three times a day as you need it. - magnesium repletion as given at home. -your Toprol was changed to short acting metoprolol -your fluticasone was changed to Advair. -we started tylenol around the clock, a lidoderm patch and long acting morphine to treat your chest pain caused by rib fractures. -Warfarin to treat the clot in your left arm . Please seek immediate medical attention if you experience worsening shortness of breath, abdominal pain, dizziness, bloody bowel movements, black tarry bowel movements or any other change from your baseline health status. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs in 1 day of 6 pounds in 3 days Adhere to 2 gm sodium diet Fluid Restriction: Followup Instructions: Gastroenterology: Please follow up with Dr. [**Last Name (STitle) 3708**] on [**4-7**] at 12:30pm. [**Hospital Ward Name 452**] 1, [**Location (un) **], [**Hospital Ward Name 516**] entrance, [**Hospital1 18**]. If you need to change this appointment please call [**Telephone/Fax (1) 463**]. . Cardiology: Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**] Phone: ([**Telephone/Fax (1) 2037**]. Date/Time: [**Telephone/Fax (1) 766**] [**4-3**] at 1:00 pm. [**Hospital Ward Name 23**] Building, [**Location (un) 436**] [**Hospital Ward Name 516**], [**Hospital1 18**] . Primary care: Pleaes call your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] an appointment after you leave the rehabilitation facility to discuss this hospital stay Completed by:[**2141-3-30**]

577,427,428,482,599,584,424,414,V586,493,272,585,V458,331,294,244,562,V533

{"Acute pancreatitis,Cardiac arrest,Chronic systolic heart failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, Stage III (moderate),Aortocoronary bypass status,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diverticulosis of colon (without mention of hemorrhage),Fitting and adjustment of automatic implantable cardiac defibrillator"}

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 and abdominal pain PRESENT ILLNESS: This is a 73 year old male with past medical history significant for CAD s/p CABG and PCI to LCx, aortic stenosis, VT/VF arrest s/p ICD, CHF (EF 20%) s/p BiV pacer, afib on coumadin, CRI and diverticulosis who presents with 1 hour of chest pain similar to anginal equivalent that radiated to abd and back. Assocated with nausea. Took ntg tab w/o relief. No pleuritic chest pain. The abd pain is LLQ predominant w/o radiation. He states that he has had black stools on both of the last 2 days associated with changed smell of the stools. He has had no bloody stool. The abd pain usually is better after eating. There have been no new foods and no sick contacts. . Of note the patient was recently in the [**Hospital1 18**] for abdominal pain in [**1-20**]. At which time his labs were unremarkable. A CT abd showed no acute pathology to explain his pain. He received IV fluids and slowly advanced his diet to normal prior to discharge. . In ED, initial vitals were 97.8 120/70 100 14 100%RA. Stools brown and OB negative. ECG was V-paced at 85bpm, cardiac enzymes were negative. Patient given aspirin, nitro tabs, morphine. . On floor, patient was with decreasing chest pain but still with nausea. The abdominal pain is also improved. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. his weight has been stable at 222-223pounds. His baseline function is 1 flight of stairs. All of the other review of systems were negative. . Cardiac review of systems is notable for paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . MEDICAL HISTORY: CAD status post CABG with simultaneous aortic aneurysm repair in [**2133**], history of stenting of the left circumflex artery [**2135**] s/p VT/VF arrest, s/p ICD placement in [**2135**] iCMP (EF 20%) s/p BiV pacer [**10-18**] Chest wall cellulitis over pacer site [**3-19**] vs. ICD pacer pocket infection AFib (not anti-coagulated due to recurrent GI bleeds) CKD Stage III b/l Cr. ~1.6 Hyperlipidemia Asthma Anxiety Alzheimer's dementia Hypothyroidism Diverticulosis GERD s/p cholecystectomy . CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: Sotalol 80 mg [**Hospital1 **] Levothyroxine 112 mcg daily Citalopram 60 mg daily Quetiapine 50 mg QAM Quetiapine 25 mg daily at noon Quetiapine 75 mg QHS Sucralfate 1 gram QID Mexiletine 150 mg Q8H Pantoprazole 40 mg Q12 Atorvastatin 20 mg daily Fluticasone-Salmeterol 250-50 mc 2 puffs [**Hospital1 **] Donepezil 5 mg QHS Metoprolol Succinate 50 mg QHS Furosemide 40 mg daily Spironolactone 12.5 mg daily Nitroglycerin 0.3 mg PRN (as needed) as needed for chest pain. Clonazepam 0.5 mg TID (3 times a day) as needed for anxiety. Trazodone 50 mg qhs:prn insomnia Metoclopramide 25 mg q8 prn Digoxin 0.0625 mcg daily Albuterol 90 mcg prn Aspirin 81 mg daily K-Dur 20 mEq daily . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission- VS: 98.5 100/71 82 16 99%2L wt. 222 lbs GENERAL: WDWN obese male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 8 cm. CARDIAC: PMI laterally displaced. RR, normal S1, S2. [**2-17**] systolic murmur at RUSB c/w AS. No r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, minimal tender to LLSB. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. guiaiac negative brown stool. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Neuro: -MS alert and oriented x3. coherent response to interview -CN II-XII intact -Motor moving all 4 extremities symmetrically. -[**Last Name (un) **] light touch intact to face/hands/feet FAMILY HISTORY: No family history of early MI, otherwise non-contributory. SOCIAL HISTORY: married, lives with wife. [**Name (NI) **] originally from [**Country 4754**]. No history of smoking. Patient was a heavy drinker until 20 years ago. No history of illicit drugs ### Response: {"Acute pancreatitis,Cardiac arrest,Chronic systolic heart failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, Stage III (moderate),Aortocoronary bypass status,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Diverticulosis of colon (without mention of hemorrhage),Fitting and adjustment of automatic implantable cardiac defibrillator"}

CHIEF COMPLAINT: Dyspnea with exertion and fatigue. PRESENT ILLNESS: This 52 year old male has known IHSS, followed with serial echocardiograms, demonstrating worsening LV outflow tract gradients. Cardiac workup was performed earlier to reveal normal coronaries and he in admitted for surgical repair at this time. MEDICAL HISTORY: hypertension hypercholesterolemia idiopathic hypertrophic subaortic stenosis MEDICATION ON ADMISSION: ASA 81mg/D Toprol XL 100mg/D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge: VS:99, 115/69, 94reg, 18, 95% RA Gen: well appearing male in NAD Skin: warm, dry HEENT:unremarkable Neck:supple, NT Chest:CTA bilat. sternal incision clean, dry, intact w/ stable sternum. Heart:RRR S1, S2 Abd:soft, round, NT, ND, +BS Ext:trace LE edema Neuro:alert and oriented x3 FAMILY HISTORY: noncontributory SOCIAL HISTORY: remote smoker (none in 25 years) few beers a week lives with his wife.

Mitral valve disorders,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia

Mitral valve disorder,Cardiac dysrhythmias NEC,Hypertension NOS,Pure hypercholesterolem

Admission Date: [**2156-12-27**] Discharge Date: [**2157-1-2**] Date of Birth: [**2104-9-20**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Dyspnea with exertion and fatigue. Major Surgical or Invasive Procedure: Septal myectomy & Mitral valve replacement (27mm St. [**Male First Name (un) 923**] mechanical) [**2156-12-27**] History of Present Illness: This 52 year old male has known IHSS, followed with serial echocardiograms, demonstrating worsening LV outflow tract gradients. Cardiac workup was performed earlier to reveal normal coronaries and he in admitted for surgical repair at this time. Past Medical History: hypertension hypercholesterolemia idiopathic hypertrophic subaortic stenosis Social History: remote smoker (none in 25 years) few beers a week lives with his wife. Family History: noncontributory Physical Exam: Discharge: VS:99, 115/69, 94reg, 18, 95% RA Gen: well appearing male in NAD Skin: warm, dry HEENT:unremarkable Neck:supple, NT Chest:CTA bilat. sternal incision clean, dry, intact w/ stable sternum. Heart:RRR S1, S2 Abd:soft, round, NT, ND, +BS Ext:trace LE edema Neuro:alert and oriented x3 Pertinent Results: [**2156-12-27**] 12:50PM BLOOD WBC-21.8*# RBC-4.09* Hgb-12.7* Hct-34.4* MCV-84 MCH-31.1 MCHC-37.0* RDW-14.2 Plt Ct-185 [**2156-12-29**] 08:50AM BLOOD WBC-10.4 RBC-3.16* Hgb-9.6* Hct-27.2* MCV-86 MCH-30.4 MCHC-35.3* RDW-14.6 Plt Ct-101* [**2156-12-27**] 11:46AM BLOOD PT-15.9* PTT-36.5* INR(PT)-1.4* [**2156-12-29**] 08:50AM BLOOD PT-19.1* INR(PT)-1.8* [**2156-12-27**] 12:50PM BLOOD UreaN-13 Creat-1.0 Cl-115* HCO3-21* [**2156-12-29**] 08:50AM BLOOD Glucose-141* UreaN-18 Creat-1.2 Na-136 K-4.5 Cl-103 HCO3-26 AnGap-12 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 79769**], [**Known firstname 412**] [**Hospital1 18**] [**Numeric Identifier 79770**] (Complete) Done [**2156-12-27**] at 8:53:12 AM PRELIMINARY Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] R. [**Hospital1 18**], Division of Cardiothorac [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2104-9-20**] Age (years): 52 M Hgt (in): 66 BP (mm Hg): / Wgt (lb): 170 HR (bpm): BSA (m2): 1.87 m2 Indication: Hypertrophic cardiomyopathy. Left ventricular function. Right ventricular function. Valvular heart disease. ICD-9 Codes: 425.1, 424.0 Test Information Date/Time: [**2156-12-27**] at 08:53 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Last Name (NamePattern5) 9958**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2009AW01-: Machine: aw2 Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *2.3 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.8 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 3.8 cm <= 5.6 cm Left Ventricle - Peak Resting LVOT gradient: *111 mm Hg <= 10 mm Hg [**Last Name (NamePattern5) **] - Annulus: 2.3 cm <= 3.0 cm [**Last Name (NamePattern5) **] - Ascending: 2.6 cm <= 3.4 cm [**Last Name (NamePattern5) **] - Arch: 2.2 cm <= 3.0 cm [**Last Name (NamePattern5) **] - Descending Thoracic: 1.7 cm <= 2.5 cm Aortic Valve - LVOT pk vel: 5.30 m/sec Aortic Valve - LVOT diam: 2.1 cm Findings LEFT ATRIUM: Normal LA and RA cavity sizes. RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is seen in the RA and extending into the RV. No ASD by 2D or color Doppler. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Severe symmetric LVH. Normal regional LV systolic function. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. [**Last Name (NamePattern5) **]: Normal diameter of [**Last Name (NamePattern5) 5236**] at the sinus, ascending and arch levels. Normal descending [**Last Name (NamePattern5) 5236**] diameter. AORTIC VALVE: Mildly thickened aortic valve leaflets. No AS. No AR. MITRAL VALVE: Myxomatous mitral valve leaflets. Elongated mitral valve leaflets. [**Male First Name (un) **] of mitral valve leaflets. Eccentric MR jet. Moderate (2+) MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. Conclusions PRE-BYPASS: The left atrium and right atrium are normal in cavity size. No atrial septal defect is seen by 2D or color Doppler. There is severe left ventricular hypertrophy. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The diameters of [**Male First Name (un) 5236**] at the sinus, ascending and arch levels are normal. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The anterior mitral valve leaflet is elongated. There is systolic anterior motion of the mitral valve leaflets. An eccentric jet of moderate (2+) mitral regurgitation is seen. There is no pericardial effusion. POST-BYPASS 1: The patient is in sinus rhythm and is on an infusion of phenylephrine. Septal myomectomy has been performed. Biventricular function is preserved. There continues to be significant [**Male First Name (un) **] of the mitral valve leaflets, and severely elevated gradients in the LVOT. POST-BYPASS 2: The patient is in sinus rhythm and is on an infusion of phenylephrine. Biventricular function is preserved. A mechanical mitral valve prosthesis is in good position with good leaflet excursion. The LVOT gradients are appropriate. The [**Male First Name (un) 5236**] is intact. The is no MR. [**First Name (Titles) **] [**Last Name (Titles) 5236**] is intact. The mid septal wall is hypokinetic. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room. I certify that I was present for this procedure in compliance with HCFA regulations. Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting physician Brief Hospital Course: On [**2156-12-27**] he was admitted and underwent a septal myectomy and mitral valve replacement as noted. See operative note for details. Following surgery he was transferred to the CVICU for invasive monitoring in stable condition. Later that day he was weaned from pressors, awoke neurologically intact and extubated. On post-op day one he was started on beta blockers and diuretics and gently diuresed towards his pre-op weight. Later on this day he was transferred to the telemetry floor for further care. Chest tubes and epicardial pacing wires were removed per protocol. Anticoagulation was started with Coumadin for INR goal 2.5-3.5 for mechanical valve.As discussed with Dr[**Hospital **] Medical assistant,[**Doctor First Name **], Dr.[**Last Name (STitle) 4541**] will follow INR/Coumadin dosing. Mr. [**Known lastname **] developed bradycardia rate 40's (asymptomatic)on POD#3 into 4 and EP was consulted. Recommendation was to monitor and hold nodal agents. The patient did subsequently develop sinus tachycardia in to the 110s and low dose beta blockade was initiated. Mr.[**Known lastname **] continued to progress and he was ready for discharge on POD#6 to home with VNA. He was advised of all follow up appointments. Medications on Admission: ASA 81mg/D Toprol XL 100mg/D Discharge Medications: 1. Outpatient Lab Work INR to be drawn on [**2157-1-3**] with results sent to the office of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4541**] ([**Telephone/Fax (1) 79771**] 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 HS (at bedtime) as needed for constipation. 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Disp:*7 Tablet(s)* Refills:*0* 7. Coumadin 2 mg Tablet Sig: Two (2) Tablet PO once a day: to be dosed by PCP based on INR goal 2.5-3.5. Disp:*60 Tablet(s)* Refills:*2* 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days. Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: vital care at home Discharge Diagnosis: Idiopathic hypertrophic subaortic stenosis s/p septal myectomy and mitral valve replacement hypertension hypercholesterolemia Discharge Condition: deconditioned Discharge Instructions: **VNA to call INR/Coumadin into Dr.[**Last Name (STitle) 4541**] #[**Telephone/Fax (1) **]. next INR draw will be drawn on [**2157-1-3**] shower daily, no baths or swimming x 6 weeks no lotions, creams or powders to incisions report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain greater than 2 pounds a day or 5 pounds a week no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks Followup Instructions: Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) Dr. [**First Name8 (NamePattern2) 79772**] [**Name (STitle) 3394**] in [**12-24**] weeks ([**Telephone/Fax (1) 79773**]) ***Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4541**] will follow Coumadin/INR #[**Telephone/Fax (1) **]. next INR draw will be [**2157-1-3**] wound clinic in 2 weeks please call for appointments Completed by:[**2157-1-2**]

424,427,401,272

{'Mitral valve disorders,Other specified cardiac dysrhythmias,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: Dyspnea with exertion and fatigue. PRESENT ILLNESS: This 52 year old male has known IHSS, followed with serial echocardiograms, demonstrating worsening LV outflow tract gradients. Cardiac workup was performed earlier to reveal normal coronaries and he in admitted for surgical repair at this time. MEDICAL HISTORY: hypertension hypercholesterolemia idiopathic hypertrophic subaortic stenosis MEDICATION ON ADMISSION: ASA 81mg/D Toprol XL 100mg/D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge: VS:99, 115/69, 94reg, 18, 95% RA Gen: well appearing male in NAD Skin: warm, dry HEENT:unremarkable Neck:supple, NT Chest:CTA bilat. sternal incision clean, dry, intact w/ stable sternum. Heart:RRR S1, S2 Abd:soft, round, NT, ND, +BS Ext:trace LE edema Neuro:alert and oriented x3 FAMILY HISTORY: noncontributory SOCIAL HISTORY: remote smoker (none in 25 years) few beers a week lives with his wife. ### Response: {'Mitral valve disorders,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Hypoxia and dyspnea PRESENT ILLNESS: 69 M h/o COPD, dCHF, on coumadin for h/o afib (per wife, though pt not taking it now) presenting for respiratory distress. Per wife, pt with 2d increasing SOB, non-productive cough, "in bed all day", multiple other family members sick with "flu." . Pt presented to the ED with VS: 97.4 153 134/89 34 83% RA, improved to 96% with NRB, though RR 40s, so pt started on CPAP, with sats 93%, SBP 130s->94, so put back on 4L, with sats 91%. pulmonary exam sounded tight, +wheezing, sinus tach on EKG, CXR showed no CHF, ?PNA in RLL. given solumedrol 125, nebs, levo/vanco for broad coverage. . Pt also with L>R edema, and bilateral LE redness concerning for cellulitis, had similar sx [**10-30**], LENIs negative. unable to lie flat for CTA. MEDICAL HISTORY: - COPD (no available PFTs) - on 2L O2 at home, keeps a nebulizer MEDICATION ON ADMISSION: -ipratropium Bromide 0.02 % IH Q6HR -albuterol Sulfate 0.083 % IH Q6HR -lisinopril 10 mg po qdaily -hctz 12.5 mg po qdaily (zestoretic) -prednisone 30mg po qdaily -bactrim 400-80 mg po qdaily -CALCIUM 500+D 500 po qdaily -chantix --- lasix (dose [**Last Name (un) 5487**] per wife, not recorded on pharmacy list) coumadin (not taking) ALLERGIES: Augmentin PHYSICAL EXAM: VS: 95.5 145 125/78 39 89%4L GEN: ill appearing, pale, blue ears, speaks in [**12-24**] word sentences, using accessory muscles. HEENT: No JVD. CV: regular, tachy, nl s1, s2, no appreciable m/r/g. PULM: poor airmovement throughout, bilateral +wheeze. ABD: soft, NT, ND, + BS, no HSM. EXT: warm, 2+ dp/radial pulses BL. B LE [**12-24**]+ EDEMA, L>R, +erythema, ?chronic venous changes vs cellulitis. NEURO: alert & oriented x 3. . FAMILY HISTORY: non-contributory SOCIAL HISTORY: TOB up to [**2-24**] ppd x 50 years, now <1 ppd. Denies etoh/illicts. Married. 8 children. Taxi driver.

Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute on chronic diastolic heart failure,Viral pneumonia, unspecified,Cellulitis and abscess of leg, except foot,Other specified cardiac dysrhythmias,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Anxiety state, unspecified,Neoplasm of uncertain behavior of skin,Encounter for palliative care

Obs chr bronc w(ac) exac,Acute respiratry failure,Ac on chr diast hrt fail,Viral pneumonia NOS,Cellulitis of leg,Cardiac dysrhythmias NEC,Long-term use anticoagul,Depend-supplement oxygen,Hypertension NOS,Anxiety state NOS,Unc behav neo skin,Encountr palliative care

Admission Date: [**2122-2-21**] Discharge Date: [**2122-2-28**] Date of Birth: [**2052-10-30**] Sex: M Service: MEDICINE Allergies: Augmentin Attending:[**First Name3 (LF) 5893**] Chief Complaint: Hypoxia and dyspnea Major Surgical or Invasive Procedure: Intubation History of Present Illness: 69 M h/o COPD, dCHF, on coumadin for h/o afib (per wife, though pt not taking it now) presenting for respiratory distress. Per wife, pt with 2d increasing SOB, non-productive cough, "in bed all day", multiple other family members sick with "flu." . Pt presented to the ED with VS: 97.4 153 134/89 34 83% RA, improved to 96% with NRB, though RR 40s, so pt started on CPAP, with sats 93%, SBP 130s->94, so put back on 4L, with sats 91%. pulmonary exam sounded tight, +wheezing, sinus tach on EKG, CXR showed no CHF, ?PNA in RLL. given solumedrol 125, nebs, levo/vanco for broad coverage. . Pt also with L>R edema, and bilateral LE redness concerning for cellulitis, had similar sx [**10-30**], LENIs negative. unable to lie flat for CTA. ROS negative for F/C/N/V/D, CP, dysuria, constipation. +sick contacts, fatigue. Past Medical History: - COPD (no available PFTs) - on 2L O2 at home, keeps a nebulizer at home and in his taxi - HTN - dCHF (TTE [**10-30**] EF>55%, RV free wall HK, mod aortic dilation) - h/o ?afib. Social History: TOB up to [**2-24**] ppd x 50 years, now <1 ppd. Denies etoh/illicts. Married. 8 children. Taxi driver. Family History: non-contributory Physical Exam: VS: 95.5 145 125/78 39 89%4L GEN: ill appearing, pale, blue ears, speaks in [**12-24**] word sentences, using accessory muscles. HEENT: No JVD. CV: regular, tachy, nl s1, s2, no appreciable m/r/g. PULM: poor airmovement throughout, bilateral +wheeze. ABD: soft, NT, ND, + BS, no HSM. EXT: warm, 2+ dp/radial pulses BL. B LE [**12-24**]+ EDEMA, L>R, +erythema, ?chronic venous changes vs cellulitis. NEURO: alert & oriented x 3. . Pertinent Results: [**2122-2-20**] 11:15PM BLOOD WBC-8.1 RBC-4.41* Hgb-14.0 Hct-42.9 MCV-97 MCH-31.7 MCHC-32.6 RDW-14.5 Plt Ct-171 [**2122-2-27**] 03:27AM BLOOD WBC-7.2 RBC-4.40* Hgb-13.7* Hct-42.3 MCV-96 MCH-31.2 MCHC-32.5 RDW-14.6 Plt Ct-148* [**2122-2-20**] 11:15PM BLOOD Neuts-83.6* Lymphs-9.2* Monos-6.4 Eos-0.7 Baso-0.1 [**2122-2-20**] 11:15PM BLOOD PT-11.7 PTT-26.7 INR(PT)-1.0 [**2122-2-27**] 03:27AM BLOOD PT-11.8 PTT-27.0 INR(PT)-1.0 [**2122-2-20**] 11:15PM BLOOD Glucose-126* UreaN-16 Creat-0.9 Na-145 K-3.5 Cl-97 HCO3-45* AnGap-7* [**2122-2-27**] 03:27AM BLOOD Glucose-78 UreaN-30* Creat-0.8 Na-139 K-4.5 Cl-91* HCO3-46* AnGap-7* [**2122-2-20**] 11:15PM BLOOD CK-MB-7 cTropnT-0.03* proBNP-5511* [**2122-2-22**] 04:00AM BLOOD CK-MB-4 cTropnT-<0.01 [**2122-2-20**] 11:15PM BLOOD Calcium-9.2 Phos-5.0* Mg-2.3 [**2122-2-21**] 12:13AM BLOOD Type-ART pO2-121* pCO2-93* pH-7.29* calTCO2-47* Base XS-14 Intubat-NOT INTUBA [**2122-2-26**] 11:35PM BLOOD Type-ART Temp-36.4 O2 Flow-3 pO2-51* pCO2-91* pH-7.35 calTCO2-52* Base XS-19 Intubat-NOT INTUBA [**2122-2-20**] 11:27PM BLOOD Lactate-1.6 [**2122-2-21**] 03:29AM BLOOD Lactate-1.0 [**2122-2-21**] 05:26AM BLOOD Lactate-0.7 FINDINGS: A single portable image of the chest was obtained and compared to the prior examination dated [**2122-2-20**]. In the interim, an endotracheal tube has been placed that terminates approximately 9 cm above the carina. The image is slightly underpenetrated. There is a new left pleural effusion. In addition, suggestion of a new left retrocardiac opacity is noted, likely secondary to the underlying effusion and atelectasis, difficult to exclude pneumonia. The right hemithorax is relatively clear. IMPRESSION: 1. Endotracheal tube not in ideal position, consider right repositioning. 2. New left retrocardiac opacity, likely secondary to a small-to-moderate size effusion and atelectasis, difficult to exclude pneumonia. EKG: The rhythm is probably sinus tachycardia. Right bundle-branch block. Left anterior fascicular block. Compared to the previous tracing of [**2121-11-3**] there has been a marked increase in rate. Otherwise, no diagnostic interim change. Brief Hospital Course: # hypoxia: Patient intially on 4L NC mainting oxygen saturations of 90%. Over the course of the first few hours of his admission, he showed worsening respiratory distress, with increasing work of breathing. Patinet was intially started on BIPAP for non-invasive ventillatory support. The etiology of his hypoxia/dyspnea was believed to be most likely secondary to a COPD flare. He demonstrated wheezes on chest exam with poor pair movement consistent with an obstructive etiology. Patient with negative LENIS, and given such a low suspicison of PE, CTA was not pursued. He had negative cardiac enzymes x 3, and no evidence of fluid overload on CXR. Patient was intubated on the second day of admission due to increasing hypercapnea and increased work of breathing that was not believed to be sustainable. The patient showed improved ABG on ventilator, with a blood gas that was believed to be consistent with his baseline of CO2 retention. The patient remained intubated for 6 days. During the ce course, he was continued on steroids, freqent nebulizer treatments, and started on levoquin for empiric atypical coverage. Invectious etiology, and more specifically viral cause, was believed to be the inciting factor to his COPD exacerbation. CXR showed no frank infiltrates, sputum Cx showed no growth, and the patient was DFA negative. Patient began to show evidence of fluid overload on exam and CXR, and was diuresed with resolution. The patient showed improvement on physical exam and ease of oxygentation, and was ultimatly extubated. Following extubation the patient showed worsened wheezes and the need for continued BIPAP. When the possibility of re-intubation was addressed, the patient refused. Prednisone was continued with plans for a slow taper. He is being discharged to hospice with BIPAP. on CPAP. Patient hyperventilating w/ anxiety. #Anxiety: Patient notably anxious following extubation, with hypertension, tachycarida, and hyperventilation. These symptoms were somewhat improved on anxietylitics and plan is to discharge patient on morphine and ativan. #cardiac: Again, given shortness of breath and LE edema, some concern of MI at time of admission. The patient had cardiac enzymes negative x three. He was intially started on ASA, which was proptly discontinued. #Diastolic HF: Patient has previously carried the diagnosis. Had LE edema on admission, but not signs of fluid overload on CXR. During the admission, patient showed worsened evidence of fluid overlaod, and was successfully diruesed. The patient will be discharged on a maintence dose of lasix that may require further adjustment. # HTN: The patient has a history of hypertension. He was continued on his home lisinopril/HCTZ, and BP was well controlled. #LE edema/erythema: On admission, the patient was noted to have left lower extremity erythema. Unclear if cellulites vs. changes from venoustasis. The patient had no elevation of WBC or LE edema. He was started on vanc because of concern of it looking worsened in intesnity. With blood cultures negative and low probablity concern of MRSA, the patient was continued on levoquin feeling that it would offer adquate coverage. The patient showed marked improvement with antibiotics and diuresis. #Leg Mass: Patient with fungating black mass on right ankle. Some concern of melanoma, and dermatology was consulted. The differential diagnosis for these lesions includes lymphangiectasia, angiokeratoma, pyogenic granuloma, venous [**Doctor Last Name **] or an atypical kaposi's sarcoma. Bx is needed to rule out KS. The clinical presentation is not consistent with melanoma. Recommened shave biopsy as an outpatient. #Disposition: The patient requested to not be intubated, and given the progressed nature of his end stage COPD, the decision was made with the patient and his family to be discharged to hospice. Medications on Admission: -ipratropium Bromide 0.02 % IH Q6HR -albuterol Sulfate 0.083 % IH Q6HR -lisinopril 10 mg po qdaily -hctz 12.5 mg po qdaily (zestoretic) -prednisone 30mg po qdaily -bactrim 400-80 mg po qdaily -CALCIUM 500+D 500 po qdaily -chantix --- lasix (dose [**Last Name (un) 5487**] per wife, not recorded on pharmacy list) coumadin (not taking) Discharge Medications: 1. BIPAP [**Last Name (un) **]: 4 liters bleed in qHS and PRN comfort: 15 cm H2O IPAP/5 cm H2O EPAP. Disp:*1 BIPAP machine* Refills:*0* 2. Home oxygen [**Last Name (un) **]: Four (4) liters continuous. Disp:*1 home oxygen delivery system* Refills:*0* 3. Albuterol 90 mcg/Actuation Aerosol [**Last Name (un) **]: One (1) nebulizer Inhalation q2-4 hours as needed for shortness of breath or wheezing. Disp:*1 box* Refills:*2* 4. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (un) **]: One (1) nebulizer Inhalation every six (6) hours. Disp:*120 aerosol* Refills:*2* 5. Roxanol Concentrate 20 mg/mL Solution [**Last Name (un) **]: [**12-24**] mL PO q2 hour as needed for shortness of breath or wheezing. Disp:*30 mL* Refills:*0* 6. Lorazepam 2 mg/mL Concentrate [**Month/Day (2) **]: One (1) mL PO q 4-6 hours as needed for anxiety or shortness of breath. Disp:*30 mL* Refills:*0* 7. Prednisone 20 mg Tablet [**Month/Day (2) **]: 3 tabs daily x 5 days; 2 tabs daily x 5 days Tablets PO once a day for 10 days: Then resume home dose of 30 mg daily. Disp:*25 Tablet(s)* Refills:*0* 8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (2) **]: [**12-24**] Tablet, Delayed Release (E.C.)s PO DAILY (Daily) as needed for constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1* 9. Senna 8.6 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*1* 10. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 11. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 12. Docusate Sodium 100 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*1* 13. Lisinopril 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home With Service Facility: [**Hospital 269**] Hospice Care Discharge Diagnosis: COPD exacerbation Hypertension AVNRT Viral Pneumonia Cellulitis Acute on chronic diastolic heart failure Discharge Condition: Stable on 3L O2 Discharge Instructions: You are being discharged from the hospital after admission for respiratory distress. This was believed to be due to a flare of you underlying, end-stage COPD. In order to help you breath, you required intubation. You were successfully extubated, but still had significant difficulty breathing. After length discussion about goals of care, you decided to pursue comfort measures only, and are now discharged how with hospice care. Followup Instructions: Additional Care provided through hospice services. Contact your PCP to apprise him of your change in care goals.

491,518,428,480,682,427,V586,V462,401,300,238,V667

{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute on chronic diastolic heart failure,Viral pneumonia, unspecified,Cellulitis and abscess of leg, except foot,Other specified cardiac dysrhythmias,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Anxiety state, unspecified,Neoplasm of uncertain behavior of skin,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: Hypoxia and dyspnea PRESENT ILLNESS: 69 M h/o COPD, dCHF, on coumadin for h/o afib (per wife, though pt not taking it now) presenting for respiratory distress. Per wife, pt with 2d increasing SOB, non-productive cough, "in bed all day", multiple other family members sick with "flu." . Pt presented to the ED with VS: 97.4 153 134/89 34 83% RA, improved to 96% with NRB, though RR 40s, so pt started on CPAP, with sats 93%, SBP 130s->94, so put back on 4L, with sats 91%. pulmonary exam sounded tight, +wheezing, sinus tach on EKG, CXR showed no CHF, ?PNA in RLL. given solumedrol 125, nebs, levo/vanco for broad coverage. . Pt also with L>R edema, and bilateral LE redness concerning for cellulitis, had similar sx [**10-30**], LENIs negative. unable to lie flat for CTA. MEDICAL HISTORY: - COPD (no available PFTs) - on 2L O2 at home, keeps a nebulizer MEDICATION ON ADMISSION: -ipratropium Bromide 0.02 % IH Q6HR -albuterol Sulfate 0.083 % IH Q6HR -lisinopril 10 mg po qdaily -hctz 12.5 mg po qdaily (zestoretic) -prednisone 30mg po qdaily -bactrim 400-80 mg po qdaily -CALCIUM 500+D 500 po qdaily -chantix --- lasix (dose [**Last Name (un) 5487**] per wife, not recorded on pharmacy list) coumadin (not taking) ALLERGIES: Augmentin PHYSICAL EXAM: VS: 95.5 145 125/78 39 89%4L GEN: ill appearing, pale, blue ears, speaks in [**12-24**] word sentences, using accessory muscles. HEENT: No JVD. CV: regular, tachy, nl s1, s2, no appreciable m/r/g. PULM: poor airmovement throughout, bilateral +wheeze. ABD: soft, NT, ND, + BS, no HSM. EXT: warm, 2+ dp/radial pulses BL. B LE [**12-24**]+ EDEMA, L>R, +erythema, ?chronic venous changes vs cellulitis. NEURO: alert & oriented x 3. . FAMILY HISTORY: non-contributory SOCIAL HISTORY: TOB up to [**2-24**] ppd x 50 years, now <1 ppd. Denies etoh/illicts. Married. 8 children. Taxi driver. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute on chronic diastolic heart failure,Viral pneumonia, unspecified,Cellulitis and abscess of leg, except foot,Other specified cardiac dysrhythmias,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Anxiety state, unspecified,Neoplasm of uncertain behavior of skin,Encounter for palliative care'}

CHIEF COMPLAINT: Speed motor cycle crash PRESENT ILLNESS: 55M s/p moderate speed motor cycle crash to back of a car and transferred to [**Hospital6 **].Pt was intoxicated at the time and was helmeted without LOC. Pt Had a neg head CT at [**Hospital3 15402**] and LLE plain films revealing closed tib fib fracture. On transfer to [**Hospital1 18**] pt only complained LLE pain. MEDICAL HISTORY: PMH: HTN PSH: Spinal Fusion of c5-7 MEDICATION ON ADMISSION: Diovan ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 10 97.9 89 132/96 20 97 FAMILY HISTORY: NC SOCIAL HISTORY: +ETOH 30Pack year tob - IVDU

Injury to posterior tibial artery,Closed fracture of unspecified part of fibula with tibia,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Alcohol abuse, unspecified,Unspecified essential hypertension,Arthrodesis status

Inj post tibial artery,Fx tibia w fibula NOS-cl,Kidney hematoma-closed,Mv collis NOS-motorcycl,Alcohol abuse-unspec,Hypertension NOS,Arthrodesis status

Admission Date: [**2126-7-13**] Discharge Date: [**2126-7-24**] Date of Birth: [**2070-9-4**] Sex: M Service: ORTHOPAEDICS Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 8587**] Chief Complaint: Speed motor cycle crash Major Surgical or Invasive Procedure: [**2126-7-13**] 1. Repair of left foot posterior tibial artery occlusion. 2. Ultrasound-guided puncture of right common femoral artery. 3. Contralateral third artery catheterization of the left superficial femoral artery. 4. Arteriogram of the left lower extremity [**2126-7-13**] 1. Closed reduction, left intra-articular distal tibia fracture, with manipulation. 2. Closed reduction, left lateral malleolus fracture, with manipulation. 3. Application of multiplanar external fixator [**2126-7-16**] 1. Operative treatment of left intra-articular distal tibia fracture with external fixator and percutaneous internal fixation. 2. Debridement to muscle and application of vac sponge [**2126-7-19**]: Irrigation and debridement lateral ankle wound, partial closure and placement of vacuum sponge. [**2126-7-22**]: Closure lateral wound. History of Present Illness: 55M s/p moderate speed motor cycle crash to back of a car and transferred to [**Hospital6 **].Pt was intoxicated at the time and was helmeted without LOC. Pt Had a neg head CT at [**Hospital3 15402**] and LLE plain films revealing closed tib fib fracture. On transfer to [**Hospital1 18**] pt only complained LLE pain. Past Medical History: PMH: HTN PSH: Spinal Fusion of c5-7 Social History: +ETOH 30Pack year tob - IVDU Family History: NC Physical Exam: 10 97.9 89 132/96 20 97 Moderate Distress CTAB RRR s, NT, ND Pelvis stable normal rectal tone left PT triphasic after reduction good cap refill Pertinent Results: [**2126-7-13**] 06:33AM BLOOD WBC-11.3* RBC-4.68 Hgb-14.1 Hct-42.5 MCV-91 MCH-30.1 MCHC-33.1 RDW-13.6 Plt Ct-359 [**2126-7-13**] 05:16PM BLOOD WBC-9.0 RBC-4.12* Hgb-12.4* Hct-37.2* MCV-90 MCH-30.2 MCHC-33.4 RDW-13.8 Plt Ct-325 [**2126-7-14**] 02:13AM BLOOD WBC-7.6 RBC-3.49* Hgb-10.7* Hct-32.1* MCV-92 MCH-30.7 MCHC-33.4 RDW-13.9 Plt Ct-264 [**2126-7-15**] 05:25AM BLOOD WBC-7.0 RBC-3.22* Hgb-10.0* Hct-29.8* MCV-93 MCH-31.2 MCHC-33.7 RDW-13.7 Plt Ct-251 [**2126-7-13**] 06:33AM BLOOD Neuts-81.9* Lymphs-14.0* Monos-3.3 Eos-0.5 Baso-0.3 [**2126-7-13**] 05:16PM BLOOD Neuts-90.2* Lymphs-6.8* Monos-1.9* Eos-0.8 Baso-0.3 [**2126-7-13**] 06:33AM BLOOD Glucose-118* UreaN-9 Creat-1.0 Na-141 K-4.1 Cl-103 HCO3-23 AnGap-19 [**2126-7-13**] 05:16PM BLOOD Glucose-138* UreaN-10 Creat-0.8 Na-142 K-4.3 Cl-108 HCO3-21* AnGap-17 [**2126-7-15**] 05:25AM BLOOD Glucose-105* UreaN-7 Creat-0.9 Na-142 K-3.4 Cl-104 HCO3-31 AnGap-10 [**2126-7-16**] 12:22PM BLOOD Glucose-130* UreaN-8 Creat-1.0 Na-140 K-4.1 Cl-101 HCO3-31 AnGap-12 Tib / fib rx 1. Comminuted displaced fracture of the distal tibia and fibula with portion of impaction and moderate soft tissue edema. 2. Minimally displaced fracture of the proximal fibula CT spine 1. Unusual alignment of the spine with loss of normal lordosis. 2. Widening of the disc space at level C4-C5 anteriorly, could be traumatic. 3. Fusion of C5, C6, C7. 4. Questionable fracture at lamina at T1 of uncertain chronicity CTA 1. Occlusion of the anterior tibial artery at the level of the lower tibial shaft fracture with subsequent reconstitution of the artery. The artery passes through the fracture into the bone marrow. Another area of occlusion at the ankle - distal tibial pilon fracture with distal reconstitution at the level of the dorsalis pedis. 2. Posterior tibial artery occlusion at the level of the lower tibial fracture with distal reconstitution at the level of the plantar artery. 3. Asymmetrically decreased generalized vascularity of the left foot as compared to right, most likely related to proximal vascular narrowing, however, distal occlusions cannot be excluded. 4. Comminuted left distal shaft and tibial pilon fracture (intra-articular extension). Comminuted left distal fibular fracture Brief Hospital Course: Patient was admitted to the trauma service. He was taken to the OR by Vascular surgery for repair of left foot posterior tibial artery occlusion VAC placement and Ortho service did closed reduction, left intra-articular distal tibia fracture, with manipulation, closed reduction, left lateral malleolus fracture, with manipulation and application of multiplanar external fixator. Patient did well after surgery, he was transferred to the floor after short stay in PACU. He was initially on Dilaudid PCA for pain. Then switched to oral pain medications. He did not required transfusion after surgery. On [**2126-7-16**] patient was taken to the operating room for operative treatment of left intra-articular distal tibia fracture with external fixator and percutaneous internal fixation and debridement to muscle and application of VAC sponge. Post op patient did well there were no perioperative complication. Patient was transferred to the Ortho service for further management. On [**2126-7-19**] he returned to the operating room and underwent an irrigation and debridement lateral ankle wound,partial closure and placement of vacuum sponge. He tolerated the procedure well. On [**2126-7-22**] he returned to the operating room and underwent closure of his lateral wound, which he tolerated well. The rest of his hospital stay was uneventful. He worked with physical therapy to improve his strength and mobility. His lab data and vital signs within normal limtis and his pain controlled. He is being discharged today in stable condition. Medications on Admission: Diovan Discharge Medications: 1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q3H (every 3 hours) as needed for pain . Disp:*90 Tablet(s)* Refills:*0* 6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 7. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. Disp:*60 Tablet(s)* Refills:*0* 10. Valsartan 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Discharge Disposition: Home With Service Facility: VNA of Southeastern Mass. Discharge Diagnosis: L perinephric hematoma L closed comminuted L distal tib/fib fracture 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: Please take all medications as directed. You have been given a prescription for narcotics. You should take a written. Do not drive or operative heavy machinery while taking narcotics. Do not drink alcohol while taking narcotics. You should not smoke or use any products containing nicotine while your fracture is healing. Physical Therapy: NWB LLE Ok to range knee Work on transfers Treatments Frequency: Please dress lateral incision with dry gauze - change daily; monitor for cellulitis Please clean pins with hydrogen peroxide daily Followup Instructions: Follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 2 weeks. Call [**Telephone/Fax (1) 1228**] to schedule this appointment. Completed by:[**2126-7-30**]

904,823,866,E812,305,401,V454

{'Injury to posterior tibial artery,Closed fracture of unspecified part of fibula with tibia,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Alcohol abuse, unspecified,Unspecified essential hypertension,Arthrodesis 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: Speed motor cycle crash PRESENT ILLNESS: 55M s/p moderate speed motor cycle crash to back of a car and transferred to [**Hospital6 **].Pt was intoxicated at the time and was helmeted without LOC. Pt Had a neg head CT at [**Hospital3 15402**] and LLE plain films revealing closed tib fib fracture. On transfer to [**Hospital1 18**] pt only complained LLE pain. MEDICAL HISTORY: PMH: HTN PSH: Spinal Fusion of c5-7 MEDICATION ON ADMISSION: Diovan ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 10 97.9 89 132/96 20 97 FAMILY HISTORY: NC SOCIAL HISTORY: +ETOH 30Pack year tob - IVDU ### Response: {'Injury to posterior tibial artery,Closed fracture of unspecified part of fibula with tibia,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Alcohol abuse, unspecified,Unspecified essential hypertension,Arthrodesis status'}

CHIEF COMPLAINT: fever PRESENT ILLNESS: [**Age over 90 **]F with multiple recent admissions to [**Hospital1 18**] following fall on [**2150-1-19**] with C1 fracture after a mechanical fall down stairs. She was evaluated for surgery but was found to be nonoperable, and was placed in a C-collar at least through [**4-19**] to be followed up with Dr. [**First Name (STitle) 23161**]. She was also noted to have an associated vertebral artery dissection and was treated conservatively with aspirin, and a large retropharyngeal hematoma. She was discharged to [**Hospital1 1501**] on [**1-27**]. . On [**1-29**] she was seen in the ED after sliding out of a chair, but the C1 fracture was stable. She was sent back to rehab, but was noted to not be eating well and have a WBC count of 34k. She was sent to [**Hospital3 **], then transferred to [**Hospital1 18**] on [**2150-2-4**] for white count of 34K, significant dehydration, intraventricular hemorrhage and question of colitis. Her hospital course was complicated by C dif sepsis with hypotension requiring pressors, acute renal failure, subdural hematoma (stable). She was discharged to [**Hospital6 **] on [**2150-2-17**]. . Today she was noted to have fevers to 101-102 and loose slightly bloody stools. She was started on flagyl, then received empiric vancomycin and imipenem and was transferred to the ED. In the ED, she was noted to be tachycardic and febrile, and received about 2 liters of fluids without improvement in her HR. She was never hypotensive. They also gave her some ativan and haldol for agitation. Cultures were drawn and she got additional 500 mg IV flagyl and was admitted to the MICU service. . ROS: denies pain. Other ROS limited by hearing loss and mental status. . MEDICAL HISTORY: Hypertension Hypothyroidism Osteoarthritis Depression Obesity Urinary Incontinence GERD s/p Total TAH C1 fracture [**12-28**] subdural hematoma ventricular hemorrhage C.difficile colitis ([**1-28**]) MEDICATION ON ADMISSION: imipenem 500 mg x1 vanco 1000 mg x 1 flagyl 500 mg po tid (start [**3-3**] for diarrhea) lorazepam 0.5 mg po qhs, [**Hospital1 **] prn agitiation TPN at 75/hour heparin SQ TID tylenol 1000 mg po q6h calcium carbonate 500 mg po tid hemorrhoidal ointment/hydrocort rectally lansoprazole 30 mg po qd levothyroxine 150 mcg po qd miconazole topically [**Hospital1 **] remeron 30 mg po qhs vitamin d 800 units po qd atrovent nebs Q6H prn ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: V: T99.7 BP 135/35 P108 R26 90% 5L NC Gen: lying in bed, moaning, opens eyes to voice HEENT: pupils 1 mm, min reactive, MM dry Neck: C collar in place, limits JVD assessment Resp: crackles bilateral bases, no wheezes CV: RRR nl s1s2 no MGR Abd: soft NTND +BS Ext: 2+ edema bilaterally Neuro: responds to voice FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Pt has been widowed for 6 yrs and currently lives alone in her home of 36 yrs. She has one daughter and four sons. Patient's daughter visits daily, and she has two sons near by. Family is close and supportive. Prior to recent trauma, patient was very independent. - EtOH - denies - Tob - denies - IVDU - denies

Septicemia due to anaerobes,Intestinal infection due to Clostridium difficile,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Atrial fibrillation,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Urinary incontinence, unspecified,Esophageal reflux,Personal history of other diseases of circulatory system,Anemia, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation

Anaerobic septicemia,Int inf clstrdium dfcile,Acute respiratry failure,Acute kidney failure NOS,Urin tract infection NOS,Pneumonia, organism NOS,Atrial fibrillation,React-oth vasc dev/graft,Pseudomonas infect NOS,Severe sepsis,Hypothyroidism NOS,Hypertension NOS,Osteoarthros NOS-unspec,Depressive disorder NEC,Obesity NOS,Urinary incontinence NOS,Esophageal reflux,Hx-circulatory dis NEC,Anemia NOS,Abn react-artif implant

Admission Date: [**2150-3-4**] [**Month/Day/Year **] Date: [**2150-3-9**] Service: MEDICINE Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 7455**] Chief Complaint: fever Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **]F with multiple recent admissions to [**Hospital1 18**] following fall on [**2150-1-19**] with C1 fracture after a mechanical fall down stairs. She was evaluated for surgery but was found to be nonoperable, and was placed in a C-collar at least through [**4-19**] to be followed up with Dr. [**First Name (STitle) 23161**]. She was also noted to have an associated vertebral artery dissection and was treated conservatively with aspirin, and a large retropharyngeal hematoma. She was discharged to [**Hospital1 1501**] on [**1-27**]. . On [**1-29**] she was seen in the ED after sliding out of a chair, but the C1 fracture was stable. She was sent back to rehab, but was noted to not be eating well and have a WBC count of 34k. She was sent to [**Hospital3 **], then transferred to [**Hospital1 18**] on [**2150-2-4**] for white count of 34K, significant dehydration, intraventricular hemorrhage and question of colitis. Her hospital course was complicated by C dif sepsis with hypotension requiring pressors, acute renal failure, subdural hematoma (stable). She was discharged to [**Hospital6 **] on [**2150-2-17**]. . Today she was noted to have fevers to 101-102 and loose slightly bloody stools. She was started on flagyl, then received empiric vancomycin and imipenem and was transferred to the ED. In the ED, she was noted to be tachycardic and febrile, and received about 2 liters of fluids without improvement in her HR. She was never hypotensive. They also gave her some ativan and haldol for agitation. Cultures were drawn and she got additional 500 mg IV flagyl and was admitted to the MICU service. . ROS: denies pain. Other ROS limited by hearing loss and mental status. . Past Medical History: Hypertension Hypothyroidism Osteoarthritis Depression Obesity Urinary Incontinence GERD s/p Total TAH C1 fracture [**12-28**] subdural hematoma ventricular hemorrhage C.difficile colitis ([**1-28**]) Social History: Pt has been widowed for 6 yrs and currently lives alone in her home of 36 yrs. She has one daughter and four sons. Patient's daughter visits daily, and she has two sons near by. Family is close and supportive. Prior to recent trauma, patient was very independent. - EtOH - denies - Tob - denies - IVDU - denies Family History: Noncontributory Physical Exam: V: T99.7 BP 135/35 P108 R26 90% 5L NC Gen: lying in bed, moaning, opens eyes to voice HEENT: pupils 1 mm, min reactive, MM dry Neck: C collar in place, limits JVD assessment Resp: crackles bilateral bases, no wheezes CV: RRR nl s1s2 no MGR Abd: soft NTND +BS Ext: 2+ edema bilaterally Neuro: responds to voice Pertinent Results: Imaging: PORTABLE ABDOMEN [**2150-3-3**] 10:25 PM IMPRESSION: Nonspecific but non-obstructive bowel gas pattern. . CHEST (PORTABLE AP) [**2150-3-3**] 10:21 PM IMPRESSION: Bibasilar atelectasis with left pleural effusion. Retrocardiac opacity likely represents combination of these two processes, although underlying consolidation cannot be excluded. . CHEST (PORTABLE AP) [**2150-3-4**] 5:09 PM IMPRESSION: 1. Moderate sized layering left pleural effusion, and small right pleural effusion, both increased from [**2150-3-3**]. 2. Increase in size and density of retrocardiac opacity, which may be related to technical differences, but this area remains suspicious for underlying consolidation or atelectasis. . CHEST (PORTABLE AP) [**2150-3-5**] 5:50 AM IMPRESSION: Moderate bibasilar pleural effusions with increasing size of the right effusion. Retrocardiac opacity suggests atelectasis or consolidation. . CHEST (PORTABLE AP) [**2150-3-6**] 5:55 PM IMPRESSION: 1. Unsatisfactory placement of Dobbhoff tube which is coiled in the upper mediastinum. Recommend immediate removal. 2. Appearance of cardiomediastinal silhouette and lung fields are not significantly changed compared to an hour prior. These findings were discussed with the SICU nurse at the time of this dictation. . CHEST (PORTABLE AP) [**2150-3-6**] 5:04 PM IMPRESSION: 1. Intrabronchial placement of Dobbhoff tube. These results were immediately called to the SICU. 2. Moderate bibasilar pleural effusions and persistent retrocardiac opacity suggesting atelectasis versus consolidation. . CHEST (PORTABLE AP) [**2150-3-7**] 10:41 AM FINDINGS: The tip of the NGT is well below the diaphragm and seen just to the left of midline by the L4 vertebral body. Perhaps the chest is obscured from view and the lower portions demonstrate some atelectatic features. . CT HEAD W/O CONTRAST [**2150-3-8**] 3:56 PM IMPRESSION: No significant interval change of left frontal cerebral convexity subdural hematoma. Decrease in lateral ventricle hemorrhage and frontal subgaleal hematomas. . PORTABLE ABDOMEN [**2150-3-8**] 11:17 AM Supine views of the abdomen and pelvis demonstrate no evidence of intestinal obstruction. Previously reported distended air-filled loops of bowel have decreased in caliber since the previous study. . CHEST (PORTABLE AP) [**2150-3-8**] 8:28 AM Nasogastric tube remains in place terminating below the diaphragm. Cardiac silhouette is enlarged but stable in size. Bilateral pleural effusions have worsened, moderate on the right and small-to-moderate on the left, with adjacent basilar opacities that likely represent atelectasis. . Micro: *[**2150-3-3**]* Blood Culture: PENDING Stool: C Diff positive *[**2150-3-4**]* Urine Culture: P. aeruginosa & VRE MRSA Screen: negative Stool: C diff positive *[**2150-3-5**]* Stool: C diff positive Blood Culture: NGTD PICC line tip culture: No growth . Labs: [**2150-3-3**] 09:50PM BLOOD WBC-15.0* RBC-3.20* Hgb-9.8* Hct-29.6* MCV-93 MCH-30.8 MCHC-33.3 RDW-18.8* Plt Ct-240# [**2150-3-6**] 03:29AM BLOOD WBC-17.9* RBC-2.81* Hgb-8.6* Hct-26.3* MCV-94 MCH-30.7 MCHC-32.8 RDW-17.5* Plt Ct-264 [**2150-3-9**] 06:10AM BLOOD WBC-20.4* RBC-3.08* Hgb-9.4* Hct-29.4* MCV-95 MCH-30.5 MCHC-32.0 RDW-17.0* Plt Ct-380 [**2150-3-3**] 09:50PM BLOOD PT-12.2 PTT-26.6 INR(PT)-1.0 [**2150-3-6**] 03:29AM BLOOD PT-12.9 PTT-25.6 INR(PT)-1.1 [**2150-3-8**] 07:25AM BLOOD PT-13.2* PTT-24.5 INR(PT)-1.1 [**2150-3-3**] 09:50PM BLOOD Glucose-99 UreaN-28* Creat-0.8 Na-141 K-4.3 Cl-103 HCO3-30 AnGap-12 [**2150-3-5**] 03:27AM BLOOD Glucose-141* UreaN-27* Creat-0.9 Na-141 K-4.1 Cl-103 HCO3-30 AnGap-12 [**2150-3-9**] 06:10AM BLOOD Glucose-106* UreaN-37* Creat-1.2* Na-147* K-4.2 Cl-109* HCO3-31 AnGap-11 [**2150-3-7**] 02:32AM BLOOD CK(CPK)-23* [**2150-3-8**] 07:25AM BLOOD ALT-11 AST-14 LD(LDH)-306* AlkPhos-117 Amylase-32 TotBili-0.3 [**2150-3-8**] 07:25AM BLOOD Lipase-20 [**2150-3-3**] 09:50PM BLOOD Calcium-7.4* Phos-3.2 Mg-2.2 [**2150-3-6**] 03:29AM BLOOD Calcium-7.3* Phos-3.1# Mg-2.3 [**2150-3-9**] 06:10AM BLOOD Calcium-7.7* Phos-3.7 Mg-2.4 [**2150-3-5**] 03:27AM BLOOD Triglyc-157* [**2150-3-8**] 07:25AM BLOOD Osmolal-303 [**2150-3-7**] 02:32AM BLOOD TSH-11* [**2150-3-7**] 02:32AM BLOOD Free T4-0.68* Brief Hospital Course: [**Age over 90 **]F with MMP including C difficle infection, UTI, PICC line infection, PNA. . #) fever, elevated WBC - Patient was on multiple antibiotics to treat C. diff, Pseudomonas/VRE UTI, Coag - staph PICC line associated bacteremia, PNA and these were likely the causes of her fevers and leuckocytosis. After discussion the family, these measures were to be discontinued prior to [**Age over 90 **]. . #) Respiratory distress: Patient with hypercarbic respiratory distress. Patient is DNI and CPAP contraindicated at this time as patient has some respiratory secretions. After discussion with the family, it was determined that the patient definitively not be intubated and she was not transferred to the MICU for respiratory ventilation. RA saturations are 86-88%. . #) Mental status - AAOx3 intermittently in the MICU, although while on the floor the patinet has been slightly responsive to noxious stimulus. Family has been by the bedside and have reassured us that this is not her baseline.. . #) Paroxysmal atrial fibrillation - Likely in setting of numerous infections. Patient was started on IV Lopressor for rate control. This medication was held in the setting of hypotension. . #) h/o C1 fracture - no new trauma since 1/[**2149**]. Patient has been in hard collar and recommendations were to keep patient in hard collar until [**2150-4-19**]. Given goals of comfort, patient will be able to remove the collar. Patient does have scheduled appointments with Neurosurgery in the upcoming months. . #) Hearing loss - appears at baseline. Patient with headphones and microphone for communication. . #) hypothyroid - Synthroid was continued although TFTs were not suggestive of such. This was likely due to decreased PO absorption in the setting of C diff infection. . # Anemia - stable, acute GI bleed resolved at this point, will continue to monitor. . # Depression - on Remeron 15 mg prior to admission but unable to take po's. . # FEN - Family have decided not to undergo PEG placement as this contradicts patient's wishes. Patient initially had an NGT placed although this was removed by the patient on the day of [**Month/Day/Year **]. . . After discussion with the patient's family, HCP, and medical staff, all were in agreement that [**Known firstname **] [**Known lastname 23162**] was a suitable candidate to [**Known lastname **] to hospice. Medications on Admission: imipenem 500 mg x1 vanco 1000 mg x 1 flagyl 500 mg po tid (start [**3-3**] for diarrhea) lorazepam 0.5 mg po qhs, [**Hospital1 **] prn agitiation TPN at 75/hour heparin SQ TID tylenol 1000 mg po q6h calcium carbonate 500 mg po tid hemorrhoidal ointment/hydrocort rectally lansoprazole 30 mg po qd levothyroxine 150 mcg po qd miconazole topically [**Hospital1 **] remeron 30 mg po qhs vitamin d 800 units po qd atrovent nebs Q6H prn [**Hospital1 **] Medications: 1. Acetaminophen 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 2. Calcium Carbonate 500 mg Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable PO TID (3 times a day). 3. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily). 4. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Inhalation Q4H (every 4 hours). 5. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Inhalation Q2H (every 2 hours) as needed. 6. Levothyroxine 50 mcg Tablet [**Hospital1 **]: Three (3) Tablet PO DAILY (Daily). 7. Nystatin 100,000 unit/g Cream [**Hospital1 **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 8. Albuterol Sulfate 0.083 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours) as needed. 9. Lorazepam 0.5 mg IV Q6H:PRN agitation 10. Pantoprazole 40 mg IV Q24H 11. Morphine Sulfate 1 mg IV Q4H:PRN pain 12. Metoprolol 5 mg IV Q6H please hold for SBP<100, HR<60 [**Hospital1 **] Disposition: Extended Care [**Hospital1 **] Diagnosis: Primary Diagnosis: C. diff, Complicated Urinary tract infection, Hypercarbic respiratory failure . Secondary Diagnoses: Hypertension Hypothyroidism Osteoarthritis Depression Obesity Urinary Incontinence GERD s/p Total TAH C1 fracture [**12-28**] subdural hematoma ventricular hemorrhage C.difficile colitis ([**1-28**]) [**Month/Year (2) **] Condition: Afebrile, normotensive, tachycardic, nonambulatory, not tolerating POs, nonresponsive [**Month/Year (2) **] Instructions: You were admitted with an infection and have been treated with antibiotics. Followup Instructions: Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. NEUROSURGERY WEST Date/Time:[**2150-4-21**] 2:00 Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2150-4-21**] 1:00 Completed by:[**2150-3-10**]

038,008,518,584,599,486,427,996,041,995,244,401,715,311,278,788,530,V125,285,E878

{'Septicemia due to anaerobes,Intestinal infection due to Clostridium difficile,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Atrial fibrillation,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Urinary incontinence, unspecified,Esophageal reflux,Personal history of other diseases of circulatory system,Anemia, unspecified,Surgical operation with implant of artificial internal device 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: fever PRESENT ILLNESS: [**Age over 90 **]F with multiple recent admissions to [**Hospital1 18**] following fall on [**2150-1-19**] with C1 fracture after a mechanical fall down stairs. She was evaluated for surgery but was found to be nonoperable, and was placed in a C-collar at least through [**4-19**] to be followed up with Dr. [**First Name (STitle) 23161**]. She was also noted to have an associated vertebral artery dissection and was treated conservatively with aspirin, and a large retropharyngeal hematoma. She was discharged to [**Hospital1 1501**] on [**1-27**]. . On [**1-29**] she was seen in the ED after sliding out of a chair, but the C1 fracture was stable. She was sent back to rehab, but was noted to not be eating well and have a WBC count of 34k. She was sent to [**Hospital3 **], then transferred to [**Hospital1 18**] on [**2150-2-4**] for white count of 34K, significant dehydration, intraventricular hemorrhage and question of colitis. Her hospital course was complicated by C dif sepsis with hypotension requiring pressors, acute renal failure, subdural hematoma (stable). She was discharged to [**Hospital6 **] on [**2150-2-17**]. . Today she was noted to have fevers to 101-102 and loose slightly bloody stools. She was started on flagyl, then received empiric vancomycin and imipenem and was transferred to the ED. In the ED, she was noted to be tachycardic and febrile, and received about 2 liters of fluids without improvement in her HR. She was never hypotensive. They also gave her some ativan and haldol for agitation. Cultures were drawn and she got additional 500 mg IV flagyl and was admitted to the MICU service. . ROS: denies pain. Other ROS limited by hearing loss and mental status. . MEDICAL HISTORY: Hypertension Hypothyroidism Osteoarthritis Depression Obesity Urinary Incontinence GERD s/p Total TAH C1 fracture [**12-28**] subdural hematoma ventricular hemorrhage C.difficile colitis ([**1-28**]) MEDICATION ON ADMISSION: imipenem 500 mg x1 vanco 1000 mg x 1 flagyl 500 mg po tid (start [**3-3**] for diarrhea) lorazepam 0.5 mg po qhs, [**Hospital1 **] prn agitiation TPN at 75/hour heparin SQ TID tylenol 1000 mg po q6h calcium carbonate 500 mg po tid hemorrhoidal ointment/hydrocort rectally lansoprazole 30 mg po qd levothyroxine 150 mcg po qd miconazole topically [**Hospital1 **] remeron 30 mg po qhs vitamin d 800 units po qd atrovent nebs Q6H prn ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: V: T99.7 BP 135/35 P108 R26 90% 5L NC Gen: lying in bed, moaning, opens eyes to voice HEENT: pupils 1 mm, min reactive, MM dry Neck: C collar in place, limits JVD assessment Resp: crackles bilateral bases, no wheezes CV: RRR nl s1s2 no MGR Abd: soft NTND +BS Ext: 2+ edema bilaterally Neuro: responds to voice FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Pt has been widowed for 6 yrs and currently lives alone in her home of 36 yrs. She has one daughter and four sons. Patient's daughter visits daily, and she has two sons near by. Family is close and supportive. Prior to recent trauma, patient was very independent. - EtOH - denies - Tob - denies - IVDU - denies ### Response: {'Septicemia due to anaerobes,Intestinal infection due to Clostridium difficile,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Atrial fibrillation,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Severe sepsis,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Urinary incontinence, unspecified,Esophageal reflux,Personal history of other diseases of circulatory system,Anemia, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 47-year-old morbidly obese woman who was transferred from an outside hospital for multiple injuries after falling from her horse three days prior. She was transferred to [**Hospital1 18**] on [**2131-4-5**]. Her injury was sustained on [**2131-3-31**]. Apparently, this patient landed on her right side. She was taken to a hospital in [**Location (un) 8641**], [**Location (un) 3844**]. The extent of her injuries there were as follows: 1. Hepatic contusion, grade III. 2. Right renal contusion. 3. Right hemothorax. 4. Right rib fractures, [**12-25**], posteriorly displaced. 5. Right scapular fracture. 6. Left transverse process fracture, L1-3. 7. Right thigh hematoma. On day number three of her hospital stay at the outside hospital, she developed abdominal pain and became hemodynamically unstable. She was taken to the OR where she was found to have a biliary leak with bile peritonitis. They were unable to close her abdomen at the outside hospital and she was transferred to [**Hospital1 18**] still intubated and sedated with an open abdomen and a right chest tube for further management. MEDICAL HISTORY: 1. Morbid obesity with a BMI of 40. 2. Adult onset diabetes. 3. Asthma. 4. Hypertension. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other early complications of trauma,Crushing injury of other specified sites of trunk,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Other accidental fall from one level to another,Bacteremia

Early complic trauma NEC,Crushing inj trunk NEC,Fx eight/more rib-closed,Acute kidney failure NOS,Fall-1 level to oth NEC,Bacteremia

Admission Date: [**2131-4-5**] Discharge Date: Date of Birth: [**2083-11-16**] Sex: F Service: TRAUMA SURGERY Of note, this discharge summary will encompass the time of admission from [**2131-4-5**] to hospital day number 17, [**2131-4-21**]. The remainder of the discharge summary will be dictated at a later time. HISTORY OF PRESENT ILLNESS: This is a 47-year-old morbidly obese woman who was transferred from an outside hospital for multiple injuries after falling from her horse three days prior. She was transferred to [**Hospital1 18**] on [**2131-4-5**]. Her injury was sustained on [**2131-3-31**]. Apparently, this patient landed on her right side. She was taken to a hospital in [**Location (un) 8641**], [**Location (un) 3844**]. The extent of her injuries there were as follows: 1. Hepatic contusion, grade III. 2. Right renal contusion. 3. Right hemothorax. 4. Right rib fractures, [**12-25**], posteriorly displaced. 5. Right scapular fracture. 6. Left transverse process fracture, L1-3. 7. Right thigh hematoma. On day number three of her hospital stay at the outside hospital, she developed abdominal pain and became hemodynamically unstable. She was taken to the OR where she was found to have a biliary leak with bile peritonitis. They were unable to close her abdomen at the outside hospital and she was transferred to [**Hospital1 18**] still intubated and sedated with an open abdomen and a right chest tube for further management. PAST MEDICAL HISTORY: 1. Morbid obesity with a BMI of 40. 2. Adult onset diabetes. 3. Asthma. 4. Hypertension. PAST SURGICAL HISTORY: 1. Cholecystectomy. 2. Total abdominal hysterectomy. 3. Umbilical hernia. ADMISSION MEDICATIONS: 1. Glucophage. 2. Monopril. 3. Albuterol. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAMINATION: Upon presentation, the patient arrived intubated and sedated with a temperature of 98.8. She had a pulse of 98 and blood pressure of 100/42. She was saturating 100%. She was on SIMV 40% 02 and PEEP of 5. General: She is an obese, pale woman who was intubated and sedated. She had a normocephalic and atraumatic HEENT examination with equal and reactive pupils, full extraocular movements. She had distant heart sounds secondary to body habitus but appeared to be in a regular rate and rhythm with no murmur heard. Lungs: Her lung sounds were likewise distant with decreased sounds at the right base. Abdomen: Her abdomen was soft. There were no bowel sounds. It was obese. There was an open wound with mesh dressing and serosanguinous drainage from two JPs. She had 2+ pitting edema of her hands bilaterally, trace edema of the arms and legs, with a wrist brace on the right wrist. Neurologic: Unable to be assessed secondary to sedation. LABORATORY AND RADIOLOGIC DATA: The initial laboratories at [**Hospital1 18**] showed a white blood cell count of 15.9, hematocrit 29.7, platelets 207,000. She had a Chem-7 with a sodium of 146, potassium 3.6, chloride 118, bicarbonate 21, BUN 22, creatinine 0.9. She had glucose of 199. She had a PT of 13.8, PTT 24.5, and an INR of 1.3. Her fibrinogen was 872. She had an ALT of 230, AST 117, and LDH of 590. Her alkaline phosphatase was 88. Her amylase was 66, total bilirubin 3.0, lipase 63, albumin 2.2, calcium 7.4, phosphate 1.4. An ABG was performed and showed adequate oxygenation and ventilation. HOSPITAL COURSE: The patient remained in the ICU and was transferred to the floor on hospital day number 15. The remainder of the hospital course will be summarized by system. 1. GASTROINTESTINAL: On the first day of admission, the patient was taken to the OR for abdominal evaluation and washout. She returned to the OR for washout on hospital day number four and hospital day number 11. At each operative intervention, she was given perioperative antibiotics. JP drains were placed. Despite aggressive diuresis and repeated OR visits, the abdomen was unable to be closed. The most recent OR evaluation showed no signs of infection of the open abdominal wound with slow healing by granulation tissue. There is currently a mesh covering the abdominal wound. Please see the operative notes for more detail. At the time of this dictation, the plan is for the patient to heal by secondary intention with granulation tissue. Plastics has been consulted for future repair of the abdominal wound with flap when deemed appropriate. She had VAC dressing placement on hospital day number 17. It is anticipated that she will be discharged to rehabilitation with this VAC dressing in place and will follow-up with plastics for further reevaluation of the healing process and the appropriate timing for flap. 2. NEUROLOGIC: The patient arrived from the outside hospital intubated and sedated. Sedation was weaned daily and the patient was always responsive and moving all extremities well. She was also able to follow commands. After extubation on hospital day number 12, she was somewhat confused and required frequent reorientation. By the time she transferred to the floor, she was alert and oriented times three. 3. RESPIRATORY: The patient was maintained on mechanical assistance. She arrived intubated and sedated. She was extubated successfully on hospital day number 12. 4. CARDIOVASCULAR: The patient was maintained on a Levophed drip with a goal of mean arterial pressure under 65. This was eventually discontinued on hospital day number 11 and she was switched over to metoprolol 12.5 mg p.o. b.i.d. She was diuresed aggressively with Lasix. Diamox was added as gases indicated an alkalotic state. All diuretics were discontinued by the time that the patient was transferred to the floor. There were no events on the ICU telemetry. Telemetry was continued 24 hours while she was on the floor with no events and then discontinued. 5. HEMATOLOGY: The patient was admitted with a hematocrit of 29. This decreased and remained stable at a hematocrit of 26. She received 2 units of packed red blood cells that were transfused on [**2131-4-5**], hospital day number one, and again 1 unit of packed red blood cells was transfused on hospital day number eight. Her hematocrit has been stable at approximately 26-28 since hospital day number eight. 6. GENITOURINARY: The patient has a Foley in place with multiple urine cultures which have been negative. 7. ENDOCRINE: The patient was on insulin drip for glycemic control while she was in the ICU. This was changed to a regular insulin sliding scale when she was on the floor and having a p.o. diet. 8. INFECTIOUS DISEASE: The patient was admitted and promptly became febrile with elevated white count. She intermittently spiked fevers since the time of her admission to hospital day number three. She was initially started on Zosyn and vancomycin but this was discontinued after approximately four days of treatment. She was cultured multiple times including surveillance cultures for MRSA which were negative. All of the multiple cultures have been negative except for blood cultures from hospital day number seven. This revealed three out of four bottles positive for Staphylococcus aereus. Sensitivities were not performed. The patient was started on vancomycin on this day and is to continue for a ten day course which will be complete on [**2131-4-23**]. During this time when she was febrile, central lines were rewired and eventually resided even though catheter tips have shown no growth. She currently has a right IJ which was placed after documentation of positive blood cultures. At the time of this dictation, hospital day number 17, the patient has been afebrile for greater than 48 hours, the longest period of time since her admission. 9. FLUIDS, ELECTROLYTES, AND NUTRITION: The patient was started on TPN when she initially arrived. Tube feeds were initiated on hospital day number seven after bowel sounds were noted and flatus was observed. An insulin drip was used while the patient was in the ICU for glycemic control. Once the patient was extubated, she was started on a clear diet on hospital day number 14 and this has been slowly advanced to a full diabetic diet. The patient has had some episodes of loose stool on hospital 16 which has been sent for Clostridium difficile. She remains on a regular insulin sliding scale now that she is on the floor. 10. VASCULAR: A surveillance ultrasound of the lower extremities was performed on hospital day number 12 and revealed a thrombosis in the left greater saphenous vein. The right leg was unremarkable. The presence of this clot was close to the junction to enter the deep venous system, although it is currently not in the deep venous system. The ultrasound was repeated of the left leg two days later on hospital day number 14 and was without change. Per Vascular recommendations, the patient will continue on Lovenox at this time and she will have a repeat ultrasound in one week which will be hospital day number 21 which is [**2131-4-25**]. 11. SPINE: A CT of the L spine was obtained and a consult was also called for. The CT of the L spine showed left transverse process fractures of L1 and L2 and a thoracic disk protrusion at T11 and T12. There is also a right disk osteophyte at L2 and L3. Final recommendations are pending from the spine team at this time. She is to be fitted for a TLSO brace when her abdominal issues are stable. 12. PROPHYLAXIS: The patient was placed on Lovenox on hospital day number three. Prior to that, she had been on subcutaneous heparin. Lovenox has been maintained throughout her stay. She has received Prevacid during the times that she was n.p.o. She has been on pneumatic boots bilaterally which was changed to a pneumatic boot on the right side only given the nature of her left thrombus. 13. FINAL SUMMARY: This is a 47-year-old woman who was transferred from an outside hospital for management of her biliary peritonitis. She also has multiple other injuries. These other injuries are a hepatic contusion, grade III, a right renal contusion, right hemothorax, right rib fractures, I-12 posteriorly and displaced, a right scapular fracture, and left transverse processes fractures of L1-3 and a right thigh hematoma. She is currently status post four trips to the OR and has an open abdominal wound that is unable to be closed primarily. The plan for closure of this wound is to allow granulation tissue to form and then to have a flap placed by Plastics. During the hospital stay here, the patient became bacteremic and febrile. She is currently afebrile and will remain on a ten day course of vancomycin, the last day of which is [**2131-4-23**]. She incidentally was found to have a thrombus of her left greater saphenous vein close to the junction of the deep venous vein system; however, it is not considered to be a DVT. A repeat ultrasound for evaluation of this is to occur on [**2131-4-25**]. She is currently on Lovenox. She is being followed by Spine Surgery for management of her lumbar transverse processes fractures. Specific recommendations are pending. At the time of this dictation, she is extubated successfully, being cared for on the floor, alert and oriented times three, taking solid foods, and has been afebrile for greater than 48 hours. Her activity is currently bed rest due to the open abdominal wound and the risk of disrupting the site as well as the unknown status of her transverse processes fractures. It is anticipated that she will be able to go to rehabilitation later this week to continue VAC dressing changes and Physical Therapy evaluation. She will return per Plastic Surgery recommendations for future grafting of her abdominal wound site. The remainder of this discharge summary will be dictated upon the patient's discharge from the hospital. This discharge summary encompasses the time from the patient's admission from [**2131-4-5**] to hospital day number 17, [**2131-4-21**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D. [**MD Number(1) 10637**] Dictated By:[**Last Name (NamePattern1) 37631**] MEDQUIST36 D: [**2131-4-21**] 03:26 T: [**2131-4-21**] 16:17 JOB#: [**Job Number 56539**] Admission Date: [**2131-4-5**] Discharge Date: [**2131-4-30**] Date of Birth: [**2083-11-16**] Sex: F Service: TRA Of note, this discharge summary will encompass the time from [**2131-4-22**], which is hospital day number 18, until the date of discharge, [**2131-4-30**], which is hospital day number 26. For a detailed description of the [**Hospital 228**] hospital course prior to this and her initial presentation, please refer to the previous discharge summary. HOSPITAL COURSE: From hospital day 18 to date of discharge, hospital day 26, the patient continued to remain afebrile and hemodynamically stable. She was fitted for a TLSO brace which was able to be placed over her anterior abdominal wound with the VAC dressing in place. She had regular VAC dressing changes every three to four days. A good seal is noted and the wound looked clean. She was evaluated by Plastic Surgery so that her continued care may be initiated early on. At this time no operative interventions for closure are planned. This will be scheduled at a future date depending on the progression of wound healing. The patient received a Nutritional consult and had vitamin supplements added to her diet as well as a marked increase in her nutritional intake in order to maintain an optimal situation for wound healing. She also had regular physical therapy instruction. When the patient is out of bed and ambulatory she is to wear her brace at all times. Her vacuum dressing is to remain to suction. With these two barriers in place, the plastic TLSO brace anteriorly and the vacuum dressing, there is some barrier protection while the patient is ambulatory. Per Physical Therapy she is seen as ambulatory and safe to discharge home. The patient's Foley was also removed once she became ambulatory. The patient had a repeat ultrasound of her left extremity to follow up on her great saphenus vein thrombus. It was determined that this thrombus was still present, however, had not changed in size or location. She will continue on Lovenox 40 subq. b.i.d. for the remainder of the month, at which point she will follow up with Dr. [**Last Name (STitle) **] for a repeat ultrasound. DISCHARGE: Patient will be discharged home in good condition. She will have vacuum dressing material at her home as well as a visiting nurse who will help her change the dressing three times weekly. FINAL DIAGNOSES: 1. Right-sided multiple displaced rib fractures in the posterior part. 2. Right hemothorax status post tube thoracostomy. 3. Right scapular fracture. 4. Right liver laceration with contusion. 5. Right kidney contusion. 6. Right thigh contusion. 7. Transverse process fractures of L1, L2, and L3 on the left side. 8. Acute renal failure, resolved. 9. Bile peritonitis. 10. Abdominal compartment syndrome. 11. Open abdominal wound unable to close status post biliary peritonitis with washouts times four. 12. Left great saphenous vein thrombus. FOLLOW UP: 1. Patient is to follow up with Plastic Surgery, Dr. [**First Name (STitle) 3228**], at [**Telephone/Fax (1) 56307**]. She should have an appointment in two weeks either on a Monday or a Wednesday when her VAC dressing is supposed to be changed. She should travel to the appointment with her VAC dressing in place and on battery power. While at the doctor's office the dressing will be taken down for a full examination. The vacuum unit should be recharged while at the doctor's office for her ride home, and the VAC dressing should be replaced at the doctor's office and the patient will drive home using the battery-powered VAC unit. [**Unit Number **]. General Surgery: Patient will be contact[**Name (NI) **] by the hospital with a phone number and name of the doctor that will be following her abdomen. She should make an appointment with this doctor within one to two weeks. If she has any questions, patient can call [**Telephone/Fax (1) 2756**] and ask to speak to the on-call surgical resident. 3. The patient should make an appointment to see her primary care doctor in one week. 4. The patient should have an appointment in one month with vascular surgeon, Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 1784**]. She should remain on Lovenox until that time. At the appointment she will have a repeat ultrasound to assess the thrombus in her left great saphenous vein and determine whether she needs to continue to need Lovenox. 5. The patient should make an appointment in one month with Orthopedic doctor, Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 1022**]. The number is [**Telephone/Fax (1) 56540**]. He will follow up on her lumbar transverse processes fractures and determine how long she will need to wear the brace. DISCHARGE MEDICATIONS: 1. Vicodin one to two tablets p.o. q. 4 to 6 hours as needed, dispense number 40. 2. Metoprolol 12.5 p.o. b.i.d. 3. Colace 100 mg p.o. b.i.d. 4. Multivitamin one capsule p.o. q.d. 5. Vitamin C 500 mg b.i.d. 6. Zinc sulfate 220 mg one tablet q.d. 7. Metformin 850 p.o. b.i.d. 8. Nystatin solution 5 ml p.o. q.i.d. p.r.n. times 7 days. 9. Albuterol inhaler one to two puffs q. 6 hours as needed. 10. Lovenox 40 mg subcutaneous b.i.d. for 30 days. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 53871**] Dictated By:[**Last Name (NamePattern1) 41037**] MEDQUIST36 D: [**2131-4-30**] 14:17:09 T: [**2131-4-30**] 16:19:26 Job#: [**Job Number 56541**]

958,926,807,584,E884,790

{'Other early complications of trauma,Crushing injury of other specified sites of trunk,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Other accidental fall from one level to another,Bacteremia'}

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 47-year-old morbidly obese woman who was transferred from an outside hospital for multiple injuries after falling from her horse three days prior. She was transferred to [**Hospital1 18**] on [**2131-4-5**]. Her injury was sustained on [**2131-3-31**]. Apparently, this patient landed on her right side. She was taken to a hospital in [**Location (un) 8641**], [**Location (un) 3844**]. The extent of her injuries there were as follows: 1. Hepatic contusion, grade III. 2. Right renal contusion. 3. Right hemothorax. 4. Right rib fractures, [**12-25**], posteriorly displaced. 5. Right scapular fracture. 6. Left transverse process fracture, L1-3. 7. Right thigh hematoma. On day number three of her hospital stay at the outside hospital, she developed abdominal pain and became hemodynamically unstable. She was taken to the OR where she was found to have a biliary leak with bile peritonitis. They were unable to close her abdomen at the outside hospital and she was transferred to [**Hospital1 18**] still intubated and sedated with an open abdomen and a right chest tube for further management. MEDICAL HISTORY: 1. Morbid obesity with a BMI of 40. 2. Adult onset diabetes. 3. Asthma. 4. Hypertension. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other early complications of trauma,Crushing injury of other specified sites of trunk,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Other accidental fall from one level to another,Bacteremia'}

CHIEF COMPLAINT: nausea, vomiting PRESENT ILLNESS: 52 yo M with Crohn's disease, s/p multiple small bowel resections, CKD, HTN, hypothyroidism presents with hypotension in the setting of 3 days of nausea and non-bloody vomiting. The emesis has occurred multiple times per day, although the patient has not had an emesis since he arrived in the ED today. He has not tolerated any PO intake for several days. He has liquid stool at baseline, with last liquid stool (small volume) on Sunday, non-bloody and not black. He does not recall passing gas from below since Friday. He had fever to 101.5 on Saturday and has had temperatures to about 100 over the past couple of days. Other more subacute to chronic symptoms include dyspnea on exertion, worsening over the past several months, sore throat for the past few weeks, and chronic right wrist swelling after an injury. No sick contacts. [**Name (NI) **] pain with urination. MEDICAL HISTORY: # Crohn's disease on chronic steroids, s/p multiple surgeries with ileocolonic resection # Chronic kidney disease- baseline creatinine 1.2-1.7 # HTN- not currently on medication as BP low # Hypothyroidism # Hyperparathyroidism # Peripheral neuropathy # Chronic back and abdominal pain # Osteopenia # Pernicious anemia # Hypogonadotrophic hypogonadism [**2-23**] opiate therapy # s/p hydrocele repair # s/p L cataract repair MEDICATION ON ADMISSION: methadone 25 mg TID methylprednisolone 16 mg daily zolpidem 10 mg QHS PRN insomnia (10 mg per patient, was 5 mg in recent discharge summary) tizanidine 8 mg TID levothyroxine 175 mcg daily omeprazole 20 mg daily diazepam 5 mg PO Q8H tamsulosin 0.4 mg QHS finasteride 5 mg daily pregabalin 100 mg [**Hospital1 **] ALLERGIES: Iodine-Iodine Containing / Mercaptopurine / Imuran PHYSICAL EXAM: Admission Physical Exam: Vitals: T:98.1 BP:132/74 P:65 R:16 O2:98%/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, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, bowel sounds present, diffusely tender, especially on right side, with no rebound tenderness or guarding Back: No CVA tenderness or tenderness of spinous processes. GU: Foley placed on arrival to ICU Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox3. Moving all extremities. FAMILY HISTORY: Mother- h/o stroke, died of breast cancer Father- died of MI at age 62 History of DM in paternal grandparents Maternal grandmother, aunt with cancers Two brothers- healthy SOCIAL HISTORY: Lives in [**Hospital1 392**] with brother. Currently on disability but used to work for oldest brother in the entertainment business. Tobacco- denies past or present use Alcohol- none Illicits- denies

Dehydration,Acute kidney failure, unspecified,Regional enteritis of small intestine with large intestine,Intestinal infection due to other organism, not elsewhere classified,Orthostatic hypotension,Nausea with vomiting,Long-term (current) use of steroids,Acquired absence of intestine (large) (small),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Acute pharyngitis,Fever, unspecified,Unspecified acquired hypothyroidism,Hyperparathyroidism, unspecified,Other specified idiopathic peripheral neuropathy,Pernicious anemia,Lumbago,Chest pain, unspecified

Dehydration,Acute kidney failure NOS,Reg enterit sm/lg intest,Viral enteritis NOS,Orthostatic hypotension,Nausea with vomiting,Long-term use steroids,Acquire absnce intestine,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,BPH w urinary obs/LUTS,Retention urine NOS,Acute pharyngitis,Fever NOS,Hypothyroidism NOS,Hyperparathyroidism NOS,Idio periph neurpthy NEC,Pernicious anemia,Lumbago,Chest pain NOS

Admission Date: [**2136-3-6**] Discharge Date: [**2136-3-9**] Date of Birth: [**2083-4-6**] Sex: M Service: MEDICINE Allergies: Iodine-Iodine Containing / Mercaptopurine / Imuran Attending:[**First Name3 (LF) 613**] Chief Complaint: nausea, vomiting Major Surgical or Invasive Procedure: none History of Present Illness: 52 yo M with Crohn's disease, s/p multiple small bowel resections, CKD, HTN, hypothyroidism presents with hypotension in the setting of 3 days of nausea and non-bloody vomiting. The emesis has occurred multiple times per day, although the patient has not had an emesis since he arrived in the ED today. He has not tolerated any PO intake for several days. He has liquid stool at baseline, with last liquid stool (small volume) on Sunday, non-bloody and not black. He does not recall passing gas from below since Friday. He had fever to 101.5 on Saturday and has had temperatures to about 100 over the past couple of days. Other more subacute to chronic symptoms include dyspnea on exertion, worsening over the past several months, sore throat for the past few weeks, and chronic right wrist swelling after an injury. No sick contacts. [**Name (NI) **] pain with urination. The patient was recently admission from [**Date range (1) 104010**] for nausea, vomiting, urinary retention and acute on chronic kidney injury. He required a Foley catheter. His urinary retention was treated with tamsolosin and finasteride, and he discharged with intermittent self-catheterization. He self-catheterized once since discharge, but otherwise has been voiding on his own. However, urine output decreased on Saturday, and the patient has been unable to urinate since he presented to the ED. . The patient was seen at [**Company 191**] today and was noted to be hypotensive to the 80s when lying down, with further SBP drop to 70 when sitting up. He was referred to the ED for further management. . In the ED inital vitals were 98.3 74 119/63 16 100% RA. Exam was notable for right CVA tenderness. Bedside ultrasound showed little urine in bladder, no hydronephrosis. Labs notable for Hct 33.5 (baseline), creatinine 1.8 (baseline). The patient was given 2L NS, solumedrol 125 mg IV, Zofran 4 mg IV. ICU admission was requested given persistent hypotension to SBP 90 despite fluid resuscitation. On transfer, vitals BP 104/71, HR 50, RR 14, Sat 100%/RA. Access is 20-gauge IV x 1. . On arrival to the ICU, the patient complain of abdominal and back pain. No nausea, vomiting. No dizziness or lightheadedness. . Review of systems: (+) Per HPI (-) +fever per HPI. Weight fluctuates. +sore throat. Denies cough. Has chronic dyspnea on exertion. Denies chest pain, chest pressure. GI and GU symptoms per HPI. Has chronic back pain. Denies rashes or skin changes. Past Medical History: # Crohn's disease on chronic steroids, s/p multiple surgeries with ileocolonic resection # Chronic kidney disease- baseline creatinine 1.2-1.7 # HTN- not currently on medication as BP low # Hypothyroidism # Hyperparathyroidism # Peripheral neuropathy # Chronic back and abdominal pain # Osteopenia # Pernicious anemia # Hypogonadotrophic hypogonadism [**2-23**] opiate therapy # s/p hydrocele repair # s/p L cataract repair Social History: Lives in [**Hospital1 392**] with brother. Currently on disability but used to work for oldest brother in the entertainment business. Tobacco- denies past or present use Alcohol- none Illicits- denies Family History: Mother- h/o stroke, died of breast cancer Father- died of MI at age 62 History of DM in paternal grandparents Maternal grandmother, aunt with cancers Two brothers- healthy Physical Exam: Admission Physical Exam: Vitals: T:98.1 BP:132/74 P:65 R:16 O2:98%/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, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, bowel sounds present, diffusely tender, especially on right side, with no rebound tenderness or guarding Back: No CVA tenderness or tenderness of spinous processes. GU: Foley placed on arrival to ICU Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox3. Moving all extremities. Pertinent Results: LABS: [**2136-3-6**] 10:00AM BLOOD WBC-9.5 RBC-4.09* Hgb-11.2* Hct-33.5* MCV-82 MCH-27.5 MCHC-33.6 RDW-15.1 Plt Ct-228 [**2136-3-6**] 10:00AM BLOOD Neuts-66.7 Lymphs-25.8 Monos-4.8 Eos-2.2 Baso-0.6 [**2136-3-6**] 10:00AM BLOOD Glucose-91 UreaN-26* Creat-1.8* Na-137 K-4.3 Cl-102 HCO3-24 AnGap-15 [**2136-3-6**] 10:00AM BLOOD ALT-11 AST-13 AlkPhos-84 TotBili-0.8 [**2136-3-6**] 10:00AM BLOOD Lipase-29 [**2136-3-6**] 10:00AM BLOOD Albumin-4.4 [**2136-3-6**] 02:00PM BLOOD Lactate-3.3* [**2136-3-6**] 05:10PM BLOOD Lactate-1.6 [**2136-3-6**] 11:35AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.006 [**2136-3-6**] 11:35AM URINE Blood-TR Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2136-3-6**] 11:35AM URINE RBC-3* WBC-<1 Bacteri-FEW Yeast-NONE Epi-<1 [**2136-3-7**] 05:34AM BLOOD WBC-8.1 RBC-3.57* Hgb-9.8* Hct-29.7* MCV-83 MCH-27.4 MCHC-32.9 RDW-15.1 Plt Ct-189 [**2136-3-7**] 05:34AM BLOOD Glucose-109* UreaN-20 Creat-1.5* Na-137 K-4.9 Cl-108 HCO3-20* AnGap-14 [**2136-3-7**] 06:51AM BLOOD Lactate-2.0 IMAGING: CXR ([**3-6**]) IMPRESSION: No acute cardiopulmonary process. KUB ([**3-6**]) FINDINGS: There are no dilated loops of small or large bowel to indicate obstruction. There is no evidence of pneumatosis, portal venous air, or pneumoperitoneum. There are stable phleboliths and a calcific density projecting in the region of the lower left pelvis as previously seen on CT from [**2135-7-12**]. The visualized osseous structures are intact. In addition, multiple calcific densities projecting over the left iliac [**Doctor First Name 362**] can be correlated to subcutaneous granulomas as demonstrated on prior CT. IMPRESSION: Non-obstructive bowel gas pattern. Brief Hospital Course: Assessment and Plan: 52 yo M with Crohn's disease, s/p multiple small bowel resections, CKD, HTN, hypothyroidism presents with hypotension and lactic acidosis in the setting of 3 days of nausea/vomiting. . # Nausea/vomiting/abdominal pain: Ddx includes Crohn's flair, partial SBO, gastroenteritis. Less likely cholecystitis or pancreatitis in the setting of normal LFTs and lactate. The patient states that the abdominal pain is similar in quality to his chronic abdominal pain, yet is more severe (nl [**5-31**], now [**7-31**]). The patient received 2L NS bolus in ED and received 1L IVF over the course of a few hours in the ICU. The patient was NPO for most of HD #1, and tolerated clear liquids overnight. The patient had a KUB overnight which showed no free air or air/fluid levels. Serial abdominal exams demonstrated stable, pain w/out peritoneal signs. Nausea managed with zofran IV alternating with compazine PO. Abdominal pain managed w/ methadone (chronic med) and dilaudid PRN for breakthrough pain. - Symptoms improved with supportive care - GI consulted: Felt that symptoms were likely related to gastroenteritis. Recommended follow up with Dr. [**Last Name (STitle) 3708**]. . # Lactic acidosis: Likely related to hypovolemia. Resolving with IVF. 3.3 --> 1.6 --> 2.0. . # Hypotension/Acute on chronic kidney injury: Likely related to hypovolemia. Hypotension resolved with IVF. He had one more episode of hypotension while on the medical floor, resolved with IVF. Cr Improved from 1.8 --> 1.5. . # Urinary retention: Likely related to BPH and pain medications. Bladder scan demonstrated > 500cc. Foley placed. continued finasteride, tamsulosin. - Foley DCd and passed voiding trial. Continued home regimen . # Crohn's disease: Unlikely flair. Continuing home steroids. contact[**Name (NI) **] Dr. [**Last Name (STitle) 3708**] (outpt GI) via e-mail. Have consulted with GI colleagues re: management of Crohn's. GI felt Crohn's not contributing. . # Chronic back pain: continued tizanidine, methadone, pregabalin per home regimen . # Hypothyroidism: stable. continued levothyroxine per home dose Medications on Admission: methadone 25 mg TID methylprednisolone 16 mg daily zolpidem 10 mg QHS PRN insomnia (10 mg per patient, was 5 mg in recent discharge summary) tizanidine 8 mg TID levothyroxine 175 mcg daily omeprazole 20 mg daily diazepam 5 mg PO Q8H tamsulosin 0.4 mg QHS finasteride 5 mg daily pregabalin 100 mg [**Hospital1 **] Discharge Medications: 1. methadone 10 mg Tablet Sig: 2.5 Tablets PO TID (3 times a day). 2. methylprednisolone 8 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for insomnia. 4. tizanidine 2 mg Tablet Sig: Four (4) Tablet PO TID (3 times a day). 5. levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 8. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 9. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. pregabalin 25 mg Capsule Sig: Four (4) Capsule PO BID (2 times a day). 11. Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8) hours for 3 days. Disp:*9 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Viral gastroenteritis SECONDARY: Crohn's disease Chronic pain 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 evaluation of nausea, vomiting, and low blood pressure. With IV fluids and supportive care your symptoms improved. GI saw you in the hospital, and felt the likely cause of your symptoms was due to a viral gastroenteritis. You should improve over the next few days. Please stay well hydrated for the next few days. Please take all medications as prescribed and keep all follow up appointments Followup Instructions: Department: [**Hospital3 249**] When: THURSDAY [**2136-3-22**] at 3:30 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2967**], RNC [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] None Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 249**] When: TUESDAY [**2136-4-10**] at 7:45 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 7323**], M.D. [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: DIV. OF GASTROENTEROLOGY When: FRIDAY [**2136-4-13**] at 8:20 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 7290**], MD [**Telephone/Fax (1) 463**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **] Campus: EAST Best Parking: Main Garage Department: PAIN MANAGEMENT CENTER When: FRIDAY [**2136-4-20**] at 8:40 AM With: [**Name6 (MD) 1089**] [**Name8 (MD) 1090**], MD [**Telephone/Fax (1) 1652**] Building: One [**Location (un) **] Place ([**Location (un) **], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: Parking on Site Name: [**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Hospital1 18**]-DIVISION OF GASTROENTEROLOGY/GI EAST Address: [**Last Name (LF) **], [**First Name3 (LF) **] ROSE 101, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 65629**] **We are working on a follow up appointment with Dr. [**Last Name (STitle) 3708**] within 1-2 weeks. You will be called at home with the appointment. If you have not heard from the office within 2 days or have any questions, please call the number above.** [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**] Completed by:[**2136-3-13**]

276,584,555,008,458,787,V586,V457,403,585,600,788,462,780,244,252,356,281,724,786

{'Dehydration,Acute kidney failure, unspecified,Regional enteritis of small intestine with large intestine,Intestinal infection due to other organism, not elsewhere classified,Orthostatic hypotension,Nausea with vomiting,Long-term (current) use of steroids,Acquired absence of intestine (large) (small),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Acute pharyngitis,Fever, unspecified,Unspecified acquired hypothyroidism,Hyperparathyroidism, unspecified,Other specified idiopathic peripheral neuropathy,Pernicious anemia,Lumbago,Chest pain, 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 PRESENT ILLNESS: 52 yo M with Crohn's disease, s/p multiple small bowel resections, CKD, HTN, hypothyroidism presents with hypotension in the setting of 3 days of nausea and non-bloody vomiting. The emesis has occurred multiple times per day, although the patient has not had an emesis since he arrived in the ED today. He has not tolerated any PO intake for several days. He has liquid stool at baseline, with last liquid stool (small volume) on Sunday, non-bloody and not black. He does not recall passing gas from below since Friday. He had fever to 101.5 on Saturday and has had temperatures to about 100 over the past couple of days. Other more subacute to chronic symptoms include dyspnea on exertion, worsening over the past several months, sore throat for the past few weeks, and chronic right wrist swelling after an injury. No sick contacts. [**Name (NI) **] pain with urination. MEDICAL HISTORY: # Crohn's disease on chronic steroids, s/p multiple surgeries with ileocolonic resection # Chronic kidney disease- baseline creatinine 1.2-1.7 # HTN- not currently on medication as BP low # Hypothyroidism # Hyperparathyroidism # Peripheral neuropathy # Chronic back and abdominal pain # Osteopenia # Pernicious anemia # Hypogonadotrophic hypogonadism [**2-23**] opiate therapy # s/p hydrocele repair # s/p L cataract repair MEDICATION ON ADMISSION: methadone 25 mg TID methylprednisolone 16 mg daily zolpidem 10 mg QHS PRN insomnia (10 mg per patient, was 5 mg in recent discharge summary) tizanidine 8 mg TID levothyroxine 175 mcg daily omeprazole 20 mg daily diazepam 5 mg PO Q8H tamsulosin 0.4 mg QHS finasteride 5 mg daily pregabalin 100 mg [**Hospital1 **] ALLERGIES: Iodine-Iodine Containing / Mercaptopurine / Imuran PHYSICAL EXAM: Admission Physical Exam: Vitals: T:98.1 BP:132/74 P:65 R:16 O2:98%/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, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, bowel sounds present, diffusely tender, especially on right side, with no rebound tenderness or guarding Back: No CVA tenderness or tenderness of spinous processes. GU: Foley placed on arrival to ICU Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A+Ox3. Moving all extremities. FAMILY HISTORY: Mother- h/o stroke, died of breast cancer Father- died of MI at age 62 History of DM in paternal grandparents Maternal grandmother, aunt with cancers Two brothers- healthy SOCIAL HISTORY: Lives in [**Hospital1 392**] with brother. Currently on disability but used to work for oldest brother in the entertainment business. Tobacco- denies past or present use Alcohol- none Illicits- denies ### Response: {'Dehydration,Acute kidney failure, unspecified,Regional enteritis of small intestine with large intestine,Intestinal infection due to other organism, not elsewhere classified,Orthostatic hypotension,Nausea with vomiting,Long-term (current) use of steroids,Acquired absence of intestine (large) (small),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Acute pharyngitis,Fever, unspecified,Unspecified acquired hypothyroidism,Hyperparathyroidism, unspecified,Other specified idiopathic peripheral neuropathy,Pernicious anemia,Lumbago,Chest pain, unspecified'}

CHIEF COMPLAINT: OSH transfer from [**Hospital1 100**] to [**Last Name (un) 33526**] to [**Hospital1 18**] for Hypotension PRESENT ILLNESS: 86 yo M w/ bullous pemphigoid p/w sepsis of unclear etiology, but likely from skin source. He was just at [**Hospital1 18**] and d/c on [**7-26**] for coag neg staph bacteremia thought from skin given areas of skin breakdown, and was treated with vancomycin with improvement, and d/c to rehab on continued vanc (today [**7-31**] was to be last day of tx). He also completed a 3-day course of cipro for a positive U/A. . Today at rehab was found to be unarousable. He was sent from there to [**Hospital1 882**] initially. At [**Hospital1 882**], clinically pt was determined to have a PE (no scans done) and he was treated with heparin gtt empirically. He was also given levofloxacin. In [**Name (NI) **], pt was hypothermic to 92F, SBP 70s, O2 sat 80 RA with obvious respiratory distress. Though he was DNR/DNI, pt's son asked to have pt intubated overnight. found to be oozing fluid from various sites in CXR without infiltrate, U/A clean. A CVL/ sepsis catheter was placed and he received 5L NS, and max dose of levophed which increased his SBP to 80s. Pt received cefepime 2g iv x 1. ED staff spoke with the family regarding the pt's poor prognosis. MEDICAL HISTORY: 1. Hypercholesterolemia 2. HTN 3. DM (not on insulin) 4. Bullous pemphoid 5. Recent h/o coag neg staph bacteremia 6. Recent ARF thought [**2-10**] prerenal etiology 7. Dementia MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: In ED: T 32.2 (r) HR 71 BP 100/39 RR 17 O2 Sat 100% GCS 7, opens eyes to voics JVD, Anicteric Decreased breath sounds bilaterally, + SOB RRR Abd:s/NTND No CVA tenderness Skin: cold extremities FAMILY HISTORY: Brother with CA SOCIAL HISTORY: Lives in [**Hospital 100**] Rehab, retired, no EtOH, no smoking

Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Pemphigoid,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Severe sepsis

Septicemia NOS,Acute respiratry failure,Pneumonia, organism NOS,CHF NOS,Pemphigoid,Atrial fibrillation,Hypertension NOS,DMII wo cmp nt st uncntr,Mental disor NEC oth dis,Severe sepsis

Admission Date: [**2191-7-31**] Discharge Date: [**2191-7-31**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: OSH transfer from [**Hospital1 100**] to [**Last Name (un) 33526**] to [**Hospital1 18**] for Hypotension Major Surgical or Invasive Procedure: ETT placement R IJ placement History of Present Illness: 86 yo M w/ bullous pemphigoid p/w sepsis of unclear etiology, but likely from skin source. He was just at [**Hospital1 18**] and d/c on [**7-26**] for coag neg staph bacteremia thought from skin given areas of skin breakdown, and was treated with vancomycin with improvement, and d/c to rehab on continued vanc (today [**7-31**] was to be last day of tx). He also completed a 3-day course of cipro for a positive U/A. . Today at rehab was found to be unarousable. He was sent from there to [**Hospital1 882**] initially. At [**Hospital1 882**], clinically pt was determined to have a PE (no scans done) and he was treated with heparin gtt empirically. He was also given levofloxacin. In [**Name (NI) **], pt was hypothermic to 92F, SBP 70s, O2 sat 80 RA with obvious respiratory distress. Though he was DNR/DNI, pt's son asked to have pt intubated overnight. found to be oozing fluid from various sites in CXR without infiltrate, U/A clean. A CVL/ sepsis catheter was placed and he received 5L NS, and max dose of levophed which increased his SBP to 80s. Pt received cefepime 2g iv x 1. ED staff spoke with the family regarding the pt's poor prognosis. Past Medical History: 1. Hypercholesterolemia 2. HTN 3. DM (not on insulin) 4. Bullous pemphoid 5. Recent h/o coag neg staph bacteremia 6. Recent ARF thought [**2-10**] prerenal etiology 7. Dementia Social History: Lives in [**Hospital 100**] Rehab, retired, no EtOH, no smoking Family History: Brother with CA Physical Exam: In ED: T 32.2 (r) HR 71 BP 100/39 RR 17 O2 Sat 100% GCS 7, opens eyes to voics JVD, Anicteric Decreased breath sounds bilaterally, + SOB RRR Abd:s/NTND No CVA tenderness Skin: cold extremities Pertinent Results: [**2191-7-31**] 06:55AM URINE HYALINE-0-2 [**2191-7-31**] 06:55AM URINE RBC-[**3-13**]* WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-0 [**2191-7-31**] 06:55AM URINE BLOOD-LG NITRITE-NEG PROTEIN-TR GLUCOSE-TR KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-SM [**2191-7-31**] 06:55AM URINE COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.017 [**2191-7-31**] 06:55AM PT-22.5* PTT-150* INR(PT)-2.2* [**2191-7-31**] 06:55AM PLT SMR-LOW PLT COUNT-114* [**2191-7-31**] 06:55AM HYPOCHROM-NORMAL ANISOCYT-2+ POIKILOCY-3+ MACROCYT-OCCASIONAL MICROCYT-1+ POLYCHROM-1+ SCHISTOCY-1+ BURR-3+ PAPPENHEI-1+ ACANTHOCY-1+ [**2191-7-31**] 06:55AM NEUTS-86.7* BANDS-0 LYMPHS-10.7* MONOS-2.2 EOS-0.3 BASOS-0.2 [**2191-7-31**] 06:55AM WBC-13.2* RBC-3.03* HGB-7.8* HCT-25.4* MCV-84 MCH-25.6* MCHC-30.6* RDW-16.5* [**2191-7-31**] 06:55AM URINE UHOLD-HOLD [**2191-7-31**] 06:55AM URINE HOURS-RANDOM [**2191-7-31**] 06:55AM ASA-NEG ACETMNPHN-NEG [**2191-7-31**] 06:55AM CALCIUM-7.1* PHOSPHATE-8.6*# MAGNESIUM-2.1 [**2191-7-31**] 06:55AM CK-MB-12* MB INDX-8.4* cTropnT-0.06* [**2191-7-31**] 06:55AM CK(CPK)-143 [**2191-7-31**] 06:55AM GLUCOSE-197* UREA N-89* CREAT-3.4*# SODIUM-141 POTASSIUM-4.8 CHLORIDE-114* TOTAL CO2-12* ANION GAP-20 [**2191-7-31**] 07:01AM LACTATE-3.4* [**2191-7-31**] 07:50AM O2 SAT-97 [**2191-7-31**] 07:50AM LACTATE-3.0* . [**7-31**] CXR AP SUPINE CHEST RADIOGRAPH: A right-sided subclavian catheter is seen with tip overlying the mid SVC. There has been interval placement of a right IJ catheter with tip overlying the distal SVC. Endotracheal tube extends below the diaphragm overlying the mid to proximal stomach with side port seen below the GE junction. An endotracheal tube is present with tip at the thoracic inlet in standard position. There are bilateral moderate-sized pleural effusions. Cannot rule out focal consolidations within the lower lobes, particularly retrocardial. IMPRESSION: Endotracheal tube is in standard position. Bilateral small-to-moderate sized pleural effusion with visceral fluid and prominent pulmonary vasculature consistent with CHF. . [**7-31**] ECG Sinus rhythm. Diffuse non-specific T wave flattening. Compared to the previous tracing of [**2191-7-12**] voltage criteria for left ventricular hypertrophy are no longer seen. Otherwise, no diagnostic changes. Brief Hospital Course: In ED, was put on Levophed gtt, was given cefipime 2 g IV, and fentanyl 25 mg IV X 2. He was intubated and a R IJ was placed and he was started on the sepsis protocol. In the ED, it was not thought he had a PE. He was hypotensive and was sent to the [**Hospital Unit Name 153**]. A/P: 86 yo M w/ sepsis of unknown etiology, likely from skin source given his clinical condition of massive skin denuded areas, recent hospitalization for coag neg staph bacteremia. CXR clear, U/A clean, and no h/o abd sxs/diarrhea/URI/ other focal sxs. . Discussion with all family members, incl 3 sons, wife, granddaughter, given max support on pressors and poor prognosis will opt for comfort care. - Morphine drip to comfort - Versed if needed for comfort - Withdraw pressors - No abx further - Was initially left intubated but was then extubated on the request of the family. - He was pronounced dead at 3:30 pm on [**2191-7-31**]. Medications on Admission: Unknown Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Expired Discharge Condition: Expired Discharge Instructions: N/A Followup Instructions: N/A

038,518,486,428,694,427,401,250,294,995

{'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Pemphigoid,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Severe sepsis'}

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: OSH transfer from [**Hospital1 100**] to [**Last Name (un) 33526**] to [**Hospital1 18**] for Hypotension PRESENT ILLNESS: 86 yo M w/ bullous pemphigoid p/w sepsis of unclear etiology, but likely from skin source. He was just at [**Hospital1 18**] and d/c on [**7-26**] for coag neg staph bacteremia thought from skin given areas of skin breakdown, and was treated with vancomycin with improvement, and d/c to rehab on continued vanc (today [**7-31**] was to be last day of tx). He also completed a 3-day course of cipro for a positive U/A. . Today at rehab was found to be unarousable. He was sent from there to [**Hospital1 882**] initially. At [**Hospital1 882**], clinically pt was determined to have a PE (no scans done) and he was treated with heparin gtt empirically. He was also given levofloxacin. In [**Name (NI) **], pt was hypothermic to 92F, SBP 70s, O2 sat 80 RA with obvious respiratory distress. Though he was DNR/DNI, pt's son asked to have pt intubated overnight. found to be oozing fluid from various sites in CXR without infiltrate, U/A clean. A CVL/ sepsis catheter was placed and he received 5L NS, and max dose of levophed which increased his SBP to 80s. Pt received cefepime 2g iv x 1. ED staff spoke with the family regarding the pt's poor prognosis. MEDICAL HISTORY: 1. Hypercholesterolemia 2. HTN 3. DM (not on insulin) 4. Bullous pemphoid 5. Recent h/o coag neg staph bacteremia 6. Recent ARF thought [**2-10**] prerenal etiology 7. Dementia MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: In ED: T 32.2 (r) HR 71 BP 100/39 RR 17 O2 Sat 100% GCS 7, opens eyes to voics JVD, Anicteric Decreased breath sounds bilaterally, + SOB RRR Abd:s/NTND No CVA tenderness Skin: cold extremities FAMILY HISTORY: Brother with CA SOCIAL HISTORY: Lives in [**Hospital 100**] Rehab, retired, no EtOH, no smoking ### Response: {'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Pemphigoid,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Severe sepsis'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 67-year-old male, with known aortic insufficiency, who has been followed with serial echoes over the years. He recently developed increased chest tightness with exertion, and had palpitations and a presyncopal episode. He then underwent stress test which was found to be positive. After the positive stress test, he was then referred for cardiac catheterization, where he was found to have a dilated aortic root with severe aortic insufficiency, and stenosis of his right coronary artery, and an ejection fraction of 45%. He was then referred to Dr. [**Last Name (Prefixes) 2545**] for aortic valve replacement and coronary artery bypass grafting. MEDICAL HISTORY: 1. Hypercholesterolemia. 2. Bilateral effusion of ankles. 3. Status post GI bleed secondary to NSAID use where he did have positive ulcer confirmed by EGD. MEDICATION ON ADMISSION: 1. Univasc 90 mg po qd. 2. Lipitor 40 mg po qd. 3. Aspirin 81 mg po qd. 4. Multivitamin qd. ALLERGIES: NSAIDs or [**Doctor Last Name **] II inhibitors, although he is able to tolerate a baby aspirin without any complications. PHYSICAL EXAM: He was a well-appearing male in no apparent distress, looking younger than his stated age. His vital signs included a heart rate of 64, blood pressure 156/48 on the right, and 147/50 on the left. His skin was intact with no signs of rashes or infections. HEENT - PERRL, anicteric sclerae, and EOMI. His neck was supple with no JVD, no thyromegaly. His chest was clear to auscultation bilaterally with no wheezing, rales or rhonchi. His heart had a regular rate and rhythm with a III/VI systolic ejection murmur. His abdomen was soft, nontender, nondistended with positive bowel sounds and no masses. His extremities were warm and well-perfused with no clubbing, cyanosis or edema, and shows no varicosities. His neuro exam showed him to have [**4-6**] bilateral lower extremity strength, and his cranial nerves II through XII were grossly intact. His pulses showed him to have 2+ bilateral pulses in the femoral arteries, dorsalis pedis arteries, posterior tibialis arteries, and radial arteries. He does not show any signs of carotid bruit. His EKG on admission showed a sinus rhythm with a 1?????? AV block and PR interval of 308. His chest x-ray showed no acute disease. FAMILY HISTORY: Significant for a brother with coronary artery disease, having had a myocardial infarction at the age of 63, and his father also expired as a result of myocardial infarction. SOCIAL HISTORY: He is retired and lives with his wife. [**Name (NI) **] does not nor has not ever smoked. He drinks a glass of wine a day.

Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,First degree atrioventricular block,Pure hypercholesterolemia

Aortic valve disorder,Surg compl-heart,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Atriovent block-1st degr,Pure hypercholesterolem

Admission Date: [**2136-8-6**] Discharge Date: [**2136-8-10**] Date of Birth: [**2069-6-14**] Sex: M Service: CARDIOTHORACIC SURGERY HI[**Last Name (STitle) 2710**]OF PRESENT ILLNESS: The patient is a 67-year-old male, with known aortic insufficiency, who has been followed with serial echoes over the years. He recently developed increased chest tightness with exertion, and had palpitations and a presyncopal episode. He then underwent stress test which was found to be positive. After the positive stress test, he was then referred for cardiac catheterization, where he was found to have a dilated aortic root with severe aortic insufficiency, and stenosis of his right coronary artery, and an ejection fraction of 45%. He was then referred to Dr. [**Last Name (Prefixes) 2545**] for aortic valve replacement and coronary artery bypass grafting. PAST MEDICAL HISTORY: 1. Hypercholesterolemia. 2. Bilateral effusion of ankles. 3. Status post GI bleed secondary to NSAID use where he did have positive ulcer confirmed by EGD. ALLERGIES: NSAIDs or [**Doctor Last Name **] II inhibitors, although he is able to tolerate a baby aspirin without any complications. MEDICATIONS ON ADMISSION: 1. Univasc 90 mg po qd. 2. Lipitor 40 mg po qd. 3. Aspirin 81 mg po qd. 4. Multivitamin qd. FAMILY HISTORY: Significant for a brother with coronary artery disease, having had a myocardial infarction at the age of 63, and his father also expired as a result of myocardial infarction. SOCIAL HISTORY: He is retired and lives with his wife. [**Name (NI) **] does not nor has not ever smoked. He drinks a glass of wine a day. REVIEW OF SYSTEMS: Significant for him wearing glasses. He has no dysphagia. He does exhibit shortness of breath with exertion. He has experienced palpitations and chest tightness. He has had GI bleed with a negative colonoscopy, but positive EGD which showed an ulcer. He does have gait problems as a result of his ankle effusion. He has had no CVAs or TIAs. PHYSICAL EXAM: He was a well-appearing male in no apparent distress, looking younger than his stated age. His vital signs included a heart rate of 64, blood pressure 156/48 on the right, and 147/50 on the left. His skin was intact with no signs of rashes or infections. HEENT - PERRL, anicteric sclerae, and EOMI. His neck was supple with no JVD, no thyromegaly. His chest was clear to auscultation bilaterally with no wheezing, rales or rhonchi. His heart had a regular rate and rhythm with a III/VI systolic ejection murmur. His abdomen was soft, nontender, nondistended with positive bowel sounds and no masses. His extremities were warm and well-perfused with no clubbing, cyanosis or edema, and shows no varicosities. His neuro exam showed him to have [**4-6**] bilateral lower extremity strength, and his cranial nerves II through XII were grossly intact. His pulses showed him to have 2+ bilateral pulses in the femoral arteries, dorsalis pedis arteries, posterior tibialis arteries, and radial arteries. He does not show any signs of carotid bruit. His EKG on admission showed a sinus rhythm with a 1?????? AV block and PR interval of 308. His chest x-ray showed no acute disease. HOSPITAL COURSE: On day of admission, [**2136-8-6**], he underwent aortic valve replacement with a #27 mm pericardial CE valve and coronary artery bypass grafting x 1 with a saphenous vein graft to the PDA. The surgery was performed by Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **] with Dr. [**Last Name (STitle) 14968**] and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], NP as assistants. The surgery was performed under general endotracheal anesthesia with cardiopulmonary bypass time of 103 minutes, and a crossclamp time of 87 minutes. The patient tolerated the procedure well and was transferred to the Surgical Recovery Unit with two atrial and two ventricular pacing wires, two mediastinal and one left pleural chest tube, AV-paced at 90 beats per minute, on a propofol drip. He, in the overnight period, maintained a mean arterial pressure of 65 with a CVP of 12, PAD of 15. In the overnight period, he did well. He was extubated without difficulty and remained hemodynamically stable with a cardiac output 7.78 and a cardiac index of 3.65. He did have his chest tubes discontinued on the first postoperative day without difficulty. He had his Swan removed, and he was transferred to the Surgical Floor on this day. On postoperative day #2, he began working more with physical therapy, and cardiac rehab was initiated. He did have a chest x-ray which showed no sign of pneumothorax and a very small bilateral effusion. On postoperative day #3, he had his pacing wires DC'd without incident and continued with cardiac rehab. His hospital course was uneventful, and it was felt, on postoperative day #4, that he would be ready to be discharged to home. DISCHARGE EXAM: Showed his vital signs to be stable, with a temp of 99.2, heart rate 84, blood pressure 120/80. His lungs were clear to auscultation bilaterally. His heart regular rate and rhythm. His abdomen was soft, nontender, nondistended with positive bowel sounds. His extremities showed no clubbing, cyanosis or edema. His wounds were healing well, and his sternum was stable. DISCHARGE LABS: Include a white count of 8.9, hematocrit 26.5%, platelet count 137,000, sodium 138, potassium 3.9, chloride 103, bicarb 29, BUN 17, creatinine 0.8, blood glucose 108. DISCHARGE MEDICATIONS: 1. Aspirin 81 mg po qd. 2. Lipitor 40 mg po qd. 3. Lopressor 25 mg po bid. 4. Lasix 40 mg po qd x 5 days. 5. Potassium Chloride 20 mEq po qd x 5 days. 6. Percocet 1-2 tabs po q 4 h prn pain. DISCHARGE DIAGNOSES: 1. Status post aortic valve replacement with a #27 CE valve and coronary artery bypass grafting x 1 on [**2136-8-6**]. 2. Status post bilateral effusion of ankles. 3. Hypercholesterolemia. 4. Gastrointestinal bleed due to nonsteroidal anti-inflammatory drugs with positive ulcer by esophagogastroduodenoscopy. FO[**Last Name (STitle) **]P PLANS: 1. Follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in 1 week. 2. Follow with his cardiologist, Dr. [**Last Name (STitle) 20222**], in 2 weeks. 3. Follow with Dr. [**Last Name (Prefixes) **] in 4 weeks. DISCHARGE INSTRUCTIONS: He should follow a cardiac diet. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Last Name (NamePattern1) 31272**] MEDQUIST36 D: [**2136-8-10**] 11:22 T: [**2136-8-10**] 10:23 JOB#: [**Job Number 52325**]

424,997,414,413,426,272

{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,First degree atrioventricular block,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: PRESENT ILLNESS: The patient is a 67-year-old male, with known aortic insufficiency, who has been followed with serial echoes over the years. He recently developed increased chest tightness with exertion, and had palpitations and a presyncopal episode. He then underwent stress test which was found to be positive. After the positive stress test, he was then referred for cardiac catheterization, where he was found to have a dilated aortic root with severe aortic insufficiency, and stenosis of his right coronary artery, and an ejection fraction of 45%. He was then referred to Dr. [**Last Name (Prefixes) 2545**] for aortic valve replacement and coronary artery bypass grafting. MEDICAL HISTORY: 1. Hypercholesterolemia. 2. Bilateral effusion of ankles. 3. Status post GI bleed secondary to NSAID use where he did have positive ulcer confirmed by EGD. MEDICATION ON ADMISSION: 1. Univasc 90 mg po qd. 2. Lipitor 40 mg po qd. 3. Aspirin 81 mg po qd. 4. Multivitamin qd. ALLERGIES: NSAIDs or [**Doctor Last Name **] II inhibitors, although he is able to tolerate a baby aspirin without any complications. PHYSICAL EXAM: He was a well-appearing male in no apparent distress, looking younger than his stated age. His vital signs included a heart rate of 64, blood pressure 156/48 on the right, and 147/50 on the left. His skin was intact with no signs of rashes or infections. HEENT - PERRL, anicteric sclerae, and EOMI. His neck was supple with no JVD, no thyromegaly. His chest was clear to auscultation bilaterally with no wheezing, rales or rhonchi. His heart had a regular rate and rhythm with a III/VI systolic ejection murmur. His abdomen was soft, nontender, nondistended with positive bowel sounds and no masses. His extremities were warm and well-perfused with no clubbing, cyanosis or edema, and shows no varicosities. His neuro exam showed him to have [**4-6**] bilateral lower extremity strength, and his cranial nerves II through XII were grossly intact. His pulses showed him to have 2+ bilateral pulses in the femoral arteries, dorsalis pedis arteries, posterior tibialis arteries, and radial arteries. He does not show any signs of carotid bruit. His EKG on admission showed a sinus rhythm with a 1?????? AV block and PR interval of 308. His chest x-ray showed no acute disease. FAMILY HISTORY: Significant for a brother with coronary artery disease, having had a myocardial infarction at the age of 63, and his father also expired as a result of myocardial infarction. SOCIAL HISTORY: He is retired and lives with his wife. [**Name (NI) **] does not nor has not ever smoked. He drinks a glass of wine a day. ### Response: {'Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,First degree atrioventricular block,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Respiratory distress PRESENT ILLNESS: 69F PMH severe COPD (2L NC home O2, FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted), tracheobronchomalacia s/p stent placement [**2190-8-6**], initially admitted to the IP service [**2190-9-3**] for acute shortness of breath and increased cough thought secondary to mucus plugging. Of note, the patient underwent bronchoscopy [**2190-8-13**] for mucus plugging and recently finished a prednisone taper [**2190-8-23**] for COPD exacerbation. The patient underwent bronchoscopy [**2190-9-3**] that showed that the stent itself appeared to be patent with minimal secretions. Granulation tissue was seen at the distal end of the stent in both the right and the left main stem bronchi. The patient underwent stent removal [**2190-9-6**], complicated by respiratory distress and hypercarbic respiratory failure with pCO2 as high as 111. The patient was intubated and transferred to the SICU. The patient was started on levofloxacin 750 IV QD and methylprednisolone 80 mg IV Q8H [**2190-9-7**] for empiric treatment of pneumonia and COPD flare. The patient was also diuresed with lasix presumably for volume overload. The patient was extubated [**2190-9-9**]. Patient required BiPap until the morning of transfer. At the time of transfer, the patient was breathing comfortably on 6L NC. Denies shortness of breath, chest pain. . The patient's blood pressure was uncontrolled at times requiring labetolol gtt, but the patient was on an oral regimen on transfer MEDICAL HISTORY: Past Medical History: 1. Severe COPD (FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted) 2. Diabetes mellitus type 2 3. Hypertension 4. Hyperlipidemia 5. Status post total thyroidectomy [**2155**] . Past Surgical History: Tracheal stent as above. MEDICATION ON ADMISSION: . Pre-hospital medications: Aspirin 81 mg, Diltiazem 240 mg, Metformin 850 mg [**Hospital1 **], Pravastatin 10 mg, Levothyroxine 75 mcg, Ezetimibe 10 mg, Tiotropium Bromide 18 mcg, Fluticasone-Salmeterol 250-50 [**Hospital1 **], Pantoprazole 40 mg, Prednisone 10 mg ending [**2190-8-23**], Mucinex 600 mg [**Hospital1 **], Albuterol, Codeine prn cough. . Medications on transfer: Heparin 5000 UNIT SC TID Insulin SC Acetylcysteine 20% 1-10 ml NEB Q2H:PRN Levothyroxine Sodium 75 mcg PO DAILY Acetaminophen 325-650 mg PO Q6H:PRN Levofloxacin 750 mg IV Q24H Albuterol 0.083% Neb Soln 1 NEB IH Q4H Ipratropium Bromide Neb 1 NEB IH Q6H HydrALAzine 25 mg PO Q6H Mucinex *NF* 1200 mg Oral [**Hospital1 **] Aspirin 325 mg PO DAILY Pantoprazole 40 mg PO Q24H Benzonatate 100 mg PO TID Pravastatin 10 mg PO DAILY Codeine Sulfate 15-30 mg PO Q6H:PRN cough MethylPREDNISolone Sodium Succ 80 mg IV Q8H Ezetimibe 10 mg PO DAILY Fluticasone-Salmeterol (250/50) 1 INH IH [**Hospital1 **] Tiotropium Bromide 1 CAP IH DAILY . ALLERGIES: Zocor / Diovan / Crestor PHYSICAL EXAM: on admission: FAMILY HISTORY: Family History: No history of heart or pulmonary disease. SOCIAL HISTORY: Social History: Lives alone. Remote 30 pack-year smoking history. Rare EtOH.

Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Other complications due to other internal prosthetic device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Other diseases of trachea and bronchus,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Comp-int prost devic NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Anemia NOS,Hypothyroidism NOS,Trachea & bronch dis NEC,Abn react-plast surg NEC

Name: [**Known lastname 6577**],[**Known firstname **] A. Unit No: [**Numeric Identifier 12272**] Admission Date: [**2190-9-3**] Discharge Date: [**2190-9-19**] Date of Birth: [**2121-6-18**] Sex: F Service: MEDICINE Allergies: Zocor / Diovan / Crestor Attending:[**First Name3 (LF) 1455**] Addendum: Addendum: Patient will be discharged to ECF to complete steroid taper. She is s/p full 7 day course of levofloxacin so will not need antibiotics after discharge. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24**], MD Discharge Disposition: Extended Care Facility: [**Hospital 12273**] Care Center - [**Hospital1 2946**] [**Name6 (MD) **] [**Last Name (NamePattern4) 1456**] MD [**MD Number(2) 1457**] Completed by:[**2190-9-19**] Admission Date: [**2190-9-3**] Discharge Date: [**2190-9-19**] Date of Birth: [**2121-6-18**] Sex: F Service: MEDICINE Allergies: Zocor / [**Year (4 digits) **] / Crestor Attending:[**First Name3 (LF) 2160**] Chief Complaint: Respiratory distress Major Surgical or Invasive Procedure: 1. Bronchoscopy 2. Endotracheal intubation History of Present Illness: 69F PMH severe COPD (2L NC home O2, FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted), tracheobronchomalacia s/p stent placement [**2190-8-6**], initially admitted to the IP service [**2190-9-3**] for acute shortness of breath and increased cough thought secondary to mucus plugging. Of note, the patient underwent bronchoscopy [**2190-8-13**] for mucus plugging and recently finished a prednisone taper [**2190-8-23**] for COPD exacerbation. The patient underwent bronchoscopy [**2190-9-3**] that showed that the stent itself appeared to be patent with minimal secretions. Granulation tissue was seen at the distal end of the stent in both the right and the left main stem bronchi. The patient underwent stent removal [**2190-9-6**], complicated by respiratory distress and hypercarbic respiratory failure with pCO2 as high as 111. The patient was intubated and transferred to the SICU. The patient was started on levofloxacin 750 IV QD and methylprednisolone 80 mg IV Q8H [**2190-9-7**] for empiric treatment of pneumonia and COPD flare. The patient was also diuresed with lasix presumably for volume overload. The patient was extubated [**2190-9-9**]. Patient required BiPap until the morning of transfer. At the time of transfer, the patient was breathing comfortably on 6L NC. Denies shortness of breath, chest pain. . The patient's blood pressure was uncontrolled at times requiring labetolol gtt, but the patient was on an oral regimen on transfer Past Medical History: Past Medical History: 1. Severe COPD (FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted) 2. Diabetes mellitus type 2 3. Hypertension 4. Hyperlipidemia 5. Status post total thyroidectomy [**2155**] . Past Surgical History: Tracheal stent as above. Social History: Social History: Lives alone. Remote 30 pack-year smoking history. Rare EtOH. Family History: Family History: No history of heart or pulmonary disease. Physical Exam: on admission: Physical Examination: Vital signs: T 97.0 P 87 BP 149/57 RR 17 O2sat 95%6L General: Lying in bed, breathing comfortably HEENT: Sclera anicteric, extraocular movements intact, mucus membranes dry Heart: Regular rate and rhythm, 2/6 systolic early peaking murmur, no rubs or gallops Lungs: Distant breath sounds, increased expiratory phase, no wheezes/rales/rhonchi Abdomen: Obese, normoactive bowel sounds, soft, nontender, nondistended Extremities: No clubbing, cyanosis, or edema Skin: Warm, no rashes Neurologic: Sleepy, arouses to touch, oriented x 3 Pertinent Results: CHEST (PORTABLE AP) Study Date of [**2190-9-10**] The patient was extubated in the meantime interval with removal of the NG tube. The cardiomediastinal silhouette is stable. Previously demonstrated patchy opacities did not change significantly in the meantime interval. [**Month (only) 116**] be atelectasis but infection cannot be ruled out. Close followup is recommended to exclude the possibility of developing pneumonia. . CHEST (PORTABLE AP) Study Date of [**2190-9-7**] IMPRESSION: 1. Decreased right lower lobe patchy opacities likely reflecting resolving atelectasis and/or pneumonitis. 2. OGT tip terminating within the gastric fundus with side port likely at or above the GE junction. [**Month (only) 116**] benefit from mild advancement. . CHEST (PORTABLE AP) Study Date of [**2190-9-6**] IMPRESSION: 1. Endotracheal tube in satisfactory position. 2. Bibasilar streaky opacities likely reflects underlying atelectasis, difficult to exclude pneumonia. . LABS . CHEM/CBC [**2190-9-6**] 04:37PM BLOOD Hct-36.7 [**2190-9-8**] 03:00AM BLOOD WBC-7.2 RBC-2.81* Hgb-9.1* Hct-27.0* MCV-96 MCH-32.5* MCHC-33.8 RDW-15.8* Plt Ct-292 [**2190-9-18**] 05:50AM BLOOD WBC-19.3* RBC-2.67* Hgb-8.6* Hct-26.1* MCV-98 MCH-32.3* MCHC-33.0 RDW-15.4 Plt Ct-328 [**2190-9-18**] 11:30AM BLOOD Hct-29.7* [**2190-9-19**] 07:05AM BLOOD WBC-17.7* RBC-2.85* Hgb-9.1* Hct-27.5* MCV-96 MCH-31.9 MCHC-33.1 RDW-16.0* Plt Ct-364 [**2190-9-6**] 04:37PM BLOOD Glucose-172* UreaN-7 Creat-0.4 Na-141 K-3.6 Cl-99 HCO3-34* AnGap-12 [**2190-9-7**] 03:01AM BLOOD Glucose-140* UreaN-9 Creat-0.4 Na-138 K-3.2* Cl-98 HCO3-31 AnGap-12 [**2190-9-18**] 05:50AM BLOOD Glucose-66* UreaN-9 Creat-0.4 Na-138 K-3.4 Cl-99 HCO3-33* AnGap-9 [**2190-9-19**] 07:05AM BLOOD Glucose-83 UreaN-10 Creat-0.4 Na-142 K-4.8 Cl-101 HCO3-35* AnGap-11 . CARDIAC LABS [**2190-9-10**] 02:01AM BLOOD proBNP-542* [**2190-9-6**] 04:37PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2190-9-6**] 04:37PM BLOOD CK(CPK)-41 . BLOOD GASES [**2190-9-6**] 07:23PM BLOOD Type-ART FiO2-100 pO2-274* pCO2-111* pH-7.11* calTCO2-38* Base XS-1 AADO2-331 REQ O2-60 Intubat-NOT INTUBA Comment-O2 DELIVER [**2190-9-6**] 08:51PM BLOOD Type-ART pO2-184* pCO2-73* pH-7.27* calTCO2-35* Base XS-4 [**2190-9-10**] 10:44PM BLOOD Type-ART pO2-123* pCO2-60* pH-7.40 calTCO2-39* Base XS-10 [**2190-9-11**] 08:30AM BLOOD Type-ART Temp-35.7 pO2-61* pCO2-53* pH-7.47* calTCO2-40* Base XS-12 Intubat-NOT INTUBA Comment-NASAL [**Last Name (un) 154**] Brief Hospital Course: IN THE MICU: Assessment/Plan: 69F PMH severe COPD (FEV1/FVC 55%, FEV1 30%predicted, also restrictive defect with TLC 72% of predicted), tracheobronchomalacia with recent stent removal transferred from SICU for managment of presumptive COPD flare. . # Respiratory Distress. Patient has history of severe COPD with frequent exacerbations and this likely represents a COPD flare. Patient has no history of CHF and does not appear fluid overloaded. Unlikely pulmonary embolus given prophylaxis. Patient on 2L NC at baseline. - Continue advair, tiotropium, standing albuterol, tessalon perles, codeine PRN; - Continue levofloxacin for presumptive pneumonia for 7-day course started [**2190-9-7**] (course finished on [**2190-9-14**]); changed to 500 mg PO - Slow steroid taper, taper methylprednisolone to prednisone 60 mg [**Last Name (LF) 244**], [**First Name3 (LF) **] decrease to 50 tomorrow and taper over 10-14d - Consider TTE as outpatient to evaluate cardiac function -BiPap machine attempted at night. not tolerated thought pt did well on NC -OOBed to chair - wean NC from 6 to 2L as tolerated with goal sat low 90s (home 02 requirement 2Lpm) . #Agitation - currently resolved though pt jittery, likely froms steroids -Possibly from steroids, has had problems in past -Discussed briefly with Son, functions well at baseline -PRN haldol, small doses (.5mg w/ good result overnight) -Will follow . # Leukocytosis. Likely due to steroids versus pneumonia given increased cough prior to admission. The patient has remained afebrile. No other localizing signs or symptoms. - Continue levofloxacin for CAP - Blood cultures pending -follow Diff -UA negative for infection, cx + for coag _ staph, likely contaminat. will hold on tx unless pt develops sx . # Hypernatremia. Appears hypovolemic; patient given lasix earlier in course. Approximately 3.5L free water deficit. Gentle IVF with 1/2 NS, Na improved this AM, now 144 -Will follow Na . # Acid-base status. pH normal; likely respiratory acidosis of COPD with metabolic alkalosis from volume depletion. - Treatment as above . # Anemia. Normocytic, stable from this admission, although baseline appears mid-30s. [**Month (only) 116**] be due to hypothyroidism. - Guaiac all stools - Iron studies, folate, B12 - TSH . # Hypertension. Has required labetolol gtt during admission but now improved control. on diltiazem 60 mg QID - Consider amlodipine if hypertensive (patient allergic to [**Last Name (LF) 26302**], [**First Name3 (LF) **] have bronchspasm with beta-blocker) . # Diabetes. home metformin restarted. Continue FSG and ISS. . # Hypothyroidism. No active issues. Continue current regimen. . # Hypercholesterolemia. Continue current regimen. . FEN: regular diet, replete K prn . Access: PIV, A-line . Comm: [**Name (NI) **] . Prophy: Heparin SC, PPI . Code: Full . Dispo: call out . The patient's respiratory status steadily improved. She continued her slow PO steroid taper which was recommended by IP to occur over 3 weeks to be continued at the ECF. She also has 2 days left of her levofloxacin regimen for presumed pneumonia. Currently, the patient's O2 sat is 99% on 2L which is her baseline oxygen requirement at home. . In terms of her leukocytosis, the cause is unknown and presumed to be secondary to her steriod taper. The patient remained afebrile and without a focal source for infection. Her WBC count remained stable between 14-17 with bands as high as 2. Her studies for infection source were all negative including ua, ucx, blood cx, sputum cx, chest, abd, and pelvis CT. Following this negative workup, the decision was made to repeat her cbc count following completion of the steriod taper as we would expect the wbc count to have decreased. . During her course on the medical floor, Mrs. [**Known lastname **] also experienced limited hemoptysis which resolved over time. At most, the pt reported cupping up to [**3-7**] of a cup of bright red blood daily. IP was made aware and the pt's aspirin and mucinex were held and her codeine was made standing. Over the course of 3 days, these symptoms resolved. . The pt's chronic issues of anemia, htn, DM, hypothyroidism, and hyperlipidemia were all managed on the floor without complications. Medications on Admission: . Pre-hospital medications: Aspirin 81 mg, Diltiazem 240 mg, Metformin 850 mg [**Hospital1 **], Pravastatin 10 mg, Levothyroxine 75 mcg, Ezetimibe 10 mg, Tiotropium Bromide 18 mcg, Fluticasone-Salmeterol 250-50 [**Hospital1 **], Pantoprazole 40 mg, Prednisone 10 mg ending [**2190-8-23**], Mucinex 600 mg [**Hospital1 **], Albuterol, Codeine prn cough. . Medications on transfer: Heparin 5000 UNIT SC TID Insulin SC Acetylcysteine 20% 1-10 ml NEB Q2H:PRN Levothyroxine Sodium 75 mcg PO DAILY Acetaminophen 325-650 mg PO Q6H:PRN Levofloxacin 750 mg IV Q24H Albuterol 0.083% Neb Soln 1 NEB IH Q4H Ipratropium Bromide Neb 1 NEB IH Q6H HydrALAzine 25 mg PO Q6H Mucinex *NF* 1200 mg Oral [**Hospital1 **] Aspirin 325 mg PO DAILY Pantoprazole 40 mg PO Q24H Benzonatate 100 mg PO TID Pravastatin 10 mg PO DAILY Codeine Sulfate 15-30 mg PO Q6H:PRN cough MethylPREDNISolone Sodium Succ 80 mg IV Q8H Ezetimibe 10 mg PO DAILY Fluticasone-Salmeterol (250/50) 1 INH IH [**Hospital1 **] Tiotropium Bromide 1 CAP IH DAILY . Allergies: Zocor / [**Hospital1 **] / Crestor Discharge Medications: 1. Pravastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 6. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). 7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 10. Mucinex 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO twice a day. 11. Codeine Sulfate 30 mg Tablet Sig: One (1) Tablet PO Q6PRN as needed for cough. 12. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1) Inhalation Q4H (every 4 hours) as needed for SOB, coughing, wheezing. 13. Prednisone 10 mg Tablet Sig: Two (2) Tablet PO once a day for 4 days: Only on [**10-23**], [**9-26**], [**9-27**]. Disp:*8 Tablet(s)* Refills:*0* 14. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day for 4 days: Only on [**10-18**], [**9-30**], [**10-1**]. Disp:*4 Tablet(s)* Refills:*0* 15. Prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day: Only on [**10-2**]. Disp:*1 Tablet(s)* Refills:*0* 16. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO once a day: Only on [**9-25**], [**9-22**], [**9-23**]. Disp:*12 Tablet(s)* Refills:*0* 17. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID PRN. 18. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours): One tablet on [**2190-9-20**]. One tablet on [**2190-9-21**] to finish 7-day course. Disp:*2 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital 24806**] Care Center - [**Hospital1 1562**] Discharge Diagnosis: Primary: Chronic obstructive pulmonary disease exacerbation Secondary: Diabetes Hypertension Hyperlipidemia Tracheal stent Discharge Condition: Good, good 02 sat on 2L, her baseline. Discharge Instructions: You were admitted to the hospital for shortness of breath. While you were here, the stent that was in your airways was reomoved and you were treated for an exacerbation of your COPD. You completed a full course of antibiotics for this exacerbation and are still completing taper of steroids. Please continue your home medications. In addition, please take the following medications: 1. Finish your prednisone taper as follows: [**2101-9-20**], 19, 20: 30 mg daily [**2105-9-24**], 23, 24: 20 mg daily [**2109-9-28**], 27, 28: 10 mg daily Continue the last 2 days of your levofloxacin antibiotic on [**9-20**] and [**9-21**] Please return to the hospital if you experience shortness of breath, chest pain, fevers, bloody coughing or any concerns. Followup Instructions: Please make an appointment to see your pulmonologist or 'lung specialist' [**Last Name (LF) **], [**Name8 (MD) **] MD [**Telephone/Fax (1) 3020**] for follow-up within the next two weeks. Please also make an appointment to see your primary care [**First Name8 (NamePattern2) **] [**Last Name (LF) **],[**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 74129**] within the next 1-2 weeks for follow-up

491,486,996,250,401,272,285,244,519,E878

{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Other complications due to other internal prosthetic device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Other diseases of trachea and bronchus,Other restorative surgery 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: Respiratory distress PRESENT ILLNESS: 69F PMH severe COPD (2L NC home O2, FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted), tracheobronchomalacia s/p stent placement [**2190-8-6**], initially admitted to the IP service [**2190-9-3**] for acute shortness of breath and increased cough thought secondary to mucus plugging. Of note, the patient underwent bronchoscopy [**2190-8-13**] for mucus plugging and recently finished a prednisone taper [**2190-8-23**] for COPD exacerbation. The patient underwent bronchoscopy [**2190-9-3**] that showed that the stent itself appeared to be patent with minimal secretions. Granulation tissue was seen at the distal end of the stent in both the right and the left main stem bronchi. The patient underwent stent removal [**2190-9-6**], complicated by respiratory distress and hypercarbic respiratory failure with pCO2 as high as 111. The patient was intubated and transferred to the SICU. The patient was started on levofloxacin 750 IV QD and methylprednisolone 80 mg IV Q8H [**2190-9-7**] for empiric treatment of pneumonia and COPD flare. The patient was also diuresed with lasix presumably for volume overload. The patient was extubated [**2190-9-9**]. Patient required BiPap until the morning of transfer. At the time of transfer, the patient was breathing comfortably on 6L NC. Denies shortness of breath, chest pain. . The patient's blood pressure was uncontrolled at times requiring labetolol gtt, but the patient was on an oral regimen on transfer MEDICAL HISTORY: Past Medical History: 1. Severe COPD (FEV1/FVC 55%, FEV1 30% predicted, also restrictive defect with TLC 72% of predicted) 2. Diabetes mellitus type 2 3. Hypertension 4. Hyperlipidemia 5. Status post total thyroidectomy [**2155**] . Past Surgical History: Tracheal stent as above. MEDICATION ON ADMISSION: . Pre-hospital medications: Aspirin 81 mg, Diltiazem 240 mg, Metformin 850 mg [**Hospital1 **], Pravastatin 10 mg, Levothyroxine 75 mcg, Ezetimibe 10 mg, Tiotropium Bromide 18 mcg, Fluticasone-Salmeterol 250-50 [**Hospital1 **], Pantoprazole 40 mg, Prednisone 10 mg ending [**2190-8-23**], Mucinex 600 mg [**Hospital1 **], Albuterol, Codeine prn cough. . Medications on transfer: Heparin 5000 UNIT SC TID Insulin SC Acetylcysteine 20% 1-10 ml NEB Q2H:PRN Levothyroxine Sodium 75 mcg PO DAILY Acetaminophen 325-650 mg PO Q6H:PRN Levofloxacin 750 mg IV Q24H Albuterol 0.083% Neb Soln 1 NEB IH Q4H Ipratropium Bromide Neb 1 NEB IH Q6H HydrALAzine 25 mg PO Q6H Mucinex *NF* 1200 mg Oral [**Hospital1 **] Aspirin 325 mg PO DAILY Pantoprazole 40 mg PO Q24H Benzonatate 100 mg PO TID Pravastatin 10 mg PO DAILY Codeine Sulfate 15-30 mg PO Q6H:PRN cough MethylPREDNISolone Sodium Succ 80 mg IV Q8H Ezetimibe 10 mg PO DAILY Fluticasone-Salmeterol (250/50) 1 INH IH [**Hospital1 **] Tiotropium Bromide 1 CAP IH DAILY . ALLERGIES: Zocor / Diovan / Crestor PHYSICAL EXAM: on admission: FAMILY HISTORY: Family History: No history of heart or pulmonary disease. SOCIAL HISTORY: Social History: Lives alone. Remote 30 pack-year smoking history. Rare EtOH. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Other complications due to other internal prosthetic device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Unspecified acquired hypothyroidism,Other diseases of trachea and bronchus,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: elective PVI PRESENT ILLNESS: 64 year old female with a history of rheumatic heart disease s/p St. [**Male First Name (un) 923**] mechanical MVR [**2108**], endocarditis, CVA, PAF and aflutter s/p elective PVI and mitral annular flutter ablation admitted to CCU for monitoring. Patient tolerated the procedure well, sheaths removed. For sedation, received fentanyl 300mcg, propofol 180mcg, midazolam 4mg. In the PACU, she was moving all 4 extremities, but was quite somnolent. Given history of CVAs, patient was admitted to CCU for monitoring. Of note, patient is on Coumadin, and INR today was 4. MEDICAL HISTORY: History of rheumatic heart disease MVR [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] mechanical valve 21 years ago, on Coumadin S/P EP studies [**7-/2118**] not inducible RVOT tachycardia S/P catheterization [**2120-4-29**], no intervention atrial fibrillation diagnosed a few years ago s/p cardioversion [**2129-11-16**] at [**Hospital3 **] History of CVA with mild right arm weakness History of multiple TIAs with right arm numbness and visual changes Breast cancer s/p left lumpectomy, rad Rx. with right nipple removal d/t bleeding GI bleed [**1-/2129**] post colonoscopy Oopherectomy Hysterectomy Tonsillectomy MEDICATION ON ADMISSION: AMLODIPINE 5 mg PO qam DIGOXIN 125 mcg Tablet PO qam FUROSEMIDE 20 mg Tablet PO qam LISINOPRIL 40 mg Tablet PO qam METOPROLOL SUCCINATE 150 mg ER PO qam POTASSIUM CHLORIDE CRYS CR 20 mEq PO bid SIMVASTATIN 20 mg PO qhs WARFARIN MON/WED/FRI/ 12.5 mg, all other 10mg. ALLERGIES: Demerol / chocolate PHYSICAL EXAM: VS: 98.7 77 118/60 19 95 RA GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. NECK: Supple with no JVD CARDIAC: . RR, normal S1, S2. Mechanical valve click. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. Groin site slightly tender to touch, no bleeding, no bruit PULSES: Right: DP 2+ with doppler, not palpable Left: DP 2+ Neuro: CN II-XII intact, sensation intact in UEs/[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l, strenght [**4-15**] except R prox/distal UE (this is residual deficit from prior stroke) FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: -Lives with husband and mother. [**Name (NI) 1403**] as cashier at Target. -Tobacco: Never -ETOH: Occasional beer

Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other malaise and fatigue,Personal history of malignant neoplasm of breast

Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Late effect CV dis NEC,Malaise and fatigue NEC,Hx of breast malignancy

Admission Date: [**2130-5-4**] Discharge Date: [**2130-5-5**] Date of Birth: [**2065-12-21**] Sex: F Service: MEDICINE Allergies: Demerol / chocolate Attending:[**Last Name (un) 11974**] Chief Complaint: elective PVI Major Surgical or Invasive Procedure: pulmonary vein isloation and mitral annular flutter ablation History of Present Illness: 64 year old female with a history of rheumatic heart disease s/p St. [**Male First Name (un) 923**] mechanical MVR [**2108**], endocarditis, CVA, PAF and aflutter s/p elective PVI and mitral annular flutter ablation admitted to CCU for monitoring. Patient tolerated the procedure well, sheaths removed. For sedation, received fentanyl 300mcg, propofol 180mcg, midazolam 4mg. In the PACU, she was moving all 4 extremities, but was quite somnolent. Given history of CVAs, patient was admitted to CCU for monitoring. Of note, patient is on Coumadin, and INR today was 4. Patient initially had EP study in [**2117**] for non-inducible RVOT tachycardia, atrial fibrillation status post a cardioversion on [**2129-11-16**] at [**Hospital3 **]. She also has a history of CVA with residual mild right arm weakness, and history of multiple TIAs with right arm numbness and visual changes. Patient has monthly INRs followed by Dr[**Name (NI) 68097**] office. Currently, patient feels sleepy. She reports b/l proximal LE pain which she has baseline. Denies SOB, palpitations, chest pain, light headedness. . REVIEW OF SYSTEMS as above . 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: History of rheumatic heart disease MVR [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] mechanical valve 21 years ago, on Coumadin S/P EP studies [**7-/2118**] not inducible RVOT tachycardia S/P catheterization [**2120-4-29**], no intervention atrial fibrillation diagnosed a few years ago s/p cardioversion [**2129-11-16**] at [**Hospital3 **] History of CVA with mild right arm weakness History of multiple TIAs with right arm numbness and visual changes Breast cancer s/p left lumpectomy, rad Rx. with right nipple removal d/t bleeding GI bleed [**1-/2129**] post colonoscopy Oopherectomy Hysterectomy Tonsillectomy Social History: -Lives with husband and mother. [**Name (NI) 1403**] as cashier at Target. -Tobacco: Never -ETOH: Occasional beer Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: VS: 98.7 77 118/60 19 95 RA GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. NECK: Supple with no JVD CARDIAC: . RR, normal S1, S2. Mechanical valve click. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. Groin site slightly tender to touch, no bleeding, no bruit PULSES: Right: DP 2+ with doppler, not palpable Left: DP 2+ Neuro: CN II-XII intact, sensation intact in UEs/[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l, strenght [**4-15**] except R prox/distal UE (this is residual deficit from prior stroke) discharge exam unchanged Pertinent Results: LABS: [**2130-5-4**] 04:10PM BLOOD WBC-3.9* RBC-4.00* Hgb-12.4 Hct-37.7 MCV-94 MCH-31.0 MCHC-32.9 RDW-14.2 Plt Ct-218 [**2130-5-4**] 04:10PM BLOOD Neuts-62.1 Lymphs-29.3 Monos-5.6 Eos-2.3 Baso-0.6 [**2130-5-5**] 01:21AM BLOOD WBC-8.2# RBC-4.03* Hgb-12.4 Hct-38.0 MCV-94 MCH-30.7 MCHC-32.5 RDW-14.3 Plt Ct-203 [**2130-5-4**] 04:10PM BLOOD PT-40.9* INR(PT)-4.0* [**2130-5-5**] 01:21AM BLOOD PT-35.1* PTT-40.2* INR(PT)-3.4* [**2130-5-4**] 04:10PM BLOOD Glucose-99 UreaN-13 Creat-0.6 Na-144 K-3.0* Cl-107 HCO3-25 AnGap-15 [**2130-5-5**] 01:21AM BLOOD Glucose-126* UreaN-10 Creat-0.5 Na-145 K-3.2* Cl-107 HCO3-27 AnGap-14 [**2130-5-5**] 01:21AM BLOOD Calcium-7.8* Phos-3.3 Mg-1.7 [**2130-5-5**] 01:38AM BLOOD freeCa-1.03* ECHO [**2130-5-4**]: No mass/thrombus is seen in the left atrium or left atrial appendage. Mild spontaneous echo contrast is present in the left atrial appendage. The left atrial appendage emptying velocity is depressed (<0.2m/s). The right atrial appendage ejection velocity is depressed (<0.2m/s). No atrial septal defect is seen by 2D or color Doppler. Overall left ventricular systolic function is normal (LVEF>55%). There are simple atheroma in the descending thoracic aorta and aortic arch. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. No masses or vegetations are seen on the aortic valve. There is no aortic valve stenosis. Trace aortic regurgitation is seen. A bileaflet mitral valve prosthesis is present. A mechanical mitral valve prosthesis is present. The motion of the mitral valve prosthetic leaflets appears normal. No mass or vegetation is seen on the mitral valve. Mild (1+) mitral regurgitation is seen. Tricuspid regurgitation is present but cannot be quantified. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Mild left atrial appendage spontaneous echo contrast without evidence of discrete thrombus. Depressed right and left atrial appendage emptying velocities. Simple atheroma in the descending thoracic aorta and aortic arch. Well-seated, normal appearing bileaflet mechanical mitral valve prosthesis. Borderline pulmonary artery systolic hypertension. Brief Hospital Course: BRIEF CLINICAL SUMMARY: 64 year old female with a history of rheumatic heart disease s/p St. [**Male First Name (un) 923**] mechanical MVR [**2108**], endocarditis, CVA, PAF and aflutter s/p elective PVI and mitral annular flutter ablation admitted to CCU for monitoring. No events or complications in the ICU. ISSUES: # S/p PVI and Flutter ablation: Patient tolerated the procedure well. No chest pain, no SOB, no palpitations. INR supratherapeutic at 4. Quite sedated, but neuro exam nonfocal except mild R arm weakness which is residual from prior stroke and currently at baseline per patient. Pt had no acute issues in ICU overnight and her mental status improved after sedation wore off. Continued coumadin at 6mg ([**12-12**] home dose). continued home metoprolol XL 150 qd. Per EP recs, placed pt on aspirin 325mg qd and omeprazole 20mg daily for 1 month s/p procedure. continued digoxin as well as other home cardiac meds. Arranged for outpatient follow up with cardiologist and [**Doctor Last Name **] Of hearts monitor for 2 weeks. # Rheumatic heart disease s/p MVR: coumadin 6mg as above. Pt to check INR on [**5-9**] and fax results to PCP. # HTN: Continued home amlodipine, lisinopril, metoprolol, lasix # HLD: Continued simvastatin. TRANSITIONAL ISSUES: 1. follow up [**Doctor Last Name **] of hearts Medications on Admission: AMLODIPINE 5 mg PO qam DIGOXIN 125 mcg Tablet PO qam FUROSEMIDE 20 mg Tablet PO qam LISINOPRIL 40 mg Tablet PO qam METOPROLOL SUCCINATE 150 mg ER PO qam POTASSIUM CHLORIDE CRYS CR 20 mEq PO bid SIMVASTATIN 20 mg PO qhs WARFARIN MON/WED/FRI/ 12.5 mg, all other 10mg. Discharge Medications: 1. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 4. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: 1.5 Tablet Extended Release 24 hrs PO once a day. 6. warfarin 10 mg Tablet Sig: One (1) Tablet PO once a day: -take this ONLY on Tues, Thurs, Sat, Sun -take this PLUS 2.5mg on Mon, Weds, Fri. 7. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO Mon, Weds, Fri: Please take a 2.5mg tab PLUS a 10mg tab on Mon, Weds, Fri. 8. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 30 days. Disp:*30 Tablet(s)* Refills:*0* 9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day for 30 days. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever or pain: please take as needed for pain at groin site. Disp:*30 Tablet(s)* Refills:*0* 11. multivitamin Tablet Sig: One (1) Tablet PO once a day. 12. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO twice a day. 13. Outpatient Lab Work Please check INR on [**5-9**] and fax results to: [**Last Name (LF) 5423**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD Fax: [**Telephone/Fax (1) 73354**] Phone: [**Telephone/Fax (1) 5424**] 14. digoxin 125 mcg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: paroxysmal atrial fibrillation atrial flutter Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms. [**Known lastname 112417**], You came to the hospital for elective ablation of your abnormal heart rhythm. The procedure went very well. You were admitted to the intensive care unit for monitoring overnight after ablation and did well. We have made the following changes to your medications: -INCREASE Aspirin to 325mg for 1 month and then resume taking 81mg daily -START Omeprazole 20mg daily for 1 month after procedure -START Tylenol as needed for pain at groin site, do not exceed 4g in 1 day Please have your INR checked on [**5-9**] (Tuesday). Prescription included. You will also wear a heart monitor for 2 weeks which Dr. [**Last Name (STitle) **], the doctor who did the procedure, will follow up and communicate to your cardiologist. Please follow up with your primary care doctor/cardiologist as scheduled below. It was a pleasure taking care of you, we wish you all the best. Followup Instructions: Name: [**Last Name (LF) 5423**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Location: [**Location (un) **] CARDIOLOGY Address: [**Last Name (un) 39144**], STE#404, [**Hospital1 **],[**Numeric Identifier 66038**] Phone: [**Telephone/Fax (1) 5424**] Appt: [**5-15**] at 11:45am [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 11975**]

427,401,272,438,780,V103

{'Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other malaise and fatigue,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: elective PVI PRESENT ILLNESS: 64 year old female with a history of rheumatic heart disease s/p St. [**Male First Name (un) 923**] mechanical MVR [**2108**], endocarditis, CVA, PAF and aflutter s/p elective PVI and mitral annular flutter ablation admitted to CCU for monitoring. Patient tolerated the procedure well, sheaths removed. For sedation, received fentanyl 300mcg, propofol 180mcg, midazolam 4mg. In the PACU, she was moving all 4 extremities, but was quite somnolent. Given history of CVAs, patient was admitted to CCU for monitoring. Of note, patient is on Coumadin, and INR today was 4. MEDICAL HISTORY: History of rheumatic heart disease MVR [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] mechanical valve 21 years ago, on Coumadin S/P EP studies [**7-/2118**] not inducible RVOT tachycardia S/P catheterization [**2120-4-29**], no intervention atrial fibrillation diagnosed a few years ago s/p cardioversion [**2129-11-16**] at [**Hospital3 **] History of CVA with mild right arm weakness History of multiple TIAs with right arm numbness and visual changes Breast cancer s/p left lumpectomy, rad Rx. with right nipple removal d/t bleeding GI bleed [**1-/2129**] post colonoscopy Oopherectomy Hysterectomy Tonsillectomy MEDICATION ON ADMISSION: AMLODIPINE 5 mg PO qam DIGOXIN 125 mcg Tablet PO qam FUROSEMIDE 20 mg Tablet PO qam LISINOPRIL 40 mg Tablet PO qam METOPROLOL SUCCINATE 150 mg ER PO qam POTASSIUM CHLORIDE CRYS CR 20 mEq PO bid SIMVASTATIN 20 mg PO qhs WARFARIN MON/WED/FRI/ 12.5 mg, all other 10mg. ALLERGIES: Demerol / chocolate PHYSICAL EXAM: VS: 98.7 77 118/60 19 95 RA GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. NECK: Supple with no JVD CARDIAC: . RR, normal S1, S2. Mechanical valve click. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. Groin site slightly tender to touch, no bleeding, no bruit PULSES: Right: DP 2+ with doppler, not palpable Left: DP 2+ Neuro: CN II-XII intact, sensation intact in UEs/[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l, strenght [**4-15**] except R prox/distal UE (this is residual deficit from prior stroke) FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: -Lives with husband and mother. [**Name (NI) 1403**] as cashier at Target. -Tobacco: Never -ETOH: Occasional beer ### Response: {'Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other malaise and fatigue,Personal history of malignant neoplasm of breast'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 40-year-old gentleman with a prior history of two myocardial infarctions, non-insulin-dependent diabetes mellitus, and hypercholesterolemia. He had increasing shortness of breath prior to his presentation as well as chest pain on the morning of presentation. He was admitted for cardiac catheterization prior to this admission which was performed on [**2191-3-11**]. The patient was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] for his cardiac disease. MEDICAL HISTORY: 1. Non-insulin-dependent diabetes mellitus. 2. Myocardial infarction times two. 3. Hypercholesterolemia. MEDICATION ON ADMISSION: Medications included atenolol, Lipitor, aspirin, lisinopril, gemfibrozil, Glucotrol-XL, metformin, folate, and vitamin E. ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION: Preoperative laboratories revealed glucose was 71, blood urea nitrogen was 29, creatinine was 1, sodium was 136, potassium was 5.2, chloride was 98, and bicarbonate was 22. Anion gap was 21. ALT was 18, AST was 19, LDH was 193, alkaline phosphatase was 79, and total bilirubin was 0.5. White blood cell count was 8.4 and hematocrit was 40.1, and platelet count was 314,000. Prothrombin time was 12.3, partial thromboplastin time was 23.6, and INR was 1. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other postoperative infection,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Old myocardial infarction,Pure hypercholesterolemia

Crnry athrscl natve vssl,Surg compl-heart,Parox ventric tachycard,Other postop infection,DMI wo cmp nt st uncntrl,Old myocardial infarct,Pure hypercholesterolem

Admission Date: [**2191-3-18**] Discharge Date: [**2191-3-24**] Date of Birth: [**2150-8-5**] Sex: M Service: Cardiothoracic Surgery HISTORY OF PRESENT ILLNESS: This is a 40-year-old gentleman with a prior history of two myocardial infarctions, non-insulin-dependent diabetes mellitus, and hypercholesterolemia. He had increasing shortness of breath prior to his presentation as well as chest pain on the morning of presentation. He was admitted for cardiac catheterization prior to this admission which was performed on [**2191-3-11**]. The patient was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] for his cardiac disease. PAST MEDICAL HISTORY: 1. Non-insulin-dependent diabetes mellitus. 2. Myocardial infarction times two. 3. Hypercholesterolemia. MEDICATIONS ON ADMISSION: Medications included atenolol, Lipitor, aspirin, lisinopril, gemfibrozil, Glucotrol-XL, metformin, folate, and vitamin E. ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION: Preoperative laboratories revealed glucose was 71, blood urea nitrogen was 29, creatinine was 1, sodium was 136, potassium was 5.2, chloride was 98, and bicarbonate was 22. Anion gap was 21. ALT was 18, AST was 19, LDH was 193, alkaline phosphatase was 79, and total bilirubin was 0.5. White blood cell count was 8.4 and hematocrit was 40.1, and platelet count was 314,000. Prothrombin time was 12.3, partial thromboplastin time was 23.6, and INR was 1. PERTINENT RADIOLOGY/IMAGING: Cardiac catheterization showed 100% left anterior descending artery lesion, 50% first diagonal, 50% circumflex lesion, 60% obtuse marginal branch, followed by 70% lesion in the obtuse marginal. Right coronary artery had an 80% medial stenosis and a 90% stenosis prior to the posterior descending artery. Ejection fraction was approximately 33%. HOSPITAL COURSE: On [**3-18**], the patient underwent coronary artery bypass grafting by Dr. [**Last Name (STitle) 70**] times four with a left internal mammary artery to the left anterior descending artery, a vein graft to the right posterior descending artery, a vein graft to the diagonal, and a vein graft to the obtuse marginal. The patient was transferred to the Cardiothoracic Intensive Care Unit in stable condition. The patient arrived in the Intensive Care Unit on intravenous propofol, intravenous milrinone, and intravenous Levophed drips. He was extubated at 3:30 that afternoon. He was hemodynamically stable. Note from postoperative day one is missing from the chart. On postoperative day two, the patient was in a sinus rhythm with a heart rate of 100. He was maintaining a good blood pressure of 96/51. He was extubated and was saturating 98%. His hematocrit was 25.3. He was stable. He was receiving oral Percocet for pain and was on no drips at that time. His postoperative blood urea nitrogen and creatinine were 15 and 0.9. He was seen by Physical Therapy and transferred out to the floor on postoperative day two. On postoperative day three, he had a blood pressure of 128/60 and temperature maximum was 98.2. His heart rate was regular in rate and rhythm. His lungs were clear bilaterally. His dressing was clean, dry, and intact with only minimal drainage. His wires were removed. His chest tube were removed, and his hematocrit was 28.5. He was seen by Case Management. He was up and around ambulating by postoperative day three. On postoperative day four, the resident was called for an episode of ventricular tachycardia (approximately a 20-beat run) which was self-limited. The patient was hemodynamically stable. He had no fall in his blood pressure, and he immediately reverted back to a sinus rhythm with occasional premature ventricular contractions. His examination was otherwise unremarkable. His sternum was stable. His incision was clean, dry, and intact. His potassium and magnesium were repleted. He was continued on telemetry. The episode was discussed with the chief resident. At this time, his potassium was 3.7 and his magnesium was 1.6. The patient was continued on intravenous vancomycin. He was seen by the Electrophysiology cardiologist for his 20-beat run of ventricular tachycardia. They suggested that the monomorphic nature might be due more to cardiac scarring rather than acute ischemia, but they recommended having an electrophysiology study done; which was done. The patient was continued on a beta blocker and ACE inhibitor. On [**3-23**], he had a diagnostic electrophysiology study done and an automatic internal cardioverter-defibrillator was placed on [**3-23**]. The patient remained stable. On [**3-24**], the patient felt well with no complaints. He had a good systolic blood pressure. His wounds were intact. His implantable cardioverter-defibrillator was checked by the Electrophysiology Service and was interrogated appropriately. DISCHARGE DISPOSITION: On [**3-24**], the patient was discharged to home in stable condition. DISCHARGE DIAGNOSES: 1. Coronary artery disease. 2. Status post coronary artery bypass grafting times four. 3. Status post implantable cardioverter-defibrillator placement. 4. Myocardial infarction. 5. Non-insulin-dependent diabetes mellitus. 6. Hypercholesterolemia. MEDICATIONS ON DISCHARGE: (Discharge medications were as follows) 1. Percocet one to two tablets p.o. q.4-6h. as needed (for pain). 2. Levofloxacin 500 mg p.o. once per day (for a 7-day course to be finished on [**3-28**]). 3. Lopressor 50 mg p.o. twice per day. 4. Metformin 1000 mg p.o. twice per day. 5. Glipizide-XL 5 mg p.o. once per day. 6. Zestril 2.5 mg p.o. once per day. 7. Ibuprofen 600 mg p.o. q.4-6h. as needed. 8. Tylenol 650 mg p.o. q.4h. as needed. 9. Aspirin 325 mg p.o. every day. 10. Lasix 20 mg p.o. twice per day (times seven days). 11. Colace 100 mg p.o. twice per day. 12. Milk of Magnesia as needed (for constipation). 13. Keflex 500 mg p.o. three times per day times six total doses. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient was instructed to follow up on [**Hospital Ward Name 121**] Two one week later for a wound check and to see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in the office in six weeks. 2. The patient was to follow up with his primary care physician (Dr. [**Last Name (STitle) 2392**] in one to two weeks after discharge. 3. The patient was to see his cardiologist (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) in approximately one to two weeks after discharge. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE STATUS: The patient was discharged to home on [**2191-3-24**]. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Last Name (NamePattern1) 76**] MEDQUIST36 D: [**2191-5-9**] 14:19 T: [**2191-5-9**] 14:34 JOB#: [**Job Number 46181**]

414,997,427,998,250,412,272

{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other postoperative infection,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Old myocardial infarction,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: PRESENT ILLNESS: This is a 40-year-old gentleman with a prior history of two myocardial infarctions, non-insulin-dependent diabetes mellitus, and hypercholesterolemia. He had increasing shortness of breath prior to his presentation as well as chest pain on the morning of presentation. He was admitted for cardiac catheterization prior to this admission which was performed on [**2191-3-11**]. The patient was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] for his cardiac disease. MEDICAL HISTORY: 1. Non-insulin-dependent diabetes mellitus. 2. Myocardial infarction times two. 3. Hypercholesterolemia. MEDICATION ON ADMISSION: Medications included atenolol, Lipitor, aspirin, lisinopril, gemfibrozil, Glucotrol-XL, metformin, folate, and vitamin E. ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION: Preoperative laboratories revealed glucose was 71, blood urea nitrogen was 29, creatinine was 1, sodium was 136, potassium was 5.2, chloride was 98, and bicarbonate was 22. Anion gap was 21. ALT was 18, AST was 19, LDH was 193, alkaline phosphatase was 79, and total bilirubin was 0.5. White blood cell count was 8.4 and hematocrit was 40.1, and platelet count was 314,000. Prothrombin time was 12.3, partial thromboplastin time was 23.6, and INR was 1. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other postoperative infection,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Old myocardial infarction,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Hepatic Encephalopathy PRESENT ILLNESS: 61 yo M w/ hx etOH cirrhosis [**2-4**] EtOh, anemia, and hepato-renal syndrome presented to OSH for routine paracentesis and was found to have hyperkalemia. Patient is confused and unable to give any hx, all data is obtained from OSH records though no d/c summary is present. Per these records, patient get regular parcentesis the last prior to admission being [**6-3**]. On presentation to OSH on [**6-13**], he complained of abdominal pain, distension, SOB, anorexia, generalized weakness. He denied melena, diarrha, fevers or chills. He was found to be hyperkalemic to 6.5 and had a Cr of 4.3 and was transferred to ER. . At OSH, treated wtih kayexelate and potassium followed. Lasix given for diuresis and nephrology consulted. Continued on cipro for SBP prophylaxis. Patient was tranfused PRBCs for anemia. He was maintained on a low protein<45g/day diet. Became increasingly lethargic and confused and was transferred for transplant work up and eval. MEDICAL HISTORY: Liver Cirrhosis followed at [**Hospital3 2358**] by the transplant team Anemia Hepato-renal syndrome MEDICATION ON ADMISSION: Protonix 40, Renagel 400mg TID, Lactulose tid, levaquin 250mg qd, SSI, Reglan prn, Docusate prn, Melatonin prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 95.9 114/76 101 20 98% RA BG 217 180# Gen: confused, mumbling, states "no I haven't" to almost all questions. Not oriented to place or date. Jaundiced HEENT: slight scleral icterus, mmm, tounge fasiculations noted, prrl CV: rrr s1s2 no m/r/g noted Pulm: diminished left sided breath sounds, right side cta Abd: ascites present, soft, not tensly distended, non-tender, Ext: trace pedal edema Neuro: Oriented to self. Does not know dates, location, president of the US. ++Asterixis FAMILY HISTORY: [**Name (NI) **] sister died of pancreatic cancer SOCIAL HISTORY: Lives alone, was a drinkier until [**2-/2140**], non-smoker. States he is a retired teacher (AP chem and physics teacher). Healthcare Proxy: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 68214**] [**Telephone/Fax (1) 68215**]. Dr. [**Last Name (STitle) 3315**] is his PCP. [**Name10 (NameIs) **] doctor is Dr. [**Last Name (STitle) 57141**].

Alcoholic cirrhosis of liver,Hepatic encephalopathy,Spontaneous bacterial peritonitis,Hyperpotassemia,Bacteremia,Unspecified pleural effusion,Anemia of other chronic disease,Benign neoplasm of colon

Alcohol cirrhosis liver,Hepatic encephalopathy,Spontan bact peritonitis,Hyperpotassemia,Bacteremia,Pleural effusion NOS,Anemia-other chronic dis,Benign neoplasm lg bowel

Admission Date: [**2140-6-20**] Discharge Date: [**2140-7-9**] Date of Birth: [**2078-7-26**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 10293**] Chief Complaint: Hepatic Encephalopathy Major Surgical or Invasive Procedure: Colonoscopy Esophagogastroduodenoscopy Serial Paracenteses Thoracocentesis History of Present Illness: 61 yo M w/ hx etOH cirrhosis [**2-4**] EtOh, anemia, and hepato-renal syndrome presented to OSH for routine paracentesis and was found to have hyperkalemia. Patient is confused and unable to give any hx, all data is obtained from OSH records though no d/c summary is present. Per these records, patient get regular parcentesis the last prior to admission being [**6-3**]. On presentation to OSH on [**6-13**], he complained of abdominal pain, distension, SOB, anorexia, generalized weakness. He denied melena, diarrha, fevers or chills. He was found to be hyperkalemic to 6.5 and had a Cr of 4.3 and was transferred to ER. . At OSH, treated wtih kayexelate and potassium followed. Lasix given for diuresis and nephrology consulted. Continued on cipro for SBP prophylaxis. Patient was tranfused PRBCs for anemia. He was maintained on a low protein<45g/day diet. Became increasingly lethargic and confused and was transferred for transplant work up and eval. Past Medical History: Liver Cirrhosis followed at [**Hospital3 2358**] by the transplant team Anemia Hepato-renal syndrome Social History: Lives alone, was a drinkier until [**2-/2140**], non-smoker. States he is a retired teacher (AP chem and physics teacher). Healthcare Proxy: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 68214**] [**Telephone/Fax (1) 68215**]. Dr. [**Last Name (STitle) 3315**] is his PCP. [**Name10 (NameIs) **] doctor is Dr. [**Last Name (STitle) 57141**]. Family History: [**Name (NI) **] sister died of pancreatic cancer Physical Exam: 95.9 114/76 101 20 98% RA BG 217 180# Gen: confused, mumbling, states "no I haven't" to almost all questions. Not oriented to place or date. Jaundiced HEENT: slight scleral icterus, mmm, tounge fasiculations noted, prrl CV: rrr s1s2 no m/r/g noted Pulm: diminished left sided breath sounds, right side cta Abd: ascites present, soft, not tensly distended, non-tender, Ext: trace pedal edema Neuro: Oriented to self. Does not know dates, location, president of the US. ++Asterixis Pertinent Results: OSH labs- [**6-20**]: WBC 6.7 Hct 27.3 Plt 31 INR 1.6 PT 17.8 Na 129 K 5.2 Cl 101 CO2 21 BUN 782 Cr 4.0 Ca 8.5 [**6-19**]: AST 33 ALT 24 Alk Ph 92 [**Doctor First Name **] 45 LIp 68 HA1c: 6.0 . UA [**6-13**]: negative . [**6-14**] renal US: large ascites. no calculus or obstruction of either renal collecting system. . [**6-13**] cxr: large left pleural effusion / [**2140-6-28**]: PFTs: FEV1 45% FVC 41% FEV1/FVC 110 TLC 46% DL/VA 116% . [**2140-6-29**]: p-MIBI: no anginal symptoms or ischemic EKG changes. Calculated EF 78% with normal myocardial perfusion and wall size and motion. . [**2140-6-30**]: MRI/A of liver: could not resolve hepatic arterial architecture. no liver masses, patent portal vein, small liver cyst . Infectious Serologies: HSV1&2, HCV, RPR, toxo IgG/M, CMV IgG/M, HbsAg, HbcAb: negative EBV IgG+/IgM-, VZV IgG+, HbsAb - borderline . Tumor Markers: CA19-9: 37, CEA 5.7, PSA 0.4 Brief Hospital Course: 61 yo m with etoh cirrhosis on regular paracentesis at baseline, presented to OSH with presumed worsened Cr (unknown baseline), hyperkalemia and worsening mental status. Transferred to [**Hospital1 18**] for transplant evaluation and further work-up. In brief the patient arrived in hepatorenal syndrome, hepatic encephalopathy, and was later found to have strept viridans sbp and bacteremia. His acute presentation slowly resolved with octreotide/midodrine/albumin, lactulose/rifaximin, and antibiotics, respectively. In addition, he continued to have elevated blood sugars requiring insulin therapy. He was evaluated in collaboration between the hepatology team and the transplant surgery to determine his candidacy for transplant. His pre-transplant evaluation included multiple infectious disease serologies, non-invasive cardiac imaging, MRI/MRA of the liver, serial paracenteses, colonoscopy and EGD, tumor markers, and dental evaluation. At the time of discharge he was stable to go home with close follow-up. He was listed for liver transplant. . # Hepatic Encephalopathy: The patient has a history of cirrhosis secondary to EtOH. On presentation his INR was 1.7, Alb was 2.6, total bili was 4.2 and ammonia level was 282. His transaminases remained within normal limits. He was very confused and had displayed prominent asterixis on exam c/w hepatic encephalopathy. He was started on lactulose, and rifaximin and observed in the MICU. His confusional state cleared after several days of aggressive lactulose/rifaximin and antibiotics for the sbp. He was transferred to the medical floor for further management. His level of consciousness gradually improved as did his asterixis with continued therapy. By discharge he was conversant with content appropriate to questioning, attentive to interview and exams, and following directions appropriately to check blood sugars and administer insulin injections. . # Spontaneous Bacterial Peritonitis: The patient has a history of refractory ascites which had been managed with weekly paracenteses. During the evaluation for the trigger for the encephalopathy, a diagnostic paracentesis was performed on the second day of his [**Hospital1 18**] stay. It revealed WBC 387 RBC 1400 polys 48%. The patient had been taking levofloxacin as sbp prophylaxis at home so the <250 PMN count was still thought to represent sbp and thus merit treatment - initially with vancomycin/zosyn. The peritoneal fluid was later cultured revealing viridans streptococci which was sensitive to penicillins (and therefore cephalosporins) and the patient was switched to ceftriaxone on which he completed a 7 day course. Serial diagnostic/therapeutic paracenteses were performed to follow clearance of the infection which was ultimately confirmed on [**6-28**]. Each paracentesis was accompanied with appropriate colloid replacement. The last paracentesis performed during this hospitalization revealed:..... Following the therapeutic course of ceftriaxone, the patient will be maintained on Bactrim SS prophylaxis as the prior microbe was resistant to quinolones. He is still likely to need regular therapeutic paracenteses to manage his ascites. . # Bacteremia: Blood cultures drawn on admission also grew viridans streptococci. The patient had a TTE to evaluate for endocarditis which was negative. Repeat blood cultures from hospital day 2 and 4 have resulted as negative. A dental consult was obtained to evaluate for an oral source to the bacteremia/sbp. No oral abscess or infectious nidus was found, but 2 teeth were recommended to be removed (see "Teeth" section below). He did have a RIJ central venous catheter in place and the time the bacteremia was detected. Although the line was not thought to be the culprit source for the infection, the line was pulled when adequate access was obtained. Cath tip culture was negative. By the time he was stabilized and transferred to the medical floor he was afebrile and remained so for the duration of his hospital stay. . # Hyperkalemia: Upon arrival to [**Hospital1 18**] the patient had a K level of 5.2. An ECG was obtained. He was treated with Kayexalate, fluid and diuresis. The hyperkalemia was thought secondary to renal failure (see below). As the renal function improved his potassium level returned to [**Location 213**]. . # Renal Failure: The patient has a history of hepatorenal syndrome and although his baseline creatinine was unknown prior to admission, his dropping UOP, euvolemic status, and pre-renal ARF were consistent with hepatorenal syndrome. This diagnosis was further supported by low urinary protein/creatinine ratio, bland urine sediment, negative for hepatis serologies, negative cryoglobulin and no hydronephrosis by u/s. He was started on octreotide/albumin/midodrine. His creatinine was at a maximum of 4.3 on admission and slowly trended down with continued treatment. However, his creatinine showed some lability and concern persisted for the need for combined liver-kidney transplant. . # End-stage liver Disease: The patient was evaluated in collaboration by the hepatology, nephrology, and transplant surgery teams. The pre-transplant evaluation revealed no contra-indications to transplant, and the patient was placed on the transplant list. For results of the pre-op evaluation, please see "Pertinent Results." . # Hyperglycemia: The patient has no history of diabetes although he did have persistent elevated blood sugars. A glycosylated hemoglobin was normal at 6% and the hyperglycemia was managed with insulin. His blood sugar control improved with a twice daily dosing regimen of NPH with a sliding scale for coverage. He will continue to monitor his blood sugars and administer insulin at home with assistance of VNA and family members. [**Name (NI) **] received extensive teaching with nursing regarding insulin administration and blood glucose measurements. . # Anemia: The patient was found to be anemic with Hct of ~28% on admission this reached a nadir of 23.3% before recovering to >31% prior to discharge. There was no evidence of blood loss or hemolysis by smear examination. He had adequate iron, folate, and B12 stores. His anemia was largely attributed to his hypersplenism and underlying liver disease. He received Epogen to stimulate his marrow, and he was transfused 3 units of pRBCs during his stay. . # Thrombocytopenia: The patient has a baseline thrombocytopenia secondary to hypersplenism. He required 6 platelet transfusions to support him while he underwent various invasive procedures. There were no precipitous declines in the platelet count to suggest HIT, but heparin products were limited in their use nonetheless. . # Teeth: During the evaluation for the source of the bacteremia, a Panarex film was obtained and a dental consult was called. No infectious nidus to be indentified, however two teeth were noted to be diseased and meriting removal (Teeth #5 and #13 both upper bicuspids). The patient was referred to the outpatient oral surgery department at [**Hospital1 2025**] for these teeth to be extracted while awaiting a liver to become available. . # FENGI: The patient was gradually advanced to full regular diet as his condition improved. . # Prophy: PPI, pneumoboots while on bedrest. # Comm: sister [**Name (NI) **] [**Name (NI) 68214**] [**Telephone/Fax (1) 68216**] . # Code: full, does have living will in chart Medications on Admission: Protonix 40, Renagel 400mg TID, Lactulose tid, levaquin 250mg qd, SSI, Reglan prn, Docusate prn, Melatonin prn Discharge Medications: 1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 3. Sevelamer 400 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours). Disp:*2700 ml* Refills:*2* 5. 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:*2* 6. Insulin - NPH Please check your blood sugar 4 times a day. Please take 10 units NPH in the morning and 8 units of NPH at night. 7. Octreotide Acetate 100 mcg/mL Solution Sig: Two (2) mL Injection Q8H (every 8 hours). 8. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) mL Injection QMOWEFR (Monday -Wednesday-Friday). Disp:*qs ml* Refills:*2* 9. Midodrine 5 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*2* 10. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: as directed units Subcutaneous once a day: Please take 10 units in the morning and 8 units at night. Disp:*qs ml* Refills:*2* 11. Insulin Syringe Syringe Sig: as needed syringe Miscell. four times a day as needed for low blood sugar: with needles. Disp:*120 syringes* Refills:*2* 12. One Touch Test Strip Sig: as needed Miscell. four times a day. Disp:*100 strips* Refills:*2* 13. One Touch UltraSoft Lancets Misc Sig: as needed Miscell. four times a day. Disp:*100 lancets* Refills:*2* 14. Insulin Regular Human 100 unit/mL Cartridge Sig: as directed units Injection four times a day as needed for high blood sugar: Per sliding scale. Disp:*qs ml* Refills:*2* 15. Syringe with Needle (Disp) 3 mL 20 x 1 Syringe Sig: as directed Miscell. QMOWEFR (Monday -Wednesday-Friday).: For Epogen. Disp:*30 syringes* Refills:*2* Discharge Disposition: Home With Service Facility: VNA CareNetwork Discharge Diagnosis: Primary: Liver Cirrhosis Hepatorenal syndrome Hepatic encephalopathy Hyperglycemia Spontaneous bacterial peritonitis Strep. viridans bacteremia Left sided pleural effusion Secondary: Refractory ascites Discharge Condition: fair - tolerating oral medications, tolerating food, ambulating well. Discharge Instructions: Please seek immediate medical assistance if you experience fevers, chills, increasing confusion, or noticeable decrease in your urination. Take your medications as prescribed. You were started on insulin while in the hospital. This will require you to take fingerstick glucose measurements and then adjust your insulin requirements according to the following schedule: . Wake up: 1) Check blood sugar, 2) give insulin - 10 units of NPH and regular insulin according to both the sliding scale and measured blood glucose, 3) eat 30 minutes after insulin. . 30 min before lunch: 1) check blood sugar, 2) give regular insulin according to sliding scale and blood glucose measurement, 3) eat 30 minutes after insulin. . 30 minutes before dinner: 1) check blood sugar, 2) give regular insulin according to both the sliding scale and blood glucose measurement, 3) eat 30 minutes after insulin. . Bedtime: 1) check blood sugar, 2) give 8 units of NPH and regular insulin depending on sliding scale and blood glucose measurement. . Please have visiting nurse fax your blood test results to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13144**]. Her fax number is [**Telephone/Fax (1) **] and her phone number is [**Telephone/Fax (1) **]. Please call Ms. [**Name13 (STitle) 13144**] if you have any further questions about your home nursing. Followup Instructions: Provider: [**Name10 (NameIs) 454**],TEN DAY CARE [**Hospital Ward Name **] 8 Date/Time:[**2140-7-14**] 2:00 . Please call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**] on Monday [**2140-7-11**] in the morning to schedule an appointment within one week of leaving the hospital. His numbers are the following: Liver Center Phone: [**Telephone/Fax (1) 2422**]; Liver Transplant Phone: [**Telephone/Fax (1) 673**]

571,572,567,276,790,511,285,211

{'Alcoholic cirrhosis of liver,Hepatic encephalopathy,Spontaneous bacterial peritonitis,Hyperpotassemia,Bacteremia,Unspecified pleural effusion,Anemia of other chronic disease,Benign neoplasm of colon'}

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: Hepatic Encephalopathy PRESENT ILLNESS: 61 yo M w/ hx etOH cirrhosis [**2-4**] EtOh, anemia, and hepato-renal syndrome presented to OSH for routine paracentesis and was found to have hyperkalemia. Patient is confused and unable to give any hx, all data is obtained from OSH records though no d/c summary is present. Per these records, patient get regular parcentesis the last prior to admission being [**6-3**]. On presentation to OSH on [**6-13**], he complained of abdominal pain, distension, SOB, anorexia, generalized weakness. He denied melena, diarrha, fevers or chills. He was found to be hyperkalemic to 6.5 and had a Cr of 4.3 and was transferred to ER. . At OSH, treated wtih kayexelate and potassium followed. Lasix given for diuresis and nephrology consulted. Continued on cipro for SBP prophylaxis. Patient was tranfused PRBCs for anemia. He was maintained on a low protein<45g/day diet. Became increasingly lethargic and confused and was transferred for transplant work up and eval. MEDICAL HISTORY: Liver Cirrhosis followed at [**Hospital3 2358**] by the transplant team Anemia Hepato-renal syndrome MEDICATION ON ADMISSION: Protonix 40, Renagel 400mg TID, Lactulose tid, levaquin 250mg qd, SSI, Reglan prn, Docusate prn, Melatonin prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 95.9 114/76 101 20 98% RA BG 217 180# Gen: confused, mumbling, states "no I haven't" to almost all questions. Not oriented to place or date. Jaundiced HEENT: slight scleral icterus, mmm, tounge fasiculations noted, prrl CV: rrr s1s2 no m/r/g noted Pulm: diminished left sided breath sounds, right side cta Abd: ascites present, soft, not tensly distended, non-tender, Ext: trace pedal edema Neuro: Oriented to self. Does not know dates, location, president of the US. ++Asterixis FAMILY HISTORY: [**Name (NI) **] sister died of pancreatic cancer SOCIAL HISTORY: Lives alone, was a drinkier until [**2-/2140**], non-smoker. States he is a retired teacher (AP chem and physics teacher). Healthcare Proxy: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 68214**] [**Telephone/Fax (1) 68215**]. Dr. [**Last Name (STitle) 3315**] is his PCP. [**Name10 (NameIs) **] doctor is Dr. [**Last Name (STitle) 57141**]. ### Response: {'Alcoholic cirrhosis of liver,Hepatic encephalopathy,Spontaneous bacterial peritonitis,Hyperpotassemia,Bacteremia,Unspecified pleural effusion,Anemia of other chronic disease,Benign neoplasm of colon'}

CHIEF COMPLAINT: light-headedness PRESENT ILLNESS: EAST HOSPITAL MEDICINE ATTENDING ADMISSION NOTE MEDICAL HISTORY: -Two-vessel Coronary artery disease s/p stent to the LCx [**10/2156**] -Ischemic cardiomyopathy, TTE [**7-3**] with EF 20-30%, 3+MR, 2+TR -Hypertension -s/p Implantable cardioverter-defibrillator -Atrial fibrillation, on coumadin (INR goal [**12-29**]) -Dyslipidemia -Chronic kidney disease, baseline Cr 1.6-1.8 -High-grade papillary TCC, non-invasive, s/p transurethral resection ([**2165-11-28**]) and 6 cycles of BCG (last on [**2166-2-13**]), s/p urethral stricture -Hypothyroidism -Sigmoid diverticulosis, internal hemorrhoids on [**2160**] colonoscopy -Iron deficiency anemia -History of deep venous thrombosis x3 ([**2101**], [**2135**], [**2139**]) -s/p left carotid endarterectomy [**2153**] -History of syncope -Left lower extremity stasis dermatitis -s/p inguinal herniorrhaphy MEDICATION ON ADMISSION: AMIODARONE [PACERONE] - 200 mg Tablet - 1 Tablet(s) by mouth once a day ATORVASTATIN - 10 mg Tablet - one Tablet(s) by mouth every day CARVEDILOL [COREG] - 3.125 mg Tablet - 1 Tablet(s) by mouth twice a day FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth daily LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once per day LIDOCAINE HCL - 2 % Gel - inject into urethra every third day before catheterization. - No Substitution LISINOPRIL - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day every evening NITROGLYCERIN - 400 MCG (1/150 GR) TABLET - PLACE ONE TABLET UNDER TONGUE Q5 MIN X 3 AS NEEDED FOR JAW OR CHEST PAIN WARFARIN - (Prescribed by Other Provider) - 5 mg Tablet - 0.5 (One half) Tablet(s) by mouth daily as directed by coumadin clinic. WARFARIN - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth as directed. Patient normally takes3.5mg Tues/Thurs/Saturday, 2.5mg all other days ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: VS: 97.8 84 20 124/80 94% 2L (90% on RA) FAMILY HISTORY: Father died of emphysema. Mother died at age [**Age over 90 **]. There is no known history of kidney or GU tract disorders; there likewise is no known history of platelet disorders. SOCIAL HISTORY: Lives with wife. Retired, former banker. Independent of ADLs, wife does the cooking. Still works in the garden. Former smoker, quit at least 10 years ago. Has not drank EtOH for 20-25 years.

Unspecified septicemia,Septic shock,Acute systolic heart failure,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Severe sepsis,Other specified forms of chronic ischemic heart disease,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Iron deficiency anemia, unspecified,Abnormal coagulation profile,Other and unspecified hyperlipidemia,Unspecified erythematous condition,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of bladder,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism

Septicemia NOS,Septic shock,Ac systolic hrt failure,Urin tract infection NOS,Acute kidney failure NOS,Severe sepsis,Chr ischemic hrt dis NEC,Thrombocytopenia NOS,Atrial fibrillation,Hypothyroidism NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Iron defic anemia NOS,Abnrml coagultion prfile,Hyperlipidemia NEC/NOS,Erythematous cond NOS,Dvrtclo colon w/o hmrhg,Hx of bladder malignancy,Long-term use anticoagul,Status autm crd dfbrltr,Status-post ptca,Hx-ven thrombosis/embols

Admission Date: [**2168-12-7**] Discharge Date: [**2168-12-15**] Date of Birth: [**2084-9-8**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 633**] Chief Complaint: light-headedness Major Surgical or Invasive Procedure: central line placement History of Present Illness: EAST HOSPITAL MEDICINE ATTENDING ADMISSION NOTE Date: [**2168-12-12**] Time: 23:30 PCP: [**Name10 (NameIs) 665**], [**Name11 (NameIs) **] [**Name Initial (NameIs) **]. MD: [**Telephone/Fax (1) 250**]; [**University/College 96450**] The patient is an 84 year-old man with a PMH significant for ischemic cardiomyopathy EF 25%, CAD, DVT/A Fib on coumadin, bladder cancer s/p transurethral resection requiring straight cath who presents to the ED following episode of lightheadness. Today wife was straight cathing the patient (typically done every 1-2 days) and a large amount of blood returned. During this time patient became lightheaded/presyncopal and consequently presented to the ED. Denies recent fever, chills, cough. Denies recent hematuria (other than todays episode) or blood in the stool. Denies recent chest pain. Denies increase in lower extremity edema. Has baseline orthopnea and PND - but no recent increase. Patient had one transient episode of shortness of breath last week but resolved without intervention. Overall patient has been feeling his usual state of health. . In the ED, VS 97.8 HR 72 BP 74/47 RR 20 O2 97%. Labs notable for HCT 31.9, WBC 11.6 (89% N, 2% bands), creatinine 2.6, lactate 4.7 (improved to 3 with 3 L NS) and positive Ua with large blood. Patient was broadly covered with Vancomycin/Zosyn. Upon placement of foley a blood clot returned but urine turned clear with continuous irrigation. Patient's blood pressure improved to 100-110 with 3 L NS but prior to ICU transfer became hypotensive (SBP 80s) requiring central line placement and started on Levophed. . ROS: The patient denies any fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia. Denies increase in cloudy urine. Denies rash. . Past Medical History: -Two-vessel Coronary artery disease s/p stent to the LCx [**10/2156**] -Ischemic cardiomyopathy, TTE [**7-3**] with EF 20-30%, 3+MR, 2+TR -Hypertension -s/p Implantable cardioverter-defibrillator -Atrial fibrillation, on coumadin (INR goal [**12-29**]) -Dyslipidemia -Chronic kidney disease, baseline Cr 1.6-1.8 -High-grade papillary TCC, non-invasive, s/p transurethral resection ([**2165-11-28**]) and 6 cycles of BCG (last on [**2166-2-13**]), s/p urethral stricture -Hypothyroidism -Sigmoid diverticulosis, internal hemorrhoids on [**2160**] colonoscopy -Iron deficiency anemia -History of deep venous thrombosis x3 ([**2101**], [**2135**], [**2139**]) -s/p left carotid endarterectomy [**2153**] -History of syncope -Left lower extremity stasis dermatitis -s/p inguinal herniorrhaphy Social History: Lives with wife. Retired, former banker. Independent of ADLs, wife does the cooking. Still works in the garden. Former smoker, quit at least 10 years ago. Has not drank EtOH for 20-25 years. Family History: Father died of emphysema. Mother died at age [**Age over 90 **]. There is no known history of kidney or GU tract disorders; there likewise is no known history of platelet disorders. Physical Exam: VS: 97.8 84 20 124/80 94% 2L (90% on RA) GEN: Well-appearing, no acute distress HEENT: dry mucosa, EOMI, PERRL, sclera anicteric, no epistaxis or petechia CV: RRR, distant heart sounds, displaced PMI. no M/G/R. PULM: Bibasilar crackles ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E NEURO: alert, oriented to person, place, and time. Symmetric DTRs. SKIN: [**Name2 (NI) **] jaundice, cyanosis, or gross dermatitis. No ecchymoses. R central line in place Pertinent Results: Labs: [**2168-12-7**] 06:00PM WBC-11.6* RBC-3.29* HGB-10.3* HCT-31.9* MCV-97 MCH-31.3 MCHC-32.2 RDW-15.1 [**2168-12-7**] 06:00PM NEUTS-89* BANDS-2 LYMPHS-5* MONOS-4 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2168-12-7**] 06:00PM PLT COUNT-158 [**2168-12-7**] 06:00PM HYPOCHROM-1+ ANISOCYT-OCCASIONAL POIKILOCY-NORMAL MACROCYT-OCCASIONAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2168-12-7**] 06:00PM PT-40.9* PTT-29.7 INR(PT)-4.3* [**2168-12-7**] 06:00PM GLUCOSE-93 UREA N-57* CREAT-2.6* SODIUM-138 POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-19* ANION GAP-19 [**2168-12-7**] 06:13PM LACTATE-4.7* [**2168-12-7**] 06:20PM URINE COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.022 [**2168-12-7**] 06:20PM URINE BLOOD-LG NITRITE-NEG PROTEIN-75 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-MOD [**2168-12-7**] 06:20PM URINE RBC->50 WBC->50 BACTERIA-MANY YEAST-NONE EPI-0 . Micro: GRAM STAIN (Final [**2168-12-9**]): >25 PMNs and <10 epithelial cells/100X field. 3+ (5-10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S). SMEAR REVIEWED; RESULTS CONFIRMED. RESPIRATORY CULTURE (Final [**2168-12-12**]): DUE TO LABORATORY ACCIDENT CULTURE PLANTED ON [**2168-11-30**]. FASTIDIOUS ORGANISMS [**Month (only) **] NOT GROW. INTERPRET RESULTS WITH CAUTION. . SPARSE GROWTH Commensal Respiratory Flora. C. Diff: negative x3 . URINE CULTURE (Final [**2168-12-10**]): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. Piperacillin/tazobactam sensitivity testing available on request. ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. SECOND MORPHOLOGY. Piperacillin/tazobactam sensitivity testing available on request. KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | ESCHERICHIA COLI | | KLEBSIELLA PNEUMONIAE | | | AMPICILLIN------------ <=2 S <=2 S AMPICILLIN/SULBACTAM-- 4 S <=2 S 4 S CEFAZOLIN------------- <=4 S <=4 S <=4 S CEFEPIME-------------- <=1 S <=1 S <=1 S CEFTAZIDIME----------- <=1 S <=1 S <=1 S CEFTRIAXONE----------- <=1 S <=1 S <=1 S CIPROFLOXACIN---------<=0.25 S <=0.25 S <=0.25 S GENTAMICIN------------ <=1 S <=1 S <=1 S MEROPENEM-------------<=0.25 S <=0.25 S <=0.25 S NITROFURANTOIN-------- 32 S <=16 S 64 I PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S <=1 S <=1 S TRIMETHOPRIM/SULFA---- <=1 S <=1 S <=1 S Blood cx: Negative Imaging: CT Abd: Pt is a 22 y.o male with h.o Crohns disease (followed by Dr. [**Last Name (STitle) 3708**] on Cimzia as has failed prior tx (pentasa, budesonide, infliximab), recently admitted with symptoms of Crohns flare and SBO, who now presents with abdominal pain and vomiting. IMPRESSION: TECHNIQUE: Axial MDCT images were acquired through the pelvis following injection of contrast via the Foley catheter. Approximately 300 cc of diluted Cysto-Conray was administered via gravity to the Foley. Coronal and sagittal reformats were produced and reviewed. FINDINGS: The bladder is moderately well distended with contrast. There is a small amount of free air in the bladder and a Foley catheter in situ. There is prominent trabeculation at the right lateral wall of the bladder with bladder diverticula seen postero-laterally on the right. There is mild residual thickening of the bladder wall seen at the left side posteriorly, near but not at the left ureteral orifice. There is reflux of contrast into the left distal ureter. No bladder leak is seen. There is a small amount of free fluid in the pelvis most seen in the right iliac fossa. No cause for this is identified on the current study. There is extensive vascular calcification noted. No pelvic lymphadenopathy is seen. BONY STRUCTURES: There is moderate-to-severe degenerative changes noted in both hips. No destructive lytic or sclerotic bony lesions are seen. . 1. No bladder leak. 2. Multiple small bladder diverticula seen. 3. Mild thickening of the bladder wall, seen in the left posterior location. 4. Reflux of contrast into the distal left ureter. CXR [**12-7**]-FINDINGS: Again seen, is a left-sided cardiac pacer/defibrillator with leads in the right atrium and right ventricle. The cardiomediastinal and hilar contours are normal. EKG clips and wires overly the chest and somewhat limit evaluation. There is subtle opacity in the left lower lung which appears stable from prior and likely represents chronic scarring. However, there is a new ill-defined opacity in the lateral aspect of the right mid-lung which could represent pneumonia versus mass. There is no pleural effusion or pneumothorax. Heart and mediastinal contour appear stable. The osseous structures are intact. IMPRESSION: New opacity in the right mid-lung may represent infection or mass - dedicated PA and lateral views or a chest CT recommended - discussed with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 49784**] at 19:53 on [**2168-12-7**]. . CXR [**12-9**]-The position of the right internal jugular line and pacemaker leads is stable. There is overall slight interval increase in the right upper lobe diffuse opacity that might represent minimal gradual progression of infection, but there is no evidence of worsening of moderate interstitial engorgement since the prior study. Chronic changes in the lung bases can be partially addressed on this non-dedicated study. Left basal atelectasis and small amount of left pleural effusion are redemonstrated. If patient is short of breath, it might be attributed actually to diffuse interstitial lung disease and correlation with dedicated chest CT may be considered. . CXR [**12-11**]-Comparison films [**12-9**]. The position of the various support lines and tubes is unchanged. The overall appearance of the chest and in particular lung fields is also unchanged. IMPRESSION: Chronic lung changes, no failure. . CXR [**12-12**] CHEST AP . Some movement artifact is present. There has been no significant change since the prior chest x-rays. The position of the various lines and tubes is unchanged. No gross failure is present. IMPRESSION: No change. . EKG [**12-11**]-Ventricular pacing with pseudofusion. The irregularities suggest the atrial rhythm is atrial fibrillation. Since the previous tracing of [**2168-12-8**] pacing with variable fusion is now present. On the prior tracing there was atrial pacing. Clinical correlation is suggested. EKG [**12-8**]-Ventricularly paced rhythm at 70 beats per minute. Compared to tracing #1 no diagnostic change. TRACING #2 . Hematology COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2168-12-15**] 08:56 7.4 2.90* 9.0* 27.9* 96 31.0 32.3 17.0* 66*1 [**2168-12-14**] 06:00 8.5 2.89* 9.0* 27.6* 95 31.2 32.7 17.1* 55*2 Source: Line-Right IJ [**2168-12-13**] 03:50 6.8 2.86* 8.8* 27.0* 95 30.8 32.5 17.2* 57*1 Source: Line-IJ [**2168-12-12**] 04:09 7.7 2.85* 8.7* 26.5* 93 30.5 32.9 16.8* 51* Source: Line-rij [**2168-12-11**] 15:25 26.5* Source: Line-central [**2168-12-11**] 03:55 8.0 2.90* 9.1* 26.9* 93 31.4 33.8 16.6* 54* Source: Line-CVL [**2168-12-10**] 14:46 30.8* Source: Line-CVL [**2168-12-10**] 02:43 10.3 3.08* 9.5* 28.8* 94 30.9 33.0 16.9* 59*3 [**2168-12-9**] 15:23 28.9* Source: Line-cental line [**2168-12-9**] 02:58 20.0* 3.02* 9.4* 28.2* 93 31.2 33.5 17.0* 86*1 [**2168-12-8**] 22:36 28.2* [**2168-12-8**] 14:56 26.3* 2.83* 8.9* 27.1* 96 31.3 32.7 15.5 105* Source: Line-central ine [**2168-12-8**] 02:50 37.4* 2.73* 8.6* 26.2* 96 31.6 33.0 14.9 172 ADDED DIFF @ 0601 ON [**2168-12-8**] [**2168-12-7**] 18:00 11.6* 3.29* 10.3* 31.9* 97 31.3 32.2 15.1 158 . BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct INR(PT) [**2168-12-15**] 08:56 66*1 [**2168-12-15**] 08:56 25.6* 86.9* 2.5* [**2168-12-14**] 06:00 55*2 Source: Line-Right IJ [**2168-12-14**] 06:00 19.9* 62.0* 1.8* Source: Line-Right IJ [**2168-12-13**] 03:50 VERY LOW3 57*1 Source: Line-IJ [**2168-12-13**] 03:50 17.0* 81.3* 1.5* Source: Line-IJ [**2168-12-12**] 04:09 51* Source: Line-rij [**2168-12-12**] 04:09 15.5* 84.1* 1.4* Source: Line-rij [**2168-12-11**] 03:55 54* Source: Line-CVL [**2168-12-11**] 03:55 14.6* 91.4* 1.3* Source: Line-CVL [**2168-12-10**] 23:00 14.6* 90.9* 1.3* Source: Line-CVl [**2168-12-10**] 14:46 14.4* 150*4 1.3* Source: Line-CVL; heparin dose: 1250 [**2168-12-10**] 02:43 VERY LOW 59*5 [**2168-12-10**] 02:43 14.9* 29.6 1.3* [**2168-12-9**] 02:58 LOW 86*1 [**2168-12-9**] 02:58 33.0* 42.4* 3.3* [**2168-12-8**] 14:56 105* Source: Line-central ine [**2168-12-8**] 14:56 56.4* 51.7* 6.3*6 Source: Line-central ine [**2168-12-8**] 02:50 172 ADDED DIFF @ 0601 ON [**2168-12-8**] [**2168-12-8**] 02:50 46.3*7 43.7* 5.0*7 [**2168-12-7**] 18:00 158 [**2168-12-7**] 18:00 40.9* 29.7 4.3* . [**2168-12-15**] 08:56 981 39* 1.7* 140 3.9 108 24 12 [**2168-12-14**] 06:00 105*1 36* 1.9* 141 3.7 108 24 13 Source: Line-Right IJ [**2168-12-13**] 03:50 105*1 30* 1.8* 1382 3.72 110*2 232 9 Source: Line-IJ [**2168-12-12**] 18:44 118*1 26* 1.7* 141 4.0 108 23 14 [**2168-12-12**] 04:09 116*1 24* 1.9* 142 3.4 113* 22 10 Source: Line-rij [**2168-12-11**] 15:25 109*1 26* 1.7* 140 4.0 112* 21* 11 Source: Line-central [**2168-12-11**] 03:55 991 28* 1.7* 142 4.3 112* 22 12 Source: Line-CVL [**2168-12-10**] 23:00 30* 1.8* 142 3.4 112* Source: Line-CVl [**2168-12-10**] 14:46 118*1 33* 1.8* 143 4.0 113* 17* 17 Source: Line-CVL [**2168-12-10**] 02:43 961 38* 1.8* 142 4.0 116* 19* 11 [**2168-12-9**] 02:58 122*1 48* 2.3* 138 4.3 111* 19* 12 [**2168-12-8**] 14:56 157*1 47* 2.3* 138 4.8 111* 16* 16 Source: Line-central ine [**2168-12-8**] 02:50 157*1 49* 2.3* 139 4.2 111* 17* 15 [**2168-12-7**] 18:00 931 57* 2.6* 138 4.2 104 19* 19 ADDED TE8-TE11 AT [**Telephone/Fax (2) 106487**] . Brief Hospital Course: Assessment/Plan: Pt is an 84 y.o male with h.o ischemic CMP EF 25%, CAD, DVT/afib on coumadin as outpt, bladder cancer s/p transurethral resection requiring straight cath who presented with hematuria and was initially admitted to ICU with urosepsis requiring pressors. Pt now improved and transferred to medical floor. While in the ICU, pt developed new thrombocytopenia. . #Urinary tract infection (s/p shock and urosepsis)-Pt's urine culture grew pan-sensitve E.coli and Klebsiella. Initially, pt required pressors and IVF to maintain SBP. Pressors weaned [**12-9**]. Initially covered broadly with vanco/zosyn, tailored to IV ceftriaxone on [**12-10**]. CT pelvis ruled out bladder perforation or abscess formation. PO cipro begun [**12-14**] and pt should continue this medication for 14 day course abx (day 1 [**12-7**])-last day [**12-21**] for complicated UTI. Discussed foley catether with urology. Pt is to have foley catheter in place until his f/u with Dr. [**Last Name (STitle) 3748**]. [**Name (NI) 1094**] wife typically self-caths him at home 3xdaily. . #hematuria-present at home prior to admit during self-cath. Resolved and did not reoccur this admission. Urology follow-up for h.o bladder cancer arranged with Dr. [**Last Name (STitle) 3748**]. . #Thrombocytopenia-plts Dropped from 158->52 during admit. Likely related to sepsis +/- antibiotic use. Pt had not been receiving heparin products prior to this fall in counts. CVL flush was ordered as saline. Pt was started on heparin gtt after the plt fall as a bridge to coumadin an counts remained stable on this medication. Heparin DC'd [**12-15**]. Pt did not display signs of bleeding. Platelet count should be monitored after discharge to ensure continued recovery. If recovery does not occur, pt should follow up with a hematologist. . #normocytic anemia-baseline appears to be 31-39. NO signs of active bleeding were present after initial hematuria. Likely related to recent hematuria, infection and hemodilution. INR also supratherapeutic on admit. Stable. Currently 27.9 upon discharge. HCt can be monitored at rehab. Iron studies/B12 and folate can be performed if persisent. Pt should discuss whether a colonoscopy is needed for routine screening. . #acute systolic CHF- EF 25%/ ICD in place Last TTE 5/[**2167**]. s/p aggressive volume resuscitation due to sepsis in the ICU. Intermittent lasix gtt during ICU. Transitioned to IV lasix on [**12-12**]. Fluid balance +800cc at time of transfer to medical floor. Pt was given daily doses of 40mg IV daily with good effect. He was started on his home dose of 40mg PO lasix on day of discharge. (In addition to 40mg IV lasix given). Pt is sating 90-91% on RA and weight on discharge was recorded as 159lbs. Pt on asa/BB/ACEI. For increased SOB/hypoxia would consider 40mg IV lasix x1. . #hypoxia-Pt's oxygen requirment vascillated between 90-91% on RA and occasionally mid 90's on 2-3L. Suspect that this was due to acute systolic heart failure. Pt did not display other clinical signs to suggest PNA and this did improve with diuresis. In addition, pt with CXR findings suggestive of basilar scaring and possible interstitial lung disease. So it is possible that 89-91% is patient's true baseline. Pt should continue to follow up and can consider imaging with CT scan or pulmonary eval in the outpatient setting. Sats 90-91% on RA at time of discharge. . #CAD-no active chest pain. 1 episode of SOB [**12-11**]. EKG without signs of ischemia. Continued statin, asa 81mg. BB and ACEi had been initially held given hypotension but restarted BB (carvedilol 3.125mg [**Hospital1 **] and ACEI lisinopril 2.5mg) on [**12-15**] with good effect. . #CKD-baseline 1.7-2.3. Elevated to 2.6 on admit. Currently 1.7 at baseline. Restarted home dose ACEI [**12-14**]. . #DVT-coumadin held on admit as supratherapeutic at 6.3. Reversed with 5mg PO vitamin K. INR trended down and [**12-11**] subtherapeutic. Heparin gtt started on [**12-10**] and bridge with coumadin begun. Pt now therapeutic INR 2.5. Heparin gtt stopped. Pt should coumadin regimen upon discharge. 2.5mg mon/wed/fri/sun and 3.5mg tue/[**Last Name (un) **]/sat. Pt's INR should be followed at rehab. . #afib-as above regarding coumadin. INR elevated, given vit K, then heparin/coumadin started. 5mg coumadin daily during admit. Pt should resume home dosing tonight. (home dosing 3.5mg/2.5mg alternating) see above. Amiodarone started [**12-12**]. Carvedilol 3.125mg [**Hospital1 **] restarted [**12-14**] with good effect. . #b/l medial toe erythema-symmetric on toes, appears to be from pressure or sleep position rather than an acute gouty flare. Areas are not warm and pt has full range of motion. Area of pain is localized to these specific areas and not the joints or the joints of the great toe.If signs of gout were to develop or occur, could consider renally dosed colchicine x1 and/or prednisone. Would avoid NSAIDs in this patient. . #bladder cancer s/p transurethral resection-followed by Dr. [**Last Name (STitle) 3748**]. Hopefully, will be able to DC foley and allow pt to return to straight cath after rehab stay and f/u with Dr. [**Last Name (STitle) 3748**]. FOley catheter should remain in place until schedule urology f/u with Dr. [**Last Name (STitle) 3748**]. . #incidential radiographic findings-CXR found subtle opacity in left lower lung that appears stable and likely represents scarring. However, CXR reports new ill-defined opacity in lateral aspect of R.mid lung that could be PNA vs. mass. Repeat CXR shows lung base chronic findings that could be suggestive of interstitial lung disease. Pt did not have fever or other clincal signs of PNA. Pt should follow up with his PCP to discuss need for further imaging and workup. Chest CT could be performed in the outpatient setting for further evaluation. . #dyslipidemia-continued atorvastatin at home dose . #hypothyroidism-continued levothyroxine at home dose . FEN: cardiac diet . DVT PPx: coumadin . Precautions for: falls . Lines: PIV . CODE: FULL . [**Hospital 106488**] rehab facility. Medications on Admission: AMIODARONE [PACERONE] - 200 mg Tablet - 1 Tablet(s) by mouth once a day ATORVASTATIN - 10 mg Tablet - one Tablet(s) by mouth every day CARVEDILOL [COREG] - 3.125 mg Tablet - 1 Tablet(s) by mouth twice a day FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth daily LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once per day LIDOCAINE HCL - 2 % Gel - inject into urethra every third day before catheterization. - No Substitution LISINOPRIL - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day every evening NITROGLYCERIN - 400 MCG (1/150 GR) TABLET - PLACE ONE TABLET UNDER TONGUE Q5 MIN X 3 AS NEEDED FOR JAW OR CHEST PAIN WARFARIN - (Prescribed by Other Provider) - 5 mg Tablet - 0.5 (One half) Tablet(s) by mouth daily as directed by coumadin clinic. WARFARIN - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth as directed. Patient normally takes3.5mg Tues/Thurs/Saturday, 2.5mg all other days Discharge Medications: 1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 7. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO q mon/wed/fri/sun. 8. Coumadin 1 mg Tablet Sig: 3.5 Tablets PO q tue/[**Last Name (un) **]/sat: 3.5mg tue/[**Last Name (un) **]/sun. 2.5mg mon/wed/fri/sun. 9. ciprofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 6 days. Disp:*6 Tablet(s)* Refills:*0* 10. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 11. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain/fever. 12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 13. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: shock due to urosepsis acute renal failure thrombocytopenia coagulopathy acute systolic CHF toe erythema . CAD afib h.o DVT 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: You were admitted to the hospital with blood in your urine and feeling lightheaded. Your blood pressure was initally low and you were found to have sepsis (a severe infection) from your urinary tract. For this, you were initally monitored in the ICU. You improved and you were transferred to the regular medical floor. You were given antibiotics for this infection and will continue this upon discharge. Your foley catheter should also remain in place until your follow up appointment with Dr. [**Last Name (STitle) 3748**]. Your coumadin was held initially as your numbers were elevated. This was restarted and you should continue to have your INR checked regularly. . You some extra fluid outside of your lungs and were given Lasix with good effect. . Medication changes: 1.Continue Cipro 750mg daily for 6 more days . Please take all of your medications as prescribed and follow up with the appointments below. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please have your rehab facility schedule you an appointment with your PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Name (STitle) 665**] at [**Telephone/Fax (1) 250**] after discharge. Department: SURGICAL SPECIALTIES When: [**2168-12-29**] at 9:00 AM With: DR. [**First Name (STitle) **] [**Doctor Last Name **] [**Telephone/Fax (1) 3752**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Department: CARDIAC SERVICES When: TUESDAY [**2169-3-21**] at 1 PM With: DEVICE CLINIC [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: CARDIAC SERVICES When: TUESDAY [**2169-3-21**] at 1:30 PM With: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], NP [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: SURGICAL SPECIALTIES When: THURSDAY [**2169-3-30**] at 10:15 AM With: DR. [**First Name (STitle) **] [**Doctor Last Name **] [**Telephone/Fax (1) 3752**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

038,785,428,599,584,995,414,287,427,244,403,585,280,790,272,695,562,V105,V586,V450,V458,V125

{'Unspecified septicemia,Septic shock,Acute systolic heart failure,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Severe sepsis,Other specified forms of chronic ischemic heart disease,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Iron deficiency anemia, unspecified,Abnormal coagulation profile,Other and unspecified hyperlipidemia,Unspecified erythematous condition,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of bladder,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism'}

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: light-headedness PRESENT ILLNESS: EAST HOSPITAL MEDICINE ATTENDING ADMISSION NOTE MEDICAL HISTORY: -Two-vessel Coronary artery disease s/p stent to the LCx [**10/2156**] -Ischemic cardiomyopathy, TTE [**7-3**] with EF 20-30%, 3+MR, 2+TR -Hypertension -s/p Implantable cardioverter-defibrillator -Atrial fibrillation, on coumadin (INR goal [**12-29**]) -Dyslipidemia -Chronic kidney disease, baseline Cr 1.6-1.8 -High-grade papillary TCC, non-invasive, s/p transurethral resection ([**2165-11-28**]) and 6 cycles of BCG (last on [**2166-2-13**]), s/p urethral stricture -Hypothyroidism -Sigmoid diverticulosis, internal hemorrhoids on [**2160**] colonoscopy -Iron deficiency anemia -History of deep venous thrombosis x3 ([**2101**], [**2135**], [**2139**]) -s/p left carotid endarterectomy [**2153**] -History of syncope -Left lower extremity stasis dermatitis -s/p inguinal herniorrhaphy MEDICATION ON ADMISSION: AMIODARONE [PACERONE] - 200 mg Tablet - 1 Tablet(s) by mouth once a day ATORVASTATIN - 10 mg Tablet - one Tablet(s) by mouth every day CARVEDILOL [COREG] - 3.125 mg Tablet - 1 Tablet(s) by mouth twice a day FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth daily LEVOTHYROXINE [LEVOXYL] - 100 mcg Tablet - 1 Tablet(s) by mouth once per day LIDOCAINE HCL - 2 % Gel - inject into urethra every third day before catheterization. - No Substitution LISINOPRIL - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day every evening NITROGLYCERIN - 400 MCG (1/150 GR) TABLET - PLACE ONE TABLET UNDER TONGUE Q5 MIN X 3 AS NEEDED FOR JAW OR CHEST PAIN WARFARIN - (Prescribed by Other Provider) - 5 mg Tablet - 0.5 (One half) Tablet(s) by mouth daily as directed by coumadin clinic. WARFARIN - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth as directed. Patient normally takes3.5mg Tues/Thurs/Saturday, 2.5mg all other days ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: VS: 97.8 84 20 124/80 94% 2L (90% on RA) FAMILY HISTORY: Father died of emphysema. Mother died at age [**Age over 90 **]. There is no known history of kidney or GU tract disorders; there likewise is no known history of platelet disorders. SOCIAL HISTORY: Lives with wife. Retired, former banker. Independent of ADLs, wife does the cooking. Still works in the garden. Former smoker, quit at least 10 years ago. Has not drank EtOH for 20-25 years. ### Response: {'Unspecified septicemia,Septic shock,Acute systolic heart failure,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Severe sepsis,Other specified forms of chronic ischemic heart disease,Thrombocytopenia, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Iron deficiency anemia, unspecified,Abnormal coagulation profile,Other and unspecified hyperlipidemia,Unspecified erythematous condition,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of bladder,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Percutaneous transluminal coronary angioplasty status,Personal history of venous thrombosis and embolism'}

CHIEF COMPLAINT: PRESENT ILLNESS: Briefly, this is a 51-year-old male who had a long history of diabetes who presented to an outside hospital with chest pain. MEDICAL HISTORY: MEDICATION ON ADMISSION: His medications upon admission included glyburide 5 mg p.o. b.i.d. (for diabetes). He also was transferred in on atenolol, aspirin, intravenous Lopressor, sublingual nitroglycerin, and nitroglycerin paste. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction

AMI anterior wall, init,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Old myocardial infarct

Admission Date: [**2166-8-28**] Discharge Date: [**2166-9-2**] Date of Birth: [**2114-9-10**] Sex: M Service: HISTORY OF PRESENT ILLNESS: Briefly, this is a 51-year-old male who had a long history of diabetes who presented to an outside hospital with chest pain. The patient was evaluated and found to be in acute myocardial infarction. He was transferred for an emergent cardiac catheterization. MEDICATIONS ON ADMISSION: His medications upon admission included glyburide 5 mg p.o. b.i.d. (for diabetes). He also was transferred in on atenolol, aspirin, intravenous Lopressor, sublingual nitroglycerin, and nitroglycerin paste. HOSPITAL COURSE: The patient was taken to the cardiac catheterization laboratory, and it was found that he had multivessel disease and emergently was taken to the operating room for coronary artery bypass grafting. He was taken on [**2166-8-28**] where a coronary artery bypass graft times six was performed; left internal mammary artery to left anterior descending artery, saphenous vein graft to right PL and then sequential to posterior descending artery, saphenous vein graft to first obtuse marginal and sequential to second obtuse marginal, saphenous vein graft to diagonal. The patient was transferred to the Cardiothoracic Surgery Recovery Unit postoperatively. Transesophageal echocardiogram during the case showed an ejection fraction of 35%. An IABP was placed in the cardiac catheterization laboratory. Postoperatively, his IABP was slowly weaned and plans for discharge were started. His Levophed was weaned off, and his milrinone was slowly weaned off as well. He was started on beta blockade at the same time. The IABP was removed after being weaned to 1:3. Shortly after that, the patient was extubated, and he did well. His oxygen saturations were good, and he was fully diuresed. The patient continued to improve in the Intensive Care Unit, and his milrinone was stopped completely. He was started on a beta blocker and began to be diuresed with Lasix. Physical Therapy was consulted at that time, and the patient did well. It was planned that the patient would be able to be discharged home upon clearance of his medical conditions. He was transferred to the floor on postoperative day two. On postoperative day three, his chest tube was removed. His Lopressor was decreased to 75 mg p.o. b.i.d. An aggressive pulmonary toilet was done. The patient continued to do well with Physical Therapy, and the patient was able to clear stairs on [**2166-9-1**]. Postoperatively, on day three, his Foley catheter was removed, and the patient's wires were left in place. On postoperative day four, his pacing wires were removed uneventfully, and the patient continued to improve. It was decided at that time the patient was in good condition and could be discharged to home. MEDICATIONS ON DISCHARGE: (The patient's discharged medications included) 1. Lopressor 75 mg p.o. b.i.d. 2. Glyburide 5 mg p.o. b.i.d. 3. Percocet one to two tablets p.o. q.4h. as needed. 4. Enteric-coated aspirin 325 mg p.o. q.d. 5. Colace 100 mg p.o. b.i.d. 6. Zantac 150 mg p.o. b.i.d. 7. Potassium chloride 20 mEq p.o. b.i.d. 8. Lasix 20 mg p.o. b.i.d. DISCHARGE STATUS: The patient was discharged to home. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE FOLLOWUP: The patient was instructed to follow up with Dr. [**Last Name (STitle) 70**] in four weeks, and with his primary care physician in one to two weeks, and with Cardiology in two to four weeks. DISCHARGE DIAGNOSES: 1. Diabetes. 2. Coronary artery disease. 3. Status post myocardial infarction. 4. Status post coronary artery bypass graft times six; emergently done. DISCHARGE DISPOSITION: The patient was discharged to home in stable condition. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Last Name (NamePattern4) **] MEDQUIST36 D: [**2166-8-31**] 15:42 T: [**2166-9-5**] 11:45 JOB#: [**Job Number 25017**]

410,414,250,412

{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Briefly, this is a 51-year-old male who had a long history of diabetes who presented to an outside hospital with chest pain. MEDICAL HISTORY: MEDICATION ON ADMISSION: His medications upon admission included glyburide 5 mg p.o. b.i.d. (for diabetes). He also was transferred in on atenolol, aspirin, intravenous Lopressor, sublingual nitroglycerin, and nitroglycerin paste. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction'}

CHIEF COMPLAINT: cc:[**CC Contact Info 18195**] PRESENT ILLNESS: HPI: 85 y/o M w/recent MICU admission for GI bleed, discharged [**5-8**] to rehab, who was admitted to ICU on [**5-9**] from rehab with BRBPR. During his prior hospitalization , he was admitted to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**4-27**] with weakness, and a Hct of 21. Patient underwent an EGD x 2, which both times revealed a large duodenal ulcer with overlying clot. Interventional was unable to be completed due to techinical difficulties. Patient subsequently failed to respond to transfusion appropriately without a significant drop in his Hct. He required a total of 12U PRBCs and 4U FFP. He was transferred to [**Hospital1 18**] on [**2152-5-2**] for further management and question of surgical intervention. Before transfer, his course at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] was complicated by hypoxemic respiratory failure requiring intubation (felt to be due to volume overload from the transfusions vs aspiration pna), and hypotension requiring pressors (which occurred after receiving propofol for sedation). MEDICAL HISTORY: Hypothyroidism Duodenal ulcer as above Afib Anemia Alcohol abuse MEDICATION ON ADMISSION: Meds at rehab: levofloxacin (to finish 14-day course) flagyl (to finish 14-day course) levothyroxine thiamine folate metoprolol 50 [**Hospital1 **] multivitamin albuterol/atrovent nebs prn ALLERGIES: Penicillins PHYSICAL EXAM: PE: T: 101.1 BP: 136/44 P: 75 R: 25 O2 sat: 97% on Gen: elderly male lying in bed under 5 blankets, shivering, coughing HEENT: pale sclerae, MM dry Neck: supple Lungs: rhonchorous anteriorly CV: tachycardic, irregular, no m/r/g Abd: soft, nt/nd. +bs. Ext: chronic venous stasis changes of BLE with 1-2+ BLE edema Neuro: oriented to person, place (hospital), but not time (thinks it is [**2112-4-1**]) FAMILY HISTORY: FH: NC SOCIAL HISTORY: SH: Large EtOH use, 2 shots of bourbon per night with a few glasses of wine. Never had EtOH W/D. No cigarette use - quit [**2100**] after 15 year smoking x 4 ppd. Lives @ home w/wife who he takes care of. He does the cooking in the house. Married x 55 years. No children but have a friend, [**Name (NI) **] [**Name (NI) 66618**], whom they consider to be their son. [**Name (NI) **] is the next in line after his wife per the durable power of attorney form. - [**Last Name (un) **] [**Known lastname **] (their home #) [**Telephone/Fax (1) 66619**] - [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 66618**] - [**Telephone/Fax (1) 66620**]

Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Pressure ulcer, lower back,Retention of urine, unspecified,Acquired coagulation factor deficiency,Alcohol abuse, unspecified,Hypovolemia,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Diverticulum of esophagus, acquired,Pain in joint, ankle and foot

Ac duodenal ulcer w hem,Ac posthemorrhag anemia,Atrial fibrillation,K. pneumoniae pneumonia,Pressure ulcer, low back,Retention urine NOS,Acq coagul factor defic,Alcohol abuse-unspec,Hypovolemia,CHF NOS,Hypothyroidism NOS,Acq esophag diverticulum,Joint pain-ankle

Admission Date: [**2152-5-9**] Discharge Date: [**2152-5-18**] Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 22401**] Chief Complaint: cc:[**CC Contact Info 18195**] Major Surgical or Invasive Procedure: s/p 8 coils in gastroduodenal artery perfomrmed by Interventional Radiology s/p failed EGD attempts x 2 due to esophageal diverticulum History of Present Illness: HPI: 85 y/o M w/recent MICU admission for GI bleed, discharged [**5-8**] to rehab, who was admitted to ICU on [**5-9**] from rehab with BRBPR. During his prior hospitalization , he was admitted to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**4-27**] with weakness, and a Hct of 21. Patient underwent an EGD x 2, which both times revealed a large duodenal ulcer with overlying clot. Interventional was unable to be completed due to techinical difficulties. Patient subsequently failed to respond to transfusion appropriately without a significant drop in his Hct. He required a total of 12U PRBCs and 4U FFP. He was transferred to [**Hospital1 18**] on [**2152-5-2**] for further management and question of surgical intervention. Before transfer, his course at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] was complicated by hypoxemic respiratory failure requiring intubation (felt to be due to volume overload from the transfusions vs aspiration pna), and hypotension requiring pressors (which occurred after receiving propofol for sedation). * Upon arrival here on [**5-2**], he was extubated and weaned off pressors. He required no further PRBC transfusions as his Hct remained stable. GI service evaluated the patient and felt that there was no diagnostic or interventional need for antoher endoscopy. He was treated with ceftriaxone, vancomycin, and flagyl for sepsis (presumed source aspiration pna). He was transferred to the floor on [**5-5**]. On the floor, he had an attempted thoracentesis as he had a pleural effusion seen on both CXR and chest CT, but they were unable to get any fluid. He remained hypoxic, requiring 2L O2 to saturate 95% and desaturated quickly with any movement. He was discharged to rehab on [**5-8**] with instructions to complete a 14-day course of levo and flagyl. * Patient at rehab on [**5-9**], developed bright red blood in his bowel movements and was sent to [**Hospital1 18**]. No records from the [**Hospital1 1501**] are available. In the ED, he was initially hypotensive to 108/53 but otherwise hemodynamically stable. Patient proceeded to have BRBPR, and his initial Hct was 23 [**5-9**] (was 28 [**5-8**] prior to d/c). The ED resident and attending were unable to place an NGT. He was transfused 2U PRBCs, given 1L NS, protonix 40 IV, and was transferred to the MICU. . In the MICU, GI evaluated him and performed EGD on [**5-10**]. They were able to advance the scope pass the upper esophageal sphincter but there after it entered a broad cavity without exit, presumably a Zenker's diverticulum with large opening. It was presumed to be Zenker's diverticulum in the crico-pharyngeus, preventing passage of the scope into the esophagus. Other techniques to document bleeding site and intervene, such as angiography were considered and patient underwent one on [**5-10**]. There was no evidence of active bleeding seen on initial angiogram. With the prior known location of duodenal ulcer, it was decided to proceed with gastroduodenal artery embolization. Patient had a 8 coil embolization of the gastroduodenal artery. On this subsequent arteriogram, a small branch arising from the proximal gastroduodenal artery was still perfused. Patient's Hct subsequently was stable. His last transfussion was on [**5-10**] (for a total of 2+2 units over [**Date range (1) 8305**]). Patient was transfered to regular floor for further care. . Patient is alert and oriented to place. He denies any fevers/chills, no lightheadedness, no abdominal pain, no nausea, or vomiting, no chest pain, no shortness of breath, no chest pain, no dysuria/hematuria, no myalgias/arthralgias. Past Medical History: Hypothyroidism Duodenal ulcer as above Afib Anemia Alcohol abuse Social History: SH: Large EtOH use, 2 shots of bourbon per night with a few glasses of wine. Never had EtOH W/D. No cigarette use - quit [**2100**] after 15 year smoking x 4 ppd. Lives @ home w/wife who he takes care of. He does the cooking in the house. Married x 55 years. No children but have a friend, [**Name (NI) **] [**Name (NI) 66618**], whom they consider to be their son. [**Name (NI) **] is the next in line after his wife per the durable power of attorney form. - [**Last Name (un) **] [**Known lastname **] (their home #) [**Telephone/Fax (1) 66619**] - [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 66618**] - [**Telephone/Fax (1) 66620**] Family History: FH: NC Physical Exam: PE: T: 101.1 BP: 136/44 P: 75 R: 25 O2 sat: 97% on Gen: elderly male lying in bed under 5 blankets, shivering, coughing HEENT: pale sclerae, MM dry Neck: supple Lungs: rhonchorous anteriorly CV: tachycardic, irregular, no m/r/g Abd: soft, nt/nd. +bs. Ext: chronic venous stasis changes of BLE with 1-2+ BLE edema Neuro: oriented to person, place (hospital), but not time (thinks it is [**2112-4-1**]) Pertinent Results: Hematology COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2152-5-18**] 06:15AM 7.6 3.27* 9.6* 28.8* 88 29.4 33.5 15.8* 434 [**2152-5-17**] 06:15AM 8.0 3.47* 10.2* 30.4* 88 29.4 33.6 15.9* 463* [**2152-5-16**] 04:30AM 9.7 3.33* 10.0* 29.0* 87 30.2 34.7 15.9* 427 [**2152-5-15**] 06:10AM 9.0 3.50* 10.4* 30.6* 88 29.6 33.8 16.0* 449* [**2152-5-14**] 06:55PM 29.6* [**2152-5-14**] 08:25AM 11.5* 3.43* 10.1* 30.5* 89 29.6 33.3 16.0* 437 [**2152-5-13**] 07:23PM 30.1* [**2152-5-13**] 08:44AM 10.4 3.43* 10.2* 30.5* 89 29.6 33.3 16.1* 425 [**2152-5-12**] 07:40PM 28.6* [**2152-5-12**] 06:25AM 11.9* 3.29* 10.0* 28.8* 88 30.3 34.6 15.9* 370 [**2152-5-11**] 08:30PM 29.8* [**2152-5-11**] 11:30AM 11.8* 3.59* 10.5* 31.4* 87 29.4 33.6 15.9* 360 [**2152-5-11**] 03:09AM 11.6* 3.34* 10.0* 29.2* 88 30.0 34.3 16.1* 327 [**2152-5-10**] 07:43PM 27.6* [**2152-5-10**] 02:42PM 28.0* [**2152-5-10**] 10:55AM 27.3* [**2152-5-10**] 04:46AM 12.5* 3.02* 9.2* 26.2* 87 30.6 35.3* 16.2* 280 [**2152-5-10**] 02:12AM 26.1* [**2152-5-9**] 08:00PM 26.1* [**2152-5-9**] 05:11PM 10.2 2.64* 7.8* 23.6*1 89 29.7 33.3 15.7* 387 [**2152-5-8**] 05:26AM 9.7 3.15* 9.4* 28.8* 91 29.8 32.7 15.7* 268 DIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas [**2152-5-9**] 05:11PM 84.1* 10.1* 3.8 1.3 0.6 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT) [**2152-5-18**] 06:15AM 434 Chemistry RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2152-5-18**] 06:15AM 91 13 1.0 132* 4.2 96 26 14 ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase TotBili DirBili [**2152-5-15**] 06:10AM 11 15 227 46 0.4 OTHER ENZYMES & BILIRUBINS Lipase [**2152-5-15**] 06:10AM 17 CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron [**2152-5-18**] 06:15AM 7.5* 3.2 1.7 . Urine: [**2152-5-17**] 01:15PM Yellow Clear 1.018 [**2152-5-15**] 12:37PM Yellow Clear 1.030 [**2152-5-10**] 02:12AM Amber1 Clear 1.023 1 ABN COLOR [**Month (only) **] AFFECT DIPSTICK DIPSTICK URINALYSIS Blood Nitrite Protein Glucose Ketone Bilirub Urobiln pH Leuks [**2152-5-17**] 01:15PM NEG NEG TR NEG NEG NEG NEG 9.0* NEG [**2152-5-15**] 12:37PM NEG NEG NEG NEG NEG NEG NEG 6.5 NEG [**2152-5-10**] 02:12AM NEG NEG NEG NEG NEG NEG NEG 6.5 TR MICROSCOPIC URINE EXAMINATION RBC WBC Bacteri Yeast Epi TransE RenalEp [**2152-5-17**] 01:15PM 0-2 0-2 FEW NONE 0-2 [**2152-5-10**] 02:12AM 0-2 0-2 FEW NONE 0-2 * EKG: rate 72, afib, nl axis, nl intervals, no ST-T changes * CXR upon d/c: The previously identified left lower lobe opacity has been slightly decreasing. There is continued small bilateral effusion. There is mild congestive heart failure with cardiomegaly. No pneumothorax is identified. . IMPRESSION: Slightly improving left lower lobe pneumonia. Mild congestive heart failure with cardiomegaly and bilateral pleural effusion. * Chest CT from [**5-6**]: IMPRESSION: 1. Multifocal pneumonia of the left lower lobe, lingula, and left upper lobe. Two small wedge-shaped pleural-based opacities of the right upper and middle lobes may represent spread of pneumonia. 2. Moderate bilateral layering pleural effusions with associated posterobasal atelectasis of the lower lobes bilaterally. 3. Probable component of congestive heart failure given pleural effusions, fissural fluid, and interstitial prominence. 4. Multiple small bilateral apical blebs. * TTE [**5-3**]: 1. The left atrium is markedly dilated. The left atrium is elongated. The right atrium is moderately dilated. 2. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). 3.Right ventricular chamber size is normal. Right ventricular systolic function is normal. 4.The aortic root is mildly dilated. 5.The aortic valve leaflets are mildly thickened. Mild (1+) aortic regurgitation is seen. 6.The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 7.Moderate [2+] tricuspid regurgitation is seen. 8. There is mild pulmonary artery systolic hypertension. 9.There is a trivial/physiologic pericardial effusion. * Video Swallow Study: . Mild oral and pharyngeal dysphagia with no evidence of aspiration. A large diverticulum is noted in the pharynx. Difficult to determine type of diverticulum (Zenker's versus Killian-[**Last Name (un) 66624**]). Solid and liquids were observed to collect within diverticulum along with backflow swallow following throat clearing. For further details, please refer to the video swallow evaluation from [**2152-5-12**]. . COILING PROCEDURE: [**5-10**]: PROCEDURE: Following written informed consent with the patient's daughter and son-in-law, the patient was positioned supine on the angiography table. Preprocedure timeout was performed to confirm patient, procedure and site. Standard sterile prep and drape of the right inguinal region. Local anesthesia with 7 cc of 1% lidocaine subcutaneously. Using a combination of palpatory and fluoroscopic guidance, a single wall puncture of the right common femoral artery was performed. A 0.035-inch guidewire was advanced through the needle into the abdominal aorta using fluoroscopic guidance. Needle was exchanged for a 5-French vascular sheath, however, due to marked tortuosity of the iliac arteries this did not provide adequate stability for catheter manipulations in the aorta. As such, the sheath was exchanged for a long 6-French vascular sheath. A cobra catheter was used to select the superior mesenteric artery and superior mesenteric arteriography was performed. Attempts were made to catheterize the celiac artery with cobra catheter, Sos Omni catheter, [**Doctor Last Name **] catheter, but these were all unsuccessful. Finally, a [**Last Name (un) 3056**] catheter was successful at selecting the celiac artery. Celiac arteriography was performed. Based on the patient's clinical presentation and the findings of the diagnostic arteriograms, it was determined that the patient was a suitable candidate for and may benefit from embolization of the gastroduodenal artery. A 3-French microcatheter was advanced with a 0.018-inch guidewire through the [**Last Name (un) 3056**] catheter and used to select the gastroduodenal artery. Gastroduodenal arteriography was performed. Coil embolization of the gastroduodenal artery was then performed through the microcatheter using a total of four 2 mm x 2 cm microcoils and four 4 mm x 4 cm microcoils. The catheter was displaced into the common hepatic artery and common hepatic arteriography was performed post- embolization. Based on the findings of this post-embolization arteriogram, we attempted to regain access to the proximal stump of the gastroduodenal artery, however, these attempts were unsuccessful. All catheters, wires, and the sheath were removed and hemostasis was ensured with direct manual compression. There were no immediate complications. Moderate sedation was provided by administering divided doses of intravenous Versed (total of 2 mg) and intravenous fentanyl (total of 200 mcg). There was a total intraservice time of 2 hours, during which the patient's hemodynamic parameters were continuously monitored. Total of 150 cc of Optiray radiographic contrast was utilized. FINDINGS: Superior mesenteric arteriography demonstrated patency of the superior mesenteric artery and its major branches. A replaced right hepatic artery arises from the proximal portion of the superior mesenteric artery. No source of bleeding or active extravasation was identified in the visualized portions of the superior mesenteric artery territory. Celiac arteriography demonstrates the splenic artery, left gastric artery and common hepatic artery to arise from the celiac artery. The left hepatic artery arises from the common hepatic artery. The gastroduodenal artery arises from the common hepatic artery. The celiac artery and its major branches are patent. Active extravasation or potential source of bleeding from the celiac artery territory was not identified. The imaging was carried out into the venous phase and the splenic vein, main and right and left main portal veins are patent. Gastroduodenal arteriography demonstrates patency of the right gastroepiploic artery and the superior pancreaticoduodenal arteries. Common hepatic arteriography post-embolization demonstrates ongoing patency of the downstream portion of the common hepatic artery and the left hepatic artery. The proximal stump of the gastroduodenal artery is patent. The coil embolization was performed from the origin of the gastroepiploic artery back to near the origin of the gastroduodenal artery. On this arteriogram, a small branch arising from the proximal gastroduodenal artery was still perfused. Attempts to reenter the gastroduodenal artery stump to embolize this branch were unsuccessful. There were no immediate complications. IMPRESSION: No arterial source of bleeding identified on celiac arteriography and superior mesenteric arteriography (with imaging focused on the superior half of the bowel). Based on the history of a duodenal ulcer with blood clot at a prior upper endoscopy at an outside hospital and the findings of the diagnostic arteriograms, it was determined that the patient may benefit from and was a suitable candidate for gastroduodenal artery embolization. This was performed with a residual small branch of the proximal gastroduodenal artery not occluded. At the time of the final angiographic run, there was still some perfusion through the superior coils into another branch of the gastroduodenal artery as well. . [**5-10**] EGD: Indications: melena Previously documented duodenal ulcer, presumably bleeding, documentation of bleeding source and potential therapy needed Procedure: The procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. The physical exam was performed. Conscious sedation was initiated by the physician. [**Name10 (NameIs) 66625**] pulse oximetry and cardiac and blood pressure monitoring were used throughout the procedure. The patient was placed in the left lateral decubitus position and an endoscope was introduced through the mouth and advanced under direct visualization until the crico-pharyngeal region was reached. The vocal cords were visualized. There were no complications. Findings: Esophagus: Excavated Lesions On each attempt to intubate the patient, the scope passed the upper esophageal sphincter and entered a broad cavity without exit, presumably a Zenker's diverticulum with large opening. Multiple attempts were made, with the neck flexed and hyperextended, the patient supine and left lateral decubitis, and after failed attempts to pass [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 66626**] dilator as a guide. Although a previous endoscopy had successfully entered the esophagus, we were unable to do so. Impression: Presumed Zenker's diverticulum in the crico-pharyngeus, preventing passage of the scope into the esophagus Recommendations: In order to intubate the esophagus, we will need some guide into the esophagus. Consider passing an NG tube with the aid of flouoroscopy, anesthesia, or thoracic surgery. In the meantime, consider other techniques to document bleeding site and intervene, such as angiography (and if appropriate, a bleeding scan). Brief Hospital Course: A/P: 85 y/o M w/recent duodenal ulcer and pneumonia who presents with BRBPR and anemia. * #. GI bleed: With a known source of duodenal ulcer, it was most likely source of patient's BRBPR. Unfortunately NG lavage or EGD could not confirm an active bleeding. Lower source (ischemic colitis from hypotension, colon Ca given longstanding anemia etc) remains in the differential. Pt. was transfused a total of 4 units PRBCs [**Date range (1) 8305**]. After failed EGD [**2-3**] esophageal diverticulum, patient underwent IR embolization of gastroduodenal artery but also without visualization of active bleeding. Of note there was partial vascularization of gastroduodenal (one of the branches) that remained in tact. Patient's Hct remained stable since the procedure with a range of 28-30 and patient's stools were guiac negative. Patient was initially continued on IV protonix [**Hospital1 **] and then switche to PO BID. Patient was also given vitamin K for reversible coagulopathy. Patient will need an outpatient colonoscopy to r/o Ca and r/o other causes of lower GI bleed. * #. Multilobar pneumonia - patient with no evidence of aspiration on video swallow. Patient with chest CT showing multifocal opacities as well as sputum culture growing pan-sensitive Klebsiella. Patient completed a 14 days course of ceftriaxone and flagyl during his hospitalization. He remained afebrile throughout his course and his WBC was within normal limits and with a downward trend. Patient did have low grade fevers 24 hours prior to discharge and was pancultured again. His UA was unremarkable, his foley was changed, and his BCx were negative and CXR prior to discharge only showed resolving PNA. Low grade fevers may also be due to grade 2 sacral ulcer or atelectatisis. * # Esophageal/Pharyngeal diverticulum - large diverticulum is noted in the pharynx. Difficult to determine type of diverticulum (Zenker's versus Killian-[**Last Name (un) 66624**]). Solid and liquids were observed to collect within diverticulum along with backflow swallow following throat clearing during video swallow. GI service also had similar findings during their two failed EGDs when the scope ended up in the blind pharyngeal pouch below first esophageal sphincter. With consultation of ENT and GI service it was felt that the patient may f/u with ENT, Dr. [**Last Name (STitle) 66627**], for potential outpatient esophagoscopy and there was no acute need for surgical intervention due to no evidence of aspiration and patient poor but improving pulmonary status. . # Urinary retention - patient with trouble voiding completely after removal of the foley resulting in 1000 cc Urinary retention. Patient's symtpoms were relieved with foley insertion. Patient may improve with further conditioning and may benefit from flomax initiation. He may need a future urology evaluation and should f/u with them. . # AFib: currently well-controlled, tolerating metoprolol well. Patient cannot have anticoagulation due to his history of severe GIB.ECG without ischemic changes. * #. Hx alcohol abuse: Was on CIWA scale while in here before, currently out of withdrawal window. -thiamine, folate * #. Elevated INR: Has been during this and prior admission (generally between 1.3-1.4). Received vitamin K for INR >1.5. Pt. received FFP last night in the setting of ongoing bleed. Etiology felt to be nutritional deficiency (+/- liver disease from alcoholism.) Likely also compounded by abx use. * #. Full Code. Complex social situation: his wife is apparently an alcoholic, and he is her caregiver. They have neighbors with whom they are very close, and the [**Last Name (STitle) **] is the primary contact who will communicate with the wife. [**Name (NI) **] is [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 66628**] [**Telephone/Fax (1) 66629**]. Medications on Admission: Meds at rehab: levofloxacin (to finish 14-day course) flagyl (to finish 14-day course) levothyroxine thiamine folate metoprolol 50 [**Hospital1 **] multivitamin albuterol/atrovent nebs prn Discharge Medications: 1. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 5. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 6. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 8. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day). 9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day): Hold for SBP<100, HR<55 . 10. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 11. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO qAM. 12. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO at bedtime for 2 months. Discharge Disposition: Extended Care Facility: [**Hospital **] Medical Center - [**Hospital1 3597**] Discharge Diagnosis: Upper GI bleeding due to presumed duodenal ulcer s/p gastroduodenal artery coiling Resolving multilobar PNA - L lower lobe, lingula, L upper lobe; R upper and middle lobes Esophageal diverticulum Urinary Retention Atrial Fibrilation Anemia - chronic EtOH abuse Hypothyroidism Discharge Condition: stable Hct, guiac negative stool, patient requiring assistance with ambulation, oxygenating well on RA. Discharge Instructions: Please take all your medications as instructed. Please seek immediate medical attention if you have fevers/chills, nausea, increasing cough or chest pain or shortness of breath. Please watch for any signs of bleeding. If you have recurrent bright red blood per rectum, or bloody emesis/vomit you will need to seek immediate medical attention. You may need Hct check next week and then in a month while patient is on [**Hospital1 **] protonix. Please follow up with ENT, Dr. [**Last Name (STitle) 66627**], to evaluate potential surgical intervention regarding your esophageal diverticulum. You may also need to see urology if your symtpoms of urinary retention don't improve despite medical management such as flomax. Followup Instructions: Please follow up with [**Last Name (STitle) 66439**] in [**1-3**] weeks after your discharge from rehab. Please call [**Telephone/Fax (1) 65735**]. . Follow up with gastroenterology. You will need OP colonoscopy. [**Hospital1 18**] gastroenterology clinic number is ([**Telephone/Fax (1) 8892**]. You can also ask your PCP for GI offices closer to your home. . Follow up with ENT as an outpatient for Zenker's repair. Dr. [**First Name (STitle) **] can be reached @ ([**Telephone/Fax (1) 7767**]. . Follow up with urology for urinary retention. [**Hospital 159**] clinic @ [**Hospital1 18**] number is ([**Telephone/Fax (1) 772**]. Completed by:[**2152-5-18**]

532,285,427,482,707,788,286,305,276,428,244,530,719

{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Pressure ulcer, lower back,Retention of urine, unspecified,Acquired coagulation factor deficiency,Alcohol abuse, unspecified,Hypovolemia,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Diverticulum of esophagus, acquired,Pain in joint, ankle and foot'}

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: cc:[**CC Contact Info 18195**] PRESENT ILLNESS: HPI: 85 y/o M w/recent MICU admission for GI bleed, discharged [**5-8**] to rehab, who was admitted to ICU on [**5-9**] from rehab with BRBPR. During his prior hospitalization , he was admitted to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**4-27**] with weakness, and a Hct of 21. Patient underwent an EGD x 2, which both times revealed a large duodenal ulcer with overlying clot. Interventional was unable to be completed due to techinical difficulties. Patient subsequently failed to respond to transfusion appropriately without a significant drop in his Hct. He required a total of 12U PRBCs and 4U FFP. He was transferred to [**Hospital1 18**] on [**2152-5-2**] for further management and question of surgical intervention. Before transfer, his course at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] was complicated by hypoxemic respiratory failure requiring intubation (felt to be due to volume overload from the transfusions vs aspiration pna), and hypotension requiring pressors (which occurred after receiving propofol for sedation). MEDICAL HISTORY: Hypothyroidism Duodenal ulcer as above Afib Anemia Alcohol abuse MEDICATION ON ADMISSION: Meds at rehab: levofloxacin (to finish 14-day course) flagyl (to finish 14-day course) levothyroxine thiamine folate metoprolol 50 [**Hospital1 **] multivitamin albuterol/atrovent nebs prn ALLERGIES: Penicillins PHYSICAL EXAM: PE: T: 101.1 BP: 136/44 P: 75 R: 25 O2 sat: 97% on Gen: elderly male lying in bed under 5 blankets, shivering, coughing HEENT: pale sclerae, MM dry Neck: supple Lungs: rhonchorous anteriorly CV: tachycardic, irregular, no m/r/g Abd: soft, nt/nd. +bs. Ext: chronic venous stasis changes of BLE with 1-2+ BLE edema Neuro: oriented to person, place (hospital), but not time (thinks it is [**2112-4-1**]) FAMILY HISTORY: FH: NC SOCIAL HISTORY: SH: Large EtOH use, 2 shots of bourbon per night with a few glasses of wine. Never had EtOH W/D. No cigarette use - quit [**2100**] after 15 year smoking x 4 ppd. Lives @ home w/wife who he takes care of. He does the cooking in the house. Married x 55 years. No children but have a friend, [**Name (NI) **] [**Name (NI) 66618**], whom they consider to be their son. [**Name (NI) **] is the next in line after his wife per the durable power of attorney form. - [**Last Name (un) **] [**Known lastname **] (their home #) [**Telephone/Fax (1) 66619**] - [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 66618**] - [**Telephone/Fax (1) 66620**] ### Response: {'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Pressure ulcer, lower back,Retention of urine, unspecified,Acquired coagulation factor deficiency,Alcohol abuse, unspecified,Hypovolemia,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Diverticulum of esophagus, acquired,Pain in joint, ankle and foot'}

CHIEF COMPLAINT: Chest and jaw pain PRESENT ILLNESS: this 62 year old caucasian female presented to the emergency room with the sudden onset o fchest pain readiating to her jaw at 1100 hours the day of admission. The pain resolved, however, she developed epigastric discomfort and general malaise. MEDICAL HISTORY: raynaud's disease ADHD s/p laminectomy for spinal stenosis s/p TAH brachial plexus injury-left MEDICATION ON ADMISSION: Estratest, Adderall, ibuprofen ALLERGIES: Morphine PHYSICAL EXAM: Admission VS T HR70 BP93/42 RR16 02sat 99%RA Gen comfortable HEENT NCAT/EOMI, OP-wnl Pulm CTA CV RRR, nl S1-S2 Abdm soft, NT/ND Ext no C/C/E Neuro speach fluent sternum stable FAMILY HISTORY: Mother had [**Name (NI) 2481**] Father had [**Name2 (NI) 499**] cancer SOCIAL HISTORY: 1.5 oz Vodka/D lactose intolerance nonsmoker retired psychiatrist

Dissection of aorta, thoracic,Unspecified pleural effusion,Vascular disorders of kidney,Attention deficit disorder with hyperactivity,Raynaud's syndrome,Brachial plexus lesions,Other iatrogenic hypotension

Dsct of thoracic aorta,Pleural effusion NOS,Renal vascular disorder,Attn deficit w hyperact,Raynaud's syndrome,Brachial plexus lesions,Iatrogenc hypotnsion NEC

Admission Date: [**2124-10-1**] Discharge Date: [**2124-10-6**] Date of Birth: [**2059-8-11**] Sex: F Service: CARDIOTHORACIC Allergies: Morphine Attending:[**First Name3 (LF) 922**] Chief Complaint: Chest and jaw pain Major Surgical or Invasive Procedure: Ascending aorta replacement (26MM Gelweave graft) Resuspension of aortic valve History of Present Illness: this 62 year old caucasian female presented to the emergency room with the sudden onset o fchest pain readiating to her jaw at 1100 hours the day of admission. The pain resolved, however, she developed epigastric discomfort and general malaise. A CTA demonstrated mural thrombus with some contrast within the clot. This involved the ascending and descending aorta tothe renal arteries. She was seen by cardiac surgery and taken emergently to the operating room. Past Medical History: raynaud's disease ADHD s/p laminectomy for spinal stenosis s/p TAH brachial plexus injury-left Social History: 1.5 oz Vodka/D lactose intolerance nonsmoker retired psychiatrist Family History: Mother had [**Name (NI) 2481**] Father had [**Name2 (NI) 499**] cancer Physical Exam: Admission VS T HR70 BP93/42 RR16 02sat 99%RA Gen comfortable HEENT NCAT/EOMI, OP-wnl Pulm CTA CV RRR, nl S1-S2 Abdm soft, NT/ND Ext no C/C/E Neuro speach fluent sternum stable Pertinent Results: [**2124-10-1**] 09:47PM WBC-10.9 RBC-2.69*# HGB-8.2* HCT-23.8* MCV-88 MCH-30.6 MCHC-34.6 RDW-13.6 [**2124-10-1**] 09:47PM PLT COUNT-261 [**2124-10-1**] 09:47PM PT-15.3* PTT-49.4* INR(PT)-1.3* [**2124-10-1**] 12:30PM ALT(SGPT)-17 AST(SGOT)-25 CK(CPK)-123 ALK PHOS-62 TOT BILI-0.5 [**2124-10-1**] 12:30PM GLUCOSE-121* UREA N-28* CREAT-1.1 SODIUM-135 POTASSIUM-4.2 CHLORIDE-101 TOTAL CO2-24 ANION GAP-14 [**2124-10-1**] 12:30PM cTropnT-<0.01 [**Known lastname 107018**],[**Known firstname 107019**] [**Medical Record Number 107020**] F 65 [**2059-8-11**] Radiology Report CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2124-10-1**] 1:39 PM [**Last Name (LF) 4758**],[**First Name3 (LF) 2353**] EU [**2124-10-1**] SCHED CTA CHEST W&W/O C&RECONS, NON-; CTA ABD W&W/O C & RECONS; CTA PELVIS W&W/O C & RECONS Clip # [**Clip Number (Radiology) 107021**] Reason: Please evaluate for aortic dissection Contrast: OPTIRAY [**Hospital 93**] MEDICAL CONDITION: 65 year old woman with no sig PMH, present with acute onset of severe chest pain, radiating to the back, started with valsalva. REASON FOR THIS EXAMINATION: Please evaluate for aortic dissection CONTRAINDICATIONS FOR IV CONTRAST: None. Wet Read: JXKc SUN [**2124-10-1**] 2:42 PM Acute intramural hematoma that begins at the aortic origin, involving the ascending and descending aortas. Emergent surgical eval recommended. d/w Dr. [**Last Name (STitle) **]. Final Report HISTORY: 65-year-old female with no significant past medical history who presents with acute onset of severe chest pain radiating to the back, started with Valsalva. Evaluate for aortic dissection. No prior studies available for comparison. TECHNIQUE: MDCT axial images were obtained from the thoracic inlet to the symphysis pubis with administration of IV contrast. Coronal and sagittal reformations were obtained. CTA AORTA: There is an acute intramural hematoma, originating from the aortic root, and extending to involve the thoracic ascending aorta as well as the descending aorta to the level of the aortic bifurcation in the abdomen. There is a focal puddling of contrast within an intramural location (3:15) in the descending thoracic aorta, as well as at the level of the renal arteries (3:54) on the right. The celiac artery, SMA, and renal arteries originate from the true lumen. CT OF THE CHEST WITH IV CONTRAST: The heart and pericardium reveal no evidence of a hemopericardium or pericardial effusion. There are no pathologically enlarged mediastinal, hilar, or axillary lymph nodes. Within the lungs, there is a focus of ill-defined airspace opacity anteriorly within the right upper lobe (3:19), likely infectious or inflammatory in nature. In addition, there is a 4-mm nodule within the right upper lobe (3:27), as well as a tiny pleural-based nodule within the right middle lobe (3:38). Otherwise, the lungs are clear. CT OF THE ABDOMEN WITH IV CONTRAST: The liver, gallbladder, spleen, pancreas, adrenal glands, and left kidney are normal. Peripheral wedge shaped hypodensities in the right kidney are concerning for renal infarcts. The stomach, small bowel, and large bowel are within normal limits. There is no free air, free fluid or pathologic adenopathy. CT OF THE PELVIS WITH IV CONTRAST: Urinary bladder, rectum, and uterus are unremarkable. There is no pelvic free fluid or adenopathy. OSSEOUS STRUCTURES: There are severe multilevel degenerative changes of the lumbar spine, with scoliosis and a Grade 2 anterolisthesis of L4 on L5. IMPRESSION: 1. Acute intramural hematoma involving the ascending and descending aorta, originating from the aortic root. A focus of contrast is seen in an intramural location within the descending thoracic aorta as well as at the level of the renal arteries. Emergent surgical evaluation recommended. 2. Segmental right renal infarct. Findings were discussed immediately with Dr. [**Last Name (STitle) **] and immediately posted to the ED dashboard. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] DR. [**First Name (STitle) 3934**] [**Name (STitle) 3935**] [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 107018**], [**Known firstname 107019**] [**Hospital1 18**] [**Numeric Identifier 107022**] (Complete) Done [**2124-10-1**] at 6:33:39 PM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 177**] C. [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2059-8-11**] Age (years): 65 F Hgt (in): 69 BP (mm Hg): / Wgt (lb): 123 HR (bpm): BSA (m2): 1.68 m2 Indication: Aortic dissection. Chest pain. ICD-9 Codes: 441.00, 786.51 Test Information Date/Time: [**2124-10-1**] at 18:33 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Last Name (NamePattern5) 9958**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2008AW5-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Ejection Fraction: 40% to 50% >= 55% Aorta - Sinus Level: 3.6 cm <= 3.6 cm Aorta - Ascending: 3.2 cm <= 3.4 cm Aorta - Arch: 2.0 cm <= 3.0 cm Aortic Valve - Peak Velocity: *9.2 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: 7 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 4 mm Hg Aortic Valve - Valve Area: *2.0 cm2 >= 3.0 cm2 Findings The is an ascending aortic intramural hematoma beginning at the origin of the coronary arteries and extending at least to the level of the takeoff of the subclavian arteries. Flow in the RCA and LMCA was verified by using color doppler. There was no dissection flap seen. LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Normal regional LV systolic function. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Normal ascending aorta diameter. Normal aortic arch diameter. Normal descending aorta diameter. Simple atheroma in descending aorta. Ascending aortic intimal flap/dissection.. Thickened aortic wall c/w intramural hematoma. AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Moderate (2+) AR. MITRAL VALVE: Normal mitral valve leaflets. No MS. [**Name13 (STitle) **] MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions PRE BYPASS 1. The left atrium is normal in size. 2. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size and free wall motion are normal. 4. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Moderate (2+) aortic regurgitation is seen. 5. The mitral valve leaflets are structurally normal. No mitral regurgitation is seen. 6. There is no pericardial effusion. POST BYPASS 1. There is mild to moderate aortic regurgitation. 2. The synthetic graft is seen with its origin at the sinotubular junction. There is no apparent leak. 3. Left ventricular function is unchanged. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2124-10-2**] 15:27 Brief Hospital Course: After evaluation and review of studies, the patient was taken emergently to the OR where circumferential clot was found in the ascending aorta, with out an obvious intimal tear. The ascending aorta was replaced with a 26mm Gelweave graft and the aortic valve was resuspended. Circulatory arrest was utilized for a 20 minute period. See operative note for details. She weaned from CPB easily and Propofol alone. She was coagulopathic and was corrected with slowing of bleeding. She remained hemodynamically stable after surgery. On the morning after surgey she self-extubated. Her chest tubes and epicardial wires were removed. She was transferred to the surgical step-down floor. Her beta-blockade was titrated up as tolerated. She was ready for discharge to home on post-operative day 5. Medications on Admission: Estratest, Adderall, ibuprofen Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. 5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 6. Amphetamine-Dextroamphetamine 5 mg Tablet Sig: Four (4) Tablet PO daily (). 7. Estratest 1.25-2.5 mg Tablet Sig: One (1) Tablet PO once a day. 8. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for pain. 9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 5 days. Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Type A Thoracic aortic dissection s/p Asc Ao replacement Raynaud's disease brachial plexus injury attention deficit hyperactivity disorder s/p hysterectomy s/p spinal stensosis surgery Discharge Condition: good Discharge Instructions: no lifting more than 10 pounds for 10 weeks no driving for 4 weeks and off all narcotics shower daily, no baths or swimming no lotions, creams or powders to incisions report any temperature greater than 100.5. report anyredness or drainage from incisions take all medications as directed Followup Instructions: [**Hospital 409**] clinic in 2 weeks Dr [**First Name (STitle) **] [**Name (STitle) 107023**] (PCP) ([**Telephone/Fax (1) 107024**] in [**2-6**] weeks Dr. [**Last Name (STitle) 914**] in 3 months with a CT scan with MMS protocol and en echocardiogram ([**Telephone/Fax (1) 170**]) Completed by:[**2124-10-6**]

441,511,593,314,443,353,458

{"Dissection of aorta, thoracic,Unspecified pleural effusion,Vascular disorders of kidney,Attention deficit disorder with hyperactivity,Raynaud's syndrome,Brachial plexus lesions,Other iatrogenic hypotension"}

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 and jaw pain PRESENT ILLNESS: this 62 year old caucasian female presented to the emergency room with the sudden onset o fchest pain readiating to her jaw at 1100 hours the day of admission. The pain resolved, however, she developed epigastric discomfort and general malaise. MEDICAL HISTORY: raynaud's disease ADHD s/p laminectomy for spinal stenosis s/p TAH brachial plexus injury-left MEDICATION ON ADMISSION: Estratest, Adderall, ibuprofen ALLERGIES: Morphine PHYSICAL EXAM: Admission VS T HR70 BP93/42 RR16 02sat 99%RA Gen comfortable HEENT NCAT/EOMI, OP-wnl Pulm CTA CV RRR, nl S1-S2 Abdm soft, NT/ND Ext no C/C/E Neuro speach fluent sternum stable FAMILY HISTORY: Mother had [**Name (NI) 2481**] Father had [**Name2 (NI) 499**] cancer SOCIAL HISTORY: 1.5 oz Vodka/D lactose intolerance nonsmoker retired psychiatrist ### Response: {"Dissection of aorta, thoracic,Unspecified pleural effusion,Vascular disorders of kidney,Attention deficit disorder with hyperactivity,Raynaud's syndrome,Brachial plexus lesions,Other iatrogenic hypotension"}

CHIEF COMPLAINT: Residual colostomy from diverticular perforation Giant abdominal Hernia residual from dehiscence with open abdomen. PRESENT ILLNESS: This is a 72-year-old man who presented three months ago with perforated diverticulitis and severe peritonitis. He had a Hartmann's procedure for this. He developed an open abdomen 2' to abdominal sepsis. This was eventually closed with full thickness skin flaps. After discharge he also developed a retracted colostomy with stenosis of the skin aperture. Therefore, he is now taken for a colostomy take-dow. This is much earlier than would be normally be planned due to the expectation of a 'hostile abdomen'. MEDICAL HISTORY: PMH: HTN, CAD s/p CABG, BPH, Diverticulosis s/p sigmoid resection, AFib (on coumadin), DVT MEDICATION ON ADMISSION: 1. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. 2. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 3. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO BID (2 times a day). 4. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for sleep. 5. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: Morphine / Haldol PHYSICAL EXAM: (at discharge) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with family, works part time as an Optometrist. No tobacco use.

Attention to colostomy,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Old myocardial infarction,Esophageal reflux

Atten to colostomy,Peritoneal adhesions,Incisional hernia,Dvrtclo colon w/o hmrhg,Hypertension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,BPH w/o urinary obs/LUTS,Atrial fibrillation,Long-term use anticoagul,Hx-ven thrombosis/embols,Old myocardial infarct,Esophageal reflux

Admission Date: [**2154-5-31**] Discharge Date: [**2154-6-6**] Date of Birth: [**2081-6-6**] Sex: M Service: SURGERY Allergies: Morphine / Haldol Attending:[**First Name3 (LF) 4691**] Chief Complaint: Residual colostomy from diverticular perforation Giant abdominal Hernia residual from dehiscence with open abdomen. Major Surgical or Invasive Procedure: [**2154-5-31**] [**Doctor Last Name **] reversal History of Present Illness: This is a 72-year-old man who presented three months ago with perforated diverticulitis and severe peritonitis. He had a Hartmann's procedure for this. He developed an open abdomen 2' to abdominal sepsis. This was eventually closed with full thickness skin flaps. After discharge he also developed a retracted colostomy with stenosis of the skin aperture. Therefore, he is now taken for a colostomy take-dow. This is much earlier than would be normally be planned due to the expectation of a 'hostile abdomen'. Past Medical History: PMH: HTN, CAD s/p CABG, BPH, Diverticulosis s/p sigmoid resection, AFib (on coumadin), DVT PSH: Hartmann's ([**1-/2154**]) c/b dehiscence, Wound Closure 3/[**2153**]. AAA repair [**2146**], CABG [**2127**] Social History: Lives with family, works part time as an Optometrist. No tobacco use. Family History: Non-contributory Physical Exam: (at discharge) NAD/AAO, pleasant gentleman in afib, regular rate CTA b/l soft, nondistended abdomen, with midline incision, no erythema, no drainage no peripheral edema Brief Hospital Course: The patient was admitted to the surgical service to a floor bed after his surgery. He was initially kept NPO and his diet was slowly advanced as tolerated once he was passing flatus. He remained afebrile with a normal WBC and his wound had no signs of infection. His pain was initially controlled with a pca and this was converted to oral medications once he was taking oral intake. At time of discharge he was ambulating without difficulty, tolerating a regular diet, and passing flatus. Medications on Admission: 1. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. 2. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 3. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO BID (2 times a day). 4. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for sleep. 5. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Medications: 1. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. 2. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 3. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO BID (2 times a day). 4. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for sleep. 5. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation: Take as needed for constipation while taking pain medication. Disp:*30 Capsule(s)* Refills:*0* 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. hydrocodone-acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: Reversal of [**Doctor Last Name 3379**] pouch 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 reversal of your colostomy. Please call your doctor or nurse practitioner or return to the Emergency Department for any of 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. 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 [**4-30**] lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. 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 staples, they will be removed at your follow-up appointment. Followup Instructions: Please follow up with the Acute Care Service next week for removal of your staples. You can schedule this appointment by calling # [**Telephone/Fax (1) 600**] Please follow-up with your PCP as usual for monitoring of your INR (coumadin level).

V553,568,553,562,401,414,V458,600,427,V586,V125,412,530

{'Attention to colostomy,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Old myocardial infarction,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: Residual colostomy from diverticular perforation Giant abdominal Hernia residual from dehiscence with open abdomen. PRESENT ILLNESS: This is a 72-year-old man who presented three months ago with perforated diverticulitis and severe peritonitis. He had a Hartmann's procedure for this. He developed an open abdomen 2' to abdominal sepsis. This was eventually closed with full thickness skin flaps. After discharge he also developed a retracted colostomy with stenosis of the skin aperture. Therefore, he is now taken for a colostomy take-dow. This is much earlier than would be normally be planned due to the expectation of a 'hostile abdomen'. MEDICAL HISTORY: PMH: HTN, CAD s/p CABG, BPH, Diverticulosis s/p sigmoid resection, AFib (on coumadin), DVT MEDICATION ON ADMISSION: 1. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. 2. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 3. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO BID (2 times a day). 4. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for sleep. 5. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: Morphine / Haldol PHYSICAL EXAM: (at discharge) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with family, works part time as an Optometrist. No tobacco use. ### Response: {'Attention to colostomy,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Old myocardial infarction,Esophageal reflux'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 72-year-old gentleman with a past medical history of hypertension, a 50-year smoking history, alcohol abuse, and chronic obstructive pulmonary disease who presented to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1888**] with a large polyp in the right colon. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Benign neoplasm of colon,Mechanical complication due to other implant and internal device, not elsewhere classified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute alcoholic intoxication in alcoholism, continuous,Intestinal infection due to Clostridium difficile,Alcoholic cirrhosis of liver

Benign neoplasm lg bowel,Malfunc oth device/graft,Atrial fibrillation,Acute respiratry failure,Chr airway obstruct NEC,Ac alcohol intox-contin,Int inf clstrdium dfcile,Alcohol cirrhosis liver

Admission Date: [**2122-10-20**] Discharge Date: [**2122-11-27**] Date of Birth: [**2050-4-2**] Sex: M Service: Surgery, Green Team HISTORY OF PRESENT ILLNESS: The patient is a 72-year-old gentleman with a past medical history of hypertension, a 50-year smoking history, alcohol abuse, and chronic obstructive pulmonary disease who presented to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1888**] with a large polyp in the right colon. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: He was taken to the operating room on [**2122-10-20**] for a right colectomy. This operation went smoothly. An ileocecectomy was done with an end-to-side ileotransverse colon anastomosis (hand sewn). There were no operative complications. The patient was kept intubated overnight on the first night due to marginal respiratory effort. He was extubated on postoperative day one. In the afternoon on postoperative day one, he was noted to be tachycardic and agitated. A workup indicated that at that point he had entered delirium tremens. The dictation from this point on will cover his protracted hospital course by systems for simplicity sake. 1. NEUROLOGIC ISSUES: The patient was started on Ativan for his delirium tremens, and this Ativan was required for extreme agitation for a number of weeks. He was very slowly tapered off the Ativan. At this point, he was maintained on clonidine and as needed Haldol for his agitation. He has also been diagnosed with metabolic encephalopathy and has a variable examination; at times only tracking with his eyes but not following commands and at other times attempting to speak and following commands. Neurologically, he also had a fall out of bed in early [**Month (only) 359**]. A full workup was done for that including a head computed tomography and a head and neck magnetic resonance imaging; all of which were negative. A cervical spine collar was removed after Orthopaedics approved his studies. 2. CARDIOVASCULAR ISSUES: From a cardiovascular standpoint, he flipped into atrial fibrillation at the time of the onset of his delirium tremens. He was started on amiodarone and Lopressor, and his heart rate was controlled well. He actually converted to a sinus rhythm on [**11-27**]. The amiodarone and Lopressor were to be continued. 3. RESPIRATORY ISSUES: The patient has respiratory failure. He was reintubated after his surgery on the night on postoperative day one. Eventually, his family agreed to a tracheostomy which was performed on [**2122-11-20**]. Currently, the patient is in continuous positive airway pressure mode on a ventilator with pressure support at 15, and positive end-expiratory pressure at 10, with 40% FIO2, and his blood gastric on these settings was satisfactory. He is on slow pressure support wean at this time. 4. GASTROINTESTINAL ISSUES: From a gastrointestinal standpoint, he underwent a right colectomy. The pathology report showed that his cecal polyp was an adenoma. He was tolerating tube feeds at goal through a percutaneous endoscopic gastrostomy tube which was also placed on [**2122-11-20**]. His tube feed rate is 85 cc per hour; which is goal. 5. GENITOURINARY ISSUES: The patient has maintained a normal blood urea nitrogen and creatinine. He has adequate urine output. He had a Foley catheter in place which was draining clear yellow urine. He has received Lasix on a regular basis to keep him at an even to slightly negative fluid balance. 6. INFECTIOUS DISEASE ISSUES: From an Infectious Disease standpoint, the patient is currently on tobramycin and meropenem as coverage for Campylobacter and Pseudomonas pneumonia. These two antibiotics are infusing through a right antecubital peripherally inserted central catheter line; his only intravenous access, and they should be continued for a full 14-day course (which ends on [**2122-12-13**]). 7. HEMATOLOGIC ISSUES: The patient was being anticoagulated for his atrial fibrillation. He has received Coumadin, and his INR is currently 1.6. MEDICATIONS ON DISCHARGE: (His current medications are) 1. Insulin sliding-scale which has not been needed. 2. Lansoprazole 30 mg by mouth once per day. 3. Amiodarone 400 mg per PEG-tube once per day. 4. Clonidine 0.4 mg per PEG-tube three times per day. 5. Lopressor 25 mg per PEG-tube twice per day. 6. Coumadin 5 mg for the last two days; to be dosed according to INR. 7. Haldol as needed. 8. Lasix as needed. 9. Tobramycin and meropenem intravenously. DISCHARGE DISPOSITION: At this point, he is deemed appropriate for ventilatory rehabilitation and will be allowed to be transferred when he is accepted at an appropriate institution. [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1890**] Dictated By:[**Last Name (NamePattern1) 7589**] MEDQUIST36 D: [**2122-11-27**] 10:06 T: [**2122-11-27**] 10:09 JOB#: [**Job Number 49325**] Name: [**Known lastname 1511**], [**Known firstname 947**] Unit No: [**Numeric Identifier 9144**] Admission Date: [**2122-10-20**] Discharge Date: [**2122-12-11**] Date of Birth: [**2050-4-2**] Sex: M Service: ADDENDUM: Please see the prior discharge summary, ending [**11-27**]. This addendum is for the dates [**11-27**] to [**12-11**]. This gentleman had been slowly improving on [**2122-11-27**], at the time of the previous discharge summary. His temperature maximum on [**11-27**] was 100.8 and he was on Tobramycin and Meropenem, days 5 and 14. He was on p.o. Amiodarone, Clonidine, Lopressor, Diamox, Benadryl and Coumadin. He had an magnetic resonance imaging scan of his neck and spine on [**2122-11-27**]. The results of this were negative for any ligamentous injury. It was thought at that time that he would need a soft collar if possible. This will be continued until he is able to state that he does not have any subjective tenderness or for six weeks. On [**11-27**], his arterial line was also discontinued. On [**2122-11-28**], he continued to do moderately well. His white count was 15,000, his hematocrit was 27.7. He was continued on his antibiotics. We continued to attempt to wean his ventilator. His chest x-ray was consistent with atelectasis and pneumonia at that time. On [**2122-11-29**], Mr. [**Known lastname **] developed an increasing white count with fever and abdominal distention. A computerized tomography scan done revealed free air. His white count increased to 20,000. He also revealed a whole in his stomach where the gastrostomy tube pulled away from the abdominal wall. On [**2122-11-29**], the patient was taken to the Operating Room with a preoperative diagnosis of gastric perforation. Because of the pain he underwent a procedure of repair of gastric perforator with placement of a feeding jejunostomy tube. Findings at the time revealed the perforation of the gastrostomy tube site. The stomach had pulled away from the tube. There was on abrasion to the abdominal wall and he received 2.5 liters of fluid and his urine output was 120. Subsequent to this he was returned to the Post Anesthesia Care Unit. He was closely monitored at that time. He received Morphine for pain. The Lopressor was increased as his blood pressure tolerated for the atrial fibrillation. A new subclavian intravenous line was placed. He was continued on antibiotic. He tolerated this procedure well and rapidly improved. On postoperative day #1, he received 3 units of packed cells and 1 unit of fresh frozen plasma. (This was postoperative day 0 and postoperative day 1.) He did tolerate his resuscitation and steadily improved over the next few postoperative days without any notable setbacks. He continued to be agitated but was responsive. His breathsounds were coarse and his abdomen was soft. His wound continued to heal. On [**12-2**] he did well, tube feeds were started. He received Lasix to assist in diuresis. He was continued on antibiotics. He was continued on ventilatory support. On [**2122-12-2**], a quad central venous line was placed over a wire. He continued to do well and his management was maintained. He was seen by the infectious disease personnel who recommended a three week course of Tobramycin and Zosyn, in addition to a four week course of Flagyl to cover him for his Clostridium difficile which did culture out on [**2122-12-5**]. On [**2122-12-5**], he was postoperative day 46 and 6, he was on Zosyn, Flagyl, Vancomycin and Tobramycin. After the cultures were negative for coagulase negative Staphylococcus from his line and blood the Vancomycin was discontinued. As mentioned he did rule in for Clostridium difficile and was maintained on Flagyl. He continued to be seen by the Infectious Disease Team who recommended discontinuing the Vancomycin. He continued to receive Flagyl, Tobramycin and Zosyn. He otherwise was started on his Coumadin to reach a therapeutic INR in light of his atrial fibrillation. His abdominal wound did slowly improve and ended up sealing up with no drainage and no erythema. By system at the time of discharge - He was neurologically much improved. He was alert. He was responding to commands. His cardiovascular status was in stable atrial fibrillation with a normal blood pressure. His pulmonary status was on ventilator requiring CPAP with varying degrees of pressure support ranging from 5 to 15 and 5 of positive end-expiratory pressure. His gastrointestinal status was stable and he was tolerating tube feeds intact at 85 cc/hr which was his goal. His renal status was stable. His infectious disease status was that he was to be continued on a total of a three week course of Zosyn and Tobramycin and as of [**2122-12-11**], he was finished on week of that three week course of Tobramycin and Zosyn. He will continue the Flagyl one week beyond the discontinuation of the Tobramycin and Zosyn. DISCHARGE MEDICATIONS: His medications upon discharge include the Tobramycin 350 mg intravenously q. 24 hours, Metronidazole 500 mg via nasogastric tube t.i.d., Zosyn 4.5 gm intravenously q. 8 hours, Benadryl 25 mg intravenously apply to each Zosyn dose, Amiodarone 400 mg via nasogastric tube q.d., Coumadin 5 mg p.o. q.d. with check of his coagulation status and adjustment of his Coumadin doses, Metoprolol 37.5 mg t.i.d. via nasogastric tube, Pepcid 20 mg b.i.d. via nasogastric tube. DISCHARGE DIAGNOSIS: 1. Metabolic encephalopathy 2. Right colon adenoma 3. Hospital-acquired pneumonia 4. Atrial fibrillation 5. Hypovolemia 6. Gastric perforation, secondary to feeding gastric tube DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-911 Dictated By:[**Dictator Info **] MEDQUIST36 D: [**2122-12-10**] 18:27 T: [**2122-12-10**] 19:02 JOB#: [**Job Number 9145**]

211,996,427,518,496,303,008,571

{'Benign neoplasm of colon,Mechanical complication due to other implant and internal device, not elsewhere classified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute alcoholic intoxication in alcoholism, continuous,Intestinal infection due to Clostridium difficile,Alcoholic cirrhosis of liver'}

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 72-year-old gentleman with a past medical history of hypertension, a 50-year smoking history, alcohol abuse, and chronic obstructive pulmonary disease who presented to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1888**] with a large polyp in the right colon. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Benign neoplasm of colon,Mechanical complication due to other implant and internal device, not elsewhere classified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute alcoholic intoxication in alcoholism, continuous,Intestinal infection due to Clostridium difficile,Alcoholic cirrhosis of liver'}

CHIEF COMPLAINT: PRESENT ILLNESS: This very pleasant 29-year-old woman had a temporary loss of consciousness following a fall from a chair. She also had experienced increasing left-sided headaches for many months. MEDICAL HISTORY: The patient is otherwise healthy. MEDICATION ON ADMISSION: ALLERGIES: She is allergic to TYLENOL WITH CODEINE. PHYSICAL EXAM: FAMILY HISTORY: There is no history of family cardiovascular disease or strokes. SOCIAL HISTORY: She is getting married next year. She does not smoke.

Hemangioma of intracranial structures,Accidental fall from chair

Hemangioma intracranial,Fall from chair

Admission Date: [**2122-8-4**] Discharge Date: [**2122-8-7**] Date of Birth: [**2092-9-29**] Sex: F Service: HISTORY OF PRESENT ILLNESS: This very pleasant 29-year-old woman had a temporary loss of consciousness following a fall from a chair. She also had experienced increasing left-sided headaches for many months. A computed tomography scan of the head was obtained. This showed a left-sided frontal skull lesion. A magnetic resonance imaging scan was then obtained. This showed a likely hemangioma. This had completely infiltrated through the inner table of the skull and had expanded the diploic space. There was a small amount of the outer table of the skull remaining. The patient's headaches had been progressive and disabling. She states that for some time she has been able to hear her heart beat in her left hear. She also has had pain in the region of her temporomandibular joint dysfunction. PAST MEDICAL HISTORY: The patient is otherwise healthy. ALLERGIES: She is allergic to TYLENOL WITH CODEINE. SOCIAL HISTORY: She is getting married next year. She does not smoke. FAMILY HISTORY: There is no history of family cardiovascular disease or strokes. PHYSICAL EXAMINATION ON PRESENTATION: On physical examination, the patient was awake and alert. She appeared in no acute distress. She was walking without difficulty. Her neck was had full painless range of motion. Her carotid pulses were 2+ and symmetric. She had severe point tenderness over her left frontal skull just above her left ear. I could not appreciate any bruit. She had no drift. Her reflexes were 2+ and symmetric. Her toes were downgoing. BRIEF SUMMARY OF HOSPITAL COURSE: The patient was taken to the operating room on [**2122-8-4**]. At that time, she had a left frontal craniectomy for removal of the skull lesion. This had been embolized the day before. The lesion was easily removed. A cranioplasty was done at the same time. A Hemovac drain was left in place. Postoperatively, the patient was awake and alert. She had moderate incisional pain. She was up and ambulating. Her drain had minimal output. It was removed on the second postoperatively day. The patient was up and ambulating. She was tolerating oral medication. Her incisional pain diminished. Her postoperative hematocrit was 29. Plans were made to discharge the patient on [**2122-8-7**]. FINAL DISCHARGE DIAGNOSES: Hemangioma of the left frontal bone. CONDITION AT DISCHARGE: Condition on discharge was fair. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient was to keep her wound clean and dry. 2. The patient was to increase her activity as tolerated. 3. The patient was to be seen in followup in 10 days. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3653**], M.D. [**MD Number(1) 3654**] Dictated By:[**Last Name (NamePattern4) 3655**] MEDQUIST36 D: [**2122-8-6**] 18:24 T: [**2122-8-8**] 07:20 JOB#: [**Job Number 13264**]

228,E884

{'Hemangioma of intracranial structures,Accidental fall from chair'}

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 very pleasant 29-year-old woman had a temporary loss of consciousness following a fall from a chair. She also had experienced increasing left-sided headaches for many months. MEDICAL HISTORY: The patient is otherwise healthy. MEDICATION ON ADMISSION: ALLERGIES: She is allergic to TYLENOL WITH CODEINE. PHYSICAL EXAM: FAMILY HISTORY: There is no history of family cardiovascular disease or strokes. SOCIAL HISTORY: She is getting married next year. She does not smoke. ### Response: {'Hemangioma of intracranial structures,Accidental fall from chair'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 74 year old male with moderate aortic stenosis and recent echocardiogram demonstrating [**Location (un) 109**] 1.4 cm2 and reports shortness of breath associated with chest tightness after climbing one flight of stairs and when walking up an incline. He was referred for right and left heart catheterization. He was found to have coronary artery disease and is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: Aortic stenosis, moderate, calculated [**Location (un) 109**] 1.4 cm2 Atrial fibrillation on Pradaxa since [**2149-4-29**] Hypertension Hyperlipidemia Gout (pt not aware, noted in records) Arthritis Cataract, bilateral S/P left knee replacement S/P appendectomy S/p carpal tunnel surgery MEDICATION ON ADMISSION: ATENOLOL 25 mg Daily DABIGATRAN ETEXILATE [PRADAXA] 150 mg [**Hospital1 **] INDOMETHACIN 50 mg TID PRN SIMVASTATIN 20 mg Daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg Capsule - one Capsule Daily ASPIRIN 81 mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse:68 Resp:18 O2 sat:98/RA B/P Right:87/52 Left:83/54 Height:5'[**47**]" Weight:190 lbs FAMILY HISTORY: Premature coronary artery disease - non contributory SOCIAL HISTORY: Race:Caucasian Last Dental Exam:3 months ago, will call dentist to have dental clearance faxed to office Lives with:Wife Contact: [**Name (NI) **] [**Name (NI) 15582**] (wife) Phone# [**Telephone/Fax (1) 110537**] Occupation: Retired elevator mechanic Cigarettes: Smoked no [] yes [x] Hx:quit 40 years ago Other Tobacco use:denies ETOH: Quit one month ago, Former daily ETOH 2-3 beers Illicit drug use:denies

Aortic valve disorders,Atrial flutter,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Unspecified cataract,Anemia, unspecified,Other iatrogenic hypotension

Aortic valve disorder,Atrial flutter,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Gout NOS,Joint replaced knee,Cataract NOS,Anemia NOS,Iatrogenc hypotnsion NEC

Name: [**Known lastname 18101**],[**Known firstname 126**] Unit No: [**Numeric Identifier 18102**] Admission Date: [**2149-5-21**] Discharge Date: [**2149-5-27**] Date of Birth: [**2075-3-3**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 135**] Addendum: Follow up wound check appointment changed to [**2149-6-3**] at 10:15am. Discharge Disposition: Home With Service Facility: [**Location (un) 42**] VNA [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**] Completed by:[**2149-5-27**] Admission Date: [**2149-5-21**] Discharge Date: [**2149-5-27**] Date of Birth: [**2075-3-3**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1406**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: [**2149-5-21**] Coronary artery bypass graft x 4, Aortic valve replacement (25mm tissue) History of Present Illness: 74 year old male with moderate aortic stenosis and recent echocardiogram demonstrating [**Location (un) 109**] 1.4 cm2 and reports shortness of breath associated with chest tightness after climbing one flight of stairs and when walking up an incline. He was referred for right and left heart catheterization. He was found to have coronary artery disease and is now being referred to cardiac surgery for revascularization. Past Medical History: Aortic stenosis, moderate, calculated [**Location (un) 109**] 1.4 cm2 Atrial fibrillation on Pradaxa since [**2149-4-29**] Hypertension Hyperlipidemia Gout (pt not aware, noted in records) Arthritis Cataract, bilateral S/P left knee replacement S/P appendectomy S/p carpal tunnel surgery Social History: Race:Caucasian Last Dental Exam:3 months ago, will call dentist to have dental clearance faxed to office Lives with:Wife Contact: [**Name (NI) **] [**Name (NI) 15582**] (wife) Phone# [**Telephone/Fax (1) 110537**] Occupation: Retired elevator mechanic Cigarettes: Smoked no [] yes [x] Hx:quit 40 years ago Other Tobacco use:denies ETOH: Quit one month ago, Former daily ETOH 2-3 beers Illicit drug use:denies Family History: Premature coronary artery disease - non contributory Physical Exam: Pulse:68 Resp:18 O2 sat:98/RA B/P Right:87/52 Left:83/54 Height:5'[**47**]" Weight:190 lbs General: Skin: Dry [x] intact [x] HEENT: EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Murmur [x] grade 2 systolic Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema [] _____ Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right: p Left: p Radial Right: p Left: p Carotid Bruit Right: - Left: - Pertinent Results: [**5-21**] TEE: LEFT ATRIUM: No spontaneous echo contrast in the body of the LA. Moderate to severe spontaneous echo contrast in the LAA. Depressed LAA emptying velocity (<0.2m/s) Cannot exclude LAA thrombus. All four pulmonary veins identified and enter the left atrium. RIGHT ATRIUM/INTERATRIAL SEPTUM: Mild spontaneous echo contrast in the body of the RA. A catheter or pacing wire is seen in the RA and extending into the RV. No ASD by 2D or color Doppler. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Mild symmetric LVH with normal cavity size and global systolic function (LVEF>55%). RIGHT VENTRICLE: Normal RV systolic function. AORTA: Focal calcifications in aortic root. Mildly dilated ascending aorta. Simple atheroma in ascending aorta. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Moderately thickened aortic valve leaflets. Mild AS (area 1.2-1.9cm2). Moderate AS (area 1.0-1.2cm2) Mild (1+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. No MS. Mild to moderate ([**1-6**]+) MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Written informed consent was obtained from the patient. A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus the patient. Conclusions PRE BYPASS No spontaneous echo contrast is seen in the body of the left atrium. Moderate to severe 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. Mild spontaneous echo contrast is seen in the body of the right atrium. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>55%). The right ventricle displays normal free wall contractility. The ascending aorta is mildly dilated. 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 moderately thickened. The left coronary cusp is essentially immobilized. There is mild to moderate aortic valve stenosis (valve area 1.4 cm2). Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild to moderate ([**1-6**]+) mitral regurgitation is seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at thetime of the study. POST BYPASS The patient is atrially paced. There is normal biventricular systolic function. There is a bioprosthesis located in the aortic position. It is well seated and the leaflets appear to be moving normally. There may be very trace aortic insufficiency though it was seen only after initial separation from bypass and its source could not be determined. The maximum gradient through the valve was 11 mmHg with a mean gradient of 5 mmHg at at cardiac output of 4.6 liters/minute. The mitral regurgitation appears to be slightly improved -now mild. The left atrial appendage has been resected. The thoracic aorta appears intact after decannulation. No other significant change from the pre-bypass period. [**2149-5-26**] 05:31AM BLOOD WBC-7.5 RBC-3.16* Hgb-9.5* Hct-29.4* MCV-93 MCH-30.0 MCHC-32.3 RDW-14.5 Plt Ct-142* [**2149-5-21**] 02:49PM BLOOD WBC-11.8* RBC-2.83* Hgb-8.7* Hct-26.3* MCV-93 MCH-30.8 MCHC-33.1 RDW-13.1 Plt Ct-128* [**2149-5-27**] 04:40AM BLOOD PT-25.7* INR(PT)-2.5* [**2149-5-21**] 08:40AM BLOOD PT-13.7* PTT-23.5* INR(PT)-1.3* [**2149-5-26**] 05:31AM BLOOD Glucose-95 UreaN-22* Creat-0.8 Na-141 K-4.0 Cl-103 HCO3-29 AnGap-13 [**2149-5-21**] 04:04PM BLOOD UreaN-12 Creat-0.7 Na-140 K-4.2 Cl-111* HCO3-23 AnGap-10 Brief Hospital Course: Mr. [**Known lastname 15582**] was a same day admit and brought to the operating room on [**5-21**] where he underwent a coronary artery bypass graft x 4 (LIMA-LAD, SVG-Diag, SVG-PLVa-PDA jump) aortic valve replacement tissue 25mm and LAA ligation. Please see operative note for surgical details. Following surgery he was transferred to the CVICU for invasive monitoring. He was a-paced over Sinus Bradycardia and required Neo and volume for hypotension and low Cardiac Index. He awoke neurologically intact and was extubated without incident. He required neo until POD#3. Mr.[**Known lastname 15582**] has a history of afib/flutter and went back into it on post-op day two. He was mostly in atrial flutter which was rapid at times and his meds were adjusted. He was rapid atrial paced to SR for several hours but returned to a-flutter. He was started briefly on amio but due to hypotension this was discontinued and he was then started on Digoxin with good effect. His pacing wires and Chest Tubes were removed per protocol, without difficulty. He had a slight drop in his platlet count but this has since resolved. On POD #4 he transferred to the floor in rate control atrial flutter and stable condition. He was evaluated by the Physical Therapy department for strength and mobility.The remainder of his hospital course was essentially uneventful. On Post-op #6 he was discharged to home with VNA services. Dr.[**First Name (STitle) 5656**], his PCP will follow Coumadin dosing. All follow up appointments were advised. [**Month (only) 116**] want to consider future ablation for atrial flutter. Medications on Admission: ATENOLOL 25 mg Daily DABIGATRAN ETEXILATE [PRADAXA] 150 mg [**Hospital1 **] INDOMETHACIN 50 mg TID PRN SIMVASTATIN 20 mg Daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg Capsule - one Capsule Daily ASPIRIN 81 mg daily Discharge Medications: 1. acetaminophen 325 mg [**Hospital1 8426**] Sig: Two (2) [**Hospital1 8426**] PO Q4H (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg [**Hospital1 8426**], Delayed Release (E.C.) Sig: One (1) [**Hospital1 8426**], Delayed Release (E.C.) PO DAILY (Daily). Disp:*60 [**Hospital1 8426**], Delayed Release (E.C.)(s)* Refills:*2* 3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 4. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO DAILY (Daily) as needed for constipation. 5. simvastatin 10 mg [**Hospital1 8426**] Sig: Two (2) [**Hospital1 8426**] PO DAILY (Daily). Disp:*60 [**Hospital1 8426**](s)* Refills:*2* 6. metoprolol tartrate 25 mg [**Hospital1 8426**] Sig: Three (3) [**Hospital1 8426**] PO TID (3 times a day). Disp:*270 [**Hospital1 8426**](s)* Refills:*2* 7. ranitidine HCl 150 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY (Daily). Disp:*60 [**Hospital1 8426**](s)* Refills:*2* 8. digoxin 250 mcg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY (Daily). Disp:*60 [**Hospital1 8426**](s)* Refills:*2* 9. hydromorphone 2 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO Q6H (every 6 hours) as needed for pain. Disp:*50 [**Hospital1 8426**](s)* Refills:*0* 10. potassium chloride 10 mEq [**Hospital1 8426**] Extended Release Sig: Two (2) [**Hospital1 8426**] Extended Release PO BID (2 times a day) for 10 days. Disp:*40 [**Hospital1 8426**] Extended Release(s)* Refills:*0* 11. warfarin 1 mg [**Hospital1 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] ONCE (Once). Disp:*90 [**Last Name (Titles) 8426**](s)* Refills:*2* 12. warfarin 2.5 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* 13. Lasix 20 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO twice a day for 10 days. Disp:*20 [**Last Name (Titles) 8426**](s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Coronary artery disease s/p Coronary artery bypass graft Aortic stenosis s/p Aortic valve replacement Past medical history: Atrial fibrillation on Pradaxa since [**2149-4-29**] Hypertension Hyperlipidemia Gout (pt not aware, noted in records) Arthritis Cataract, bilateral S/P left knee replacement S/P appendectomy S/p carpal tunnel surgery Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema 1+ 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**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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 WOUND CARE Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2149-5-29**] 11:00 Surgeon: Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 170**] Date/Time:[**2149-6-26**] 1:00 Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4469**] [**2149-6-13**] at 2:15p Please call to schedule appointments with your Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5656**] in [**4-10**] 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** Completed by:[**2149-5-27**]

424,427,414,401,272,274,V436,366,285,458

{'Aortic valve disorders,Atrial flutter,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Unspecified cataract,Anemia, unspecified,Other iatrogenic hypotension'}

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 PRESENT ILLNESS: 74 year old male with moderate aortic stenosis and recent echocardiogram demonstrating [**Location (un) 109**] 1.4 cm2 and reports shortness of breath associated with chest tightness after climbing one flight of stairs and when walking up an incline. He was referred for right and left heart catheterization. He was found to have coronary artery disease and is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: Aortic stenosis, moderate, calculated [**Location (un) 109**] 1.4 cm2 Atrial fibrillation on Pradaxa since [**2149-4-29**] Hypertension Hyperlipidemia Gout (pt not aware, noted in records) Arthritis Cataract, bilateral S/P left knee replacement S/P appendectomy S/p carpal tunnel surgery MEDICATION ON ADMISSION: ATENOLOL 25 mg Daily DABIGATRAN ETEXILATE [PRADAXA] 150 mg [**Hospital1 **] INDOMETHACIN 50 mg TID PRN SIMVASTATIN 20 mg Daily TRIAMTERENE-HYDROCHLOROTHIAZID 37.5 mg-25 mg Capsule - one Capsule Daily ASPIRIN 81 mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse:68 Resp:18 O2 sat:98/RA B/P Right:87/52 Left:83/54 Height:5'[**47**]" Weight:190 lbs FAMILY HISTORY: Premature coronary artery disease - non contributory SOCIAL HISTORY: Race:Caucasian Last Dental Exam:3 months ago, will call dentist to have dental clearance faxed to office Lives with:Wife Contact: [**Name (NI) **] [**Name (NI) 15582**] (wife) Phone# [**Telephone/Fax (1) 110537**] Occupation: Retired elevator mechanic Cigarettes: Smoked no [] yes [x] Hx:quit 40 years ago Other Tobacco use:denies ETOH: Quit one month ago, Former daily ETOH 2-3 beers Illicit drug use:denies ### Response: {'Aortic valve disorders,Atrial flutter,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Knee joint replacement,Unspecified cataract,Anemia, unspecified,Other iatrogenic hypotension'}

CHIEF COMPLAINT: Abdominal Pain PRESENT ILLNESS: (by Dr. [**Last Name (STitle) **] The patient is a [**Age over 90 **] y.o. F without cognitive decline, atrial fibrillation, ischemic colitis, recently transferred to [**Hospital1 5595**] LTC in [**2123-3-30**] who was transferred to [**Hospital1 18**] for abdominal pain and decreased appetite. At [**Hospital1 5595**] BP = 80/50, HR = 55, O2 sat = 78% on RA. Upon further discussion with her grandaughter it was decided that she should come to [**Hospital1 18**] for evaluation. <br> In the ED she was given levofloxacin 500 mg IV, Flagyl 500 mg IV, Morphine 16 mg IV, and fentanyl 100 mg. Her vitals were T = 34.7 rectally, HR = 60, BP = 101/61, 100 % on RA. In the ED multiple code status discussions were held with the family, patient and interpretor. The patient per staff at [**Hospital1 5595**] and Dr. [**Name (NI) 75203**] note does not have dementia and has capacity to make her decisions. I paged the interpretor who interpreted in person for the patient in the ED. She reported that the patient declined surgery multiple times. She did agree to being admitted to [**Hospital1 18**] to have IV antibiotics and IVF. Per the ED central line access was discussed but the family refused. Per the ED the patient was made [**Hospital1 3225**] and was transported to 11 R. <br> Upon arrival to the floor the patient was alert and talking. She responded to me in Russian. When I paged the interpretor to discuss goals of care she told her, "I am tired, I cannot talk now, I don't feel well." She denied pain in her abdomen. Upon further discussions with her grand-daughter [**Name (NI) **] the patient is not [**Name (NI) 3225**] and they do want her to have antibiotics. While on the floor she became unresponsive but continued to have spontaneous respirations. Her O2 sat decreased to 80% on RA. She was placed on a NRB and her O2 sat fluctuated from 86-100% on NRB. She remained unresponsive to vigorous painful stimuli even in the presence of her family speaking in Russian. She was given 0.6 mg IV narcan without effect prior to transfer to the ICU. Her family was made aware of her transfer to the ICU prior to their departure. MEDICAL HISTORY: (Obtained from Dr. [**First Name (STitle) **] [**Name (STitle) **] admission note) Atrial fibrillation- c/b L atrial thrombus B/L deep vein thromboses [**3-6**] OA HTN Ischemic Colitis Urinary incontinece Shoulder pain Chronic renal failure with baseline Cr = 2.2 and BUN = 45 Gait disorder MEDICATION ON ADMISSION: oxycodone 10 mg po bid tylenol 650 mg q 4 hrs prn Magnesium hydroxide 30 cc clonidine 0.3 mg weekly Lidocaine 5% 1 patch daily coumadin imdur 60 mg qd tylenol 650 [**Hospital1 **] Comapazine 5 mg q 8hrs prn Prilosec po qd Lopressor 25 mg [**Hospital1 **] MRSA and VRE precautions ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission to the floor: VS T = 92.3, 91/78, P = 60 RR = 22 O2Sat = 98% on RA GENERAL: Elderly female, laying in bed. Speaking in full sentences HEENT: PERRL, EOMI without nystagmus, no scleral icterus noted, MMM, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: bradycardia with distant heart sounds. Abdomen: decreased bs in all four quadrants. Soft, nt. Denies pain when I press via the Russian interpretor over the telephone. Extremities: Poor skin integrity. Gross anasarca. Large bleeding heel uclers and L foot and L leg. Pin point stage 2 on Coccyx. DPP not appreciated. Neurologic: -mental status: Alert talkative initially then not responsive to painful stimuli. Rest of neuro exam deferred given clinical instability. . On admission to the ICU: VS - T 90.5ax, BP 93/47, HR 54, RR 15, sats 97% on NRB Gen: Somnolent, minimally responsive elderly Russian female. NRB in place, but does not appear agitated or in distress. HEENT: Sclera anicteric. Pupils 3mm, minimally reactive, bilateral cataracts. Not able to follow commands to assess EOM. Could not assess JVP due to body habitus. NRB in place. CV: Bradycardic, irregular, NL S1, S2, no m/r/g. Lungs: Coarse breath sounds heard throughout anterior lung fields. Abd: Soft, ND, but diffusely tender to palpation. No rebound or guarding. Could not accurately assess [**Doctor Last Name 515**] sign. Hyperactive bowel sounds. Ext: 3+ pitting edema throughout (generalized anasarca). Multiple areas of skin breakdown and weeping through bandages. Scattered ecchymoses. Neuro: Not responding to sternal rub. Moving all 4 extremities to painful stimuli. Moves bilateral arms to deep palpation of abdomen. FAMILY HISTORY: NC SOCIAL HISTORY: Former accountant in [**Country 532**]. She is not a smoker or drinker.

Unspecified septicemia,Septic shock,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Personal history of venous thrombosis and embolism

Septicemia NOS,Septic shock,Atrial fibrillation,CHF NOS,Acute kidney failure NOS,Hypertension NOS,Anemia NOS,Hx-ven thrombosis/embols

Admission Date: [**2123-8-10**] Discharge Date: [**2123-8-11**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2485**] Chief Complaint: Abdominal Pain Major Surgical or Invasive Procedure: None History of Present Illness: (by Dr. [**Last Name (STitle) **] The patient is a [**Age over 90 **] y.o. F without cognitive decline, atrial fibrillation, ischemic colitis, recently transferred to [**Hospital1 5595**] LTC in [**2123-3-30**] who was transferred to [**Hospital1 18**] for abdominal pain and decreased appetite. At [**Hospital1 5595**] BP = 80/50, HR = 55, O2 sat = 78% on RA. Upon further discussion with her grandaughter it was decided that she should come to [**Hospital1 18**] for evaluation. <br> In the ED she was given levofloxacin 500 mg IV, Flagyl 500 mg IV, Morphine 16 mg IV, and fentanyl 100 mg. Her vitals were T = 34.7 rectally, HR = 60, BP = 101/61, 100 % on RA. In the ED multiple code status discussions were held with the family, patient and interpretor. The patient per staff at [**Hospital1 5595**] and Dr. [**Name (NI) 75203**] note does not have dementia and has capacity to make her decisions. I paged the interpretor who interpreted in person for the patient in the ED. She reported that the patient declined surgery multiple times. She did agree to being admitted to [**Hospital1 18**] to have IV antibiotics and IVF. Per the ED central line access was discussed but the family refused. Per the ED the patient was made [**Hospital1 3225**] and was transported to 11 R. <br> Upon arrival to the floor the patient was alert and talking. She responded to me in Russian. When I paged the interpretor to discuss goals of care she told her, "I am tired, I cannot talk now, I don't feel well." She denied pain in her abdomen. Upon further discussions with her grand-daughter [**Name (NI) **] the patient is not [**Name (NI) 3225**] and they do want her to have antibiotics. While on the floor she became unresponsive but continued to have spontaneous respirations. Her O2 sat decreased to 80% on RA. She was placed on a NRB and her O2 sat fluctuated from 86-100% on NRB. She remained unresponsive to vigorous painful stimuli even in the presence of her family speaking in Russian. She was given 0.6 mg IV narcan without effect prior to transfer to the ICU. Her family was made aware of her transfer to the ICU prior to their departure. Past Medical History: (Obtained from Dr. [**First Name (STitle) **] [**Name (STitle) **] admission note) Atrial fibrillation- c/b L atrial thrombus B/L deep vein thromboses [**3-6**] OA HTN Ischemic Colitis Urinary incontinece Shoulder pain Chronic renal failure with baseline Cr = 2.2 and BUN = 45 Gait disorder Social History: Former accountant in [**Country 532**]. She is not a smoker or drinker. Family History: NC Physical Exam: On admission to the floor: VS T = 92.3, 91/78, P = 60 RR = 22 O2Sat = 98% on RA GENERAL: Elderly female, laying in bed. Speaking in full sentences HEENT: PERRL, EOMI without nystagmus, no scleral icterus noted, MMM, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: bradycardia with distant heart sounds. Abdomen: decreased bs in all four quadrants. Soft, nt. Denies pain when I press via the Russian interpretor over the telephone. Extremities: Poor skin integrity. Gross anasarca. Large bleeding heel uclers and L foot and L leg. Pin point stage 2 on Coccyx. DPP not appreciated. Neurologic: -mental status: Alert talkative initially then not responsive to painful stimuli. Rest of neuro exam deferred given clinical instability. . On admission to the ICU: VS - T 90.5ax, BP 93/47, HR 54, RR 15, sats 97% on NRB Gen: Somnolent, minimally responsive elderly Russian female. NRB in place, but does not appear agitated or in distress. HEENT: Sclera anicteric. Pupils 3mm, minimally reactive, bilateral cataracts. Not able to follow commands to assess EOM. Could not assess JVP due to body habitus. NRB in place. CV: Bradycardic, irregular, NL S1, S2, no m/r/g. Lungs: Coarse breath sounds heard throughout anterior lung fields. Abd: Soft, ND, but diffusely tender to palpation. No rebound or guarding. Could not accurately assess [**Doctor Last Name 515**] sign. Hyperactive bowel sounds. Ext: 3+ pitting edema throughout (generalized anasarca). Multiple areas of skin breakdown and weeping through bandages. Scattered ecchymoses. Neuro: Not responding to sternal rub. Moving all 4 extremities to painful stimuli. Moves bilateral arms to deep palpation of abdomen. Pertinent Results: LABS on admission: WBC-14.7* Hct-29.0* Plt Ct-342 DIFF: Neuts-95* Bands-2 Lymphs-2* Monos-1* NRBC-3* PT-150* PTT-150* INR(PT)->22.8* Glucose-107* UreaN-122* Creat-4.1* Na-134 K-5.6* Cl-109* HCO3-9* AnGap-22* Albumin-1.6* Calcium-7.2* Phos-7.3* Mg-1.8 Lactate-4.0* -> Lactate-9.2* pH-7.20* . CXR: 1. Left lower lobe opacity likely represents atelectasis. 2. Distended stomach, without evidence of distal obstruction. An NG tube may be used to alleviate the stomach distention. 3. Severe osteopenic and bony degenerative changes. 4. Borderline cardiomegaly. 5. Pulmonary artery distention consistent with pulmonary hypertension Brief Hospital Course: Mrs. [**Known lastname 75204**] is [**Age over 90 **] y.o. female without clear cognitive impairment, atrial fibrillation, and ischemic colitis who presented with with abdominal pain and hypotension. . On arrival to the [**Hospital1 18**] ER, her VS were T 34.7 rectal (93.4F), BP 96/66, HR 69, RR 26 and sats 100% on NRB. Given her abdominal pain and h/o ischemic colitis, there was concern for an intraabdominal process. Initial labs revealed worsening renal function, a bicarb of 9, and a lactate of 4.0. She was given flagyl and levaquin IV, with plans to perform an abdomen and pelvis CT. Interpreters were called in order to communicate with the patient and the patient refused surgery if that was what would be needed. After lengthy discussions with the patient, her family, and the interpreters, the conclusion was that there would be no imaging as the patient would not pursue surgical intervention if an abnormality was found. Given that she was a known DNR/DNI, the decision was made to not put a CVL in and she would be treated with IVF, IV antibiotics and pain medication as needed. In the ER, her BP ranged from 72-123/39-99, HR 58-67, and O2 sats 96-100% on 2L nc. It was noted that the interpreter was called repeatedly for ? of agitation, restlessness and pain (mostly in her legs). In total, she received 100mcg IV fentanyl and 16mg IV morphine between 1800 and 2100. She was then transferred to the floor to be [**Hospital1 3225**]. . However, on arrival to the floor, the patient's family inquired about antibiotics and goals of care were readdressed. It was then felt that the patient was not truly [**Hospital1 3225**], but that she would want care up to the point of CPR and intubation. In the midst of this conversation, she became somnolent and unresponsive to sternal rub. Her O2 sats dropped down to 76% on 10L and she was placed on a NRB. Her HR was noted to be down in the 30s and her temperature was 92. She was given 1L NS bolus and a total of 0.6mg narcan with minimal improvement. Decision was made to transfer her to the ICU for further care. . In the ICU, she continued to decline. It was felt that her hypotension was likely due to sepsis, probably from her UTI but an abdominal source could not be excluded. Her antibiotics were thus broadened to meropenem, ciprofloxacin, linezolid and flagyl (to double-cover for GNR and to cover for both MRSA and VRE - she had positive swabs for both in the past). She was given IVF (with bicarbonate, given her low bicarbonate on labs) to attempt to maintain a SBP >90 or a MAP >60. However, given her DNI status, fluid resuscitation was limited by her respiratory status. She was warmed with a BairHugger and was also started on steroids for presumed adrenal insufficiency from sepsis. She was also found to be bradycardic, which was concerning. Her calcium was repleted and we attempted to improve her bicarbonate by supplementing her IVF with bicarbonate. Glucagon was considered, given that the patient is on lopressor and cardizem at home, but it was felt to be less likely due to her medications given that she had not yet received her medications today. Repeat lab tests revealed an INR of 22.8 and showed that the patient was in worsening renal failure. . A discussion was held with the family ([**First Name9 (NamePattern2) 22858**] [**Doctor First Name **]) in the ICU regarding the patient's poor prognosis. She understood the patient's grave state, but wanted to continue antibiotics and IVF resuscitation. The patient remained a DNR/DNI. The patient's status continued to decline overnight. She became persistently hypotensive despite multiple IVF boluses. Her granddaughter [**Name (NI) **] was notified of her worsening status. The patient's oxygen saturations then began to drop, she remained somnolent, and her bradycardia progressed to asystole. She expired at 5:25AM on [**2123-8-11**]. Her granddaughter was notified and refused an autopsy. Given that the patient was in the hospital less then 24 hours, the medical examiner was also notified and refused the case. . Medications on Admission: oxycodone 10 mg po bid tylenol 650 mg q 4 hrs prn Magnesium hydroxide 30 cc clonidine 0.3 mg weekly Lidocaine 5% 1 patch daily coumadin imdur 60 mg qd tylenol 650 [**Hospital1 **] Comapazine 5 mg q 8hrs prn Prilosec po qd Lopressor 25 mg [**Hospital1 **] MRSA and VRE precautions Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Urosepsis Discharge Condition: Expired Discharge Instructions: N/A Followup Instructions: N/A

038,785,427,428,584,401,285,V125

{'Unspecified septicemia,Septic shock,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Personal history of venous thrombosis and embolism'}

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: (by Dr. [**Last Name (STitle) **] The patient is a [**Age over 90 **] y.o. F without cognitive decline, atrial fibrillation, ischemic colitis, recently transferred to [**Hospital1 5595**] LTC in [**2123-3-30**] who was transferred to [**Hospital1 18**] for abdominal pain and decreased appetite. At [**Hospital1 5595**] BP = 80/50, HR = 55, O2 sat = 78% on RA. Upon further discussion with her grandaughter it was decided that she should come to [**Hospital1 18**] for evaluation. <br> In the ED she was given levofloxacin 500 mg IV, Flagyl 500 mg IV, Morphine 16 mg IV, and fentanyl 100 mg. Her vitals were T = 34.7 rectally, HR = 60, BP = 101/61, 100 % on RA. In the ED multiple code status discussions were held with the family, patient and interpretor. The patient per staff at [**Hospital1 5595**] and Dr. [**Name (NI) 75203**] note does not have dementia and has capacity to make her decisions. I paged the interpretor who interpreted in person for the patient in the ED. She reported that the patient declined surgery multiple times. She did agree to being admitted to [**Hospital1 18**] to have IV antibiotics and IVF. Per the ED central line access was discussed but the family refused. Per the ED the patient was made [**Hospital1 3225**] and was transported to 11 R. <br> Upon arrival to the floor the patient was alert and talking. She responded to me in Russian. When I paged the interpretor to discuss goals of care she told her, "I am tired, I cannot talk now, I don't feel well." She denied pain in her abdomen. Upon further discussions with her grand-daughter [**Name (NI) **] the patient is not [**Name (NI) 3225**] and they do want her to have antibiotics. While on the floor she became unresponsive but continued to have spontaneous respirations. Her O2 sat decreased to 80% on RA. She was placed on a NRB and her O2 sat fluctuated from 86-100% on NRB. She remained unresponsive to vigorous painful stimuli even in the presence of her family speaking in Russian. She was given 0.6 mg IV narcan without effect prior to transfer to the ICU. Her family was made aware of her transfer to the ICU prior to their departure. MEDICAL HISTORY: (Obtained from Dr. [**First Name (STitle) **] [**Name (STitle) **] admission note) Atrial fibrillation- c/b L atrial thrombus B/L deep vein thromboses [**3-6**] OA HTN Ischemic Colitis Urinary incontinece Shoulder pain Chronic renal failure with baseline Cr = 2.2 and BUN = 45 Gait disorder MEDICATION ON ADMISSION: oxycodone 10 mg po bid tylenol 650 mg q 4 hrs prn Magnesium hydroxide 30 cc clonidine 0.3 mg weekly Lidocaine 5% 1 patch daily coumadin imdur 60 mg qd tylenol 650 [**Hospital1 **] Comapazine 5 mg q 8hrs prn Prilosec po qd Lopressor 25 mg [**Hospital1 **] MRSA and VRE precautions ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission to the floor: VS T = 92.3, 91/78, P = 60 RR = 22 O2Sat = 98% on RA GENERAL: Elderly female, laying in bed. Speaking in full sentences HEENT: PERRL, EOMI without nystagmus, no scleral icterus noted, MMM, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: bradycardia with distant heart sounds. Abdomen: decreased bs in all four quadrants. Soft, nt. Denies pain when I press via the Russian interpretor over the telephone. Extremities: Poor skin integrity. Gross anasarca. Large bleeding heel uclers and L foot and L leg. Pin point stage 2 on Coccyx. DPP not appreciated. Neurologic: -mental status: Alert talkative initially then not responsive to painful stimuli. Rest of neuro exam deferred given clinical instability. . On admission to the ICU: VS - T 90.5ax, BP 93/47, HR 54, RR 15, sats 97% on NRB Gen: Somnolent, minimally responsive elderly Russian female. NRB in place, but does not appear agitated or in distress. HEENT: Sclera anicteric. Pupils 3mm, minimally reactive, bilateral cataracts. Not able to follow commands to assess EOM. Could not assess JVP due to body habitus. NRB in place. CV: Bradycardic, irregular, NL S1, S2, no m/r/g. Lungs: Coarse breath sounds heard throughout anterior lung fields. Abd: Soft, ND, but diffusely tender to palpation. No rebound or guarding. Could not accurately assess [**Doctor Last Name 515**] sign. Hyperactive bowel sounds. Ext: 3+ pitting edema throughout (generalized anasarca). Multiple areas of skin breakdown and weeping through bandages. Scattered ecchymoses. Neuro: Not responding to sternal rub. Moving all 4 extremities to painful stimuli. Moves bilateral arms to deep palpation of abdomen. FAMILY HISTORY: NC SOCIAL HISTORY: Former accountant in [**Country 532**]. She is not a smoker or drinker. ### Response: {'Unspecified septicemia,Septic shock,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Personal history of venous thrombosis and embolism'}

CHIEF COMPLAINT: hypertensive urgency, altered mental status PRESENT ILLNESS: HPI: 58M h/o HBV, HCV, COPD, CAD, PE s/p IVC filter and multiple admissions for malignant hypertension found sitting on a park bench confused, hypertensive with SBP 230s and bradycardic to the 30s. Pt reports being held at gunpoint and hit on the back of the head with weapon. . In the ED, vital signs were T 96.1 HR 46 BP 222/110 RR 12 SpO2 98% on RA FSBG 126. Pt was started on nitro gtt for hypertention and empirically treated with vanco and Ceftriaxone for retrocardiac opacity on CT Chest. Received banana bag. Cardiac enzymes negative x 2; tox screen positive for methadone and benzos. Pt complained of b/L hand pain for which plastics was consulted regarding ? of compartment syndrome in hands. However, low level of suspicion. . In MICU, nitro gtt was d/c'd. Abx also were d/c'd as no sx/suspicion for infection. . On my exam, patient complains of constant, persistent chest pain ([**6-2**]) since his assault that worsens with movement and deep breathing. Pt also reports SOB, which is relieved while lying flat. No diaphoresis or nausea. Also with bilateral hand pain and swelling and occipital headache. Also complains of blurred vision that began several days ago. Denies abdominal pain, diarrhea, cough, numbness, weakness. MEDICAL HISTORY: Hypertension- Uncontrolled. Normal P-MIBI [**6-28**], normal EF on echo [**3-29**]. MRI of Kidneys were negative for RAS. TSH was normal. Random AM cortisol normal. COPD GERD h/o heroin abuse- now on methadone h/o PE/DVT s/p IVC filter Hepatitis B Hepatitis C, undetectable HCV RNA [**3-29**] Post traumatic stress disorder Anxiety Depression Antisocial personality disorder-several psychiatric hospitalizations Microcytic Anemia Vit B12 deficiency MEDICATION ON ADMISSION: Medications (per recent d/c summary): Tyenol prn ASA 325 daily Bisacodyl, colace, senna Clonidine 0.2mg tid Clonazepam 2mg tid Labetalol 200mg [**Hospital1 **] Lactulose prn Methadone 135mg daily Nifedipine CR 30mg daily Combivent inh 1-2 puffs q6h prn ALLERGIES: Compazine / Codeine / Atenolol PHYSICAL EXAM: T 96.2 HR 59 BP 122/80 RR 16 100% on RA General: WDWN male in NAD, somewhat lethargic HEENT: PERRL, EOMI, anicteric Neck: supple, trachea midline, no LAD Chest: diffuse pain on palpation of chest wall Cardiac: RRR s1s2 normal, no m/r/g Pulmonary: diffuse wheezes Abdomen: soft, nontender, nondistended, +BS, no HSM Extremities: warm, bilateral hand edema tender to palpation, <2 sec cap refill, 2+ radial pulses, no LE edema 2+ DP/PT pulses Neuro: A&Ox3, CNII-XII intact FAMILY HISTORY: NC SOCIAL HISTORY:

Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Opioid type dependence, unspecified,Drug withdrawal,Pulmonary collapse,Esophageal reflux,Personal history of venous thrombosis and embolism,Dysthymic disorder,Posttraumatic stress disorder,Antisocial personality disorder,Other B-complex deficiencies,Iron deficiency anemia, unspecified,Personal history of tobacco use,Other specified cardiac dysrhythmias,Other chest pain,Pain in limb,Lack of housing

Malignant hypertension,Chr airway obstruct NEC,Hpt B acte wo cm wo dlta,Opioid dependence-unspec,Drug withdrawal,Pulmonary collapse,Esophageal reflux,Hx-ven thrombosis/embols,Dysthymic disorder,Posttraumatic stress dis,Antisocial personality,B-complex defic NEC,Iron defic anemia NOS,History of tobacco use,Cardiac dysrhythmias NEC,Chest pain NEC,Pain in limb,Lack of housing

Admission Date: [**2107-7-28**] Discharge Date: [**2107-8-4**] Date of Birth: [**2047-9-9**] Sex: M Service: MEDICINE Allergies: Compazine / Codeine / Atenolol Attending:[**First Name3 (LF) 783**] Chief Complaint: hypertensive urgency, altered mental status Major Surgical or Invasive Procedure: None History of Present Illness: HPI: 58M h/o HBV, HCV, COPD, CAD, PE s/p IVC filter and multiple admissions for malignant hypertension found sitting on a park bench confused, hypertensive with SBP 230s and bradycardic to the 30s. Pt reports being held at gunpoint and hit on the back of the head with weapon. . In the ED, vital signs were T 96.1 HR 46 BP 222/110 RR 12 SpO2 98% on RA FSBG 126. Pt was started on nitro gtt for hypertention and empirically treated with vanco and Ceftriaxone for retrocardiac opacity on CT Chest. Received banana bag. Cardiac enzymes negative x 2; tox screen positive for methadone and benzos. Pt complained of b/L hand pain for which plastics was consulted regarding ? of compartment syndrome in hands. However, low level of suspicion. . In MICU, nitro gtt was d/c'd. Abx also were d/c'd as no sx/suspicion for infection. . On my exam, patient complains of constant, persistent chest pain ([**6-2**]) since his assault that worsens with movement and deep breathing. Pt also reports SOB, which is relieved while lying flat. No diaphoresis or nausea. Also with bilateral hand pain and swelling and occipital headache. Also complains of blurred vision that began several days ago. Denies abdominal pain, diarrhea, cough, numbness, weakness. Past Medical History: Hypertension- Uncontrolled. Normal P-MIBI [**6-28**], normal EF on echo [**3-29**]. MRI of Kidneys were negative for RAS. TSH was normal. Random AM cortisol normal. COPD GERD h/o heroin abuse- now on methadone h/o PE/DVT s/p IVC filter Hepatitis B Hepatitis C, undetectable HCV RNA [**3-29**] Post traumatic stress disorder Anxiety Depression Antisocial personality disorder-several psychiatric hospitalizations Microcytic Anemia Vit B12 deficiency Family History: NC Physical Exam: T 96.2 HR 59 BP 122/80 RR 16 100% on RA General: WDWN male in NAD, somewhat lethargic HEENT: PERRL, EOMI, anicteric Neck: supple, trachea midline, no LAD Chest: diffuse pain on palpation of chest wall Cardiac: RRR s1s2 normal, no m/r/g Pulmonary: diffuse wheezes Abdomen: soft, nontender, nondistended, +BS, no HSM Extremities: warm, bilateral hand edema tender to palpation, <2 sec cap refill, 2+ radial pulses, no LE edema 2+ DP/PT pulses Neuro: A&Ox3, CNII-XII intact Pertinent Results: [**2107-7-28**] 03:44PM BLOOD WBC-4.4 RBC-4.01* Hgb-11.0* Hct-33.3* MCV-83 MCH-27.5 MCHC-33.1 RDW-16.1* Plt Ct-187 [**2107-8-4**] 05:50AM BLOOD WBC-4.2 RBC-3.99* Hgb-11.2* Hct-32.0* MCV-80* MCH-28.0 MCHC-35.0 RDW-15.6* Plt Ct-161 [**2107-7-29**] 02:52AM BLOOD PT-12.2 PTT-31.9 INR(PT)-1.0 [**2107-7-28**] 03:44PM BLOOD Glucose-103 UreaN-16 Creat-1.2 Na-139 K-4.7 Cl-109* HCO3-23 AnGap-12 [**2107-8-4**] 05:50AM BLOOD Glucose-90 UreaN-22* Creat-1.2 Na-140 K-4.3 Cl-104 HCO3-26 AnGap-14 [**2107-7-28**] 03:44PM BLOOD ALT-11 AST-19 CK(CPK)-213* AlkPhos-124* Amylase-62 TotBili-0.3 [**2107-8-3**] 05:45AM BLOOD ALT-13 AST-21 AlkPhos-95 TotBili-0.3 [**2107-7-28**] 03:44PM BLOOD CK-MB-9 cTropnT-<0.01 [**2107-7-29**] 02:52AM BLOOD CK-MB-7 cTropnT-<0.01 [**2107-8-2**] 05:40AM BLOOD TSH-4.9* [**2107-7-28**] 03:44PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**8-3**] SUPINE AND UPRIGHT ABDOMINAL RADIOGRAPHS. There is a nonobstructive bowel gas pattern with no abnormally dilated loops of bowel identified. A moderate amount of stool is noted within the ascending and transverse colon. Trace amount of air is noted distally within the region of the rectum. No evidence of pneumatosis or pneumoperitoneum. There is stable appearance to an IVC filter and mild levoscoliosis of the lumbar spine. IMPRESSION: No signs of underlying obstruction. Moderate amount of stool noted within the ascending and transverse colon. No pneumoperitoneum. [**8-3**] PA AND LATERAL CHEST: Patchy left lower lobe opacity is again seen, probably unchanged from [**2107-7-28**], given differences in technique between exams. This opacity was not present in [**Month (only) **] or [**2106-7-24**], and most likely represents a focus of pneumonia. There are no other consolidations, and no congestive failure. Cardiac and mediastinal contours are unchanged, with a mildly tortuous aorta. No pleural effusions or pneumothorax. Osseous structures are unremarkable. IMPRESSION: Left lower lobe patchy opacity is unchanged from six days ago, and likely represents pneumonia. Brief Hospital Course: On presentation to the floor, the patient continued to complain of chest and abdominal discomfort. He was found not be experiencing myocardial ischemia as evidenced by lack of cardiac enzymes and ECG changes. He continued to complain of nausea, and diahrrea, and it was felt that the patient was receiving an inadequate dose of his methadone. The patient reported thatthe dose of his methadoen was in fact correct, however he was not familiar with the dosage form being tablets of 40mg, as compared to his usual tablets of 10mg. His systolic blood pressure was gradually lowered over a span of 4 days from the 170's to the 130's, with the addition of nifedipine and lisinopril to the clonidine he was already taking. He continued to complain of light headedness while walking. Physical therapy worked with the patient daily and did not report decreased blood pressure or decreased oxygen saturation on ambulation. Psychiatry met with the patient on several occasions, though he was resistant to speaking with them. They eventually recommended he go to a pain clinic, which could be handled as an outpatient. his TSH was also found to be elevated and he was started on levothyroxine. He was discharged on [**8-4**], afebrile, with stable vital signs and systolic blood pressure in the 130's. He was given instructions to follow up with his new primary care physician on [**8-24**], and to return to the hospital if he experiences any further chest pain. Medications on Admission: Medications (per recent d/c summary): Tyenol prn ASA 325 daily Bisacodyl, colace, senna Clonidine 0.2mg tid Clonazepam 2mg tid Labetalol 200mg [**Hospital1 **] Lactulose prn Methadone 135mg daily Nifedipine CR 30mg daily Combivent inh 1-2 puffs q6h prn Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-25**] Puffs Inhalation Q6H (every 6 hours) as needed. Disp:*qs * Refills:*0* 3. Clonazepam 2 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*0* 4. Clonidine 0.2 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 5. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. Disp:*30 Tablet Sustained Release(s)* Refills:*2* 6. Methadone 5 mg Tablet Sig: Twenty Seven (27) Tablet PO DAILY (Daily). 7. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 9. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-25**] Puffs Inhalation Q6H (every 6 hours). Disp:*1 1* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Hypertensive Urgency Opiate withdrawal Discharge Condition: Good Discharge Instructions: Keep all of your follow-up appointments. Take all of your medications as directed. Call your doctor or go to the ER for any of the following: chest pain, blurry vision, headache, lightheadedness, fevers/chills, shortness of [**Month/Day (2) 1440**], nausea/vomiting or any other concerning symptoms. Followup Instructions: Follow-up with primary careProvider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2107-8-24**] 1:30 You will need a repeat Chest X-Ray in 6 weeks. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

401,496,070,304,292,518,530,V125,300,309,301,266,280,V158,427,786,729,V600

{'Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Opioid type dependence, unspecified,Drug withdrawal,Pulmonary collapse,Esophageal reflux,Personal history of venous thrombosis and embolism,Dysthymic disorder,Posttraumatic stress disorder,Antisocial personality disorder,Other B-complex deficiencies,Iron deficiency anemia, unspecified,Personal history of tobacco use,Other specified cardiac dysrhythmias,Other chest pain,Pain in limb,Lack of housing'}

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: hypertensive urgency, altered mental status PRESENT ILLNESS: HPI: 58M h/o HBV, HCV, COPD, CAD, PE s/p IVC filter and multiple admissions for malignant hypertension found sitting on a park bench confused, hypertensive with SBP 230s and bradycardic to the 30s. Pt reports being held at gunpoint and hit on the back of the head with weapon. . In the ED, vital signs were T 96.1 HR 46 BP 222/110 RR 12 SpO2 98% on RA FSBG 126. Pt was started on nitro gtt for hypertention and empirically treated with vanco and Ceftriaxone for retrocardiac opacity on CT Chest. Received banana bag. Cardiac enzymes negative x 2; tox screen positive for methadone and benzos. Pt complained of b/L hand pain for which plastics was consulted regarding ? of compartment syndrome in hands. However, low level of suspicion. . In MICU, nitro gtt was d/c'd. Abx also were d/c'd as no sx/suspicion for infection. . On my exam, patient complains of constant, persistent chest pain ([**6-2**]) since his assault that worsens with movement and deep breathing. Pt also reports SOB, which is relieved while lying flat. No diaphoresis or nausea. Also with bilateral hand pain and swelling and occipital headache. Also complains of blurred vision that began several days ago. Denies abdominal pain, diarrhea, cough, numbness, weakness. MEDICAL HISTORY: Hypertension- Uncontrolled. Normal P-MIBI [**6-28**], normal EF on echo [**3-29**]. MRI of Kidneys were negative for RAS. TSH was normal. Random AM cortisol normal. COPD GERD h/o heroin abuse- now on methadone h/o PE/DVT s/p IVC filter Hepatitis B Hepatitis C, undetectable HCV RNA [**3-29**] Post traumatic stress disorder Anxiety Depression Antisocial personality disorder-several psychiatric hospitalizations Microcytic Anemia Vit B12 deficiency MEDICATION ON ADMISSION: Medications (per recent d/c summary): Tyenol prn ASA 325 daily Bisacodyl, colace, senna Clonidine 0.2mg tid Clonazepam 2mg tid Labetalol 200mg [**Hospital1 **] Lactulose prn Methadone 135mg daily Nifedipine CR 30mg daily Combivent inh 1-2 puffs q6h prn ALLERGIES: Compazine / Codeine / Atenolol PHYSICAL EXAM: T 96.2 HR 59 BP 122/80 RR 16 100% on RA General: WDWN male in NAD, somewhat lethargic HEENT: PERRL, EOMI, anicteric Neck: supple, trachea midline, no LAD Chest: diffuse pain on palpation of chest wall Cardiac: RRR s1s2 normal, no m/r/g Pulmonary: diffuse wheezes Abdomen: soft, nontender, nondistended, +BS, no HSM Extremities: warm, bilateral hand edema tender to palpation, <2 sec cap refill, 2+ radial pulses, no LE edema 2+ DP/PT pulses Neuro: A&Ox3, CNII-XII intact FAMILY HISTORY: NC SOCIAL HISTORY: ### Response: {'Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Opioid type dependence, unspecified,Drug withdrawal,Pulmonary collapse,Esophageal reflux,Personal history of venous thrombosis and embolism,Dysthymic disorder,Posttraumatic stress disorder,Antisocial personality disorder,Other B-complex deficiencies,Iron deficiency anemia, unspecified,Personal history of tobacco use,Other specified cardiac dysrhythmias,Other chest pain,Pain in limb,Lack of housing'}

CHIEF COMPLAINT: Coffee ground emesis PRESENT ILLNESS: Ms. [**Known lastname **] is a 66 yo woman with hx of OSA, discoid lupus, GERD, HTN, and DM who initially presented to the ED with left calf pain and some shortness of breath. She had no EKG changes, her vitals were stable, and left LENI negative. Those symptoms all resolved in the ED, but when PT saw her, she was unstable. She was in observation in the ED and planned to go to rehab when she developed nausea and vomitting. This was intially kept at bay with antiemetics, but then the emesis became coffee ground. It was guaiac posistive. NG lavage was done and showed more coffee ground emesis. Her Hct was stable at 39. MEDICAL HISTORY: 1. Non-insulin dependent diabetes mellitus 2. Gastroesophageal reflux disease 3. Coronary artery disease. Dobutamine MIBI in [**2156**]: No Dobutamine-induced perfusion abnormalities identified. Ejection fraction of 46%. 4. Hypertension 5. History of SVT 6. History of Congestive heart failure (felt to be diastolic dysfunction). ECHO in [**2156**]: Overall left ventricular systolic function is normal (LVEF>55%). Mild to moderate ([**12-30**]+) mitral regurgitation is seen. Borderline pulmonary artery systolic hypertension. 7. Schizo-affective disorder 8. Depression 9. History of CVA with MRI in [**2156**] with here are moderate microvascular changes in the cerebral white matter, which appear to have progressed slightly compared to the proton-density images from [**2153-12-5**]. 10. History of seziures 11. History of right lower extremity deep venous thrombosis 12. Discoid lupus erythematosus 13. Chronic obstructive pulmonary disease 14. History of acute renal failure 15. History of cellulitis 16. s/p total abdominal hysterectomy. 17. History of partial small bowel obstruction in [**4-2**] MEDICATION ON ADMISSION: Atenolol 50mg qam and 25mg qpm Wellbutrin SR 300 mg daily clonidine 0.2mg twice daily Plavix 75mg daily Clozapine 100mg qHS Combivent as needed Diltiazem 360mg daily fluticasone (flovent) 1 puff daily Lasix 40mg daily K-lor 10 Lipitor 10mg nightly metformin 1gm twice daily Zofran 4mg as needed Protonix 40mg EC Calcium 500mg TID docusate 100mg twice daily vitamin 400mg daily iron 325mg daily MVP ALLERGIES: Penicillins / Cipro / Aspirin / Nsaids / Dicloxacillin / Aldomet / Motrin / Lisinopril / Vioxx / Keflex PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T: 99.7 BP: 179/80 P: 88 RR: 22 O2Sat: 97% 2L Gen: nauseated, vomitting HEENT: Clear OP, dry mucous membranes NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops LUNGS: CTA, BS BL, No W/R/C ABD: Soft, obese. some pain to palpation, no guarding EXT: trace edema LLE SKIN: No lesions NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**12-30**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: Father died of MI less than 50 years of age. Mother diagnosed with breast CA for 4 years Notes that mother has history of mental illness, but does not know what kind. SOCIAL HISTORY: Discharge Summary Social History Signed [**Last Name (LF) **],[**First Name8 (NamePattern2) 734**] [**Last Name (NamePattern1) **] WED [**7-4**],[**2158**] 8:08 PM She lives in an apartment adjacent to her daughter. -Tobacco: 1ppd x 35 yrs ~ 35 pack-years. Currently smokes 1 pack per day. -History of cocaine abuse in the past, most recently 30 years ago. -EtOH: History of heavy EtOH use, none currently. Drank up to "a fifth" or a quart of "[**First Name4 (NamePattern1) 4884**] [**Last Name (NamePattern1) 4886**]" at the most in one night.

Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other diseases of lung, not elsewhere classified,Congestive heart failure, unspecified,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Benign essential hypertension,Hypovolemia,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Peripheral autonomic neuropathy in disorders classified elsewhere,Other postoperative infection,Urinary tract infection, site not specified,Schizoaffective disorder, chronic,Other specified cardiac dysrhythmias,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Dyspepsia and other specified disorders of function of stomach,Lupus erythematosus,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled

Hx TIA/stroke w/o resid,Abn reac-organ rem NEC,Other lung disease NEC,CHF NOS,Depressive disorder NEC,Chr airway obstruct NEC,Benign hypertension,Hypovolemia,Intestinal adhes w obstr,Toxic encephalopathy,Gastrointest hemorr NOS,Aut neuropthy in oth dis,Other postop infection,Urin tract infection NOS,Schizoaffective dis-chr,Cardiac dysrhythmias NEC,Gstr/ddnts NOS w/o hmrhg,Stomach function dis NEC,Lupus erythematosus,Obstructive sleep apnea,Esophageal reflux,DMII neuro uncntrld

Admission Date: [**2162-7-19**] Discharge Date: [**2162-8-17**] Date of Birth: [**2095-10-11**] Sex: F Service: SURGERY Allergies: Penicillins / Cipro / Aspirin / Nsaids / Dicloxacillin / Aldomet / Motrin / Lisinopril / Vioxx / Keflex Attending:[**First Name3 (LF) 974**] Chief Complaint: Coffee ground emesis Major Surgical or Invasive Procedure: None. History of Present Illness: Ms. [**Known lastname **] is a 66 yo woman with hx of OSA, discoid lupus, GERD, HTN, and DM who initially presented to the ED with left calf pain and some shortness of breath. She had no EKG changes, her vitals were stable, and left LENI negative. Those symptoms all resolved in the ED, but when PT saw her, she was unstable. She was in observation in the ED and planned to go to rehab when she developed nausea and vomitting. This was intially kept at bay with antiemetics, but then the emesis became coffee ground. It was guaiac posistive. NG lavage was done and showed more coffee ground emesis. Her Hct was stable at 39. Of note, she has a history of nausea and vomitting, which is being worked up as an outpatient currently. She has had an EGD that showed retained food and a gastric emptying study that showed delayed empting. In the ED, her SBP was in the 140s-160s, Hr 70-80, T 98.9 and setting high 90s on RA, RR 18. Past Medical History: 1. Non-insulin dependent diabetes mellitus 2. Gastroesophageal reflux disease 3. Coronary artery disease. Dobutamine MIBI in [**2156**]: No Dobutamine-induced perfusion abnormalities identified. Ejection fraction of 46%. 4. Hypertension 5. History of SVT 6. History of Congestive heart failure (felt to be diastolic dysfunction). ECHO in [**2156**]: Overall left ventricular systolic function is normal (LVEF>55%). Mild to moderate ([**12-30**]+) mitral regurgitation is seen. Borderline pulmonary artery systolic hypertension. 7. Schizo-affective disorder 8. Depression 9. History of CVA with MRI in [**2156**] with here are moderate microvascular changes in the cerebral white matter, which appear to have progressed slightly compared to the proton-density images from [**2153-12-5**]. 10. History of seziures 11. History of right lower extremity deep venous thrombosis 12. Discoid lupus erythematosus 13. Chronic obstructive pulmonary disease 14. History of acute renal failure 15. History of cellulitis 16. s/p total abdominal hysterectomy. 17. History of partial small bowel obstruction in [**4-2**] Social History: Discharge Summary Social History Signed [**Last Name (LF) **],[**First Name8 (NamePattern2) 734**] [**Last Name (NamePattern1) **] WED [**7-4**],[**2158**] 8:08 PM She lives in an apartment adjacent to her daughter. -Tobacco: 1ppd x 35 yrs ~ 35 pack-years. Currently smokes 1 pack per day. -History of cocaine abuse in the past, most recently 30 years ago. -EtOH: History of heavy EtOH use, none currently. Drank up to "a fifth" or a quart of "[**First Name4 (NamePattern1) 4884**] [**Last Name (NamePattern1) 4886**]" at the most in one night. Family History: Father died of MI less than 50 years of age. Mother diagnosed with breast CA for 4 years Notes that mother has history of mental illness, but does not know what kind. Physical Exam: ADMISSION PHYSICAL EXAM: Vitals: T: 99.7 BP: 179/80 P: 88 RR: 22 O2Sat: 97% 2L Gen: nauseated, vomitting HEENT: Clear OP, dry mucous membranes NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops LUNGS: CTA, BS BL, No W/R/C ABD: Soft, obese. some pain to palpation, no guarding EXT: trace edema LLE SKIN: No lesions NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**12-30**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant Pertinent Results: AMDISSION LABS: [**2162-7-19**] 10:25AM GLUCOSE-139* UREA N-16 CREAT-1.2* SODIUM-140 POTASSIUM-5.2* CHLORIDE-104 TOTAL CO2-27 ANION GAP-14 [**2162-7-19**] 10:25AM CALCIUM-9.7 PHOSPHATE-3.6 MAGNESIUM-2.0 [**2162-7-19**] 10:25AM WBC-9.1 RBC-4.61 HGB-11.5* HCT-36.2 MCV-79* MCH-25.0* MCHC-31.8 RDW-16.8* [**2162-7-19**] 10:25AM NEUTS-62.8 LYMPHS-30.1 MONOS-3.4 EOS-2.9 BASOS-0.8 [**2162-7-19**] 10:25AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG [**2162-7-19**]: Lt LENI: IMPRESSION: No evidence of DVT involving the left lower extremity. [**2162-7-19**] CXR: IMPRESSION: Limited study due to low lung volumes with no evidence of pneumonia or pulmonary edema. Mild cardiomegaly however could be related in part to AP projection. [**2162-7-21**] EGD: Erythema, erosion and granularity in the whole stomach compatible with gastritis (biopsy) Nodule in the antrum (biopsy) Duodenum with significant retained fluid, possibly secondary to poor motility or distal obstruction. Normal mucosa in the esophagus Otherwise normal EGD to third part of the duodenum CT Abdomen/Pelvis [**2162-7-21**]: Small bowel obstruction, with a transition point in the mid- pelvis, without an identifiable cause for the obstruction. No secondary findings to suggest associated bowel ischemia. URINE STUDIES: [**2162-7-22**] 12:28PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.030 [**2162-7-22**] 12:28PM URINE Blood-MOD Nitrite-NEG Protein-30 Glucose-NEG Ketone-150 Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR [**2162-7-22**] 12:28PM URINE URINE CULTURE (Final [**2162-7-24**]): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. AMPICILLIN------------ <=2 S AMPICILLIN/SULBACTAM-- <=2 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S PIPERACILLIN---------- <=4 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S Brief Hospital Course: 66F admitted for partial SBO. She was managed conservatively with NGT decompression, IVF and NPO. She was followed closely by the GI and surgery services. On [**7-25**], her NG tube was pulled w/o complication, and she was started on a clear diet. However, she began to have vomiting on the evening of [**7-27**], her NGT was replaced on [**7-28**] and she was again made NPO. She underwent ex lap, small bowel resection, LOA on [**7-30**]. Patient tolerated the procedure well and was briefly taken to PACU prior to be transferred to the surgical floor. Patient's systolic BP was 185-190. Patient was given IV Lopressor and hydralazine. On POD2 patient became tachycardic with pulse 155-185. EKG showed narrow complex tachycardia SVT vs afib/flutter. Patient was transferred to ICU for CV management. Patient was loaded with esmolol drip at rate of 100mc/kg/min, IV lopressor. Then the patient rhythm became sinus. Esmolol drip was continued and lopressor was titrated up. POD3: Patient was weaned off esmolol drip and placed on home dose of BP meds. Lopressor IV was used PRN for HR>110. POD4 ([**8-12**]) # UTI: Urine cultures showed greater than 100,000 E.Coli. She completed a 3-day course ending [**2162-7-26**]. . # Hypertension: Clonidine patch, IV metoprolol, IV Hydralzine while NPO; home doses of diltiazem, atenolol, and PO clonidine were restarted [ ] . # Diabetes Mellitus II: well-controlled on sliding scale during admission. . # CAD: cont. lipitor, B-blocker; plavix was held as indication unclear, especially peri-operatively. . # Schizoaffective disorder: continued Clozapine 100mg and Wellbutrin SR Medications on Admission: Atenolol 50mg qam and 25mg qpm Wellbutrin SR 300 mg daily clonidine 0.2mg twice daily Plavix 75mg daily Clozapine 100mg qHS Combivent as needed Diltiazem 360mg daily fluticasone (flovent) 1 puff daily Lasix 40mg daily K-lor 10 Lipitor 10mg nightly metformin 1gm twice daily Zofran 4mg as needed Protonix 40mg EC Calcium 500mg TID docusate 100mg twice daily vitamin 400mg daily iron 325mg daily MVP Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Primary: Small Bowel Obstruction Upper GI Bleed UTI Secondary: Hypertension Discharge Condition: Fair. Discharge Instructions: Please call your surgeon if you develop chest pain, shortness of breath, fever greater than 101.5, foul smelling or colorful drainage from your incisions, redness or swelling, severe abdominal pain or distention, persistent nausea or vomiting, inability to eat or drink, or any other symptoms which are concerning to you. No tub baths or swimming. Your nurse may wash you, however, do not shower until your wound has closed. If there is clear drainage from your incisions, cover with a dry dressing. Please have your nurse pack your wound with moist sterile dressing three times per day. Activity: No heavy lifting of items [**10-13**] pounds until the follow up appointment with your doctor. Medications: Resume your home medications. You should take a stool softener, Colace 100 mg twice daily as needed for constipation. You will be given pain medication which may make you drowsy. No driving while taking pain medicine. Followup Instructions: Please follow-up with your pcp [**Last Name (NamePattern4) **] 1 week: Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] S. [**Telephone/Fax (1) 250**]. Please call Dr.[**Name (NI) 18535**] office regarding you follow up appointment [**Telephone/Fax (1) 2359**]. Completed by:[**2162-8-16**]

V125,E878,518,428,311,496,401,276,560,349,578,337,998,599,295,427,535,536,695,327,530,250

{'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other diseases of lung, not elsewhere classified,Congestive heart failure, unspecified,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Benign essential hypertension,Hypovolemia,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Peripheral autonomic neuropathy in disorders classified elsewhere,Other postoperative infection,Urinary tract infection, site not specified,Schizoaffective disorder, chronic,Other specified cardiac dysrhythmias,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Dyspepsia and other specified disorders of function of stomach,Lupus erythematosus,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled'}

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 PRESENT ILLNESS: Ms. [**Known lastname **] is a 66 yo woman with hx of OSA, discoid lupus, GERD, HTN, and DM who initially presented to the ED with left calf pain and some shortness of breath. She had no EKG changes, her vitals were stable, and left LENI negative. Those symptoms all resolved in the ED, but when PT saw her, she was unstable. She was in observation in the ED and planned to go to rehab when she developed nausea and vomitting. This was intially kept at bay with antiemetics, but then the emesis became coffee ground. It was guaiac posistive. NG lavage was done and showed more coffee ground emesis. Her Hct was stable at 39. MEDICAL HISTORY: 1. Non-insulin dependent diabetes mellitus 2. Gastroesophageal reflux disease 3. Coronary artery disease. Dobutamine MIBI in [**2156**]: No Dobutamine-induced perfusion abnormalities identified. Ejection fraction of 46%. 4. Hypertension 5. History of SVT 6. History of Congestive heart failure (felt to be diastolic dysfunction). ECHO in [**2156**]: Overall left ventricular systolic function is normal (LVEF>55%). Mild to moderate ([**12-30**]+) mitral regurgitation is seen. Borderline pulmonary artery systolic hypertension. 7. Schizo-affective disorder 8. Depression 9. History of CVA with MRI in [**2156**] with here are moderate microvascular changes in the cerebral white matter, which appear to have progressed slightly compared to the proton-density images from [**2153-12-5**]. 10. History of seziures 11. History of right lower extremity deep venous thrombosis 12. Discoid lupus erythematosus 13. Chronic obstructive pulmonary disease 14. History of acute renal failure 15. History of cellulitis 16. s/p total abdominal hysterectomy. 17. History of partial small bowel obstruction in [**4-2**] MEDICATION ON ADMISSION: Atenolol 50mg qam and 25mg qpm Wellbutrin SR 300 mg daily clonidine 0.2mg twice daily Plavix 75mg daily Clozapine 100mg qHS Combivent as needed Diltiazem 360mg daily fluticasone (flovent) 1 puff daily Lasix 40mg daily K-lor 10 Lipitor 10mg nightly metformin 1gm twice daily Zofran 4mg as needed Protonix 40mg EC Calcium 500mg TID docusate 100mg twice daily vitamin 400mg daily iron 325mg daily MVP ALLERGIES: Penicillins / Cipro / Aspirin / Nsaids / Dicloxacillin / Aldomet / Motrin / Lisinopril / Vioxx / Keflex PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T: 99.7 BP: 179/80 P: 88 RR: 22 O2Sat: 97% 2L Gen: nauseated, vomitting HEENT: Clear OP, dry mucous membranes NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops LUNGS: CTA, BS BL, No W/R/C ABD: Soft, obese. some pain to palpation, no guarding EXT: trace edema LLE SKIN: No lesions NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**12-30**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: Father died of MI less than 50 years of age. Mother diagnosed with breast CA for 4 years Notes that mother has history of mental illness, but does not know what kind. SOCIAL HISTORY: Discharge Summary Social History Signed [**Last Name (LF) **],[**First Name8 (NamePattern2) 734**] [**Last Name (NamePattern1) **] WED [**7-4**],[**2158**] 8:08 PM She lives in an apartment adjacent to her daughter. -Tobacco: 1ppd x 35 yrs ~ 35 pack-years. Currently smokes 1 pack per day. -History of cocaine abuse in the past, most recently 30 years ago. -EtOH: History of heavy EtOH use, none currently. Drank up to "a fifth" or a quart of "[**First Name4 (NamePattern1) 4884**] [**Last Name (NamePattern1) 4886**]" at the most in one night. ### Response: {'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other diseases of lung, not elsewhere classified,Congestive heart failure, unspecified,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Benign essential hypertension,Hypovolemia,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Toxic encephalopathy,Hemorrhage of gastrointestinal tract, unspecified,Peripheral autonomic neuropathy in disorders classified elsewhere,Other postoperative infection,Urinary tract infection, site not specified,Schizoaffective disorder, chronic,Other specified cardiac dysrhythmias,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Dyspepsia and other specified disorders of function of stomach,Lupus erythematosus,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled'}

CHIEF COMPLAINT: Speech arrest and R hand weakness PRESENT ILLNESS: This is a 87yo R-handed man with HTN, hypercholesterolemia, CAD, strokes (L-hemiparesis in 03,resolved; sensory TIA in [**1-25**]) who presented with difficulties in speech and R-sided weakness. . On the day of presentation at 4:30pm, the patient was in his USOH. He went upstairs to the bathroom. He was found by his wife, stooped over to the right, drooling, not able to talk. Per EMS records, the patient was not able to move his R arm, had some movement in his R-leg and was mumbling. His fingerstick was 89 and SBP was 190. . The patient arrived in the ED at 5:30pm. A code stroke was called. Neurology was at the bedside at 5:32pm. The stroke fellow arrived at 5:50pm. A head CT w/o contrast was done and was negative for intracranial bleed. Because of the right sided weakness and speech difficulties, the suspicion for a left MCA distribution infarct was high and the decision was made, along with the patient and his family, to administer IV t-PA. Following the infusion, the patient was able to move his R-arm at the elbow and the shoulder, lift L-arm and wiggle his toes. . Of note on arrival to the ED the patient's blood pressure was 146/93. After the CT his BP rose to 208/80. Labetolol was given to maintain the his SBP >140 and <180. Upon completion of the t-PA the patient's SBP was 150. He was transferred to the SICU for further managment. MEDICAL HISTORY: MI x 2('[**08**] and '[**09**]) s/p angioplasty and stenting both times CVA [**2113**] with L sides weakness now resolved sensory TIA [**2116-1-21**] Atrial fibrillation (taken off coumadin for h/o falls), Dementia B12 deficiency HTN Hypercholesterolemia Alzheimer's Disease MEDICATION ON ADMISSION: -ASA -aricept -zestril -zoloft (being tapered) -isosorbide mononitrate -cardizem CD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Physical Exam FAMILY HISTORY: Mother: [**Name (NI) 3730**] Father: MI SOCIAL HISTORY: Social History: Occupation: used to be electrician Married: yes children: 1 son

Cerebral embolism with cerebral infarction,Atrial fibrillation,Volume depletion, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Old myocardial infarction,Unspecified hypertensive heart disease without heart failure,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other B-complex deficiencies

Crbl emblsm w infrct,Atrial fibrillation,Volume depletion NOS,Alzheimer's disease,Dementia w/o behav dist,Old myocardial infarct,Hyp hrt dis NOS w/o hf,Pure hypercholesterolem,Crnry athrscl natve vssl,Status-post ptca,B-complex defic NEC

Admission Date: [**2116-10-26**] Discharge Date: [**2116-10-29**] Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5018**] Chief Complaint: Speech arrest and R hand weakness Major Surgical or Invasive Procedure: s/p TPA (Tissue plasminogen activator) History of Present Illness: This is a 87yo R-handed man with HTN, hypercholesterolemia, CAD, strokes (L-hemiparesis in 03,resolved; sensory TIA in [**1-25**]) who presented with difficulties in speech and R-sided weakness. . On the day of presentation at 4:30pm, the patient was in his USOH. He went upstairs to the bathroom. He was found by his wife, stooped over to the right, drooling, not able to talk. Per EMS records, the patient was not able to move his R arm, had some movement in his R-leg and was mumbling. His fingerstick was 89 and SBP was 190. . The patient arrived in the ED at 5:30pm. A code stroke was called. Neurology was at the bedside at 5:32pm. The stroke fellow arrived at 5:50pm. A head CT w/o contrast was done and was negative for intracranial bleed. Because of the right sided weakness and speech difficulties, the suspicion for a left MCA distribution infarct was high and the decision was made, along with the patient and his family, to administer IV t-PA. Following the infusion, the patient was able to move his R-arm at the elbow and the shoulder, lift L-arm and wiggle his toes. . Of note on arrival to the ED the patient's blood pressure was 146/93. After the CT his BP rose to 208/80. Labetolol was given to maintain the his SBP >140 and <180. Upon completion of the t-PA the patient's SBP was 150. He was transferred to the SICU for further managment. Past Medical History: MI x 2('[**08**] and '[**09**]) s/p angioplasty and stenting both times CVA [**2113**] with L sides weakness now resolved sensory TIA [**2116-1-21**] Atrial fibrillation (taken off coumadin for h/o falls), Dementia B12 deficiency HTN Hypercholesterolemia Alzheimer's Disease Social History: Social History: Occupation: used to be electrician Married: yes children: 1 son Family History: Mother: [**Name (NI) 3730**] Father: MI Physical Exam: Admission Physical Exam Vitals: HR 72 BP 186/76 RR14 FS 89 in the field Gen: NAD, head tilted to L HEENT: mmm Neck: no LAD; no carotid bruits Lungs: Clear to auscultation bilaterally Cardiovascular: Regular rate and rhythm, normal S1 and S2, no murmurs, gallops and rubs. Abdomen: normal bowel sounds, soft, nontender, nondistended Extremities: no clubbing, cyanosis, ecchymosis, or edema . Mental Status: Awake and alert, not able to say any understandable words; following simple one step commands. Not able to say his name, date etc. Making eye contact. Somewhat agitated, clearly not understanding what was happening. . Cranial Nerves: II: Visual fields: blink to threat; pupils equally round and reactive to light both directly and consensually, 2 -->1 mm bilaterally. III, IV, VI: Extraocular movements intact without nystagmus. V: reports sensation on both sides of his face equally. VII: Right facial droop. VIII: Hearing: responds to vocal cues. IX: Palate elevates in midline. XII: Tongue: not able to move on command. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius deferred. . Motor System: Normal bulk and tone bilaterally, given his age. No adventitious movements, no tremor. Strength: would move all exremities antigravity. Pronator drift R. Upon later testing (following t-PA: able to move R-arm in shoulder and elbow, finger extensors and flexors weak; more formal exam not possible due to inability to follow commands, but R-leg and L-arm and L-leg seemed to have good strength) . Sensory system: Sensation: would respond (grimace face) to pin prick (noxious) throughout except for his R-arm. . Reflexes: B T Br Pa Pl Right 2 2 2 2 1 Left 2 2 2 2 1 Toes: upgoing R; mute L. . Coordination: could not be assessed. . Gait: could not be assessed. Pertinent Results: Labs on Admission [**2116-10-26**] 05:42PM BLOOD WBC-8.3 RBC-4.31* Hgb-14.0 Hct-39.1* MCV-91 MCH-32.5* MCHC-35.9* RDW-13.4 Plt Ct-234 [**2116-10-26**] 05:42PM BLOOD Neuts-74.7* Lymphs-17.1* Monos-4.7 Eos-3.0 Baso-0.4 [**2116-10-26**] 05:42PM BLOOD PT-12.5 PTT-27.3 INR(PT)-1.0 [**2116-10-26**] 05:42PM BLOOD Glucose-94 UreaN-28* Creat-1.5* Na-137 K-4.2 Cl-103 HCO3-23 AnGap-15 [**2116-10-26**] 05:42PM BLOOD CK(CPK)-94 [**2116-10-26**] 05:42PM BLOOD Calcium-8.7 Phos-3.5 Mg-2.1 [**2116-10-27**] 02:25AM BLOOD Triglyc-207* HDL-41 CHOL/HD-4.7 LDLcalc-111 . Labs on Discharge [**2116-10-29**] 05:50AM BLOOD WBC-9.6 RBC-3.45* Hgb-11.6* Hct-31.3* MCV-91 MCH-33.8* MCHC-37.2* RDW-13.7 Plt Ct-206 [**2116-10-29**] 05:50AM BLOOD Plt Ct-206 [**2116-10-29**] 05:50AM BLOOD Glucose-91 UreaN-28* Creat-1.5* Na-139 K-3.6 Cl-109* HCO3-21* AnGap-13 [**2116-10-29**] 05:50AM BLOOD Calcium-8.1* Phos-3.4 Mg-2.0 . Lipid Panel [**2116-10-27**] 02:25AM BLOOD Triglyc-207* HDL-41 CHOL/HD-4.7 LDLcalc-111 . Cardiac Enzymes [**2116-10-26**] 05:42PM BLOOD CK-MB-NotDone cTropnT-0.03* [**2116-10-27**] 02:25AM BLOOD CK-MB-6 cTropnT-0.08* [**2116-10-27**] 10:30AM BLOOD CK-MB-10 MB Indx-3.0 [**2116-10-27**] 04:41PM BLOOD CK-MB-10 MB Indx-2.4 cTropnT-0.08* [**2116-10-28**] 05:10AM BLOOD CK-MB-13* MB Indx-2.4 . Radiology CT Head w/o Contrast [**2116-10-26**] CONCLUSION: No definite evidence for acute brain ischemia, although this study is obviously far less sensitive in this regard than MRI scanning with diffusion-weighted imaging. . CT Head w/o Contrast [**2116-10-27**] IMPRESSION: Since the previous study and following TPA, an identifiable infarction has not developed. There is no acute intracranial hemorrhage. . Carotid Ultrasound [**2116-10-27**] IMPRESSION: Significant right ICA plaque with an associated stenosis of approximately 80%, minimal left ICA plaque, no appreciable associated stenosis. Of note is reconstituted right external carotid artery. . ECHO [**2116-10-27**] IMPRESSION: EF: 60%. Significant right ICA plaque with an associated stenosis of approximately 80%, minimal left ICA plaque, no appreciable associated stenosis. Of note is reconstituted right external carotid artery. Brief Hospital Course: This is an 87 y/o male who presented with R sided weakness secondary to a left middle cerebral artery stroke. His hospital course was as follows: . 1. s/p possible Left middle cerebral artery stroke The patient arrived in ED at 5:30pm. His blood pressure on arrival was 146/93. Neurology and the stroke team arrived at the bedside promptly. CT-head w/o contrast was negative for hemorrhage or mass. After CT the patient's blood pressure increased to 208/80. Labetalol was given to keep the SBP <180 and >140. On neurological exam, prior to the t-PA the patient had a pronator drift on the right. t-PA was started around 6:15 and completed before 7:30pm. Upon completion of t-PA the patient's SBP was 150. . Following t-PA the patient was able to move his R-arm in shoulder and elbow, finger extensors and flexors weak; more formal exam not possible due to inability to follow commands, but R-leg and L-arm and L-leg seemed to have good strength (>[**2-25**]). The patient was transferred to the SICU for further management. . In the ICU the patient had q15min vital sign and neurochecks for the first 4 hrs, then q 1 hour for next 18 hours. Labetatol was given to maintain his SBP> 140and SBP<180. Tight glycemic control was maintained. The patient received IVF. Foley was inserted in the ICU. . ECHO findings were consistent with a hypertensive heart. The EF was estimated to be 60%. Duplex carotid ultrasound showed significant right ICA plaque with a 80%stenosis and minimal left ICA plaque with no significant stenosis. . With stabilization of his medical issues, the patient was transferred out of the ICU. He was started on aggrenox. . Throughout his hospital course the patient had serial neurological exams. He had significant improvement in R sided strength. The patient had a L sided droop, but this was residual side effect of his past CVAs. . 2. Ischemia The patient has a history of coronary artery disease and is s/p MI X 2. The patient was maintained on diltiazem and isordil. He was also started on Lipitor because his LDL was 111. . 3. Atrial fibrillation / Tachycardia Per PCP, [**Name10 (NameIs) **] patient has a history of atrial fibrillation. He was placed on Coumadin after his stroke in [**2113**]. The patient was discontinued on Coumadin about 1 year ago because of the patient's risk to fall. The patient was placed on ASA 81mg instead. . The patient's course was complicated by periods of atrial fibrillation and tachycardia to the 150s. Dilt was increased from 30 QID to 45 QID. Diltiazem 10mg IV was also given. A beta-blocker was not started because the SBPs were in the 90-110s. The patient was aymptomatic. An ECG was consistent with atrial fibrillation. Thyroid studies were within normal limits. . On clinical exam, the patient was dry. His tacchycardia was secondary to his intravascular volume depletion. After receiving a 500cc bolus of NS the patient's HR improved to 81. . 4. Pump An Echo on [**2116-10-27**] was consistent with hypertensive heart. EF was 60%. No cardiac source of embolus was identified. . 5. R/O Pulmonary embolism Due to the patient's tachycardia, a D-dimer was order to r/o a pulmonary embolism. It was elevated at 3472. However in the setting of receiving TPA this may be falsely elevated. O2 sats have been stable. . 6.Pernicious Anemia - Pt. was noted to have dropping Hct in the SICU. A foley catheter had been placed s/p t-PA. There was some gross hematuria which subsequently resolved without intervention. - Follow Hct, transfuse to keep Hct > 30. Repeat Hct at discharged was 33. . 7. Dementia The patient was continued on Donepezil without complications. . 8. F/E/N Lytes were repleted as needed. As per speech and swallow - As per speech and swallow recommendations the patient was maintained thickened pureed liquid diet. Medication (except for sustained release and aggrenox) were crushed. . 9. Prophylaxis: The patient was maintained on a proton pump inhibitor and venodynes. Medications on Admission: -ASA -aricept -zestril -zoloft (being tapered) -isosorbide mononitrate -cardizem CD Discharge Medications: 1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Isosorbide Dinitrate 10 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). 3. Cardizem CD 180 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO twice a day. Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2* 4. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 HR Sig: One (1) Cap PO DAILY (Daily) for 1 days. Disp:*1 Cap(s)* Refills:*0* 7. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 HR Sig: One (1) Cap, Multiphasic Release 12 HR PO twice a day. Disp:*60 Cap, Multiphasic Release 12 HR(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Left middle cerebral artery ischemic infarct Atrial fibrillation B12 deficiency Hypertension Hypercholesterolemia Alzheimer's Disease Discharge Condition: Good VS: Tc 98, BP 118-130/58-64, HR 64, R 18-20, O2 sat 95%RA Discharge Instructions: You are to seek medical services immediately if you should experience any difficulty speaking, ambulatiing, numbness, tingling, chest pain, shortness of breath or any other worrisome symptom. . Please continue taking your medications as prescribed. You are being discharged on two medications called Aggrenox and Lipitor. These medications will help to prevent future strokes. In terms of your aggrenox, please take 1 pill on [**2116-10-30**], thereafter you will take 1 pill twice a day. Aggrenox can cause headaches. Please consult your doctor if you should experience headaches. Do not discontinue any of your medications without first speaking with your doctor. Followup Instructions: You are to followup with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11302**] within 1-2 weeks of discharge. You are to also follow up with your neurologist Dr. [**Last Name (STitle) **] on [**2116-12-8**] at 3:30pm on [**Location (un) **] of the [**Hospital Ward Name 23**] Building. (Prior to your appt please call the office to provide them with your registration information.) . Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 2780**] [**Name (STitle) 2781**] Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2116-12-8**] 3:30 [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

434,427,276,331,294,412,402,272,414,V458,266

{"Cerebral embolism with cerebral infarction,Atrial fibrillation,Volume depletion, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Old myocardial infarction,Unspecified hypertensive heart disease without heart failure,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other B-complex deficiencies"}

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: Speech arrest and R hand weakness PRESENT ILLNESS: This is a 87yo R-handed man with HTN, hypercholesterolemia, CAD, strokes (L-hemiparesis in 03,resolved; sensory TIA in [**1-25**]) who presented with difficulties in speech and R-sided weakness. . On the day of presentation at 4:30pm, the patient was in his USOH. He went upstairs to the bathroom. He was found by his wife, stooped over to the right, drooling, not able to talk. Per EMS records, the patient was not able to move his R arm, had some movement in his R-leg and was mumbling. His fingerstick was 89 and SBP was 190. . The patient arrived in the ED at 5:30pm. A code stroke was called. Neurology was at the bedside at 5:32pm. The stroke fellow arrived at 5:50pm. A head CT w/o contrast was done and was negative for intracranial bleed. Because of the right sided weakness and speech difficulties, the suspicion for a left MCA distribution infarct was high and the decision was made, along with the patient and his family, to administer IV t-PA. Following the infusion, the patient was able to move his R-arm at the elbow and the shoulder, lift L-arm and wiggle his toes. . Of note on arrival to the ED the patient's blood pressure was 146/93. After the CT his BP rose to 208/80. Labetolol was given to maintain the his SBP >140 and <180. Upon completion of the t-PA the patient's SBP was 150. He was transferred to the SICU for further managment. MEDICAL HISTORY: MI x 2('[**08**] and '[**09**]) s/p angioplasty and stenting both times CVA [**2113**] with L sides weakness now resolved sensory TIA [**2116-1-21**] Atrial fibrillation (taken off coumadin for h/o falls), Dementia B12 deficiency HTN Hypercholesterolemia Alzheimer's Disease MEDICATION ON ADMISSION: -ASA -aricept -zestril -zoloft (being tapered) -isosorbide mononitrate -cardizem CD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Physical Exam FAMILY HISTORY: Mother: [**Name (NI) 3730**] Father: MI SOCIAL HISTORY: Social History: Occupation: used to be electrician Married: yes children: 1 son ### Response: {"Cerebral embolism with cerebral infarction,Atrial fibrillation,Volume depletion, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Old myocardial infarction,Unspecified hypertensive heart disease without heart failure,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other B-complex deficiencies"}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 77 year old female with diabetes mellitus times thirteen years, history of gastrointestinal bleed, seen by outpatient cardiologist [**2190-12-15**], for preoperative clearance for cataract surgery. In the office, the patient complained of substernal chest pain radiating to the left arm with nausea over the past day. Electrocardiogram showed a 2.0 to 3.[**Street Address(2) 52938**] elevation, right-sided leads consistent with right ventricular infarct. Troponin 13.5. She was transferred to [**Hospital1 69**] for catheterization on Heparin drip, Integrilin, Plavix and Aspirin. Cardiac catheterization revealed 100% proximal occlusion of the distal collateral filling, status post successful Hepacoat stents times two. The procedure was complicated by sinus node dysfunction exacerbated by transient no reflow. The patient was transferred to the CCU for control with AV pacing wires on Dopamine. MEDICAL HISTORY: 1. Diabetes mellitus times thirteen years. 2. History of upper gastrointestinal bleed. MEDICATION ON ADMISSION: 1. Amitriptyline. 2. Multivitamin. 3. Eye drops. 4. Humulin. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: No family history of myocardial infarction. SOCIAL HISTORY: The patient lives with husband. [**Name (NI) 482**] Hindi. The patient denies alcohol use.

Acute myocardial infarction of other inferior wall, initial episode of care,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

AMI inferior wall, init,Hemorrhage complic proc,Surg compl-heart,Food/vomit pneumonitis,CHF NOS,Crnry athrscl natve vssl,Cardiac dysrhythmias NEC,DMII wo cmp nt st uncntr

Admission Date: [**2190-12-15**] Discharge Date: [**2191-1-5**] Date of Birth: [**2113-10-6**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: This is a 77 year old female with diabetes mellitus times thirteen years, history of gastrointestinal bleed, seen by outpatient cardiologist [**2190-12-15**], for preoperative clearance for cataract surgery. In the office, the patient complained of substernal chest pain radiating to the left arm with nausea over the past day. Electrocardiogram showed a 2.0 to 3.[**Street Address(2) 52938**] elevation, right-sided leads consistent with right ventricular infarct. Troponin 13.5. She was transferred to [**Hospital1 69**] for catheterization on Heparin drip, Integrilin, Plavix and Aspirin. Cardiac catheterization revealed 100% proximal occlusion of the distal collateral filling, status post successful Hepacoat stents times two. The procedure was complicated by sinus node dysfunction exacerbated by transient no reflow. The patient was transferred to the CCU for control with AV pacing wires on Dopamine. MEDICATIONS ON ADMISSION: 1. Amitriptyline. 2. Multivitamin. 3. Eye drops. 4. Humulin. PAST MEDICAL HISTORY: 1. Diabetes mellitus times thirteen years. 2. History of upper gastrointestinal bleed. SOCIAL HISTORY: The patient lives with husband. [**Name (NI) 482**] Hindi. The patient denies alcohol use. FAMILY HISTORY: No family history of myocardial infarction. PHYSICAL EXAMINATION: On examination, temperature is 98.8, heart rate 98, blood pressure 90 to 110 over 50 to 60. Head, eyes, ears, nose and throat - Extraocular movements are intact. The pupils are equal, round, and reactive to light and accommodation. Normocephalic and atraumatic. Neck revealed no jugular venous distention. Respiratory - intubated. Clear breath sounds bilaterally. Cardiovascular is regular rate and rhythm, normal S1 and S2, II/VI holosystolic murmur. Extremities showed 2+ dorsalis pedis bilaterally, warm, no edema. Abdomen is soft, nontender, nondistended. LABORATORY DATA: Electrocardiogram precatheterization showed sinus at 75 beats per minute, normal axis, early R wave progression, inferior ST elevation myocardial infarction, 2.0 to 3.0 millimeters, small Q wave, aVL less than 1.0 millimeter, ST depressions V5 and V6 with less than 1.[**Street Address(2) 52939**] elevations consistent with prior study. Echocardiogram on [**2190-12-15**], showed symmetric left ventricular hypertrophy, unusually small left ventricular cavity, mild regional left ventricular systolic dysfunction, resting regional wall motion abnormalities including inferolateral akinesis and hypokinesis. The right ventricular cavity is dilated. Right ventricular systolic function was depressed. The aortic valve leaflets are moderately thickened, mild 1+ aortic regurgitation, mild 1+ mitral regurgitation, 2+ tricuspid regurgitation. Cardiac catheterization on [**2190-12-15**], showed left anterior descending 40 to 50% of the mid posterior diagonal, left circumflex 80% at the mid large obtuse marginal, right coronary artery 100% proximally with distal collaterals. Left ventriculogram showed ejection fraction of 40%, severe right ventricular hypokinesis. Creatinine 1.1, hematocrit 37.1. HOSPITAL COURSE: 1. Coronary artery disease - The patient had initial cardiac catheterization and stents placed to the right coronary artery as described above. She had two right coronary artery stents placed and at the time of catheterization had temporary AV pacing wires placed. She was intubated at the time. Her catheterization was complicated by bouts of bradycardia and hypotension with initial balloon dilation requiring Atropine, Dopamine and right ventricular pacing. Coronary sinus pacing wire was placed with continuous Dopamine drip for augmentation of blood pressure. During her CCU course she ultimately regained intrinsic pacing function and her pacing wires were discontinued. She was started on an Aspirin, Plavix, statin, ace inhibitor and beta blocker. Pump function - Echocardiogram as described above. Initially, the patient had severe right ventricular dysfunction, however, she regained much of her function in her right ventricle and subsequent echocardiogram on [**2190-12-27**], showed a mildly dilated left atrium, left ventricular wall thickness, cavity size and systolic function are normal with an ejection fraction of 55%. The right ventricular cavity was mildly dilated. Right ventricular systolic function depressed. Mild 1+ aortic regurgitation, moderate 2+ mitral regurgitation, and compared to the findings of the prior report, the inferior wall motion abnormality had resolved. Rhythm - The patient temporarily required AV pacing, however, her sinus function was regained and she has maintained a normal sinus rhythm during her hospitalization. 2. Pulmonary - The patient was intubated in the catheterization laboratory for agitation and initially failed extubation secondary to increased granulation tissue around the intubation tubing. On [**2190-12-28**], she failed a second extubation secondary to the airway edema. On [**2190-12-29**], an open tracheostomy was performed by the ENT service in the operating room. Since that time, she has been progressively changed to smaller and smaller tracheostomy tubes and at the time of this dictation, the expectation is that she will not need a tracheostomy for long term care and that she will regain regular upper airway pulmonary function. However, in the meantime, she will need rehabilitation services. 3. Gastroenterology - The patient had a history of upper gastrointestinal bleed and, while intubated, she was maintained on tube feedings. After extubation and tracheostomy placement, the patient failed a speech and swallow test on two separate occasions. A percutaneous endoscopic gastrostomy tube was placed on [**2191-1-4**], for feeding purposes until the time when she is able to swallow on her own. 4. Infectious disease - The patient had a period of time during her hospitalization where she had fevers of unknown etiology. She completed a course of Vancomycin, Levaquin and Flagyl for suspected aspiration pneumonia. At the time of this dictation, all cultures have not grown anything to date. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: To rehabilitation facility with follow-up with cardiology. Her primary cardiologist is Dr. [**Last Name (STitle) 1159**] at [**Hospital3 1280**]. MEDICATIONS ON DISCHARGE: 1. Metoprolol 100 mg p.o. twice a day. 2. Insulin sliding scale. 3. NPH 28 units twice a day. 4. Lisinopril 10 mg p.o. once daily. 5. Atrovent MDI two puffs q6hours p.r.n. 6. Colace 100 mg p.o. twice a day. 7. Lansoprazole 30 mg p.o. twice a day. 8. Senna 1 mg p.o. once daily. 9. Heparin subcutaneous 5000 units twice a day. 10. Lipitor 20 mg p.o. once daily. 11. Plavix 75 mg p.o. once daily. FOLLOW-UP: The patient will follow-up with Dr. [**Last Name (STitle) 1159**] in cardiology clinic within the next month. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D. [**MD Number(1) 7169**] Dictated By:[**Last Name (NamePattern1) 2706**] MEDQUIST36 D: [**2191-1-4**] 19:59 T: [**2191-1-4**] 20:20 JOB#: [**Job Number 52940**]

410,998,997,507,428,414,427,250

{'Acute myocardial infarction of other inferior wall, initial episode of care,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

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 77 year old female with diabetes mellitus times thirteen years, history of gastrointestinal bleed, seen by outpatient cardiologist [**2190-12-15**], for preoperative clearance for cataract surgery. In the office, the patient complained of substernal chest pain radiating to the left arm with nausea over the past day. Electrocardiogram showed a 2.0 to 3.[**Street Address(2) 52938**] elevation, right-sided leads consistent with right ventricular infarct. Troponin 13.5. She was transferred to [**Hospital1 69**] for catheterization on Heparin drip, Integrilin, Plavix and Aspirin. Cardiac catheterization revealed 100% proximal occlusion of the distal collateral filling, status post successful Hepacoat stents times two. The procedure was complicated by sinus node dysfunction exacerbated by transient no reflow. The patient was transferred to the CCU for control with AV pacing wires on Dopamine. MEDICAL HISTORY: 1. Diabetes mellitus times thirteen years. 2. History of upper gastrointestinal bleed. MEDICATION ON ADMISSION: 1. Amitriptyline. 2. Multivitamin. 3. Eye drops. 4. Humulin. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: No family history of myocardial infarction. SOCIAL HISTORY: The patient lives with husband. [**Name (NI) 482**] Hindi. The patient denies alcohol use. ### Response: {'Acute myocardial infarction of other inferior wall, initial episode of care,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Altered Mental status, respiratory failure PRESENT ILLNESS: 78 y/o gentleman with CAD, systolic CHF EF 20%, ischemic/hemorrhagic CVA, ESRD/HD, recurrent PNA presents with respiratory failure and altered mental status. History obtained from wife and two daughters. [**Name (NI) **] experienced an ischemic stroke which converted to hemorrhagic in [**2187-5-22**] and was admitted to [**Hospital1 112**]. He then had respiratory failure, recurrent PNA (including MRSA and Klebsiella), unable to wean off vent and trach placement. He was transfered to [**Hospital1 392**]. His last PNA was one month ago and was treated with vanc/cefepime for two weeks. Patient was transfered to [**Hospital 38**] rehab yesterday. He was at his usual baseline yesterday. He has residual left sided weakness from stroke. He is alert and oriented x 3, able to read/write and do math problems. [**Name (NI) **] was recently weaned off of vent. This morning his duaghter found him to be less responsive. His oxygen saturation decreased to 80s with systolic BP to 80s later on prior to HD session. He was transfered to [**Hospital3 13347**]. He was found to have WBC to 40s with bandemia to 30s. He was given Vancomycin IV, cefepime and flagyl per verbal report from ED. He was transfered to [**Hospital1 18**] as there was no beds available there. When patient arrived to [**Hospital1 18**] his vitals were T 98.3 BP 102/58 HR 95 RR 20 100 % CMV. His BP then dropped to 80s requiring 1 L NS. He was started on low dose midazolam as he was 'fighting the vent' per ED signout. On arrival to the ICU his vitals were T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. He was not able to provide any history. According to family patient has experienced increased bowel movements today. He did not compain of any fever, chills, nightsweats, chest pain, abdominal pain, nausea, vomitting, headache, change in vision, hearing, new weakness, numbness yesterday. He was able to recognize his family in the ED today after the antibiotics but less responsive after midazolam drip. MEDICAL HISTORY: CVA [**2174**] ? [**2179**]. In [**2187-5-22**] ischemic converted to hemorrhagic. MEDICATION ON ADMISSION: albuterol ipratropium q6h carvedilol 25 mg daily carvedilol 25 mg on sun, mon, wed, and fri chlorhexindine clortrimazoel topical NPH novolin 4 units qhs levetiracetam 750 mg [**Hospital1 **] mvi nystatin swish and spit omeprazole 20 mg daily acetaminophen prn albuterol nebs prn bisacodyl prn ALLERGIES: Heparin Agents PHYSICAL EXAM: Vitals: T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. Gen: Patient unable to give any history. Not responding to verbal stimuli. Cachectic. Spontaneously moved left upper extremity. HEENT: Pupils round and minimally reactive to light, MMM, OP clear Heart: S1S2 RRR, distant heart sounds Lungs: Crackles in bilat lower half of lung fields, coarse breath sounds bilaterally. Abdomen: [**Name (NI) 282**] tube in place. Hypoactive BS. Soft ND. Ext: Sacral decubitus ulcer. No edema. WWP. Neuro: Plantars down going. Reflexes 1+ bilaterally. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Patient lived at home prior to stroke in [**5-29**] with his wife. [**Name (NI) **] three daughter living nearby. 30 pack year history quit approx 40 years ago. No ETOH.

Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Methicillin resistant Staphylococcus aureus septicemia,Severe sepsis,Septic shock,Pressure ulcer, stage III,End stage renal disease,Chronic systolic heart failure,Atrial flutter,Candidiasis of mouth,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Thrombocytopenia, unspecified,Herpes zoster without mention of complication,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension of hemodialysis,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diarrhea,Anemia, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Infection with microorganisms without mention of resistance to multiple drugs,Gastrostomy status,Renal dialysis status,Personal history of tuberculosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Tracheostomy status

Acute & chronc resp fail,K. pneumoniae pneumonia,MRSA septicemia,Severe sepsis,Septic shock,Pressure ulcer,stage III,End stage renal disease,Chr systolic hrt failure,Atrial flutter,Thrush,Meth resis Staph carrier,Thrombocytopenia NOS,Herpes zoster NOS,Crnry athrscl natve vssl,Old myocardial infarct,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Hemododialysis hypotensn,Abn react-renal dialysis,Diarrhea,Anemia NOS,Epilep NOS w/o intr epil,Inf mcr rst ot drg nt ml,Gastrostomy status,Renal dialysis status,Prsnl hst tuberculosis,Hx TIA/stroke w/o resid,Tracheostomy status

Admission Date: [**2187-10-25**] Discharge Date: [**2187-11-2**] Date of Birth: [**2109-9-12**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Altered Mental status, respiratory failure Major Surgical or Invasive Procedure: -hemodialysis -PICC placement History of Present Illness: 78 y/o gentleman with CAD, systolic CHF EF 20%, ischemic/hemorrhagic CVA, ESRD/HD, recurrent PNA presents with respiratory failure and altered mental status. History obtained from wife and two daughters. [**Name (NI) **] experienced an ischemic stroke which converted to hemorrhagic in [**2187-5-22**] and was admitted to [**Hospital1 112**]. He then had respiratory failure, recurrent PNA (including MRSA and Klebsiella), unable to wean off vent and trach placement. He was transfered to [**Hospital1 392**]. His last PNA was one month ago and was treated with vanc/cefepime for two weeks. Patient was transfered to [**Hospital 38**] rehab yesterday. He was at his usual baseline yesterday. He has residual left sided weakness from stroke. He is alert and oriented x 3, able to read/write and do math problems. [**Name (NI) **] was recently weaned off of vent. This morning his duaghter found him to be less responsive. His oxygen saturation decreased to 80s with systolic BP to 80s later on prior to HD session. He was transfered to [**Hospital3 13347**]. He was found to have WBC to 40s with bandemia to 30s. He was given Vancomycin IV, cefepime and flagyl per verbal report from ED. He was transfered to [**Hospital1 18**] as there was no beds available there. When patient arrived to [**Hospital1 18**] his vitals were T 98.3 BP 102/58 HR 95 RR 20 100 % CMV. His BP then dropped to 80s requiring 1 L NS. He was started on low dose midazolam as he was 'fighting the vent' per ED signout. On arrival to the ICU his vitals were T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. He was not able to provide any history. According to family patient has experienced increased bowel movements today. He did not compain of any fever, chills, nightsweats, chest pain, abdominal pain, nausea, vomitting, headache, change in vision, hearing, new weakness, numbness yesterday. He was able to recognize his family in the ED today after the antibiotics but less responsive after midazolam drip. Past Medical History: CVA [**2174**] ? [**2179**]. In [**2187-5-22**] ischemic converted to hemorrhagic. - CAD s/p MI - systolic CHF EF 20% - ESRD/HD - Type 2 DM - Dyslipidemia - h/o TB approx 30 years ago was treated - Stage 3 decub ulcer - chronic thrombocytopenia - failed speech and [**Last Name (LF) **], [**First Name3 (LF) 282**] placed Social History: Patient lived at home prior to stroke in [**5-29**] with his wife. [**Name (NI) **] three daughter living nearby. 30 pack year history quit approx 40 years ago. No ETOH. Family History: Noncontributory Physical Exam: Vitals: T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. Gen: Patient unable to give any history. Not responding to verbal stimuli. Cachectic. Spontaneously moved left upper extremity. HEENT: Pupils round and minimally reactive to light, MMM, OP clear Heart: S1S2 RRR, distant heart sounds Lungs: Crackles in bilat lower half of lung fields, coarse breath sounds bilaterally. Abdomen: [**Name (NI) 282**] tube in place. Hypoactive BS. Soft ND. Ext: Sacral decubitus ulcer. No edema. WWP. Neuro: Plantars down going. Reflexes 1+ bilaterally. Pertinent Results: [**2187-10-25**] 10:10PM BLOOD WBC-40.4* RBC-3.20* Hgb-9.5* Hct-30.1* MCV-94 MCH-29.7 MCHC-31.5 RDW-16.5* Plt Ct-99* [**2187-10-26**] 05:53PM BLOOD WBC-23.1* RBC-3.45*# Hgb-11.0*# Hct-30.5*# MCV-89 MCH-31.9 MCHC-36.1*# RDW-16.5* Plt Ct-80* [**2187-10-28**] 02:47AM BLOOD WBC-17.2* RBC-3.28* Hgb-9.9* Hct-29.8* MCV-91 MCH-30.3 MCHC-33.3 RDW-16.3* Plt Ct-66* [**2187-10-30**] 02:11AM BLOOD WBC-8.9 RBC-3.11* Hgb-9.4* Hct-28.7* MCV-92 MCH-30.3 MCHC-32.9 RDW-15.9* Plt Ct-66* [**2187-11-1**] 02:51AM BLOOD WBC-6.7 RBC-3.02* Hgb-9.3* Hct-28.2* MCV-94 MCH-30.7 MCHC-32.9 RDW-16.3* Plt Ct-56* [**2187-11-2**] 04:12AM BLOOD WBC-6.2 RBC-2.87* Hgb-8.5* Hct-26.4* MCV-92 MCH-29.7 MCHC-32.4 RDW-15.5 Plt Ct-53* [**2187-10-25**] 10:10PM BLOOD Neuts-85* Bands-10* Lymphs-1* Monos-4 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2187-10-27**] 04:07AM BLOOD Neuts-88.6* Lymphs-4.3* Monos-6.4 Eos-0.5 Baso-0.1 [**2187-11-1**] 02:51AM BLOOD Neuts-53 Bands-6* Lymphs-14* Monos-18* Eos-4 Baso-1 Atyps-1* Metas-2* Myelos-1* [**2187-11-2**] 04:12AM BLOOD Neuts-50 Bands-10* Lymphs-14* Monos-15* Eos-3 Baso-0 Atyps-4* Metas-3* Myelos-1* [**2187-10-25**] 10:10PM BLOOD PT-15.5* PTT-34.0 INR(PT)-1.4* [**2187-10-26**] 04:57AM BLOOD PT-16.6* PTT-38.6* INR(PT)-1.5* [**2187-10-27**] 04:07AM BLOOD PT-16.4* PTT-38.8* INR(PT)-1.5* [**2187-10-30**] 02:11AM BLOOD PT-16.9* PTT-37.8* INR(PT)-1.5* [**2187-11-2**] 04:12AM BLOOD PT-14.1* PTT-33.2 INR(PT)-1.2* [**2187-10-25**] 10:10PM BLOOD Glucose-249* UreaN-143* Creat-3.7* Na-131* K-5.4* Cl-95* HCO3-18* AnGap-23* [**2187-10-26**] 05:53PM BLOOD Glucose-145* UreaN-20 Creat-0.9# Na-137 K-2.9* Cl-99 HCO3-27 AnGap-14 [**2187-10-27**] 04:07AM BLOOD Glucose-173* UreaN-37* Creat-1.5* Na-137 K-3.3 Cl-100 HCO3-27 AnGap-13 [**2187-10-29**] 02:00AM BLOOD Glucose-70 UreaN-93* Creat-3.0* Na-136 K-4.0 Cl-103 HCO3-22 AnGap-15 [**2187-10-31**] 03:53AM BLOOD Glucose-128* UreaN-63* Creat-2.3* Na-136 K-4.3 Cl-102 HCO3-24 AnGap-14 [**2187-11-1**] 02:51AM BLOOD Glucose-143* UreaN-32* Creat-1.5* Na-138 K-4.7 Cl-105 HCO3-27 AnGap-11 [**2187-11-2**] 04:12AM BLOOD Glucose-233* UreaN-58* Creat-2.3* Na-135 K-3.4 Cl-102 HCO3-25 AnGap-11 [**2187-10-26**] 04:57AM BLOOD LD(LDH)-189 CK(CPK)-69 TotBili-0.5 [**2187-10-26**] 11:45AM BLOOD CK(CPK)-82 [**2187-10-26**] 04:57AM BLOOD CK-MB-NotDone cTropnT-3.75* [**2187-10-26**] 11:45AM BLOOD CK-MB-NotDone cTropnT-3.75* [**2187-10-26**] 04:57AM BLOOD Calcium-8.6 Phos-6.4* Mg-2.5 [**2187-10-27**] 04:07AM BLOOD Calcium-8.2* Phos-1.8* Mg-1.7 [**2187-10-29**] 02:00AM BLOOD Calcium-8.2* Phos-4.8*# Mg-1.9 [**2187-10-31**] 03:53AM BLOOD Calcium-8.4 Phos-4.3 Mg-2.4 [**2187-11-2**] 04:12AM BLOOD Calcium-8.0* Phos-4.9*# Mg-1.8 [**2187-10-30**] 02:11AM BLOOD calTIBC-91* Ferritn-GREATER TH TRF-70* [**2187-10-25**] 10:16PM BLOOD Temp-38.0 Rates-20/5 Tidal V-400 PEEP-5 FiO2-100 pO2-396* pCO2-36 pH-7.37 calTCO2-22 Base XS--3 AADO2-296 REQ O2-54 -ASSIST/CON Intubat-INTUBATED [**2187-10-27**] 08:05AM BLOOD Type-ART Temp-37.1 Rates-18/2 Tidal V-400 PEEP-5 FiO2-50 pO2-206* pCO2-34* pH-7.50* calTCO2-27 Base XS-4 Intubat-INTUBATED Vent-CONTROLLED [**2187-10-28**] 03:03AM BLOOD Type-ART pO2-192* pCO2-32* pH-7.49* calTCO2-25 Base XS-2 [**2187-10-30**] 02:24PM BLOOD Type-ART Temp-38.1 Rates-/22 Tidal V-350 PEEP-5 FiO2-40 pO2-171* pCO2-39 pH-7.43 calTCO2-27 Base XS-2 -ASSIST/CON Intubat-INTUBATED [**2187-10-27**] 9:01 pm SPUTUM Site: ENDOTRACHEAL ENDOTRACHEAL. GRAM STAIN (Final [**2187-10-27**]): >25 PMNs and <10 epithelial cells/100X field. NO MICROORGANISMS SEEN. SMEAR REVIEWED; RESULTS CONFIRMED. RESPIRATORY CULTURE (Preliminary): OROPHARYNGEAL FLORA ABSENT. KLEBSIELLA PNEUMONIAE. MODERATE GROWTH. WARNING! This isolate is an extended-spectrum beta-lactamase (ESBL) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. Consider Infectious Disease consultation for serious infections caused by ESBL-producing species. KLEBSIELLA PNEUMONIAE. SPARSE GROWTH. SENT TO [**Hospital1 4534**] LABORATORIES FOR COLISTIN SUSCEPTIBILITY. STAPH AUREUS COAG +. RARE GROWTH. Please contact the Microbiology Laboratory ([**5-/2485**]) immediately if sensitivity to clindamycin is required on this patient's isolate. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations Rifampin should not be used alone for therapy. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ KLEBSIELLA PNEUMONIAE | KLEBSIELLA PNEUMONIAE | | STAPH AUREUS COAG + | | | AMIKACIN-------------- 16 S =>64 R AMPICILLIN/SULBACTAM-- =>32 R =>32 R CEFAZOLIN------------- =>64 R =>64 R CEFEPIME-------------- R 32 R CEFTAZIDIME----------- R =>64 R CEFTRIAXONE----------- R CEFUROXIME------------ R =>64 R CIPROFLOXACIN--------- =>4 R =>4 R ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ =>16 R =>16 R <=0.5 S LEVOFLOXACIN---------- =>8 R MEROPENEM-------------<=0.25 S OXACILLIN------------- =>4 R PENICILLIN G---------- =>0.5 R PIPERACILLIN/TAZO----- =>128 R =>128 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- <=1 S TOBRAMYCIN------------ =>16 R =>16 R TRIMETHOPRIM/SULFA---- =>16 R =>16 R <=0.5 S VANCOMYCIN------------ <=1 S [**2187-10-29**] 5:27 pm SPUTUM Site: ENDOTRACHEAL Source: Endotracheal. **FINAL REPORT [**2187-10-31**]** GRAM STAIN (Final [**2187-10-29**]): [**9-15**] PMNs and <10 epithelial cells/100X field. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS. RESPIRATORY CULTURE (Final [**2187-10-31**]): RARE GROWTH OROPHARYNGEAL FLORA. KLEBSIELLA PNEUMONIAE. RARE GROWTH. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 50803**] [**2187-10-27**]. KLEBSIELLA PNEUMONIAE. RARE GROWTH 2ND MORPHOLOGY. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 50803**] [**2187-10-27**]. CXR [**10-25**]: FINDINGS: Portable AP view of the chest in supine position was obtained. There is a right-sided dual-lumen hemodialysis catheter with the tip in the right atrium. Tracheostomy tube is seen. The cardiac silhouette is enlarged. The aorta is tortuous and calcified. Bilateral pleural effusions, left greater than right. Retrocardiac opacity may represent a combination of atelectasis and pleural effusion. There are diffuse interstitial abnormalities with patchy areas of more nodular opacities. There is no pneumothorax. IMPRESSION: The constellation of findings may represent acute on chronic process such as pulmonary edema in a patient with chronic interstitial lung disease; however, superimposed infection or other entities cannot be excluded. PA and lateral views of the chest after appropriate treatment is recommended. CT would also be helpful if clinically indicated. ========================================= . Micro results from [**Hospital6 **]. . [**2187-9-27**] Sputum Klebsiella Pneumoniae resistant to Amikacin, amp, amp/sulbacam, aztreonam, cefazolin, cefepime, ceftazidime, ceftriaxone, cipro, gent, topramycin, bacrim. Sensitive to Cefotetan, imipenem, [**Doctor Last Name **]/tazo. . Staph aureus: MRSA sensitive to linezolid, tetracycline, bactrim, vanco . Klebsiella Pneumoniae Strain #2. Reisistant to Amikacin, amp, amp/sulbactam, cefazolin, ceftazidime, cipro, genta, [**Doctor Last Name **]/tazo, tobramycin, bactrim. Sensitive to aztreonam, cefepime, cefotetan, ceftriaxone, imipenem. Brief Hospital Course: 78 y/o gentleman with CAD, systolic CHF EF 20%, ischemic/hemorrhagic CVA, ESRD/HD, recurrent PNA presents with septic shock, respiratory failure and altered mental status. . # Sepsis/pneumonia: Patient has known pneumonia with MRSA and klebsiella in the past. Known to have VRE in the past. On presentation patient had crakles on exam, sputum production, leukocytosis, bandermia, and abnormal CXR consistent with pneumonia. Blood, urine, sputum, and stool cultures were drawn, and he was started empirically on vancomycin and meropenem. Also given reports of loose stools he was started on empiric oral vancomycin and IV flagyl. Patient was noted to have decubitus ulcer and a scabbed, dried vescicled rash in a dermatomal pattern (R T10) that appeared consistent with healing zoster. Neither of these was felt to be significantly contributing to his clinical picture. His [**10-27**] Sputum culture grew Klebsiella with 2 separate lines isolated which was originally both sensitive to amikacin and meropenem. On further testing one line was found to be resistant to meropenem and anikacin. At this time, it is thought that one of his Klebsiella species was ESBL sensitive to Meropenem. The other Klebsiella strain which was resistant to Meropenem, likely due to intrinsic carbapenemase activity but is not ESBL so it could potentially be sensitive to some beta lactams although resistance pattern did show resistence to Unasyn and Zosyn. ID Did not recommend any further antibiotic therapy at this time. MRSA was also added to [**10-27**] sputum. He was continued on Meropenem and vancomycin (although vancomycin was discontinued on [**10-30**] and restarted [**11-2**] once MRSA added to [**10-27**] sputum culture. Fevers have largely subsided and leukocytosis decreased as has sputum production. Transient reports of hypotension during admission were found to be associated to positioning of A-line and/or post-HD hypotension (fluid responsive) so unlikely to be due to sepsis. His oral vancomycin and IV flagyl were discontinued on [**10-29**] once C difficile toxin A&B were negative in 3 separate samples. He will need to complete a 14 day course of vancomycin to finish on [**2187-11-16**]. A two week course of meropenem should continue until [**11-9**]. His vancomyin will need to be dosed per HD protocol. Due to Mr [**Known lastname **] multiple resistant pathogens a private room and strict contact precautions should be maintained. Please trend LFTS weekly for side effects of meropenem. . # AMS: Likely secondary to sepsis and midazolam administration. The patient's mental status improved per family (who was at bedside daily) since admission with treating infection as above. At time of discharge, patient was at his most recent baseline according to his family. . # Hypoxia: Most likely due to pneumonia. The patient was maintained on assist control for most of his admission, with daily trials at pressure support. His respiratory status improved with administration of antibiotics. At the time of discharge he was still unable to wean from assist control. He will need to work on weaning as an outpatient. . # CHF: patient has known ischemic cardiomyopathy with last known EF 20%. His only CHF med at the time of admission was variable doses of carvedilol. On admission his dose was initially decreased to 12.5 mg [**Hospital1 **] and then uptitrated to 25 mg [**Hospital1 **]. He was also started on a trial of Isordil and hyralazine. However, he had periods of low blood pressures, particularly after HD. Renal was concerned that these medications were limiting their ability to perform ultrafiltration so these medications were discontinued. His carvedilol am dose was held on HD days. In the future, you could consider initiating a low dose ace inhibitor or [**Last Name (un) **]. . # CAD: Normal CK at OSH and elevated tropinin in the setting of renal failure. EKG changes are most likely due to LVH with strain pattern. No clear ischemic changes. He ruled out for MI with serial cardiac enzymes. His ischemic cardiomyopathy was managed as above. He was continued on baby aspirin, statin, and beta blocker. In the future, if he has recurrent ischemia, caution will need to be taken with any anticoagulation and antiplatelet therapies given his history of heparin allergy and recent hemorrhagic stroke. . # ESRD/HD: He continued on HD throughout his hospital admission Q monday, wednesday, friday. He tolerated 3-4 L of ultrafiltration per day. After some HDs, he had periods of low BP which were felt to be due to over ultrafiltration and he responded to IV fluid boluses. His last HD session was on the day of discharge [**11-2**]. . # Diarrhea: On admission elevated WBC and bandemia raised concern for C difficile in the setting of recent antibiotics. As above, he was started on empiric oral vancomycin and IV flagyl which were discontinued on [**10-29**] once his stool cultures were negative for C difficile x 3. . # atrial flutter: patient had no prior history of atrial fibrillation and atrial flutter. He went into atrial flutter after having a temp on [**10-31**]. He was well rate controlled with variable block and ventricular responses in the 70s. He spontaneously converted to NSR on [**11-1**]. On [**11-2**], during dialysis he had some periods of sinus bradycardia into the 40s. However, a line tracing showed excellent blood pressures despite bradycardia with SBPs in 130s. It is possiblehe has some element of sick sinus sindrome/tachy brady syndrome. At this time he is asymptomatic. We are continuing his beta blocker at the current dose. If he has episodes of bradycardia with decreased BP, one could consider decreasing his carvedilol dose. He is a poor anticoagulation candidate given his history of stroke and allergy to heparin. Can consider increasing aspirin to full dose. However this was not done prior to discharge given his baseline thrombocytopenia. . # chronic thrombocytopenia: levels fluctuated throughout hospital course but remained reasonably stable without evidence of bleeding with the exception of his zoster site. His aspirin dose was maintained at 81 mg due to this. Also given his abnormal differentials and chronic anemai during his hospital admission hematology was consulted. They did not think any further treatment needed to be pursued with the exception of supportive care but he will follow up with Hematolgy as an outpatient. Please trend platelets at rehab and replete for plts < 20 or if actively bleeding . # Diabetes: he was continued on lantus and humalog insulin sliding scale. . # seizure disorder: likely secondary to his preceding stroke. He had no seizure activity during his admission and he was continued on his regular dose keppra. . # Decubitus ulcer: Improving per daughter. Wound care was consulted and he had no evidence of infection throughout his hospital admission. Wound care recs: pressure redistribution per pressure ulcer guidliens. Turn and reposition q2h off back. After cleaning pat dry and apply wound gel. No sting barrier wipe to perinum, allow to dry. Plase NS [**Last Name (un) 26535**] (barely damp) on ulcer, cover with dry gauze, abd pad. Secure with tape . # herpes zoster: patient was noted to have R sided herpes zoster on admission in T10 distribution. Over the course of admission, vesicles unroofed and scabbed. He had increased ecchymoses surrounding rash felt to be due to chronic thrombocytopenia. It continued to resolve during his admission. No treatment was pursued. Wound should be cleared daily with commercial cleanser and left open to air when possible. . # Code: Full code, no central lines after discussing with family (wife [**Name (NI) **] [**Name (NI) **], daughters [**Name (NI) **] and [**Name (NI) 21212**]) . # Contact: Wife [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 50804**], Daughter [**Name (NI) **] [**Telephone/Fax (1) 50805**], [**Name2 (NI) 21212**] [**Telephone/Fax (1) 50806**] Medications on Admission: albuterol ipratropium q6h carvedilol 25 mg daily carvedilol 25 mg on sun, mon, wed, and fri chlorhexindine clortrimazoel topical NPH novolin 4 units qhs levetiracetam 750 mg [**Hospital1 **] mvi nystatin swish and spit omeprazole 20 mg daily acetaminophen prn albuterol nebs prn bisacodyl prn Discharge Medications: 1. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15) ML Mucous membrane [**Hospital1 **] (2 times a day) as needed. 2. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 3. Calcium Carbonate 500 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable PO TID (3 times a day). 4. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: Six [**Age over 90 1230**]y (650) mg PO Q6H (every 6 hours) as needed. 5. Albuterol 90 mcg/Actuation Aerosol [**Age over 90 **]: Six (6) Puff Inhalation Q4H (every 4 hours). 6. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Age over 90 **]: Six (6) Puff Inhalation Q4H (every 4 hours). 7. Aspirin 81 mg Tablet, Chewable [**Age over 90 **]: One (1) Tablet, Chewable PO DAILY (Daily). 8. Nystatin 100,000 unit/mL Suspension [**Age over 90 **]: Ten (10) ML PO QID (4 times a day) as needed for thrush: give until thrush clears. 9. Atorvastatin 10 mg Tablet [**Age over 90 **]: One (1) Tablet PO DAILY (Daily). 10. Levetiracetam 250 mg Tablet [**Age over 90 **]: Three (3) Tablet PO BID (2 times a day). 11. Carvedilol 12.5 mg Tablet [**Age over 90 **]: Two (2) Tablet PO BID (2 times a day): hold for SBP < 100, HR < 60, please hold am dose on dialysis days . 12. 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. 13. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Age over 90 **]: One (1) gram Intravenous HD PROTOCOL (HD Protochol): previously on [**10-26**] to [**10-30**], restarted [**11-2**]. Complete 2 week continuous course to [**11-16**] . 14. Meropenem 500 mg Recon Soln [**Month/Year (2) **]: One (1) Recon Soln Intravenous Q24H (every 24 hours): give dose AFTER dialysis, on HD days. Complete two week course on [**11-9**]. 15. Insulin Lispro 100 unit/mL Solution [**Month/Year (2) **]: see ISS units Subcutaneous four times a day: As directed by HISS. 16. Lantus 100 unit/mL Solution [**Month/Year (2) **]: Six (6) units Subcutaneous at bedtime: use in conjunction with humalog ISS. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Primary: 1. Klebsiella pneumonia 2. MRSA pneumonia 3. ESRD on dialysis 4. herpes zoster 5. stage 3 decubitus ulcer 6. acute on chronic respiratory failure 7. Anemia 8. Paroxsymal Atrial flutter 9. Thursh Secondary: 1. chronic systolic heart failure 2. history of cerebrovascular accident 3. thrombocytopenia 4. seizure disorder 5. diabetes 6. hyperlipidemia 7. CAD Discharge Condition: Nonverbal. Interactive with family. Ventilator dependent with trach and [**Hospital1 282**]. HR and BP stable. Discharge Instructions: You were admitted to the hospital for a change in your mental status. You were found to have a pneumonia and were treated with strong antibiotics. You will need to continue on these antibiotics as prescribed below. We were unable to wean you off the ventilator, this process will continue at rehab. Please follow up with your regular doctors as below. The following perninant changes were made to your medications: Started on Meropenem to be taken for 2 week course until [**11-9**] for pneumonia. Started on Vancomycin to be taken for 2 week course to end on [**11-16**] If you develop worsening fevers, increased ventilator requirement, abdominal pain, diarrhea, worsening mental status, chest pain, focal weakness, or any other worrisome symptoms please seek urgent medical attention. Followup Instructions: Please call your primary care provider [**Last Name (NamePattern4) **]. [**First Name (STitle) 39968**] at [**Telephone/Fax (1) **] to schedule a follow up appointment after discharge from rehab or sooner should the need arise. . As you requested here is the number of the Cardiology department at [**Hospital1 69**]. Please call [**Telephone/Fax (1) 62**] to schedule a new patient appointment. . Please continue with your regular dialysis schedule. . Please follow up with Hematology as below: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 647**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2187-11-8**] 3:00 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3014**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2187-11-8**] 3:00 [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2187-11-2**] Name: [**Known lastname **],[**Known firstname 909**] POY Unit No: [**Numeric Identifier 9448**] Admission Date: [**2187-10-25**] Discharge Date: [**2187-11-2**] Date of Birth: [**2109-9-12**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**Last Name (NamePattern4) 3776**] Addendum: Of note, records obtained from [**Hospital6 9449**] Hospital from original hospitalization in [**6-29**] indicate patient was positive for VRE on screening swab. He also then had a MSSA pneumonia diagnosed on sputum sample from [**6-26**]. Records were obtained from [**Hospital6 9230**] from hospitalization [**9-29**]. Patient had MRSA in sputum as well as two Klebsiella species. Please see results section for full details. Discharge Disposition: Extended Care Facility: [**Hospital3 14**] & Rehab Center - [**Hospital1 15**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 593**] [**Name8 (MD) 304**] MD [**MD Number(1) 594**] Completed by:[**2187-11-2**]

518,482,038,995,785,707,585,428,427,112,V025,287,053,414,412,272,250,458,E879,787,285,345,V098,V441,V451,V120,V125,V440

{'Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Methicillin resistant Staphylococcus aureus septicemia,Severe sepsis,Septic shock,Pressure ulcer, stage III,End stage renal disease,Chronic systolic heart failure,Atrial flutter,Candidiasis of mouth,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Thrombocytopenia, unspecified,Herpes zoster without mention of complication,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension of hemodialysis,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diarrhea,Anemia, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Infection with microorganisms without mention of resistance to multiple drugs,Gastrostomy status,Renal dialysis status,Personal history of tuberculosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Tracheostomy 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: Altered Mental status, respiratory failure PRESENT ILLNESS: 78 y/o gentleman with CAD, systolic CHF EF 20%, ischemic/hemorrhagic CVA, ESRD/HD, recurrent PNA presents with respiratory failure and altered mental status. History obtained from wife and two daughters. [**Name (NI) **] experienced an ischemic stroke which converted to hemorrhagic in [**2187-5-22**] and was admitted to [**Hospital1 112**]. He then had respiratory failure, recurrent PNA (including MRSA and Klebsiella), unable to wean off vent and trach placement. He was transfered to [**Hospital1 392**]. His last PNA was one month ago and was treated with vanc/cefepime for two weeks. Patient was transfered to [**Hospital 38**] rehab yesterday. He was at his usual baseline yesterday. He has residual left sided weakness from stroke. He is alert and oriented x 3, able to read/write and do math problems. [**Name (NI) **] was recently weaned off of vent. This morning his duaghter found him to be less responsive. His oxygen saturation decreased to 80s with systolic BP to 80s later on prior to HD session. He was transfered to [**Hospital3 13347**]. He was found to have WBC to 40s with bandemia to 30s. He was given Vancomycin IV, cefepime and flagyl per verbal report from ED. He was transfered to [**Hospital1 18**] as there was no beds available there. When patient arrived to [**Hospital1 18**] his vitals were T 98.3 BP 102/58 HR 95 RR 20 100 % CMV. His BP then dropped to 80s requiring 1 L NS. He was started on low dose midazolam as he was 'fighting the vent' per ED signout. On arrival to the ICU his vitals were T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. He was not able to provide any history. According to family patient has experienced increased bowel movements today. He did not compain of any fever, chills, nightsweats, chest pain, abdominal pain, nausea, vomitting, headache, change in vision, hearing, new weakness, numbness yesterday. He was able to recognize his family in the ED today after the antibiotics but less responsive after midazolam drip. MEDICAL HISTORY: CVA [**2174**] ? [**2179**]. In [**2187-5-22**] ischemic converted to hemorrhagic. MEDICATION ON ADMISSION: albuterol ipratropium q6h carvedilol 25 mg daily carvedilol 25 mg on sun, mon, wed, and fri chlorhexindine clortrimazoel topical NPH novolin 4 units qhs levetiracetam 750 mg [**Hospital1 **] mvi nystatin swish and spit omeprazole 20 mg daily acetaminophen prn albuterol nebs prn bisacodyl prn ALLERGIES: Heparin Agents PHYSICAL EXAM: Vitals: T 99.1 HR 92 BP 95/42 100% CMV/AS FiO2 50% PEEP 5 TV 400. Gen: Patient unable to give any history. Not responding to verbal stimuli. Cachectic. Spontaneously moved left upper extremity. HEENT: Pupils round and minimally reactive to light, MMM, OP clear Heart: S1S2 RRR, distant heart sounds Lungs: Crackles in bilat lower half of lung fields, coarse breath sounds bilaterally. Abdomen: [**Name (NI) 282**] tube in place. Hypoactive BS. Soft ND. Ext: Sacral decubitus ulcer. No edema. WWP. Neuro: Plantars down going. Reflexes 1+ bilaterally. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Patient lived at home prior to stroke in [**5-29**] with his wife. [**Name (NI) **] three daughter living nearby. 30 pack year history quit approx 40 years ago. No ETOH. ### Response: {'Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Methicillin resistant Staphylococcus aureus septicemia,Severe sepsis,Septic shock,Pressure ulcer, stage III,End stage renal disease,Chronic systolic heart failure,Atrial flutter,Candidiasis of mouth,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Thrombocytopenia, unspecified,Herpes zoster without mention of complication,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension of hemodialysis,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diarrhea,Anemia, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Infection with microorganisms without mention of resistance to multiple drugs,Gastrostomy status,Renal dialysis status,Personal history of tuberculosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Tracheostomy status'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 34 year old man with advanced chronic kidney disease and nephrotic range proteinuria attributed to long standing diabetes (without kidney biopsy) with recurrent admissions/ED visits for dyspnea and leg edema who presented this time with anasarca, dyspnea, orthopnea, and paroxismal night dyspnea. He takes Lasix 40 mg po BID, which is underdosed for his GFR. He was to follow up with outpatient nephrology for consideration of kidney biopsy to confirm the diagnosis. He has been compliant with Lasix and low salt diet. He has cough with clear sputum but no chest pain or fever. He noticed decreased urine output but no other urinary symptoms. No GI symptoms or neurological symptoms. In ED, he received IV antibiotics for "pneumonia" and a very small, ineffective dose of IV lasix 20 mg. MEDICAL HISTORY: Diabetes Type II (diagnosed when he was 18) Gastroparesis (diagnosed in [**12-31**]) Hypertension Chronic renal insufficiency with nephrotic range protienuria Hyperlipidemia Anxiety/Depression MEDICATION ON ADMISSION: AMLODIPINE 10 mg daily PREVAC FUROSEMIDE 40 mg [**Hospital1 **] HYDRALAZINE 25 mg QID INSULIN GLARGINE 50 units SC nightly INSULIN LISPRO 20 units SC with meals LISINOPRIL 10 mg daily (on Hold) LORAZEPAM 1 mg [**Hospital1 **] METOCLOPRAMIDE 10 mg QID with meals and at bedtime METOPROLOL TARTRATE 100 mg [**Hospital1 **] ONDANSETRON 8 mg TID prn Tablet, Rapid Dissolve - one Tablet(s) by mouth three times daily as needed for nausea/vomiting ASPIRIN 81 mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: Alert, oriented, no acute distress with generalized anasarca HEENT: Sclera anicteric, MMM, oropharynx somewhat dry Neck: supple, JVP could not be determined, no LAD Lungs: Clear to auscultation bilaterally except for bibasilar small rales, no wheezes CV: regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, obese, bowel sounds hypoactive, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, but with generalized anasarca (up to the chest) FAMILY HISTORY: His mother has diabetes. Denies a family history of gastrointestinal disease. SOCIAL HISTORY: He lives with his wife and son. [**Name (NI) **] is on disability. He denies tobacco, alcohol, or drug use except for smoking marijuana.

Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephrotic syndrome in diseases classified elsewhere,Chronic kidney disease, Stage V,Gastroparesis,Other and unspecified hyperlipidemia,Hyperpotassemia,Edema

Anxiety state NOS,Depressive disorder NEC,Long-term use of insulin,DMII renl nt st uncntrld,Ac on chr diast hrt fail,Hyp kid NOS w cr kid V,Nephrotic syn in oth dis,Chron kidney dis stage V,Gastroparesis,Hyperlipidemia NEC/NOS,Hyperpotassemia,Edema

Admission Date: [**2145-1-5**] Discharge Date: [**2145-1-11**] Date of Birth: [**2110-8-15**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 896**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: None History of Present Illness: 34 year old man with advanced chronic kidney disease and nephrotic range proteinuria attributed to long standing diabetes (without kidney biopsy) with recurrent admissions/ED visits for dyspnea and leg edema who presented this time with anasarca, dyspnea, orthopnea, and paroxismal night dyspnea. He takes Lasix 40 mg po BID, which is underdosed for his GFR. He was to follow up with outpatient nephrology for consideration of kidney biopsy to confirm the diagnosis. He has been compliant with Lasix and low salt diet. He has cough with clear sputum but no chest pain or fever. He noticed decreased urine output but no other urinary symptoms. No GI symptoms or neurological symptoms. In ED, he received IV antibiotics for "pneumonia" and a very small, ineffective dose of IV lasix 20 mg. Past Medical History: Diabetes Type II (diagnosed when he was 18) Gastroparesis (diagnosed in [**12-31**]) Hypertension Chronic renal insufficiency with nephrotic range protienuria Hyperlipidemia Anxiety/Depression Social History: He lives with his wife and son. [**Name (NI) **] is on disability. He denies tobacco, alcohol, or drug use except for smoking marijuana. Family History: His mother has diabetes. Denies a family history of gastrointestinal disease. Physical Exam: General: Alert, oriented, no acute distress with generalized anasarca HEENT: Sclera anicteric, MMM, oropharynx somewhat dry Neck: supple, JVP could not be determined, no LAD Lungs: Clear to auscultation bilaterally except for bibasilar small rales, no wheezes CV: regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, obese, bowel sounds hypoactive, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, but with generalized anasarca (up to the chest) Discharge: Clear lungs [**1-25**]+ lower extremity edema weight 240 lbs on standing scale Pertinent Results: Admission Labs [**2145-1-5**] WBC-16.3* RBC-3.13* Hgb-9.1* Hct-27.9* MCV-89 MCH-29.1 MCHC-32.7 RDW-13.3 Plt Ct-406 Neuts-85.0* Lymphs-8.9* Monos-5.1 Eos-0.5 Baso-0.6 Glucose-197* UreaN-61* Creat-4.4* Na-134 K-5.1 Cl-104 HCO3-20* AnGap-15 Calcium-8.2* Phos-5.2* Mg-2.0 CK-MB-8 proBNP-[**Numeric Identifier 20968**]* Discharge Labs [**2145-1-10**] WBC-8.5 RBC-2.63* Hgb-7.6* Hct-23.3* MCV-89 MCH-28.8 MCHC-32.5 RDW-12.7 Plt Ct-379 Glucose-64* UreaN-57* Creat-4.5* Na-131* K-4.1 Cl-98 HCO3-24 AnGap-13 ECHO: Moderate mitral regurgitation with mild leaflet thickening. Mild pulmonary artery systolic hypertension. Mild symmetric left ventricular hypertrophy with normal regional and low normal global left ventricular systolic function. CXR: 1. Mild volume overload, increased in comparison to prior study from [**2145-1-2**]. 2. There are also bilateral small pleural effusions, left greater than right; however, early development of left lower lobe opacity cannot be excluded. Repeat radiographs after diuresis is recommended to evaluate for early development of consolidation. Brief Hospital Course: 1. Anasarca due to nephrotic syndrome and congestive heart failure. Admitted with recurrent SOB, orthopnea, PND and dyspnea on exertion. He was initially diuresed on the floor then transferred to the ICU on [**1-7**] when he became acutely SOB requiring NRB to saturate in the low 90's. In the ICU he was aggressively diuresed with metolazone and furosemide. After returning to the floor, diuresis was continued with furosemide alone (80 mg [**Hospital1 **]) with discharge weight of 240 lbs. 2. Chronic kidney disease. An ACE-I was initially held but restarted once GRF improved. Left arm was protected in preparation for possible HD acces in the near future. Calcium carbonate was initiated for hyperphosphatemia. 3. Positive H.Pylori. Patient was continued on Prevpack and completed his course on [**1-9**]. 4. Diabetes Mellitus. Maintained on home-dose Lantus and ISS. Medications on Admission: AMLODIPINE 10 mg daily PREVAC FUROSEMIDE 40 mg [**Hospital1 **] HYDRALAZINE 25 mg QID INSULIN GLARGINE 50 units SC nightly INSULIN LISPRO 20 units SC with meals LISINOPRIL 10 mg daily (on Hold) LORAZEPAM 1 mg [**Hospital1 **] METOCLOPRAMIDE 10 mg QID with meals and at bedtime METOPROLOL TARTRATE 100 mg [**Hospital1 **] ONDANSETRON 8 mg TID prn Tablet, Rapid Dissolve - one Tablet(s) by mouth three times daily as needed for nausea/vomiting ASPIRIN 81 mg daily Discharge Medications: 1. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. furosemide 40 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 4. insulin glargine 100 unit/mL Solution Sig: Twenty Five (25) units Subcutaneous at bedtime. 5. insulin lispro 100 unit/mL Solution Sig: Twenty (20) units Subcutaneous three times a day: with meals. 6. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 9. metoprolol tartrate 100 mg Tablet Sig: One (1) Tablet PO twice a day. 10. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO three times a day as needed for nausea. 11. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 12. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet, Chewable(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Nephrotic syndrome Congestive heart failure 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 with shortness of breath resulting from excess fluid accumulation. Please be sure to continue with your low sodium diet and take your furosemide (LASIX), as prescribed. Your weight at discharge is 240 lbs. Please be sure to check your weight EVERY MORNING. If it increases by >2 lbs, please call either Dr. [**Last Name (STitle) **] or [**Doctor Last Name 4090**] to discuss next steps. Followup Instructions: Department: [**Hospital3 1935**] CENTER When: WEDNESDAY [**2145-1-13**] at 1:20 PM With: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. [**Telephone/Fax (1) 253**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 1935**] CENTER When: WEDNESDAY [**2145-1-13**] at 1:20 PM With: LASER PROCEDURE [**Telephone/Fax (1) 253**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital1 18**] [**Location (un) 2352**]- ADULT MED When: THURSDAY [**2145-1-14**] at 10:40 AM With: [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4012**], MD [**Telephone/Fax (1) 1144**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site

300,311,V586,250,428,403,581,585,536,272,276,782

{'Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephrotic syndrome in diseases classified elsewhere,Chronic kidney disease, Stage V,Gastroparesis,Other and unspecified hyperlipidemia,Hyperpotassemia,Edema'}

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 PRESENT ILLNESS: 34 year old man with advanced chronic kidney disease and nephrotic range proteinuria attributed to long standing diabetes (without kidney biopsy) with recurrent admissions/ED visits for dyspnea and leg edema who presented this time with anasarca, dyspnea, orthopnea, and paroxismal night dyspnea. He takes Lasix 40 mg po BID, which is underdosed for his GFR. He was to follow up with outpatient nephrology for consideration of kidney biopsy to confirm the diagnosis. He has been compliant with Lasix and low salt diet. He has cough with clear sputum but no chest pain or fever. He noticed decreased urine output but no other urinary symptoms. No GI symptoms or neurological symptoms. In ED, he received IV antibiotics for "pneumonia" and a very small, ineffective dose of IV lasix 20 mg. MEDICAL HISTORY: Diabetes Type II (diagnosed when he was 18) Gastroparesis (diagnosed in [**12-31**]) Hypertension Chronic renal insufficiency with nephrotic range protienuria Hyperlipidemia Anxiety/Depression MEDICATION ON ADMISSION: AMLODIPINE 10 mg daily PREVAC FUROSEMIDE 40 mg [**Hospital1 **] HYDRALAZINE 25 mg QID INSULIN GLARGINE 50 units SC nightly INSULIN LISPRO 20 units SC with meals LISINOPRIL 10 mg daily (on Hold) LORAZEPAM 1 mg [**Hospital1 **] METOCLOPRAMIDE 10 mg QID with meals and at bedtime METOPROLOL TARTRATE 100 mg [**Hospital1 **] ONDANSETRON 8 mg TID prn Tablet, Rapid Dissolve - one Tablet(s) by mouth three times daily as needed for nausea/vomiting ASPIRIN 81 mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: Alert, oriented, no acute distress with generalized anasarca HEENT: Sclera anicteric, MMM, oropharynx somewhat dry Neck: supple, JVP could not be determined, no LAD Lungs: Clear to auscultation bilaterally except for bibasilar small rales, no wheezes CV: regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, obese, bowel sounds hypoactive, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, but with generalized anasarca (up to the chest) FAMILY HISTORY: His mother has diabetes. Denies a family history of gastrointestinal disease. SOCIAL HISTORY: He lives with his wife and son. [**Name (NI) **] is on disability. He denies tobacco, alcohol, or drug use except for smoking marijuana. ### Response: {'Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephrotic syndrome in diseases classified elsewhere,Chronic kidney disease, Stage V,Gastroparesis,Other and unspecified hyperlipidemia,Hyperpotassemia,Edema'}

CHIEF COMPLAINT: Gunshot wound to chest PRESENT ILLNESS: 21M [**Location (un) **] s/p GSW to chest by 40 caliber handgun, intubated at scene and brought to [**Hospital1 18**] MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: Penicillins PHYSICAL EXAM: Discharge: AAOx3 NAD RRR CTAB wounds c/d/i soft NT/ND FAMILY HISTORY: SOCIAL HISTORY:

Traumatic hemothorax with open wound into thorax,Open fracture of sternum,Acute posthemorrhagic anemia,Hypotension, unspecified,Injury due to legal intervention by firearms

Traum hemothorax-open,Fracture of sternum-open,Ac posthemorrhag anemia,Hypotension NOS,Legal intervent-firearm

Admission Date: [**2174-3-15**] Discharge Date: [**2174-3-23**] Date of Birth: [**2151-7-17**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 2969**] Chief Complaint: Gunshot wound to chest Major Surgical or Invasive Procedure: Bilateral tube thoracostomy left VATs and evacuation of hemithorax History of Present Illness: 21M [**Location (un) **] s/p GSW to chest by 40 caliber handgun, intubated at scene and brought to [**Hospital1 18**] Past Medical History: none Physical Exam: Discharge: AAOx3 NAD RRR CTAB wounds c/d/i soft NT/ND Pertinent Results: [**2174-3-15**] 10:00AM BLOOD WBC-26.6* RBC-3.94* Hgb-12.2* Hct-33.8* MCV-86 MCH-31.0 MCHC-36.2* RDW-12.8 Plt Ct-324 [**2174-3-19**] 08:50AM BLOOD WBC-5.3 RBC-3.18* Hgb-9.6* Hct-27.6* MCV-87 MCH-30.0 MCHC-34.6 RDW-13.6 Plt Ct-265 [**2174-3-19**] 08:50AM BLOOD Plt Ct-265 [**2174-3-18**] 08:00AM BLOOD Glucose-98 UreaN-6 Creat-0.8 Na-141 K-3.4 Cl-105 HCO3-27 AnGap-12 CT [**3-15**] Status post gunshot wound to the left anterior chest wall with active extravasation in the left anterior chest wall most likely from intercostal/internal mammary artery injury. 2. Consolidation of the left upper lobe most likely secondary to pulmonary hemorrhage/contusion. 3. Dense consolidation of the left lower lobe most likely secondary to atelectasis. 4. Small bilateral basilar pneumothoraces. 5. Proper placement of endotracheal tube, NG tube, and bilateral chest tubes. 6. Fractures of inferior part of sternum and anteroinferior left ribs. 7. Bullet lies in right subcutaneous tissues Wet read was put in ED dashboard at the time of initial review. Brief Hospital Course: Medflighted here and Bilat. chest tubes placed in ED, patient went directly to OR for thoracoscopy, bronchoscopy and evacuation of hemothorax [**3-15**] given increased L. chest tube output and hypotension in ED. Post op he had anemia and for which he received 3 units. This resolved. Left chest tube put out more than the right. He was extubated on [**3-16**] without difficulty after having a bronchoscopy at the bedside to clear secretions. Right and then the left CT's were placed on waterseal and then removed without complications. On day of discharge he is in good condition for transfer to Shaduck facility. Medications on Admission: none Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 2. Morphine 2 mg/mL Syringe Sig: [**1-25**] Injection Q4-6H (every 4 to 6 hours) as needed for break through. 3. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed. 4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Extended Care Facility: [**Hospital6 2222**] - [**Location (un) 538**] Discharge Diagnosis: Gunshot wound to chest anterior to heart Discharge Condition: Good Discharge Instructions: Please call or return if you have chest pain, fevers, shortness of breath, or anything that causes you concern Followup Instructions: Provider: [**Name10 (NameIs) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 170**] Call to schedule appointment Name: [**Known lastname **],[**Known firstname 394**] Unit No: [**Numeric Identifier 12039**] Admission Date: [**2174-3-15**] Discharge Date: [**2174-3-23**] Date of Birth: [**2151-7-17**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 9814**] Addendum: there is no addendum necessary for this d/c summary. thank you. Discharge Disposition: Extended Care [**First Name11 (Name Pattern1) 3549**] [**Last Name (NamePattern1) 9816**] MD [**MD Number(2) 9817**] Completed by:[**2174-8-18**]

860,807,285,458,E970

{'Traumatic hemothorax with open wound into thorax,Open fracture of sternum,Acute posthemorrhagic anemia,Hypotension, unspecified,Injury due to legal intervention by firearms'}

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: Gunshot wound to chest PRESENT ILLNESS: 21M [**Location (un) **] s/p GSW to chest by 40 caliber handgun, intubated at scene and brought to [**Hospital1 18**] MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: Penicillins PHYSICAL EXAM: Discharge: AAOx3 NAD RRR CTAB wounds c/d/i soft NT/ND FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Traumatic hemothorax with open wound into thorax,Open fracture of sternum,Acute posthemorrhagic anemia,Hypotension, unspecified,Injury due to legal intervention by firearms'}

CHIEF COMPLAINT: Abnormal stress test. PRESENT ILLNESS: Mr. [**Known lastname 1058**] is a 52-year-old patient of Dr. [**Last Name (STitle) 7659**] who had an abnormal stress test as an outpatient, referred for cardiac catheterization to further evaluate. The patient had a cardiac cath done in [**2106-4-25**] at [**Hospital3 **] due to chest pain, and at that time it revealed 50 percent LAD, with a normal ejection fraction. The patient reports that he has been followed by Dr. [**Last Name (STitle) 7659**] since that time with annual stress tests and echocardiograms. He reports that he has been feeling fine with no symptoms of chest pain or dyspnea. He walks three miles five times per week with no symptoms. He had an exercise tolerance test done in [**Month (only) 216**] of this year that was negative for angina or ischemia on EKG, but positive for apical wall motion ischemia, with an EF of 50 percent. After getting the results of the stress test, he reports having occasional chest soreness and throat discomfort that occurs both at rest and with exertion lasting for a few minutes and resolving spontaneously. He does report feeling extremely anxious since finding out that he needed to have a cardiac catheterization done. MEDICAL HISTORY: Hypertension. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: NEURO: Alert and oriented x 3, moves all extremities, follows commands, nonfocal exam. PULMONARY: Clear to auscultation bilaterally. CARDIAC: Regular rate and rhythm, S1, S2, with no murmur, rub or gallop. Sternum is stable. Incision with Steri-Strips, open to air, clean and dry. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well- perfused with no edema. Left endoscopic vein graft harvest site with Steri-Strips, open to air, clean and dry. FAMILY HISTORY: Positive for CAD. His dad died of an MI at age 74, and he has a brother who has had a CABG. SOCIAL HISTORY: Married. Works in sales. Remote tobacco, quit 10 years ago. Occasional alcohol.

Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2116-10-7**] Discharge Date: [**2116-10-13**] Date of Birth: [**2063-10-18**] Sex: M Service: CSU CHIEF COMPLAINT: Abnormal stress test. HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname 1058**] is a 52-year-old patient of Dr. [**Last Name (STitle) 7659**] who had an abnormal stress test as an outpatient, referred for cardiac catheterization to further evaluate. The patient had a cardiac cath done in [**2106-4-25**] at [**Hospital3 **] due to chest pain, and at that time it revealed 50 percent LAD, with a normal ejection fraction. The patient reports that he has been followed by Dr. [**Last Name (STitle) 7659**] since that time with annual stress tests and echocardiograms. He reports that he has been feeling fine with no symptoms of chest pain or dyspnea. He walks three miles five times per week with no symptoms. He had an exercise tolerance test done in [**Month (only) 216**] of this year that was negative for angina or ischemia on EKG, but positive for apical wall motion ischemia, with an EF of 50 percent. After getting the results of the stress test, he reports having occasional chest soreness and throat discomfort that occurs both at rest and with exertion lasting for a few minutes and resolving spontaneously. He does report feeling extremely anxious since finding out that he needed to have a cardiac catheterization done. PAST MEDICAL HISTORY: Hypertension. Hyperlipidemia. ALLERGIES: No known drug allergies. MEDICATIONS: 1. Lotrel 50/20 1 tab [**Hospital1 **]. 2. Advicor 500/20 1 tab [**Hospital1 **]. 3. Atenolol/Chlor 50/25 once daily. 4. Aspirin 81 once daily. FAMILY HISTORY: Positive for CAD. His dad died of an MI at age 74, and he has a brother who has had a CABG. SOCIAL HISTORY: Married. Works in sales. Remote tobacco, quit 10 years ago. Occasional alcohol. PHYSICAL EXAMINATION: VITAL SIGNS: Heart rate 58, blood pressure 148/68, respiratory rate 18, O2 sat 98 percent on room air. NEURO: Nonfocal exam. CARDIOVASCULAR: Regular rate and rhythm, S1, S2, with no murmurs. RESPIRATORY: Clear to auscultation bilaterally. Abdomen is soft, nontender. Extremities are warm and well-perfused with no edema. As stated, the patient was admitted to cath lab. Please see cath report for full details. In summary, the patient had a normal left main, LAD with 70 percent lesion, left circumflex with a 70 percent lesion, and an RCA with a proximal occlusion that had collateral filling. LAB DATA: White count 6.7, hematocrit 43.6, platelets 244, INR 1.2, sodium 139, potassium 3.9, chloride 102, CO2 30, BUN 13, creatinine 0.8. HOSPITAL COURSE: Following catheterization, the patient was admitted to the [**Hospital Unit Name 196**] service, and CT surgery was consulted. The patient was seen and accepted for coronary artery bypass grafting, and on [**10-8**] he was brought to the operating room. Please see the OR report for full details. In summary, the patient had a coronary artery bypass grafting x 3 with a LIMA to the LAD, saphenous vein graft to OM1, and saphenous vein graft to the diag. His bypass time was 63 minutes with a crossclamp time of 42 minutes. The patient 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 a normal sinus rhythm at 88 beats per minute with a mean arterial pressure of 88, and a CVP of 6. He had propofol at 20 mcg/kg/min. The patient did well in the immediate postoperative period. He remained hemodynamically stable. His anesthesia was reversed, he was weaned from the ventilator and successfully extubated. On postoperative day 1, the patient remained hemodynamically stable. His central venous access was removed, and he was transferred from the floor to Far-2 for continuing postoperative care and cardiac rehabilitation. On postoperative day 2, the patient continued to be hemodynamically stable. With the assistance of the nursing staff and the physical therapy staff, his activity level was gradually increased. Also on postoperative day 2, his chest tubes, Foley catheter and temporary pacing wires were removed. Over the next several days, the patient's activity level was increased with the assistance of nursing and physical therapy. He remained hemodynamically stable throughout this period and had an uneventful hospital course. Ultimately, on postoperative day 5, it was decided that the patient was stable and ready to be discharged to home. At the time of this dictation, the patient's physical exam is as follows: Temperature 98.5, heart rate 86/sinus rhythm, blood pressure 140/84, respiratory rate 18, O2 sat 96 percent on room air, weight on day of discharge 109, preoperatively 104. LAB DATA [**2116-10-11**]: White count 7.3, hematocrit 31.4, platelets 193, sodium 140, potassium 3.8, chloride 101, CO2 29, BUN 9, creatinine 0.7, glucose 127, mag 2.1. PHYSICAL EXAM: NEURO: Alert and oriented x 3, moves all extremities, follows commands, nonfocal exam. PULMONARY: Clear to auscultation bilaterally. CARDIAC: Regular rate and rhythm, S1, S2, with no murmur, rub or gallop. Sternum is stable. Incision with Steri-Strips, open to air, clean and dry. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well- perfused with no edema. Left endoscopic vein graft harvest site with Steri-Strips, open to air, clean and dry. CONDITION ON DISCHARGE: Stable. He is to be discharged to home with visiting nurses. He is to have follow-up with Dr. [**Last Name (STitle) 7659**] in [**2-27**] weeks, and follow-up with Dr. [**Last Name (STitle) 70**] in 6 weeks. DISCHARGE MEDICATIONS: 1. Aspirin 325 once daily. 2. Percocet 5/325, 1-2 tabs q 4 h prn. 3. Plavix 75 mg once daily x 1 month. 4. Metoprolol 100 mg [**Hospital1 **]. 5. Lasix 40 mg once daily x 10 days. 6. Potassium chloride 10 mEq once daily x 10 days. 7. Advicor 500/20, 1 tablet [**Hospital1 **]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**] Dictated By:[**Last Name (NamePattern4) 1718**] MEDQUIST36 D: [**2116-10-13**] 18:06:05 T: [**2116-10-14**] 10:34:27 Job#: [**Job Number 56751**]

414,401,272

{'Coronary atherosclerosis of native coronary artery,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: Abnormal stress test. PRESENT ILLNESS: Mr. [**Known lastname 1058**] is a 52-year-old patient of Dr. [**Last Name (STitle) 7659**] who had an abnormal stress test as an outpatient, referred for cardiac catheterization to further evaluate. The patient had a cardiac cath done in [**2106-4-25**] at [**Hospital3 **] due to chest pain, and at that time it revealed 50 percent LAD, with a normal ejection fraction. The patient reports that he has been followed by Dr. [**Last Name (STitle) 7659**] since that time with annual stress tests and echocardiograms. He reports that he has been feeling fine with no symptoms of chest pain or dyspnea. He walks three miles five times per week with no symptoms. He had an exercise tolerance test done in [**Month (only) 216**] of this year that was negative for angina or ischemia on EKG, but positive for apical wall motion ischemia, with an EF of 50 percent. After getting the results of the stress test, he reports having occasional chest soreness and throat discomfort that occurs both at rest and with exertion lasting for a few minutes and resolving spontaneously. He does report feeling extremely anxious since finding out that he needed to have a cardiac catheterization done. MEDICAL HISTORY: Hypertension. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: NEURO: Alert and oriented x 3, moves all extremities, follows commands, nonfocal exam. PULMONARY: Clear to auscultation bilaterally. CARDIAC: Regular rate and rhythm, S1, S2, with no murmur, rub or gallop. Sternum is stable. Incision with Steri-Strips, open to air, clean and dry. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well- perfused with no edema. Left endoscopic vein graft harvest site with Steri-Strips, open to air, clean and dry. FAMILY HISTORY: Positive for CAD. His dad died of an MI at age 74, and he has a brother who has had a CABG. SOCIAL HISTORY: Married. Works in sales. Remote tobacco, quit 10 years ago. Occasional alcohol. ### Response: {'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: Patient is a 70 y/o F with history of restrictive/obstructive lung diseases, asthma, pulm hypertension, dCHF, hypoventilation, OSA who presents with shortness of breath over the past week, worsening. She did not want to come in, and today her daughter forced her to. MEDICAL HISTORY: - Severe kyphoscoliosis s/p operative repair in [**2140**]. Last spirometry [**8-/2165**] FVC 30% pred (490cc), FEV1 27% pred (300cc), ratio 0.62, DLCO 17% pred - Severe sleep disordered breathing - Hypoventilation syndrome due to severe restrictive lung disease - Asthma - Chronic hypercapneic, hypoxic respiratory failure- resting ABG MEDICATION ON ADMISSION: Albuterol nebs as needed Albuterol inhaler as needed Fosamax 70mg weekly [**Doctor First Name **] 180mg daily during allergy season Fluocinonide 0.05% daily Fluticasone 220mcg twice daily Lasix 80mg daily Lisinopril 40mg nightly Metoclopramide 10mg TId with with meals Pantoprazole 40mg daily Salmeterol 50mch inhaled 1 puff at bedtime Calcium Coenzyme Q10 Colace Vitamin D Multivitamin with iron Omega 3 fatty acid O2 3L NC at all times ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 99.2 BP: 144/66 P: 75 R: 22 O2: 95%/2L General: Alert, oriented, mildly labored breathing HEENT: Sclera anicteric, MMM, oropharynx clear Neck: JVP elevated. Lungs: severe kyphosis and scoliosis. rales diffusely, also some wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: misshapen secondary to childhood burn injury. nontender FAMILY HISTORY: Father died of liver cancer. Daughter with breast cancer at 45. Also history of colon cancer. No history of pulmonary disease. SOCIAL HISTORY: Prior smoke (X 11 years) but quit in [**2138**]. No alcohol. Lives with daughter and performs own ADLs (bathing, dressing, cooking). Previously worked as a home health aide. Widowed.

Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Chronic obstructive asthma with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Kyphosis (acquired) (postural),Chronic kidney disease, Stage II (mild),Other constipation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia of other chronic disease,Esophageal reflux,Osteoporosis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other dependence on machines, supplemental oxygen,Personal history of tobacco use,Long-term (current) use of steroids

Acute & chronc resp fail,Ac on chr diast hrt fail,Acute kidney failure NOS,Ch obst asth w (ac) exac,Hyperosmolality,Chr pulmon heart dis NEC,Obstructive sleep apnea,Kyphosis NOS,Chro kidney dis stage II,Constipation NEC,Hy kid NOS w cr kid I-IV,Anemia-other chronic dis,Esophageal reflux,Osteoporosis NOS,Diaphragmatic hernia,Depend-supplement oxygen,History of tobacco use,Long-term use steroids

Admission Date: [**2166-6-23**] Discharge Date: [**2166-6-27**] Date of Birth: [**2096-1-17**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 613**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: None History of Present Illness: Patient is a 70 y/o F with history of restrictive/obstructive lung diseases, asthma, pulm hypertension, dCHF, hypoventilation, OSA who presents with shortness of breath over the past week, worsening. She did not want to come in, and today her daughter forced her to. The patient reports decreased exercise tolerance over the past week. already minimally active, but now even less active. She denies change in her diet or weight, but is weighing in higher than baseline (b/; ~93lbs, here 97). denies increased salt in her diet. She denies fevers, chills, cough, abdominal pain, dysurea. She is on 3L NC at home. She reports that she has been wearing her Bipap every night since her last visit with Dr. [**Last Name (STitle) 4507**]. No sputum production, no cough. slight runny nose consistent with allergies. She reports no change in her routine, has been compliant with her medications. Per OMR notes, her Lasix PO was decreased from 80mg daily to 40mg because of high creatinine. Patient also reports that she has had intermittent headache since starting the bipap. In the ER, her intial vitals were, T 98.6, BP 151/60, RR 28, 69% on 2NC. She was started on a nitro gtt, given Lasix 80mg IV x2, having put out about 800cc. On the floor, The patient was interactive and breathing fast. She reports shortness of breath, no chest pain, cough, fever, see above. Review of sytems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies , sinus tenderness, 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: - Severe kyphoscoliosis s/p operative repair in [**2140**]. Last spirometry [**8-/2165**] FVC 30% pred (490cc), FEV1 27% pred (300cc), ratio 0.62, DLCO 17% pred - Severe sleep disordered breathing - Hypoventilation syndrome due to severe restrictive lung disease - Asthma - Chronic hypercapneic, hypoxic respiratory failure- resting ABG pH of 7.40 and PCO2 of 85 on continuous home oxygen - Chronic diastolic heart failure - Pulmonary hypertension - TTE [**1-/2166**] with TR gradient 60-70, RVH and mild RV dilation in setting of elevated PCWP. - Large hiatal hernia - GERD - Hypertension - h/o severe skin burns as child - Osteoporosis - h/o hip and back pain Social History: Prior smoke (X 11 years) but quit in [**2138**]. No alcohol. Lives with daughter and performs own ADLs (bathing, dressing, cooking). Previously worked as a home health aide. Widowed. Family History: Father died of liver cancer. Daughter with breast cancer at 45. Also history of colon cancer. No history of pulmonary disease. Physical Exam: Vitals: T: 99.2 BP: 144/66 P: 75 R: 22 O2: 95%/2L General: Alert, oriented, mildly labored breathing HEENT: Sclera anicteric, MMM, oropharynx clear Neck: JVP elevated. Lungs: severe kyphosis and scoliosis. rales diffusely, also some wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: misshapen secondary to childhood burn injury. nontender GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: CBC [**2166-6-23**] 08:50AM BLOOD WBC-5.6 RBC-3.26* Hgb-9.6* Hct-31.8* MCV-98 MCH-29.5 MCHC-30.2* RDW-16.6* Plt Ct-212 [**2166-6-24**] 04:22AM BLOOD WBC-2.9* RBC-3.02* Hgb-8.9* Hct-29.5* MCV-98 MCH-29.4 MCHC-30.1* RDW-15.6* Plt Ct-179 [**2166-6-25**] 04:31AM BLOOD WBC-4.2 RBC-3.04* Hgb-8.9* Hct-29.2* MCV-96 MCH-29.3 MCHC-30.5* RDW-16.0* Plt Ct-209 Diff [**2166-6-23**] 08:50AM BLOOD Neuts-65.6 Lymphs-24.4 Monos-6.8 Eos-2.7 Baso-0.4 Chem 7 [**2166-6-23**] 08:50AM BLOOD Glucose-111* UreaN-22* Creat-1.6* Na-148* K-3.5 Cl-96 HCO3-47* AnGap-9 [**2166-6-23**] 07:08PM BLOOD Glucose-124* UreaN-19 Creat-1.3* Na-150* K-3.7 Cl-97 HCO3-45* AnGap-12 [**2166-6-24**] 04:22AM BLOOD Glucose-148* UreaN-17 Creat-1.3* Na-145 K-3.5 Cl-94* HCO3-46* AnGap-9 [**2166-6-24**] 03:18PM BLOOD Glucose-153* UreaN-18 Creat-1.6* Na-138 K-3.8 Cl-89* HCO3-43* AnGap-10 [**2166-6-25**] 04:31AM BLOOD Glucose-84 UreaN-21* Creat-1.6* Na-139 K-4.4 Cl-92* HCO3-40* AnGap-11 Other chemistry [**2166-6-24**] 04:22AM BLOOD Calcium-8.4 Phos-2.4* Mg-1.7 [**2166-6-25**] 04:31AM BLOOD Calcium-8.5 Phos-2.4* Mg-2.6 ABG [**2166-6-23**] 03:34PM BLOOD Type-ART Temp-36.1 pO2-81* pCO2-113* pH-7.28* [**2166-6-23**] 05:37PM BLOOD Type-ART pO2-80* pCO2-128* pH-7.25* calTCO2-59* [**2166-6-25**] 08:20AM BLOOD ART Temp-38.0 O2 Flow-3 pO2-75* pCO2-94* pH-7.34* CHEST (PORTABLE AP) Study Date of [**2166-6-23**] There are bilateral fluffy perihilar opacities. Lung volumes are low. There is chronic elevation of the bilateral diaphragms; however, bilateral pleural effusions are likely present. There is scoliosis with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 931**] rod in place. Significant deviation of the trachea is present; however, similar in appearance to prior examinations. IMPRESSION: Findings consistent with volume overload. Brief Hospital Course: Ms. [**Known lastname 80571**] is a 70 year old woman with a history of hypercarbic respiratory, failure, hypoventilation secondary to kyphosis, and sleep disordered breathing. She presented to the ICU with SOB and hypercarbic respiratory failure. # Hypercarbic respiratory failure: She has a history of hypercarbia, sleep disordered breathing, restriction from kyphosis. Baseline pCO2 is 85. Upon admisison, pCO2 in 90??????s. Respiratory failure likely multifactorial- infection/allergy, diastolic CHF, bronchospasm. She was treated with BiPAP and did not require intubation. She was started on antibiotics with Vanc, Zosyn, and Levofloxacin to cover hospital acquired and atypical pneumonia. She was also started on methylprednisolone and then changed to oral steroids with prednisone 60 mg Q day, and she was on standing nebulizers. Her goal oxygenation is 88-92%. She was also given diuretics with good response. She was transferred to the Medicine floor on [**6-25**], where she continued to improve and was at her baseline oxygen requirement of 2L. Antibiotics were narrowed to levofloxacin, as there was no radiographic evidence of pneumonia. . # Obstructive Sleep Apnea: She was continued on BiPAP. Her outpatient sleep physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], made arrangements for her to receive a new BIPAP SV AUTO machine with increased supplemental O2. He coordinated this with her homecare company. He arranged to have [**Hospital 6549**] Medical deliver the machine to [**Hospital1 **], where it will be in Ms. [**Known lastname 80572**] possession. She will need to take it home with her. . # Acute on chronic diastolic heart failure: EF 75%. JVP elevated on admission with BNP at high of [**Numeric Identifier **]. She was treated with furosemide IV as noted above, and on the medical floor she was switched back to her prior dose of 80mg po once daily. . # Acute on Chronic renal failure: Baseline 1.1, then 1.6 on admission, prerenal in etiology. This improved with treatment of her CHF. Ace-Inhibitor was held in MICU and restarted on the day of discharge. . # Hypertension: Elevated BP first day of admission, later improved. . # Anemia: Chronic normocytic, attributed to chronic disease, stable. . Medications on Admission: Albuterol nebs as needed Albuterol inhaler as needed Fosamax 70mg weekly [**Doctor First Name **] 180mg daily during allergy season Fluocinonide 0.05% daily Fluticasone 220mcg twice daily Lasix 80mg daily Lisinopril 40mg nightly Metoclopramide 10mg TId with with meals Pantoprazole 40mg daily Salmeterol 50mch inhaled 1 puff at bedtime Calcium Coenzyme Q10 Colace Vitamin D Multivitamin with iron Omega 3 fatty acid O2 3L NC at all times Medications on Transfer Heparin 5000 UNIT SC TID Albuterol 0.083% Neb Soln 1 NEB IH Q6H Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN wheezes Fexofenadine 60 mg PO BID Pantoprazole 40 mg IV Q24H Vancomycin 1000 mg IV Q48H Levofloxacin 750 mg IV Q48H Piperacillin-Tazobactam 2.25 g IV Q6H Ipratropium Bromide Neb 1 NEB IH Q6H PredniSONE 60 mg PO/NG DAILY Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q2H (every 2 hours) as needed for wheezes. 3. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 5. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily) for 1 weeks: decrease dose by 10mg per week until you are down to 20mg daily, then see your lung doctor. 6. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 7. Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation HS (at bedtime). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 10. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily). 13. Docusate [**Hospital1 **] 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 16. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 17. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO every other day for 5 doses: next dose is due tonight ([**6-27**]). Discharge Disposition: Extended Care Facility: [**Hospital **] Hospital - [**Hospital1 8**] Discharge Diagnosis: # hypercarbic and hypoxic respiratory failure # COPD exacerbation # acute on chronic diastolic CHF # acute renal failure # chronic kidney disease stage II # obstructive sleep apnea # hypertension 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: You were admitted with respiratory failure due to exacerbation of your chronic obstructive lung disease (COPD) as well as exacerbation of heart failure. In the intensive care unit, you were managed with BiPAP, steroids, bronchodilators, antibiotics, and diuretics (lasix). You improved markedly and were transferred to the medicine floor. You were assessed by Physical Therapy, who recommended rehab. When you get home, please weigh yourself every morning, and [**Name8 (MD) 138**] MD if your weight goes up more than 3 lbs. Followup Instructions: Department: [**Hospital3 249**] When: FRIDAY [**2166-7-11**] at 4:15 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4131**], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: PULMONARY FUNCTION LAB When: WEDNESDAY [**2166-7-30**] at 2:30 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**] Completed by:[**2166-6-27**]

518,428,584,493,276,416,327,737,585,564,403,285,530,733,553,V462,V158,V586

{'Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Chronic obstructive asthma with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Kyphosis (acquired) (postural),Chronic kidney disease, Stage II (mild),Other constipation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia of other chronic disease,Esophageal reflux,Osteoporosis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other dependence on machines, supplemental oxygen,Personal history of tobacco use,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: Shortness of breath PRESENT ILLNESS: Patient is a 70 y/o F with history of restrictive/obstructive lung diseases, asthma, pulm hypertension, dCHF, hypoventilation, OSA who presents with shortness of breath over the past week, worsening. She did not want to come in, and today her daughter forced her to. MEDICAL HISTORY: - Severe kyphoscoliosis s/p operative repair in [**2140**]. Last spirometry [**8-/2165**] FVC 30% pred (490cc), FEV1 27% pred (300cc), ratio 0.62, DLCO 17% pred - Severe sleep disordered breathing - Hypoventilation syndrome due to severe restrictive lung disease - Asthma - Chronic hypercapneic, hypoxic respiratory failure- resting ABG MEDICATION ON ADMISSION: Albuterol nebs as needed Albuterol inhaler as needed Fosamax 70mg weekly [**Doctor First Name **] 180mg daily during allergy season Fluocinonide 0.05% daily Fluticasone 220mcg twice daily Lasix 80mg daily Lisinopril 40mg nightly Metoclopramide 10mg TId with with meals Pantoprazole 40mg daily Salmeterol 50mch inhaled 1 puff at bedtime Calcium Coenzyme Q10 Colace Vitamin D Multivitamin with iron Omega 3 fatty acid O2 3L NC at all times ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 99.2 BP: 144/66 P: 75 R: 22 O2: 95%/2L General: Alert, oriented, mildly labored breathing HEENT: Sclera anicteric, MMM, oropharynx clear Neck: JVP elevated. Lungs: severe kyphosis and scoliosis. rales diffusely, also some wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: misshapen secondary to childhood burn injury. nontender FAMILY HISTORY: Father died of liver cancer. Daughter with breast cancer at 45. Also history of colon cancer. No history of pulmonary disease. SOCIAL HISTORY: Prior smoke (X 11 years) but quit in [**2138**]. No alcohol. Lives with daughter and performs own ADLs (bathing, dressing, cooking). Previously worked as a home health aide. Widowed. ### Response: {'Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Chronic obstructive asthma with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Kyphosis (acquired) (postural),Chronic kidney disease, Stage II (mild),Other constipation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia of other chronic disease,Esophageal reflux,Osteoporosis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other dependence on machines, supplemental oxygen,Personal history of tobacco use,Long-term (current) use of steroids'}

CHIEF COMPLAINT: variceal bleed PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old man with hx of known cirrhosis, complicated by esophageal varices and HCC, recently placed on home hospice, presenting today for hematemesis. He was reportedly feeling tired and nauseated all day and had 3 small episodes of bloody and black hematemesis. Reported feeling significantly worse later during the day, experienced large volume hematemesis at home, after which he called EMS himself. SBP was reportedly 80/palp in the field. . In the ED, lowest SBP was in 90s. He had another episode of hematemesis 800cc bright red with black clots in the ED. He was noted to be just mildly encephalopathic, but mentating well enough to confirm that he would want intubation in the temporary setting to protect his airway for upper endoscopy. When preparing to do an IJ, pt had another large volume hematemesis. Pt was intubated with racuronium and etomidate; racuronium was used in the setting of elevated K to 6.8. A PIV was placed in hand and sterile Right Femoral Cordis placed as well. Patient received 3u pRBCs as well as 1300cc total NS in EMS and ED. He was started on octreotide bolus + gtt as well as pantoprazole bolus + gtt. He is on fentanyl and versed for sedation. Vitals in the ED prior to transfer to MICU were as follows: 76 145/76 FiO2 100% PEEP 5 Vt 500 RR 14. MEDICAL HISTORY: Onc Hx: -[**2150-11-19**]: resection of 4x4x3.8cm liver lesion in segment 5. Pathology consistent with HCC. No lymphovascular invasion -[**2151-5-20**]: resection of 1.8cm lesion in segment 5 -[**2152-2-14**]: chemoembolization of a branch of right hepatic artery with taxotere and embospheres for two right lobe lesions measuring 1.5 and 0.5 cm along with microwave ablation of the 1.5cm lesion -had been on transplant list when MRI [**2152-8-11**] showed 2.4 x 4.3cm MEDICATION ON ADMISSION: 1. spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission: Vitals: T: BP: 115/59 P: 76 R: 15 O2: 100% on AC FI02 100% General: Intubated and sedated; general wasting HEENT: Sclera icteric; OG tube in place Neck: JVP not elevated, no LAD Lungs: Vented breath sounds with transmitted upper airway noises FAMILY HISTORY: Father: Cirrhosis, EtOH. SOCIAL HISTORY: Recently moved from [**State 531**] to [**Location (un) 86**] to be near his son. Lives alone but son lives ten minutes away. Worked in the past as sheet metal worker but now retired. Denies hx of smoking, EtOH or illicit drug use, including IV drugs.

Esophageal varices with bleeding,Unspecified viral hepatitis C with hepatic coma,Acute kidney failure, unspecified,Other ascites,Malignant neoplasm of liver, primary,Acidosis,Cirrhosis of liver without mention of alcohol,Do not resuscitate status

Esophag varices w bleed,Hpt C w hepatic coma NOS,Acute kidney failure NOS,Ascites NEC,Mal neo liver, primary,Acidosis,Cirrhosis of liver NOS,Do not resusctate status

Admission Date: [**2153-8-19**] Discharge Date: [**2153-8-22**] Date of Birth: [**2089-5-11**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Doctor First Name 3290**] Chief Complaint: variceal bleed Major Surgical or Invasive Procedure: Endotracheal intubation Upper GI endoscopy with variceal banding Femoral central venous catheter placement History of Present Illness: Mr. [**Known lastname **] is a 64 year old man with hx of known cirrhosis, complicated by esophageal varices and HCC, recently placed on home hospice, presenting today for hematemesis. He was reportedly feeling tired and nauseated all day and had 3 small episodes of bloody and black hematemesis. Reported feeling significantly worse later during the day, experienced large volume hematemesis at home, after which he called EMS himself. SBP was reportedly 80/palp in the field. . In the ED, lowest SBP was in 90s. He had another episode of hematemesis 800cc bright red with black clots in the ED. He was noted to be just mildly encephalopathic, but mentating well enough to confirm that he would want intubation in the temporary setting to protect his airway for upper endoscopy. When preparing to do an IJ, pt had another large volume hematemesis. Pt was intubated with racuronium and etomidate; racuronium was used in the setting of elevated K to 6.8. A PIV was placed in hand and sterile Right Femoral Cordis placed as well. Patient received 3u pRBCs as well as 1300cc total NS in EMS and ED. He was started on octreotide bolus + gtt as well as pantoprazole bolus + gtt. He is on fentanyl and versed for sedation. Vitals in the ED prior to transfer to MICU were as follows: 76 145/76 FiO2 100% PEEP 5 Vt 500 RR 14. Past Medical History: Onc Hx: -[**2150-11-19**]: resection of 4x4x3.8cm liver lesion in segment 5. Pathology consistent with HCC. No lymphovascular invasion -[**2151-5-20**]: resection of 1.8cm lesion in segment 5 -[**2152-2-14**]: chemoembolization of a branch of right hepatic artery with taxotere and embospheres for two right lobe lesions measuring 1.5 and 0.5 cm along with microwave ablation of the 1.5cm lesion -had been on transplant list when MRI [**2152-8-11**] showed 2.4 x 4.3cm lesion in segment 8 and thrombosis of a portal vein branch. Underwent biopsy of the lesion which revealed a moderately differentiated hepatocellular carcinoma with tumor embolus in the portal vein branch. AFP started rising, 232ng/mL. Delisted from transplant list. -attempt to enroll in SEARCH trial. However, pt had anemia (despite d/c-ing internferon and ribavarin), making him ineligible from study -began radiation in [**11/2152**] and finished 01/[**2153**]. Since [**2153-1-22**] he has been on sorafenib 400mg [**Hospital1 **]. AFP steadily increasing over last 5 months to 3000s. -required large volume paracentesis twice [**2-/2153**] (7.6L and 7.8L). Episodes of anemia secondary to GI bleeding. EGD and colonoscopy performed, revealing esophageal varices, hemorrhoids and mild portal gastropathy. -hospital admission [**2153-3-5**] for drop in Hct for which he received PRBCs. No site of bleeding identified. . Other Past Medical History: - HTN - ? CHF - Hepatitis C as above, felt to be obtained on the job due to numerous episodes of bleeding and other injury. - h/o back spasms for which he takes narcotics. . Past surgical history: - s/p cholecystectomy. - s/p appendectomy. - s/p tonsillectomy. - s/p procedure for shoulder dislocation Social History: Recently moved from [**State 531**] to [**Location (un) 86**] to be near his son. Lives alone but son lives ten minutes away. Worked in the past as sheet metal worker but now retired. Denies hx of smoking, EtOH or illicit drug use, including IV drugs. Family History: Father: Cirrhosis, EtOH. Physical Exam: Admission: Vitals: T: BP: 115/59 P: 76 R: 15 O2: 100% on AC FI02 100% General: Intubated and sedated; general wasting HEENT: Sclera icteric; OG tube in place Neck: JVP not elevated, no LAD Lungs: Vented breath sounds with transmitted upper airway noises CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: tensely distended; tympanic to percussion; normoactive bowel sounds present; anus with erythematous, bulging hemorrhoids. Skin surrounding anus with small amount of dried red blood. GU: foley in place Skin: Jaundiced Ext: cool, doughy; 1+ DP and PT pulses . Transfer to the floor from the MICU Vitals: R [**10-26**] General: Extubated; general wasting HEENT: Sclera icteric; MM dry Neck: JVP not elevated, no LAD Lungs: CTAB with transmitted upper airway noises CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: tensely distended; tympanic to percussion; +BS GU: foley in place Skin: Jaundiced Ext: cool, no edema Pertinent Results: ADMISSION [**2153-8-19**] 09:38PM GLUCOSE-81 UREA N-44* CREAT-2.0* SODIUM-132* POTASSIUM-6.8* CHLORIDE-104 TOTAL CO2-13* ANION GAP-22* [**2153-8-19**] 09:38PM ALT(SGPT)-52* AST(SGOT)-89* ALK PHOS-194* TOT BILI-10.1* [**2153-8-19**] 09:38PM LIPASE-16 [**2153-8-19**] 09:38PM ALBUMIN-2.2* CALCIUM-8.5 PHOSPHATE-6.0*# MAGNESIUM-1.9 [**2153-8-19**] 09:38PM WBC-12.2*# RBC-2.53* HGB-9.0* HCT-27.2* MCV-108* MCH-35.7* MCHC-33.2 RDW-23.4* [**2153-8-19**] 09:38PM NEUTS-83.9* LYMPHS-9.3* MONOS-6.4 EOS-0.1 BASOS-0.3 [**2153-8-19**] 09:38PM PLT COUNT-153 [**2153-8-19**] 09:38PM PT-22.8* PTT-37.1* INR(PT)-2.1* [**2153-8-19**] 09:17PM PH-7.35 [**2153-8-19**] 09:17PM GLUCOSE-65* LACTATE-6.5* NA+-131* K+-6.3* CL--109 TCO2-13* [**2153-8-19**] 09:17PM HGB-7.8* calcHCT-23 O2 SAT-95 . LAST LABS [**2153-8-20**] 12:00AM BLOOD WBC-11.1* RBC-3.35*# Hgb-11.5*# Hct-34.0* MCV-102* MCH-34.4* MCHC-33.8 RDW-23.2* Plt Ct-107* [**2153-8-20**] 12:00AM BLOOD Glucose-97 UreaN-45* Creat-2.0* Na-129* K-6.5* Cl-101 HCO3-14* AnGap-21* [**2153-8-20**] 12:00AM BLOOD Calcium-8.4 Phos-6.0* Mg-2.0 [**2153-8-20**] 12:30AM BLOOD Lactate-5.4* K-6.4* [**2153-8-20**] 12:30AM BLOOD freeCa-1.09* Brief Hospital Course: 64M with known history of cirrhosis, complicated by HCC and esophageal varices, recently placed on Hospice, presenting with large volume variceal bleed. . # Goals of Care Patient was admitted with hematemesis due to an upper gastrointestinal bleed secondary to bleeding varicies status post variceal banding. Discussion with family led to a decision of transitioning goals of care to comfort measures only. Patient was then transferred from the MICU to the floor and the patient was kept comfortable with morphine and scopolamine. Patient passed away about 48 hours after transfer to the floor. Family was notified and came to the hospital shortly thereafter. . # Variceal Bleed Pt was admitted with hematemesis secondary to variceal bleed and underwent emergent upper endoscopy with variceal banding while in the ICU. He received a total of four units of red cells, and was started on pantoprazole and octreotide drips. Patient with known history of HCV cirrhosis, complicated by variceal bleeding in the past, and last banded in [**11/2152**], per son. Previously received medical care in [**State 531**]. Further observation and treatment were held as the patient was made CMO. . # Hyperkalemia Likely due to constipation, and also likely due to acute kidney injury. No significant acidemia on VBG. No EKG changes. Kayexelate was offered, but the family declined as the patient was made CMO. . # Acute Renal Failure Likely prerenal etiology in setting of large volume upper GI bleed. However, as patient has elevated lactate, hypoperfusion may have been severe enough for acute kidney injury to be due acute tubular necrosis. His creatinine was 2.0 upon transfer, but further treatment was held. . # Anion gap metabolic acidosis Likely due to lactic acidosis, though etiology unclear. Possibly due to hypoperfusion from gastrointestinal bleed. However, as patient has elevated WBC count, sepsis also possible. Per son, patient may also have GI obstruction evidenced by constipation. Lactate peaked at 7 but fell to 5.4 when his last set of labs were checked. No further treatment as patient was made CMO. . #Hyponatremia - Likely hypovolemic hyponatremia in the setting of hypoperfusion/decreased effective circulating volume. Baseline in the mid 130s. This was monitored and was stable at 129 upon transfer. . #HCV Cirrhosis Patient has a history of HCV cirrhosis with multifocal hepatocellular carcinoma, complicated by portal vein thrombosis, esophageal varices, and hepatic encephalopathy. Prior to intubation, patient mildly encephalopathic and reportedly had not stooled for 36 hours prior to admission. Lactulose was stopped as patient was made CMO. . #Leukocytosis Infectious etiology broad in this patient with HCV cirrhosis with variceal bleed, and status post intubation. Patient has been afebrile and hemodynamically stable since admission. He may have had a primary pneumonia, or may have had an aspiration event. Must also consider SBP in this patient. Urinalysis negative for UTI. As concern for intestinal obstruction, may consider infectious GI complication or perforation, but no evidence of sepsis. As patient afebrile, leukocytosis may also be reactive. White counts were trending down when his last set of labs were checked. No further treatment or evaluation as the patient was made CMO. Medications on Admission: 1. spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. oxycodone 10 mg Tablet Extended Release 12 hr Sig: Two (2) Tablet Extended Release 12 hr PO Q12H (every 12 hours). 6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for back spasm. 7. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day): Take [**1-15**] doses daily with a goal of 3 bowel movements per day. Discharge Medications: None. Discharge Disposition: Expired Discharge Diagnosis: Intubation Right Femoral Central Venous Catheter Insertion Upper Endoscopy status post Variceal Banding x4 Discharge Condition: Deceased. Discharge Instructions: Deceased. Completed by:[**2153-8-26**]

456,070,584,789,155,276,571,V498

{'Esophageal varices with bleeding,Unspecified viral hepatitis C with hepatic coma,Acute kidney failure, unspecified,Other ascites,Malignant neoplasm of liver, primary,Acidosis,Cirrhosis of liver without mention of alcohol,Do not resuscitate 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: variceal bleed PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old man with hx of known cirrhosis, complicated by esophageal varices and HCC, recently placed on home hospice, presenting today for hematemesis. He was reportedly feeling tired and nauseated all day and had 3 small episodes of bloody and black hematemesis. Reported feeling significantly worse later during the day, experienced large volume hematemesis at home, after which he called EMS himself. SBP was reportedly 80/palp in the field. . In the ED, lowest SBP was in 90s. He had another episode of hematemesis 800cc bright red with black clots in the ED. He was noted to be just mildly encephalopathic, but mentating well enough to confirm that he would want intubation in the temporary setting to protect his airway for upper endoscopy. When preparing to do an IJ, pt had another large volume hematemesis. Pt was intubated with racuronium and etomidate; racuronium was used in the setting of elevated K to 6.8. A PIV was placed in hand and sterile Right Femoral Cordis placed as well. Patient received 3u pRBCs as well as 1300cc total NS in EMS and ED. He was started on octreotide bolus + gtt as well as pantoprazole bolus + gtt. He is on fentanyl and versed for sedation. Vitals in the ED prior to transfer to MICU were as follows: 76 145/76 FiO2 100% PEEP 5 Vt 500 RR 14. MEDICAL HISTORY: Onc Hx: -[**2150-11-19**]: resection of 4x4x3.8cm liver lesion in segment 5. Pathology consistent with HCC. No lymphovascular invasion -[**2151-5-20**]: resection of 1.8cm lesion in segment 5 -[**2152-2-14**]: chemoembolization of a branch of right hepatic artery with taxotere and embospheres for two right lobe lesions measuring 1.5 and 0.5 cm along with microwave ablation of the 1.5cm lesion -had been on transplant list when MRI [**2152-8-11**] showed 2.4 x 4.3cm MEDICATION ON ADMISSION: 1. spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission: Vitals: T: BP: 115/59 P: 76 R: 15 O2: 100% on AC FI02 100% General: Intubated and sedated; general wasting HEENT: Sclera icteric; OG tube in place Neck: JVP not elevated, no LAD Lungs: Vented breath sounds with transmitted upper airway noises FAMILY HISTORY: Father: Cirrhosis, EtOH. SOCIAL HISTORY: Recently moved from [**State 531**] to [**Location (un) 86**] to be near his son. Lives alone but son lives ten minutes away. Worked in the past as sheet metal worker but now retired. Denies hx of smoking, EtOH or illicit drug use, including IV drugs. ### Response: {'Esophageal varices with bleeding,Unspecified viral hepatitis C with hepatic coma,Acute kidney failure, unspecified,Other ascites,Malignant neoplasm of liver, primary,Acidosis,Cirrhosis of liver without mention of alcohol,Do not resuscitate status'}

CHIEF COMPLAINT: Fever, hypotension PRESENT ILLNESS: HPI: Mr. [**Known lastname 11753**] is a 68 YOM with COPD (on 2-4L O2 baseline), CLL, hypertension, PE (on coumadin c/b recent GI bleed [**4-23**] requiring 4 units pRBCs), chronic systolic heart failure (EF 35%), atrial fibrillation, and recent admission for Enterococcus faecalis bacteremia treated with ampicillin, who was admitted from rehab facility on [**2185-5-12**] for hypotension, lethargy, and fever. . Of note, E. faecalis during prior admission was treated with ampicillin. Antibiotics were completed [**2185-4-30**], however his PICC was retained. He then had chills and night sweats during night for 3 days preceding admission. During this time he became febrile to 102 on [**2185-5-10**], and PICC was removed [**2185-5-11**]. Blood culture drawn on [**2185-5-10**] at rehab reportedly grew GPC in chains. CXR, UA were reportedly negative. On [**2185-5-12**] the patient was noted to have SBP in the mid-80s (baseline 110-130s) with tachypnea and increased oxygen requirement (baseline 88-90% on NC 3-5L). Vancomycin was considered but not given due to no IV access. He was transferred to [**Hospital1 18**]. . In the ED, sBP 94, RR 26, HR 120s (irregularly irregular). Blood, urine cultures sent. He received Unasyn, levofloxacin, and NS 800cc. On arrival to floor from ED he was hypoxic with oxygen saturation in upper 70s and was found to have atrial fibrillation with RVR (rate 120-130s), tachypnea, and increasd crackles. Oxygen was increased to 6L by nasal cannula with rapid improvement of oxygen saturation to 95%. ABG 7.50 // 30 // 58. He was transferred to the MICU. MEDICAL HISTORY: - Chronic lymphoid leukemia - COPD (FVC 79% pred, FEV1 71% pred, FEV1/FVC 90% pred [**2-/2185**]) - [**Hospital1 **]-ventricular systolic failure, EF 45%; dilated RV with signs of overload - Pulmonary hypertension - Depression - Hypertension - Hyperlipidemia - Peptic ulcer disease - Right eye cataract (S/p removal at the age of 12. He had an injury to his eye and has no vision in that eye for years) - Deviated nasal septum, s/p nasal septal surgery - Cervical arthritis - History of colon polyps (? adenoma) - History of herniated disks - Chronic back pain - Pulmonary nodules - Pulmonary embolism s/p intubation, complicated by VAP - Enterococcus faecalis bacteremia MEDICATION ON ADMISSION: 5% lidocaine patch to R ribs 6a-6p daily Aspirin 81 mg daily oxycodone 5 mg po q6h prn pain diltiazem 60 mg po QID KCl 20 mEq po daily Multivitamin daily Spiriva 18 mcg inh [**Hospital1 **] Lopressor 100 mg po BID Pulmicort 90 mcg 2 puffs [**Hospital1 **] Levalbuterol 0.63/3 ml q6h senna Lasix 40 mg po qam Ativan 0.5 mg po qhs Remeron 7.5 mg po qhs [**Name (NI) **] unclear dosing, ?4 mg daily, scheduled for 3 mg po the night of admit which he did not receive. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 98.2, 125, 123/69, 22, 100% 6L NC Gen: Comfortable, mildy tachypneic HEENT: Right surgical pupil; left pupil reactive to light; moist mucous membranes Neck: JVP elevated approximately 12cm CV: Irregularly irregular; tachycardic; normal S1/S2; no murmurs appreciated Pulmonary: Bibasilar crackles Abdomen: Hypoactive bowel sounds; soft, nontender, not distended Ext: 1+ edema at ankles, trace to knees bilaterally; radial, DP pulses 2+ except left DP 1+ Neuro: Left EOMI; left pupil reactive to light; CN II-XII other than above intact Psych: AOx3; answers questions appropriately FAMILY HISTORY: Mother died at age 85, complications of Alzheimer's disease. Father died at age 74, complications of congestive heart failure. He reports no history of colon cancer, polyps or coronary disease in his family. A brother developed [**Name (NI) 5895**] disease. SOCIAL HISTORY: Married. Most recently at [**Hospital **] [**Hospital **] Nursing Home; was previously at home. He smoked 1PPD >50 years, and quit within the past one month. He denies alcohol or illicit drug use.

Streptococcal septicemia,Acute on chronic systolic heart failure,Chronic lymphoid leukemia, without mention of having achieved remission,Sepsis,Atrial fibrillation,Mitral valve disorders,Retention of urine, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other chronic pulmonary heart diseases,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Hypoxemia,Other emphysema

Streptococcal septicemia,Ac on chr syst hrt fail,Ch lym leuk wo achv rmsn,Sepsis,Atrial fibrillation,Mitral valve disorder,Retention urine NOS,Hypertension NOS,Hx-ven thrombosis/embols,Long-term use anticoagul,Chr pulmon heart dis NEC,Depressive disorder NEC,Hyperlipidemia NEC/NOS,Hypoxemia,Emphysema NEC

Admission Date: [**2185-5-12**] Discharge Date: [**2185-5-26**] Date of Birth: [**2117-2-8**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: Fever, hypotension Major Surgical or Invasive Procedure: Transthoracic echocardiogram History of Present Illness: HPI: Mr. [**Known lastname 11753**] is a 68 YOM with COPD (on 2-4L O2 baseline), CLL, hypertension, PE (on coumadin c/b recent GI bleed [**4-23**] requiring 4 units pRBCs), chronic systolic heart failure (EF 35%), atrial fibrillation, and recent admission for Enterococcus faecalis bacteremia treated with ampicillin, who was admitted from rehab facility on [**2185-5-12**] for hypotension, lethargy, and fever. . Of note, E. faecalis during prior admission was treated with ampicillin. Antibiotics were completed [**2185-4-30**], however his PICC was retained. He then had chills and night sweats during night for 3 days preceding admission. During this time he became febrile to 102 on [**2185-5-10**], and PICC was removed [**2185-5-11**]. Blood culture drawn on [**2185-5-10**] at rehab reportedly grew GPC in chains. CXR, UA were reportedly negative. On [**2185-5-12**] the patient was noted to have SBP in the mid-80s (baseline 110-130s) with tachypnea and increased oxygen requirement (baseline 88-90% on NC 3-5L). Vancomycin was considered but not given due to no IV access. He was transferred to [**Hospital1 18**]. . In the ED, sBP 94, RR 26, HR 120s (irregularly irregular). Blood, urine cultures sent. He received Unasyn, levofloxacin, and NS 800cc. On arrival to floor from ED he was hypoxic with oxygen saturation in upper 70s and was found to have atrial fibrillation with RVR (rate 120-130s), tachypnea, and increasd crackles. Oxygen was increased to 6L by nasal cannula with rapid improvement of oxygen saturation to 95%. ABG 7.50 // 30 // 58. He was transferred to the MICU. Past Medical History: - Chronic lymphoid leukemia - COPD (FVC 79% pred, FEV1 71% pred, FEV1/FVC 90% pred [**2-/2185**]) - [**Hospital1 **]-ventricular systolic failure, EF 45%; dilated RV with signs of overload - Pulmonary hypertension - Depression - Hypertension - Hyperlipidemia - Peptic ulcer disease - Right eye cataract (S/p removal at the age of 12. He had an injury to his eye and has no vision in that eye for years) - Deviated nasal septum, s/p nasal septal surgery - Cervical arthritis - History of colon polyps (? adenoma) - History of herniated disks - Chronic back pain - Pulmonary nodules - Pulmonary embolism s/p intubation, complicated by VAP - Enterococcus faecalis bacteremia Social History: Married. Most recently at [**Hospital **] [**Hospital **] Nursing Home; was previously at home. He smoked 1PPD >50 years, and quit within the past one month. He denies alcohol or illicit drug use. Family History: Mother died at age 85, complications of Alzheimer's disease. Father died at age 74, complications of congestive heart failure. He reports no history of colon cancer, polyps or coronary disease in his family. A brother developed [**Name (NI) 5895**] disease. Physical Exam: 98.2, 125, 123/69, 22, 100% 6L NC Gen: Comfortable, mildy tachypneic HEENT: Right surgical pupil; left pupil reactive to light; moist mucous membranes Neck: JVP elevated approximately 12cm CV: Irregularly irregular; tachycardic; normal S1/S2; no murmurs appreciated Pulmonary: Bibasilar crackles Abdomen: Hypoactive bowel sounds; soft, nontender, not distended Ext: 1+ edema at ankles, trace to knees bilaterally; radial, DP pulses 2+ except left DP 1+ Neuro: Left EOMI; left pupil reactive to light; CN II-XII other than above intact Psych: AOx3; answers questions appropriately Pertinent Results: ADMISSION LABS: [**2185-5-12**] 03:30PM WBC-13.6* RBC-3.97* Hgb-11.1* Hct-34.8* MCV-88 Plt Ct-293 [**2185-5-12**] 03:30PM Neuts-35* Bands-0 Lymphs-49* Monos-8 Eos-0 Baso-0 Atyps-8* Metas-0 Myelos-0 [**2185-5-12**] 03:30PM Hypochr-1+ Anisocy-1+ Poiklo-1+ Macrocy-NORMAL Microcy-1+ Polychr-1+ Schisto-1+ Burr-1+ [**2185-5-12**] 03:30PM PT-20.2* PTT-32.8 INR(PT)-1.9* [**2185-5-12**] 03:30PM Glucose-95 UreaN-16 Creat-1.0 Na-137 K-4.3 Cl-100 HCO3-28 AnGap-13 [**2185-5-12**] 03:30PM ALT-19 AST-29 CK(CPK)-30* AlkPhos-64 TotBili-0.6 [**2185-5-12**] 03:30PM CK-MB-NotDone cTropnT-0.03* proBNP-[**Numeric Identifier 31519**]* [**2185-5-12**] 03:30PM Albumin-3.6 [**2185-5-12**] 08:07PM Type-ART pO2-58* pCO2-30* pH-7.50* calTCO2-24 Base XS-0 [**2185-5-12**] 04:07PM Lactate-2.3* OTHER PERTINENT LABS: [**2185-5-26**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-25**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-24**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-23**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-23**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-22**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-21**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-21**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-20**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2185-5-20**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-19**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-18**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-18**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-18**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-17**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2185-5-17**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT DISCHARGE LABS: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2185-5-26**] 06:31 15.9* 3.31* 8.6* 28.5* 86 25.9* 30.1* 18.7* 226 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct INR(PT) [**2185-5-26**] 06:31 21.1* 2.0* RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2185-5-26**] 06:31 861 16 0.9 138 4.3 103 27 12 CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron Cholest [**2185-5-26**] 06:31 8.2* 3.0 1.9 MICRO: [**2185-5-12**] 3:40 pm BLOOD CULTURE ENTEROCOCCUS FAECALIS. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | ENTEROCOCCUS FAECALIS | | AMPICILLIN------------ 0.5 S <=2 S DAPTOMYCIN------------ S S LINEZOLID------------- 2 S 2 S PENICILLIN G---------- 2 S 4 S TETRACYCLINE---------- =>16 R VANCOMYCIN------------ 1 S 1 S [**2185-5-16**] Blood Culture, Routine (Preliminary): GRAM POSITIVE COCCUS(COCCI). IN PAIRS AND CHAINS. URINE: [**2185-5-12**] 03:40PM Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015 [**2185-5-12**] 03:40PM Blood-NEG Nitrite-NEG Protein-25 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-TR [**2185-5-12**] 03:40PM RBC-0-2 WBC-[**2-25**] Bacteri-NONE Yeast-FEW Epi-0-2 [**2185-5-12**] [**Last Name (un) **] Legionella: negative URINE CULTURE (Final [**2185-5-13**]): MIXED BACTERIAL FLORA Sputum: [**2185-5-13**] SputumCx: GPR, budding yeast [**2185-5-16**] SputumCx: SPARSE GROWTH Commensal Respiratory Flora. [**2185-5-12**] Chest X ray IMPRESSION: Left inferior hemithorax is excluded from the field of view. No interval change from prior with continued bilateral small pleural effusions and bibasilar airspace opacities, which may reflect infection or atelectasis. [**2185-5-13**] trans thoracic Echo The left atrium is mildly dilated. The right atrium is moderately dilated. Left ventricular wall thicknesses and cavity size are normal. There is moderate global left ventricular hypokinesis (LVEF = 35%). There is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. The right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. There is moderate/severe mitral valve prolapse. An eccentric, posteriorly-directed jet of moderate to severe (3+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is a small pericardial effusion. IMPRESSION: Mitral valve prolapse with moderate to severe regurgitation. Moderate global biventricular systolic dysfunction. Compared with the prior study (images reviewed) of [**2185-4-15**], the findings are similar, although no distinct aortic valve mass is identified on today's study. Overall LV function appears similar and was probably slightly OVERestimated on the prior study. [**2185-5-13**] Lower extremity ultrasound IMPRESSION: No evidence of DVT in bilateral lower extremities. [**2185-5-17**] Trans esophageal Echocardiogram No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. A very small patent foramen ovale is present. There is mild global left ventricular hypokinesis (LVEF = 40-45 %). The right ventricular cavity is dilated with depressed free wall contractility. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. There are complex (>4mm), non-mobile atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. No masses or vegetations are seen on the aortic valve. No aortic regurgitation is seen. The mitral valve leaflets are myxomatous with mild mitral valve prolapse. No mass or vegetation is seen on the mitral valve. Mild to moderate ([**12-25**]+) mitral regurgitation is seen. No vegetation/mass is seen on the pulmonic valve. There is a very small pericardial effusion. IMPRESSION: No evidence of valvular vegetation, mass or abscess. Biventricular systolic dysfunction. Mild to moderate mitral regurgitation. Compared with the findings of the prior study (images reviewed) of [**2185-4-18**], the severity of mitral regurgitation is reduced. [**2185-5-19**] ABDOMINAL ULTRASOUND: The liver is normal in size and echotexture. There is no focal or infiltrative liver lesion. The common bile duct is not dilated and measures 0.3 cm. There is no intra- or extra-hepatic biliary dilatation. The pancreas is unremarkable. The spleen is normal in appearance and mildly enlarged measuring 13.4 cm, previously measured 12.4 cm. The gallbladder is normal in appearance without stones. The main portal vein is patent with normal hepatopetal flow. There is diffuse calcified atherosclerosis throughout the abdominal aorta without aneurysm formation or significant stenosis noted. Small bilateral pleural effusion is unchanged. IMPRESSION: 1. No evidence of intra- or extra-hepatic biliary dilatation. 2. Mild splenomegaly. 3. Small bilateral pleural effusion. [**2185-5-20**] MR OF THE ABDOMEN WITH IV GADOLINIUM (MR ENTEROGRAPHY): T2-weighted dynamic images demonstrate normal peristalsis of the stomach and small bowel. The intra-abdominal portion of large and small bowel is unremarkable without inflammatory change, wall thickening, dilatation, stricture or mass lesion. There is a very small amount of free fluid layering along the margin of the liver. No significant abnormality detected of the solid abdominal organs. As demonstrated on the recent CT angiogram of the abdomen and pelvis is diffuse atherosclerotic plaque throughout the abdominal aorta. Fusiform dilatation of the infrarenal abdominal aorta to 2.6 cm. The right common iliac artery is aneurysmally dilated to 1.6 cm. These findings are stable over the short interval compared to the recent CT angiogram of the abdomen and pelvis. MR OF THE PELVIS WITH IV GADOLINIUM (MR ENTEROGRAPHY): The pelvic portions of large and small bowel including terminal ileum and rectosigmoid are unremarkable without evidence of inflammatory change, wall thickening, stricture or mass lesion. Stool is distributed throughout the colon and rectum. There is no free pelvic fluid. The bladder, prostate, seminal vesicles are unremarkable. Multiplanar 2D and 3D reformations and subtraction images generated on an independent workstation were valuable in assessment for source of infection or bleeding. IMPRESSION: 1. No source for gastrointestinal bleeding or nidus of infection identified. 2. Atherosclerotic disease including infrarenal abdominal aortic aneurysm and right common iliac artery aneurysm not changed over the short interval compared to CTA abdomen and pelvis [**2185-4-23**]. [**2185-5-21**] CT chest: There is stable severe emphysema with bullous change at the lung apices as well as the right lung base. There has been interval increase in the bilateral pleural effusions. There is some loculated fluid within the fissure on the left. There is also a new right lower lobe pulmonary nodule (series 2, 45) measuring roughly 7 mm. This is in the area of some scarring. No other pulmonary nodules are seen. There is atherosclerotic calcification of the aorta and coronary arteries. There is cardiomegaly with marked enlargement of the right atrium. There is dilation of the IVC and hepatic veins which can be seen in right-sided heart failure. Note is made of a small amount of mucus within the left main stem bronchus. There is a pectus deformity. Otherwise the osseous structures are unremarkable. IMPRESSION: 1. Interval increased bilateral pleural effusions. 2. Stable severe emphysema. 3. New 7-mm right lower lobe pulmonary nodule. Four month followup chest CT recommended. 4. Cardiomegaly with enlarged right atrium and dilated IVC and hepatic veins, which can be seen in right-sided heart failure. Brief Hospital Course: #. Respiratory distress: The patient was admitted and transferred to the medicine floor. Upon arrival he developed respiratory distress in the setting of atrial fibrillation with RVR and IVF administration in the ED, likely causing fluid overload in a patient with tenuous respiratory status at baseline, h/o COPD and on home O2, with recent PE. The patient had an ECHO, which showed an EF of 35%. He was diuresed with IV Lasix and showed improvement, O2 requirement decreased from 6LNC to 4LNC. Rate control was obtained with Digoxin (pt was loaded), Diltiazem, and Metoprolol. Diltiazem was subsequently stopped. Chest X ray showed bibasilar opacities and air-space opacities consistent with atelectasis vs pneumonia. He had a sputum which only showed mixed respiratory flora. LENIs were obtained and were negative for DVT. The patient was subtherapeutic on his coumadin so a heparin bridge was briefly initiated until he became therapeutic. Cardiac enzymes were also obtained and were negative x3 sets. Once the patient stabilized he was transferred back to the medicine floor where he continued to require 2 to 4 L of oxygen. As he was not on oxygen prior to [**Month (only) 958**], it was thought that he was in acute heart failure with poor baseline reserve from his COPD, so he was aggressively diuresed with lasix. He remained 2 L negative per day for 5 days with only mild improvement in his oxygen requirement (low 80s on RA - 94% 4L). Chest Ct was obtained and showed bilateral pleural effusions, stable severe emphasema, cardiomegally, and a new 7 mm right lower lobe pulmonary nodule. It was thought that his continued hypoxia was from acute CHF with a component of recent pulmonary events. He was discharged on lasix 40 mg PO daily, spironolactone 12.5 mg daily and home O2. #. Enterococcus Bacteremia: The patient presented from rehab with fevers. He had a positive blood culture at the rehab center and had his PICC line removed (per report the tip was cultured and showed no growth). His first set of blood cultures obtained at [**Hospital1 18**] was positive for Enterococcus, pan-sensitive. Because he had a recent positive VRE swab, he was empirically treated with Linezolid, but this was then changed to ampicillin after cultures showed it was sensitive. Surveillance cultures remained negative until [**2185-5-16**] when they showed one culture positive for gram positive cocci. A transthoracic and trans esophageal echocardiogram were performed and showed no vegetations. The source of the patient's recurrent enterococcus bacteremia was further investigated, and GI was consulted to determine if he was seeding his blood from a source in the gut. Because he had recently had a colonoscopy that was negative for a source (colon cancer), an MR enterography was performed to investigate the small bowel. This study was also unrevealing for a source of his bacteremia. The patient will need to continue ampicillin for a total of four week course to end on [**2185-6-13**] He will follow up with ID on [**2185-6-9**]. His PICC line was not centrally located at discharge but after discussion with pharmacy and nursing it was concluded it could be still be used as a midline for Ampicillin administration. #. Atrial fibrillation: The patient presented with atrial fibrillation with rapid ventricular rate. In the ICU he was loaded with Digoxin and started on diltiazem in addition to his metoprolol. He was rate controlled on this regimen with rates in the 80s-90s. Eventually the diltiazem was discontinued and he remained well controlled. Coumadin was continued and he was found to have a subtheraputic INR during which time he was bridged with heparin. His INR later became therapeutic and heparin was stopped. He should continue on the metoprolol, digoxin, and coumadin. #. Hypertension: The patient was started on Dogoxin, and diltiazem in addition to his home dose metoprolol as above for rate control. His blood pressure remained in the SBP 100s-120s on this regimen. He was also started on lasix for his CHF. His diltiazem was discontinued and he was aggressively diuresed as his blood pressure could tolerate. He was not started on an ACE inhibitor depite his low ejection fraction because he was heavily diuresed with lasix and his SBP remained 90's-110's after he was re-started on his PO lasix dose. He should continue to take 40 mg PO of lasix daily. He should discuss with his PCP the need to start an ACE inhibitor due to his low ejection fraction. #. Acute systolic CHF: The patient had an ECHO with EF 35%, similar to prior a study on [**4-2**]. It was thought that in the setting of sepsis and IV fluid administration as well as a fib with RVR, the patient had decompensation of his CHF. He diuresed well to Lasix 20mg IV, and was negative 1 to 2 liters a day during the course of his admission. His respiratory status improved, however he still required supplemental oxygen at discharge. He will need to continue his lasix and metoprolol. He was started on spironolactone 12.5 mg daily for mortality benefit and on simvastatin 20 mg daily. As above, he should eventually start an ACE inhibitor if his blood pressure can tolerate it. He was given an appointment with Dr. [**First Name (STitle) 437**] from cardiology for outpatient follow up. # Urinary retention: The patient had a foley placed in the ICU when he was being resuscitated. After the foley was removed he failed his voiding trial. He was started on finasteride and tamsulosin and his urinary retention improved. He will need to follow up with urology. He has an appointment on [**2185-7-13**]. # CLL: The patient has known CLL. His WBC count was elevated between 13 and 19, which was lower than baseline. There was no evidence of transformation. He can continue his regular follow up with oncology as an outpatient . # Pulmonary nodule: Seen on CT scan of the chest. The patient should have a follow up CT scan in four months. Medications on Admission: 5% lidocaine patch to R ribs 6a-6p daily Aspirin 81 mg daily oxycodone 5 mg po q6h prn pain diltiazem 60 mg po QID KCl 20 mEq po daily Multivitamin daily Spiriva 18 mcg inh [**Hospital1 **] Lopressor 100 mg po BID Pulmicort 90 mcg 2 puffs [**Hospital1 **] Levalbuterol 0.63/3 ml q6h senna Lasix 40 mg po qam Ativan 0.5 mg po qhs Remeron 7.5 mg po qhs [**Name (NI) **] unclear dosing, ?4 mg daily, scheduled for 3 mg po the night of admit which he did not receive. Discharge Medications: 1. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): to area of pain. 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for Pain. 4. Multivitamin Capsule Sig: One (1) Capsule PO once a day. 5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Spironolactone 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for Insomnia. 9. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 11. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 13. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). 15. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 16. Budesonide-Formoterol 80-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) puffs Inhalation twice a day. 17. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation twice a day. 18. Levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig: Three (3) ML Inhalation every 4-6 hours as needed for Shortness of breath. 19. Ampicillin Sodium 2 gram Recon Soln Sig: One (1) Recon Soln Injection Q4H (every 4 hours) for 18 days. 20. Oxygen Please provide oxygen supplementation 3-4 L by nasal canula Discharge Disposition: Extended Care Facility: [**Hospital **] [**Hospital **] Nursing Home - [**Location (un) **] Discharge Diagnosis: Primary: Enterococcus bacteremia Acute systolic CHF COPD Atrial fibrilation Urinary retention Secondary diagnosis: Chronic lymphocytic leukemia Hypertension 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: You came to the hospital because you were having fevers at your rehab center. You were found to have a blood infection with a bacteria called ENTEROCOCCUS. You were started on antibiotics for this infection. You had tests which showed that it was not coming from your heart. You also had an MRI which showed that there is no evidence of cancer in your gut that could have caused this. You will need to continue to take antibiotics by IV until [**2185-6-13**]. You will need to follow up as an outpatient with the ID doctors (see below). You also developed an episode of shortness of breath while you were in the hospital and had to be transferred to the ICU. It was thought that your fast heart rate and CHF caused you to be short of breath. You were given medicines to take fluid off and your breathing was better - although not back to your baseline from [**Month (only) 958**]. It was thought that your CHF and COPD were contributing to your chronic shortness of breath. You will need to continue to take lasix to prevent fluid from building up in your lungs and causing you to be short of breath. You also developed some urinary retention. We have made an appointment for you with the Urologist as an outpatient if your symptoms persist. Please note the following changes to your medications: Start: Ampicillin 2 g IV every 4 hours until [**2185-6-13**] Start: Spironolactone 12.5 mg daily Start: Digoxin 0.125 mg daily Start: Finasteride 5 mg daily Start: Tamsulosin 0.4 mg daily Start: Metoprolol succinate 100 mg daily Start: Simvastain 20 mg daily Start: Symbicort 2 puffs twice a day Stop: Metorpolol tartrate (Lopressor) Stop: Diltiazem Stop: Budesonide Stop: KCl Please go to your follow up appointments (see below) It was a pleasure taking part in your care, Mr. [**Known lastname 11753**]. Followup Instructions: Department: INFECTIOUS DISEASE When: THURSDAY [**2185-6-9**] at 1:30 PM With: [**Doctor First Name 1412**] [**Name Initial (MD) **] [**Name8 (MD) 1413**], M.D. [**Telephone/Fax (1) 457**] Building: LM [**Hospital Unit Name **] [**Hospital 1422**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: PULMONARY FUNCTION LAB When: THURSDAY [**2185-6-16**] at 2:10 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: PFT When: THURSDAY [**2185-6-16**] at 2:30 PM Department: SURGICAL SPECIALTIES When: WEDNESDAY [**2185-7-13**] at 9:30 AM With: UROLOGY UNIT [**Telephone/Fax (1) 164**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: CARDIAC SERVICES When: MONDAY [**2185-7-11**] at 11:00 AM With: DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **] [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

038,428,204,995,427,424,788,401,V125,V586,416,311,272,799,492

{'Streptococcal septicemia,Acute on chronic systolic heart failure,Chronic lymphoid leukemia, without mention of having achieved remission,Sepsis,Atrial fibrillation,Mitral valve disorders,Retention of urine, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other chronic pulmonary heart diseases,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Hypoxemia,Other emphysema'}

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: HPI: Mr. [**Known lastname 11753**] is a 68 YOM with COPD (on 2-4L O2 baseline), CLL, hypertension, PE (on coumadin c/b recent GI bleed [**4-23**] requiring 4 units pRBCs), chronic systolic heart failure (EF 35%), atrial fibrillation, and recent admission for Enterococcus faecalis bacteremia treated with ampicillin, who was admitted from rehab facility on [**2185-5-12**] for hypotension, lethargy, and fever. . Of note, E. faecalis during prior admission was treated with ampicillin. Antibiotics were completed [**2185-4-30**], however his PICC was retained. He then had chills and night sweats during night for 3 days preceding admission. During this time he became febrile to 102 on [**2185-5-10**], and PICC was removed [**2185-5-11**]. Blood culture drawn on [**2185-5-10**] at rehab reportedly grew GPC in chains. CXR, UA were reportedly negative. On [**2185-5-12**] the patient was noted to have SBP in the mid-80s (baseline 110-130s) with tachypnea and increased oxygen requirement (baseline 88-90% on NC 3-5L). Vancomycin was considered but not given due to no IV access. He was transferred to [**Hospital1 18**]. . In the ED, sBP 94, RR 26, HR 120s (irregularly irregular). Blood, urine cultures sent. He received Unasyn, levofloxacin, and NS 800cc. On arrival to floor from ED he was hypoxic with oxygen saturation in upper 70s and was found to have atrial fibrillation with RVR (rate 120-130s), tachypnea, and increasd crackles. Oxygen was increased to 6L by nasal cannula with rapid improvement of oxygen saturation to 95%. ABG 7.50 // 30 // 58. He was transferred to the MICU. MEDICAL HISTORY: - Chronic lymphoid leukemia - COPD (FVC 79% pred, FEV1 71% pred, FEV1/FVC 90% pred [**2-/2185**]) - [**Hospital1 **]-ventricular systolic failure, EF 45%; dilated RV with signs of overload - Pulmonary hypertension - Depression - Hypertension - Hyperlipidemia - Peptic ulcer disease - Right eye cataract (S/p removal at the age of 12. He had an injury to his eye and has no vision in that eye for years) - Deviated nasal septum, s/p nasal septal surgery - Cervical arthritis - History of colon polyps (? adenoma) - History of herniated disks - Chronic back pain - Pulmonary nodules - Pulmonary embolism s/p intubation, complicated by VAP - Enterococcus faecalis bacteremia MEDICATION ON ADMISSION: 5% lidocaine patch to R ribs 6a-6p daily Aspirin 81 mg daily oxycodone 5 mg po q6h prn pain diltiazem 60 mg po QID KCl 20 mEq po daily Multivitamin daily Spiriva 18 mcg inh [**Hospital1 **] Lopressor 100 mg po BID Pulmicort 90 mcg 2 puffs [**Hospital1 **] Levalbuterol 0.63/3 ml q6h senna Lasix 40 mg po qam Ativan 0.5 mg po qhs Remeron 7.5 mg po qhs [**Name (NI) **] unclear dosing, ?4 mg daily, scheduled for 3 mg po the night of admit which he did not receive. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 98.2, 125, 123/69, 22, 100% 6L NC Gen: Comfortable, mildy tachypneic HEENT: Right surgical pupil; left pupil reactive to light; moist mucous membranes Neck: JVP elevated approximately 12cm CV: Irregularly irregular; tachycardic; normal S1/S2; no murmurs appreciated Pulmonary: Bibasilar crackles Abdomen: Hypoactive bowel sounds; soft, nontender, not distended Ext: 1+ edema at ankles, trace to knees bilaterally; radial, DP pulses 2+ except left DP 1+ Neuro: Left EOMI; left pupil reactive to light; CN II-XII other than above intact Psych: AOx3; answers questions appropriately FAMILY HISTORY: Mother died at age 85, complications of Alzheimer's disease. Father died at age 74, complications of congestive heart failure. He reports no history of colon cancer, polyps or coronary disease in his family. A brother developed [**Name (NI) 5895**] disease. SOCIAL HISTORY: Married. Most recently at [**Hospital **] [**Hospital **] Nursing Home; was previously at home. He smoked 1PPD >50 years, and quit within the past one month. He denies alcohol or illicit drug use. ### Response: {'Streptococcal septicemia,Acute on chronic systolic heart failure,Chronic lymphoid leukemia, without mention of having achieved remission,Sepsis,Atrial fibrillation,Mitral valve disorders,Retention of urine, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other chronic pulmonary heart diseases,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Hypoxemia,Other emphysema'}

CHIEF COMPLAINT: Syncope PRESENT ILLNESS: 87 y/o M with PMHx of CAD, [**Month/Day/Year 19874**] (EF=40-45%), HTN, HL, COPD presented to OSH on [**11-3**] after feeling faint and pressing his LifeLine button. Per OSH records, he has been more tired for several days, had transient chest pain, RUQ pain prior to syncoplal episode on morning of presentation. Initially on presentation, was somnolent, SBP in the 80s, responded to fluids, fever to 100.1. Initial labs showing AST 400, ALT 300, TB 1.0. Repeat labs AST 550, ALT 5000, ALP 230, lipase 1800, amylase 1300). RUQ ultrasound showed cholelithiasis with wall thickening, but no wall edema and no CBD dilitation, negative [**Doctor Last Name **] sign. CXR with small pleural effusion. U/A normal. Surgery consulted on the patient and he was not a surgical candidate. Started on Unasyn. GI consulted and thought patient requires ERCP for concern of cholangitis. Of note his blood pressures were persistently low, he required 2 250 cc boluses at least to keep his SBPs < 90 in addition to maintenance fluids. . On arrival to the ICU, patient awake, alert but confused. VS 99.1; 85; 94/67; 20; 95%3LNC. Complains of epigastric and RUQ pain. . Review of systems: (+) Per HPI (-) Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: Dementia CAD [**Last Name (LF) 19874**], [**First Name3 (LF) **] 40-45% HTN HL COPD MEDICATION ON ADMISSION: ASA 81mg daily Carvedilol 3.125mg daily Fish oil 1200mg daily Temazepam 7.5mg daily MVT daily Klorcon 10meq daily Lasix 20mg daily Lisinopril 2.5mg daily Citalopram 20mg daily Advair 250/50 [**Hospital1 **] Spiriva 18mcg 1 cap daily Continuous home O2 3LNC ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission exam: Vitals: T: 99.1 BP: 94/67 P: 84 R: 18 O2: 95%3LNC General: Alert, only oriented to self, no acute distress HEENT: Sclera anicteric, MMM, poor dentition Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur, no rubs or gallops Abdomen: Soft, + BS, tenderness to palpation in epigastric and RUQ, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . [**First Name3 (LF) **] exam: Vitals: T 98.2 HR 90 BP 116/62 RR 23 O2Sat 91% on 5L NC General: Alert, oriented only to self Abdomen: soft, distended, +BS, no tenderness to palpation, no rebound/guarding Exam otherwise stable FAMILY HISTORY: Unable to obtain due to dementia SOCIAL HISTORY: - Tobacco: heavy smoking history, but quit many years ago - Alcohol: Denies - Illicits: Denies

Acute pancreatitis,Cholangitis,Chronic systolic heart failure,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Chronic airway obstruction, not elsewhere classified,Dementia, unspecified, without behavioral disturbance,Other chest pain,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia

Acute pancreatitis,Cholangitis,Chr systolic hrt failure,Choledocholithiasis NOS,Chr airway obstruct NEC,Demen NOS w/o behv dstrb,Chest pain NEC,Elev transaminase/ldh,Cor ath unsp vsl ntv/gft,Hypertension NOS,Hyperlipidemia NEC/NOS

Admission Date: [**2189-11-4**] [**Month/Day/Year **] Date: [**2189-11-5**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 3326**] Chief Complaint: Syncope Major Surgical or Invasive Procedure: Endoscopic retrograde cholangiopancreatography - [**2189-11-4**] History of Present Illness: 87 y/o M with PMHx of CAD, [**Month/Day/Year 19874**] (EF=40-45%), HTN, HL, COPD presented to OSH on [**11-3**] after feeling faint and pressing his LifeLine button. Per OSH records, he has been more tired for several days, had transient chest pain, RUQ pain prior to syncoplal episode on morning of presentation. Initially on presentation, was somnolent, SBP in the 80s, responded to fluids, fever to 100.1. Initial labs showing AST 400, ALT 300, TB 1.0. Repeat labs AST 550, ALT 5000, ALP 230, lipase 1800, amylase 1300). RUQ ultrasound showed cholelithiasis with wall thickening, but no wall edema and no CBD dilitation, negative [**Doctor Last Name **] sign. CXR with small pleural effusion. U/A normal. Surgery consulted on the patient and he was not a surgical candidate. Started on Unasyn. GI consulted and thought patient requires ERCP for concern of cholangitis. Of note his blood pressures were persistently low, he required 2 250 cc boluses at least to keep his SBPs < 90 in addition to maintenance fluids. . On arrival to the ICU, patient awake, alert but confused. VS 99.1; 85; 94/67; 20; 95%3LNC. Complains of epigastric and RUQ pain. . Review of systems: (+) Per HPI (-) Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. Past Medical History: Dementia CAD [**Last Name (LF) 19874**], [**First Name3 (LF) **] 40-45% HTN HL COPD Social History: - Tobacco: heavy smoking history, but quit many years ago - Alcohol: Denies - Illicits: Denies Family History: Unable to obtain due to dementia Physical Exam: Admission exam: Vitals: T: 99.1 BP: 94/67 P: 84 R: 18 O2: 95%3LNC General: Alert, only oriented to self, no acute distress HEENT: Sclera anicteric, MMM, poor dentition Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur, no rubs or gallops Abdomen: Soft, + BS, tenderness to palpation in epigastric and RUQ, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . [**First Name3 (LF) **] exam: Vitals: T 98.2 HR 90 BP 116/62 RR 23 O2Sat 91% on 5L NC General: Alert, oriented only to self Abdomen: soft, distended, +BS, no tenderness to palpation, no rebound/guarding Exam otherwise stable Pertinent Results: [**2189-11-4**] 01:37AM BLOOD WBC-8.8 RBC-3.69* Hgb-10.7* Hct-31.2* MCV-85 MCH-29.1 MCHC-34.4 RDW-15.1 Plt Ct-168 [**2189-11-4**] 01:37AM BLOOD Neuts-86.2* Lymphs-6.2* Monos-4.5 Eos-2.8 Baso-0.2 [**2189-11-4**] 01:37AM BLOOD PT-13.0* PTT-28.5 INR(PT)-1.2* [**2189-11-4**] 01:37AM BLOOD Glucose-106* UreaN-32* Creat-1.4* Na-142 K-5.0 Cl-105 HCO3-28 AnGap-14 [**2189-11-4**] 01:37AM BLOOD ALT-598* AST-448* LD(LDH)-377* CK(CPK)-93 AlkPhos-227* Amylase-966* TotBili-3.0* [**2189-11-4**] 01:37AM BLOOD Lipase-1116* [**2189-11-4**] 01:37AM BLOOD CK-MB-2 cTropnT-<0.01 [**2189-11-4**] 01:37AM BLOOD Albumin-3.7 Calcium-8.5 Phos-3.5 Mg-2.3 [**2189-11-4**] 01:37AM BLOOD Ethanol-NEG Acetmnp-NEG [**2189-11-4**] 03:41AM BLOOD Lactate-1.0 . MICROBIOLOGY: Blood culture x 2 ([**2189-11-4**])- no growth to date, pending final Urine culture ([**2189-11-4**])- no growth . (OSH) CXR: [**2189-11-3**] Small right sided pleural effusion versus pleural thickening. Probable left sided atelectasis/scarring . RUQ ultrasound: [**2189-11-3**]: Evaluation is limited due to patients body habitus. The liver is heterogenoeous in echotexture with no focal lesions identified. There is no evidence of intra-or extrahepatic ductal dilation. The common hepatic duct measures 2mm and within normal limits. The gallbladder is visualized and appears to contain a 1 cm stone. There is mild gallbladder wall mildly thickened to 5mm however no evidence of gallbladder wall edema, pericholecystic fluid. A negative [**Doctor Last Name **] sign was elicited. There is no free fluiid. The pancreas is not visualized due to overlying bowel gas. The right kidney is unremarkable. . [**Hospital1 18**] CXR [**2189-11-4**]: There is mild cardiomegaly. There are low lung volumes. Small-to-moderate right pleural effusion is associated with adjacent opacities, likely atelectases. Ill-defined rounded nodular opacities in the left upper lobe have a broad differential diagnosis as etiology including infectious process. The pulmonary arteries are enlarged. Ill-defined faint opacity in the left lower lobe obscures partially the lung vessels. . CT is recommended for further evaluation of the chest to exclude pulmonary embolism, pulmonary artery hypertension, and further assessment of probable infectious process in the left lung. . ERCP Report ([**2189-11-4**]): Esophagus: Limited exam of the esophagus was normal Stomach: Limited exam of the stomach was normal Duodenum: Limited exam of the duodenum was normal Major Papilla: Normal major papilla Cannulation: Cannulation of the biliary duct was initially unsuccessful. Thus, a careful pre-cut sphincterotomy was performed to gain access. Cannulation was subsequently successful and deep with a sphincterotome after a guidewire was placed. Contrast medium was injected resulting in complete opacification. . Biliary Tree Fluoroscopic Interpretation: A mild diffuse dilation was seen at the biliary tree with the CBD measuring 9 mm. There were no filling defects seen. An occlusion cholangiogram was not done given concern for cholangitis. Given cholangitis and gallstone pancreatitis, decision was made to extend the pre-cut sphincterotomy. An extension sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. Balloon sweep x 2 was performed with successful extraction of sludge. Pancreas Fluoroscopic Interpretation: A limited pancreatogram was normal. . Impression: Cannulation of the biliary duct was initially unsuccessful. A careful pre-cut sphincterotomy was performed to gain access to the biliary tree. Cannulation was subsequently successful and deep with a sphincterotome after a guidewire was placed. Contrast medium was injected resulting in complete opacification. A mild diffuse dilation was seen at the biliary tree with the CBD measuring 9 mm. There were no filling defects seen. An occlusion cholangiogram was not done given concern for cholangitis. Given cholangitis and gallstone pancreatitis, decision was made to extend the pre-cut sphincterotomy. An extension sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. Balloon sweep x 2 was performed with successful extraction of sludge. . Brief Hospital Course: 87 y/o M with PMHx of CAD, [**Month/Day/Year 19874**] (EF=40-45%), HTN, HL, COPD presented to OSH on [**11-3**] with RUQ, fever, and rapidly developing transaminitis and pancreatic enzymes, transferred to [**Hospital1 18**] for ERCP with concern for cholangitis. . # Gallstone pancreatitis - Bisap score= 4 on admission. RUQ ultrasound at OSH showed evidence of gallstone with common bile duct dilation. Amylase and lipase were grossly elevated, consistent with pancreatitis. ERCP performed on HD1 with sphincterotomy performed (see attached report). Amylase/lipase were downtrending following ERCP. Patient was pain free following procedure and vital signs were stable. On HD2 patient was started on clear liquid diet and advanced to a regular diet which he tolerated without issue. . # Suspected cholangitis - Evidence of biliary dilation on ERCP and with known gallstone, concern for cholangitis. Patient started on cipro/Flagyl to cover biliary bacteria. Thus far, cultures are negative. AST/ALT downtrending following ERCP. Plan to continue oral cipro and flagyl for 10 day course (day 1=[**2189-11-4**], ending [**2189-11-10**]). . # Hypotension - Patient was hypotensive at [**Hospital **] Hospital but responsive to fluid boluses. Patient treated for septic shock with IV antibiotics for biliary bacteria and fluid boluses. Following ERCP, patient's blood pressure normalized and he did not require fluid boluses or pressure support. His home anti-hypertensives were held at the time of transfer. . # Altered mental status - Patient has baseline dementia. Unclear baseline function, but does have report of increasing solmnolence at OSH, likely d/t initial hypotension. Currently AAOx1, but awake, alert and conversant. Per HCP, this is patient??????s baseline. . # CAD- Patient reported chest pain prior to syncopal event. EKG showed RBBB, unchanged from [**3-/2189**], and cardiac enzymes were negative x2. Chest pain likely from abdominal process. . # [**Year (4 digits) 19874**]- No signs of acute heart failure. Did not appear volume overloaded. Continued aspirin 81 mg daily and held carvedilol, lasix and lisinopril in the setting of hypotension. These medications were restarted on HD... . # Hypertension- Blood pressure medications were initially held in the setting of hypotension and were not restarted at the time of transfer. . # COPD- No evidence of exacerbation. Continued on home advair, spiriva and 3LNC. . # Transitional issues- - HCP [**Name (NI) **] [**Name (NI) 41275**] H [**Telephone/Fax (1) 92536**] C [**Telephone/Fax (1) 92537**] - Patient will need physical therapy evaluation; consider short term rehab vs visiting nurse services. Patient lives at home alone and has significant dementia. It is unlikely that he will be able to administer antibiotics without assistance. HCP very concerned about mental status/ability to be alone. Medications on Admission: ASA 81mg daily Carvedilol 3.125mg daily Fish oil 1200mg daily Temazepam 7.5mg daily MVT daily Klorcon 10meq daily Lasix 20mg daily Lisinopril 2.5mg daily Citalopram 20mg daily Advair 250/50 [**Hospital1 **] Spiriva 18mcg 1 cap daily Continuous home O2 3LNC [**Hospital1 **] Medications: TRANSFER MEDICATIONS: Ciprofloxacin 500mg po q12h (day 1=[**2189-11-4**], ending [**2189-11-13**]) Metronidazole 500mg po q8h (day 1=[**2189-11-4**], ending [**2189-11-13**]) Aspirin 81mg po daily Fluticasone-salmeterol 250/50 INH [**Hospital1 **] Tiotropium 1 cap INH daily Ipratropium bromide Neb INH q6h prn shortness of breath/wheezing Docusate 100mg po BID prn constipation Senna 1 tab po BID prn constipation [**Hospital1 **] Disposition: Extended Care Facility: [**Hospital1 **] - [**Location (un) 47**] [**Location (un) **] Diagnosis: Primary diagnosis: 1. Gallstone pancreatitis 2. Cholangitis . Secondary diagnosis: 1. Chronic obstructive pulmonary disease 2. Congestive heart failure [**Location (un) **] Condition: Stable Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. [**Location (un) **] Instructions: Dear Mr [**Known lastname 26438**], It was a pleasure taking care of you during your recent stay at [**Hospital1 18**]. You were transferred here because a there was a stone in your biliary system causing your pancreas to be inflammed and an infection to form. You underwent a procedure to remove the stone and relieve the obstruction. You were started on IV antibiotics. You tolerated this procedure very well and your pain and fever improved. You were able to start eating regular food without any issue. You will be transferred back to [**Hospital1 **] for further management. You will need evaluation from physical therapy to determine how safe you are to return home. Followup Instructions: - Physical therapy: please evaluate for home safety - Please schedule an appointment with the patient's primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **].

577,576,428,574,496,294,786,790,414,401,272

{'Acute pancreatitis,Cholangitis,Chronic systolic heart failure,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Chronic airway obstruction, not elsewhere classified,Dementia, unspecified, without behavioral disturbance,Other chest pain,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Coronary atherosclerosis of unspecified type of vessel, native or graft,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: Syncope PRESENT ILLNESS: 87 y/o M with PMHx of CAD, [**Month/Day/Year 19874**] (EF=40-45%), HTN, HL, COPD presented to OSH on [**11-3**] after feeling faint and pressing his LifeLine button. Per OSH records, he has been more tired for several days, had transient chest pain, RUQ pain prior to syncoplal episode on morning of presentation. Initially on presentation, was somnolent, SBP in the 80s, responded to fluids, fever to 100.1. Initial labs showing AST 400, ALT 300, TB 1.0. Repeat labs AST 550, ALT 5000, ALP 230, lipase 1800, amylase 1300). RUQ ultrasound showed cholelithiasis with wall thickening, but no wall edema and no CBD dilitation, negative [**Doctor Last Name **] sign. CXR with small pleural effusion. U/A normal. Surgery consulted on the patient and he was not a surgical candidate. Started on Unasyn. GI consulted and thought patient requires ERCP for concern of cholangitis. Of note his blood pressures were persistently low, he required 2 250 cc boluses at least to keep his SBPs < 90 in addition to maintenance fluids. . On arrival to the ICU, patient awake, alert but confused. VS 99.1; 85; 94/67; 20; 95%3LNC. Complains of epigastric and RUQ pain. . Review of systems: (+) Per HPI (-) Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: Dementia CAD [**Last Name (LF) 19874**], [**First Name3 (LF) **] 40-45% HTN HL COPD MEDICATION ON ADMISSION: ASA 81mg daily Carvedilol 3.125mg daily Fish oil 1200mg daily Temazepam 7.5mg daily MVT daily Klorcon 10meq daily Lasix 20mg daily Lisinopril 2.5mg daily Citalopram 20mg daily Advair 250/50 [**Hospital1 **] Spiriva 18mcg 1 cap daily Continuous home O2 3LNC ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission exam: Vitals: T: 99.1 BP: 94/67 P: 84 R: 18 O2: 95%3LNC General: Alert, only oriented to self, no acute distress HEENT: Sclera anicteric, MMM, poor dentition Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur, no rubs or gallops Abdomen: Soft, + BS, tenderness to palpation in epigastric and RUQ, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . [**First Name3 (LF) **] exam: Vitals: T 98.2 HR 90 BP 116/62 RR 23 O2Sat 91% on 5L NC General: Alert, oriented only to self Abdomen: soft, distended, +BS, no tenderness to palpation, no rebound/guarding Exam otherwise stable FAMILY HISTORY: Unable to obtain due to dementia SOCIAL HISTORY: - Tobacco: heavy smoking history, but quit many years ago - Alcohol: Denies - Illicits: Denies ### Response: {'Acute pancreatitis,Cholangitis,Chronic systolic heart failure,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Chronic airway obstruction, not elsewhere classified,Dementia, unspecified, without behavioral disturbance,Other chest pain,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: On [**2185-2-25**], Mr. [**Known firstname 6930**] [**Last Name (NamePattern1) 46878**] was a 76-year-old male with a past medical history significant for coronary artery disease status post myocardial infarction, history of seizure disorder, diabetes mellitus, sensorineural hearing loss left greater than right, and gout presented status post being struck by a car with question rotational component injury. Had poor recall of the event, and had a questionable loss of consciousness. He was hemodynamically stable with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma score of 15 upon arrival. He was complaining of just head/forehead pain and left shoulder pain. MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction non-Q-wave. 2. History of seizure disorder. 3. History of diabetes mellitus. 4. History of sensorineural hearing loss left greater than right. 5. History of gout. MEDICATION ON ADMISSION: ALLERGIES: None. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Is married. Denies significant tobacco or alcohol history currently. Works as a landscaper.

Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Closed fracture of other facial bones,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of forehead, without mention of complication,Closed fracture of coracoid process of scapula

Cl skull vlt fx/hem NEC,Traum hemothorax-closed,Fx mult ribs NOS-closed,Fx dorsal vertebra-close,DMII wo cmp uncntrld,Fx facial bone NEC-close,Mv coll w pedest-pedest,Open wound of forehead,Fx scapul, corac proc-cl

Admission Date: [**2185-2-25**] Discharge Date: [**2185-3-3**] Date of Birth: [**2125-1-5**] Sex: M Service: TRAUMA HISTORY OF PRESENT ILLNESS: On [**2185-2-25**], Mr. [**Known firstname 6930**] [**Last Name (NamePattern1) 46878**] was a 76-year-old male with a past medical history significant for coronary artery disease status post myocardial infarction, history of seizure disorder, diabetes mellitus, sensorineural hearing loss left greater than right, and gout presented status post being struck by a car with question rotational component injury. Had poor recall of the event, and had a questionable loss of consciousness. He was hemodynamically stable with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma score of 15 upon arrival. He was complaining of just head/forehead pain and left shoulder pain. Trauma activation thereafter followed, and ATLS protocols were carried out for his resuscitation and evaluation. PAST MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction non-Q-wave. 2. History of seizure disorder. 3. History of diabetes mellitus. 4. History of sensorineural hearing loss left greater than right. 5. History of gout. MEDICATIONS AT HOME: 1. Aspirin. 2. Insulin regimen. 3. Dilantin. 4. Allopurinol. 5. Antihypertensive regimen, not otherwise specified. ALLERGIES: None. PAST SURGICAL HISTORY: States prior right kidney surgery, not otherwise specified. SOCIAL HISTORY: Is married. Denies significant tobacco or alcohol history currently. Works as a landscaper. REVIEW OF SYSTEMS: Noncontributory. PHYSICAL EXAMINATION: Upon presentation, he was afebrile, hemodynamically stable. Blood pressure was in the 130s/palp with a heart rate of 100 sating appropriately. His mid face was stable. Extraocular movements are intact. He had bilateral orbital ecchymosis left greater than right. His mid face was stable. He had no malocclusion. Trachea is midline. Lungs were clear, but decreased on the left side markedly. Heart was regular, tachycardic. Abdomen was soft and nontender. Extremities were noted for just left shoulder pain and left anterior chest wall pain with no crepitus. Pelvis was stable. Back was nontender, no step-off. Rectal examination: Normal tone, guaiac negative, normal prostate. Lower extremities were normal. Evaluation included a CT scan of the head showing a depressed frontal skull fracture with extension to the inner table with questionable left frontal subdural hemorrhage and possible interparenchymal-interventricular blood. Additionally, he had a CT scan of the face with fine cuts in 2 mm intervals revealing a bilateral laminal papryceea as well as bilateral orbital wall fractures and a questionable cribriform plate fracture. A CT scan of the C spine revealed thyroid mass plus possible C1-C2 rotational injury. A follow-up MRI of the spine however, was negative. CTA of the chest was performed showing a small hemothorax, bilateral first rib fractures, left ribs one through five were fractured with rib three having two separate fracture sites. He also had a spinous process fracture T5 through T9 as well as a left coracoid fracture. CT scan of the abdomen was done which was otherwise negative. Consultation was attained with Plastic Surgery and Neurosurgery as well as Orthopedics. Plastic Surgery managed his frontal forehead laceration over the left orbit. This is sutured in the Intensive Care Unit once the patient was stabilized and brought to the Trauma Intensive Care Unit for observation. Neurosurgical evaluation revealed that the patient did not require any ICP monitoring as he had a GCS of 15. Was alert and oriented, had a reliable examination, and followup head CT scan was done the next day showing no interval change, and he had no neurological deficits. Patient was in the Intensive Care Unit for approximately 48 hours. He did receive a left sided chest tube for the small hemothorax. Approximately 200 cc of what looked like older blood came out, but over the ensuing days of his hospitalization, the patient was ultimately transferred to the floor. His diet was advanced. He was working with Physical Therapy, albeit somewhat decreased with his ability to ambulate, is ultimately screened for rehabilitation setting as it was found that the patient would likely benefit from further Physical Therapy and rehabilitation. His home medications were restarted. His diet was advanced to a diabetic diet. Blood glucose control is achieved with NPH and insulin. Ultimately by [**2185-3-3**], the patient was deemed appropriate and stable for discharge. DISCHARGE MEDICATIONS: 1. Sliding scale insulin NPH tid. 2. Dilantin. 3. Protonix. 4. SubQ Heparin. 5. Tylenol for pain. 6. Allopurinol. Please see page one for the remaining details of his medication doses. DISPOSITION: Rehabilitation. FINAL DIAGNOSIS: Status post motor vehicle crash/struck or dragging by car with multiple traumas. Please see the history of present illness for the extent of his injuries. FOLLOW-UP INSTRUCTIONS: Follow up will be to see Neurosurgery in approximately two weeks from time of discharge. He will follow up in the [**Hospital **] Clinic in approximately two weeks from the time of discharge. Can followup in the Trauma Clinic in approximately two weeks from discharge. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. [**MD Number(1) 521**] Dictated By:[**Last Name (NamePattern4) 3204**] MEDQUIST36 D: [**2185-3-3**] 06:51 T: [**2185-3-3**] 06:54 JOB#: [**Job Number 46879**] Name: [**Known lastname 6553**], [**Known firstname 8687**] Unit No: [**Numeric Identifier 8688**] Admission Date: [**2185-2-25**] Discharge Date: [**2185-3-5**] Date of Birth: [**2125-1-5**] Sex: M Service: HOSPITAL COURSE: The patient has remained stable throughout the course of his hospital stay. On the floor, he has received all his home medications and has been hemodynamically stable. His glycemic control has been an issue since transfer to the floor. He has been restarted on his NPH at 15 units subcutaneously three times a day and in the 24 hours prior to his discharge his blood glucose has been well controlled. The patient has continued to see the physical therapist while in the hospital. They have cleared him for discharge from the hospital to home. DISCHARGE INSTRUCTIONS: 1. Follow-up with Plastic Surgery Clinic for possible repair of facial fractures at [**Telephone/Fax (1) 8689**]. Appointment should be made in the next one to two weeks. 2. Follow-up with Dr. [**Last Name (STitle) 998**] of orthopedics in one to two weeks, [**Telephone/Fax (1) 8690**]. 3. Follow-up with neurosurgery in one to two weeks, Call telephone [**Telephone/Fax (1) 8691**], for an appointment. 4. Follow-up with primary care physician in the next one week at the [**Hospital **] Health Care System, [**Telephone/Fax (1) 8692**]. MEDICATIONS ON DISCHARGE: 1. Zocor 20 mg p.o. q.h.s. 2. Isosorbide Dinitrate 40 mg p.o. three times a day. 3. Dilantin 300 mg p.o. q.h.s. 4. Irbesartan 75 mg p.o. q.o.d. 5. Aspirin 325 mg p.o. once daily. 6. Atenolol 50 mg p.o. once daily. 7. Allopurinol 200 mg p.o. once daily. 8. Insulin 15 units NPH three times a day. 9. Sliding scaler per patient. 10. Tylenol 325 to 650 mg p.o. q4-6hours p.r.n. DISCHARGE STATUS: To home. CONDITION ON DISCHARGE: Good. [**First Name11 (Name Pattern1) 1080**] [**Last Name (NamePattern4) 3711**], M.D. [**MD Number(1) 3712**] Dictated By:[**Last Name (NamePattern1) 8693**] MEDQUIST36 D: 03/01/2093 09:01 T: [**2185-3-5**] 09:29 JOB#: [**Job Number 8694**]

800,860,807,805,250,802,E814,873,811

{'Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Closed fracture of other facial bones,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of forehead, without mention of complication,Closed fracture of coracoid process of scapula'}

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: On [**2185-2-25**], Mr. [**Known firstname 6930**] [**Last Name (NamePattern1) 46878**] was a 76-year-old male with a past medical history significant for coronary artery disease status post myocardial infarction, history of seizure disorder, diabetes mellitus, sensorineural hearing loss left greater than right, and gout presented status post being struck by a car with question rotational component injury. Had poor recall of the event, and had a questionable loss of consciousness. He was hemodynamically stable with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma score of 15 upon arrival. He was complaining of just head/forehead pain and left shoulder pain. MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction non-Q-wave. 2. History of seizure disorder. 3. History of diabetes mellitus. 4. History of sensorineural hearing loss left greater than right. 5. History of gout. MEDICATION ON ADMISSION: ALLERGIES: None. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Is married. Denies significant tobacco or alcohol history currently. Works as a landscaper. ### Response: {'Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Closed fracture of other facial bones,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of forehead, without mention of complication,Closed fracture of coracoid process of scapula'}

CHIEF COMPLAINT: PRESENT ILLNESS: This 61 year old female was seen originally by the Cardiac Surgery team on [**2165-11-1**], prior to her admission. She was status post myocardial infarction in [**2152**] with DCA of her left circumflex. She was recathed in [**2157**] which showed subtotal LAD occlusion. She was treated medically at that time. She now reports one year history of dyspnea, exertion. Stress test in [**2165-1-17**] showed an apical ischemia of EF of 67 percent. She has had ongoing symptoms and was referred for cath on [**2165-11-1**] which showed left vein 70 percent lesion, LAD 100 percent occluded, RCA 50 percent, ostium 70 percent mid lesion. She was referred to Dr. [**First Name (STitle) **] [**Name (STitle) **] for coronary artery bypass graft. She reports angina symptoms since [**2152**], worse lately with DOE and edema. She denies nausea, vomiting, diarrhea, or syncope. MEDICAL HISTORY: Myocardial infarction with coronary artery disease. MEDICATION ON ADMISSION: ALLERGIES: Codeine which causes vomiting but stated that Percocet was OK to use. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives alone in [**Location (un) 4444**] with three children in the area. She works full time as a legal secretary. She quit smoking 13 years ago with a 30-year pack a day history. She has rare alcoholic drinks. Her mother had a coronary artery disease at age [**Age over 90 **]. The patient's weight was stable. She did have a history of psoriasis.

Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux

Crnry athrscl natve vssl,Angina pectoris NEC/NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Esophageal reflux

Admission Date: [**2165-11-12**] Discharge Date: [**2165-11-18**] Date of Birth: [**2103-12-29**] Sex: F Service: CSU HISTORY OF PRESENT ILLNESS: This 61 year old female was seen originally by the Cardiac Surgery team on [**2165-11-1**], prior to her admission. She was status post myocardial infarction in [**2152**] with DCA of her left circumflex. She was recathed in [**2157**] which showed subtotal LAD occlusion. She was treated medically at that time. She now reports one year history of dyspnea, exertion. Stress test in [**2165-1-17**] showed an apical ischemia of EF of 67 percent. She has had ongoing symptoms and was referred for cath on [**2165-11-1**] which showed left vein 70 percent lesion, LAD 100 percent occluded, RCA 50 percent, ostium 70 percent mid lesion. She was referred to Dr. [**First Name (STitle) **] [**Name (STitle) **] for coronary artery bypass graft. She reports angina symptoms since [**2152**], worse lately with DOE and edema. She denies nausea, vomiting, diarrhea, or syncope. PAST MEDICAL HISTORY: Myocardial infarction with coronary artery disease. Status post DCA of left circumflex. Insulin dependent diabetes mellitus. Hypertension. Hyperlipidemia. Gastroesophageal reflux disease. Obesity. Psoriasis. PAST SURGICAL HISTORY: Cesarean sections. Tonsillectomy and right eye cataract removal. ALLERGIES: Codeine which causes vomiting but stated that Percocet was OK to use. MEDICATIONS: Medications prior to admission are as follows: 1. Procardia XL 90 mg po daily. 2. Atenolol 50 mg po daily. 3. Lipitor 80 mg po daily. 4. Aspirin 81 mg po daily. 5. Zantac 150 mg po daily. 6. Zestril 40 mg po daily. 7. Hydrochlorothiazide 25 mg daily. 8. Halobetasol prn for psoriasis. 9. Novolin insulin 24 units [**Hospital1 **]. 10. Humalog 12 units [**Hospital1 **]. 11. Glucophage 50 mg po daily. SOCIAL HISTORY: The patient lives alone in [**Location (un) 4444**] with three children in the area. She works full time as a legal secretary. She quit smoking 13 years ago with a 30-year pack a day history. She has rare alcoholic drinks. Her mother had a coronary artery disease at age [**Age over 90 **]. The patient's weight was stable. She did have a history of psoriasis. PHYSICAL EXAMINATION: VITAL SIGNS: Height was 5'2", weight 210, sinus rhythm at 68, respiratory rate 16, blood pressure 160/74 and oxygen saturations 97 percent on room air. She is lying flat in bed in no apparent distress. She is alert and oriented x 3 and appropriate. HEENT: Neck was supple with no carotid bruits. LUNGS: Clear bilaterally anteriorly with distant sounds. HEART: Regular rate and rhythm with S1 and S2 tones and no murmur, rub, or gallop. ABDOMEN: Soft, obese and nontender, nondistended with positive bowel sounds. EXTREMITIES: Warm and well perfused with no edema or varicosities. Pulses were 2+ bilaterally for radials, 1+ DP on the right, 2+ on the left and 2+ PT bilaterally. PREOPERATIVE LABORATORY DATA: Preop labs are as follows: White blood cell count 6.6 hematocrit 33.3, platelet count 294,000, sodium 138, K 4.2, chloride 102, bicarb 23, BUN 13, creatinine 0.8 with a blood sugar of 163, PT 12.6, PTT 30.4, INR 1.0, ALT 24, AST 24, alkaline phosphatase 88. Amylase 54. Total bilirubin 0.3, albumin 4.4. Urinalysis was negative preoperatively. Additional labs were vitamin B12 level 229, triglycerides 159, HDL 57, cholesterol HDL ratio 2.9, LDL 78. Preop chest x-ray showed no acute cardiopulmonary process. On [**2165-11-12**], the patient underwent coronary artery bypass graft x 3 with left internal mammary artery to the LAD and vein graft to the RCA and vein graft to the ramus. The patient was transferred to the cardiothoracic Intensive Care Unit in stable condition on an insulin drip at 3 units an hour and propofol drip at 15 ug/kg per minute. The patient had some inferior ST elevation status post her coronary artery bypass graft; related to that Cardiology was called to do a TTE. TTE was attempted but without windows clean enough to judge wall motion. The patient was pain free with a blood pressure of 111/60 and heart rate of 104 at the time of echo on 40 ug of nitroglycerine and 45 ug of Neo-Synephrine. Please refer to the Cardiology note. The patient was extubated on the early morning hours of [**2165-11-13**]. On postoperative day 1, the patient started some epinephrine. The patient continued to improve in sinus rhythm in the 90's with blood pressure of 127/59, epi was on at 0.02 ug/kg/minute, insulin drip remained on at 3 units an hours and a small amount of Neo-Synephrine drop at 0.75 ug/kg/minute. POSTOPERATIVE LABORATORY DATA: Postoperative labs are as follows: White blood cell count 14.1 hematocrit 31.5, platelet count 293,000, K 4.5, BUN 12, creatinine 0.9 with a blood sugar of 81. Examination was unremarkable. The lungs were clear bilaterally with 1+ peripheral edema. Beta blockade was held. Lasix intravenous 6 began, epi was discontinued later in the day and Neo-Synephrine was continued. The patient remained on Intensive Care Unit on postoperative day 2. The patient received one dose of Lasix overnight and remained only on Neo- Synephrine drip at 0.21. She was stable hemodynamically with a pressure of 92/46 and in sinus rhythm in the 80's, saturating 93 percent on 4 liters nasal cannula. Chest tubes remained in place with no air leak. Examination was unremarkable. Creatinine was stable at 1.0, hematocrit dropped slightly at 25.6. Chest tubes and Foley were discontinued. The patient was transferred out to the floor. Lasix diuresis was continued and beta blockade with Lopressor 12.5 mg po b.i.d. was started. The patient was also seen by the [**Last Name (un) **] consult followed at the request of the Cardiac Surgery team and was evaluated by physical therapy. The patient was switched over to PO Percocet for pain. On postoperative day 3, she was also started on her vitamins and iron. Glucophage was restarted. The patient had some volume overload with dyspnea. Hematocrit was rechecked. This dropped to 24.3. The patient continued with Lasix diuresis intravenous and was transfused 1 unit of packed red blood cells with additional Lasix and also prn nebulizer treatments were ordered. [**Last Name (un) **] consult recommendations were appreciated. The patient was also seen by case management. On postoperative day 4, the patient had decreased breath sounds bilaterally, was stable hemodynamically in sinus rhythm, oxygen saturations 96 percent on 2 liters nasal cannula. The patient continued diuresis and aggressive physical therapy with respiratory therapist also. Incisions were cleaned, dry and intact. Examination was otherwise unremarkable. The patient was receiving Percocet and Motrin po with good effect for pain management. [**Last Name (un) **] follow up was also done on [**2165-11-17**]. The patient was also encouraged to continue ambulating to her maximal abilities and postoperative day 6, the day of discharge, the patient was in sinus rhythm at 80 with blood pressure of 147/71. The weight was down 0.2 kg from preoperative and hematocrit was stable at 28.5, K 3.9, magnesium 1.5, saturating at 96 percent on room air. The examination was unremarkable. In addition the patient was discharged in stable condition with the following discharge diagnoses. 1. Status post coronary artery bypass graft x 3. 2. Status post myocardial infarction with coronary artery disease and prior PTCA of circumflex. 3. Insulin dependent diabetes mellitus. 4. Hypertension. 5. Hyperlipidemia. 6. Gastroesophageal reflux disease. 7. Obesity. 8. Status post cesarean section. 9. Status post tonsillectomy. 10. Status post right eye cataract removal. DISCHARGE MEDICATIONS: 1. Colace 100 mg po bid. 2. Percocet 5/325 one tablet po prn q 4 to 6 hours for pain. 3. Enteric coated aspirin 81 mg po once daily. 4. Lipitor 80 mg po once daily. 5. Metformin 1000 mg po twice daily. 6. Ferrous sulfate 325 (65 mg tablet) one tablet po daily. 7. Vitamin C 500 mg po twice a day. 8. Ibuprofen 600 mg po q8 hours prn. 9. NPH insulin - human recombinant 100 units per ml suspension 12 units subcutaneously [**Hospital1 **]. The patient will adjust according to the blood sugars [**First Name8 (NamePattern2) **] [**Last Name (un) **] protocol. 10. Lasix 40 mg po bid x 7 days. 11. Metoprolol tartrate 50 mg po bid. 12. Potassium chloride 20 milliequivalents po bid x 7 days. 13. Humalog 100 units per ml solution prn units subcutaneous per q day as directed by Dr. [**Last Name (STitle) 174**] of [**Hospital **] Clinic. The patient was instructed to follow with Dr. [**First Name (STitle) **], her primary care physician, [**Last Name (NamePattern4) **] 2 to 3 weeks, and follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the cardiologist, in 2 to 3 weeks, to follow up with Dr. [**Last Name (STitle) 174**] of [**Hospital **] Clinic as needed and to make appointment to see Dr. [**First Name (STitle) **] [**Name (STitle) **], M.D. in the office postoperatively 4 weeks for postoperative surgical visit. The patient was discharged home in stable condition on [**2165-11-18**]. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2165-12-13**] 15:28:38 T: [**2165-12-13**] 17:19:23 Job#: [**Job Number 26663**]

414,413,250,401,530

{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,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: PRESENT ILLNESS: This 61 year old female was seen originally by the Cardiac Surgery team on [**2165-11-1**], prior to her admission. She was status post myocardial infarction in [**2152**] with DCA of her left circumflex. She was recathed in [**2157**] which showed subtotal LAD occlusion. She was treated medically at that time. She now reports one year history of dyspnea, exertion. Stress test in [**2165-1-17**] showed an apical ischemia of EF of 67 percent. She has had ongoing symptoms and was referred for cath on [**2165-11-1**] which showed left vein 70 percent lesion, LAD 100 percent occluded, RCA 50 percent, ostium 70 percent mid lesion. She was referred to Dr. [**First Name (STitle) **] [**Name (STitle) **] for coronary artery bypass graft. She reports angina symptoms since [**2152**], worse lately with DOE and edema. She denies nausea, vomiting, diarrhea, or syncope. MEDICAL HISTORY: Myocardial infarction with coronary artery disease. MEDICATION ON ADMISSION: ALLERGIES: Codeine which causes vomiting but stated that Percocet was OK to use. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives alone in [**Location (un) 4444**] with three children in the area. She works full time as a legal secretary. She quit smoking 13 years ago with a 30-year pack a day history. She has rare alcoholic drinks. Her mother had a coronary artery disease at age [**Age over 90 **]. The patient's weight was stable. She did have a history of psoriasis. ### Response: {'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux'}

CHIEF COMPLAINT: Syncope and question of seizure. PRESENT ILLNESS: The patient is a 47-year-old man with a sudden onset of loss of consciousness on the morning of admission. His wife witnessed shaking and frothing activities for about 2-3 minutes. The patient awoke with memory of the fall or syncope and never had signs or symptoms before like this. Now feels woozy, lightheaded but not confused or disoriented. Full sensory, motor intact. Now ambulating without difficulty. CT at the outside hospital shows a colloid cyst of the third ventricle. He was transferred to [**Hospital1 69**] for further management. PAST MEDICAL HISTORY: Includes hypercholesterolemia, MVR in [**2097**] on Coumadin, status post ablation and cardioversion, hypertension, GERD, CHF, Dressler's syndrome and hepatitis C. MEDICAL HISTORY: Includes hypercholesterolemia, MVR in [**2097**] on Coumadin, status post ablation and cardioversion, hypertension, GERD, CHF, Dressler's syndrome and hepatitis C. MEDICATION ON ADMISSION: 1. Toprol XL 200 mg p.o. q.d. 2. Maxzide 25 mg p.o. q.d. 3. Colchicine 0.6 mg p.o. q.d. 4. Zocor 40 mg p.o. q.d. 5. Nexium 40 mg p.o. q.d. 6. Coumadin 9 mg five days a week and 10 mg on the weekends. 7. Oxycontin 40 mg p.o. q.d. 8. Combivent two puffs b.i.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other specified congenital anomalies of brain,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Anxiety state, unspecified,Heart valve replaced by other means

Brain anomaly NEC,Iatrogen CV infarc/hmrhg,Hypertension NOS,Pure hypercholesterolem,Esophageal reflux,Anxiety state NOS,Heart valve replac NEC

Admission Date: [**2103-2-23**] Discharge Date: [**2103-3-15**] Date of Birth: [**2055-5-8**] Sex: M HISTORY OF PRESENT ILLNESS: The patient is a 47-year-old man with a sudden onset of loss of consciousness on the morning of admission. His wife witnessed shaking and frothing activities for about 2-3 minutes. The patient awoke with memory of the fall or syncope and never had signs or symptoms before like this. Now feels woozy, lightheaded but not confused or disoriented. Full sensory, motor intact. Now ambulating without difficulty. CT at the outside hospital shows a colloid cyst of the third ventricle. He was transferred to [**Hospital1 69**] for further management. PAST MEDICAL HISTORY: Includes hypercholesterolemia, MVR in [**2097**] on Coumadin, status post ablation and cardioversion, hypertension, GERD, CHF, Dressler's syndrome and hepatitis C. PHYSICAL EXAMINATION: He is in no acute distress. His vital signs are stable. His pupils are equal, round and reactive to light. Extraocular movements intact. Bilateral upper and lower extremities are [**4-22**], reflexes are 2+ throughout. He is ambulating normally. His EKG was normal on admission. His Chem 7, sodium 141, potassium 3.8, chloride 104, CO2 27, BUN 11, creatinine .9, glucose 99. Coags on admission, PT 25, INR 4.1 and his PTT was 33. HOSPITAL COURSE: The patient was started on Heparin. His INR was allowed to drift down to the 2.5 range and then he was started on Heparin. Cardiology assessed him and felt that it was important to continue the Heparin and that once he was able to start back on Coumadin, that his INR be 2.5 to 3.0. On [**2103-3-1**] the patient underwent transcollossal resection of colloid cyst. The patient was monitored on the surgical Intensive Care Unit post-op. His blood pressure was 120/50, heart rate 95, sats 95% on two liters. Neurologically the patient was awake and alert, oriented times two, following commands with a decreased affect and decreased motor strength of the left upper extremity. On postoperative day #1 the patient underwent head CT which revealed a venous infarct on the right frontal lobe. The patient remained in the Intensive Care Unit with close neurologic evaluation. He had a slight interval increase in the size of the right frontal lobe bleed and infarct. On [**2103-3-5**] the patient had a repeat head CT which showed slight interval increase in the size of the infarct and edema. The patient was continued to be monitored in the surgical Intensive Care Unit, neurologically remained awake and alert, oriented times [**1-21**], and continued to have some decreased strength in the left upper extremity. The patient was restarted on Heparin on [**2103-3-7**] and remained stable neurologically on IV Heparin. He was started on po Coumadin [**2103-3-8**]. He was transferred to the regular floor on [**2103-3-7**] in stable and neurologic condition. His left upper extremity weakness improved. He was out of bed ambulating, tolerating regular diet, voiding spontaneously and became therapeutic on his Coumadin on [**2103-3-14**]. He was discharged home in stable condition with follow-up with Dr. [**First Name (STitle) **] in one month time. His incision was clean, dry and intact at the time of discharge and his vital signs remained stable. He will follow-up with his primary care physician for his Coumadin treatment. [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D. [**MD Number(1) 343**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2103-3-14**] 11:04 T: [**2103-3-14**] 11:16 JOB#: [**Job Number 38027**] Admission Date: [**2103-2-23**] Discharge Date: [**2103-3-18**] Date of Birth: [**2055-5-8**] Sex: M Service: NEUROSURGERY CHIEF COMPLAINT: Syncope and question of seizure. HISTORY OF PRESENT ILLNESS: This is a 47 year old gentleman with sudden loss of consciousness the morning of admission. The wife witnessed "shaking and frothing" activity for confusion but had full recall from the time of awakening. There was no memory of the fall or syncope. The patient never had symptoms before like this. The patient felt woozy and light-headed but was not confused or disoriented. There was full sensory and motor function intact by the time the patient arrived to the Emergency Department The patient had a CT at an outside hospital prior to transfer to the [**Hospital1 69**] Emergency Department that showed a "colloid cyst at the take-off of the third ventricle". The patient was transferred to [**Hospital1 346**] for further workup. PAST MEDICAL HISTORY: Significant for: 1. Hypercholesterolemia. 2. Mitral valve replacement, question rheumatic heart disease, in [**2097**]. The patient is chronically on Coumadin. 3. Status post ablation and cardioversion. 4. Hypertension. 5. Gastroesophageal reflux disease. 6. Congestive heart failure. 7. Dressler's syndrome. 8. Hepatitis C. MEDICATIONS ON ADMISSION: 1. Toprol XL 200 mg p.o. q.d. 2. Maxzide 25 mg p.o. q.d. 3. Colchicine 0.6 mg p.o. q.d. 4. Zocor 40 mg p.o. q.d. 5. Nexium 40 mg p.o. q.d. 6. Coumadin 9 mg five days a week and 10 mg on the weekends. 7. Oxycontin 40 mg p.o. q.d. 8. Combivent two puffs b.i.d. ALLERGIES: No known drug allergies. PHYSICAL EXAMINATION: The patient is in no apparent distress with stable vital signs. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. He had bilateral upper extremity and lower extremity strength and sensation, [**4-22**] and equal. His reflexes were 2+ bilaterally equally and he ambulated normally. LABORATORY DATA: Admission laboratories showed an INR of 4.1 with a prothrombin time of 25 and partial thromboplastin time was 33. His sodium was 141, potassium 3.8, chloride 104, bicarbonate 27.6, blood urea nitrogen 11 and creatinine 0.9 with a glucose of 99. He had a CT of the head at the outside hospital that showed a colloid cyst that was approximately 1.0 centimeter by 1.0 centimeter at the take-off of the third ventricle. There was no hydrocephalus and no intracranial bleed. HOSPITAL COURSE: The patient is admitted on [**2103-2-23**], for workup of this colloid cyst and to receive magnetic resonance scan. He was started on a Heparin drip and he was taken off his Coumadin to continue him on anticoagulation for a operative correction of this lesion. The patient was admitted to the service and was seen by cardiology during his preoperative evaluation and it was recommended that he should have a INR of 2.5 to 3.0. He was cleared for surgery, and underwent excision of his mass through a transcollossal approach on [**2103-3-1**]. He was admitted to the Surgical Intensive Care Unit postoperatively and was doing quite well. He was weaned off Nipride for blood pressure control and continued to be stable neurologically. He was transferred to the floor on postoperative day two. He had a slight difficulty in orientation and verbal speech but this continued to improve. He had some left arm neglect and weakness in the Intensive Care Unit and continued on his Heparin drip for anticoagulation. He was stable on the floor and continued to have some emotional instability. There was CT of the head that showed a right frontal lobe bleed/infarct and a repeat CT in the Intensive Care Unit on [**2103-3-4**], showed slight increase in this right frontal lobe lesion but no symptomatic changes. With stabilized scan, the patient actually went to the floor on [**2103-3-6**]. He continued to be stable on the floor although on the evening of [**2103-3-8**], the patient had an episode of confusion and agitation which required Ativan and Haldol overnight to stabilize him. He continued to have episodes of confusion and anxiety overnight but this was sufficiently treated with p.r.n. Ativan. He continued to improve neurologically and continued to be in-house while his INR was attempted to be raised to the goal therapeutic level of 2.0 to 2.5. He was on Coumadin doses of 7.5 mg originally but was raised to Coumadin doses of 10 mg to get his INR greater than 2.0. On [**2103-3-18**], his INR was in fact 2.0 and it was decided that he could be discharged with strict follow-up of his INR to keep the goal between 2.0 and 2.5. He will be discharged home in stable condition. DISCHARGE DIAGNOSIS: Status post resection of colloid cyst, third ventricle. FOLLOW-UP: He will follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital 341**] Clinic in approximately two weeks. He will continue on his Coumadin regimen at 7.5 mg p.o. q.d. with necessary adjustments for a goal INR of 2.0 to 2.5. MEDICATIONS ON ADMISSION: 1. Toprol XL 200 mg p.o. q.d. 2. Maxzide 25 mg p.o. q.d. 3. Colchicine 0.6 mg p.o. q.d. 4. Zocor 40 mg p.o. q.d. 5. Nexium 40 mg p.o. q.d. 6. Coumadin 7.5 mg p.o. q.d. 7. Oxycontin 40 mg p.o. q.d. 8. Combivent two puffs b.i.d. 9. Ativan 1 mg p.o. q8hours p.r.n. [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D. [**MD Number(1) 343**] Dictated By:[**Last Name (NamePattern1) 9800**] MEDQUIST36 D: [**2103-3-18**] 08:19 T: [**2103-3-18**] 08:51 JOB#: [**Job Number 38028**]

742,997,401,272,530,300,V433

{'Other specified congenital anomalies of brain,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Anxiety state, unspecified,Heart valve replaced by other means'}

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: Syncope and question of seizure. PRESENT ILLNESS: The patient is a 47-year-old man with a sudden onset of loss of consciousness on the morning of admission. His wife witnessed shaking and frothing activities for about 2-3 minutes. The patient awoke with memory of the fall or syncope and never had signs or symptoms before like this. Now feels woozy, lightheaded but not confused or disoriented. Full sensory, motor intact. Now ambulating without difficulty. CT at the outside hospital shows a colloid cyst of the third ventricle. He was transferred to [**Hospital1 69**] for further management. PAST MEDICAL HISTORY: Includes hypercholesterolemia, MVR in [**2097**] on Coumadin, status post ablation and cardioversion, hypertension, GERD, CHF, Dressler's syndrome and hepatitis C. MEDICAL HISTORY: Includes hypercholesterolemia, MVR in [**2097**] on Coumadin, status post ablation and cardioversion, hypertension, GERD, CHF, Dressler's syndrome and hepatitis C. MEDICATION ON ADMISSION: 1. Toprol XL 200 mg p.o. q.d. 2. Maxzide 25 mg p.o. q.d. 3. Colchicine 0.6 mg p.o. q.d. 4. Zocor 40 mg p.o. q.d. 5. Nexium 40 mg p.o. q.d. 6. Coumadin 9 mg five days a week and 10 mg on the weekends. 7. Oxycontin 40 mg p.o. q.d. 8. Combivent two puffs b.i.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other specified congenital anomalies of brain,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Anxiety state, unspecified,Heart valve replaced by other means'}

CHIEF COMPLAINT: Shock PRESENT ILLNESS: 71 year old female with a history of PVD s/p multiple interventions, multiple recent hospitalizations (see summary below) most recently with a liver abscesss presents with hypotension. She had been discharged [**2-10**] feeling mildly fatigued but able to ambulate around her home. Over the next several days, she became progressively more fatigued with nausea and vomiting. On the morning of admission, she was unable to get up off her chair -> [**Hospital1 18**] [**Location (un) **] and subsequently transferred to [**Hospital1 18**]. MEDICAL HISTORY: HTN Hyperlipidemia Severe PVD: s/p multiple stents to iliac and femoral arteries Renal artery stenosis Rheumatoid Arthritis Asthma Osteoporosis Spinal stenosis, s/p cervical and lumbar laminectomies S/p appendectomy MEDICATION ON ADMISSION: Medications at last DC [**2-11**]: --Hydroxychloroquine 200 mg [**Hospital1 **] --Simvastatin 20 mg --Lasix 40 mg Tablet PO Q MWF. --Folic Acid 1 mg daily --Docusate Sodium 100 mg [**Hospital1 **] --Fluticasone-Salmeterol 250-50 mcg/Dose Disk [**Hospital1 **] --Prilosec OTC 20 mg Tablet qday --FOSAMAX 70 mg PO once a week. --Xopenex 0.63 mg/3 mL qday (Also was on ASA 81mg daily and Plavix 75mg daily prior to [**Month (only) 958**] admission, these meds have been held since IR procedure on [**2147-2-7**]) PRN: --Loperamide 2 mg QID prn --Acetaminophen prn --Compazine 10 mg prn. --Darvocet-N 50 50-325 mg prn ALLERGIES: Norvasc / Sulfa (Sulfonamides) / Latex / Codeine / Ace Inhibitors PHYSICAL EXAM: Tc 96.9 BP 98/63 on 0.12 levophed. HR 126, RR 20, sats 94% on RA. CVP 16. SvO2: pending I/O: 4 L /80 + unrecorded from the ED. Gen: Pleasant, elderly female in NAD. Appears tachypnic. HEENT: Sclera anicteric, MMdry. CV: tachy, refular rhythm, normal S1 and S2. No m/r/g. L subclavian in place. Lungs: Clear on left, crackles at R and L base ABD: Soft, ND, NT, neg [**Doctor Last Name 515**] sign. No rebound or guarding. No hepatomegaly. + BS. EXT: No c/c/e. Pulses not palpable bilaterally DP/PT but are dopplerable FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Smoked 1 ppd x 30 yrs, quit 10 yr prior. No alcohol. Used to work as a LPN in a nursing home. Now retired. Lives with husband in [**Name (NI) 620**]. Has 3 adult children and 3 grandchildren.

Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Other and unspecified coagulation defects,Other primary cardiomyopathies,Acute and subacute necrosis of liver,Acidosis,Diastolic heart failure, unspecified,Unspecified protein-calorie malnutrition,Severe sepsis,Vascular disorders of kidney

Septicemia NOS,Septic shock,Acute respiratry failure,Acute kidney failure NOS,Coagulat defect NEC/NOS,Prim cardiomyopathy NEC,Acute necrosis of liver,Acidosis,Diastolc hrt failure NOS,Protein-cal malnutr NOS,Severe sepsis,Renal vascular disorder

Admission Date: [**2147-2-13**] Discharge Date: [**2147-2-27**] Date of Birth: [**2075-4-18**] Sex: F Service: MEDICINE Allergies: Norvasc / Sulfa (Sulfonamides) / Latex / Codeine / Ace Inhibitors Attending:[**First Name3 (LF) 2932**] Chief Complaint: Shock Major Surgical or Invasive Procedure: R subclavian central venous line R radial arterial line R femoral arterial line History of Present Illness: 71 year old female with a history of PVD s/p multiple interventions, multiple recent hospitalizations (see summary below) most recently with a liver abscesss presents with hypotension. She had been discharged [**2-10**] feeling mildly fatigued but able to ambulate around her home. Over the next several days, she became progressively more fatigued with nausea and vomiting. On the morning of admission, she was unable to get up off her chair -> [**Hospital1 18**] [**Location (un) **] and subsequently transferred to [**Hospital1 18**]. In the ED, her vitals were T 99.3, P 123, BP 86/p. 97 3L. She was started on levophed. Left CVL placed under sterile conditions. She underwent a RUQ US and CT abdomen and received vancomycin and levofloxacin. She was then admitted to the medical ICU for further management. At time of admission, she noted mild shortness of breath. She denied CP, HA, nausea, abdominal pain, or urinary symptoms. Of note, the patient has had several recent hospitalizations, which are sumarized below: [**1-11**] - [**1-19**]: Admission at NEBH for pneumonia with pleuritis and severe pleurodynia. She had an abdominal US at that time which showed a normal liver. [**2-3**] - [**2-10**]: Admitted to [**Hospital1 18**] after [**Doctor First Name **] outpatient CT scan obtained to evaluate new RUQ pain revealeda 6.3 cm subcapsular liver abscess. IR performed a CT-guided drainage (sterile culture). Urine culture grew VRE (not treated). She was discharged on levofloxacin and metronidazole. [**2-10**]: CT abdmoen showed decrease of the abscess and pigtail was removed (no longer draining). Past Medical History: HTN Hyperlipidemia Severe PVD: s/p multiple stents to iliac and femoral arteries Renal artery stenosis Rheumatoid Arthritis Asthma Osteoporosis Spinal stenosis, s/p cervical and lumbar laminectomies S/p appendectomy Social History: Smoked 1 ppd x 30 yrs, quit 10 yr prior. No alcohol. Used to work as a LPN in a nursing home. Now retired. Lives with husband in [**Name (NI) 620**]. Has 3 adult children and 3 grandchildren. Family History: Non-contributory. Physical Exam: Tc 96.9 BP 98/63 on 0.12 levophed. HR 126, RR 20, sats 94% on RA. CVP 16. SvO2: pending I/O: 4 L /80 + unrecorded from the ED. Gen: Pleasant, elderly female in NAD. Appears tachypnic. HEENT: Sclera anicteric, MMdry. CV: tachy, refular rhythm, normal S1 and S2. No m/r/g. L subclavian in place. Lungs: Clear on left, crackles at R and L base ABD: Soft, ND, NT, neg [**Doctor Last Name 515**] sign. No rebound or guarding. No hepatomegaly. + BS. EXT: No c/c/e. Pulses not palpable bilaterally DP/PT but are dopplerable Pertinent Results: Admission labs: [**2147-2-13**] GLUCOSE-85 UREA N-41* CREAT-1.2* SODIUM-132* POTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-18* ANION GAP-15 ALBUMIN-2.5* CALCIUM-7.3* PHOSPHATE-2.4* MAGNESIUM-1.8 WBC-20.9*# RBC-3.11* HGB-9.7* HCT-28.8* MCV-93 MCH-31.1 MCHC-33.6 RDW-16.5* PLT COUNT-208 NEUTS-92.9* BANDS-0 LYMPHS-3.5* MONOS-3.2 EOS-0.2 BASOS-0.1 PT-18.1* PTT-33.0 INR(PT)-1.7* ALT(SGPT)-44* AST(SGOT)-43* CK(CPK)-74 ALK PHOS-95 AMYLASE-17 TOT BILI-0.6 CK-MB-3 cTropnT-0.11* CORTISOL-55.8* LACTATE-1.5 U/A: [**Year/Month/Day 3143**]-LG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-TR RBC-[**10-3**]* WBC-21-50* BACTERIA-MOD YEAST-NONE EPI-0-2 Radiology Cxr on admission [**2147-2-13**]: The newly inserted right subclavian CV line has its tip within the right atrium. The heart is mildly enlarged. Mild pulmonary vascular prominence is noted. Small bilateral pleural effusions are unchanged. No evidence of pneumothorax or consolidation is noted. Dense opacification at the right lung base most likely represents a reactive subpulmonic effusion secondary to hepatic fluid collection. CT Abd/Pelvis [**2147-2-14**]: Interval removal of pigtail catheter with only small residual rim of fluid noted in the perihepatic space under the diaphragm by the dome of the liver. Findings highly consistent with infarction of the right kidney. The edematous kidney with adjacent perinephric stranding are highly suggestive of relatively acute onset. Diagnostic considerations include arterial dissection/thrombosis versus renal vein thrombosis. No bowel pathology with no free intraperitoneal fluid or air noted. Echo [**2147-2-14**]: The left ventricular cavity size is top normal/borderline dilated. There is severe global left ventricular hypokinesis (ejection fraction 20 percent). No masses or thrombi are seen in the left ventricle. Right ventricular systolic function appears depressed. Mild (1+) aortic regurgitation is seen. Moderate (2+) mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. Echo [**2147-2-16**]: Compared with the prior study of [**2147-2-14**], estimated pulmonary artery sysotlic pressure is now higher and mitral regurgitation is now more prominent. Left ventricular systolic function appears similar. Renal U/S [**2147-2-16**]: The right kidney measures 10.1 cm. Several attempts at Doppler evaluation of the right kidney demonstrate only venous flow. No arterial waveforms could be obtained. The left kidney measures 11.4 cm. Doppler evaluation of the left kidney was extremely limited as well, due to the patient's inability to hold her breath and difficulty with positioning. Venous flow is noted on the left. Cxr [**2147-2-20**]: Mild pulmonary edema continues to improve and bilateral pleural effusion, moderate on the right and small on the left are also slightly smaller. New nasogastric feeding tube with a wire stylet in place is looped in the stomach. Tip of the right subclavian line projects over the superior cavoatrial junction. Mild cardiomegaly, decreased since [**2-17**]. Brief Hospital Course: 71 year old female with recent UTI and liver abscess presents with hypotension. The patient was admitted to the medical ICU on broad-spectrum antibiotics/pressors with a concern for septic shock, given multiple recent infections. The source of infection was unclear ([**Name2 (NI) **] cultures negative, urine culture with only 10-100k yeast, chest X-ray without clear infiltrate, nearly completely resolved liver abscess) On [**2147-2-14**], she developed respiratory distress requiring intubation (attributed to flash pulmonary edema) and SVT requiring cardioversion X 2 (unsuccessful). An echocardiogram was obtained, which revealed EF 20% with global hypokinesis, suggesting that cardiogenic shock may have been contributing to her presenting hypotension, possibly related to known severe acidosis. Given negative CKMB fraction (TnT peak 0.39), ACS was felt to be unlikely. The patient subsequently developed acute renal failure (creatinine rising to 6.4), which was felt to be secondary to ischemic ATN (muddy brown casts on urinary sediment). The renal consult team was consulted, but, given the patient's multiple comorbidities, poor prognosis for renal recovery, and her desire to avoid long-term life support, dialysis was not pursued. The patient's mental status gradually worsened and she became progressively coagulopathic (INR 1.7-1.9), possibly related to shock liver. With diuresis, the patient's pulmonary status improved and she was extubated in the ICU. A family meeting was held, attended by the critical care and renal consult teams. Given the poor prognosis regarding recovery of renal function as outlined by the renal team, the pt's wishes not to be on long term dialysis, her multiple comorbidities, and her rapidly declining clinical status, the patient's husband and daughter decided to pursue comfort-oriented care. She was transferred to the general medical floor on a morphine drip and passed away on [**2147-2-27**] at 11:10 a.m. Medications on Admission: Medications at last DC [**2-11**]: --Hydroxychloroquine 200 mg [**Hospital1 **] --Simvastatin 20 mg --Lasix 40 mg Tablet PO Q MWF. --Folic Acid 1 mg daily --Docusate Sodium 100 mg [**Hospital1 **] --Fluticasone-Salmeterol 250-50 mcg/Dose Disk [**Hospital1 **] --Prilosec OTC 20 mg Tablet qday --FOSAMAX 70 mg PO once a week. --Xopenex 0.63 mg/3 mL qday (Also was on ASA 81mg daily and Plavix 75mg daily prior to [**Month (only) 958**] admission, these meds have been held since IR procedure on [**2147-2-7**]) PRN: --Loperamide 2 mg QID prn --Acetaminophen prn --Compazine 10 mg prn. --Darvocet-N 50 50-325 mg prn Discharge Disposition: Expired Discharge Diagnosis: Primary: sepsis Secondary: cardiomyopathy, acute renal failure, coagulopathy Discharge Condition: Deceased Discharge Instructions: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**] Completed by:[**2147-2-27**]

038,785,518,584,286,425,570,276,428,263,995,593

{'Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Other and unspecified coagulation defects,Other primary cardiomyopathies,Acute and subacute necrosis of liver,Acidosis,Diastolic heart failure, unspecified,Unspecified protein-calorie malnutrition,Severe sepsis,Vascular disorders of kidney'}

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: Shock PRESENT ILLNESS: 71 year old female with a history of PVD s/p multiple interventions, multiple recent hospitalizations (see summary below) most recently with a liver abscesss presents with hypotension. She had been discharged [**2-10**] feeling mildly fatigued but able to ambulate around her home. Over the next several days, she became progressively more fatigued with nausea and vomiting. On the morning of admission, she was unable to get up off her chair -> [**Hospital1 18**] [**Location (un) **] and subsequently transferred to [**Hospital1 18**]. MEDICAL HISTORY: HTN Hyperlipidemia Severe PVD: s/p multiple stents to iliac and femoral arteries Renal artery stenosis Rheumatoid Arthritis Asthma Osteoporosis Spinal stenosis, s/p cervical and lumbar laminectomies S/p appendectomy MEDICATION ON ADMISSION: Medications at last DC [**2-11**]: --Hydroxychloroquine 200 mg [**Hospital1 **] --Simvastatin 20 mg --Lasix 40 mg Tablet PO Q MWF. --Folic Acid 1 mg daily --Docusate Sodium 100 mg [**Hospital1 **] --Fluticasone-Salmeterol 250-50 mcg/Dose Disk [**Hospital1 **] --Prilosec OTC 20 mg Tablet qday --FOSAMAX 70 mg PO once a week. --Xopenex 0.63 mg/3 mL qday (Also was on ASA 81mg daily and Plavix 75mg daily prior to [**Month (only) 958**] admission, these meds have been held since IR procedure on [**2147-2-7**]) PRN: --Loperamide 2 mg QID prn --Acetaminophen prn --Compazine 10 mg prn. --Darvocet-N 50 50-325 mg prn ALLERGIES: Norvasc / Sulfa (Sulfonamides) / Latex / Codeine / Ace Inhibitors PHYSICAL EXAM: Tc 96.9 BP 98/63 on 0.12 levophed. HR 126, RR 20, sats 94% on RA. CVP 16. SvO2: pending I/O: 4 L /80 + unrecorded from the ED. Gen: Pleasant, elderly female in NAD. Appears tachypnic. HEENT: Sclera anicteric, MMdry. CV: tachy, refular rhythm, normal S1 and S2. No m/r/g. L subclavian in place. Lungs: Clear on left, crackles at R and L base ABD: Soft, ND, NT, neg [**Doctor Last Name 515**] sign. No rebound or guarding. No hepatomegaly. + BS. EXT: No c/c/e. Pulses not palpable bilaterally DP/PT but are dopplerable FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Smoked 1 ppd x 30 yrs, quit 10 yr prior. No alcohol. Used to work as a LPN in a nursing home. Now retired. Lives with husband in [**Name (NI) 620**]. Has 3 adult children and 3 grandchildren. ### Response: {'Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Other and unspecified coagulation defects,Other primary cardiomyopathies,Acute and subacute necrosis of liver,Acidosis,Diastolic heart failure, unspecified,Unspecified protein-calorie malnutrition,Severe sepsis,Vascular disorders of kidney'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 22-year-old male who reportedly rolled down a [**Doctor Last Name **] in a barrel with moving all 4 extremities at the scene. However, became combated and was intubated and sedated at an outside hospital. CAT scan of his head showed a left convexity lens-shaped hemorrhage deep to the skull fracture, which had increased in size from his outside hospital film. There is subarachnoid and intraparenchymal hemorrhage surrounding edema of the right anterior cranial fossa, which was unchanged from his outside films. There was a third extraaxial hemorrhage located laterally along the right convexity, which was unchanged from his outside films. He also had a left occipital fracture at the base of his skull. A T-spine CAT scan was negative for any thoracic fractures. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cervicalgia,Other accidental fall from one level to another

Cl skl base fx/menin hem,Cervicalgia,Fall-1 level to oth NEC

Admission Date: [**2179-10-7**] Discharge Date: [**2179-10-13**] Date of Birth: [**2157-9-29**] Sex: M Service: MED HISTORY OF PRESENT ILLNESS: This is a 22-year-old male who reportedly rolled down a [**Doctor Last Name **] in a barrel with moving all 4 extremities at the scene. However, became combated and was intubated and sedated at an outside hospital. CAT scan of his head showed a left convexity lens-shaped hemorrhage deep to the skull fracture, which had increased in size from his outside hospital film. There is subarachnoid and intraparenchymal hemorrhage surrounding edema of the right anterior cranial fossa, which was unchanged from his outside films. There was a third extraaxial hemorrhage located laterally along the right convexity, which was unchanged from his outside films. He also had a left occipital fracture at the base of his skull. A T-spine CAT scan was negative for any thoracic fractures. HOSPITAL COURSE: The patient was admitted to the Trauma Intensive Care Unit where he was monitored with serial CAT scans, which did not show any additional increase in size of his hemorrhages. He was placed on Decadron, Dilantin, and mannitol. He received one dose of mannitol. He was kept sedated and intubated for the first 24 hours. In the evening of [**10-7**], he had a repeat CAT scan, which did not show any increased hemorrhage on his CAT scan. He underwent a diagnostic cerebral angiogram, which showed no evidence of carotid or vertebral injury or any problems with his middle meningeal branch. During angiogram, there was a question of expanding epidural. He went down for a stat head CT, which showed again a lens-shaped hemorrhage along the left inner convexity, which measured 9 mm in its greatest width, which was not significantly changed compared to the prior study. He returned back to the Intensive Care Unit where he remained neurologically intact and he was extubated on the morning of [**2178-10-7**]. His fluid balance was kept euvolemic to negative. His pupils were 3 to 2. He was moving all extremities spontaneously. His blood pressure was kept in the 120 to 130 range. He had a repeat head CT on [**10-8**], which showed no change in multiple foci of hemorrhage within the brain. On [**10-9**], he was transferred to the Step Down Surgical Unit where he was continued with q.1 hour nerve checks and close monitoring. He remained awake, alert, had difficulty at times with orientation and sometimes required one-to-one supervision. On [**10-11**], he was seen by speech therapy, who found him stage 2, who cleared him for regular diet. He was then transferred to the surgical floor where he continued to make good progress. He was seen by physical therapy who felt that he would need some assistance with mobility and balance training. However, he ambulated with minimal difficulty. He was reassessed on [**10-13**], and they felt he was safe to be discharged home. Also on [**10-13**], he had flexion-extension films, which showed no cervical or spinal instability. However, he had complained of some neck pain the 2 days prior to having these films done and he was out of the 72 hour window to receive MRI assessment for ligamentous injury. So, it was recommended that he maintain in a cervical collar for the next 2 weeks' and follow-up again with flexion-extension films. DISCHARGE DIAGNOSES: Closed head injury. Epidural hematoma. Multiple cerebral contusions. Occipital fracture. DISCHARGE INSTRUCTIONS: Keep his hard collar on at all times. Continue on Dilantin. No heavy lifting greater than 10 pounds. No driving until he follows up. He should call Dr.[**Name (NI) 9224**] office if he develops headache which is not relieved by medication or dizziness. He should have his Dilantin level checked by his primary care physician. [**Name10 (NameIs) **] should follow-up with Dr. [**Last Name (STitle) 1132**] on [**10-29**] with flexion-extension films; those are done at [**Hospital Ward Name 23**] at 11 o'clock in the morning, and then follow-up with a CAT scan at 11:30, and then follow-up with Dr. [**Last Name (STitle) 1132**] at 12:30. FOLLOWUP MEDICATIONS: 1. Dilantin 200 mg 1 p.o. b.i.d. 2. Tylenol as needed. 3. Percocet 1 to 2 tablets p.o. q. 4 to 6 hours. On his discharge day of [**10-13**], his Dilantin level was 1.0. He was loaded with 1 g of Dilantin and his medication was increased to 200 mg b.i.d., which he should follow-up with a primary care physician to have his Dilantin level checked. [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**] Dictated By:[**Last Name (NamePattern1) 8633**] MEDQUIST36 D: [**2179-10-13**] 15:47:32 T: [**2179-10-14**] 04:38:34 Job#: [**Job Number 58193**]

801,723,E884

{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cervicalgia,Other accidental fall from one level to another'}

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 22-year-old male who reportedly rolled down a [**Doctor Last Name **] in a barrel with moving all 4 extremities at the scene. However, became combated and was intubated and sedated at an outside hospital. CAT scan of his head showed a left convexity lens-shaped hemorrhage deep to the skull fracture, which had increased in size from his outside hospital film. There is subarachnoid and intraparenchymal hemorrhage surrounding edema of the right anterior cranial fossa, which was unchanged from his outside films. There was a third extraaxial hemorrhage located laterally along the right convexity, which was unchanged from his outside films. He also had a left occipital fracture at the base of his skull. A T-spine CAT scan was negative for any thoracic fractures. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cervicalgia,Other accidental fall from one level to another'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a [**Age over 90 **] year old female who was admitted to [**Hospital3 3583**] on [**2110-12-20**] after having a syncopal episode at home. Workup revealed sinus dysfunction with long pauses, longest documented at eight seconds. MEDICAL HISTORY: 1. Syncope. 2. Seizure disorder. 3. Labile hypertension. 4. Hyponatremia. 5. Noninsulin dependent diabetes mellitus, diet controlled. 6. Hypothyroidism. 7. Breast cancer. MEDICATION ON ADMISSION: Aspirin, Tegretol, Synthroid, Norvasc 5 mg p.o.q.d., hydrochlorothiazide 25 mg p.o.q.d., and potassium chloride. ALLERGIES: ACE inhibitors, Levoxyl, Tenex. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Unspecified disease of pericardium,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac pacemaker in situ,Other convulsions,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism

Pericardial disease NOS,Accidental op laceration,Status cardiac pacemaker,Convulsions NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS

Admission Date: [**2110-12-23**] Discharge Date: [**2110-12-29**] Service: CT Surgery HISTORY OF PRESENT ILLNESS: The patient is a [**Age over 90 **] year old female who was admitted to [**Hospital3 3583**] on [**2110-12-20**] after having a syncopal episode at home. Workup revealed sinus dysfunction with long pauses, longest documented at eight seconds. A permanent pacemaker was placed on [**2110-12-22**]. A post procedure CT scan revealed a pneumothorax on the left side and, as a result, a chest tube was placed. The patient was noted to have desaturation and hypotension. An echocardiogram revealed moderate pericardial effusion and the patient was therefore transferred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] on [**2110-12-23**]. PAST MEDICAL HISTORY: 1. Syncope. 2. Seizure disorder. 3. Labile hypertension. 4. Hyponatremia. 5. Noninsulin dependent diabetes mellitus, diet controlled. 6. Hypothyroidism. 7. Breast cancer. MEDICATIONS ON ADMISSION: Aspirin, Tegretol, Synthroid, Norvasc 5 mg p.o.q.d., hydrochlorothiazide 25 mg p.o.q.d., and potassium chloride. ALLERGIES: ACE inhibitors, Levoxyl, Tenex. PHYSICAL EXAMINATION: On physical examination, the patient had a heart rate of 67, ventricular paced, with remainder of vital signs stable. Chest: Clear to auscultation bilaterally. Cardiovascular: Regular rate and rhythm. Abdomen: Soft, nontender, nondistended. Extremities: 1 to 2+ peripheral edema. HOSPITAL COURSE: The patient was taken to the Operating Room emergently on [**2110-12-23**], where she had a mediastinal exploration and large blood clot removal. She was transferred to the Intensive Care Unit postoperatively, where she was rapidly extubated. On postoperative day number one, the patient had a mild drop in the hematocrit and received a total of three units of packed red blood cells. On postoperative day number two, chest tube output was minimal and the chest tubes were removed. A post chest tube pull chest x-ray revealed no pneumothorax and minimal bilateral pleural effusions. On postoperative day number two, the patient was transferred to the floor in stable condition. The electrophysiology service team was involved in the patient's care during this admission. Her pacemaker was interrogated on [**2118-12-24**] and 11, [**2110**]. Each time, interrogation revealed that the pacemaker was functioning well. On the floor, the patient had minimally elevated blood sugars, from 120 to 200. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3208**] consult was obtained and they recommended starting Glucophage XR 500 mg daily. The patient was tolerating a regular diet and was ambulating at a minimal level. CONDITION ON DISCHARGE: Stable. DISCHARGE MEDICATIONS: Norvasc 5 mg p.o.b.i.d. Percocet one p.o.q.4-6h.p.r.n. Colace 100 mg p.o.b.i.d. Tegretol 400 mg p.o.b.i.d. Synthroid 0.075 mcg p.o.q.d. Caltrate 1,200 mg p.o.q.d. Aspirin 81 mg p.o.q.d. Hydrochlorothiazide 12.5 mg p.o.q.d. Potassium chloride 10 mEq p.o.q.d. Glucotrol XL 500 mg p.o.q.d. DISCHARGE STATUS: It was highly encouraged that the patient go to a rehabilitation facility, however, she refused and will be going home. She has a son and granddaughter who will be actively involved with her care. They were made aware that we recommended rehabilitation for the disposition of this patient. The patient will have visiting nurses for blood sugar checks, wound checks and aid with ambulation. FOLLOW-UP: The patient will follow up with her primary care physician or cardiologist in three weeks. The patient will follow up with Dr. [**Last Name (STitle) 70**] in four weeks. DISCHARGE DIAGNOSES: 1. Pericardial tamponade, status post mediastinal exploration and clot evacuation. 2. Noninsulin dependent diabetes mellitus. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Name8 (MD) 1308**] MEDQUIST36 D: [**2110-12-29**] 12:37 T: [**2110-12-29**] 12:35 JOB#: [**Job Number 16510**]

423,998,V450,780,401,250,244

{'Unspecified disease of pericardium,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac pacemaker in situ,Other convulsions,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: The patient is a [**Age over 90 **] year old female who was admitted to [**Hospital3 3583**] on [**2110-12-20**] after having a syncopal episode at home. Workup revealed sinus dysfunction with long pauses, longest documented at eight seconds. MEDICAL HISTORY: 1. Syncope. 2. Seizure disorder. 3. Labile hypertension. 4. Hyponatremia. 5. Noninsulin dependent diabetes mellitus, diet controlled. 6. Hypothyroidism. 7. Breast cancer. MEDICATION ON ADMISSION: Aspirin, Tegretol, Synthroid, Norvasc 5 mg p.o.q.d., hydrochlorothiazide 25 mg p.o.q.d., and potassium chloride. ALLERGIES: ACE inhibitors, Levoxyl, Tenex. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Unspecified disease of pericardium,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac pacemaker in situ,Other convulsions,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}

CHIEF COMPLAINT: Bright red blood loss per rectum PRESENT ILLNESS: Ms. [**Known lastname 5903**] is a 79 yo female with h/o CAD, PVD, DM2, CKD and diverticulosis, who presented on [**2116-6-1**] with BRBPR on multiple BMs starting the day of arrival. She had no cramping, pain, nausea, or other symptoms at the time. VS were stable in the ED, and Hct was noted to be dropping from 35 recently to 30 and then to 27 with continued bloody BMs. MEDICAL HISTORY: - CAD s/p CABG [**2107**] - PVD - CKD, stage III - HTN - DM2 complicated by retinopathy, nephropathy - diverticulosis; pt denied prior episodes of GIB - s/p toe amputation MEDICATION ON ADMISSION: - aspirin 81 daily - lisinopril 40 daily - simvastatin 80 daily - metoprolol 50 twice daily - HCTZ 12.5 daily (?) - insulin lantus - cosopt eye gtt - xalatan eye gtt - naproxen prn ([**12-25**]/month) - ca / vit d ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS on arrival to the floor: 98.4, 159/83, 82, 16, 98% RA General: Pleasant, conversant, overweight female in NAD Heent: MMM. Partial dentures. Neck: JVP flat. Cardiac: rate regular, soft II/VI systolic murmur at apex Lungs: : CTA b/l, No wheeze. Abdomen: obese, soft, + BS, NTND, no HSM. Rectal deferred Enxtremities: no edema 2+ R DP pulse, 1+ L DP pulse. SVG harvest scar left leg, s/p hallux amputation Neuro: AAO x 3, appropriate affect, CN grossly intact. FAMILY HISTORY: Diabetes mellitus-- mother, brother, and sister [**Name (NI) 5905**] mother, father. There is no history of kidney disease. SOCIAL HISTORY: She is a retired administrator at [**Street Address(1) 5904**] Inn. She works out at a senior gym three times a week. She does not smoke cigarettes, drink alcohol, or use any recreational drugs. Her diet does contain a moderate amount of salt.

Diverticulosis of colon (without mention of hemorrhage),Acute kidney failure, unspecified,Urinary tract infection, site not specified,Subendocardial infarction, initial episode of care,Benign neoplasm of colon,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Internal hemorrhoids without mention of complication,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Leukocytosis, unspecified,Anemia, unspecified,Pure hypercholesterolemia,Aortocoronary bypass status

Dvrtclo colon w/o hmrhg,Acute kidney failure NOS,Urin tract infection NOS,Subendo infarct, initial,Benign neoplasm lg bowel,Cor ath unsp vsl ntv/gft,Hypertension NOS,Int hemorrhoid w/o compl,DMII renl nt st uncntrld,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Leukocytosis NOS,Anemia NOS,Pure hypercholesterolem,Aortocoronary bypass

Admission Date: [**2116-6-1**] Discharge Date: [**2116-6-10**] Date of Birth: [**2037-5-2**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 689**] Chief Complaint: Bright red blood loss per rectum Major Surgical or Invasive Procedure: Colonoscopy History of Present Illness: Ms. [**Known lastname 5903**] is a 79 yo female with h/o CAD, PVD, DM2, CKD and diverticulosis, who presented on [**2116-6-1**] with BRBPR on multiple BMs starting the day of arrival. She had no cramping, pain, nausea, or other symptoms at the time. VS were stable in the ED, and Hct was noted to be dropping from 35 recently to 30 and then to 27 with continued bloody BMs. ROS was negative for fevers, chills, unintentional weight changes, orthopnea, chest pain, dyspnea, abdominal pain, easing bruising, dysuria, and rashes. Past Medical History: - CAD s/p CABG [**2107**] - PVD - CKD, stage III - HTN - DM2 complicated by retinopathy, nephropathy - diverticulosis; pt denied prior episodes of GIB - s/p toe amputation Social History: She is a retired administrator at [**Street Address(1) 5904**] Inn. She works out at a senior gym three times a week. She does not smoke cigarettes, drink alcohol, or use any recreational drugs. Her diet does contain a moderate amount of salt. Family History: Diabetes mellitus-- mother, brother, and sister [**Name (NI) 5905**] mother, father. There is no history of kidney disease. Physical Exam: ADMISSION PHYSICAL EXAM: VS on arrival to the floor: 98.4, 159/83, 82, 16, 98% RA General: Pleasant, conversant, overweight female in NAD Heent: MMM. Partial dentures. Neck: JVP flat. Cardiac: rate regular, soft II/VI systolic murmur at apex Lungs: : CTA b/l, No wheeze. Abdomen: obese, soft, + BS, NTND, no HSM. Rectal deferred Enxtremities: no edema 2+ R DP pulse, 1+ L DP pulse. SVG harvest scar left leg, s/p hallux amputation Neuro: AAO x 3, appropriate affect, CN grossly intact. Pertinent Results: ADMISSION LABS: [**2116-6-1**] 06:00PM BLOOD WBC-12.4* RBC-3.46* Hgb-10.1* Hct-30.1* MCV-87 MCH-29.2 MCHC-33.6 RDW-14.5 Plt Ct-307 [**2116-6-2**] 01:52AM BLOOD Neuts-79.0* Lymphs-16.5* Monos-2.3 Eos-1.7 Baso-0.4 [**2116-6-1**] 06:00PM BLOOD Glucose-145* UreaN-48* Creat-1.9* Na-141 K-4.5 Cl-107 HCO3-24 AnGap-15 [**2116-6-2**] 01:52AM BLOOD Calcium-9.2 Phos-4.5 Mg-2.0 CARDIAC ENZYMES [**2116-6-3**] 02:01AM BLOOD CK(CPK)-215* [**2116-6-3**] 05:50PM BLOOD CK(CPK)-469* [**2116-6-4**] 03:00AM BLOOD CK(CPK)-508* [**2116-6-4**] 05:50AM BLOOD CK(CPK)-479* [**2116-6-5**] 05:50AM BLOOD CK(CPK)-398* [**2116-6-3**] 02:01AM BLOOD CK-MB-7 cTropnT-<0.01 [**2116-6-3**] 05:50PM BLOOD CK-MB-15* MB Indx-3.2 cTropnT-0.09* [**2116-6-4**] 03:00AM BLOOD CK-MB-11* MB Indx-2.2 cTropnT-0.07* [**2116-6-4**] 05:50AM BLOOD CK-MB-10 MB Indx-2.1 cTropnT-0.05* [**2116-6-5**] 05:50AM BLOOD CK-MB-9 cTropnT-0.04* [**2116-6-4**] URINALYSIS: [**2116-6-4**] 03:19AM URINE Color-Straw Appear-Hazy Sp [**Last Name (un) **]-1.011 [**2116-6-4**] 03:19AM URINE Blood-TR Nitrite-NEG Protein-TR Glucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-MOD [**2116-6-4**] 03:19AM URINE RBC-4* WBC-123* Bacteri-MANY Yeast-NONE Epi-1 [**2116-6-4**] URINE CULTURE: CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). 10,000-100,000 ORGANISMS/ML.. ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- 16 I CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S PIPERACILLIN---------- 32 I PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S ADMISSION ECG: NSR at 74 bpm, nl axis, nl intervals, no ischemic ST/Twave changes, one PVC, no concerning changes [**2116-6-3**] COLONOSCOPY: Impression: Polyp in the sigmoid colon Diverticulosis of the sigmoid colon Stool in the whole colon The colon was long and tortuous. Grade 1 internal hemorrhoids Otherwise normal colonoscopy to proximal ascending colon Poor visualization of the cecum, ascending colon and sigmoid colon [**2116-6-5**] TAGGED RBC BLEEDING SCAN: No active gastrointestinal bleeding is identified. [**2116-6-8**] TAGGED RBC BLEEDING SCAN: No evidence of GI bleed at 90 min and at 6 hours. Brief Hospital Course: LOWER GI BLEED, LIKELY FROM DIVERTICULOSIS: Ms. [**Known lastname 5903**] was admitted with BRBLPR, which began the day of admission and, per the patient, was the first time this had happened. She had an NG lavage performed in the ED, which was negative. Aspirin, metoprolol and lisinorpil were held on admission. She remained hemodynamically, but was admitted to the MICU for observation. She required two units of RBC's after having ongoing blood BM's with the colonoscopy prep. Colonosocpy performed on [**2116-6-3**] prior to transfer to the floor showed multiple divertculi but no active bleeding. A single sessile polyp was noted but was not biopsied due to concern for causing bleeding; one-year follow-up was recommended for the polyp. After the colonoscopy she had no more blood loss for two days and was about to be discharged on [**2116-6-5**] when she rebled. GI deferred an emergent scope. A STAT tagged RBC bleeding scan was performed and was negative for ongoing bleeding. IR angio embolization was deferred because of the negative RBC scan. She required one unit of RBC's on [**2116-6-5**] to maintain Hct > 28 (the higher transfusion threshold was chosen because of the cardiac ischemia earlier in the week (see below)). Again, she rebled on [**2116-6-7**] and required a unit of blood. The morning of [**2116-6-8**], she rebled a fourth time and received another unit (for a total of four over the course of the admission). Another tagged RBC scan was ordered, which was negative. Although she did not have blood loss from below thorughout the day, the scan was repeated about six hours after the morning study in the hopes that the source could be found (unfortunately, it was not). General surgery was also consulted, but felt emergent surgery was not indicated beause she remained hemodynamically stable. Her last episode of blood loss was in the morning of [**2116-6-8**]. She remained hemodynamically stable throughout. Serial Hct's were stable and she was discharged with a Hct of 31.1. she did have a bowel movement that was semi-formed and non-bloody prior to discharge. She was sent home on metoprolol 12.5 mg [**Hospital1 **] (compared to 50 mg [**Hospital1 **] that she was on at admission), but lisinopril and aspirin were held. Ultimately, it was suspected that her bleeding was secondary to diverticulosis, although the source was never definitely found on colonoscopy or tagged RBC scans. CHEST PAIN: On [**6-2**] in the evening, she also complained of chest pain. The first set of enzymes on [**6-3**] at 2 am showed trop < 0.01, CK 215. EKG showed diffuse ST changes, but unchanged from priors. Cyclic cardiac enzymes did increase, and it was flet she had some demand ischemia in the setting of the bleed. Aspirin, which was initially discontinued on admission, was restarted on [**2116-6-4**] given the ischemia. However, on [**2116-6-5**] when she rebled, it was discontinued. She was not sent home on aspirin, and the decision to restart has been deferred to the PCP. [**Name10 (NameIs) 616**] the one episode of chest pain, she remained asymptomatic throughout the rest of the hospitalization. A higher transfusion threshold was kept (at Hct 28) given the cardiac ischemia. UTI: Although she denied symptoms, she was found to have an E. coli UTI. She was initially treated empirically with ciprofloxacin, but was changed to Bactrim when sensitives were returned and showed ciprofloxacin resistance. She was treated with a three day course. ISSUES FOR FOLLOW-UP: (1) VNA was given instructions to check Hct and fax to PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5906**], on [**2116-6-11**], the day after discharge. (2) She was scheduled to see Dr. [**Last Name (STitle) **] in cardiology as a new patient. This appointment was originally scheduled for [**2116-6-9**], but was canceled when Ms. [**Known lastname 5903**] remained in the hospital after the rebleed. Housestaff were unable to make a new appointment wiht Dr.[**Name (NI) 5907**] office, and Ms. [**Known lastname 5903**] was given their phone number to make an appointment for the next 1 - 2 weeks. (3) Aspirin and lisinopril were held and not restarted at discharge. Her dose of metoprolol on discharge was also kept low at 12.5 mg [**Hospital1 **]. Titration of her BP meds and the decision to restart aspirin will be left to her PCP. (4) Ms. [**Known lastname 5903**] needs a follow-up colonoscopy in one year with Dr.[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 172**] to remove sigmoid polyp (area was not biopsied at time of in-patient colonocopy given bleeding risk). Medications on Admission: - aspirin 81 daily - lisinopril 40 daily - simvastatin 80 daily - metoprolol 50 twice daily - HCTZ 12.5 daily (?) - insulin lantus - cosopt eye gtt - xalatan eye gtt - naproxen prn ([**12-25**]/month) - ca / vit d Discharge Medications: 1. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation: You can take this to help keep your stools soft. Disp:*60 Capsule(s)* Refills:*2* 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 4. Calcium Oral 5. Vitamin D Oral 6. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic DAILY (Daily). 7. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO twice a day: Please take a half tablet (12.5 mg) twice a day. Disp:*30 Tablet(s)* Refills:*2* 9. Insulin Glargine Subcutaneous Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary Diagnoses: (1) Lower GI bleed (2) Diverticulosis (3) Anemia Secondary Diagnoses: (1) Chronic kidney disease Discharge Condition: Stable-- satting in the mid to upper 90's on room air; no shortness of breath; no blood loss from below in 48+ hours prior to discharge; hematocrit stable and hemodynamically stable. Discharge Instructions: You were admitted with a bleed from your GI tract which was likely from your diverticuli, although the exact source of the bleeding could not be found on the colonoscopy or tagged red blood cell scans. Your blood counts have been stable over the last two days, but your primary care doctor needs to check your blood counts later this week. You should call your doctor if you notice any more blood loss. If you cannot reach your doctor or if you have a lot of blood loss, feel dizzy or feel weak, you should return to the emergency room for an evaluation. You should follow the medication given to you on discharge. Your aspirin was stopped because of your bleeding; you should ask your primary care doctor when this should be restarted. One of your blood pressure medications (lisinopril) was also stopped because of the risk of low blood pressure with bleeding. Your dose of metoprolol was decreased to 12.5 mg twice a day. You will talk to your primary care doctor on [**6-12**] about restarting the lisinopril and increasing the metoprolol dose (she will check your blood pressure to see if the medications need to be increased). You will also have home physical therapy for strengthening and balance exercises. Please take your insulin at the same dose you were taking before you came into the hospital. Followup Instructions: You have the following appointments: (1) You have an appointment with your primary care doctor, Dr. [**Last Name (STitle) 5908**], on [**Last Name (LF) 2974**], [**6-12**], at 11:15 am. The phone number is [**Telephone/Fax (1) 133**]. (2) You should call to make an appointment with Dr. [**Last Name (STitle) **] in cardiology. Please try to be seen in the next 1 - 2 weeks. Their office is on the [**Location (un) 436**] of the [**Hospital Ward Name 23**] Building on the [**Hospital Ward Name 516**] of [**Hospital1 **] Hospital. The phone number is ([**Telephone/Fax (1) 5909**]. Also, you are having your blood counts checked on Thursday, [**6-9**]. The visiting nurse will draw your blood and fax the results to Dr. [**Last Name (STitle) 5906**] to review. She will call you if there are any problems.

562,584,599,410,211,414,401,455,250,583,362,288,285,272,V458

{'Diverticulosis of colon (without mention of hemorrhage),Acute kidney failure, unspecified,Urinary tract infection, site not specified,Subendocardial infarction, initial episode of care,Benign neoplasm of colon,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Internal hemorrhoids without mention of complication,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Leukocytosis, unspecified,Anemia, unspecified,Pure hypercholesterolemia,Aortocoronary bypass 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: Bright red blood loss per rectum PRESENT ILLNESS: Ms. [**Known lastname 5903**] is a 79 yo female with h/o CAD, PVD, DM2, CKD and diverticulosis, who presented on [**2116-6-1**] with BRBPR on multiple BMs starting the day of arrival. She had no cramping, pain, nausea, or other symptoms at the time. VS were stable in the ED, and Hct was noted to be dropping from 35 recently to 30 and then to 27 with continued bloody BMs. MEDICAL HISTORY: - CAD s/p CABG [**2107**] - PVD - CKD, stage III - HTN - DM2 complicated by retinopathy, nephropathy - diverticulosis; pt denied prior episodes of GIB - s/p toe amputation MEDICATION ON ADMISSION: - aspirin 81 daily - lisinopril 40 daily - simvastatin 80 daily - metoprolol 50 twice daily - HCTZ 12.5 daily (?) - insulin lantus - cosopt eye gtt - xalatan eye gtt - naproxen prn ([**12-25**]/month) - ca / vit d ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS on arrival to the floor: 98.4, 159/83, 82, 16, 98% RA General: Pleasant, conversant, overweight female in NAD Heent: MMM. Partial dentures. Neck: JVP flat. Cardiac: rate regular, soft II/VI systolic murmur at apex Lungs: : CTA b/l, No wheeze. Abdomen: obese, soft, + BS, NTND, no HSM. Rectal deferred Enxtremities: no edema 2+ R DP pulse, 1+ L DP pulse. SVG harvest scar left leg, s/p hallux amputation Neuro: AAO x 3, appropriate affect, CN grossly intact. FAMILY HISTORY: Diabetes mellitus-- mother, brother, and sister [**Name (NI) 5905**] mother, father. There is no history of kidney disease. SOCIAL HISTORY: She is a retired administrator at [**Street Address(1) 5904**] Inn. She works out at a senior gym three times a week. She does not smoke cigarettes, drink alcohol, or use any recreational drugs. Her diet does contain a moderate amount of salt. ### Response: {'Diverticulosis of colon (without mention of hemorrhage),Acute kidney failure, unspecified,Urinary tract infection, site not specified,Subendocardial infarction, initial episode of care,Benign neoplasm of colon,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Internal hemorrhoids without mention of complication,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Leukocytosis, unspecified,Anemia, unspecified,Pure hypercholesterolemia,Aortocoronary bypass status'}

CHIEF COMPLAINT: [**Doctor First Name 3941**] firing. PRESENT ILLNESS: Mr. [**Known lastname **] is a 43 y/o M w/ DM, HTN, HPL, s/p STEMI with DES to prox LAD in 7/00, s/p [**Known lastname 3941**] placement in 12/00 for NSVT in setting of low EF, presenting after syncopal episode and [**Known lastname 3941**] firing. . The patient stated that he was in his usual state of health this afternoon when approx between 1-2pm he had an episode where he became dizzy and quickly fell to the floor. Patient states the he does not recall the events after he was on the floor, but regained consciousness after 2-3 mins (reportedly). Patient suffered a chipped left incisor as a result of the fall. Patient went about his usual day. Of note, patient had been drinking wine (one whole bottle on Saturday, unclear amount on day of admission). . Patient states three hours later, patient was lying on his bed and stated that he felt 'lightheaded' and then soon felt his [**Known lastname 3941**] fire. Pt had several more similar episodes, and EMS was called. During his transport by EMS, [**Known lastname 3941**] fired another 4-5 times. . On presentation to the ER, VS were 98.4, 110, 122/86, 24, 100 on NRB. Patient's [**Known lastname 3941**] fired another 4-5 times in ER. Pt was loaded Amio 150mg bolus and started on 1mg/hr gtt. Also administered 5mg IV and 50mg po metoprolol with 500cc bolus in ED. EKG in the ER, in NSR, did not show any ST-T changes concerning for ischemia. . On arrival to floor, VS were 92, 117/78, 18, 100% 2LNC . On assessment of patient's functional capacity, patient able to climb one flight of stairs, walk [**12-4**] city block, and sleep on 1 pillow before getting short of breath. Patient states that he is compliant with his medication regimen. . Cardiac review of systems is notable for absence of chest pain, ankle edema. All other ROS negative unless otherwise specified above. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: Lisinopril 10mg daily Lipitor 10mg daily Furosemide 10mg daily (recently reduced) Spironolactone 25mg daily Coreg 25mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: The patient lives with his female companion. He is currently unemployed. He smokes approximately one pack of cigarettes per week. He states he drinks wine only on the weekends and denies other recreational drug use. Per the chart, has a history of alcohol and substance abuse.

Paroxysmal ventricular tachycardia,Acute respiratory failure,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acute pancreatitis,Cardiac complications, not elsewhere classified,Anoxic brain damage,Urinary tract infection, site not specified,Chronic systolic heart failure,Hyperosmolality and/or hypernatremia,Dependence on respirator, status,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Automatic implantable cardiac defibrillator in situ

Parox ventric tachycard,Acute respiratry failure,Acute kidney failure NOS,Acute necrosis of liver,Acute pancreatitis,Surg compl-heart,Anoxic brain damage,Urin tract infection NOS,Chr systolic hrt failure,Hyperosmolality,Respirator depend status,Enterococcus group d,DMII wo cmp nt st uncntr,Hypertension NOS,Alcoh dep NEC/NOS-unspec,Anemia NOS,Crnry athrscl natve vssl,Status-post ptca,Status autm crd dfbrltr

Admission Date: [**2202-9-19**] Discharge Date: [**2202-10-5**] Date of Birth: [**2159-5-5**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Doctor First Name 1402**] Chief Complaint: [**Doctor First Name 3941**] firing. Major Surgical or Invasive Procedure: [**9-20**] - VT ablation, clinical VT non-inducible. Made substrate modification around apical scar region. At end induced non-clincal VT that was shocked and pt went into PEA. TTE showed no effusion although needle was stuck into pericardial/RV space and slow recovery of LV. ACLS with CPR started. . EEG . Evoking potential . Tracheostomy . PEG placement History of Present Illness: Mr. [**Known lastname **] is a 43 y/o M w/ DM, HTN, HPL, s/p STEMI with DES to prox LAD in 7/00, s/p [**Known lastname 3941**] placement in 12/00 for NSVT in setting of low EF, presenting after syncopal episode and [**Known lastname 3941**] firing. . The patient stated that he was in his usual state of health this afternoon when approx between 1-2pm he had an episode where he became dizzy and quickly fell to the floor. Patient states the he does not recall the events after he was on the floor, but regained consciousness after 2-3 mins (reportedly). Patient suffered a chipped left incisor as a result of the fall. Patient went about his usual day. Of note, patient had been drinking wine (one whole bottle on Saturday, unclear amount on day of admission). . Patient states three hours later, patient was lying on his bed and stated that he felt 'lightheaded' and then soon felt his [**Known lastname 3941**] fire. Pt had several more similar episodes, and EMS was called. During his transport by EMS, [**Known lastname 3941**] fired another 4-5 times. . On presentation to the ER, VS were 98.4, 110, 122/86, 24, 100 on NRB. Patient's [**Known lastname 3941**] fired another 4-5 times in ER. Pt was loaded Amio 150mg bolus and started on 1mg/hr gtt. Also administered 5mg IV and 50mg po metoprolol with 500cc bolus in ED. EKG in the ER, in NSR, did not show any ST-T changes concerning for ischemia. . On arrival to floor, VS were 92, 117/78, 18, 100% 2LNC . On assessment of patient's functional capacity, patient able to climb one flight of stairs, walk [**12-4**] city block, and sleep on 1 pillow before getting short of breath. Patient states that he is compliant with his medication regimen. . Cardiac review of systems is notable for absence of chest pain, ankle edema. All other ROS negative unless otherwise specified above. Past Medical History: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: s/p STEMI [**6-/2193**], w/ large thrombus in the proximal LAD complicated by cardiogenic shock -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: [**6-/2193**] STEMI w/ DES to prox LAD -PACING/[**Month/Year (2) 3941**]: [**11/2193**]: [**Month/Year (2) 3941**] placement for Low EF, runs of NSVT. [**10-7**] - [**Month/Year (2) 3941**] Generator change- 3. OTHER PAST MEDICAL HISTORY: diabetes mellitus type 2 h/o alcohol and substance abuse h/o deep vein thrombosis partially treated with Coumadin positive hepatitis B serologies in the past, Social History: The patient lives with his female companion. He is currently unemployed. He smokes approximately one pack of cigarettes per week. He states he drinks wine only on the weekends and denies other recreational drug use. Per the chart, has a history of alcohol and substance abuse. Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 10 cm. CARDIAC: Inferiorly displaced PMI, midclavicular line. RR, normal S1, loud S2. III/VI Holosystolic murmur at LLSB. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Pertinent Results: Admission labs: [**2202-9-19**] WBC-4.0 RBC-3.75* Hgb-11.9* Hct-37.4* MCV-100* MCH-31.7 MCHC-31.7 RDW-15.7* Plt Ct-260# [**2202-9-19**] PT-13.5* PTT-28.1 INR(PT)-1.2* [**2202-9-19**] Glucose-126* UreaN-31* Creat-1.8* Na-140 K-4.3 Cl-102 HCO3-23 AnGap-19 [**2202-9-19**] Lipase-137* GGT-527* [**2202-9-19**] Calcium-9.0 Phos-4.5 Mg-1.9 . LFT's dramatic increase from [**9-23**] to [**9-24**]: [**2202-9-23**] ALT-31 AST-43* LD(LDH)-364* AlkPhos-212* TotBili-1.9* [**2202-9-24**] ALT-1860* AST-5436* LD(LDH)-4536* AlkPhos-225* TotBili-2.8* . CBC: [**2202-9-24**] 04:44AM BLOOD WBC-10.8 RBC-3.51* Hgb-10.9* Hct-35.0* MCV-100* MCH-31.0 MCHC-31.1 RDW-15.3 Plt Ct-174 [**2202-9-24**] 10:09PM BLOOD WBC-17.8*# RBC-3.48* Hgb-11.1* Hct-34.9* MCV-100* MCH-31.7 MCHC-31.7 RDW-15.4 Plt Ct-138* [**2202-9-25**] 02:47AM BLOOD WBC-18.5* RBC-3.32* Hgb-10.6* Hct-33.2* MCV-100* MCH-31.8 MCHC-31.8 RDW-15.4 Plt Ct-128* [**2202-9-28**] 04:30AM BLOOD WBC-10.9 RBC-3.15* Hgb-9.6* Hct-30.7* MCV-98 MCH-30.6 MCHC-31.4 RDW-15.8* Plt Ct-239 [**2202-10-4**] 04:51AM BLOOD WBC-15.0* RBC-3.23* Hgb-10.1* Hct-32.0* MCV-99* MCH-31.2 MCHC-31.5 RDW-16.5* Plt Ct-275 . Coagulation: [**2202-9-25**] 02:47AM BLOOD PT-35.0* PTT-91.3* INR(PT)-3.6* [**2202-9-27**] 06:40PM BLOOD PT-32.4* PTT-70.8* INR(PT)-3.3* [**2202-9-28**] 04:30AM BLOOD PT-31.2* PTT-65.8* INR(PT)-3.1* [**2202-9-30**] 04:19AM BLOOD PT-25.2* PTT-37.3* INR(PT)-2.4* [**2202-10-3**] 03:25AM BLOOD PT-16.6* PTT-31.6 INR(PT)-1.5* . Lytes: [**2202-9-25**] 02:47AM BLOOD Glucose-178* UreaN-59* Creat-4.6* Na-140 K-4.3 Cl-103 HCO3-15* AnGap-26* [**2202-9-25**] 04:55PM BLOOD Glucose-108* UreaN-65* Creat-5.0* Na-144 K-4.0 Cl-104 HCO3-19* AnGap-25* [**2202-9-26**] 06:16AM BLOOD Glucose-95 UreaN-73* Creat-5.8* Na-145 K-3.7 Cl-104 HCO3-20* AnGap-25* [**2202-9-30**] 04:19AM BLOOD Glucose-158* UreaN-50* Creat-2.6* Na-150* K-3.9 Cl-119* HCO3-21* AnGap-14 [**2202-10-4**] 04:51AM BLOOD Glucose-126* UreaN-29* Creat-1.4* Na-147* K-3.8 Cl-111* HCO3-26 AnGap-14 Liver Enzymes: [**2202-9-24**] 04:44AM BLOOD ALT-1860* AST-5436* LD(LDH)-4536* AlkPhos-225* TotBili-2.8* [**2202-9-25**] 02:47AM BLOOD ALT-3616* AST-9190* LD(LDH)-7895* AlkPhos-217* TotBili-3.7* [**2202-10-1**] 05:19AM BLOOD ALT-800* AST-278* AlkPhos-220* TotBili-4.9* [**2202-9-24**] 04:44AM BLOOD Lipase-74* [**2202-9-24**] 08:09AM BLOOD Lipase-98* [**2202-9-24**] 10:09PM BLOOD Lipase-126* [**2202-9-25**] 02:47AM BLOOD Lipase-183* [**2202-9-28**] 04:30AM BLOOD Lipase-850* . Cardiac Enzymes: [**2202-9-20**] 04:36AM BLOOD CK-MB-3 cTropnT-<0.01 [**2202-9-20**] 09:46PM BLOOD CK-MB-8 cTropnT-0.61* [**2202-9-21**] 01:23PM BLOOD CK-MB-NotDone cTropnT-0.75* [**2202-9-22**] 04:57AM BLOOD CK-MB-NotDone cTropnT-0.49* [**2202-9-24**] 10:09PM BLOOD Albumin-3.7 Calcium-8.2* Phos-6.9*# Mg-1.9 [**2202-9-26**] 06:16AM BLOOD Albumin-3.7 Calcium-8.7 Phos-5.3* Mg-2.6 [**2202-9-28**] 04:30AM BLOOD Albumin-3.4 Calcium-8.6 Phos-2.6* Mg-2.1 [**2202-10-4**] 04:51AM BLOOD Calcium-9.2 Phos-3.1 Mg-1.5* . Others: [**2202-9-24**] 08:09AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE HBcAb-POSITIVE HAV Ab-POSITIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE [**2202-9-19**] 07:20PM BLOOD ASA-NEG Ethanol-244* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2202-9-29**] 03:22AM BLOOD Lactate-1.3 . RESPIRATORY CULTURE (Final [**2202-9-25**]): SPARSE GROWTH Commensal Respiratory Flora. GRAM NEGATIVE ROD #1. SPARSE GROWTH. GRAM NEGATIVE ROD #2. RARE GROWTH. NEISSERIA MENINGITIDIS. MODERATE GROWTH. BETA-LACTAMASE NEGATIVE: PRESUMPTIVELY SENSITIVE TO PENICILLIN. gram stain reviewed: 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE DIPLOCOCCI were observed ([**2202-9-24**]). . URINE CULTURE (Final [**2202-9-25**]): ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ <=2 S NITROFURANTOIN-------- <=16 S TETRACYCLINE---------- =>16 R VANCOMYCIN------------ <=1 S + + + + + + + + + + + ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Studies: EKG [**2202-9-30**] Sinus rhythm. Prolonged Q-T interval. Left anterior fascicular block. Reverse anterior R wave progression. Probable prior lateral myocardial infarction. Non-specific inferolateral T wave flattening. Compared to the previous tracing of [**2202-9-25**] Q-T interval is longer. UNILAT UP EXT VEINS US Study Date of [**2202-9-29**] IMPRESSION: 1. No evidence of DVT in left upper extremity. 2. Diminished phasicity of waveforms in the left subclavian vein compared to the right could be seen with a proximal venous stenosis; of note left sided pacemaker leads are present. CT HEAD W/O CONTRAST Study Date of [**2202-9-29**] IMPRESSION: Minimal change from the previous study; specifically, no evidence of herniation. Evoked Potential Study Date of [**2202-9-27**] MEDIAN NERVE SOMATOSENSORY EVOKED POTENTIAL (09-108): After stimulation of the right median nerve there were well-formed evoked potential peaks at the Erb's point and at the P/N13 waveform position. The peak at the N19 position was not well-formed but was legible and occurred within a normal latency. Thus, this is a normal median nerve somatosensory evoked potential after stimulation of the right median nerve. After stimulation of the left median nerve there were normal evoked potential peaks at Erb's point and at the P/N13 waveform positions, but there was no discernible peak at the N19 position. This study indicates normal large fiber somatosensory conducting system activity through the lower brain stem, but the absence of the N19 peak raises concern for dysfunction in the cortical thalamic areas after left median nerve stimulation. The normal-appearing AP after right median stimulation precludes use of this study for prognosis in coma. ABDOMEN U.S. (COMPLETE STUDY) Study Date of [**2202-9-24**] IMPRESSION: 1. Unremarkable hepatic architecture and no biliary dilatation. 2. Patent hepatic vasculature with markedly undulating bidirectional flow seen in the portal veins suggestive of right heart failure. CT HEAD W/ & W/O CONTRAST Study Date of [**2202-9-21**] IMPRESSION: 1. No acute intracranial process. 2. No pathologic focus of enhancement. 3. Paranasal sinus disease with fluid and secretions seen in the nasopharynx and sphenoid sinuses, presumably related to the presence of the endotracheal tube. NOTE ADDED IN ATTENDING REVIEW: There is no evidence of acute territorial infarction; there is a 10mm chronic lacune in the mid-left cerebellar hemisphere, in addition to the smaller one in the left thalamus, both likely unchanged since the remote [**12-4**] study. N.B. This study does not constitute formal CT angiography. Portable TTE (Complete) Done [**2202-9-21**] IMPRESSION: Left ventricular cavity enlargmenet with severe systolic dysfunction c/w multivessel CAD or other diffuse process. Probable apical left ventricular mural thrombus. Right ventricular cavity enlargement with free wall hypokinesis. Pulmonary artery systolic hypertension. Compared with the prior study (morning of [**2202-9-20**]; images reviewed), the right ventricular systolic function is now more depressed. Left ventricular cavity size and free wall motion are similar. A mural thrombus is also suggested on the prior study. CT ABDOMEN W/O CONTRAST Study Date of [**2202-9-20**] IMPRESSION: 1. No evidence of free gas in the abdomen or retroperitoneal hematoma. Small to moderate ascites of intermediate density that may reflect a small amount of hemorrhage within ascitic fluid, but not frank hemoperitoneum. 2. Small pleural effusions. 3. Intra-aortic balloon pump. Electrophysiology Study [**2202-9-20**] 1. The baseline rhythm was sinus, with SCL 867ms, AH 85ms, HV 69ms. 2. Electroanatomical mapping of the LV using CARTO was performed. There was an area of low voltage near the anterior septal and apical region consistent with scar. The EGMs recorded looked far field suggesting that there may have been a laminated clot at that region. 3. Double ventricular extra stimuli from the RV down to [**Telephone/Fax (3) 105113**] and 400-300-240 did not induce any sustained arrhythmias. Triple VES also did not induce any sustained arrhythmias. At most there were 2 VPC of similar morphology to his clinical VT, RBBB Right/Superior axis with V4 transition. 4. Dopamine up to 10mcg.kg/min was started. 5. Susbstrate modification involving encircling the border region of the suspected exit site and inside the scar was performed. 6. At the end of the substrate modification, we tried to induce VT again. 7. At [**Telephone/Fax (3) 105114**] from the LV ablation catheter, a sustained MMVT TCL 255, RBBB left/inf axis V2 transition was induced. It was different from the clinical VT and hemodynamically not tolerated. After 18 seconds he was externally cardioverted at 200J back into sinus rhythm. 8. After cardioversion, it was noticed he was back in sinus rhythm but had no blood pressure. This was confirmed with flushing of the arterial line and feeling no pulse. All catheters were removed from the heart and PEA code was called. 9. CPR was initiated immediately. Quick look under fluoroscopy showed that the heart borders were not moving but not enlarged. Stat TTE was ordered. Epinephrine was given IV. 10. Because of possible tamponade, and the stat TTE machine had not arrived, a pericardiocentesis needle was inserted into the pericardial space by the interventional cardiology attending. No pericardial blood was seen, but the needle did puncture the RV. The needle was withdrawn and pressure held. 11. Portable stat TTE showed that there was no pericardial effusion, RV was contracting, but the LV was minimally contracting. 12. Additional medications including epinephrine gtt, calcium gluconate, vasopressin, dopamine gtt was infused. With high pressor doses, the TTE showed some contraction of the LV infero-lateral wall with anterior akinesis similar to baseline. When the pressors were withdrawn, the LV function deteriorated. There was still no pericardial effusion seen. 13. The patient remained in sinus rhythm but with all the pressors was able to maintain a blood pressure with palpable pulses. At this time CPR was stopped. During CPR, the pressure in the arterial line was always in the low 100's. 14. An IABP was placed by the intervential cardiology attending. A TEE probe was placed and showed poor LV contraction with no pericardial effusion. 15. The patient was stabilized and then transferred to CT of the abdomen before going to the CCU. There was a question of distended abdomen and intra-abdominal bleeding. 16. 3 venous catheters and 1 IABP access in the R femoral groin was still present when sent to CCU. The [**Telephone/Fax (3) 3941**] therapies were re-activated. Brief Hospital Course: 43 y/o M w/ h/o Ischemic Dilated Cardiomyopathy (EF 20%) s/p [**Telephone/Fax (3) 3941**] placement who presents with VT Storm. # RHYTHM: Patient thought to have inferior focus of VT likely secondary to scar. Was taken for electrophysiology study for VT ablation, clinical VT non-inducible. Made substrate modification around apical scar region. At end induced non-clincal VT that was shocked and pt went into PEA. TTE showed no effusion although needle was stuck into pericardial/RV space and slow recovery of LV. ACLS with CPR started, pt was intubated. Returned to ICU on ballon pump. Balloon pump pulled [**9-20**], sedation continued as patient became very agitated on vent with propofol. Off propofol since 2pm on [**9-22**] with little improvement in MS. On [**9-23**], pt had multiple episodes of SVT ?????? [**Month/Year (2) 3941**] shocked him back into sinus tachycardia. These episodes improved with lidocane gtt (dc??????d [**9-25**]) and Amiodarone. Now transitioned to Dronedarone for rhythm control and out of concern for toxicity with Amiodarone. Digoxin also dc??????d given renal failure. Usually noted to have HR 68-82 SR with short periods of ventricular bigeminy. BP 89-123/60-70 on metoprolol and dronederone. On oral magnesium given daily need for magnesium repletion. # mental status: Concern for anoxic brain injury s/p hypoperfusion, (vs. etoh withdrawal, or excess sedation not being cleared by liver/kidneys.) Neuro does not believe this is sub-clinical seizures based on EEG. Off sedation since [**9-22**] at 2pm. Evoked potential noted to be intact, per neuro they feel that his neuro status may recover (1-10%) chance; if it does improve, would expect to happen in the next three weeks. Ongoing discussion with family re: goals of care, prognosis. The family has decided to pursue Trach/Peg for the patient. This was placed on [**10-4**]. - [**Month (only) 116**] use PEG for tube feeds starting noon on [**10-5**] (24 hrs after placement). - Family will have to reassess goals of care for patient if neurologic recovery cannot be seen within ~3 weeks, which is the time frame estimated by neurology in which improvement ought to be seen if it will happen at all. # Respiratory status: He is initiating spontaneous breathing. Questionable if patient is able to tolerate off the vent and likely will aspirate. Intubated: CPAP w/ PS @ FiO2 40%/5 PSV/ 5 peep. O2 sat 100%. RR 13-20. Lung sounds clear but diminished at bases. Very strong cough and frequently requires suctioning for clear, thick ETT secretions. # Fever/Leukocytosis: Fever improved but WBC remains elevated. UA growing enterococcus. Positive sputum cx, speciation pending, positive U/A growing Enterococcus,. Patient started on antibiotics on [**9-22**]. Foley draining amber colored urine. Completed course of IV ampicillin for treatment of enteroccoccal UTI (afebrile). - Ampicillin for vanc-sensitive enterococcus in urine (day 1=[**9-26**], to end [**10-5**]) - All recent cultures negative thus far. - Please follow up sputum and blood cultures on [**2202-10-5**]. # PUMP/Chronic Systolic Heart Failure: Euvolemic on examination without significant pedal edema. Antero-apical akinesis on TTE, had been off coumadin at home given non-compliance with INR checks as an outpatient. It was initially felt that patient had LV thrombus on TTE, but after further discussion it was felt that this was just fibrin and that anticoagulation was not warranted.. IABP removed [**9-21**]. Patient was intially volume overloaded with poor urine output but responded well to IV lasix and diuresed to euvolemia. - continue Metoprolol - lisinopril held due to renal failure - Lasix 40 mg daily, please follow up lytes # CORONARIES: Patient s/p large anterior myocardial infarction in [**2192**]. - Continue statin, aspirin, beta blocker. # ETOHism - Chronic issue. Patient likely minimizes his ETOH use. Not requiring CIWA currently given sedation. - CIWA Scale in place for when patient is extubated - MVI, folate, thiamine (NG) # Transaminitis: Improving transaminases, Likely shock liver from hypoperfusion Patient had unremarkable abdominal CT ([**9-20**]), negative RUQ US ([**9-24**]). Neg Hep serologies. LFTs now downtrending. - trend LFTs daily - check albumin, INR daily to follow liver function - keep tylenol level to less than 2gm / day - [**Hospital1 **] electrolytes # ARF: Patient presented with acute renal failure, likely [**1-4**] poor perfusion during arrest in the setting of poor forward flow [**1-4**] EF 20%. Improved over course of hospitalization with Cr 1.3 on discharge. # hypernatremia ?????? Patient had numerous episodes of hypernatremia during admission with Na as high as 150. Improved with correction of free water deficit (gentle D5W IV boluses +/- free water flushes with tube feeds). # ?LV mural thrombus ?????? Initially felt that thrombus/embolus seen on TTE [**9-21**], head CT negative for embolic CVA or other acute process. After discussion with EP, it was felt that this was likely just fibrin and no clear thrombus was present. - SQ heparin for DVT prophylaxis # cool L Lower Extremity: Hx of L foot slightly cooler than R but stable/improved clinically. # abd distension: Stable, +BS, CT negative. # macrocytic anemia: Likely secondary to alcohol. Continuing to trend daily. # COMMUNICATION: Fiance Quala [**Telephone/Fax (1) 105115**], Brother [**Name (NI) 13740**] [**Telephone/Fax (1) 105116**], [**Name2 (NI) **]r [**Name (NI) **] [**Telephone/Fax (1) 105117**] Medications on Admission: Lisinopril 10mg daily Lipitor 10mg daily Furosemide 10mg daily (recently reduced) Spironolactone 25mg daily Coreg 25mg daily Discharge Medications: 1. Aspirin 325 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY (Daily). 2. Atorvastatin 10 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY (Daily). 3. Therapeutic Multivitamin Liquid [**Telephone/Fax (1) **]: One (1) PO DAILY (Daily). 4. Thiamine HCl 100 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY (Daily). 5. Folic Acid 1 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY (Daily). 6. Dronedarone 400 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO BID (2 times a day). 7. Metoprolol Tartrate 25 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO BID (2 times a day). 8. Insulin Regular Human 100 unit/mL Solution [**Telephone/Fax (1) **]: PER SLIDING SCALE Injection ASDIR (AS DIRECTED). 9. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette [**Telephone/Fax (1) **]: [**12-4**] Drops Ophthalmic PRN (as needed) as needed for dry eye. 10. Acetaminophen 160 mg/5 mL Solution [**Month/Day (2) **]: [**12-4**] PO Q6H (every 6 hours) as needed for fever, comfort. 11. Magnesium Oxide 400 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO DAILY (Daily). 12. 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. 13. Heparin (Porcine) 5,000 unit/mL Solution [**Month/Day (2) **]: 5000 (5000) units Injection TID (3 times a day). 14. Chlorhexidine Gluconate 0.12 % Mouthwash [**Month/Day (2) **]: Fifteen (15) ML Mucous membrane [**Hospital1 **] (2 times a day). 15. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler [**Hospital1 **]: One (1) Puff Inhalation Q4H (every 4 hours) as needed for wheezing. 16. Lasix 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day: titrate to evolemia. 17. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] once a day. 18. Lab Work Please continue to check sodium, BUN, creatinine, potassium, and magnesium daily. Discharge Disposition: Extended Care Facility: [**Hospital3 672**] Hospital - Radius [**Hospital 7755**] Hospital Discharge Diagnosis: anoxic brain injury Ventricular Tachycardia storm Pulseless electrical activity urinary tract infection Pancreatitis alcoholism Discharge Condition: hemodynamically stable on ventilator with trach in place. Neurologically is non-responsive but does spontaneously open eyes. His eyes are injected with blood bilaterally and he has thin blood secretions on suctioning. Discharge Instructions: You came to the hospital with [**Hospital 3941**] firing secondary to VT storm. During ablation procedure, you have gone into cardiac arrest with pulseless electrical activity to 30 minutes which resulted in neurological damage. You have been in a coma since, however, hemodynamically stable. You were also treated for a vancomycin-sensitive enterococcus urinary tract infection. You completed 10 days of treatment with ampicillin. Followup Instructions: Provider: [**Name10 (NameIs) 3941**] CALL TRANSMISSIONS Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2202-10-25**] 10:00 Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2203-1-19**] 10:00 Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2203-1-19**] 9:30 Completed by:[**2202-10-5**]

427,518,584,570,577,997,348,599,428,276,V461,041,250,401,303,285,414,V458,V450

{'Paroxysmal ventricular tachycardia,Acute respiratory failure,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acute pancreatitis,Cardiac complications, not elsewhere classified,Anoxic brain damage,Urinary tract infection, site not specified,Chronic systolic heart failure,Hyperosmolality and/or hypernatremia,Dependence on respirator, status,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,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: [**Doctor First Name 3941**] firing. PRESENT ILLNESS: Mr. [**Known lastname **] is a 43 y/o M w/ DM, HTN, HPL, s/p STEMI with DES to prox LAD in 7/00, s/p [**Known lastname 3941**] placement in 12/00 for NSVT in setting of low EF, presenting after syncopal episode and [**Known lastname 3941**] firing. . The patient stated that he was in his usual state of health this afternoon when approx between 1-2pm he had an episode where he became dizzy and quickly fell to the floor. Patient states the he does not recall the events after he was on the floor, but regained consciousness after 2-3 mins (reportedly). Patient suffered a chipped left incisor as a result of the fall. Patient went about his usual day. Of note, patient had been drinking wine (one whole bottle on Saturday, unclear amount on day of admission). . Patient states three hours later, patient was lying on his bed and stated that he felt 'lightheaded' and then soon felt his [**Known lastname 3941**] fire. Pt had several more similar episodes, and EMS was called. During his transport by EMS, [**Known lastname 3941**] fired another 4-5 times. . On presentation to the ER, VS were 98.4, 110, 122/86, 24, 100 on NRB. Patient's [**Known lastname 3941**] fired another 4-5 times in ER. Pt was loaded Amio 150mg bolus and started on 1mg/hr gtt. Also administered 5mg IV and 50mg po metoprolol with 500cc bolus in ED. EKG in the ER, in NSR, did not show any ST-T changes concerning for ischemia. . On arrival to floor, VS were 92, 117/78, 18, 100% 2LNC . On assessment of patient's functional capacity, patient able to climb one flight of stairs, walk [**12-4**] city block, and sleep on 1 pillow before getting short of breath. Patient states that he is compliant with his medication regimen. . Cardiac review of systems is notable for absence of chest pain, ankle edema. All other ROS negative unless otherwise specified above. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: Lisinopril 10mg daily Lipitor 10mg daily Furosemide 10mg daily (recently reduced) Spironolactone 25mg daily Coreg 25mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: The patient lives with his female companion. He is currently unemployed. He smokes approximately one pack of cigarettes per week. He states he drinks wine only on the weekends and denies other recreational drug use. Per the chart, has a history of alcohol and substance abuse. ### Response: {'Paroxysmal ventricular tachycardia,Acute respiratory failure,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acute pancreatitis,Cardiac complications, not elsewhere classified,Anoxic brain damage,Urinary tract infection, site not specified,Chronic systolic heart failure,Hyperosmolality and/or hypernatremia,Dependence on respirator, status,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Automatic implantable cardiac defibrillator in situ'}

CHIEF COMPLAINT: s/p VF arrest PRESENT ILLNESS: 50M h/o childhood myocardial defect s/p repair presents s/p VF arrest at 1330. By report from an eye witness, patient was up on a lift with hands over his head stripping paint. Then dropped to his knees and arms were limp over railing of his lift w/ head back. Patient was brought down to ground level, and CPR was started within 1-2 minutes. BU Police arrived with defibrillator after 5-10 minutes and shocked 5-6 times. EMS arrival after 15 minutes, good carotid pulse, BP 120/60-70. Given 150 amio bolus, and drip. Intubated. EKG with RBBB. St up in AVR. . In the ED, vitals: . Labs notable for lactate 3.3 -> 1.4 on repeat. ABG 7.34/39/448 on AC/600/12/100%. Given ASA 600mg PR and taken to cath. . Cardiac cath Left Heart demonstrated clean coronary arteries. Moderate global hypokinesis LVEF of 46%, right dominant circulation. MEDICAL HISTORY: -s/p surgical repair of 'hole in heart' at age 9 - ? [**Location (un) 19930**]Hospital -h/o heavy EtOH abuse MEDICATION ON ADMISSION: none ALLERGIES: Shellfish PHYSICAL EXAM: VS: T95.5 , BP 156/94, HR 97 , RR 12, O2 94 % on 50% FiO2 Vent Settings: A/C 5 PEEP, Tv 600ml, R 12 Gen: WDWN middle aged male intubated, calm. HEENT: No evidence of trauma to the head. Sclera anicteric. PERRL, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple, CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits, r-femoral sheath in place. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: Family history notable for brother deceased from "a heart attack" in his 30's - history is unclear as brother was estranged and living on the street - ? drug overdose, mother deceased in 50's from cancer, father in his 80's w/o significant medical history. SOCIAL HISTORY: Social history is significant for the presence of current tobacco use - approx 1ppd 30-40 years. Social etoh with usually social drinking, but occasional almost 6 6-packs per week in "a heavy week". Patient is adopted and was in state care at the time of his childhood surgery.

Ventricular fibrillation,Paralytic ileus,Cellulitis and abscess of upper arm and forearm,Infection and inflammatory reaction due to other vascular device, implant, and graft,Tobacco use disorder,Long-term (current) use of anticoagulants,Phlebitis and thrombophlebitis of superficial veins of upper extremities

Ventricular fibrillation,Paralytic ileus,Cellulitis of arm,React-oth vasc dev/graft,Tobacco use disorder,Long-term use anticoagul,Phlbts sprfc vn up extrm

Admission Date: [**2144-12-1**] Discharge Date: [**2144-12-11**] Date of Birth: [**2090-3-22**] Sex: M Service: MEDICINE Allergies: Shellfish Attending:[**First Name3 (LF) 2704**] Chief Complaint: s/p VF arrest Major Surgical or Invasive Procedure: Cardiac Catheterization ICD placement History of Present Illness: 50M h/o childhood myocardial defect s/p repair presents s/p VF arrest at 1330. By report from an eye witness, patient was up on a lift with hands over his head stripping paint. Then dropped to his knees and arms were limp over railing of his lift w/ head back. Patient was brought down to ground level, and CPR was started within 1-2 minutes. BU Police arrived with defibrillator after 5-10 minutes and shocked 5-6 times. EMS arrival after 15 minutes, good carotid pulse, BP 120/60-70. Given 150 amio bolus, and drip. Intubated. EKG with RBBB. St up in AVR. . In the ED, vitals: . Labs notable for lactate 3.3 -> 1.4 on repeat. ABG 7.34/39/448 on AC/600/12/100%. Given ASA 600mg PR and taken to cath. . Cardiac cath Left Heart demonstrated clean coronary arteries. Moderate global hypokinesis LVEF of 46%, right dominant circulation. Past Medical History: -s/p surgical repair of 'hole in heart' at age 9 - ? [**Location (un) 19930**]Hospital -h/o heavy EtOH abuse Social History: Social history is significant for the presence of current tobacco use - approx 1ppd 30-40 years. Social etoh with usually social drinking, but occasional almost 6 6-packs per week in "a heavy week". Patient is adopted and was in state care at the time of his childhood surgery. Family History: Family history notable for brother deceased from "a heart attack" in his 30's - history is unclear as brother was estranged and living on the street - ? drug overdose, mother deceased in 50's from cancer, father in his 80's w/o significant medical history. Physical Exam: VS: T95.5 , BP 156/94, HR 97 , RR 12, O2 94 % on 50% FiO2 Vent Settings: A/C 5 PEEP, Tv 600ml, R 12 Gen: WDWN middle aged male intubated, calm. HEENT: No evidence of trauma to the head. Sclera anicteric. PERRL, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple, CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits, r-femoral sheath in place. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Neuro: No response to voice or withdrawal to pain. PERRL 3->2mm. Corneal reflexes intact on left, absent on right. Flexor posturing of upper extremities bilaterally without purposeful movements. Gag present. Doll's eyes equivocal. No myoclonus. Negative babinski. Pertinent Results: RADIOLOGY Final Report CHEST (PORTABLE AP) [**2144-12-1**] 2:57 PM CHEST (PORTABLE AP) Reason: Please eval endotracheal tube placement, acute cariopulm pro [**Hospital 93**] MEDICAL CONDITION: 54 year old man with V. Fib arrest. Now intubated REASON FOR THIS EXAMINATION: Please eval endotracheal tube placement, acute cariopulm processes HISTORY: Endotracheal tube placement. FINDINGS: In comparison with earlier study of this date, there has been placement of an endotracheal tube with its tip about 3 cm above the carina. There is also a nasogastric tube that is coiled within the upper stomach and then proceeds distally. Small area of increased opacification is seen in the right infrahilar region. This could represent atelectasis or even developing pneumonia. Followup of this region is recommended. DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**] Approved: TUE [**2144-12-1**] 4:32 PM Cardiac Cath COMMENTS: 1. Selective coronary angiography of this right dominant system revealed no angiographically apparent coronary artery disease. The LMCA, LAD, LCX, and RCA are all without any significant angiographic apparent flow-limiting stenoses. 2. Limited resting hemodynamics revealed severe systolic arterial hypertension of 170/88 mm Hg. Left sided filling pressures were normal with LVEDP of 15 mm Hg. 3. Left ventriculography revealed global LV hypokinesis with an ejection fraction 40-45%. FINAL DIAGNOSIS: 1. Angiographically normal coronary arteries. 2. Globally depressed left ventricular function. 3. Severe systemic arterial hypertension. . HEAD CT HISTORY: 50-year-old male status post myocardial repair with VF arrest, assess for stroke. TECHNIQUE: Contiguous 5-mm axial images were obtained from the skull base to the vertex. FINDINGS: No comparisons are available. There are no intracranial hemorrhages or masses. The [**Doctor Last Name 352**]/white matter differentiation is maintained. The ventricles and extra-axial CSF spaces are normal. The visualized orbits are normal. There is an orogastric tube in place. Mucosal thickening of the sphenoid sinus and posterior ethmoid air cells are seen. There is fluid within the nasal cavity and nasopharynx. No suspicious bony abnormalities are seen. IMPRESSION: No intracranial abnormalities. Consider MR if there is strong clinical suspicion for an acute infarct. . Echo: Impression: 1. Evidence of prior cardiac surgery with a ventricular septal patch and a small residual membranous ventricular septal defect. No significant intracardiac shunting. 2. Normal left ventricular cavity size with moderate global hypokinesis. The LVEF was moderately decreased at 33%. The effective forward LVEF was moderately decreased at 33%. 3. Mildly increased right ventricular cavity size and moderately depressed systolic function. The RVEF was moderately depressed at 32%. No MR evidence of right ventricular fatty infiltration/dysplasia. Focal hyperenhancement in the right ventricular outflow tract consistent with myocardial scarring. 4. Mild aortic regurgitation. Moderate-to-severe pulmonic regurgitation 5. The indexed diameters of the ascending and descending thoracic aorta were normal. The main pulmonary artery diameter index was normal. 6. Mild right atrial enlargement. 7. A note is made of a non-enhancing cyst in the upper pole of the left kidney. A renal ultrasound is recommended to better characterize this finding. A pulmonary nodule was noted in the right upper lobe. Prior imaging should be reviewed or a chest CT should be performed to better characterize the nodule. In addition, a small left pleural effusion was present. . These findings suggest earlier surgical repair of tetralogy of Fallot, although may represent a simpler patch repair of a membranous ventricular septal defect. . The images were reviewed by Drs. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name5 (PTitle) **] [**Doctor Last Name **], and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**]. . Dr. [**Last Name (STitle) **] was notified of the findings in person on [**2144-12-8**]. . MRI Brain: IMPRESSION: . Mild volume loss. No intracranial mass or abnormality of the medial temporal lobes/hippocampi is seen. . Large sphenoid sinus fluid level. RADIOLOGY Final Report . UNILAT UP EXT VEINS US LEFT [**2144-12-7**] 1:06 PM . UNILAT UP EXT VEINS US LEFT . Reason: Please evaluate for presence of DVT. . [**Hospital 93**] MEDICAL CONDITION: 54 year old man a/w V. Fib arrest. Now w/ LUE swelling, erythema, and palpable cord. REASON FOR THIS EXAMINATION: Please evaluate for presence of DVT. INDICATION: 54-year-old man with left upper extremity swelling, erythema, palpable cord, evaluate for DVT. . COMPARISON: No previous exams for comparison. . FINDINGS: Grayscale, color and Doppler son[**Name (NI) 1417**] of the left IJ, subclavian, axillary, brachial, basilic, and cephalic veins were performed. There is no flow identified in the left cephalic vein and it is noncompressible. Normal flow, compression, and augmentation is seen in the remainder of the left arm vessels. . IMPRESSION: No evidence of deep vein thrombosis. Thrombus seen in the left cephalic vein, which is a superficial vein. . Cardiac MRI: Impression: 1. Evidence of prior cardiac surgery with a ventricular septal patch and a small residual membranous ventricular septal defect. No significant intracardiac shunting. 2. Normal left ventricular cavity size with moderate global hypokinesis. The LVEF was moderately decreased at 33%. The effective forward LVEF was moderately decreased at 33%. 3. Mildly increased right ventricular cavity size and moderately depressed systolic function. The RVEF was moderately depressed at 32%. No MR evidence of right ventricular fatty infiltration/dysplasia. Focal hyperenhancement in the right ventricular outflow tract consistent with myocardial scarring. 4. Mild aortic regurgitation. Moderate-to-severe pulmonic regurgitation 5. The indexed diameters of the ascending and descending thoracic aorta were normal. The main pulmonary artery diameter index was normal. 6. Mild right atrial enlargement. 7. A note is made of a non-enhancing cyst in the upper pole of the left kidney. A renal ultrasound is recommended to better characterize this finding. A pulmonary nodule was noted in the right upper lobe. Prior imaging should be reviewed or a chest CT should be performed to better characterize the nodule. In addition, a small left pleural effusion was present. . These findings suggest earlier surgical repair of tetralogy of Fallot, although may represent a simpler patch repair of a membranous ventricular septal defect. Brief Hospital Course: Patient was admitted to the CCU for management of V. Fib arrest: . #V. Fib: On arrival, GCS score was < 10, and time since arrest was within appropriate interval for cooling protocol. Patient was started on cooling protocol without delay. During the cooling process, patient became increasing bradycardic and SBP's steadily decreased. Target core temperature of 32-34 was achieved, but patient continued to cool beyond goal temperature. With cooling he became increasingly bradycardic and hypotensive requiring dopamine for pressure support. Patient was given atropine for bradycardia, and core temperature goal was increased to 34C from 33C. Patient continued to cool and began to develop stable VT. Dopamine was discontinued as it was felt to be contributing to VT and alternative pressors were attempted. Cooling protocol was ultimately ceased and patient's core temperature was increased. Patient received approximately 6-8 hours of cooling. Following the end of the protocol patient was weaned off pressors. He had no recurrence of his VT during his hospital stay but had several runs of NSVT. Initially on Amio, gut given bradycardia amio was held as it was deemed a possible contributing factor to severe bradycardia. Amio was later held due on recommendations of EP who planned for EP study. Patient had a few other runs of NSVT prior to discharge, and ultimately had ICD placed on day prior to discharge. CXR demonstrated no pneumothorax, and interrogation revealed device was working properly. Patient was discharged home with 5 days antibiotics and outpatient follow-up. . #CAD: Patient had clean coronoaries on his catheterization. No intervention. . #Superficial Clot: During his hospitalization patient developed superficial thrombophlebitis, and USD demonstrated cephalic vein thrombosis. Given plan for ICD placement, EP recommended heparin gtt and IV antibiotics prior to placement. Patient was discharged on coumadin with goal INR of 1.5-2. Plan for 6 months anticoagulation, and then discontinuation of coumadin. Patient was not bridged. . #Neuro: Patient with severe short term memory loss s/p arrest. Neuro consulted. CT/MRI negative. Symptoms improved with time. Plan for outpatient follow-up with Dr. [**First Name (STitle) **], Neuro-Psych, who specializes in V. Fib arrest. Patient w/o other focal neuro findings on exam. . Remainder of his hospital course was uneventful. Medications on Admission: none Discharge Medications: 1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*5 Tablet(s)* Refills:*0* 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. Disp:*12 Tablet(s)* Refills:*0* 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO at bedtime for 6 weeks. Disp:*42 Tablet(s)* Refills:*0* 7. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO once a day. Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*3* Discharge Disposition: Home Discharge Diagnosis: Ventricular Fibrillation and Cardiac Arrest Superficial Vein thrombosis Discharge Condition: Stable, s/p ICD placement Discharge Instructions: You were admitted to the hospital for ventricular fibrillation and cardiac arrest. Prior to arrival at the hospital, you received CPR and defibrillation to restore your normal heart rhythm. On arrival to the hospital you were taken to the Cardiac Cath lab where imaging of your coronary arteries revealed that there was no evidence of any coronary artery disease. You were then observed in the Cardiac Care Unit where you recieved a body cooling protocol to lower your core body temperature. Upon stopping the cooling protocol your breathing tube was removed. You were then observed in the CCU for any further ventricular arrhythmias. . Ultimately you were transfered to the floor where an ICD was placed to shock your heart in the event of a recurrence of your abnormal heart rhythm. . It is important for you to quit smoking. We discussed the risks involved with smoking with you during this admission. You were placed on a nicotine patch. If you need help quitting smoking, you should discuss this with your primary care doctor. . Upon leaving the hospital, please take all medications as directed and keep all follow-up appointments. Please return to the ED or call your doctor if you have any chest pain, sudden shortness of breath, palpitations lasting more than just a few moments, or palpitations causing any symptoms such as light headedness, chest pain, or your debrillator to discharge. . The following changes were made to your medications: 1. Aspirin 81mg daily 2. Levofloxacin 500mg qd for 5 days 3. Thiamine 100mg daily 4. Folate 1mg daily 5. Multivitamin 1 tab daily 6. Oxycodone-Acetaminophen 5/325 1 tab daily 7. Coumadin 2.5mg PO daily (goal INR 1.5-2.0) for 6 weeks 8. Toprol XL 75 mg daily Followup Instructions: 1. DEVICE CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2144-12-18**] 10:30, Cardiology . 2. Renal Ultrasound Friday [**1-1**], [**Hospital Unit Name 1825**], [**Hospital Ward Name 5074**] Main Entrance [**Location (un) 470**], Radiology, at 1:30pm - for further evaluation of a renal cyst noted on your MRI. . 3. Dr. [**Last Name (STitle) **], Cardiology, 3:20pm [**1-1**], [**Hospital Ward Name 23**] Building [**Hospital1 69**] [**Location (un) **], ([**Telephone/Fax (1) 22784**], . 4. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6403**], MD Phone:[**Telephone/Fax (1) 1690**] Date/Time:[**2145-1-21**] 4:00 - Neurology . 5. [**Hospital3 **], Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **], Thursday [**2-12**], [**2145**] at 9AM, [**Hospital Ward Name 23**] Building of [**Hospital1 **] [**Hospital Ward Name 516**] - you will receive a letter in the mail to confirm this appointment. . 6. Repeat CT scan of the chest in 6 months for interval evaluation of lung nodules noted on your MRI. Discuss with your PCP. . 7. Tuesday, [**2144-12-11**] in [**Hospital3 **]. The clinic will call you to set up the time of your appointment.

427,560,682,996,305,V586,451

{'Ventricular fibrillation,Paralytic ileus,Cellulitis and abscess of upper arm and forearm,Infection and inflammatory reaction due to other vascular device, implant, and graft,Tobacco use disorder,Long-term (current) use of anticoagulants,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}

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 VF arrest PRESENT ILLNESS: 50M h/o childhood myocardial defect s/p repair presents s/p VF arrest at 1330. By report from an eye witness, patient was up on a lift with hands over his head stripping paint. Then dropped to his knees and arms were limp over railing of his lift w/ head back. Patient was brought down to ground level, and CPR was started within 1-2 minutes. BU Police arrived with defibrillator after 5-10 minutes and shocked 5-6 times. EMS arrival after 15 minutes, good carotid pulse, BP 120/60-70. Given 150 amio bolus, and drip. Intubated. EKG with RBBB. St up in AVR. . In the ED, vitals: . Labs notable for lactate 3.3 -> 1.4 on repeat. ABG 7.34/39/448 on AC/600/12/100%. Given ASA 600mg PR and taken to cath. . Cardiac cath Left Heart demonstrated clean coronary arteries. Moderate global hypokinesis LVEF of 46%, right dominant circulation. MEDICAL HISTORY: -s/p surgical repair of 'hole in heart' at age 9 - ? [**Location (un) 19930**]Hospital -h/o heavy EtOH abuse MEDICATION ON ADMISSION: none ALLERGIES: Shellfish PHYSICAL EXAM: VS: T95.5 , BP 156/94, HR 97 , RR 12, O2 94 % on 50% FiO2 Vent Settings: A/C 5 PEEP, Tv 600ml, R 12 Gen: WDWN middle aged male intubated, calm. HEENT: No evidence of trauma to the head. Sclera anicteric. PERRL, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple, CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits, r-femoral sheath in place. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: Family history notable for brother deceased from "a heart attack" in his 30's - history is unclear as brother was estranged and living on the street - ? drug overdose, mother deceased in 50's from cancer, father in his 80's w/o significant medical history. SOCIAL HISTORY: Social history is significant for the presence of current tobacco use - approx 1ppd 30-40 years. Social etoh with usually social drinking, but occasional almost 6 6-packs per week in "a heavy week". Patient is adopted and was in state care at the time of his childhood surgery. ### Response: {'Ventricular fibrillation,Paralytic ileus,Cellulitis and abscess of upper arm and forearm,Infection and inflammatory reaction due to other vascular device, implant, and graft,Tobacco use disorder,Long-term (current) use of anticoagulants,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}