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CHIEF COMPLAINT: right upper extremity weakness, dyspnea PRESENT ILLNESS: 69 yo F with DM, COPD, metastatic breast CA s/p cycle 1 of adriamycin/cytoxan [**5-29**] awaiting 2nd cycle who was recently seen MEDICAL HISTORY: 1. Diabetes. followed at [**Last Name (un) **] Diabetes Center. Her last hemoglobin A1c was 6.0 in 05/[**2104**]. 2. Hypercholesterolemia/?hypertension 3. Schizoaffective disorder. The patient is followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] and is on Clozaril with q 1 month CBCs 4. COPD/Asthma. The patient is maintained on Advair and albuterol for this. She does state that she uses her albuterol approximately one time per day. Her last pulmonary function tests were in [**2096**]. 5. h/o Falls 6. Back pain 7. ? Severe sleep apnea: as documented above and per recent d/c summary. Improved with BiPAP in the unit last month. . Breast Ca history: - dx [**2104-6-9**] w dyspnea, hypoxia, falls w right breast mass - [**6-17**]: cytoxan, adriamycin, neupogen, emend, steroids MEDICATION ON ADMISSION: Albuterol IH q 4-6 hours prn aspirin 81 mg daily Clozapine 125mg qAM, 100mg qPM SC heparin advair 250-50 [**Hospital1 **] ibuprofen 600 mg tid lisinopril 10 mg daily ondansetron 4mg q8 prn oxycodone 5 mg q4 hours prn pioglitazone 45 mg daily spiriva 1 puff daily acetaminophen prn bisacodyl prn docusate sodium [**Hospital1 **] NPH 75 units q AM, 34 units in PM omeprazole 20 mg daily vitamin D 800mg daily vancomycin 1g IV q 12 metronidazole 500 PO TID ALLERGIES: Penicillins / Codeine / Sulfonamides PHYSICAL EXAM: VS: 96.8 HR 97 94/43 20 100% NRB and 94% on 60% FiO2 Manual BP 126/60 w pulsus of [**6-29**] Gen: sleepy but arousable. Neuro: AAO to person, place, situation, time. Does fall asleep mid-sentence. localizes to voice, withdraws/localizes to pain. FAMILY HISTORY: The patient's grandmother had coronary artery disease. Her parent's died of cervical cancer and stroke. SOCIAL HISTORY: Has been residing at [**Hospital 100**] Rehab since her last hospitalization. Health Care proxy is [**Name (NI) **] [**Name (NI) **]. She does not

Secondary malignant neoplasm of brain and spinal cord,Acute respiratory failure,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of breast (female), unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Anemia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other convulsions,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of allergy to penicillin,Personal history of allergy to sulfonamides

Sec mal neo brain/spine,Acute respiratry failure,Second malig neo liver,Pneumonia, organism NOS,Malign neopl breast NOS,DMII wo cmp nt st uncntr,Schizoaffective dis NOS,Chronic obst asthma NOS,Hypotension NOS,Anemia NOS,Obstructive sleep apnea,Convulsions NEC,Hyperlipidemia NEC/NOS,Obesity NOS,Hx-penicillin allergy,Hx-sulfonamides allergy

Admission Date: [**2104-8-9**] Discharge Date: [**2104-8-20**] Date of Birth: [**2035-1-17**] Sex: F Service: MEDICINE Allergies: Penicillins / Codeine / Sulfonamides Attending:[**First Name3 (LF) 3016**] Chief Complaint: right upper extremity weakness, dyspnea Major Surgical or Invasive Procedure: none History of Present Illness: 69 yo F with DM, COPD, metastatic breast CA s/p cycle 1 of adriamycin/cytoxan [**5-29**] awaiting 2nd cycle who was recently seen in [**Hospital **] clinic and noted to have persistent RUE weakness. MRI C spine showed mets to C5-C7 causing moderate compression of cord. She was admitted on [**8-9**] for spine eval and treatment. She was started on steroids. Pt triggered on [**8-10**] afternoon for hypotension, low UOP, and hypoxia. Pt refused interventions. Started on broad abx and reportedly stabilized. . Tonight she was noted to be hypoxic to 85% on 6L. She was "difficult to arouse." O2 sats improved with NRB. VBG showed 7.44/47/47 w lactate 1.0. Review of prior admit suggested that she became altered almost nightly until rx with BiPAP which successfully treated her sx. This was tried on the floor but patient became hypoxic and did not tolerate mask. She is admitted to ICU for w/u and rx with BiPAP. . Currently, she reports that she wants to be left alone. She denies any CP, SOB, abd pain. . Of note, she was hypoxic during her previous admission in [**Month (only) 116**]/[**Month (only) **]. At that point, the etiology was unclear. It was thought [**2-23**] lymphangitic spread of tumor. Also considered PE (although CTA neg) and tamponade (although echo not c/w hd sig tamponade). Also considered fluid overload and she seemed to improve somewhat with diuresis. It was ultimately thought that sleep apnea was large contributor. She was treated w BiPap nightly with significant improvement in mental status. Past Medical History: 1. Diabetes. followed at [**Last Name (un) **] Diabetes Center. Her last hemoglobin A1c was 6.0 in 05/[**2104**]. 2. Hypercholesterolemia/?hypertension 3. Schizoaffective disorder. The patient is followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] and is on Clozaril with q 1 month CBCs 4. COPD/Asthma. The patient is maintained on Advair and albuterol for this. She does state that she uses her albuterol approximately one time per day. Her last pulmonary function tests were in [**2096**]. 5. h/o Falls 6. Back pain 7. ? Severe sleep apnea: as documented above and per recent d/c summary. Improved with BiPAP in the unit last month. . Breast Ca history: - dx [**2104-6-9**] w dyspnea, hypoxia, falls w right breast mass - [**6-17**]: cytoxan, adriamycin, neupogen, emend, steroids Social History: Has been residing at [**Hospital 100**] Rehab since her last hospitalization. Health Care proxy is [**Name (NI) **] [**Name (NI) **]. She does not smoke but notes that her mother smoked heavily.(HCP [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 105120**]). Family History: The patient's grandmother had coronary artery disease. Her parent's died of cervical cancer and stroke. Physical Exam: VS: 96.8 HR 97 94/43 20 100% NRB and 94% on 60% FiO2 Manual BP 126/60 w pulsus of [**6-29**] Gen: sleepy but arousable. Neuro: AAO to person, place, situation, time. Does fall asleep mid-sentence. localizes to voice, withdraws/localizes to pain. - cn: PERRLA, EOMI although limited by lack of cooperativity. face symmetric. - motor: 3/5 strength RUEx, [**5-26**] LUEx. lower ex limited by effort although at least [**3-26**] bilat. - toes equiv bilat. 1+ ankle and knee bilat Heent; Dry MM, JVP flat Cards: RRR no MGR Lungs: no rales, CTAB Abd: obese, mildly tender diffusely. No rebound or guarding Ext: edema throughout Pertinent Results: EKG [**8-10**]: NSR NA NI, TW flattening V5-V6. no apprec right heart strain other than small Q in III. . 140 102 12 ---------------< 178 3.8 31 0.5 . WBC: 11 - stable HCT: 27 - stable PLT: 526 - stable PT: 16.0 PTT: 34.3 INR: 1.4 . VBG: 7.44/47/47 lactate 1 . ABG on arrival to unit: [**Unit Number **].39/53/114/33 . CXR: my read: linear atelectasis right mid lung but no evidence of PNA. Stable widening of mediastinum. . MRI Brain prelim: Multiple intracranial metastases, many of which are leptomeningeal. Right frontal epidural metastasis. Multiple bone metastases. . [**8-9**] MRI C-spine w/o contrast: (PRELIM): Metastatic disease involving C5-C7 vertebral bodies with vertebral collapse and retropulsion and epidural component causing moderate compression on the cord. . TTE [**8-11**]: Left ventricular wall thicknesses are normal. The left ventricular cavity is unusually small. Regional left ventricular wall motion is normal. Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. There is no valvular aortic stenosis. The increased transaortic velocity is likely related to increased stroke volume due to aortic regurgitation. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. There are no echocardiographic signs of tamponade. IMPRESSION: Small, hyperdynamic left ventricle with normal regional systolic function. Trivial pericardial effusion without tamponade. Compared with the prior study (images reviewed) of [**2104-6-17**], the pericardial effusion is smaller. The other findings are similar. [**2104-8-9**] 12:50PM GLUCOSE-234* UREA N-11 CREAT-0.6 SODIUM-140 POTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-31 ANION GAP-11 [**2104-8-9**] 12:50PM estGFR-Using this [**2104-8-9**] 12:50PM ALT(SGPT)-14 AST(SGOT)-26 LD(LDH)-285* ALK PHOS-186* TOT BILI-0.3 [**2104-8-9**] 12:50PM WBC-9.3 RBC-3.44* HGB-8.9* HCT-28.9* MCV-84 MCH-25.8* MCHC-30.7* RDW-22.7* [**2104-8-9**] 12:50PM NEUTS-82.6* LYMPHS-6.9* MONOS-6.0 EOS-4.1* BASOS-0.4 [**2104-8-9**] 12:50PM PLT COUNT-623* [**2104-8-9**] 12:50PM PT-15.4* PTT-32.1 INR(PT)-1.4* Brief Hospital Course: # Metastatic breast cancer: with C5-7 cord compression, right upper extremity weakness improving on steroids. Also found to have brain metastases and the patient has been treated with Decadron. After extensive discussion with Ms. [**Known lastname 5655**], her HCP and her outpatient psychiatrist, further chemotherapy or radiation was refused. She was determined to have capacity to make this decision and understands the risk of paralysis without treatment. She will be discharged to maximize functional status and control symptoms. . # Resp failure/hypoxia: intermittent and likely related to obstructive sleep apnea. Ms [**Known lastname 5655**] refused all interventions, including BiPAP/CPAP and occassionally oxygen. She was treated with an 8 day course of antibiotics for health care associated pneumonia with improvement in her pulmonary status. She was maintained on nebulizer treatments and was on 4L O2 nasal canula at discharge. # Altered ms: underlying psychiatric illness with intermittent hypoxia related to obstructive sleep apnea and brain metastases. She waxed and waned through the hospitalization, but was at our observed baseline at discharge. Her outpatient dose of clozapine was continued initially however the patient had periods of agitation during her admission and the clozapine was held. Her agitation was treated with ativan and zydis as needed. The clozapine was not restarted on discharge. # Hypotension: The patients home dose of lisinopril was held second to her hypotension on admission. Her blood pressure remained in the 130/60-70s so the lisinopril was not restarted. She may need to be monitored for hypertension and be re-evaluated by her primary physician when lisinopril can be restarted safely. # ID: For her cough with productive sputum, the patient completed a course of vancomycin and zosyn. Her cough improved and she remained afebrile for the duration of her admission. At discharge she was complaining of dysuria and frequency, but was unable to provide a urine sample. She will be empirically treated with a 7 day course of ciprofloxacin (history of pan-sensitive e.coli in the past) # DM: Outpatient doses of NPH were continued including a sliding scale insulin as needed. #Seizure: the day prior to discharge, she had new onset complex partial seizure manifested as left lateral eye gaze with blinking and incontinence. The seizure activity was stopped with 2mg IV ativan. She was started on Keppra 500 mg [**Hospital1 **] without any recurrence of seizure activity. Medications on Admission: Albuterol IH q 4-6 hours prn aspirin 81 mg daily Clozapine 125mg qAM, 100mg qPM SC heparin advair 250-50 [**Hospital1 **] ibuprofen 600 mg tid lisinopril 10 mg daily ondansetron 4mg q8 prn oxycodone 5 mg q4 hours prn pioglitazone 45 mg daily spiriva 1 puff daily acetaminophen prn bisacodyl prn docusate sodium [**Hospital1 **] NPH 75 units q AM, 34 units in PM omeprazole 20 mg daily vitamin D 800mg daily vancomycin 1g IV q 12 metronidazole 500 PO TID Discharge Medications: 1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: [**1-23**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day). 2. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed. 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: [**1-23**] Adhesive Patch, Medicateds Topical DAILY (Daily). 7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 8. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: [**1-23**] Inhalation Q4H (every 4 hours). 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 10. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 11. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 13. Oxycodone 5 mg Capsule Sig: One (1) Capsule PO every [**4-27**] hours as needed for pain. 14. Pioglitazone 45 mg Tablet Sig: One (1) Tablet PO once a day. 15. Bisacodyl 5 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for constipation. 16. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Seventy Five (75) Units Subcutaneous qAM. 17. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Thirty Five (35) Units Subcutaneous qPM. 18. Cipro 250 mg Tablet Sig: One (1) Tablet PO every twelve (12) hours for 7 days. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Metastatic breast cancer-brain, bone C5-C7 spinal cord compression [**Hospital 77965**] Healthcare associated pneumonia Diabetes mellitus Hypertension Schizoaffective disorder with paranoia Discharge Condition: Stable, refusing further intervention for metastatic breast cancer and spinal cord compression. Goals of care are symptom control and maximization of function. Discharge Instructions: You were admitted with arm weakness and were found to have breast cancer spread to your bones and brain. You were treated with steroids, but declined further chemotherapy or radiation therapy. You will be discharged to a rehabilitation facility to help maximize your function and control your symptoms. You understand the potential for paralysis with untreated spinal cord compression. . Please call your doctor or return to the ED if you develop chest pain, shortness of breath, inability to tolerate your medications or any other concerning symptom. Followup Instructions: Please follow up with your doctors at the [**Hospital3 **] facility. [**Name6 (MD) **] [**Name8 (MD) 831**] MD, [**Doctor First Name 3018**]

198,518,197,486,174,250,295,493,458,285,327,780,272,278,V140,V142

{'Secondary malignant neoplasm of brain and spinal cord,Acute respiratory failure,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of breast (female), unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Anemia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other convulsions,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of allergy to penicillin,Personal history of allergy to sulfonamides'}

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: right upper extremity weakness, dyspnea PRESENT ILLNESS: 69 yo F with DM, COPD, metastatic breast CA s/p cycle 1 of adriamycin/cytoxan [**5-29**] awaiting 2nd cycle who was recently seen MEDICAL HISTORY: 1. Diabetes. followed at [**Last Name (un) **] Diabetes Center. Her last hemoglobin A1c was 6.0 in 05/[**2104**]. 2. Hypercholesterolemia/?hypertension 3. Schizoaffective disorder. The patient is followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] and is on Clozaril with q 1 month CBCs 4. COPD/Asthma. The patient is maintained on Advair and albuterol for this. She does state that she uses her albuterol approximately one time per day. Her last pulmonary function tests were in [**2096**]. 5. h/o Falls 6. Back pain 7. ? Severe sleep apnea: as documented above and per recent d/c summary. Improved with BiPAP in the unit last month. . Breast Ca history: - dx [**2104-6-9**] w dyspnea, hypoxia, falls w right breast mass - [**6-17**]: cytoxan, adriamycin, neupogen, emend, steroids MEDICATION ON ADMISSION: Albuterol IH q 4-6 hours prn aspirin 81 mg daily Clozapine 125mg qAM, 100mg qPM SC heparin advair 250-50 [**Hospital1 **] ibuprofen 600 mg tid lisinopril 10 mg daily ondansetron 4mg q8 prn oxycodone 5 mg q4 hours prn pioglitazone 45 mg daily spiriva 1 puff daily acetaminophen prn bisacodyl prn docusate sodium [**Hospital1 **] NPH 75 units q AM, 34 units in PM omeprazole 20 mg daily vitamin D 800mg daily vancomycin 1g IV q 12 metronidazole 500 PO TID ALLERGIES: Penicillins / Codeine / Sulfonamides PHYSICAL EXAM: VS: 96.8 HR 97 94/43 20 100% NRB and 94% on 60% FiO2 Manual BP 126/60 w pulsus of [**6-29**] Gen: sleepy but arousable. Neuro: AAO to person, place, situation, time. Does fall asleep mid-sentence. localizes to voice, withdraws/localizes to pain. FAMILY HISTORY: The patient's grandmother had coronary artery disease. Her parent's died of cervical cancer and stroke. SOCIAL HISTORY: Has been residing at [**Hospital 100**] Rehab since her last hospitalization. Health Care proxy is [**Name (NI) **] [**Name (NI) **]. She does not ### Response: {'Secondary malignant neoplasm of brain and spinal cord,Acute respiratory failure,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of breast (female), unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Anemia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other convulsions,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of allergy to penicillin,Personal history of allergy to sulfonamides'}

CHIEF COMPLAINT: Dyspnea and chest discomfort. PRESENT ILLNESS: The patient is a 53-year-old female with Crohn's disease with increased dyspnea on exertion and mild chest discomfort this morning. The patient was found to have large bilateral pulmonary emboli affecting all segmental branches. MEDICAL HISTORY: 1. Crohn's disease for 18 years; on chronic steroids. 2. Status post fistulectomy 12 years ago. 3. Thrombocytosis; deemed secondary to Crohn's disease. Peak count is 1.2 times 10:6 per the patient. 4. Bilateral cataracts; status post surgery on the right. 5. Status post cervical conization in [**2110**] for dysplasia. 6. History of pleurisy in her 30s. 7. History of shingles on her right face 25 years ago. 8. History of right calf thrombophlebitis; on topical estrogen. 9. History of iron deficiency anemia. 10. History of a miscarriage. MEDICATION ON ADMISSION: 1. Doxycycline 100 mg p.o. twice per day. 2. Prednisone 10 mg p.o. twice per day. 3. Progesterone topically. 4. Aspirin 81 mg p.o. once per week. ALLERGIES: CIPROFLOXACIN and BIAXIN (give the patient hives). CODEINE (gives the patient nausea and vomiting). PHYSICAL EXAM: FAMILY HISTORY: Paternal grandfather passed away of diabetes at the age of 88. Paternal grandmother passed away of uterine cancer at the age of 48. Mother's grandmother alive with a stroke. Father alive at 80, living with neuropathy. Mother died at the age of 77 from idiopathic cirrhosis. SOCIAL HISTORY: Marketing in sales for a high-technical investment company. Very sedentary long daily commute. The patient is not married. She lives with a roommate. No tobacco. Three to four glasses of wine per week.

Other pulmonary embolism and infarction,Regional enteritis of unspecified site

Pulm embol/infarct NEC,Regional enteritis NOS

Admission Date: [**2133-7-2**] Discharge Date: [**2133-7-9**] Date of Birth: [**2080-4-26**] Sex: F Service: Medicine CHIEF COMPLAINT: Dyspnea and chest discomfort. HISTORY OF PRESENT ILLNESS: The patient is a 53-year-old female with Crohn's disease with increased dyspnea on exertion and mild chest discomfort this morning. The patient was found to have large bilateral pulmonary emboli affecting all segmental branches. Approximately one year ago she was diagnosed with a right calf thrombophlebitis by her gynecologist in the setting of estrogen therapy. The patient was switched off estrogen and onto monotherapy with progesterone. No further workup was pursued at that time, and she was not anticoagulated. Approximately eleven days ago the patient returned from a 2-hour flight from [**State **] and noted tenderness while walking up the stairs at the airport. She then noted left calf pain over the next several days without swelling which seemed to resolve over the weekend. Then, this morning, she was in the shower when she noted transient sharp pain in her left thigh lasting for minutes, followed by the sudden onset of chest discomfort and feeling winded while walking across the room. Her chest pain lasted two hours and was resolved by the time she had reached the hospital. She was directed to the Emergency Department by her primary care physician and found to be in sinus tachycardia at 130 to 140 beats per minute. The patient was hemodynamically stable. White blood cell count was 20. A computerized axial tomography and arteriogram showed large bilateral pulmonary emboli. REVIEW OF SYSTEMS: Review of systems was negative for fevers, chills, headaches, or changes in vision. The patient denied syncope, nausea, vomiting, cough, dysuria, or gout aches. The patient reports urinary frequency since this morning. Positive multiple crampy loose bowel movements (six to eight per day times one day). PAST MEDICAL HISTORY: 1. Crohn's disease for 18 years; on chronic steroids. 2. Status post fistulectomy 12 years ago. 3. Thrombocytosis; deemed secondary to Crohn's disease. Peak count is 1.2 times 10:6 per the patient. 4. Bilateral cataracts; status post surgery on the right. 5. Status post cervical conization in [**2110**] for dysplasia. 6. History of pleurisy in her 30s. 7. History of shingles on her right face 25 years ago. 8. History of right calf thrombophlebitis; on topical estrogen. 9. History of iron deficiency anemia. 10. History of a miscarriage. MEDICATIONS ON ADMISSION: 1. Doxycycline 100 mg p.o. twice per day. 2. Prednisone 10 mg p.o. twice per day. 3. Progesterone topically. 4. Aspirin 81 mg p.o. once per week. ALLERGIES: CIPROFLOXACIN and BIAXIN (give the patient hives). CODEINE (gives the patient nausea and vomiting). SOCIAL HISTORY: Marketing in sales for a high-technical investment company. Very sedentary long daily commute. The patient is not married. She lives with a roommate. No tobacco. Three to four glasses of wine per week. FAMILY HISTORY: Paternal grandfather passed away of diabetes at the age of 88. Paternal grandmother passed away of uterine cancer at the age of 48. Mother's grandmother alive with a stroke. Father alive at 80, living with neuropathy. Mother died at the age of 77 from idiopathic cirrhosis. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination revealed vital signs with a temperature of 99.9, blood pressure was 126/81, heart rate was 130s and regular, respiratory rate was 16, and the patient's oxygen saturation was 98% to 100% on 2.5 liters via nasal cannula. In general, a pleasant and well-appearing 53-year-old white female in no apparent distress. She appeared comfortable. She was speaking in full sentences. Skin was warm and dry. Sclerae were anicteric. No rashes. Head, eyes, ears, nose, and throat examination revealed the right pupil was surgical. The left pupil was reactive. Positive cataracts. The oropharynx was clear. The neck was supple. Jugular venous pulsation about 8 cm. The lungs were clear to auscultation bilaterally. Resonant to percussion. Cardiovascular examination revealed tachycardia, regular. A 2/6 systolic murmur at the base. No heaves. Abdominal examination revealed bowel sounds were present. The abdomen was soft and nontender. No hepatosplenomegaly. Rectal examination was guaiac-negative (per the Emergency Department). Extremities were symmetric. No edema. No calf tenderness or cords. Mild tenderness to palpation of the left calf and thigh. Neurologic examination revealed cranial nerves II through XII were grossly intact. Fully alert and oriented. The patient was appropriate. Moved all extremities. PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratories revealed white blood cell count was 20.1, hematocrit was 29.5, and platelets were 174. Prothrombin time was 13, INR was 1.1, and partial thromboplastin time was 26.9. Sodium was 141, potassium was 4.4, chloride was 106, bicarbonate was 21, blood urea nitrogen was 19, creatinine was 1, and blood glucose was 75. Creatine kinase was 23. Troponin was 1. PERTINENT RADIOLOGY/IMAGING: A computerized axial tomography of the chest revealed bilateral pulmonary emboli affecting all segmental branches. No adenopathy. No effusions. A small pericardial effusion. A chest x-ray was negative. Electrocardiogram revealed sinus tachycardia with a rate of 127. Normal axis and normal intervals. Early precordial transition. HOSPITAL COURSE BY ISSUE/SYSTEM: The patient was admitted to the Intensive Care Unit. She remained tachycardic but hemodynamically stable. She was started on a heparin bolus in the Emergency Department and was continued on a heparin drip. A bedside echocardiogram was done which showed the left atrium was normal in size. Left ventricular wall thickness and systolic function were normal with an ejection fraction of 55%. The right ventricular size and free wall motion were normal. The aortic valve leaflets appeared structurally normal with good leaflet excursion. No aortic regurgitation. There was moderate pulmonary artery systolic hypertension, but no pericardial effusions. The patient was kept overnight in the Intensive Care Unit and did well. For her Crohn's disease, she was continued on her home regimen of doxycycline and prednisone. The patient was hydrated with intravenous fluids while in the Intensive Care Unit. The patient was moved out of the Intensive Care Unit on [**7-3**] to the Medicine Service/[**Hospital1 139**] Firm. She was started on Coumadin 5 mg on the evening of [**7-3**] and was ordered to have 72 hours of bed rest. It was decided not to give the patient an inferior vena cava filter. The patient was continued on a heparin drip until the Coumadin was therapeutic. Coumadin became therapeutic on day five with an INR of 2.1. The heparin drip was continued and overlapped for 24 hours with Coumadin to reach a final INR of 2.5 prior to discharge. The patient remained on bed rest for 72 hours. After this, she was ambulating with ease. However, she was still complaining of some mild chest discomfort. On [**7-8**], prior to discharge, a second computerized axial tomography was ordered to look at further showering of pulmonary embolus; however, the results showed a lessening of clot burden. The patient was deemed stable for discharge and was to continue her Coumadin at 5 mg p.o. q.h.s. and was to follow up with her primary care physician (Dr. [**Last Name (STitle) 931**] on Tuesday, [**7-14**]. CONDITION AT DISCHARGE: Condition on discharge was stable. MEDICATIONS ON DISCHARGE: (The patient's discharge medications included) 1. Doxycycline 100 mg p.o. twice per day. 2. Prednisone 10 mg p.o. twice per day. 3. Progesterone topically. 4. Aspirin 81 mg p.o. once per week. 5. Coumadin 5 mg p.o. q.h.s. DISCHARGE INSTRUCTIONS/FOLLOWUP: The patient was to have blood work drawn to check her INR at her visit with Dr. [**Last Name (STitle) 931**] on Tuesday, [**7-14**]. DISCHARGE DIAGNOSES: 1. Large bilateral pulmonary emboli. 2. Crohn's disease. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D. [**MD Number(1) 1212**] Dictated By:[**Last Name (NamePattern1) 9244**] MEDQUIST36 D: [**2133-7-9**] 18:46 T: [**2133-7-16**] 10:46 JOB#: [**Job Number 8011**]

415,555

{'Other pulmonary embolism and infarction,Regional enteritis of unspecified site'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Dyspnea and chest discomfort. PRESENT ILLNESS: The patient is a 53-year-old female with Crohn's disease with increased dyspnea on exertion and mild chest discomfort this morning. The patient was found to have large bilateral pulmonary emboli affecting all segmental branches. MEDICAL HISTORY: 1. Crohn's disease for 18 years; on chronic steroids. 2. Status post fistulectomy 12 years ago. 3. Thrombocytosis; deemed secondary to Crohn's disease. Peak count is 1.2 times 10:6 per the patient. 4. Bilateral cataracts; status post surgery on the right. 5. Status post cervical conization in [**2110**] for dysplasia. 6. History of pleurisy in her 30s. 7. History of shingles on her right face 25 years ago. 8. History of right calf thrombophlebitis; on topical estrogen. 9. History of iron deficiency anemia. 10. History of a miscarriage. MEDICATION ON ADMISSION: 1. Doxycycline 100 mg p.o. twice per day. 2. Prednisone 10 mg p.o. twice per day. 3. Progesterone topically. 4. Aspirin 81 mg p.o. once per week. ALLERGIES: CIPROFLOXACIN and BIAXIN (give the patient hives). CODEINE (gives the patient nausea and vomiting). PHYSICAL EXAM: FAMILY HISTORY: Paternal grandfather passed away of diabetes at the age of 88. Paternal grandmother passed away of uterine cancer at the age of 48. Mother's grandmother alive with a stroke. Father alive at 80, living with neuropathy. Mother died at the age of 77 from idiopathic cirrhosis. SOCIAL HISTORY: Marketing in sales for a high-technical investment company. Very sedentary long daily commute. The patient is not married. She lives with a roommate. No tobacco. Three to four glasses of wine per week. ### Response: {'Other pulmonary embolism and infarction,Regional enteritis of unspecified site'}

CHIEF COMPLAINT: Trauma: PRESENT ILLNESS: This patient is a 19 year old male who complains of LIVER LAC. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital where he was kneed in the epigastrium playing football at approximately 5 PM. He ultimately had a CT scan of his abdomen which showed a significant liver laceration with hemoperitoneum. He feels slightly dizzy. No other injuries sustained. His blood pressure en route trended down from 120 systolic to 100 systolic, with a heart rate persistently in the 60s. MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAMINATION: upon admission [**9-30**] FAMILY HISTORY: nc SOCIAL HISTORY: quit smoking 1 week ago, social EtOH, no IVDU

Injury to liver without mention of open wound into cavity, laceration, major,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Striking against or struck accidentally by object in sports with subsequent fall

Liver laceration, major,Peritoneum injury-closed,Sports acc w sub fall

Admission Date: [**2161-9-30**] Discharge Date: [**2161-10-4**] Date of Birth: [**2141-12-26**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern1) 4659**] Chief Complaint: Trauma: abdominal pain related to knee to epigastrium Major Surgical or Invasive Procedure: none History of Present Illness: This patient is a 19 year old male who complains of LIVER LAC. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital where he was kneed in the epigastrium playing football at approximately 5 PM. He ultimately had a CT scan of his abdomen which showed a significant liver laceration with hemoperitoneum. He feels slightly dizzy. No other injuries sustained. His blood pressure en route trended down from 120 systolic to 100 systolic, with a heart rate persistently in the 60s. Past Medical History: none Social History: quit smoking 1 week ago, social EtOH, no IVDU Family History: nc Physical Exam: PHYSICAL EXAMINATION: upon admission [**9-30**] HR: 67 BP: 107/60 Resp: 18 O(2)Sat: 100 Normal Constitutional: Comfortable HEENT: Normocephalic, atraumatic Oropharynx within normal limits Chest: Clear to auscultation Cardiovascular: Regular Rate and Rhythm Abdominal: Soft, Nondistended mild diffuse tenderness. Fast exam positive in right upper, left upper, and bladder views Rectal: Heme Negative GU/Flank: No costovertebral angle tenderness Extr/Back: No cyanosis, clubbing or edema Skin: No rash d/c vitals & PE 96.7 79 116/70 16 98% RA Constitutional: Comfortable, happy to leave HEENT: NC/AT Chest: CTAB CV: RRR, no m/r/g Abdominal: Soft, Nondistended mild uConstitutional: Comfortable HEENT: Normocephalic, atraumatic Oropharynx within normal limits Chest: Clear to auscultation Cardiovascular: Regular Rate and Rhythm Abdominal: Soft, Nondistended mild upper abdominal tenderness. Skin: No rash Pertinent Results: [**2161-10-2**] 05:20AM BLOOD WBC-10.4# RBC-3.99* Hgb-11.8* Hct-30.5* MCV-76* MCH-29.5 MCHC-38.6* RDW-15.9* Plt Ct-178 [**2161-10-2**] 12:24AM BLOOD Hct-31.1* [**2161-10-1**] 06:00PM BLOOD Hct-32.0* [**2161-9-30**] 01:00AM BLOOD WBC-11.6* RBC-4.34* Hgb-12.6* Hct-33.4* MCV-77* MCH-29.2 MCHC-37.8* RDW-16.3* Plt Ct-177 [**2161-9-30**] 01:00AM BLOOD Neuts-87.8* Lymphs-7.9* Monos-3.3 Eos-1.0 Baso-0.1 [**2161-10-2**] 05:20AM BLOOD Plt Ct-178 [**2161-10-1**] 04:16AM BLOOD Plt Ct-143* [**2161-9-30**] 03:10AM BLOOD PT-13.1 PTT-22.3 INR(PT)-1.1 [**2161-10-2**] 05:20AM BLOOD Glucose-88 UreaN-9 Creat-0.8 Na-134 K-3.8 Cl-96 HCO3-27 AnGap-15 [**2161-10-1**] 06:23AM BLOOD Glucose-117* Na-136 K-3.6 Cl-100 [**2161-10-2**] 05:20AM BLOOD ALT-380* AST-139* AlkPhos-96 TotBili-2.4* [**2161-9-30**] 03:10AM BLOOD ALT-585* AST-527* AlkPhos-110 TotBili-1.0 [**2161-10-2**] 05:20AM BLOOD Calcium-9.0 Phos-3.9# Mg-1.8 [**2161-10-1**] 04:16AM BLOOD Calcium-7.5* Phos-2.1*# Mg-1.7 [**2161-10-2**] 12:24AM BLOOD Hct-31.1* [**2161-10-2**] 05:20AM BLOOD WBC-10.4# RBC-3.99* Hgb-11.8* Hct-30.5* MCV-76* MCH-29.5 MCHC-38.6* RDW-15.9* Plt Ct-178 [**2161-10-3**] 06:00AM BLOOD WBC-7.1 RBC-3.90* Hgb-11.5* Hct-29.8* MCV-77* MCH-29.5 MCHC-38.5* RDW-15.9* Plt Ct-187 [**2161-10-4**] 06:10AM BLOOD WBC-5.8 RBC-3.98* Hgb-11.5* Hct-30.0* MCV-75* MCH-29.0 MCHC-38.5* RDW-15.8* Plt Ct-201 [**2161-10-2**] 05:20AM BLOOD ALT-380* AST-139* AlkPhos-96 TotBili-2.4* [**2161-10-3**] 06:00AM BLOOD ALT-282* AST-79* AlkPhos-92 TotBili-1.7* [**2161-10-4**] 06:10AM BLOOD ALT-205* AST-48* AlkPhos-92 TotBili-1.4 [**2161-9-30**]: cat scan abdomen and pelvis: IMPRESSION: 1. Extensive liver laceration, extending from the lateral hepatic lobe to the hilum, with regions of devascularization but no active extravasation. The overall degree of injury is comparable to the initial study from the outside hospital. Moderate amount of hemorrhagic fluid around the perihepatic region, without significant interval increase in volume. 2. No evidence of other solid organ or hollow viscus injury. No acute fracture. 3. No intrathoracic acute injury. No pericardial effusion. [**2161-10-1**]: EKG: Sinus rhythm. Within normal limits. No previous tracing available for comparison. [**2161-10-2**]: Gallbladder: IMPRESSION: Two intrahepatic foci in the right lobe of the liver that accumulate radiotracer up until 45 minutes and then remains stable for the remainder of the study which lasted 85 minutes. These foci likely represent a contained bile leaks or bilomas [**2161-10-3**]: CT Abd/Pelvis w/contrast IMPRESSION: 1. Unchanged liver laceration. 2. Shift of the hemoperitoneum from the upper abdomen to the dependent part of the pelvis. 3. No drainable fluid collections are seen in the abdomen. Brief Hospital Course: 19 year old gentleman admitted to the acute care service after he received a knee to the epigastric area while playing football. Initial admission to an outside hospital where he received additional fluids, but remained hemodynamically stable. Radiographic imaging showed a grade 4 liver laceration with a hemoperitoneum. He was transferred here and admitted to the intensive care unit where he remained NPO, given intraveous fluids, and had serial blood counts drawn. On HD #2, he was transferred to the surgical floor where he was started on clear liquids with progression to a regular diet. His hematocrit remained stable at 30. His abdominal pain was controlled with both intravenous and oral analgesia. On HD # 3, he was found to have elevated liver studies with a bilirubin of 2.4. He underwent a HIDA scan which showed 2 areas of retained contrast in the liver concerning for bilomas or bile leakage. His liver enzymes continued to trend downward, he had a CT scan on HD#4 which did not reveal any drainable focus. ERCP was contact[**Name (NI) **] who commented that given the improvement in liver enzymes he does not require stenting or ERCP at this time. He has been tolerating a regular diet and pain is well controlled with tramadol, seldom needing breakthrough medication. Medications on Admission: none Discharge Medications: 1. tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*40 Tablet(s)* Refills:*0* 2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain: Use for pain when tramadol is not effective. Disp:*30 Tablet(s)* Refills:*0* 3. docusate sodium 100 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Trauma: grade 4 liver laceration 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 you were kneed during a football game. YOu were found to have a laceration to your liver. You were monitored in the intensive care unit and transferred to the surgical floor once your vital signs stabilized. You are now preparing for discharge home with the following instrucitons: *Please rest for 2 weeks *AVOID contact sports and/or any activity that may cause injury to your abdominal area for the next 6-8 weeks. *If you suddenly become dizzy, lightheaded, feeling as if you are going to pass out go to the nearest Emergency Room as this could be a sign that you are having inernal bleeding from your liver or spleen injury. *AVOID any blood thinners such as Motrin, Naprosyn, Indocin, Aspirin, Coumadin or Plavix for at least 3-5 days unless otherwise instructed by the MD/NP/PA. Please report the following: *fainting *dizzinesss *increased abdominal pain *racing heart *lightheaded-ness Followup Instructions: Please follow-up with the acute care service in 2 weeks. You can schedule your appointment 24 hours after discharge by calling # [**Telephone/Fax (1) 600**]. You should also follow-up with your primary care provider [**Last Name (NamePattern4) **] [**1-4**] weeks. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **] MD, [**MD Number(3) 4661**] Completed by:[**2161-10-4**]

864,868,E917

{'Injury to liver without mention of open wound into cavity, laceration, major,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Striking against or struck accidentally by object in sports with subsequent fall'}

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: Trauma: PRESENT ILLNESS: This patient is a 19 year old male who complains of LIVER LAC. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital where he was kneed in the epigastrium playing football at approximately 5 PM. He ultimately had a CT scan of his abdomen which showed a significant liver laceration with hemoperitoneum. He feels slightly dizzy. No other injuries sustained. His blood pressure en route trended down from 120 systolic to 100 systolic, with a heart rate persistently in the 60s. MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAMINATION: upon admission [**9-30**] FAMILY HISTORY: nc SOCIAL HISTORY: quit smoking 1 week ago, social EtOH, no IVDU ### Response: {'Injury to liver without mention of open wound into cavity, laceration, major,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Striking against or struck accidentally by object in sports with subsequent fall'}

CHIEF COMPLAINT: Carotid stenosis PRESENT ILLNESS: MEDICAL HISTORY: PMH: orthostatic hypotension p CVA, GERD, CRI, laryngeal CA (s/p surgery and [**Month/Day/Year 16859**]), PTSD, ex-smoker MEDICATION ON ADMISSION: ambien 10hs, coumadin 5', flomax 0.8', klonopin 0.5", florinef 0.2', percocet, zantac 300', vicodin, zoloft 200', dipyridamole 75" ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Tracheostomy status,Personal history of malignant neoplasm of larynx

Ocl crtd art wo infrct,Mal hy kid w cr kid I-IV,Chronic kidney dis NOS,Tracheostomy status,Hx-laryngeal malignancy

Admission Date: [**2145-3-2**] Discharge Date: [**2145-3-6**] Date of Birth: [**2072-4-10**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4748**] Chief Complaint: Carotid stenosis Major Surgical or Invasive Procedure: R CEA [**2145-3-2**] Past Medical History: PMH: orthostatic hypotension p CVA, GERD, CRI, laryngeal CA (s/p surgery and [**Month/Day/Year 16859**]), PTSD, ex-smoker PSH: laryngectomy '[**31**], trach for tracheal stenosis, L CEA of external '[**39**] (L internal occluded), GT, TURP Pertinent Results: [**2145-3-2**] 12:30PM GLUCOSE-210* UREA N-17 CREAT-1.0 POTASSIUM-3.6 [**2145-3-2**] 12:30PM HCT-27.5* [**2145-3-2**] 12:30PM PT-15.3* INR(PT)-1.4* Brief Hospital Course: Patient was admitted for R CEA. He underwent surgery without intraoperative complications. Post-operative, his course was complicated by a labile blood pressure with SBP's as high as 220 despite, nitro, lopressor, and hydralazine. He was transferred to the SICU for a higher level of care until his blood pressure could be stabilized. On POD 3 his blood pressure stabilized on his home doses of anti-hypertensives and he was transferred back to [**Hospital Ward Name 121**] 11. On route to [**Hospital Ward Name 121**] 11, his G-tube came out. It was replaced with a new tube and the position was confirmed with a gastrograffin KUB. The patient was discharged on POD 4 doing well, tolerating a regular diet, with a stable BP, and no new neurological deficits. Medications on Admission: ambien 10hs, coumadin 5', flomax 0.8', klonopin 0.5", florinef 0.2', percocet, zantac 300', vicodin, zoloft 200', dipyridamole 75" Discharge Medications: 1. Dipyridamole 75 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. 3. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Sertraline 100 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: Two (2) Capsule, Sust. Release 24HR PO HS (at bedtime). 6. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*20 Tablet(s)* Refills:*0* 7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*2* 9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 10. Fludrocortisone 0.1 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: GERD CRI laryngeal CA s/p laryngectomy and [**Name (NI) 16859**] PTSD trachostomy L external carotid endarterectomy TURP G tube R CEA [**2145-3-2**] Discharge Condition: Good Discharge Instructions: You may shower. Pat incision dry immediately afterward. Allow tapes on incision to fall off. You may remove them [**3-11**] if still in place. You may not drive until after you've seen Dr. [**Last Name (STitle) 1391**] in follow-up. Call your Primary Care Provider and make an appointment this week to assess your blood pressure. Followup Instructions: On [**Last Name (LF) 766**], [**3-8**], please call [**Telephone/Fax (1) 1393**] to make an appointment to see Dr. [**Last Name (STitle) 1391**]

433,403,585,V440,V102

{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Tracheostomy status,Personal history of malignant neoplasm of larynx'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Carotid stenosis PRESENT ILLNESS: MEDICAL HISTORY: PMH: orthostatic hypotension p CVA, GERD, CRI, laryngeal CA (s/p surgery and [**Month/Day/Year 16859**]), PTSD, ex-smoker MEDICATION ON ADMISSION: ambien 10hs, coumadin 5', flomax 0.8', klonopin 0.5", florinef 0.2', percocet, zantac 300', vicodin, zoloft 200', dipyridamole 75" ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Tracheostomy status,Personal history of malignant neoplasm of larynx'}

CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: 65 year old male with hx/o PCI x7 who presents with unstable angina. He has had anginal symptoms that have increased in severity over the past four days. He believes he may have had symmptoms related to his heart since [**Month (only) 1096**]. At that time he experienced intermittent sharp & "tight" right subscapular pain that occurred while he was sleeping & also on turning his head to the right. He has not experienced any limitation on physical activity until roughly 4 days ago. At that time, he noticed substernal chest pain associated with severe diaphoresis on walking to work (roughly 7 minutes into his walk). This pain was relieved immediately on rest. He had another episode of this pain while walking to his car which was associated with diaphoresis, tingling on the ulnar aspect of his right hand, & nausea. He was admitted for further evaluation. He was found to have LAD disease upon cardiac catheterization and is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: Coronary artery disease s/p Myocardial infarction x 2 PCI [**2171**] BMS x 3 to dRCA PCI [**2167**] [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 4 to pRCA Hypertension Hyperlipidemia Post-MI depression Gout Ulnar neuropathy Internal & external hemorrhoids MEDICATION ON ADMISSION: Atenolol-Chlorthalidone 100 mg/25 mg daily Aspirin 325 mg daily Plavix 75 mg daily Ramipril 20 mg daily Escitalopram 10 mg daily Lipitor 80 mg daily Indomethacin 75 mg ER [**Hospital1 **] AC PRN gout ALLERGIES: Penicillins / antitoxin PHYSICAL EXAM: Pulse:62 Resp:12 O2 sat:99/RA B/P Right:163/97 Left:165/98 Height: 5'6" Weight: 162 lbs FAMILY HISTORY: - Father: Died at 49 from MI (had 2 MIs total) - Mother: Died at 94 from "old age" SOCIAL HISTORY: - Married, no children - Works in as medical malpractice lawyer - [**Name (NI) 1139**]: Smoked up to 3 ppd x 20 years (quit 23 yrs ago) - EtOH: 1 glass of wine or beer daily - Illicit: Denies

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Gout, unspecified,Other and unspecified hyperlipidemia,Constipation, unspecified,Other iatrogenic hypotension,Hiccough,Anemia, unspecified,Personal history of tobacco use,Family history of ischemic heart disease

Crnry athrscl natve vssl,Intermed coronary synd,Status-post ptca,Old myocardial infarct,Hypertension NOS,Gout NOS,Hyperlipidemia NEC/NOS,Constipation NOS,Iatrogenc hypotnsion NEC,Hiccough,Anemia NOS,History of tobacco use,Fam hx-ischem heart dis

Admission Date: [**2175-3-28**] Discharge Date: [**2175-4-1**] Date of Birth: [**2109-5-8**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins / antitoxin Attending:[**First Name3 (LF) 1406**] Chief Complaint: Chest Pain Major Surgical or Invasive Procedure: [**2175-3-28**] Coronary artery bypass grafting x3 with the left internal mammary artery to left anterior descending artery and reverse saphenous vein graft to posterior descending artery and the obtuse marginal artery History of Present Illness: 65 year old male with hx/o PCI x7 who presents with unstable angina. He has had anginal symptoms that have increased in severity over the past four days. He believes he may have had symmptoms related to his heart since [**Month (only) 1096**]. At that time he experienced intermittent sharp & "tight" right subscapular pain that occurred while he was sleeping & also on turning his head to the right. He has not experienced any limitation on physical activity until roughly 4 days ago. At that time, he noticed substernal chest pain associated with severe diaphoresis on walking to work (roughly 7 minutes into his walk). This pain was relieved immediately on rest. He had another episode of this pain while walking to his car which was associated with diaphoresis, tingling on the ulnar aspect of his right hand, & nausea. He was admitted for further evaluation. He was found to have LAD disease upon cardiac catheterization and is now being referred to cardiac surgery for revascularization. Past Medical History: Coronary artery disease s/p Myocardial infarction x 2 PCI [**2171**] BMS x 3 to dRCA PCI [**2167**] [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 4 to pRCA Hypertension Hyperlipidemia Post-MI depression Gout Ulnar neuropathy Internal & external hemorrhoids Social History: - Married, no children - Works in as medical malpractice lawyer - [**Name (NI) 1139**]: Smoked up to 3 ppd x 20 years (quit 23 yrs ago) - EtOH: 1 glass of wine or beer daily - Illicit: Denies Family History: - Father: Died at 49 from MI (had 2 MIs total) - Mother: Died at 94 from "old age" Physical Exam: Pulse:62 Resp:12 O2 sat:99/RA B/P Right:163/97 Left:165/98 Height: 5'6" Weight: 162 lbs General: awake, alert, NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur [] grade ______ Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema [] _none_ Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right: palp Left: palp DP Right: palp Left: palp PT [**Name (NI) 167**]: palp Left: palp Radial Right: palp Left: palp R radial art s/p puncture, c/d/i, minimal ooze on gauze, no hematoma Carotid Bruit Right: none Left: none Discharge Exam: VS: T: 99.1 HR: 74-100 SR BP: 76-131/77 Sats: 93% RA WT: 75.5 kg General: 65 year-old male in no apparent distress HEENT: mucus membranes moist Neck: supple no lymphadenopathy Card: RRR normal S1,S2 no murmur Resp: decreased breath sounds throughout. No crackles or wheezes GI: abdomen soft non-tender/non-distended Extr: warm no edema Incision: sternal and LLE clean, dry intact no erythema or discharge Neuro: awake, alert oriented moves all extremities Pertinent Results: [**2175-3-28**] Echo: PRE-BYPASS: No spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. A patent foramen ovale is present. A left-to-right shunt across the interatrial septum is seen at rest. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with hypokinesis of the mid inferior wall. Overall left ventricular systolic function is low normal (LVEF 50-55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. There are complex (>4mm) atheroma in the aortic arch. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no 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. CXR: [**2175-4-1**]: The left basal chest tube has been removed since the preceding radiograph. No pneumothorax is identified. Increased atelectasis in the left lower lobe and a small stable left pleural effusion are noted. The right lung is clear. A small amount of pneumomediastinum is expected postoperatively. The patient is status post median sternotomy and CABG with wires intact. The cardiac silhouette is enlarged but stable. [**2175-4-1**] WBC-7.8 RBC-2.84* Hgb-9.2* Hct-25.2* MCV-89 MCH-32.2* MCHC-36.3* RDW-12.8 Plt Ct-215 [**2175-3-28**] WBC-10.9 RBC-3.40*# Hgb-10.8*# Hct-31.2*# MCV-92 MCH-31.7 MCHC-34.6 RDW-12.5 Plt Ct-193 [**2175-4-1**] UreaN-12 Creat-0.7 Na-136 K-3.3 Cl-95* [**2175-3-28**] UreaN-13 Creat-0.8 Na-134 K-3.4 Cl-106 HCO3-24 AnGap-7* [**2175-4-1**] Mg-2.0 [**2175-3-28**] 12:37 MRSA SCREEN (Final [**2175-3-30**]): No MRSA isolated. Brief Hospital Course: Mr. [**Known lastname 24975**] was a same day admit and on [**3-28**] he was brought directly to the operating room where he underwent a coronary artery bypass graft x 3. Please see operative note for surgical details. Following surgery he was transferred to the CVICU in stable condition for invasive monitoring. Later this day he was weaned from sedation, 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 step-down floor for further care. Chest tubes and epicardial pacing wires were removed per protocol. Aggressive pulmonary toilet and good pain control he titrated off oxygen. His beta-blocker were titrated as needed. His home dose Plavix was continued. The Foley was replaced for failure to voided. Bladder scan with 950 cc. Renal function normal. He was given multiple laxatives for constipation with success. He worked with physical therapy for strength and conditioning and was cleared for home. He continued to make steady progress and was discharged to home with VNA on [**2175-4-1**]. He will follow-up as an outpatient. Medications on Admission: Atenolol-Chlorthalidone 100 mg/25 mg daily Aspirin 325 mg daily Plavix 75 mg daily Ramipril 20 mg daily Escitalopram 10 mg daily Lipitor 80 mg daily Indomethacin 75 mg ER [**Hospital1 **] AC PRN gout Discharge Medications: 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*5* 2. escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever or pain. 7. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 8. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: tba Discharge Diagnosis: Coronary artery disease s/p Coronary artery bypass graft x 3 Past medical history: Myocardial infarction x 2 PCI [**2171**] BMS x 3 to dRCA PCI [**2167**] [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 4 to pRCA Hypertension Hyperlipidemia Post-MI depression Gout Ulnar neuropathy Internal & external hemorrhoids Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema: none 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 cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: Please call Dr.[**Name (NI) 10342**] office [**Telephone/Fax (1) 170**] on Monday [**2175-4-3**] for a follow-up appointment with him and for the [**Hospital 409**] Clinic Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 24976**]: please call his office for a follow-up appointment within 3 weeks Please call to schedule appointments with your Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 131**] in [**5-11**] 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** Completed by:[**2175-4-1**]

414,411,V458,412,401,274,272,564,458,786,285,V158,V173

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Gout, unspecified,Other and unspecified hyperlipidemia,Constipation, unspecified,Other iatrogenic hypotension,Hiccough,Anemia, unspecified,Personal history of tobacco use,Family history of ischemic heart disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: 65 year old male with hx/o PCI x7 who presents with unstable angina. He has had anginal symptoms that have increased in severity over the past four days. He believes he may have had symmptoms related to his heart since [**Month (only) 1096**]. At that time he experienced intermittent sharp & "tight" right subscapular pain that occurred while he was sleeping & also on turning his head to the right. He has not experienced any limitation on physical activity until roughly 4 days ago. At that time, he noticed substernal chest pain associated with severe diaphoresis on walking to work (roughly 7 minutes into his walk). This pain was relieved immediately on rest. He had another episode of this pain while walking to his car which was associated with diaphoresis, tingling on the ulnar aspect of his right hand, & nausea. He was admitted for further evaluation. He was found to have LAD disease upon cardiac catheterization and is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: Coronary artery disease s/p Myocardial infarction x 2 PCI [**2171**] BMS x 3 to dRCA PCI [**2167**] [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 4 to pRCA Hypertension Hyperlipidemia Post-MI depression Gout Ulnar neuropathy Internal & external hemorrhoids MEDICATION ON ADMISSION: Atenolol-Chlorthalidone 100 mg/25 mg daily Aspirin 325 mg daily Plavix 75 mg daily Ramipril 20 mg daily Escitalopram 10 mg daily Lipitor 80 mg daily Indomethacin 75 mg ER [**Hospital1 **] AC PRN gout ALLERGIES: Penicillins / antitoxin PHYSICAL EXAM: Pulse:62 Resp:12 O2 sat:99/RA B/P Right:163/97 Left:165/98 Height: 5'6" Weight: 162 lbs FAMILY HISTORY: - Father: Died at 49 from MI (had 2 MIs total) - Mother: Died at 94 from "old age" SOCIAL HISTORY: - Married, no children - Works in as medical malpractice lawyer - [**Name (NI) 1139**]: Smoked up to 3 ppd x 20 years (quit 23 yrs ago) - EtOH: 1 glass of wine or beer daily - Illicit: Denies ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Gout, unspecified,Other and unspecified hyperlipidemia,Constipation, unspecified,Other iatrogenic hypotension,Hiccough,Anemia, unspecified,Personal history of tobacco use,Family history of ischemic heart disease'}

CHIEF COMPLAINT: ? seizure PRESENT ILLNESS: Ms. [**Known lastname 31390**] is a 73-year-old right-handed female with a history of hypertension, hyperlipidemia, and probable right pontine lacunar stroke (she presented with right CN VI and VII palsies that have since resolved) in [**2137**] who was noted by her son on [**2139-5-6**] to be in her usual state of good health. They were riding in the car, and at one point during the ride he asked her a question and got no response. When he looked over to see if she had heard him, he saw that she was flexing both arms and arching her back, a position she held for one minute. This was followed by a period of 15-20 minutes of confusion and extreme fatigue. Her son noted no clonic activity, incontinence or tongue biting during the event. They were three minutes away from the hospital when this all occurred, and the patient's son immediately brought her to the ED. MEDICAL HISTORY: 1) Likely right pontine lacunar stroke The patient was admitted in [**10/2137**] after developing blurred vision, diploplia worse with right gaze, and a right-sided facial droop. Prior to this, she had no history of stroke/TIA. MRI performed during this admission showed no acute territorial infarct within the brain, but did show scattered old lacunar infarcts within the cerebellar hemispheres, and chronic periventricular white matter changes that were noted were seen as evidence of stroke. On her exam, she had a 6th and 7th nerve palsy. An extensive workup was done to evaluate whether her symptoms could be due to other causes (detailed in Dr. [**Last Name (STitle) **] discharge summary from [**2137-10-23**]), but all tests returned negative, and therefore the diagnosis of a small pontine stroke which was not seen on MRI is the most likely possibility. Interestingly, an echocardiogram from [**2137-10-23**] revealed a small secundum atrial septal defect, but left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). No clot was seen. The patient is followed by Dr. [**Last Name (STitle) 1693**]. MEDICATION ON ADMISSION: - Aspirin 325mg po daily - lipitor 10mg po daily - lisinopril 20mg po daily - fluticasone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION ([**2139-5-7**] at 9:30pm, upon transfer from SICU to floor): Vitals: T 99.1, BP 108/35, HR 70, RR 19, O2 sat 97% General: Sitting up in bed, mild rhythmic facial tremor. Pleasant, talkative, in no acute distress Neck: Supple, no JVD or lymphadenopathy. Negative Kernig/Brudzinski signs per ICU admit note. CV: Regular rate and rhythm, no murmurs, rubs, or gallops Pulmonary: Lungs clear to auscultation bilaterally, anteriorly, without wheezes or rhonchi Abdomen: Soft, nontender, nondistended, without palpable masses Extremities: No clubbing, cyanosis, edema GU: Foley catheter in place, draining dark yellow urine FAMILY HISTORY: Mother with history of tremor, died of gastric cancer. Father died of coronary artery disease. Denies family history of seizures or other neurologic disorders. SOCIAL HISTORY: Lives alone with two cats and one dog. Walks and performs all ADLs independently. She has three sons (two firefighters, one policeman) and five grandchildren who live close by. One of her sons is staying at her home caring for her pets while she is in the hospital. She worked as a nurse at [**Hospital6 17390**] and retired three years ago. She has a 25 pack-year history of cigarette smoking (50yrs with about ?????? pack daily) and currently smokes [**2-28**] cigarettes per day; claims she is trying to quit. Denies alcohol and drug use. Does not engage in formal exercise but spends a lot of time playing actively with her children, especially since retirement.

Other convulsions,Acidosis,Unspecified late effects of cerebrovascular disease,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Convulsions NEC,Acidosis,Late effect CV dis NOS,Hypertension NOS,DMII wo cmp nt st uncntr

Admission Date: [**2139-5-6**] Discharge Date: [**2139-5-8**] Date of Birth: [**2066-2-22**] Sex: F Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1032**] Chief Complaint: ? seizure Major Surgical or Invasive Procedure: MRI, EEG History of Present Illness: Ms. [**Known lastname 31390**] is a 73-year-old right-handed female with a history of hypertension, hyperlipidemia, and probable right pontine lacunar stroke (she presented with right CN VI and VII palsies that have since resolved) in [**2137**] who was noted by her son on [**2139-5-6**] to be in her usual state of good health. They were riding in the car, and at one point during the ride he asked her a question and got no response. When he looked over to see if she had heard him, he saw that she was flexing both arms and arching her back, a position she held for one minute. This was followed by a period of 15-20 minutes of confusion and extreme fatigue. Her son noted no clonic activity, incontinence or tongue biting during the event. They were three minutes away from the hospital when this all occurred, and the patient's son immediately brought her to the ED. The patient later explained that her last memory is of getting into the car with her son to run errands, and she remembers nothing from that point up until being extubated this morning. She denies prior episodes consistent with her son's description of what occurred. She denies prior episodes consistent with auras, or prior episodes of syncope or dizziness. She denies recent headaches, fever, chills, nausea, vomiting, or changes in urination or bowel movements. She reports that ever since retiring three years ago and spending more time at home, she has been drinking increased amounts of iced coffee and iced tea. She reportedly drank a lot of iced coffee before the event occurred on [**5-6**]. She denies having eaten anything out of the ordinary or taking any medications aside from her usual daily medications at their normal doses. Past Medical History: 1) Likely right pontine lacunar stroke The patient was admitted in [**10/2137**] after developing blurred vision, diploplia worse with right gaze, and a right-sided facial droop. Prior to this, she had no history of stroke/TIA. MRI performed during this admission showed no acute territorial infarct within the brain, but did show scattered old lacunar infarcts within the cerebellar hemispheres, and chronic periventricular white matter changes that were noted were seen as evidence of stroke. On her exam, she had a 6th and 7th nerve palsy. An extensive workup was done to evaluate whether her symptoms could be due to other causes (detailed in Dr. [**Last Name (STitle) **] discharge summary from [**2137-10-23**]), but all tests returned negative, and therefore the diagnosis of a small pontine stroke which was not seen on MRI is the most likely possibility. Interestingly, an echocardiogram from [**2137-10-23**] revealed a small secundum atrial septal defect, but left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). No clot was seen. The patient is followed by Dr. [**Last Name (STitle) 1693**]. 2) Hypertension Diagnosed when she was admitted to the [**Hospital1 18**] in [**2137-10-19**] for likely lacunar stroke (blood pressure was 184/90 upon admission). Blood pressure was noted to be elevated at visits subsequent to the visit (140/70, 160/80). Blood pressure currently controlled with Lisinopril 20mg PO qday. 3) Borderline diabetes Patient reports that she was told that her blood glucose was elevated when admitted to the [**Hospital1 18**] in [**2137-10-19**]. She checked her sugars at home for some time after discharge, but they were never elevated, so about one year ago she stopped checking her sugars at home. 4) Hyperlipidemia Lipid panel during [**2137-10-19**] admission revealed LDL elevated at 117. Patient currently is maintained on lipitor 10mg PO qday. LDL (calculated) was last measured at 72 in [**2138-11-19**] and then 126 in [**2139-3-19**]. 5) Tremors Began at the age of 21. This tremor started in her hands and then spread to her head (also present in her mother). Likely essential tremor, the most common neurologic cause of postural or action tremor (estimated prevalence worldwide of up to 5 percent of the population) given that she has a family history, it started in her youth, and has not progressed to include other neurologic symptoms. Head tremor, which she has, is more likely to be a manifestation of essential tremor, whereas tremor of the jaw or lips is more typically parkinsonian. 6) Frostbite In both feet, many years ago 7) S/p bilateral cataract surgery 8) S/p right lumpectomy for benign breast lesion roughly 20 years ago. Social History: Lives alone with two cats and one dog. Walks and performs all ADLs independently. She has three sons (two firefighters, one policeman) and five grandchildren who live close by. One of her sons is staying at her home caring for her pets while she is in the hospital. She worked as a nurse at [**Hospital6 17390**] and retired three years ago. She has a 25 pack-year history of cigarette smoking (50yrs with about ?????? pack daily) and currently smokes [**2-28**] cigarettes per day; claims she is trying to quit. Denies alcohol and drug use. Does not engage in formal exercise but spends a lot of time playing actively with her children, especially since retirement. Family History: Mother with history of tremor, died of gastric cancer. Father died of coronary artery disease. Denies family history of seizures or other neurologic disorders. Physical Exam: PHYSICAL EXAMINATION ([**2139-5-7**] at 9:30pm, upon transfer from SICU to floor): Vitals: T 99.1, BP 108/35, HR 70, RR 19, O2 sat 97% General: Sitting up in bed, mild rhythmic facial tremor. Pleasant, talkative, in no acute distress Neck: Supple, no JVD or lymphadenopathy. Negative Kernig/Brudzinski signs per ICU admit note. CV: Regular rate and rhythm, no murmurs, rubs, or gallops Pulmonary: Lungs clear to auscultation bilaterally, anteriorly, without wheezes or rhonchi Abdomen: Soft, nontender, nondistended, without palpable masses Extremities: No clubbing, cyanosis, edema GU: Foley catheter in place, draining dark yellow urine NEUROLOGIC EXAM([**2139-5-7**] at 9:30pm, upon transfer from SICU to floor): Mental Status: Patient is awake, alert, and fully oriented. She is attentive, able to say the months of the year backwards clearly and without hesitation. Repetition is [**4-22**] and recall [**3-22**] at 5 minutes ([**4-22**] with multiple choice). Speech is fluent, without dysarthria, and comprehension is intact. She is able to name all objects on card, able to read words and full sentences, able to repeat "He, she, and I are here". No signs of apraxia: patient is able to bring right hand to left ear and point to ceiling without difficulty. Cranial Nerves: CN I: not tested CN II: visual fields full to confrontation. Pupils 2->1 bilaterally. No extinction or evidence of left-sided neglect. Fundi clear. CN III, IV, VI: extraocular muscles intact, without nystagmus or ptosis. CN V: intact to light touch throughout CN VII: Smile symmetric, facial movements intact CN VIII: hearing intact to finger rub bilaterallyl CN IX, X: palate rises symmetrically CN [**Doctor First Name 81**]: Trapezius and sternocleidomastoid intact. CN XII: Tongue protrudes at midline and moves with normal speed Motor: Normal bulk and tone throughout. No pronator drift or signs of asterixis. D B T WE FE FF IP Q H DF PF TE L 5 5 5 5 5 5 5 5 5 5 5 5 R 5 5 5 5 5 5 5 5 5 5 5 5 Sensory: Sensation to light touch and cold intact throughout. Proprioception intact throughout. Vibration mildly decreased in bilateral lower extremities. Reflexes: Hyperreflexive everywhere except ankles, but more so in right upper extremity than left upper extremity. Spread present on right and left but more prominent on the right. Bic Tric [**Last Name (un) 1035**] Pat Ankle R 3+ 3+ 3+ 3+ 1+ L 3+ 3+ 3+ 3+ 1+ Babinski reflex negative (downgoing toes). Coordination: Finger-to-nose testing revealed slight bilateral tremor (consistent with known history of probable essential tremor) but no ataxia. Rapid alternating movements (finger tapping, hand waving) intact. Gait: Unable to walk far because of IV pole, but few steps revealed a narrow-based gait that was slightly unsteady. Pertinent Results: LABS [**2139-5-7**] 02:07a 141 111 17 ------------<122 3.7 21 0.8 Ca: 8.1 Mg: 2.3 P: 3.2 ALT: 24 AP: 81 Tbili: 0.4 Alb: 3.4 AST: 23 LDH: 154 Vit-B12:371 Folate:17.1 CBC: WBC 11.1, Hgb 13.2, Hct 39.3, Plt 202, MCV 95 PT: 11.1 PTT: 30.0 INR: 0.9 [**2139-5-6**] 4:12p pH 7.30 pCO2 46 pO2 260 HCO3 24 BaseXS -3 (Arterial, intubated, vent controlled, FiO2%:60; Rate:14/; TV:500) [**2139-5-6**] 1:20p Urine Benzos, Barbs, Opiates, Cocaine, Amphet, Mthdne Negative [**2139-5-6**] 12:10p 147 105 21 ------------<78 4.0 13 1.0 CK: 69 MB: [**First Name9 (NamePattern2) 18190**] [**Doctor First Name **]: 68 Serum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative Trop-T: <0.01 PT: 12.1 PTT: 22.8 INR: 1.0 Fibrinogen: 350 CBC: WBC 9.3, Hgb 16.4, Hct 52.1, Plt 301, MCV 101 [**2139-5-6**] 12:00a UA negative for UTI IMAGING: CXR [**5-6**]: Negative for pneumonia or other cardiopulmonary abnormalities. Head CT [**5-6**]: Probable tiny chronic small vessel infarct in the right periatrial white matter. MRI scanning recommended for better detection of a seizure focus. Head CTA [**5-6**]: No definite signs for basilar artery stenosis or occlusion. Head MR/MRA [**5-6**]: No acute infarct. There is FLAIR sulcal hyperintensity which can be seen with leptomeningeal processes or high inspired FIO2. Head MR [**5-7**]: No significant change since prior study. Stable probable small vessel ischemic sequela. Mild stable sulcal hyperintensities which can be seen with leptomeningeal processes or high inspired FiO2. No evidence for leptomeningeal enhancement seen. Brief Hospital Course: In the ED on [**2139-5-6**], the patient was sedated with Propofol and intubated for airway protection. The patient became hypotensive and Propofol was discontinued. Fentanyl was used to sedate her overnight and to obtain an MRI. She was hemoconcentrated (hematocrit 52.1) and acidotic (bicarb 13 with anion gap of 29) upon arrival; both of these abnormalities were resolved on the morning of [**5-7**] after IV hydration. Her home medications (Lipitor 10mg, Lisinopril 20mg, and aspirin 325mg per day) were continued in the hospital. She was monitored on telemetry. Cardiac enzymes drawn to rule out MI returned normal. CXR revealed no evidence of cardiopulmonary abnormality. Urine and blood toxicology screens were negative. MRI, MRA, CT, and CTA showed no evidence of acute infarct, mass, or vascular abnormality. EEG showed delta slowing but no epileptiform discharges. On the morning of [**5-7**], the patient was extubated without difficulty, and no apparent neurologic or other deficits were noted. She was transferred to the floor on the night of [**5-7**] and did well overnight. Neurological and physical examination were normal on the morning of [**2139-5-8**], and physical therapy evaluation was obtained to make sure the patient would be able to walk on her own steadily once discharged. Walking was successful. Since the EEG was negative as well as the MRI, there is no obvious focus for the seizures. It is likely that the patient had a seizure from a site of an old stroke given her vascular risk factors. Since it is her first seizure, it is not necessary that she start medications. However, because she lives alone, we presented her with the option of starting a medicaion to prevent a future seizure. The patient elected not to start an antiepileptic medication at this time, with the understanding that if she did in fact have a second seizure, the chance of having recurrent seizures would rise exponentially and she would likely need to start a medication at this time. The need to refrain from driving for six months and to take other seizure precautions was discussed. She was discharged to home on the afternoon of [**5-7**] with follow-up appointments scheduled with PCP and with neurology. Medications on Admission: - Aspirin 325mg po daily - lipitor 10mg po daily - lisinopril 20mg po daily - fluticasone Discharge Medications: 1. Lisinopril 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Seizure likely secondary to an old stroke Discharge Condition: Good - no deficits Discharge Instructions: Please take all your medications as directed and attend your follow up appointments. Because you have had a seizure, you cannot drive for at least the next 6 months. You should also avoid heights or any situation that would put you at risk for falling should you have another seizure. Also, avoid baths or swimming pools and take showers instead. Followup Instructions: Please follow up with your primary care doctor, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on Wednesday, [**2139-5-13**], at 1:00pm. Please follow up Neurology, [**Name6 (MD) **] [**Name8 (MD) **], M.D. and [**First Name4 (NamePattern1) 1104**] [**Last Name (NamePattern1) 4638**], Phone:[**Telephone/Fax (1) 2574**] Date/Time:[**2139-8-4**] 2:30. The clinic is located on [**Hospital Ward Name 23**], [**Location (un) **]. [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD, [**MD Number(3) 1041**]

780,276,438,401,250

{'Other convulsions,Acidosis,Unspecified late effects of cerebrovascular disease,Unspecified essential hypertension,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: ? seizure PRESENT ILLNESS: Ms. [**Known lastname 31390**] is a 73-year-old right-handed female with a history of hypertension, hyperlipidemia, and probable right pontine lacunar stroke (she presented with right CN VI and VII palsies that have since resolved) in [**2137**] who was noted by her son on [**2139-5-6**] to be in her usual state of good health. They were riding in the car, and at one point during the ride he asked her a question and got no response. When he looked over to see if she had heard him, he saw that she was flexing both arms and arching her back, a position she held for one minute. This was followed by a period of 15-20 minutes of confusion and extreme fatigue. Her son noted no clonic activity, incontinence or tongue biting during the event. They were three minutes away from the hospital when this all occurred, and the patient's son immediately brought her to the ED. MEDICAL HISTORY: 1) Likely right pontine lacunar stroke The patient was admitted in [**10/2137**] after developing blurred vision, diploplia worse with right gaze, and a right-sided facial droop. Prior to this, she had no history of stroke/TIA. MRI performed during this admission showed no acute territorial infarct within the brain, but did show scattered old lacunar infarcts within the cerebellar hemispheres, and chronic periventricular white matter changes that were noted were seen as evidence of stroke. On her exam, she had a 6th and 7th nerve palsy. An extensive workup was done to evaluate whether her symptoms could be due to other causes (detailed in Dr. [**Last Name (STitle) **] discharge summary from [**2137-10-23**]), but all tests returned negative, and therefore the diagnosis of a small pontine stroke which was not seen on MRI is the most likely possibility. Interestingly, an echocardiogram from [**2137-10-23**] revealed a small secundum atrial septal defect, but left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). No clot was seen. The patient is followed by Dr. [**Last Name (STitle) 1693**]. MEDICATION ON ADMISSION: - Aspirin 325mg po daily - lipitor 10mg po daily - lisinopril 20mg po daily - fluticasone ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION ([**2139-5-7**] at 9:30pm, upon transfer from SICU to floor): Vitals: T 99.1, BP 108/35, HR 70, RR 19, O2 sat 97% General: Sitting up in bed, mild rhythmic facial tremor. Pleasant, talkative, in no acute distress Neck: Supple, no JVD or lymphadenopathy. Negative Kernig/Brudzinski signs per ICU admit note. CV: Regular rate and rhythm, no murmurs, rubs, or gallops Pulmonary: Lungs clear to auscultation bilaterally, anteriorly, without wheezes or rhonchi Abdomen: Soft, nontender, nondistended, without palpable masses Extremities: No clubbing, cyanosis, edema GU: Foley catheter in place, draining dark yellow urine FAMILY HISTORY: Mother with history of tremor, died of gastric cancer. Father died of coronary artery disease. Denies family history of seizures or other neurologic disorders. SOCIAL HISTORY: Lives alone with two cats and one dog. Walks and performs all ADLs independently. She has three sons (two firefighters, one policeman) and five grandchildren who live close by. One of her sons is staying at her home caring for her pets while she is in the hospital. She worked as a nurse at [**Hospital6 17390**] and retired three years ago. She has a 25 pack-year history of cigarette smoking (50yrs with about ?????? pack daily) and currently smokes [**2-28**] cigarettes per day; claims she is trying to quit. Denies alcohol and drug use. Does not engage in formal exercise but spends a lot of time playing actively with her children, especially since retirement. ### Response: {'Other convulsions,Acidosis,Unspecified late effects of cerebrovascular disease,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: altered mental status, left sided weakness PRESENT ILLNESS: [**Known firstname **] [**Known lastname 93995**] is a 71 yo right handed man with a history of dementia transferred from [**Hospital **] Hospital. History from the transfer records state that the patient was brought to the hospital this morning from his [**Last Name (un) **] Rehabiliation center for a change in mental status. Apparently the patient is normally alert, oriented and appropriate. This morning during AM care he was not following commands, had left facial and arm weakness. He was also noted to be unable to follow objects with his eyes. Fingerstick was 279. Vitals at [**Hospital **] hospital were: 161/72 18 99% 2 L. Labs were notable for Na 125, Cl 89, glucose 404, BUN 23, Cre 1, WBC 11 and HCT 34. CT of the head was obtained and showed a right frontal intraparenchymal hemorrhage. The patient was given 4 units of insulin and transferred to [**Hospital1 18**] for further evaluation. MEDICAL HISTORY: -Dementia- diagnosed [**2128**] as combination of Alzheimers disease and alcoholic dementia; this was in the setting of osteomyelitis and his symptoms improved (somewhat) following amputation of his left leg. -Diabetes -CAD s/p stent, patient reports 5 yrs ago, on Plavix -[**Name (NI) **] wife reports "[**Name2 (NI) **]", patient reports having difficulty walking and talking -Neuropathy -Cellulitis -Pressure ulcers -Dysphagia -Hypertension -Venous Insufficiency -Anemia -Osteoarthritis -hx Alcohol abuse -Hx of Mood Disorder -Hx of delusional disorder MEDICATION ON ADMISSION: Atenolol 50 mg PO DAILY Lisinorpil 25mg daily Vitamin B Complex 1 CAP PO DAILY Atorvastatin 10 mg PO DAILY Ascorbic Acid 500 mg PO BID Insulin/lantus 20mg QHS, Insulin/Humalog 5/4/6 units Breakfast, lunch and dinner Donepezil 5 mg PO HS Mirtazipine 7.5mg QHS Plavix 75mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: T 97.8 BP 162/70 HR 80 RR 18 98 O2% General: Awake, NAD. Head and Neck: no cranial abnormalities, no scleral icterus noted, mm dry, no lesions noted in oropharynx Neck supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs clear to auscultation bilaterally Cardiac: regular rate and rhythm, No murmurs. Abdomen: soft, non-tender, normoactive bowel sounds. Extremities: left BKA. Skin: no rashes or lesions noted. FAMILY HISTORY: Grandfather with stroke and MI Mother with Diabetes 5 brothers and sisters which are reportedly in good health SOCIAL HISTORY: Married. Has been in Rehab since [**Month (only) 359**] when he developed pneumonia and was unable to be cared for at home. He as a remote history of tobacco (>20 years ago) and alcohol abuse. No drugs.

Intracerebral hemorrhage,Other amyloidosis,Hyposmolality and/or hyponatremia,Unspecified cerebrovascular disease,Fever, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Dysphagia, unspecified,Mononeuritis of unspecified site,Above knee amputation status

Intracerebral hemorrhage,Amyloidosis NEC,Hyposmolality,Cerebrovasc disease NOS,Fever NOS,Alzheimer's disease,Dementia w/o behav dist,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Status-post ptca,Hypertension NOS,Venous insufficiency NOS,Osteoarthros NOS-unspec,Anemia NOS,Dysphagia NOS,Mononeuritis NOS,Status amput above knee

Admission Date: [**2131-4-17**] Discharge Date: [**2131-4-18**] Date of Birth: [**2059-6-27**] Sex: M Service: NEUROLOGY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 618**] Chief Complaint: altered mental status, left sided weakness Major Surgical or Invasive Procedure: none History of Present Illness: [**Known firstname **] [**Known lastname 93995**] is a 71 yo right handed man with a history of dementia transferred from [**Hospital **] Hospital. History from the transfer records state that the patient was brought to the hospital this morning from his [**Last Name (un) **] Rehabiliation center for a change in mental status. Apparently the patient is normally alert, oriented and appropriate. This morning during AM care he was not following commands, had left facial and arm weakness. He was also noted to be unable to follow objects with his eyes. Fingerstick was 279. Vitals at [**Hospital **] hospital were: 161/72 18 99% 2 L. Labs were notable for Na 125, Cl 89, glucose 404, BUN 23, Cre 1, WBC 11 and HCT 34. CT of the head was obtained and showed a right frontal intraparenchymal hemorrhage. The patient was given 4 units of insulin and transferred to [**Hospital1 18**] for further evaluation. Currently, the patient feels fatigued. He states that he has felt "funny" since yesterday, when he was having numbness and tingling in his feet (pt reports bilateral symptoms though he has a left BKA). He also feels his thinking is off. He has had tingling in his fingers as well for the last week. Otherwise, he denied headache, loss of vision, blurred vision, diplopia, dysarthria, lightheadedness, vertigo, tinnitus or hearing difficulty. He denied difficulties producing or comprehending speech. Denied focal weakness, bowel or bladder incontinence or retention. He states that he walks with crutches/prosthetic at baseline, but mostly uses a wheelchair. Past Medical History: -Dementia- diagnosed [**2128**] as combination of Alzheimers disease and alcoholic dementia; this was in the setting of osteomyelitis and his symptoms improved (somewhat) following amputation of his left leg. -Diabetes -CAD s/p stent, patient reports 5 yrs ago, on Plavix -[**Name (NI) **] wife reports "[**Name2 (NI) **]", patient reports having difficulty walking and talking -Neuropathy -Cellulitis -Pressure ulcers -Dysphagia -Hypertension -Venous Insufficiency -Anemia -Osteoarthritis -hx Alcohol abuse -Hx of Mood Disorder -Hx of delusional disorder Social History: Married. Has been in Rehab since [**Month (only) 359**] when he developed pneumonia and was unable to be cared for at home. He as a remote history of tobacco (>20 years ago) and alcohol abuse. No drugs. Family History: Grandfather with stroke and MI Mother with Diabetes 5 brothers and sisters which are reportedly in good health Physical Exam: T 97.8 BP 162/70 HR 80 RR 18 98 O2% General: Awake, NAD. Head and Neck: no cranial abnormalities, no scleral icterus noted, mm dry, no lesions noted in oropharynx Neck supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs clear to auscultation bilaterally Cardiac: regular rate and rhythm, No murmurs. Abdomen: soft, non-tender, normoactive bowel sounds. Extremities: left BKA. Skin: no rashes or lesions noted. Neurologic: -Mental Status: Alert, oriented to [**2131-8-18**], [**Location (un) 86**]. Was able to count backwards from 10. Perseverative and spends much of the interview picking at his fingers. Minimal spontaneous speech. Language is fluent with intact repetition and comprehension. Decreased prosody. There were naming errors (called hammock=knapsack, collar=twig and knuckles=fingers), and occasional stuttering ("bo, [**Location (un) **]"). Occasional errors with [**Location (un) 1131**] "they heard him break on the radio last night". The patient was able to read without difficulty. Speech was mildly dysarthric. There was no evidence of apraxia or neglect, calculations intact. He could follow both midline and appendicular commands. -Cranial Nerves: I: Olfaction not tested. II: PERRL 4 to 2mm and brisk. Pt would not cooperate with fixation enough to fully test visual fields; they were grossly full to movement. III, IV, VI: restricted upgaze. Impaired smooth persuit, particularly to the left. V: Facial sensation intact to light touch. VII: Mild left facial droop (has facial hair which obscures full view) but also weakness of the right orbicularis which can be opened easily on forced eye closure. VIII: Hearing intact to finger-rub bilaterally. IX, X: Palate elevates symmetrically. [**Doctor First Name 81**]: 5/5 strength in trapezii and sternocleidomastoid bilaterally. XII: Tongue protrudes in midline. -Motor: Normal bulk, increased tone/rigidity throughout, slightly more on the right than the left with. Pt unable to fully supinate his arms, but no clear pronator drift and able to sustaine both arms antigravity bilaterally. Delt Bic Tri WrE FFl FE IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB L 5- 5 4 5 5 4+ 5 5 5 ------------------- R 5 5 5 5 5 4+ 5 5 5 5 5 5 5 5 -Sensory: No deficits to light touch, No extinction to double simultaneous stimuli. -Reflexes: Brisk thoughout the upper extremities with + peck and jaw jerk. + Glabellar and snout reflexes. Absent patellar bilaterally and achilles on the right. Plantar response was flexor on the right. -Coordination: No intention tremor, no dysmetria on FNF. -Gait: deferred at this time. Pertinent Results: [**2131-4-17**] 03:25PM BLOOD WBC-11.8* RBC-3.87* Hgb-12.3* Hct-34.6* MCV-89 MCH-31.8 MCHC-35.6* RDW-12.7 Plt Ct-267 [**2131-4-17**] 03:25PM BLOOD Neuts-76.8* Lymphs-15.6* Monos-5.6 Eos-1.3 Baso-0.8 [**2131-4-17**] 03:25PM BLOOD PT-11.3 PTT-20.9* INR(PT)-0.9 [**2131-4-17**] 03:25PM BLOOD Glucose-303* UreaN-23* Creat-0.9 Na-128* K-4.9 Cl-92* HCO3-27 AnGap-14 [**2131-4-18**] 02:19AM BLOOD Glucose-182* UreaN-22* Creat-1.0 Na-131* K-4.6 Cl-94* HCO3-29 AnGap-13 [**2131-4-17**] 03:25PM BLOOD ALT-41* AST-35 LD(LDH)-198 AlkPhos-141* TotBili-0.5 [**2131-4-17**] 03:25PM BLOOD Calcium-9.5 Phos-3.0 Mg-1.9 Cholest-158 [**2131-4-17**] 03:25PM BLOOD Triglyc-124 HDL-33 CHOL/HD-4.8 LDLcalc-100 [**2131-4-17**] 06:04PM BLOOD %HbA1c-7.9* eAG-180* UA negative Urine and blood cx pending CXR: No acute cardiopulmonary abnormality. Head CT (personal read): 3.5x3.0 cm Right frontal IPH. No evidence of subarachnoid, subdural blood, no ventricular extension. Diffuse sucal widening elsewhere. MRI/A: R IPH as above. 2 very small additional microbleeds on suspectibility sequences. No vascular malformation. No underlying mass. Brief Hospital Course: NEURO: [**Known firstname **] [**Known lastname 93995**] is a 71 yo right handed man wit an extensive past medical history including Alzheimers dementia, CAD s/p stent, diabetes s/p L BKA, vascular disease. He presented from his nursing home with impairment of following commands and left sided weakness. CT of the head at [**Hospital **] Hospital demonstrated a cortical-based right frontal intraparenchymal hemorrhage. At [**Hospital1 18**], he was admitted for observation to the neuro ICU. The most likely etiology for the IPH is amyloid angiopathy. The patient has a history of Alzheimers dementia, which is associated with the same type of amyloid deposition. The location of the bleed is also extremely characteristic for amyloid. There are 2 other very small microbleeds seen on MRI suspectibility images. MRI/A did not show any other underlying mass for bleed, such as vascular malformation or tumor. Neurologic exam on discharge was notable for L lower facial weakness. He also had paratonia, limited upgaze, grasp, snout, glabellar, and jaw jerk reflexes. His speech is sparse with occasional stuttering and semantic errors. Naming was intact for high but not low frequency objects, repetition and comprehension was intact. There was no neglect. In regards to his underlying dementia, the patient did exhibit signs of Parkinsonism including cogwheeling with distraction, and should be monitored carefully to see if he develops additional Parkinsonian features. At this point, his dementia is still relatively mild, and it is difficult to accurately diagnose the type during one brief hospital visit. He will follow up closely with his primary neurologist in [**Hospital1 **]. BLOOD PRESSURE: Blood pressure was well controlled on home dose of atenlol. His blood pressure should be maintainned at SBP 140-160. His lisinopril was held, and should be restarted in the next week or so as his blood pressure tolerates. CAD: Plavix was held, and should be restarted in 2 weeks. FEVER: Patient had fever to 101.3 on evening of admission. CXR was clear, UA negative, urine and blood cx pending. He remained afebrile. WBC trended down. This may have been reactive to the intracranial bleed itself. FEN: Hyponatremic on admission, most likely hypovolemic hyponatremia as it improved with 1L NS overnight. Patient passed speech and swallow evaluation for regular consistency diet. ENDO: continued home regimen of insulin FOLLOW UP: He should have another CT with contrast in about 2.5-3 months which could be done at [**Hospital1 **] to make sure that there is no pathological lesion or a mass that is underlying the hemorrhage. F/u with Neurology in 3 months. Medications on Admission: Atenolol 50 mg PO DAILY Lisinorpil 25mg daily Vitamin B Complex 1 CAP PO DAILY Atorvastatin 10 mg PO DAILY Ascorbic Acid 500 mg PO BID Insulin/lantus 20mg QHS, Insulin/Humalog 5/4/6 units Breakfast, lunch and dinner Donepezil 5 mg PO HS Mirtazipine 7.5mg QHS Plavix 75mg daily Discharge Medications: 1. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. B complex vitamins Capsule Sig: One (1) Cap PO DAILY (Daily). 3. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Lantus 100 unit/mL Solution Sig: Twenty (20) units Subcutaneous at bedtime. 6. Humalog 100 unit/mL Solution Sig: see comments Subcutaneous three times a day: 5/4/6 units Breakfast, lunch and dinner . 7. donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 8. mirtazapine 7.5 mg Tablet Sig: One (1) Tablet PO at bedtime. Discharge Disposition: Extended Care Facility: [**Hospital 6594**] Rehab. and Nursing Center Discharge Diagnosis: intraparenchymal hemorrhage 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 were admitted with a bleed in your brain. This was likely caused by amyloid angiopathy, which is deposits of abnormal proteins in the blood vessels of your brain that make them rupture. Your Plavix will be held for 2 weeks. Your lisinopril will be held temporarily. Followup Instructions: Please schedule a head CT with contrast in 2.5 to 3 months, this can be done at [**Hospital **] Hospital if preferred. Please schedule an appointment with Dr. [**Last Name (STitle) 58298**] in 3 months. [**Telephone/Fax (1) 2574**] [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

431,277,276,437,780,331,294,250,414,V458,401,459,715,285,787,355,V497

{"Intracerebral hemorrhage,Other amyloidosis,Hyposmolality and/or hyponatremia,Unspecified cerebrovascular disease,Fever, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Dysphagia, unspecified,Mononeuritis of unspecified site,Above knee amputation 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, left sided weakness PRESENT ILLNESS: [**Known firstname **] [**Known lastname 93995**] is a 71 yo right handed man with a history of dementia transferred from [**Hospital **] Hospital. History from the transfer records state that the patient was brought to the hospital this morning from his [**Last Name (un) **] Rehabiliation center for a change in mental status. Apparently the patient is normally alert, oriented and appropriate. This morning during AM care he was not following commands, had left facial and arm weakness. He was also noted to be unable to follow objects with his eyes. Fingerstick was 279. Vitals at [**Hospital **] hospital were: 161/72 18 99% 2 L. Labs were notable for Na 125, Cl 89, glucose 404, BUN 23, Cre 1, WBC 11 and HCT 34. CT of the head was obtained and showed a right frontal intraparenchymal hemorrhage. The patient was given 4 units of insulin and transferred to [**Hospital1 18**] for further evaluation. MEDICAL HISTORY: -Dementia- diagnosed [**2128**] as combination of Alzheimers disease and alcoholic dementia; this was in the setting of osteomyelitis and his symptoms improved (somewhat) following amputation of his left leg. -Diabetes -CAD s/p stent, patient reports 5 yrs ago, on Plavix -[**Name (NI) **] wife reports "[**Name2 (NI) **]", patient reports having difficulty walking and talking -Neuropathy -Cellulitis -Pressure ulcers -Dysphagia -Hypertension -Venous Insufficiency -Anemia -Osteoarthritis -hx Alcohol abuse -Hx of Mood Disorder -Hx of delusional disorder MEDICATION ON ADMISSION: Atenolol 50 mg PO DAILY Lisinorpil 25mg daily Vitamin B Complex 1 CAP PO DAILY Atorvastatin 10 mg PO DAILY Ascorbic Acid 500 mg PO BID Insulin/lantus 20mg QHS, Insulin/Humalog 5/4/6 units Breakfast, lunch and dinner Donepezil 5 mg PO HS Mirtazipine 7.5mg QHS Plavix 75mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: T 97.8 BP 162/70 HR 80 RR 18 98 O2% General: Awake, NAD. Head and Neck: no cranial abnormalities, no scleral icterus noted, mm dry, no lesions noted in oropharynx Neck supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs clear to auscultation bilaterally Cardiac: regular rate and rhythm, No murmurs. Abdomen: soft, non-tender, normoactive bowel sounds. Extremities: left BKA. Skin: no rashes or lesions noted. FAMILY HISTORY: Grandfather with stroke and MI Mother with Diabetes 5 brothers and sisters which are reportedly in good health SOCIAL HISTORY: Married. Has been in Rehab since [**Month (only) 359**] when he developed pneumonia and was unable to be cared for at home. He as a remote history of tobacco (>20 years ago) and alcohol abuse. No drugs. ### Response: {"Intracerebral hemorrhage,Other amyloidosis,Hyposmolality and/or hyponatremia,Unspecified cerebrovascular disease,Fever, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Dysphagia, unspecified,Mononeuritis of unspecified site,Above knee amputation status"}

CHIEF COMPLAINT: altered mental status, hyperglycemia, renal failure PRESENT ILLNESS: 63 yof with IDDM c/b nephropathy, neuropathy and retinopathy, htn, and anemia who presents with three days of nausea, vomiting, cough, and high blood sugars. On the night prior to admission her sugars where critically high, > 600. She was evaluated by Dr. [**First Name (STitle) 216**] at her home who recommended 20U of NPH at night and 40U lispro. She became altered overnight and was brought into the ED in the AM for hydration. PCP recommended adjustment of BP medications while hospitalized. . In the ED, vs were T101 BP126/60 HR56 RR16 O2 sat 100% 2L. Her mental status had improved at this point and she was alert and oriented X 3. She was given Ceftriaxone 1gm, Tylenol 1mg and Azithromycin 500mg. She refused Levofloxacin. She was given 2L normal saline. Labs were notable for normal electrolytes, AG of 15, ketones in the urine. CXR showed left lower lobe infiltrate. . On the floor, pt is refusing to answer questions, affirms thirst, nausea, vomiting. Admits to low po intake and low urine output for three days. Asks that all questions be directed to her husband. MEDICAL HISTORY: DM1, last A1c 8.5% on [**4-/2123**], c/b gastroparesis, retinopathy, and neuropathy Hypertension Depression Anemia OSA on CPAP 11 CM Legally blind h/o pneumonia x2 h/o MSSA bacteremia h/o T10-T11 discitis s/p lap cholecystectomy s/p ORIF left ankle MEDICATION ON ADMISSION: Atenolol 25mg daily Chlorthalidone 25mg daily Clonidine 0.1mg qAm and 0.2mg qpm Diltiazem 540mg daily Fluoxetine 40mg daily Lispro 4 units tid for BG > 200 Metoclopramide 5mg daily Omprazole 20mg daily Percocet 0.5-1 tab q6h prn pain Simvastatin 40mg qhs ASA 81mg daily Calcium + vit D [**Hospital1 **] Vit D 100 U daily MVI NPH 20mg daily Fish oil 1000mg daily . Allergies: Codeine Lisinopril ALLERGIES: Codeine / Lisinopril PHYSICAL EXAM: Physical Exam: Vitals: T 98.9 BP 151/56 P 61 RR 18 SaO2 97 RA Blood glucose 133-440 General: mildly fatigued elderly woman with left eye closed HEENT: Sclera anicteric, MM dry, oropharynx clear Neck: supple, JVP flat, no LAD, thyromegally Lungs: Reduced breathsounds at LL base, otherwise clear bilatearlly without wheezes, rales or rhonchi. CV: RRR, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives w/ husband. [**Name (NI) 1403**] as an administrator at BU. Walks w/ cane. Never smoked. [**1-26**] glass wine daily. No illicits.

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Polyneuropathy in diabetes,Gastroparesis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)

DMI ketoacd uncontrold,Acute kidney failure NOS,Neuropathy in diabetes,Gastroparesis,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Long-term use of insulin,Pure hypercholesterolem,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Depressive disorder NEC,Obstructive sleep apnea

Admission Date: [**2126-10-31**] Discharge Date: [**2126-11-7**] Date of Birth: [**2063-9-7**] Sex: F Service: MEDICINE Allergies: Codeine / Lisinopril Attending:[**First Name3 (LF) 678**] Chief Complaint: altered mental status, hyperglycemia, renal failure Major Surgical or Invasive Procedure: None History of Present Illness: 63 yof with IDDM c/b nephropathy, neuropathy and retinopathy, htn, and anemia who presents with three days of nausea, vomiting, cough, and high blood sugars. On the night prior to admission her sugars where critically high, > 600. She was evaluated by Dr. [**First Name (STitle) 216**] at her home who recommended 20U of NPH at night and 40U lispro. She became altered overnight and was brought into the ED in the AM for hydration. PCP recommended adjustment of BP medications while hospitalized. . In the ED, vs were T101 BP126/60 HR56 RR16 O2 sat 100% 2L. Her mental status had improved at this point and she was alert and oriented X 3. She was given Ceftriaxone 1gm, Tylenol 1mg and Azithromycin 500mg. She refused Levofloxacin. She was given 2L normal saline. Labs were notable for normal electrolytes, AG of 15, ketones in the urine. CXR showed left lower lobe infiltrate. . On the floor, pt is refusing to answer questions, affirms thirst, nausea, vomiting. Admits to low po intake and low urine output for three days. Asks that all questions be directed to her husband. Past Medical History: DM1, last A1c 8.5% on [**4-/2123**], c/b gastroparesis, retinopathy, and neuropathy Hypertension Depression Anemia OSA on CPAP 11 CM Legally blind h/o pneumonia x2 h/o MSSA bacteremia h/o T10-T11 discitis s/p lap cholecystectomy s/p ORIF left ankle Social History: Lives w/ husband. [**Name (NI) 1403**] as an administrator at BU. Walks w/ cane. Never smoked. [**1-26**] glass wine daily. No illicits. Family History: Non-contributory Physical Exam: Physical Exam: Vitals: T 98.9 BP 151/56 P 61 RR 18 SaO2 97 RA Blood glucose 133-440 General: mildly fatigued elderly woman with left eye closed HEENT: Sclera anicteric, MM dry, oropharynx clear Neck: supple, JVP flat, no LAD, thyromegally Lungs: Reduced breathsounds at LL base, otherwise clear bilatearlly without wheezes, rales or rhonchi. CV: RRR, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: Admission labs: Labs: WBC 11.7 Hct 30.3 Plt 220 N:80.3 L:12.1 M:7.1 E:0.2 Bas:0.3 . 133 92 69 ---------------181 4.3 26 3.9 [**2126-10-31**] 01:40PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-150 GLUCOSE-1000 KETONE-50 BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-NEG [**2126-10-31**] 02:21PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2126-10-31**] 02:21PM URINE HOURS-RANDOM [**2126-10-31**] 03:37PM URINE OSMOLAL-355 [**2126-10-31**] 12:10PM GLUCOSE-181* UREA N-69* CREAT-3.9*# SODIUM-133 POTASSIUM-4.3 CHLORIDE-92* TOTAL CO2-26 ANION GAP-19 [**2126-10-31**] 12:10PM estGFR-Using this [**2126-10-31**] 12:10PM CK(CPK)-90 [**2126-10-31**] 12:10PM CK-MB-3 cTropnT-0.06* [**2126-10-31**] 12:10PM OSMOLAL-306 [**2126-10-31**] 12:10PM WBC-11.7*# RBC-3.17* HGB-10.2* HCT-30.3* MCV-96 MCH-32.3* MCHC-33.8 RDW-14.5 [**2126-10-31**] 12:10PM NEUTS-80.3* LYMPHS-12.1* MONOS-7.1 EOS-0.2 BASOS-0.3 [**2126-10-31**] 12:10PM PLT COUNT-220 CXR: [**10-30**]: Minimal left basilar atelectasis. Unchanged right minor fissural thickening. CXR: [**10-31**]: In comparison with the study of [**10-30**] there is little overall change. Continued low lung volumes with mild engorgement of pulmonary vessels and atelectatic changes primarily in the retrocardiac region. Minimal blunting of both costophrenic angles could reflect some small pleural effusions. There is slight asymmetric opacification in the left perihilar region when compared to the right. This could merely reflect slight differences in pulmonary vascular engorgement. However, if there is strong clinical concern for infection, this could be an area of developing consolidation. CXR [**11-5**] 1. Interval improvement in vascular congestion. 2. Trace atelectasis at the left costophrenic angle. No evidence of aspiration. Brief Hospital Course: 63 year old female with IDDM, who presents with DKA c/b worsening dysphagia. . # DKA/hyperglycemia - The patient presented with DKA, perhaps precipitated by an acute viral syndrome. On admission she was sent to the ICU. Her anion gap was small and likely atleast partially contiributed to by her acute on chronic renal failure. However, there were ketones in the urine, though these may also be secondary to poor po intake. HONK was also on the differential initially but her serum osms were within normal limits. Her blood glucose on presentation was 184, which had been increasing slowly. She was started on insulin drip administered with D5, 1/2NS when sugars < 200. This was stopped once glucose was controlled. Once anion gap was closed and sugars were under better control the patient was switched to ISS and home NPH (qAM) and transferred to the floor. Despite being on the home regimen, pt's sugars continued to have some high elevations with episodes of hypoglycemia. Given the patient had been hard to manage diabetic, [**Last Name (un) **] was consulted and recommended lantus and changing sliding scale. The patient's sugars were better managed however did continue to experience some elevations. The patient will follow-up with [**Last Name (un) **] as an outpatient. . # Inability to swallow: Speech and Swallow evaluated the patient and found she was at aspiration risk for solids and liquids. The cause was unclear, could be recrudescence of deficits from [**2-3**] lacunar infarct [**2-26**] hypovolemia. The patient was made NPO but was adamant that she could eat full diet. The patient and husband were counseled about the risks of aspiration and potential morbidities associated with it and agreed that they were willing to accept the risk of aspiration. On repeat S&S the following recommendations were made: 1. Safest recommendation would be videoswallow study for better objective assessment of swallow function 2. If pt remains uninterested in discussion of aspiration risk, modified diet, and further testing, would return her to regular diet with thin liquids at her own risk. 3. If pt is to take PO, aspiration precautions including: a) feed only when awake/alert b) sit fully upright for all PO c) remain upright at least 30 minutes after meals d) do not lower HOB below 30 degrees. . # LLL infiltrate - The patient had a CXR questionable for LLL infiltrate, along wiht cough, fever, and leukocytosis. She was started on ceftriaxone and azithro given suspicion for CAP. However given the inconclusiveness of the xray, the fact that the patient was asymptomatic, and her slight leukocytosis on admission was likely [**2-26**] DKA, we stopped antibiotics and the pt continued afebrile, stable on ra. Repeat PA and lateral showed interval improvement. UA negative, blood cx neg. . # Acute on chronic renal failure: Pt shows evidence of volume depletion from hyperosmolar state suggesting a prerenal azotemia. No sediment on UA to suggest intrinsic renal pathology. No evidence of outflow obstruction. She was treated with IVF and Cr improved to baseline. . #Hypertension - Dr. [**First Name (STitle) 216**] had been concerned about her blood pressure for some time and recommended titration while hospitalized. However, in the ICU she was normotensive, likely due to volume depletion. Chlorthalidone 25mg daily was held due to acute on chronic renal failure, and reduced diltiazem to 30mg qid (120mg daily vs 540mg home dose)changed atenolol 25mg daily to metoprolol tartrate 12.5mg tid given renal failure and continued clonidinen 0.1mg qAM and 0.2mg qPM. On the floor, Diltiazem was uptitrated to 360mg, she was continued on metoprolol 25mg TID, continued clonidine and started on hydralazine 25mg PO TID, as well as restarted on chlorthalidone home dose. . #Elevated troponins - without elevation in CK/MB, no ECG changes, there was very low suspicion for MI. . # Anemia: Hct trended from 34 to 27 this admission, likely secondary volume resuscitation. Now 30. Baseline anemia is likely due to CKD. . # Depression: Psych was consulted and signed off due to patient's lack of interest in talking to them further. She was continued on home fluoxetine . #HL - continued home simvastatin Medications on Admission: Atenolol 25mg daily Chlorthalidone 25mg daily Clonidine 0.1mg qAm and 0.2mg qpm Diltiazem 540mg daily Fluoxetine 40mg daily Lispro 4 units tid for BG > 200 Metoclopramide 5mg daily Omprazole 20mg daily Percocet 0.5-1 tab q6h prn pain Simvastatin 40mg qhs ASA 81mg daily Calcium + vit D [**Hospital1 **] Vit D 100 U daily MVI NPH 20mg daily Fish oil 1000mg daily . Allergies: Codeine Lisinopril Discharge Medications: 1. fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 6. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day). 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily) as needed for constipation. 10. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 11. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO qAM. 12. chlorthalidone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. diltiazem HCl 180 mg Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO DAILY (Daily). Disp:*60 Capsule, Sustained Release(s)* Refills:*2* 14. hydralazine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 15. metoclopramide 5 mg Tablet Sig: One (1) Tablet PO once a day. 16. clonidine 0.2 mg Tablet Sig: One (1) Tablet PO qPM. 17. M.V.I. Adult 1-5-10-200 mg-mcg-mg-mg Solution Sig: One (1) Intravenous once a day. 18. Fish Oil 1,000 mg Capsule Sig: One (1) Capsule PO once a day. 19. insulin glargine 100 unit/mL Cartridge Sig: Eighteen (18) unit Subcutaneous at bedtime. Disp:*1 month supply* Refills:*2* 20. insulin lispro 100 unit/mL Cartridge Sig: sliding scale insulin units per ss Subcutaneous qachs: BREAKFAST: <80 give 4, 80-130 give 7, 131-180 give 8, 181-230 give 9...increase 1unit lispro every 50 increase of sugar. LUNCH and DINNER: <80 give 3u, 80-130 give 5u, 131-180 give 6u, continue to increase insulin 1u for every 50 increase of blood sugar. BEFORE BED: if blood sugar 181-230 give 2u lispro, continue to increase 1u insulin per 50 increase sugar. . Disp:*1 month supply* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: 1) DKA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mrs. [**Known lastname **], You were admitted for diabetic ketoacidosis (very high blood sugars) likely precipitated by a respiratory illness probably from a virus. You were in the intensive care unit where they brought down your sugars with an insulin drip and then transitioned you to the general wards. While here you were consulted by [**Last Name (un) **] Diabetes Center and they changed your insulin sliding scale and switched you from NPH to Lantus (insulin glargine). You will follow up with a doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] as an outpatient to further optimize your diabetes management. You were also found to have difficulty swallowing and were evaluated by speech and swallow. They found that you do aspirate some food and liquids while eating and drinking, especially thin liquids. However, in consultation with you and your husband, you decided to accept the risks of eating in order to have an unrestricted diet. If you decide in the future that you want more specific recommendations on diet in order to decrease the risk of aspirating, further imaging can be done to better identify the source of this difficulty swallowing. If you develop increased pain, sugars >500 that are not being controlled with insulin, or other symptoms that concern you, please call Dr. [**First Name (STitle) 216**] or return to the ED. ********* Please START the following medications: Lantus 18u at bedtime Metoprolol 25mg every 8h Hydralazine 25mg every 8h Senna, Colace, Miralax as needed for constipation . Please STOP the following medications: Atenolol NPH insulin . The following medications have been CHANGED: Take Diltiazem at 360mg daily The Lispro sliding scale has changed Followup Instructions: Department: [**Hospital3 249**] When: WEDNESDAY [**2126-11-13**] at 10:30 AM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Last Name (un) **] Diabetes Center will call you with an appointment. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(1) 684**]

250,584,357,536,403,585,V586,272,583,362,311,327

{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Polyneuropathy in diabetes,Gastroparesis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)'}

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, hyperglycemia, renal failure PRESENT ILLNESS: 63 yof with IDDM c/b nephropathy, neuropathy and retinopathy, htn, and anemia who presents with three days of nausea, vomiting, cough, and high blood sugars. On the night prior to admission her sugars where critically high, > 600. She was evaluated by Dr. [**First Name (STitle) 216**] at her home who recommended 20U of NPH at night and 40U lispro. She became altered overnight and was brought into the ED in the AM for hydration. PCP recommended adjustment of BP medications while hospitalized. . In the ED, vs were T101 BP126/60 HR56 RR16 O2 sat 100% 2L. Her mental status had improved at this point and she was alert and oriented X 3. She was given Ceftriaxone 1gm, Tylenol 1mg and Azithromycin 500mg. She refused Levofloxacin. She was given 2L normal saline. Labs were notable for normal electrolytes, AG of 15, ketones in the urine. CXR showed left lower lobe infiltrate. . On the floor, pt is refusing to answer questions, affirms thirst, nausea, vomiting. Admits to low po intake and low urine output for three days. Asks that all questions be directed to her husband. MEDICAL HISTORY: DM1, last A1c 8.5% on [**4-/2123**], c/b gastroparesis, retinopathy, and neuropathy Hypertension Depression Anemia OSA on CPAP 11 CM Legally blind h/o pneumonia x2 h/o MSSA bacteremia h/o T10-T11 discitis s/p lap cholecystectomy s/p ORIF left ankle MEDICATION ON ADMISSION: Atenolol 25mg daily Chlorthalidone 25mg daily Clonidine 0.1mg qAm and 0.2mg qpm Diltiazem 540mg daily Fluoxetine 40mg daily Lispro 4 units tid for BG > 200 Metoclopramide 5mg daily Omprazole 20mg daily Percocet 0.5-1 tab q6h prn pain Simvastatin 40mg qhs ASA 81mg daily Calcium + vit D [**Hospital1 **] Vit D 100 U daily MVI NPH 20mg daily Fish oil 1000mg daily . Allergies: Codeine Lisinopril ALLERGIES: Codeine / Lisinopril PHYSICAL EXAM: Physical Exam: Vitals: T 98.9 BP 151/56 P 61 RR 18 SaO2 97 RA Blood glucose 133-440 General: mildly fatigued elderly woman with left eye closed HEENT: Sclera anicteric, MM dry, oropharynx clear Neck: supple, JVP flat, no LAD, thyromegally Lungs: Reduced breathsounds at LL base, otherwise clear bilatearlly without wheezes, rales or rhonchi. CV: RRR, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives w/ husband. [**Name (NI) 1403**] as an administrator at BU. Walks w/ cane. Never smoked. [**1-26**] glass wine daily. No illicits. ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Polyneuropathy in diabetes,Gastroparesis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)'}

CHIEF COMPLAINT: Pyelonephritis PRESENT ILLNESS: This is a 21 year old female with a history of frequent urinary tract infections who presents from home with right sided back pain for seven days and fevers for three days. She was previously in her usual state of health until one week ago when she developed right sided back pain. She has never experienced this pain before. It was not associated with trauma. She developed fevers and chills three days ago and presented to her new primary care physician on the morning of presentation for evaluation. She has also noticed some lightheadedness, dizziness and general weakness over the past few days but has not had any falls. She has also had nausea and decreased PO intake but no vomiting, dysuria, hematuria, decreased urine output, leg pain or swelling. She has a history of recurrent urinary tract infections but her last course of antibiotics was one year ago and she has never been hospitalized. Her baseline blood pressures are in the high 90s systolic. She was seen by her new primary care physician who referred her to the emergency room. . In the ED, initial vs were: T: 102.9 P: 102 BP: 96/50 R: 18 O2 sat 100% on RA. While in the emergency room her blood pressure fell as low as 76/44. She received 8 liters of normal saline. She received ciprofloxacin 400 mg IV x 1, flagyl 500 mg IV x 1, tylenol 650 mg PO x 1, ibuprofen 800 mg PO x 1, and zofran 4 mg IV x 1. Labs were notable for a WBC count of 16.3 with 90% neutrophils. UCG was negative. Lactate was normal at 1.0. She had a positive urinalysis. She underwent CT of the abdomen which was consistent with left sided pyelonephritis. She was admitted to the ICU for further management. . On the floor, she continues to have fevers and complain of right sided flank and abdominal pain. Lightheadedness has improved. She has mild nausea. She urinated 3 times in the emergency room but does not have a foley catheter. She has mild shortness of breath in the setting of aggressive fluid hydration but is breathing comfortably on nasal canula. All other review fo systems negative in detail. MEDICAL HISTORY: Recurrent Urinary tract infections MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE on admission [**2138-9-9**]: Vitals: T: 98.9 BP: 91/49 P: 76 R: 20 O2: 98% on 2L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Crackles at the bases bilaterally, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness, positive voluntary guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . PE on discharge (**date**): Vitals: General: Pleasant, alert, oriented, NAD, breathing comfortably on 4L nasal canula HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: CTA b/l, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Mother and maternal aunt have a history of urinary tract infections and pyelonephritis. SOCIAL HISTORY: Student majoring in philosophy and also works part time. Smokes [**1-17**] cigarettes per day. Drinks occassionally.

Septicemia due to escherichia coli [E. coli],Acute edema of lung, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Acidosis,Severe sepsis,Hypoxemia,Hypotension, unspecified,Hypocalcemia

E coli septicemia,Acute lung edema NOS,Ac pyelonephritis NOS,Acidosis,Severe sepsis,Hypoxemia,Hypotension NOS,Hypocalcemia

Admission Date: [**2138-9-9**] Discharge Date: [**2138-9-13**] Date of Birth: [**2116-9-21**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1990**] Chief Complaint: Pyelonephritis Major Surgical or Invasive Procedure: none History of Present Illness: This is a 21 year old female with a history of frequent urinary tract infections who presents from home with right sided back pain for seven days and fevers for three days. She was previously in her usual state of health until one week ago when she developed right sided back pain. She has never experienced this pain before. It was not associated with trauma. She developed fevers and chills three days ago and presented to her new primary care physician on the morning of presentation for evaluation. She has also noticed some lightheadedness, dizziness and general weakness over the past few days but has not had any falls. She has also had nausea and decreased PO intake but no vomiting, dysuria, hematuria, decreased urine output, leg pain or swelling. She has a history of recurrent urinary tract infections but her last course of antibiotics was one year ago and she has never been hospitalized. Her baseline blood pressures are in the high 90s systolic. She was seen by her new primary care physician who referred her to the emergency room. . In the ED, initial vs were: T: 102.9 P: 102 BP: 96/50 R: 18 O2 sat 100% on RA. While in the emergency room her blood pressure fell as low as 76/44. She received 8 liters of normal saline. She received ciprofloxacin 400 mg IV x 1, flagyl 500 mg IV x 1, tylenol 650 mg PO x 1, ibuprofen 800 mg PO x 1, and zofran 4 mg IV x 1. Labs were notable for a WBC count of 16.3 with 90% neutrophils. UCG was negative. Lactate was normal at 1.0. She had a positive urinalysis. She underwent CT of the abdomen which was consistent with left sided pyelonephritis. She was admitted to the ICU for further management. . On the floor, she continues to have fevers and complain of right sided flank and abdominal pain. Lightheadedness has improved. She has mild nausea. She urinated 3 times in the emergency room but does not have a foley catheter. She has mild shortness of breath in the setting of aggressive fluid hydration but is breathing comfortably on nasal canula. All other review fo systems negative in detail. Past Medical History: Recurrent Urinary tract infections Social History: Student majoring in philosophy and also works part time. Smokes [**1-17**] cigarettes per day. Drinks occassionally. Family History: Mother and maternal aunt have a history of urinary tract infections and pyelonephritis. Physical Exam: PE on admission [**2138-9-9**]: Vitals: T: 98.9 BP: 91/49 P: 76 R: 20 O2: 98% on 2L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Crackles at the bases bilaterally, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness, positive voluntary guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . PE on discharge (**date**): Vitals: General: Pleasant, alert, oriented, NAD, breathing comfortably on 4L nasal canula HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: CTA b/l, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: On admission [**Date range (3) 10746**]: WBC-16.3* RBC-4.21 Hgb-13.3 Hct-38.2 MCV-91 MCH-31.5 MCHC-34.7 RDW-12.9 Plt Ct-208 Neuts-89.6* Lymphs-4.7* Monos-4.8 Eos-0.6 Baso-0.3 PT-14.9* PTT-32.5 INR(PT)-1.3* Glucose-104 UreaN-11 Creat-1.0 Na-132* K-3.7 Cl-100 HCO3-20* AnGap-16 Albumin-2.8* Calcium-6.9* Phos-1.9* Mg-1.6 Lactate-1.0 . On discharge (**date**): . Micro: Urinalysis - positive Urine culture - E.coli, pan-sensitive Blood cultures - pending MRSA- pending . Imaging: CT [**Last Name (un) **]/Pelvis [**2138-9-9**]: 1. Striated nephrogram on the right indicative of right pyelonephritis in the appropriate clinical context. A followup son[**Name (NI) **] is recommended when clinical symptoms abate to rule out underlying renal mass. 2. Normal appendix. 3. Periportal edema and pericholecystic fluid, possibly related to intravenous volume overload. . CXR [**2138-9-9**]: Diffusely increased interstitial markings, suggesting pulmonary edema. A followup chest radiograph, after volume stats correction, is recommended to document resolution. . ECHO [**2138-9-10**]: Normal global and regional biventricular systolic function. No diastolic dysfunction, pulmonary hypertension or significant valvular disease seen. Left pleural effusion and ascites are seen. . CXR [**2138-9-11**]: There has been interval improvement in aeration of both lungs. Small bibasilar pleural effusion, right greater than left and bibasilar atelectasis permanently affecting left retrocardiac region have slightly improved. No pneumothorax is visualized. [**Known lastname **],[**Known firstname 2618**] [**Medical Record Number 84590**] F [**2136-10-5**] Radiology Report CHEST (PA & LAT) Study Date of [**2138-9-12**] 9:16 AM [**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] 11R [**2138-9-12**] 9:16 AM CHEST (PA & LAT) Clip # [**Clip Number (Radiology) 84591**] Reason: 21F pyelo, agressive hydration, resolving pulmonary overload [**Hospital 93**] MEDICAL CONDITION: 21F pyelo, agressive hydration, resolving pulmonary overload, desat to mid 80s last PM. REASON FOR THIS EXAMINATION: 21F pyelo, agressive hydration, resolving pulmonary overload, desat to mid 80s last PM. Final Report INDICATION: 21-year-old patient with pyelonephritis and resolving pulmonary hypovolemia. TECHNIQUE: PA and lateral chest x-ray. COMPARISON: Portable chest x-ray from [**2138-9-11**]. FINDINGS: Interstitial pulmonary edema continues to improve with currently only minimal residual prominence of the interstitial markings. The cardiomediastinal silhouette and hila are normal. There are tiny bilateral pleural effusions. IMPRESSION: Interstitial pulmonary edema continues to improve significantly. Brief Hospital Course: #Severe Sepsis/Pyelonephritis: Patient with fevers and hypotension in the setting of complicated urinary tract infection. She received 8 liters of normal saline in the emergency and antibiotic coverage with ciprofloxacin and Flagyl. In the ICU, patient received Zosyn x2d for empiric treatment of complicated pyelonephritis, and then converted to PO ciprofloxacin once cultures demonstrated pan-sensitive E. coli. Her BP's remained stable with adequate fluid resuscitation. Urology was consulted to evaluate for obstruction. They felt pooling of contrast on CT was due to infection and recommended supportive care with urology out-patient f/u for evaluation of recurrent UTI's. Abdominal CT was consistent with R-sided pyelonephritis with a notation of a R sided renal hypodensity which could be consistent with an early abscess. The patient remained clinically stable and afebrile on po antibiotics and it was felt that she was clinically safe for discharge. We recommend renal ultrasound after completing 14d total antibiotic course (Ciprofloxacin 500mg [**Hospital1 **]; course will end [**2138-9-21**]) or earlier if clinical worsening. The patient was advised to return to the ED or to contact her primary care physician if fevers recur following discharge. She has a follow-up appointment scheduled with her primary care physician. . #Hypoxemia: During [**Hospital Unit Name 153**] course (HD1) patient had episode of cough, tachypnea, and desaturation to 70% on RA. Patient also noted to have cough productive of blood-tinged sputum. She was transiently placed on Bi-PAP given persistent tachypnea. CXR with bilateral pulmonary infiltrates. Most likely etiology was pulmonary edema in the setting of recent aggressive fluid hydration. She received lasix with significant diuresis associated with reduction in oxygen requirement and interval improvement of radiographic change. A TTE was normal. A sputum culture was sent with no growth. The day prior to discharge patient was noted to have ambulatory saturations of 81%. CXR at the time showed continued interval resolution of interstitial change. Ambulatory saturations improved during the course of the day in the setting of lasix administration and incentive spirometry. She remained afebrile during this time. On the day of discharge on my exam she had saturations of 83% with ambulation on room air. I called a pulmonary consultation. Dr. [**First Name (STitle) **] came to see [**Known firstname **] and walked her up and down the stairs. Her oxygen saturations remained 98% throughout this. We concluded that I had not obtained accurate plethysmography; at any rate her hypoxemia has resolved. Dr. [**First Name (STitle) **] recommended pulmonary follow up in approx one month with CXR and spirometry/dlco prior (she will arrange), as she felt that there may possibly have been a component of ARDS involved in Ms. [**Known lastname **] hypoxemia in the setting of sepsis. . There was no historical evidence supportive of aspiration. We deferred empiric coverage for HAP/VAP given radiographic and clinical improvement in the setting of diuresis. On discharge the patient had adequate oxygen saturations without dyspnea (resting and with ambulation). Medications on Admission: None Discharge Medications: 1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 9 days: Last day of antibiotics will be [**2138-9-21**]. . Disp:*18 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Pyelonephritis Secondary Diagnosis Pulmonary edema Discharge Condition: Stable, afebrile, breathing well Discharge Instructions: You were admitted to the hospital with a urinary tract infection that spread to your kidneys. As a result, you developed low blood pressure and were given lots of fluids to help support your blood pressure. Because of this fluid and your infection, some of the fluid went into your lungs. You were given medications to help remove this fluid from your body and your oxygen requirement returned to [**Location 213**]. We did an echocardiogram which demonstrated that your heart is functioning normally and is not a cause of this fluid going to your lungs. . New medications started during this admission included: 1. Ciprofloxacin (course will complete [**2138-9-21**]) . If you experience shortness of breath, dizziness, light headedness at rest or with exertion or if you experience new onset back pain, decreased urine output, pain or discomfort with urination, abdominal pain, nausea, vomiting, diarrhea, chest pain, chest pressure, worsening headache, fever, or any symptom that concerns you contact your primary care physician or return to the hospital. Followup Instructions: Dr [**First Name8 (NamePattern2) 781**] [**Last Name (NamePattern1) 797**] (PCP) Date and time: [**Last Name (LF) 766**], [**9-29**] at 1:50pm Location: [**Hospital1 778**] CHC, [**Location (un) **], [**Location (un) 86**] Phone number: [**Telephone/Fax (1) 798**] Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3748**] (Urology) Date and time: Thursday, [**10-16**] at 1:45pm Location: [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Bldg (corner [**Location (un) 71679**] [**Hospital1 84592**]) [**Hospital **] Medical Specialties Phone number: [**Telephone/Fax (1) 3752**] Call the pulmonary clinic to arrange a follow up with them for one month from now: [**Telephone/Fax (1) 612**]. Dr. [**First Name8 (NamePattern2) 4944**] [**Last Name (NamePattern1) **] saw you in the hospital - if she is not available you can see any of the providers. Dr. [**First Name (STitle) **] will arrange for you to have a chest xray and lung tests (spirometry and dlco testing) prior to your pulmonary appointment.

038,518,590,276,995,799,458,275

{'Septicemia due to escherichia coli [E. coli],Acute edema of lung, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Acidosis,Severe sepsis,Hypoxemia,Hypotension, unspecified,Hypocalcemia'}

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: Pyelonephritis PRESENT ILLNESS: This is a 21 year old female with a history of frequent urinary tract infections who presents from home with right sided back pain for seven days and fevers for three days. She was previously in her usual state of health until one week ago when she developed right sided back pain. She has never experienced this pain before. It was not associated with trauma. She developed fevers and chills three days ago and presented to her new primary care physician on the morning of presentation for evaluation. She has also noticed some lightheadedness, dizziness and general weakness over the past few days but has not had any falls. She has also had nausea and decreased PO intake but no vomiting, dysuria, hematuria, decreased urine output, leg pain or swelling. She has a history of recurrent urinary tract infections but her last course of antibiotics was one year ago and she has never been hospitalized. Her baseline blood pressures are in the high 90s systolic. She was seen by her new primary care physician who referred her to the emergency room. . In the ED, initial vs were: T: 102.9 P: 102 BP: 96/50 R: 18 O2 sat 100% on RA. While in the emergency room her blood pressure fell as low as 76/44. She received 8 liters of normal saline. She received ciprofloxacin 400 mg IV x 1, flagyl 500 mg IV x 1, tylenol 650 mg PO x 1, ibuprofen 800 mg PO x 1, and zofran 4 mg IV x 1. Labs were notable for a WBC count of 16.3 with 90% neutrophils. UCG was negative. Lactate was normal at 1.0. She had a positive urinalysis. She underwent CT of the abdomen which was consistent with left sided pyelonephritis. She was admitted to the ICU for further management. . On the floor, she continues to have fevers and complain of right sided flank and abdominal pain. Lightheadedness has improved. She has mild nausea. She urinated 3 times in the emergency room but does not have a foley catheter. She has mild shortness of breath in the setting of aggressive fluid hydration but is breathing comfortably on nasal canula. All other review fo systems negative in detail. MEDICAL HISTORY: Recurrent Urinary tract infections MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE on admission [**2138-9-9**]: Vitals: T: 98.9 BP: 91/49 P: 76 R: 20 O2: 98% on 2L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Crackles at the bases bilaterally, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness, positive voluntary guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . PE on discharge (**date**): Vitals: General: Pleasant, alert, oriented, NAD, breathing comfortably on 4L nasal canula HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: CTA b/l, no wheezes or ronchi, good air movement bilaterally CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in right upper quadrant and right flank, bowel sounds present, no rebound tenderness Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Mother and maternal aunt have a history of urinary tract infections and pyelonephritis. SOCIAL HISTORY: Student majoring in philosophy and also works part time. Smokes [**1-17**] cigarettes per day. Drinks occassionally. ### Response: {'Septicemia due to escherichia coli [E. coli],Acute edema of lung, unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Acidosis,Severe sepsis,Hypoxemia,Hypotension, unspecified,Hypocalcemia'}

CHIEF COMPLAINT: aortic stenosis PRESENT ILLNESS: 74 yo F with pmh of CAD s/p CABG [**2177**] (lima to LAD and SVG to circ) and s/p PCI (BMS of RCA in [**6-1**]), severe AS ([**Location (un) 109**] 0.7 /echo; 0.5/cath), CHF, HTN, asthma presents from an OSH (admitted there on [**2182-7-25**]) for surgical/ cardiology evaluation of her AS. She has had progressive DOE x 1 year. This had worsened over the past 1 week (DOE with 5 steps), accompanied by cough. She was initially treated with levaquin by her PCP for presumed PNA with little relief. She also has c/o orthopnea. When she did not improve she was sent to the ED by her PCP. [**Name10 (NameIs) **] the OSH she was treated for pneumonia (total 14 days levaquin), CHF (BNP in 6000's), and eval. by CT [**Doctor First Name **] for AVR. She also had elevated LFTs thought [**12-28**] to hepatic congestion. Per records she was HIT positive with a plt drop of 273 to 151 (?borderline via criteria). She was started on lepirudin, which was briefly held for gum bleeding after surgery (teeth extraction x 3). Additionally, she was found to have a EF of 15% by ECHO (previously 60% in [**6-1**]). CT [**Doctor First Name **] felt she was too high risk for surgery. She was then transferred to [**Hospital1 18**] per family wish for further eval/2nd opinion. Of note, plavix was stopped at OSH. On transfer the pt. was tachypneic (rr>30's), using accessory muscles for breathing, tachy to 110, but maintaining her BP. Due to her respiratory distress the patient was transferred to the CCU. MEDICAL HISTORY: Chronic systolic heart failure MI s/p CABG ('[**77**] LIMA to LAD; SVG to LCx), RCA stent in [**2181**] (BMS), Asthma, HTN, aortic stenosis (0.7cm on echo, 0.5cm on c.cath), diverticulitis s/p abscess w/ surgical correction, herpes zoster, psoriasis, PE in [**2177**], h/o DVT, IVC filter in [**2176**], APPY, ventral hernia repair, shoulder ORIF, recent tooth extraction for periodontal disease. MEDICATION ON ADMISSION: On admission to CCU: atrovent nebs q6h prn albuterol nebs q4h prn trazodone 25mg hs prn asa 81mg qday ezetimibe 10mg qday paroxetine 20mg qday mupirocin nasal ointmnet 2% 1 app [**Hospital1 **] x 5 days protonix 40m gpo qday neurontin 100mg tid Lepirudin 0.15mg/kg per hour, no bolus . Home meds: ASA 81 qday plavix 75 qday (held at OSH on [**7-27**] per cardiology 6 wks s/p stent) zetia 10 qday cartia xt 180 qday (held at OSH [**12-28**] to hypotension) paxil 20mg qday albuterol 2 puffs flovent 2 puffs ALLERGIES: Penicillins / Heparin Agents PHYSICAL EXAM: VS - 97.1 107 104/57 70 18 93% 5L Gen: elderly F in bed in mild discomfort [**12-28**] to SOB HEENT: ecchymosis on lower jaw [**12-28**] to teeth removal for pre-op FAMILY HISTORY: not contributory SOCIAL HISTORY: daughter lives nearby, involved in her mother's care

Aortic valve disorders,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Other and unspecified hyperlipidemia,Other premature beats

Aortic valve disorder,CHF NOS,Chr airway obstruct NEC,Urin tract infection NOS,Crnry athrscl natve vssl,Hypertension NOS,Renal & ureteral dis NOS,Aortocoronary bypass,Old myocardial infarct,Hx-ven thrombosis/embols,Prsnl hst ot spf dgst ds,Hyperlipidemia NEC/NOS,Premature beats NEC

Admission Date: [**2182-8-3**] Discharge Date: [**2182-8-23**] Date of Birth: [**2108-4-27**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / Heparin Agents Attending:[**First Name3 (LF) 1267**] Chief Complaint: aortic stenosis Major Surgical or Invasive Procedure: cardiac catheterization redo sternotomy/ AVR(#21 StJude [**First Name3 (LF) 9041**] Porcine)[**8-13**] History of Present Illness: 74 yo F with pmh of CAD s/p CABG [**2177**] (lima to LAD and SVG to circ) and s/p PCI (BMS of RCA in [**6-1**]), severe AS ([**Location (un) 109**] 0.7 /echo; 0.5/cath), CHF, HTN, asthma presents from an OSH (admitted there on [**2182-7-25**]) for surgical/ cardiology evaluation of her AS. She has had progressive DOE x 1 year. This had worsened over the past 1 week (DOE with 5 steps), accompanied by cough. She was initially treated with levaquin by her PCP for presumed PNA with little relief. She also has c/o orthopnea. When she did not improve she was sent to the ED by her PCP. [**Name10 (NameIs) **] the OSH she was treated for pneumonia (total 14 days levaquin), CHF (BNP in 6000's), and eval. by CT [**Doctor First Name **] for AVR. She also had elevated LFTs thought [**12-28**] to hepatic congestion. Per records she was HIT positive with a plt drop of 273 to 151 (?borderline via criteria). She was started on lepirudin, which was briefly held for gum bleeding after surgery (teeth extraction x 3). Additionally, she was found to have a EF of 15% by ECHO (previously 60% in [**6-1**]). CT [**Doctor First Name **] felt she was too high risk for surgery. She was then transferred to [**Hospital1 18**] per family wish for further eval/2nd opinion. Of note, plavix was stopped at OSH. On transfer the pt. was tachypneic (rr>30's), using accessory muscles for breathing, tachy to 110, but maintaining her BP. Due to her respiratory distress the patient was transferred to the CCU. Past Medical History: Chronic systolic heart failure MI s/p CABG ('[**77**] LIMA to LAD; SVG to LCx), RCA stent in [**2181**] (BMS), Asthma, HTN, aortic stenosis (0.7cm on echo, 0.5cm on c.cath), diverticulitis s/p abscess w/ surgical correction, herpes zoster, psoriasis, PE in [**2177**], h/o DVT, IVC filter in [**2176**], APPY, ventral hernia repair, shoulder ORIF, recent tooth extraction for periodontal disease. Social History: daughter lives nearby, involved in her mother's care Family History: not contributory Physical Exam: VS - 97.1 107 104/57 70 18 93% 5L Gen: elderly F in bed in mild discomfort [**12-28**] to SOB HEENT: ecchymosis on lower jaw [**12-28**] to teeth removal for pre-op CV: SEM at RUSB. Chest: expiratory wheezes, rales 1/3 up lungs bilaterally. Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: trace edema Pertinent Results: OSH Echo [**2182-6-11**] shows preserved LV fxn w/ EF 20%, normal LV dimensions. mild concentric LVH, severe AS w/ [**Location (un) **] and peak gradients of 56 and 91mmHg with calculated calce area of 0.7cm2. . TTE [**2182-8-12**]: The left atrium is mildly dilated. The estimated right atrial pressure is [**4-4**] mmHg. A small secundum type atrial septal defect is seen with left-to-right flow. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe regional left ventricular systolic dysfunction with near akinesis of the septum, anterior wall and apex. The inferior and inferolateral walls contract best.[Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] No masses or thrombi are seen in the left ventricle. The right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. The aortic valve leaflets (?#) are severely thickened/deformed. There is severe aortic valve stenosis (area <0.8cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate (2+) mitral regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . Cardiac Cath [**2182-8-12**]: 1. Coronary angiography of this right dominant system revealed native 3 vessel CAD. The LMCA had no angiographically apparent flow limiting disease. The proximal LAD had a 70% stenosis with competitive LIMA flow. The LCx had a severely diseased OM branch with competitive SVG flow. The RCA had a patent proximal proximal stent. 2. Arterial conduit angiography revealed the LIMA-->LAD graft to be widely patent. The SVG to OM was widely patent. 3. Resting hemodynamics revealed normal systemic arterial systolic and diastolic blood pressures. 4. Severe aortic stenosis as described by echocardiogram. No attempt was made to cross the aortic valve due to patient's clinical condition. 5. Left ventriculography was deferred. FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Widely patent LIMA and SVG grafts. 3. Cardiomyopathy with severe aortic stenosis. [**2182-8-21**] 06:00AM BLOOD WBC-13.3* RBC-3.10* Hgb-9.2* Hct-28.5* MCV-92 MCH-29.7 MCHC-32.3 RDW-17.4* Plt Ct-316 [**2182-8-21**] 06:00AM BLOOD WBC-13.3* RBC-3.10* Hgb-9.2* Hct-28.5* MCV-92 MCH-29.7 MCHC-32.3 RDW-17.4* Plt Ct-316 [**2182-8-19**] 02:42AM BLOOD WBC-14.5* RBC-3.26* Hgb-9.5* Hct-29.5* MCV-91 MCH-29.0 MCHC-32.1 RDW-17.1* Plt Ct-281 [**2182-8-21**] 06:00AM BLOOD Plt Ct-316 [**2182-8-19**] 02:42AM BLOOD PT-13.4* PTT-28.2 INR(PT)-1.2* [**2182-8-21**] 06:00AM BLOOD Glucose-79 UreaN-13 Creat-0.7 Na-134 K-3.7 Cl-103 HCO3-24 AnGap-11 Brief Hospital Course: Pt admitted to CCU for respiratory distress and diuresis in the setting of severe AS. Patient was diuresed while awaiting valve replacement. Patient's respiratory distress improved with diuresis. It was felt to be secondary to chronic pulmonary edema and aortic stenosis. According to medical records, platelets decreased from 273 to 140's, pt HIT Ab positive. Started on lepirudin at OSH per Heme/onc consult, which was briefly held [**12-28**] to gum bleeding post-dental surgery then restarted. Upon admission, patient was started on argatroban, which was continued until her serotonin release assay came back negative and it was decided she did not have HIT. Treated at OSH for presumed PNA with 14 days of levaquin. She did develop asymptomatic bacturia with coagulase negative staph. Given that she was awaiting surgery, there was a low threshold for treatment. She received vanc until sensitivities came back, at which time she was switched to doxycycline. Plavix was held in anticipation of surgery as she had received a bare metal stent more than six weeks prior to presentation. Incidental finding of right kidney on CTA of chest and abdomen: "There is 9.4 x 6.9 mm exophytic enhancing lesion arising from the interpolar cortex of the right kidney. This lesion is worrisome and may be further assessed with an MRI." Patient requires follow-up as an outpatient. She was taken to the operating room on [**8-13**] where she underwent a redo-sternotomy, AVR (#21 St. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 9041**] Porcine). She was transferred to the ICU in critical but stable condition on vasopressin, levophed and epinephrine. She was extubated later that same day. She was weaned from her vasoactive srips by POD #2. She initally had poor oxygenation but improved with aggresive diuresis. She was transferred to the floor on POD #6. She complained of difficulty swallowing and swallow evaluation but refused speech and swallow evaluation and she had no further problems with eating or drinking. She required a 1:1 sitter for confusion but improved when her narcotics were discontinued and she was given small doses of haldol. She was ready for discharge to rehab on [**2182-8-23**] Medications on Admission: On admission to CCU: atrovent nebs q6h prn albuterol nebs q4h prn trazodone 25mg hs prn asa 81mg qday ezetimibe 10mg qday paroxetine 20mg qday mupirocin nasal ointmnet 2% 1 app [**Hospital1 **] x 5 days protonix 40m gpo qday neurontin 100mg tid Lepirudin 0.15mg/kg per hour, no bolus . Home meds: ASA 81 qday plavix 75 qday (held at OSH on [**7-27**] per cardiology 6 wks s/p stent) zetia 10 qday cartia xt 180 qday (held at OSH [**12-28**] to hypotension) paxil 20mg qday albuterol 2 puffs flovent 2 puffs Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 6. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 7 days. 9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7 days. Discharge Disposition: Extended Care Facility: [**Location (un) **] Discharge Diagnosis: PMH: CAD-MI s/p CABG ('[**77**] LIMA to LAD; SVG to LCx), PTCA(BMS)->RCA '[**81**], Asthma, HTN, AS , diverticulitis s/p abscess w/ surgical correction, herpes zoster, psoriasis, PE '[**77**], DVT, IVC filter '[**76**], APPY, ventral hernia repair, shoulder ORIF, Discharge Condition: Good. Discharge Instructions: Call with fever, redness or drainage from incision or weight gain more than 2 pounds ion one day or five in one week. Shower, no baths, no lotions, creams or powders to incisions. No lifting more than 10 pounds or driving until follow up with surgeon. Followup Instructions: Dr. [**Last Name (STitle) 42718**] 2 weeks Dr. [**Last Name (STitle) **] 2 weeks Dr. [**Last Name (STitle) **] 4 weeks Completed by:[**2182-8-23**]

424,428,496,599,414,401,593,V458,412,V125,V127,272,427

{'Aortic valve disorders,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Other and unspecified hyperlipidemia,Other premature beats'}

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: aortic stenosis PRESENT ILLNESS: 74 yo F with pmh of CAD s/p CABG [**2177**] (lima to LAD and SVG to circ) and s/p PCI (BMS of RCA in [**6-1**]), severe AS ([**Location (un) 109**] 0.7 /echo; 0.5/cath), CHF, HTN, asthma presents from an OSH (admitted there on [**2182-7-25**]) for surgical/ cardiology evaluation of her AS. She has had progressive DOE x 1 year. This had worsened over the past 1 week (DOE with 5 steps), accompanied by cough. She was initially treated with levaquin by her PCP for presumed PNA with little relief. She also has c/o orthopnea. When she did not improve she was sent to the ED by her PCP. [**Name10 (NameIs) **] the OSH she was treated for pneumonia (total 14 days levaquin), CHF (BNP in 6000's), and eval. by CT [**Doctor First Name **] for AVR. She also had elevated LFTs thought [**12-28**] to hepatic congestion. Per records she was HIT positive with a plt drop of 273 to 151 (?borderline via criteria). She was started on lepirudin, which was briefly held for gum bleeding after surgery (teeth extraction x 3). Additionally, she was found to have a EF of 15% by ECHO (previously 60% in [**6-1**]). CT [**Doctor First Name **] felt she was too high risk for surgery. She was then transferred to [**Hospital1 18**] per family wish for further eval/2nd opinion. Of note, plavix was stopped at OSH. On transfer the pt. was tachypneic (rr>30's), using accessory muscles for breathing, tachy to 110, but maintaining her BP. Due to her respiratory distress the patient was transferred to the CCU. MEDICAL HISTORY: Chronic systolic heart failure MI s/p CABG ('[**77**] LIMA to LAD; SVG to LCx), RCA stent in [**2181**] (BMS), Asthma, HTN, aortic stenosis (0.7cm on echo, 0.5cm on c.cath), diverticulitis s/p abscess w/ surgical correction, herpes zoster, psoriasis, PE in [**2177**], h/o DVT, IVC filter in [**2176**], APPY, ventral hernia repair, shoulder ORIF, recent tooth extraction for periodontal disease. MEDICATION ON ADMISSION: On admission to CCU: atrovent nebs q6h prn albuterol nebs q4h prn trazodone 25mg hs prn asa 81mg qday ezetimibe 10mg qday paroxetine 20mg qday mupirocin nasal ointmnet 2% 1 app [**Hospital1 **] x 5 days protonix 40m gpo qday neurontin 100mg tid Lepirudin 0.15mg/kg per hour, no bolus . Home meds: ASA 81 qday plavix 75 qday (held at OSH on [**7-27**] per cardiology 6 wks s/p stent) zetia 10 qday cartia xt 180 qday (held at OSH [**12-28**] to hypotension) paxil 20mg qday albuterol 2 puffs flovent 2 puffs ALLERGIES: Penicillins / Heparin Agents PHYSICAL EXAM: VS - 97.1 107 104/57 70 18 93% 5L Gen: elderly F in bed in mild discomfort [**12-28**] to SOB HEENT: ecchymosis on lower jaw [**12-28**] to teeth removal for pre-op FAMILY HISTORY: not contributory SOCIAL HISTORY: daughter lives nearby, involved in her mother's care ### Response: {'Aortic valve disorders,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Aortocoronary bypass status,Old myocardial infarction,Personal history of venous thrombosis and embolism,Personal history of other diseases of digestive system,Other and unspecified hyperlipidemia,Other premature beats'}

CHIEF COMPLAINT: Morbid obesity. PRESENT ILLNESS: Ms. [**Known lastname 3075**] is a 35-year-old female with morbid obesity who presents for gastric bypass surgery. She has a weight of 450 pounds, with a body mass L5-S1 herniated disk with spinal stenosis and compression, and mild hypertension. MEDICAL HISTORY: MEDICATION ON ADMISSION: 2. Flexeril 10 mg p.o. t.i.d. p.r.n. 3. Lortab p.o. p.r.n. 4. Meridia 10 mg p.o. q.d. ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Her father is 61 and has coronary artery disease, status post coronary artery bypass grafting and obesity. Mother is 59 with coronary artery disease, status post coronary artery bypass graft, diabetes, asthma, arthritis, and obesity. SOCIAL HISTORY:

Morbid obesity,Accidental puncture or laceration during a procedure, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation

Morbid obesity,Accidental op laceration,Food/vomit pneumonitis,Hyperpotassemia,Acc cut/hem in surgery

Admission Date: [**2127-2-19**] Discharge Date: [**2127-2-27**] Date of Birth: [**2091-11-6**] Sex: F Service: Surgery CHIEF COMPLAINT: Morbid obesity. HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname 3075**] is a 35-year-old female with morbid obesity who presents for gastric bypass surgery. She has a weight of 450 pounds, with a body mass L5-S1 herniated disk with spinal stenosis and compression, and mild hypertension. PAST SURGICAL HISTORY: Past surgical history is notable for a laparoscopic procedure for an ectopic pregnancy in [**2114**]. MEDICATIONS ON ADMISSION: 2. Flexeril 10 mg p.o. t.i.d. p.r.n. 3. Lortab p.o. p.r.n. 4. Meridia 10 mg p.o. q.d. ALLERGIES: She has no known drug allergies. FAMILY HISTORY: Her father is 61 and has coronary artery disease, status post coronary artery bypass grafting and obesity. Mother is 59 with coronary artery disease, status post coronary artery bypass graft, diabetes, asthma, arthritis, and obesity. PHYSICAL EXAMINATION ON PRESENTATION: On physical examination, her pulse was 90, her blood pressure was 160/90. There were no skin lesions or rashes. Head, eyes, ears, nose, and throat were within normal limits. There was no cervical lymphadenopathy, thyromegaly or carotid bruits. Lungs were clear to auscultation bilaterally. Heart sounds were distant, but were with a regular rate and rhythm. The abdomen was obese, soft and nontender, with normal bowel activity. Extremities were without edema, venous insufficiency or evidence of joint swelling or inflammation. She did have low back spinal tenderness on palpation, but no focal neurologic deficits. RADIOLOGY/IMAGING: An abdominal ultrasound was negative for gallstones. HOSPITAL COURSE: On [**2127-2-19**], the patient was admitted to the General Surgery Service for a Roux-en-Y gastric bypass procedure. During the procedure the staple line of the pouch appeared to be incomplete and was therefore oversewn with silk suture. With air insufflation no air bubbles were seen and it was felt that the patient's staple line was intact. The gastrojejunostomy appeared completely intact. Postoperatively, she had a very large intravenous fluid requirement. An upper gastrointestinal study was obtained that demonstrated a leak. Therefore, on [**2127-2-20**], the patient was taken emergently back to the operating room for a re- exploration. The repaired staple line site was completely intact but more proximal, there was a second staple line site that was incomplete. This was also oversewn both on the pouch side and the stomach remnant side. With both methylene blue and air insufflation challenge, there was no leak. A gastrostomy tube and a JP drain were placed. Postoperatively, the patient was taken intubated to the Intensive Care Unit. The remainder of her hospital stay is dictated by systems. 1. NEUROLOGY: The patient was sedated in the Intensive Care Unit and received analgesia with Dilaudid. Once she was extubated, her Dilaudid continued until she was able to take adequate oral intake. At this time, she was switched to Roxicet elixir which adequately managed her pain up until discharge. 2. CARDIOVASCULAR: The patient was stable for her entire hospitalization. 3. PULMONARY: The patient was kept intubated after her second procedure. The patient was extubated the following day, but throughout the course of the day developed respiratory distress secondary to bronchospasm. She was therefore reintubated. The patient remained intubated for several days after this time. She did have a left lower lobe consolidation and thick mucous that was suctioned. On the [**3-7**] th postoperative days, the patient was extubated. She subsequently did very well and was transferred to the floor. She remained on oxygen by nasal cannula for the next day or two, but by the time of the patient's discharge her saturations were adequate on room air. 4. GASTROINTESTINAL: After the second procedure, the patient had another swallow study that demonstrated no leak. On the 4/5th postoperative day, she was started on stage I gastric bypass diet and was advanced along in a normal fashion. By the time of her discharge, she was tolerating a stage III gastric bypass diet without any problems. [**Name (NI) **] gastroesophageal tube was clamped prior to her discharge, and the patient was educated in the care of her gastroesophageal tube. She was mainained on ulcer prohpylaxis throughout her recovery. A JP drain was placed at the time of the second procedure and this was removed after she tolerated advancement of her diet without evidence of a leak. ON the day of her discharge, she developed loose stools. A Cdiff specimen was obtained. 5. INFECTIOUS DISEASE: She was given intravenous Kefzol in the perioperative period after the first procedure. This was broadened to Flagyl after the leak was diagnosed. She continued on these for approximately eight days. They were discontinued prior to her discharge, and it was felt that she was safe to go home without the need of further antibiotic therapy. DISCHARGE STATUS: On [**2127-2-27**], the patient was discharged home in the care of her family. CONDITION AT DISCHARGE: In stable condition. DISCHARGE FOLLOWUP: She will have visiting nurse assistance to assist her with home physical therapy, assess the progress of her wound healing, and initially supervise her gastroesophageal flushes. MEDICATIONS ON DISCHARGE: (The patient was discharged home on the following medications) 1. Roxicet elixir 5 cc to 10 cc p.o. q.4-6h. p.r.n. 2. Zantac elixir 150 mg p.o. b.i.d. 3. Vitamin B12 1000 mcg p.o. q.d. 4. Actigall 300 mg p.o. b.i.d. 5. Flexeril 10 mg p.o. t.i.d. p.r.n. DISCHARGE INSTRUCTIONS: The patient was instructed not to combine Lortab with Roxicet elixir. The patient verbalized an understanding of all of her discharge instructions. DISCHARGE FOLLOWUP: She was to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in the Gastric [**Hospital 3798**] Clinic in approximately two weeks. DISCHARGE DIAGNOSES: The patient's discharge diagnosis include was morbid obesity. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 13186**], M.D. [**MD Number(1) 13187**] Dictated By:[**Last Name (NamePattern1) 9638**] MEDQUIST36 D: [**2127-2-27**] 09:38 T: [**2127-2-27**] 09:16 JOB#: [**Job Number 37738**]

278,998,507,276,E870

{'Morbid obesity,Accidental puncture or laceration during a procedure, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Accidental cut, puncture, perforation or hemorrhage during surgical 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: Morbid obesity. PRESENT ILLNESS: Ms. [**Known lastname 3075**] is a 35-year-old female with morbid obesity who presents for gastric bypass surgery. She has a weight of 450 pounds, with a body mass L5-S1 herniated disk with spinal stenosis and compression, and mild hypertension. MEDICAL HISTORY: MEDICATION ON ADMISSION: 2. Flexeril 10 mg p.o. t.i.d. p.r.n. 3. Lortab p.o. p.r.n. 4. Meridia 10 mg p.o. q.d. ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Her father is 61 and has coronary artery disease, status post coronary artery bypass grafting and obesity. Mother is 59 with coronary artery disease, status post coronary artery bypass graft, diabetes, asthma, arthritis, and obesity. SOCIAL HISTORY: ### Response: {'Morbid obesity,Accidental puncture or laceration during a procedure, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Hyperpotassemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}

CHIEF COMPLAINT: End Stage Renal Disease PRESENT ILLNESS: 47-year-old man with a history of hypertension, ESRD on dialysis for more than six years, currently through a left radiocephalic fistula. He is active on blood group O transplant list. He urinates about 0.5-1L/day. He has a history of recurrent tunneled catheter infections. He usually gets exhausted after dialysis, and he does not gain any weight gain in between dialysis. He had a negative stress test about 6 months ago. Otherwise he does not complain of any other symptoms, denies any fever, chills, cough, diarrhea or recent infections. MEDICAL HISTORY: Hypertension, gout, back pain MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Atenolol 100', Lisinopril 20'', Nifedipine 90', Calcium acetate w meals, sensipar 90', percocet prn back pain ALLERGIES: cefazolin PHYSICAL EXAM: Physical Exam: Vitals: T 98.9F, HR 85, BP (164/88) rr15 98% RA, pain 3 GEN: A&Ox3, NAD, conversant, pleasant CV: regular rate and rhythm, normal s1 s2 Lungs: Clear to auscultation bilaterally. ABD: Soft, non distended, appropriately tender to palpation in right lower quadrant near incision site. Staples in place no oozing or pus draining from rlq incision. Dressing CDI over removed JP incision. Abdomen otherwise non tender to palpation to rebound or guarding. Ext: Radial pulses bilaterally. Left radiocephalic AV fistula with thrill. No C/C/E. FAMILY HISTORY: Brother with ESRD s/p KTX SOCIAL HISTORY: Snow truck driver. Married. Lives with wife and 2 [**Name2 (NI) 25400**]. Drinks about 7 drinks a week. Denies any tobacco or illicit drug use.

Precipitous drop in hematocrit,Renal dialysis status,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease

Drop, hematocrit, precip,Renal dialysis status,Gout NOS,Hyp kid NOS w cr kid V,End stage renal disease

Admission Date: [**2150-10-31**] Discharge Date: [**2150-11-5**] Date of Birth: [**2103-9-20**] Sex: M Service: SURGERY Allergies: cefazolin Attending:[**First Name3 (LF) 668**] Chief Complaint: End Stage Renal Disease Major Surgical or Invasive Procedure: Kidney Transplant History of Present Illness: 47-year-old man with a history of hypertension, ESRD on dialysis for more than six years, currently through a left radiocephalic fistula. He is active on blood group O transplant list. He urinates about 0.5-1L/day. He has a history of recurrent tunneled catheter infections. He usually gets exhausted after dialysis, and he does not gain any weight gain in between dialysis. He had a negative stress test about 6 months ago. Otherwise he does not complain of any other symptoms, denies any fever, chills, cough, diarrhea or recent infections. Past Medical History: Hypertension, gout, back pain Social History: Snow truck driver. Married. Lives with wife and 2 [**Name2 (NI) 25400**]. Drinks about 7 drinks a week. Denies any tobacco or illicit drug use. Family History: Brother with ESRD s/p KTX Physical Exam: Physical Exam: Vitals: T 98.9F, HR 85, BP (164/88) rr15 98% RA, pain 3 GEN: A&Ox3, NAD, conversant, pleasant CV: regular rate and rhythm, normal s1 s2 Lungs: Clear to auscultation bilaterally. ABD: Soft, non distended, appropriately tender to palpation in right lower quadrant near incision site. Staples in place no oozing or pus draining from rlq incision. Dressing CDI over removed JP incision. Abdomen otherwise non tender to palpation to rebound or guarding. Ext: Radial pulses bilaterally. Left radiocephalic AV fistula with thrill. No C/C/E. Pertinent Results: [**2150-11-3**] 01:52AM BLOOD WBC-11.6* RBC-3.12* Hgb-9.3* Hct-27.3* MCV-87 MCH-29.6 MCHC-33.9 RDW-15.6* Plt Ct-109* [**2150-11-4**] 05:45AM BLOOD WBC-5.1# RBC-3.09* Hgb-9.3* Hct-27.2* MCV-88 MCH-30.1 MCHC-34.1 RDW-15.7* Plt Ct-104* [**2150-11-5**] 07:05AM BLOOD WBC-3.0* RBC-2.95* Hgb-9.0* Hct-26.5* MCV-90 MCH-30.4 MCHC-33.8 RDW-15.4 Plt Ct-118* [**2150-11-3**] 01:52AM BLOOD PT-10.1 PTT-28.4 INR(PT)-0.9 [**2150-10-31**] 11:53PM BLOOD Glucose-94 UreaN-36* Creat-8.4*# Na-138 K-4.0 Cl-86* HCO3-40* AnGap-16 [**2150-11-4**] 05:45AM BLOOD Glucose-120* UreaN-41* Creat-6.5*# Na-135 K-4.4 Cl-94* HCO3-31 AnGap-14 [**2150-11-5**] 07:05AM BLOOD Glucose-108* UreaN-63* Creat-7.7*# Na-133 K-5.0 Cl-92* HCO3-29 AnGap-17 Urine culture Negative. CMV negative. Brief Hospital Course: HD1: Patient presented to [**Hospital1 18**] for a kidney transplant. The donor kidney was transplanted on the right side. A 19 [**Doctor Last Name **] drain was placed and incision was closed with staples. Patient received 2 units of pbrcs intraoperatively for decreased hematocrit. Blood loss during the operation was 150cc. In the PACU, the patient was hypertensive to the 190's/110s. Initially, conventional antihypertensives were tried which could not control the patients blood pressure. He was placed on a nicardipine drip. Since his blood pressure could not be controlled without nipride drip, he was transferred to the sicu HD1 for pain/blood pressure control. Also, of note, he had a femoral line placed since he subclavian/ij central access could not be attained. He received his first dose of ATG in the or. His urine output was approximately 50cc/hr. His drain output was sanguinous and putting out approx 400cc. He received another unit of red cells in the SICU. Notably, he received the standard immunosuppresion proptocol of FK506, solumedrol, renally dosed valcyte, and cellcept. HD2: Patient remained in the SICU and was given 100 lasix for low UoP. He received another unit of blood and ATG. His blood pressure was under control. His pain was well controlled on PCA. He received HD in the SICU. His diet was advanced to clears HD3: Diet advanced to regular. Was transfer to [**Wardname 13487**]. His blood pressure remained under control. His PCA was dc'd. Pain well tolerated on PO pain meds. Patient received transplant med training book. HD4: Patient received another dose of ATG [**12-31**] delayed graft function. HD5: Femoral line was DC. Blood pressure well controlled. Pain controlled. Bowel regimen to good effect and had 2 BM. Ambulatex1. Foley dc'd and able to void HD6: Pain controlled. ambulating several times. JP removed. Renal did not feel that HD was warranted as he would be receiving it the following day. The patient was tolerating a regular diet with instructions to follow up with transplant clinic, have his fk levels checked, and resume dialysis Medications on Admission: [**Last Name (un) 1724**]: Atenolol 100', Lisinopril 20'', Nifedipine 90', Calcium acetate w meals, sensipar 90', percocet prn back pain Discharge Medications: 1. prednisone 10 mg Tablet Sig: 2.5 Tablets PO ONCE (Once) for 1 doses: take [**11-6**] (last dose). Disp:*3 Tablet(s)* Refills:*0* 2. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 3. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 6. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO prn: every 6 hours as needed for pain. 7. valganciclovir 450 mg Tablet Sig: One (1) Tablet PO 2X/WEEK (WE,SA). 8. tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 9. tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO twice a day. 10. nifedipine 90 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO DAILY (Daily). 11. PhosLo 667 mg Capsule Sig: One (1) Capsule PO three times a day: with meals. 12. Sensipar 90 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: End Stage Renal Disease s/p renal transplant delayed renal graft function htn Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted for a kidney transplant. Please resume your normal dialysis schedule (Monday-Wed-Friday at [**Location (un) 270**] Dialysis)starting tomorrow [**11-6**] at 4pm. You will follow up with Dr. [**First Name (STitle) **] next week and he will inform you more about the need for doing dialysis in the future. Please take all medications that are prescribed. General Discharge Instructions: 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 [**4-7**] lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips 7-10 days after surgery. Followup Instructions: Saturday [**11-7**], 8:30 AM, [**Hospital Ward Name 1826**] 7, [**Hospital Ward Name 516**]; [**Location (un) **] [**Location (un) 86**]. Trough Prograf level and transplant labs Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2150-11-12**] 2:40 Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2150-11-20**] 8:30 Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2150-12-1**] 8:20

790,V451,274,403,585

{'Precipitous drop in hematocrit,Renal dialysis status,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: End Stage Renal Disease PRESENT ILLNESS: 47-year-old man with a history of hypertension, ESRD on dialysis for more than six years, currently through a left radiocephalic fistula. He is active on blood group O transplant list. He urinates about 0.5-1L/day. He has a history of recurrent tunneled catheter infections. He usually gets exhausted after dialysis, and he does not gain any weight gain in between dialysis. He had a negative stress test about 6 months ago. Otherwise he does not complain of any other symptoms, denies any fever, chills, cough, diarrhea or recent infections. MEDICAL HISTORY: Hypertension, gout, back pain MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Atenolol 100', Lisinopril 20'', Nifedipine 90', Calcium acetate w meals, sensipar 90', percocet prn back pain ALLERGIES: cefazolin PHYSICAL EXAM: Physical Exam: Vitals: T 98.9F, HR 85, BP (164/88) rr15 98% RA, pain 3 GEN: A&Ox3, NAD, conversant, pleasant CV: regular rate and rhythm, normal s1 s2 Lungs: Clear to auscultation bilaterally. ABD: Soft, non distended, appropriately tender to palpation in right lower quadrant near incision site. Staples in place no oozing or pus draining from rlq incision. Dressing CDI over removed JP incision. Abdomen otherwise non tender to palpation to rebound or guarding. Ext: Radial pulses bilaterally. Left radiocephalic AV fistula with thrill. No C/C/E. FAMILY HISTORY: Brother with ESRD s/p KTX SOCIAL HISTORY: Snow truck driver. Married. Lives with wife and 2 [**Name2 (NI) 25400**]. Drinks about 7 drinks a week. Denies any tobacco or illicit drug use. ### Response: {'Precipitous drop in hematocrit,Renal dialysis status,Gout, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease'}

CHIEF COMPLAINT: chest pain, nausea, vomiting PRESENT ILLNESS: 59 y/o male with hypertension presents with 11 days of diarrhea and nausea with vomiting and 4 days of chest pain. Diarrhea not associated with new food intake, sick contact, bloody stools, or mucous in stools. No recent travel. Nausea and vomiting not associated with alcohol use, hematemesis, sick contacts, or toxic ingestions. Chest pain began four days ago and is left sided in nature beginning under the arm and radiating to the front. . On ROS, he does endorse some headache, fever, chills, cough, dyspnea, and sputum production. . In the ED, he had T to 100.3, BP 186/91, HR 109, Sat 98% on RA. He received 3 SL nitro, aspirin, 5 mg IV Hydralazine, 5 mg IV lopressor, 5 mg IV ativan in total, 3 mg IV dilaudid in total, 750 mg PO levofloxacin, and 2 L NS. He was started on nitro drip for elevated blood pressures. 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: Clonidine 0.2 mg TID Aspirin 325 mg DAILY Pantoprazole 40 mg DAILY Docusate Sodium 100 mg [**Hospital1 **] Clonazepam 2 mg TID Labetalol 100 mg [**Hospital1 **] Methadone 125mg DAILY ALLERGIES: Compazine / Codeine / Atenolol PHYSICAL EXAM: Tired appearing white male, NG tube in place, with blood from nose. T 98.0 HR 60 BP 189/96 RR 12 SAT 98 % 2L NC SKIN: no rashes HEENT: NC/AT. Pupils 6mm and reactive. Sclera anicteric. NECK: No cervical LAD. No thyroid nodules. Normal carotid pulses. CHEST: No axillary LAD. Lungs with diffusely increased sounds. HEART: Regular rhythm. S4 gallop audible. ABD: NABS. Soft, mild diffuse tenderness. No rebound. Voluntary guarding. GUAIAC: Negative per ED report EXT: Good pulses. No edema. FAMILY HISTORY: NC SOCIAL HISTORY: His living situation is not clear as he has family but has also been in shelters. Gets Methadone [**Street Address(1) 10970**] ([**Telephone/Fax (1) 10971**] and denies ongoing IV opioid abuse. Also claims that he has not had alcohol 30+ years. Admits to tobacco use ([**1-25**] ppd). No children.

Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Acute kidney failure, unspecified,Dehydration,Esophageal reflux,Posttraumatic stress disorder,Dysthymic disorder,Intestinal infection due to other organism, not elsewhere classified

Malignant hypertension,Chr airway obstruct NEC,Opioid dependence-contin,Hpt B chrn wo cm wo dlta,Acute kidney failure NOS,Dehydration,Esophageal reflux,Posttraumatic stress dis,Dysthymic disorder,Viral enteritis NOS

Admission Date: [**2107-4-11**] Discharge Date: [**2107-4-16**] Date of Birth: [**2047-9-9**] Sex: M Service: MEDICINE Allergies: Compazine / Codeine / Atenolol Attending:[**First Name3 (LF) 1974**] Chief Complaint: chest pain, nausea, vomiting Major Surgical or Invasive Procedure: None. History of Present Illness: 59 y/o male with hypertension presents with 11 days of diarrhea and nausea with vomiting and 4 days of chest pain. Diarrhea not associated with new food intake, sick contact, bloody stools, or mucous in stools. No recent travel. Nausea and vomiting not associated with alcohol use, hematemesis, sick contacts, or toxic ingestions. Chest pain began four days ago and is left sided in nature beginning under the arm and radiating to the front. . On ROS, he does endorse some headache, fever, chills, cough, dyspnea, and sputum production. . In the ED, he had T to 100.3, BP 186/91, HR 109, Sat 98% on RA. He received 3 SL nitro, aspirin, 5 mg IV Hydralazine, 5 mg IV lopressor, 5 mg IV ativan in total, 3 mg IV dilaudid in total, 750 mg PO levofloxacin, and 2 L NS. He was started on nitro drip for elevated blood pressures. 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 Social History: His living situation is not clear as he has family but has also been in shelters. Gets Methadone [**Street Address(1) 10970**] ([**Telephone/Fax (1) 10971**] and denies ongoing IV opioid abuse. Also claims that he has not had alcohol 30+ years. Admits to tobacco use ([**1-25**] ppd). No children. Family History: NC Physical Exam: Tired appearing white male, NG tube in place, with blood from nose. T 98.0 HR 60 BP 189/96 RR 12 SAT 98 % 2L NC SKIN: no rashes HEENT: NC/AT. Pupils 6mm and reactive. Sclera anicteric. NECK: No cervical LAD. No thyroid nodules. Normal carotid pulses. CHEST: No axillary LAD. Lungs with diffusely increased sounds. HEART: Regular rhythm. S4 gallop audible. ABD: NABS. Soft, mild diffuse tenderness. No rebound. Voluntary guarding. GUAIAC: Negative per ED report EXT: Good pulses. No edema. Pertinent Results: CT HEAD: no acute process . CT ABD: 1. No intra-abdominal pathology to account for the patient's symptoms. 2. Unchanged appearance of L1 compression deformity with retropulsion of fracture fragments abutting the spinal canal. . . ECG: Sinus rhythm Left atrial abnormality Probable left anterior fascicular block Since previous tracing of [**2107-1-27**], rate faster and low T wave amplitude is improved . . CXR: Repeat PA together with a lateral view were performed at approximately 1607 hours. The current views show no acute infiltrate, no pleural effusion, and no pneumothorax. . . [**2107-4-11**] 03:40PM WBC-4.2 RBC-3.74* HGB-10.0* HCT-29.0* MCV-78* MCH-26.7* MCHC-34.5 RDW-14.9 [**2107-4-11**] 03:40PM NEUTS-77.4* LYMPHS-18.8 MONOS-2.1 EOS-1.6 BASOS-0.2 [**2107-4-11**] 03:40PM PLT COUNT-193 [**2107-4-11**] 03:40PM CK-MB-NotDone cTropnT-<0.01 proBNP-904* [**2107-4-11**] 03:40PM GLUCOSE-102 UREA N-27* CREAT-1.3* SODIUM-143 POTASSIUM-4.3 CHLORIDE-109* TOTAL CO2-26 ANION GAP-12 [**2107-4-11**] 03:40PM ALT(SGPT)-8 AST(SGOT)-11 CK(CPK)-60 ALK PHOS-85 AMYLASE-52 TOT BILI-0.2 Brief Hospital Course: 1) Hypertensive Urgency: Likely due to his inability to take medications because of n/v. [**Month (only) 116**] also be withrawing from Klonopin or methadone but no clear evidence of this. No blood in U/A. Pt admitted to ICU and placed on nitro drip. His outpt labetalol was increased to 400 [**Hospital1 **] with some improvement. Nitro gtt was weaned off. As BP remained high, hydralazine was initially added. He was continued on clonidine and ACEI. Hydralazine was not working very well so switched to nifedipine (low dose). With this regimen of labetalol, nifedipine, clonidine, and lisinopril his overall BP was well controlled. He continued to have some excursions of SBP up to 160s particularly in AM prior to meds. It is likely anxiety was contributing as well. Pt should have complete workup for secondary HTN as outpt as many of the labs are sendouts. Some of this ie MRA kidneys has already been done. . 2) N/V/Diarrhea: Likely viral gastroenteritis, although time course appears prolonged. CT abd negative for other acute process. He had a low grade temperature (<101) to go along with viral infection. Pt did not provide stool sample. But diarrhea and vomiting resolved and he was tolerating POs. He did have some mild nausea remaining. . 3) Chest Pain: Negative cardiac enzymes and no EKG changes made cardiac ischemia very unlikely. Reproducible with palpation. . 4) Anemia: Stable microcytic anemia. Iron studies, B12, folate wnl. Hct was stable so no further workup done as inpatient. . 5) h/o Substance abuse: He is on methadone 130 mg daily. He gets his methadone from outpatient methadone maintenance clinic [**Street Address(1) 10972**] ([**Telephone/Fax (1) 10971**]. He is also on klonopin 2mg TID. . 6) Hepatitis B,C: These were not active issues during this admission. Medications on Admission: Clonidine 0.2 mg TID Aspirin 325 mg DAILY Pantoprazole 40 mg DAILY Docusate Sodium 100 mg [**Hospital1 **] Clonazepam 2 mg TID Labetalol 100 mg [**Hospital1 **] Methadone 125mg DAILY Discharge Medications: 1. Labetalol 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 2. Clonidine 0.2 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO qPM. Disp:*30 Tablet Sustained Release(s)* Refills:*2* 5. Methadone 10 mg/mL Concentrate Sig: One [**Age over 90 10973**]y (130) mg PO DAILY (Daily). 6. Phenergan 25 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for nausea for 7 days. Disp:*30 Tablet(s)* Refills:*0* 7. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 8. Clonazepam 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*0* 9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. Discharge Disposition: Home Discharge Diagnosis: PRIMARY: Hypertensive urgency Gastroenteritis Discharge Condition: Good. Discharge Instructions: 1. Take medications as prescribed. 2. Please call your doctor or return to the hospital if you have any fevers, chills, inability to tolerate food and liquids, persistent diarrhea. Followup Instructions: Please follow up at Medical Care of [**Location (un) 86**] in [**1-25**] weeks. If you need a new primary care doctor, you can [**Location 10974**] (([**Telephone/Fax (1) 2535**]) or [**Hospital1 **] Community Health Center (([**Telephone/Fax (1) 10975**]).

401,496,304,070,584,276,530,309,300,008

{'Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Acute kidney failure, unspecified,Dehydration,Esophageal reflux,Posttraumatic stress disorder,Dysthymic disorder,Intestinal infection due to other organism, 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: chest pain, nausea, vomiting PRESENT ILLNESS: 59 y/o male with hypertension presents with 11 days of diarrhea and nausea with vomiting and 4 days of chest pain. Diarrhea not associated with new food intake, sick contact, bloody stools, or mucous in stools. No recent travel. Nausea and vomiting not associated with alcohol use, hematemesis, sick contacts, or toxic ingestions. Chest pain began four days ago and is left sided in nature beginning under the arm and radiating to the front. . On ROS, he does endorse some headache, fever, chills, cough, dyspnea, and sputum production. . In the ED, he had T to 100.3, BP 186/91, HR 109, Sat 98% on RA. He received 3 SL nitro, aspirin, 5 mg IV Hydralazine, 5 mg IV lopressor, 5 mg IV ativan in total, 3 mg IV dilaudid in total, 750 mg PO levofloxacin, and 2 L NS. He was started on nitro drip for elevated blood pressures. 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: Clonidine 0.2 mg TID Aspirin 325 mg DAILY Pantoprazole 40 mg DAILY Docusate Sodium 100 mg [**Hospital1 **] Clonazepam 2 mg TID Labetalol 100 mg [**Hospital1 **] Methadone 125mg DAILY ALLERGIES: Compazine / Codeine / Atenolol PHYSICAL EXAM: Tired appearing white male, NG tube in place, with blood from nose. T 98.0 HR 60 BP 189/96 RR 12 SAT 98 % 2L NC SKIN: no rashes HEENT: NC/AT. Pupils 6mm and reactive. Sclera anicteric. NECK: No cervical LAD. No thyroid nodules. Normal carotid pulses. CHEST: No axillary LAD. Lungs with diffusely increased sounds. HEART: Regular rhythm. S4 gallop audible. ABD: NABS. Soft, mild diffuse tenderness. No rebound. Voluntary guarding. GUAIAC: Negative per ED report EXT: Good pulses. No edema. FAMILY HISTORY: NC SOCIAL HISTORY: His living situation is not clear as he has family but has also been in shelters. Gets Methadone [**Street Address(1) 10970**] ([**Telephone/Fax (1) 10971**] and denies ongoing IV opioid abuse. Also claims that he has not had alcohol 30+ years. Admits to tobacco use ([**1-25**] ppd). No children. ### Response: {'Malignant essential hypertension,Chronic airway obstruction, not elsewhere classified,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Acute kidney failure, unspecified,Dehydration,Esophageal reflux,Posttraumatic stress disorder,Dysthymic disorder,Intestinal infection due to other organism, not elsewhere classified'}

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: Ms. [**Known lastname **] is an 85 year old Russian-speaking woman w/PMHx of CAD s/p CABG, systolic and diastolic CHF, afib on coumadin, CRI (basleine creatinine ~1.5), complete heart block s/p permanent pacer, hip fracture [**11-15**] after a fall who presents with SOB. History is taken with help of her son as an interpreter. Her son noticed that occasionally at rehab she was on oxygen intermittently but was not requiring oxygen at home. She has been at [**Hospital 100**] Rehab since [**Month (only) **] and came home 1 day prior to admission. Her lasix dose was being adjusted at rehab. She has been progressively short of breath with worsening LE edema for the past few weeks but markedly worse since in the past [**3-9**] days. No chest pain or pressure. No lightheaded or dizzy feelings. No fevers or chills. She has a non-productive cough. + Orthopnea which is chronic. She uses a walker at home and has had worsening DOE. Her son thinks she was adhering to a low salt diet. . In the ED, initial VS 99.8 73 139/60 16 100% 15L NRB, weaned to 97% on 2L. BNP was 23,00. CXR showed CHF. She received 60mg IV Lasix and a foley catheter was placed. ECG was paced. Vitals prior to transfer: 98.7 72 138/57 18 98%/2 L nc. MEDICAL HISTORY: 1. CAD - s/p 2V CABG [**4-/2145**] to OM/CX and to RCA. Recath [**8-/2145**] - occluded RCA [**Last Name (LF) **], [**First Name3 (LF) **] OM [**First Name3 (LF) **] disease, previously diseased LCx and LAD free of disease (followed by Vainov/[**Doctor Last Name **]) 2. Chronic Systolic Heart Failure EF 30-35% 3. Atrial fibrillation on warfarin and amiodarone 4. s/p DDD pacer for 2:1 AV block 5. Hypertension 6. Hyperlipidemia 7. Peptid Ulcer Disease 8. Glaucoma 9. Hypercalcemia [**2-7**] hyperparathyroidism - s/p parathyroid resection in '[**28**]'s now with recurrence; noted to have new large complex left-sided thyroid nodule (inconclusive biopsies) - followed by Endocrine 10. s/p TAH/BSO 11. Osteoporosis 12. h/o neurogenic bladder, urethral stricture 13. Hyperplastic colonic polyps 14. h/o mod MR, mild PAH, LAE (TTE [**2144**]) 15. Congestive heart failure, systolic, EF 40% 16. Hypothyroidism MEDICATION ON ADMISSION: Xalatan 0.005 % eye drops 1 drop qHS Patanol 0.1% eye drops 1 drop each eye [**Hospital1 **] Carvedilol 6.25mg PO daily Protonix 40mg PO BID Senna 8.6mg 2 tabs [**Hospital1 **] Vitamin D2 50,000 units PO every other week Aspirin 81mg PO daily Ativan 0.5mg PO PRN anxiety Calcitriol 0.25mg PO daily Losartan 12.5mg PO daily Digoxin 125mcg sig: .5 tabs PO QOD Imdur 30mg PO daily Amiodarone 200mg PO daily Meclizine 12.5mg PO daily Nitroglycerin 0.4mg SL PRN Hydroxyzine 5mg PO qHS PRN itching Spironolactone 25mg PO daily Ambien 5mg PO qHS PRN insomnia Levothyroxine 50mcg PO daily Ferrous Sulfate 325mg PO daily Warfarin 1mg daily (per son) Lasix 60mg PO daily ALLERGIES: Zithromax PHYSICAL EXAM: VS: T97.2 BP 108/80 HR 72 RR 20 96% on 3L. GENERAL: Well-appearing woman in NAD, comfortable, appropriate. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: She lives alone in an apartment in [**Location (un) 86**] and cares for herself. Son and daughter live nearby. Husband died last year. She denies any tobacco or EtOH use. Retired ENT physician from [**Country 532**].

Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other and unspecified coagulation defects,Unspecified protein-calorie malnutrition,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Atrial fibrillation,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified glaucoma,Anemia in chronic kidney disease,Do not resuscitate status

Ac/chr syst/dia hrt fail,Food/vomit pneumonitis,Acute respiratry failure,Acute kidney failure NOS,Hyperosmolality,Coagulat defect NEC/NOS,Protein-cal malnutr NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Atrial fibrillation,Long-term use anticoagul,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Status cardiac pacemaker,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Glaucoma NOS,Anemia in chr kidney dis,Do not resusctate status

Admission Date: [**2159-6-2**] Discharge Date: [**2159-6-10**] Date of Birth: [**2073-6-26**] Sex: F Service: MEDICINE Allergies: Zithromax Attending:[**First Name3 (LF) 1650**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Known lastname **] is an 85 year old Russian-speaking woman w/PMHx of CAD s/p CABG, systolic and diastolic CHF, afib on coumadin, CRI (basleine creatinine ~1.5), complete heart block s/p permanent pacer, hip fracture [**11-15**] after a fall who presents with SOB. History is taken with help of her son as an interpreter. Her son noticed that occasionally at rehab she was on oxygen intermittently but was not requiring oxygen at home. She has been at [**Hospital 100**] Rehab since [**Month (only) **] and came home 1 day prior to admission. Her lasix dose was being adjusted at rehab. She has been progressively short of breath with worsening LE edema for the past few weeks but markedly worse since in the past [**3-9**] days. No chest pain or pressure. No lightheaded or dizzy feelings. No fevers or chills. She has a non-productive cough. + Orthopnea which is chronic. She uses a walker at home and has had worsening DOE. Her son thinks she was adhering to a low salt diet. . In the ED, initial VS 99.8 73 139/60 16 100% 15L NRB, weaned to 97% on 2L. BNP was 23,00. CXR showed CHF. She received 60mg IV Lasix and a foley catheter was placed. ECG was paced. Vitals prior to transfer: 98.7 72 138/57 18 98%/2 L nc. Past Medical History: 1. CAD - s/p 2V CABG [**4-/2145**] to OM/CX and to RCA. Recath [**8-/2145**] - occluded RCA [**Last Name (LF) **], [**First Name3 (LF) **] OM [**First Name3 (LF) **] disease, previously diseased LCx and LAD free of disease (followed by Vainov/[**Doctor Last Name **]) 2. Chronic Systolic Heart Failure EF 30-35% 3. Atrial fibrillation on warfarin and amiodarone 4. s/p DDD pacer for 2:1 AV block 5. Hypertension 6. Hyperlipidemia 7. Peptid Ulcer Disease 8. Glaucoma 9. Hypercalcemia [**2-7**] hyperparathyroidism - s/p parathyroid resection in '[**28**]'s now with recurrence; noted to have new large complex left-sided thyroid nodule (inconclusive biopsies) - followed by Endocrine 10. s/p TAH/BSO 11. Osteoporosis 12. h/o neurogenic bladder, urethral stricture 13. Hyperplastic colonic polyps 14. h/o mod MR, mild PAH, LAE (TTE [**2144**]) 15. Congestive heart failure, systolic, EF 40% 16. Hypothyroidism Social History: She lives alone in an apartment in [**Location (un) 86**] and cares for herself. Son and daughter live nearby. Husband died last year. She denies any tobacco or EtOH use. Retired ENT physician from [**Country 532**]. Family History: Non-contributory Physical Exam: VS: T97.2 BP 108/80 HR 72 RR 20 96% on 3L. GENERAL: Well-appearing woman in NAD, comfortable, appropriate. HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. NECK: Supple, no thyromegaly, JVD ~13cm. Visibly pulsatile carotid pulse in the neck. no carotid bruits. HEART: RRR, harsh [**2-11**] ejection murmur at RUSB. + chest heave. LUNGS: Resp unlabored. Diffuse wheezes and crackles through left lung field. Right is more clear. ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding. EXTREMITIES: WWP, 2+ peripheral edema to thighs bilaterally, L perhaps slightly greater than R, 2+ peripheral pulses. SKIN: No rashes or lesions. LYMPH: No cervical LAD. . Discharge Exam: VS: 97.0 131/63 71 28 95%2L GENERAL: NAD, thin, pale elderly woman HEENT: PERRL, EOMI, MMM, OP clear. NECK: Supple, no JVD HEART: RRR, harsh [**2-11**] ejection murmur at RUSB LUNG: Stable diffuse rhonci and crackles at 1/2way up, good airmovement. ABD: Soft/NT/ND, no masses or HSM, no rebound/guarding. EXTREMITIES: WWP, 1+ peripheral edema to thighs bilaterally. SKIN: No rashes or lesions. LYMPH: No cervical LAD Pertinent Results: Blood Counts [**2159-6-2**] 10:00PM BLOOD WBC-7.6 RBC-4.23# Hgb-12.7# Hct-38.1# MCV-90 MCH-30.0 MCHC-33.4 RDW-16.7* Plt Ct-252 [**2159-6-4**] 12:00PM BLOOD WBC-14.4*# RBC-4.67 Hgb-13.6 Hct-42.9 MCV-92 MCH-29.2 MCHC-31.8 RDW-16.1* Plt Ct-233 [**2159-6-5**] 05:05AM BLOOD WBC-17.1* RBC-4.19* Hgb-12.4 Hct-37.4 MCV-89 MCH-29.6 MCHC-33.2 RDW-16.6* Plt Ct-191 [**2159-6-10**] 04:18AM BLOOD WBC-7.8 RBC-3.79* Hgb-11.0* Hct-33.2* MCV-88 MCH-29.0 MCHC-33.1 RDW-15.6* Plt Ct-169 Coags [**2159-6-2**] 10:00PM BLOOD PT-22.5* PTT-26.7 INR(PT)-2.1* [**2159-6-10**] 04:18AM BLOOD PT-33.8* PTT-30.8 INR(PT)-3.4* Chemistry [**2159-6-2**] 10:00PM BLOOD Glucose-126* UreaN-35* Creat-1.8* Na-144 K-3.6 Cl-106 HCO3-27 AnGap-15 [**2159-6-4**] 07:20AM BLOOD Glucose-86 UreaN-30* Creat-1.5* Na-143 K-3.6 Cl-103 HCO3-33* AnGap-11 [**2159-6-7**] 07:08AM BLOOD Glucose-89 UreaN-50* Creat-1.7* Na-149* K-3.4 Cl-110* HCO3-29 AnGap-13 [**2159-6-10**] 04:18AM BLOOD Glucose-82 UreaN-36* Creat-1.5* Na-145 K-3.9 Cl-106 HCO3-30 AnGap-13 Cardiac [**2159-6-2**] 10:00PM BLOOD proBNP-[**Numeric Identifier 104764**]* [**2159-6-2**] 10:00PM BLOOD cTropnT-0.01 [**2159-6-3**] 07:30AM BLOOD CK-MB-2 cTropnT-<0.01 [**2159-6-4**] 07:20AM BLOOD CK-MB-2 cTropnT-0.02* Reports [**2159-6-2**] CXR: Cardiomegaly with mild congestive heart failure. Probable small bilateral pleural effusions and left basilar atelectasis. . [**2159-6-4**] CXR: Increasing confluent opacities within the left mid lung zone and right lower lung zone may represent pulmonary edema given the rapid onset with the differential being infection or aspiration. . [**2159-6-5**] TTE: The left atrium is elongated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is moderate regional left ventricular systolic dysfunction with mid- and distal anterior and septal akinesis, as well as inferior hypokinesis and probable akinesis of the true LV apex (segment incompletely visualized). The remaining segments contract normally (LVEF = 35%). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. 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. Moderate to severe (3+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. Moderate regional left ventricular systolic dysfunction, most c/w multivessel CAD. Mild aortic regurgitation. Moderate to severe mitral regurgitation. Moderate pulmonary hypertension. Compared with the prior study (images reviewed) of [**2158-1-4**], there is more prominent anterior/septal regional LV dysfunction and the overall LVEF is lower. The other findings are similar. . [**2159-6-6**] Video Swallow: Several episodes of penetration and aspiration with administration of thin liquids. The study and the report were reviewed by the staff radiologist. Brief Hospital Course: HOSPITAL COURSE 85 year old Russian-speaking woman p/w worsening systolic CHF, course complicated by aspiration pneumonia, s/p abx and diuresis, ready for discharge to rehab . ACTIVE ISSUES: # Acute on Chronic Systolic Heart Failure: Patient was admitted with SOB and hypoxia with signs of fluid overload on exam/imaging and an markedly elevated BNP. Course was complicated by a stay in the CCU for a lasix drip to treat hypoxia in the setting of failure. Patient was subsequently diuresed with improvement in resp status and transfer back to the floor. Diuresis was also complicated by an episode of hypotension thought to be secondary to over diuresis and scheduling of medications; decreased dosing of spironolactone and isosorbide mononitrate, and spread out administration of medications to decrease risk of hypotension during the daytime. The remaineder of her CHF regimen (carvediolol, digoxin and losartan) was continued unchanged. . # Recurrent Aspiration PNA: During hospital course patient was found to have RLL infiltrate. Vanco/cefepime was started for treatment of presumed aspiration PNA. Video swallow showed unpreventable silent aspiration with all fluid consistencies. Per family meeting, patiend wished to continue eating and to be rehospitalized if she aspirates in the future. At discharge patient was planned for cotinuation of antibiotics until [**2159-6-11**] . . # Medication changes due to age: Ativan, hydroxyzine, ambien, meclizine were stopped given patients age and risk of causing delirium. . INACTIVE ISSUES: # CAD: continued aspirin, carvedilol . # Anemia: Continued iron sulfate. . # Afib on Coumadin: Pacer dependent, on coumadin and amiodarone (INR goal [**2-8**]). CHADS2=2. . # Glaucoma: Continued Latanoprost. . #Hypothyroidism: Continued levothyroxine . TRANSITIONAL ISSUES: 1. Code status - Patient remained DNR/DNI 2. Pending Labs - No labs/studies were pending at time of discharge 3. Transition of Care: Patient was discharged to [**Hospital 4542**] Rehab Facility in [**Location (un) 38**]. 4. Barriers to Care: The family was made aware of the unpreventable silent aspiration and a family meeting was held. The patient requested that she be allowed to eat and understood the potential risk for ongoing aspiration and re-hospitalization. She has asked to be rehospitalized and treated with antibitiotics. Medications on Admission: Xalatan 0.005 % eye drops 1 drop qHS Patanol 0.1% eye drops 1 drop each eye [**Hospital1 **] Carvedilol 6.25mg PO daily Protonix 40mg PO BID Senna 8.6mg 2 tabs [**Hospital1 **] Vitamin D2 50,000 units PO every other week Aspirin 81mg PO daily Ativan 0.5mg PO PRN anxiety Calcitriol 0.25mg PO daily Losartan 12.5mg PO daily Digoxin 125mcg sig: .5 tabs PO QOD Imdur 30mg PO daily Amiodarone 200mg PO daily Meclizine 12.5mg PO daily Nitroglycerin 0.4mg SL PRN Hydroxyzine 5mg PO qHS PRN itching Spironolactone 25mg PO daily Ambien 5mg PO qHS PRN insomnia Levothyroxine 50mcg PO daily Ferrous Sulfate 325mg PO daily Warfarin 1mg daily (per son) Lasix 60mg PO daily Discharge Medications: 1. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 2. Patanol 0.1 % Drops Sig: One (1) drop Ophthalmic twice a day: Each eye. 3. carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. 5. senna 8.6 mg Capsule Sig: Two (2) Capsule PO twice a day. 6. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1) Capsule PO every other week. 7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 8. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). 9. losartan 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 10. digoxin 125 mcg Tablet Sig: One Half Tablet PO EVERY OTHER DAY (Every Other Day). 11. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tab Sublingual once a day as needed for chest pain. 13. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 16. Lasix 20 mg Tablet Sig: Three (3) Tablet PO once a day. 17. heparin, porcine (PF) 10 unit/mL Syringe Sig: Ten (10) ML Intravenous PRN (as needed) as needed for line flush: PICC. 18. cefepime 2 gram Recon Soln Sig: Two (2) g Injection Q24H (every 24 hours) for 1 doses: Last day [**6-11**]. 19. Outpatient Lab Work Vancomycin trough [**2159-6-8**] before PM dose. Fax results to Rehab physician for titration of Vancomycin, goal trough = 15-20. 20. DuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL Solution for Nebulization Sig: One (1) Neb Inhalation every six (6) hours. 21. spironolactone 25 mg Tablet Sig: 0.5 Tablet PO QPM (once a day (in the evening)). 22. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: 0.5 Tablet Extended Release 24 hr PO DAILY (Daily). 23. vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1) gram Intravenous Q48H (every 48 hours) for 1 doses: last day [**6-11**]. Discharge Disposition: Extended Care Facility: [**Hospital 4542**] Rehabilitation and Nursing of [**Location (un) 38**] Discharge Diagnosis: PRIMARY: -Acute on Chronic Diastolic Heart Failure -Aspiration Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). - Patient w stable ronchorus breathing, satting mid90s on 2 liters Discharge Instructions: It was a pleasure taking care of you at [**Hospital1 827**]. You were hospitalized for treatment of shortness of breath. Your symptoms were a result of your worsening of your heart failure (your heart having trouble pumping), in addition to an infection in your lungs. Fluid was taken off from your lungs with medications, and you were given antibioitics. . Your pneumonia was likely caused by difficulty swallowing, with saliva, liquids, and food falling into your lungs. The swallow team evaluated you and was unable to make diet recommendations to that would prevent this aspiration process. By continuing to eat, you will continue to have the risk of aspirating. They recommended that you see a speach therapist to help teach you proper eating techniques. You indicated that you would like to continue eating. . During this hospitalization the following changes were made to your medications: -STARTED IV Vancomycin to treat for pneumonia -STARTED IV Cefepime to treat for pneumonia -STARTED nebulizer treatments -DECREASED isosorbide mononitrate -DECREASED spironolactone -STOPPED Ativan, Ambien, Meclizine, Hydroxyzine as this can cause disorientation in patient's your age Followup Instructions: Your care after discharge will be overseen by the extended care facility physician. [**Name10 (NameIs) **] extended care physician should schedule [**Name Initial (PRE) **] follow-up appointment with your primary care physician 2 weeks after discharge from the extended care facility. Department: Voice, Speech, and Swallowing Phone: [**Telephone/Fax (1) 3731**] Please call and book a follow up appointment within 2 weeks of discharge. If you have any questions or concerns please call the office. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 1653**]

428,507,518,584,276,286,263,414,V458,427,V586,403,585,V450,244,272,365,285,V498

{'Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other and unspecified coagulation defects,Unspecified protein-calorie malnutrition,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Atrial fibrillation,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified glaucoma,Anemia in chronic kidney disease,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: shortness of breath PRESENT ILLNESS: Ms. [**Known lastname **] is an 85 year old Russian-speaking woman w/PMHx of CAD s/p CABG, systolic and diastolic CHF, afib on coumadin, CRI (basleine creatinine ~1.5), complete heart block s/p permanent pacer, hip fracture [**11-15**] after a fall who presents with SOB. History is taken with help of her son as an interpreter. Her son noticed that occasionally at rehab she was on oxygen intermittently but was not requiring oxygen at home. She has been at [**Hospital 100**] Rehab since [**Month (only) **] and came home 1 day prior to admission. Her lasix dose was being adjusted at rehab. She has been progressively short of breath with worsening LE edema for the past few weeks but markedly worse since in the past [**3-9**] days. No chest pain or pressure. No lightheaded or dizzy feelings. No fevers or chills. She has a non-productive cough. + Orthopnea which is chronic. She uses a walker at home and has had worsening DOE. Her son thinks she was adhering to a low salt diet. . In the ED, initial VS 99.8 73 139/60 16 100% 15L NRB, weaned to 97% on 2L. BNP was 23,00. CXR showed CHF. She received 60mg IV Lasix and a foley catheter was placed. ECG was paced. Vitals prior to transfer: 98.7 72 138/57 18 98%/2 L nc. MEDICAL HISTORY: 1. CAD - s/p 2V CABG [**4-/2145**] to OM/CX and to RCA. Recath [**8-/2145**] - occluded RCA [**Last Name (LF) **], [**First Name3 (LF) **] OM [**First Name3 (LF) **] disease, previously diseased LCx and LAD free of disease (followed by Vainov/[**Doctor Last Name **]) 2. Chronic Systolic Heart Failure EF 30-35% 3. Atrial fibrillation on warfarin and amiodarone 4. s/p DDD pacer for 2:1 AV block 5. Hypertension 6. Hyperlipidemia 7. Peptid Ulcer Disease 8. Glaucoma 9. Hypercalcemia [**2-7**] hyperparathyroidism - s/p parathyroid resection in '[**28**]'s now with recurrence; noted to have new large complex left-sided thyroid nodule (inconclusive biopsies) - followed by Endocrine 10. s/p TAH/BSO 11. Osteoporosis 12. h/o neurogenic bladder, urethral stricture 13. Hyperplastic colonic polyps 14. h/o mod MR, mild PAH, LAE (TTE [**2144**]) 15. Congestive heart failure, systolic, EF 40% 16. Hypothyroidism MEDICATION ON ADMISSION: Xalatan 0.005 % eye drops 1 drop qHS Patanol 0.1% eye drops 1 drop each eye [**Hospital1 **] Carvedilol 6.25mg PO daily Protonix 40mg PO BID Senna 8.6mg 2 tabs [**Hospital1 **] Vitamin D2 50,000 units PO every other week Aspirin 81mg PO daily Ativan 0.5mg PO PRN anxiety Calcitriol 0.25mg PO daily Losartan 12.5mg PO daily Digoxin 125mcg sig: .5 tabs PO QOD Imdur 30mg PO daily Amiodarone 200mg PO daily Meclizine 12.5mg PO daily Nitroglycerin 0.4mg SL PRN Hydroxyzine 5mg PO qHS PRN itching Spironolactone 25mg PO daily Ambien 5mg PO qHS PRN insomnia Levothyroxine 50mcg PO daily Ferrous Sulfate 325mg PO daily Warfarin 1mg daily (per son) Lasix 60mg PO daily ALLERGIES: Zithromax PHYSICAL EXAM: VS: T97.2 BP 108/80 HR 72 RR 20 96% on 3L. GENERAL: Well-appearing woman in NAD, comfortable, appropriate. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: She lives alone in an apartment in [**Location (un) 86**] and cares for herself. Son and daughter live nearby. Husband died last year. She denies any tobacco or EtOH use. Retired ENT physician from [**Country 532**]. ### Response: {'Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other and unspecified coagulation defects,Unspecified protein-calorie malnutrition,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Atrial fibrillation,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified glaucoma,Anemia in chronic kidney disease,Do not resuscitate status'}

CHIEF COMPLAINT: right upper lob lung mass followed on close follow-up PRESENT ILLNESS: 80-year-old woman who is a lifelong nonsmoker but has a prior history of non-Hodgkin lymphoma as well as carcinoma of the breast. On careful followup, she has been found to have a slowly-growing, spiculated, noncalcified, solid right upper lobe mass. She has no prior symptoms referable to this. She does have a recent 10-pound weight loss. A remote metastatic survey was unremarkable. The lesion has grown from approximately 9 x 16 mm in [**2109-11-1**] to a current size of 13 x 20 mm. MEDICAL HISTORY: Non- hodkins lymphoma s/p chemotherapy, Left breast cancer s/p mastectomy, now with Right upper lobe lung mass. MEDICATION ON ADMISSION: ALPRAZOLAM 250 ASPIRIN FUROSEMIDE 20 LISINOPRIL 10 MECLIZINE HCL 25 SCOPOLAMINE HYDROBROMIDE 1.5MG/72HR ALLERGIES: Penicillins PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: non- smoker

Nodular lymphoma, unspecified site, extranodal and solid organ sites,Congestive heart failure, unspecified,Diseases of tricuspid valve,Atrial flutter,Personal history of malignant neoplasm of breast,Esophageal reflux,Scoliosis [and kyphoscoliosis], idiopathic

Ndlr lym unsp xtrndl org,CHF NOS,Tricuspid valve disease,Atrial flutter,Hx of breast malignancy,Esophageal reflux,Idiopathic scoliosis

Admission Date: [**2110-8-12**] Discharge Date: [**2110-8-29**] Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 2969**] Chief Complaint: right upper lob lung mass followed on close follow-up Major Surgical or Invasive Procedure: thoracotomy for right upper lobectomy History of Present Illness: 80-year-old woman who is a lifelong nonsmoker but has a prior history of non-Hodgkin lymphoma as well as carcinoma of the breast. On careful followup, she has been found to have a slowly-growing, spiculated, noncalcified, solid right upper lobe mass. She has no prior symptoms referable to this. She does have a recent 10-pound weight loss. A remote metastatic survey was unremarkable. The lesion has grown from approximately 9 x 16 mm in [**2109-11-1**] to a current size of 13 x 20 mm. Past Medical History: Non- hodkins lymphoma s/p chemotherapy, Left breast cancer s/p mastectomy, now with Right upper lobe lung mass. Social History: non- smoker Pertinent Results: Hematology COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2110-8-22**] 05:06AM 17.5* 3.26* 10.0* 30.4* 93 30.6 32.8 14.1 414 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT) [**2110-8-29**] 05:03AM 18.2*1 2.2 1 NOTE NEW NORMAL RANGE AS OF 12 AM [**2110-5-31**] Chemistry RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2110-8-27**] 04:21AM 3.6 ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase TotBili DirBili [**2110-8-22**] 05:06AM 47* 35 138* CPK ISOENZYMES CK-MB cTropnT [**2110-8-16**] 01:33AM 2 CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron [**2110-8-26**] 06:32AM 8.9 2.7 2.0 PITUITARY TSH [**2110-8-19**] 01:13AM 5.8* RADIOLOGY Final Report CHEST (PA & LAT) [**2110-8-29**] 10:07 AM Reason: interval change in PTX/acute lung process/pleural effusion [**Hospital 93**] MEDICAL CONDITION: 80 year old woman with RULobectomy s/p pleural tap REASON FOR THIS EXAMINATION: interval change in PTX/acute lung process/pleural effusion HISTORY: Right upper lobectomy. Following pleural tap. IMPRESSION: PA and lateral chest compared to [**8-28**] and prior films since [**2110-8-25**]: There has been no change since [**8-27**]. Considerable consolidation is still present at both lung bases, small-to-moderate right and left pleural effusions are stable and there is no pneumothorax. The heart is top normal size. The left internal jugular catheter cannulates the azygous vein as it has for more than a week. The persistent abnormality in the lower lungs has been attributed to asymmetric edema, but the chronicity now begins to suggest pulmonary hemorrhage, less likely pneumonia because both areas were atelectatic when larger pleural effusions were present. Pathology Examination Name Birthdate Age Sex Pathology # [**Hospital1 18**] [**Known lastname 101592**],[**Known firstname **] [**2029-12-14**] 80 Female [**-6/2747**] [**Numeric Identifier 101593**] Report to: DR. [**Last Name (STitle) **]. [**Doctor Last Name **] Gross Description by: DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 65106**]/mtd SPECIMEN SUBMITTED: CELL BLOCK. Procedure date Tissue received Report Date Diagnosed by [**2110-8-27**] [**2110-9-2**] [**2110-9-5**] DR. [**Last Name (STitle) **]. FU/cwg Previous biopsies: [**-6/2501**] (Right) upper lobe lung nodule for Immunophenotyping. [**-5/2476**] RIGHT UPPER LOBE NODULE. [**Numeric Identifier 101594**] BONE MARROW/mk. [**Numeric Identifier 101595**] RETROPERITONEAL MASS/tk. DIAGNOSIS: Pleural fluid, cell block: No malignancy identified. Reactive mesothelial cells, many lymphocytes and blood. Note: Immunocytochemical stains including LCA, keratin cocktail (AE1/AE3/CAM 5.2) and calretinin performed and confirmed the presence of above cells. Please see cytology report (C05-29022G) for additional information. Brief Hospital Course: Pt admitted SDA [**2110-8-12**] for Right upper lobectomy for RUL mass. Pt tolerated procedure well and transferred to PACU in stable condition, Ct x2 to sx. PACU course complicated by brief administration of phenylephrine gtt and transfusion PRBC x2 for HCT 25. Pt transferred to floor POD#1 in stable condition. CTx2 output of 120/465 POD#1, pain control w/ epidural- Dilaudid and bupivicaine, PT consult, OOB, IS. Epidural in place until POD#5 when chest tube x2 d/c. Patient's post -op course complicated by: Afib on POD#3 refractory to lopressor iv in large doses,with rate 130-150 w/o response. Cardiology consult POD#6- Amiodarone iv started, transitioned to po w/ good rate effect,anticoagulation w/ Heparin gtt initiated, check TSH. Pt transitioned to lovenox and to coumadin (POD#6) w/ goal INR [**3-6**]. INR elevated w/ amiodarone, therefore coumadin held, and INR corrected w/ FFP daily x3 days. No coumadin given up to discharge w/ level 2.2 [**8-29**]. Lasix cont qd, brief administration Diltiazem IV (POD#8)for rate control when unable to take po meds, transitioned to po POD#10. Intestinal impaction, mild ileus POD#8 w/ inability to tolerate po intake, some nausea and vomitting. Rx given w/ resolution POD#10, slowly increasing po intake. Prolapse of rectum reduced x2 during this time. Pleural effusions-O2 requirement increased (O2 sat 93-94% 3-3.5Lnc) and persisted despite lasix qd w/ diminished BS and DOE on POD#13, with thoracentesis of right chest for 1300 cc, and left chest of 900 cc; no complication with significant improvement in respiratory status on POD#15-7/29/05 of O2 Sat 92% RA. In addition. intermittent episodes of NSR evident. Patient discharged to home POD#15/PPD#2 to home w/ VNA services and home O2. Coumadin andINR management by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**], MD office. Medications on Admission: ALPRAZOLAM 250 ASPIRIN FUROSEMIDE 20 LISINOPRIL 10 MECLIZINE HCL 25 SCOPOLAMINE HYDROBROMIDE 1.5MG/72HR Discharge Medications: 1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Meclizine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 5. Diltiazem HCl 30 mg Tablet Sig: Three (3) Tablet PO QID (4 times a day). Disp:*360 Tablet(s)* Refills:*2* 6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed. 8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) for 21 days: take 2 pills in am for 3 weeks, then 1 pill in am ongoing. Disp:*60 Tablet(s)* Refills:*0* 9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed. 10. Chlorhexidine Gluconate 0.12 % Liquid Sig: Five (5) ML Mucous membrane QID (4 times a day). 11. Warfarin Sodium 1 mg Tablet Sig: 0.5 Tablet PO ONCE (once): take as directed. Disp:*30 Tablet(s)* Refills:*0* 12. oxygen O2 1-2L/min continuous for portability pulse dose system Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: right upper lobectomy, thoracotomy, mediastinoscopy. Discharge Condition: good Discharge Instructions: Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] if you experience chest pain, shortness of breath, fever, chills, or productive cough. Take new medications such as coumadin as directed. Take half coumadin pill Saturday evening- [**8-30**] ONLY. (.5MG) Your blood will be drawn on MOnday [**9-1**] and Dr.[**Name (NI) 7916**] office will instruct you for next dose. REsume your previous medications as stated on discharge instructions. Call Dr.[**Name (NI) 7916**] office for an appointment in the next [**11-14**] days. Call Dentist for a Dental visit and cleaning. Followup Instructions: Dr.[**Doctor Last Name 4738**] appointment [**2110-9-4**] at 10am at the [**Hospital Ward Name 23**] Clinical Center- [**Location (un) **]- Thoracic Surgery office. For any questions call-[**Telephone/Fax (1) 170**]. Go to [**Hospital Ward Name 23**] Clinical Center Radiology, [**Location (un) **], RADIOLOGY, 45 MINUTES PRIOR TO YOUR APPOINTMENT, for Chest XRAY. Completed by:[**2110-9-11**]

202,428,397,427,V103,530,737

{'Nodular lymphoma, unspecified site, extranodal and solid organ sites,Congestive heart failure, unspecified,Diseases of tricuspid valve,Atrial flutter,Personal history of malignant neoplasm of breast,Esophageal reflux,Scoliosis [and kyphoscoliosis], idiopathic'}

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: right upper lob lung mass followed on close follow-up PRESENT ILLNESS: 80-year-old woman who is a lifelong nonsmoker but has a prior history of non-Hodgkin lymphoma as well as carcinoma of the breast. On careful followup, she has been found to have a slowly-growing, spiculated, noncalcified, solid right upper lobe mass. She has no prior symptoms referable to this. She does have a recent 10-pound weight loss. A remote metastatic survey was unremarkable. The lesion has grown from approximately 9 x 16 mm in [**2109-11-1**] to a current size of 13 x 20 mm. MEDICAL HISTORY: Non- hodkins lymphoma s/p chemotherapy, Left breast cancer s/p mastectomy, now with Right upper lobe lung mass. MEDICATION ON ADMISSION: ALPRAZOLAM 250 ASPIRIN FUROSEMIDE 20 LISINOPRIL 10 MECLIZINE HCL 25 SCOPOLAMINE HYDROBROMIDE 1.5MG/72HR ALLERGIES: Penicillins PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: non- smoker ### Response: {'Nodular lymphoma, unspecified site, extranodal and solid organ sites,Congestive heart failure, unspecified,Diseases of tricuspid valve,Atrial flutter,Personal history of malignant neoplasm of breast,Esophageal reflux,Scoliosis [and kyphoscoliosis], idiopathic'}

CHIEF COMPLAINT: R sided weakness PRESENT ILLNESS: 39F with a history of AIDS (CD4 113 [**2-25**], VL 109), Hep B, pancreatitis, candidiasis, HSV, pyelonephritis, gonorrhea, syphilis and cocaine abuse who presents with acute right sided weakness for one day. Per report (compiled from the patient, her group home, and mother), the patient yesterday complained of R leg numbness/weakness and a mild headache. She lay down and felt better but awoke at ~4am with an inability to ambulate [**12-20**] R leg weakness and slurred speech. Her group home became concerned and called EMS at this time. Of note, the patient reports intermittant R leg numbness over the past several months but the mother has noticed her daughter complain of bilateral LE symptoms for >1yr. Over the past week, the patient denies any fevers/chills/night sweats, N/V, abdominal pain, rash, cough, weight loss, SOB, medication non-compliance, diarrhea, or obvious sick contacts. She does endorse some mild pressure type non-radiating chest pain in the ED today along with palpatations that had since resolved. . In the ED, the patient was noted to have a variable mental status and exam. They observed discordant neurologic exam findings on the R compared to the L and a code stroke was called. CT scan showed marked destruction of her sinuses c/w old surgical procedures but infectious cause could not be excluded. No recent infarcts were seen on this scan. Neurology evaluated the patient and felt her picture was more consistent with an infectious etiology but suggested an acute MRI to exclude CVA. ENT was consulted who felt the CT was suggestive of an acute vs chronic sinusitis but noted that this was unlikely to cause her neurologic symptoms. Her telemetry showed a NSR with intermittant runs of a rate related LBBB that had been seen previously in [**7-23**]. She was admitted to the medicine service for further work-up. . On the floor, her exam was significant for a ? of R sided neglect and marked R sided UE/LE weakness. Her history was occassionally inconsistent but was mostly c/w the history noted above. She received her MRI soon after reaching the floor which showed multiple acute infarctions present within the left frontal lobe and another within the right amygdala that were thought to be c/w either embolic or watershed strokes. . MEDICAL HISTORY: AIDS (CD4 113 [**2-25**], VL 109) Hep B pancreatitis candidiasis HSV pyelonephritis gonorrhea syphilis and cocaine abuse MEDICATION ON ADMISSION: Azithromycin 1200mg qwk Bactrim DS daily Benadryl prn NPH 6u [**Hospital1 **] Novolog sliding scale Reyataz 300mg daily Ritonavir 100mg daily Truvada 200mg-300mg daily Valtrex 1g [**Hospital1 **] x10d prn ALLERGIES: Penicillins / Clarithromycin PHYSICAL EXAM: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Significant drug use (most recently crack cocaine) but clean for >4mo per her program. Remote IVDU but denies ETOH abuse. 1 PPD smoker for 20 years, says she recently stopped. Currently living at a substance abuse program (UMMIS). Has two children aged 19 and 13 who are in [**Doctor Last Name **] care.

Occlusion and stenosis of carotid artery with cerebral infarction,Human immunodeficiency virus [HIV] disease,Cocaine abuse, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hemiplegia, unspecified, affecting unspecified side,Aphasia,Chronic sphenoidal sinusitis,Asthma, unspecified type, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin

Ocl crtd art w infrct,Human immuno virus dis,Cocaine abuse-continuous,Hpt B chrn wo cm wo dlta,Unsp hemiplga unspf side,Aphasia,Chr sphenoidal sinusitis,Asthma NOS,DMII wo cmp nt st uncntr,Long-term use of insulin

Admission Date: [**2116-3-10**] Discharge Date: [**2116-3-16**] Date of Birth: [**2076-5-21**] Sex: F Service: NEUROLOGY Allergies: Penicillins / Clarithromycin Attending:[**First Name3 (LF) 618**] Chief Complaint: R sided weakness Major Surgical or Invasive Procedure: Intubation Sinus surgery History of Present Illness: 39F with a history of AIDS (CD4 113 [**2-25**], VL 109), Hep B, pancreatitis, candidiasis, HSV, pyelonephritis, gonorrhea, syphilis and cocaine abuse who presents with acute right sided weakness for one day. Per report (compiled from the patient, her group home, and mother), the patient yesterday complained of R leg numbness/weakness and a mild headache. She lay down and felt better but awoke at ~4am with an inability to ambulate [**12-20**] R leg weakness and slurred speech. Her group home became concerned and called EMS at this time. Of note, the patient reports intermittant R leg numbness over the past several months but the mother has noticed her daughter complain of bilateral LE symptoms for >1yr. Over the past week, the patient denies any fevers/chills/night sweats, N/V, abdominal pain, rash, cough, weight loss, SOB, medication non-compliance, diarrhea, or obvious sick contacts. She does endorse some mild pressure type non-radiating chest pain in the ED today along with palpatations that had since resolved. . In the ED, the patient was noted to have a variable mental status and exam. They observed discordant neurologic exam findings on the R compared to the L and a code stroke was called. CT scan showed marked destruction of her sinuses c/w old surgical procedures but infectious cause could not be excluded. No recent infarcts were seen on this scan. Neurology evaluated the patient and felt her picture was more consistent with an infectious etiology but suggested an acute MRI to exclude CVA. ENT was consulted who felt the CT was suggestive of an acute vs chronic sinusitis but noted that this was unlikely to cause her neurologic symptoms. Her telemetry showed a NSR with intermittant runs of a rate related LBBB that had been seen previously in [**7-23**]. She was admitted to the medicine service for further work-up. . On the floor, her exam was significant for a ? of R sided neglect and marked R sided UE/LE weakness. Her history was occassionally inconsistent but was mostly c/w the history noted above. She received her MRI soon after reaching the floor which showed multiple acute infarctions present within the left frontal lobe and another within the right amygdala that were thought to be c/w either embolic or watershed strokes. . Past Medical History: AIDS (CD4 113 [**2-25**], VL 109) Hep B pancreatitis candidiasis HSV pyelonephritis gonorrhea syphilis and cocaine abuse Social History: Significant drug use (most recently crack cocaine) but clean for >4mo per her program. Remote IVDU but denies ETOH abuse. 1 PPD smoker for 20 years, says she recently stopped. Currently living at a substance abuse program (UMMIS). Has two children aged 19 and 13 who are in [**Doctor Last Name **] care. Family History: Noncontributory Brief Hospital Course: The patient was admitted to the medicine service and transferred to neurology upon discovery of stroke. TEE showed no vegetations, no asd/vsd and a bubble study was negative. ID was consulted regarding sinusitis and recommended broadening her coverage for sinusitis from antibiotics to include antifungals and they recommended tissue biopsy/debridement. Neurosurgery was also consulted, who recommended repeat MRI/MRA, as the first study was degraded by motion. This showed "Similar to the previous examination, there is a soft tissue mass that destroys the sphenoid sinus. Following the administration of intravenous gadolinium, there is diffuse enhancement of this invasive mass. Enhancement appears to extend along the wall of the left maxillary sinus. The soft tissues of the nasal sinuses also diffusely enhance. Enhancement extends into the cavernous sinus bilaterally. Multiple areas of abnormal signal intensity within the cerebral hemispheres are consistent with subacute infarction. The largest of these areas is located in the left parietal lobe and measures approximately 3.2 x 3.5 cm. An area of hyperintensity within the left frontal lobe is much more pronounced on today's examination compared to the exam from [**2116-3-11**]. The areas of infarction within the left frontoparietal lobe superiorly also appear more extensive compared to the previous examination. The abnormal hyperintense signal within the right temporal lobe is unchanged. MRA: Time-of-flight imaging demonstrates no flow within the carotid arteries intracranially, again similar to the findings from [**2116-3-11**]." The risk of ENT surgery was discussed with the family, who decided to proceed. This was performed, with precautions to keep HOB flat, maintain good hydration with IVF, and keep sbp>160 and avoiding sharp drops in blood pressure in the postoperative period. On [**3-13**], the patient underwent CT-guided bilateral sphenoid sinus surgical endoscopy with biopsy. Postoperatively, she was admitted to the SICU for further care. On [**3-15**], head CT was performed for decreased responsivenss. It showed "Very large right MCA and ACA infarct continues to evolve with enlarging mass effect and shift of the median midline structures, subfalcine herniation now 10 mm across the midline, previously 5 with associated effacement of the lateral ventricle. The suprasellar cistern is also effaced with deviate asymmetry of the quadrigemminal plate cistern secondary to transtentorial herniation that has also worsened in the interval. There is also effacement of the [**Doctor Last Name 352**]-white matter differentiation along the left MCA and ACA territory secondary to infarct though to a much lesser involvement. New hypodensity in the right cerebral peduncle is also suspicious for ischemia" and the patient was started on mannitol. On [**3-15**], she was started on neosynephrine to keep her MAP>90. She spiked overnight to [**3-16**] and was started on a cooling blanket. During the day of [**3-16**], the patient's pupils ceased to be reactive and an emergent head CT was obtained. it showed worsening herniation and neurosurgery was again consulted. Upon discussion with the family, surgical intervention was deemed futile. Later that day, after extensive discussion, the patient was made DNR and the decision was made to initiate comfort measures only and the patient expired. Medications on Admission: Azithromycin 1200mg qwk Bactrim DS daily Benadryl prn NPH 6u [**Hospital1 **] Novolog sliding scale Reyataz 300mg daily Ritonavir 100mg daily Truvada 200mg-300mg daily Valtrex 1g [**Hospital1 **] x10d prn Discharge Medications: Expired Discharge Disposition: Expired Discharge Diagnosis: Bilateral strokes AIDS Sinusitis Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] Completed by:[**2116-3-17**]

433,042,305,070,342,784,473,493,250,V586

{'Occlusion and stenosis of carotid artery with cerebral infarction,Human immunodeficiency virus [HIV] disease,Cocaine abuse, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hemiplegia, unspecified, affecting unspecified side,Aphasia,Chronic sphenoidal sinusitis,Asthma, unspecified type, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: R sided weakness PRESENT ILLNESS: 39F with a history of AIDS (CD4 113 [**2-25**], VL 109), Hep B, pancreatitis, candidiasis, HSV, pyelonephritis, gonorrhea, syphilis and cocaine abuse who presents with acute right sided weakness for one day. Per report (compiled from the patient, her group home, and mother), the patient yesterday complained of R leg numbness/weakness and a mild headache. She lay down and felt better but awoke at ~4am with an inability to ambulate [**12-20**] R leg weakness and slurred speech. Her group home became concerned and called EMS at this time. Of note, the patient reports intermittant R leg numbness over the past several months but the mother has noticed her daughter complain of bilateral LE symptoms for >1yr. Over the past week, the patient denies any fevers/chills/night sweats, N/V, abdominal pain, rash, cough, weight loss, SOB, medication non-compliance, diarrhea, or obvious sick contacts. She does endorse some mild pressure type non-radiating chest pain in the ED today along with palpatations that had since resolved. . In the ED, the patient was noted to have a variable mental status and exam. They observed discordant neurologic exam findings on the R compared to the L and a code stroke was called. CT scan showed marked destruction of her sinuses c/w old surgical procedures but infectious cause could not be excluded. No recent infarcts were seen on this scan. Neurology evaluated the patient and felt her picture was more consistent with an infectious etiology but suggested an acute MRI to exclude CVA. ENT was consulted who felt the CT was suggestive of an acute vs chronic sinusitis but noted that this was unlikely to cause her neurologic symptoms. Her telemetry showed a NSR with intermittant runs of a rate related LBBB that had been seen previously in [**7-23**]. She was admitted to the medicine service for further work-up. . On the floor, her exam was significant for a ? of R sided neglect and marked R sided UE/LE weakness. Her history was occassionally inconsistent but was mostly c/w the history noted above. She received her MRI soon after reaching the floor which showed multiple acute infarctions present within the left frontal lobe and another within the right amygdala that were thought to be c/w either embolic or watershed strokes. . MEDICAL HISTORY: AIDS (CD4 113 [**2-25**], VL 109) Hep B pancreatitis candidiasis HSV pyelonephritis gonorrhea syphilis and cocaine abuse MEDICATION ON ADMISSION: Azithromycin 1200mg qwk Bactrim DS daily Benadryl prn NPH 6u [**Hospital1 **] Novolog sliding scale Reyataz 300mg daily Ritonavir 100mg daily Truvada 200mg-300mg daily Valtrex 1g [**Hospital1 **] x10d prn ALLERGIES: Penicillins / Clarithromycin PHYSICAL EXAM: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Significant drug use (most recently crack cocaine) but clean for >4mo per her program. Remote IVDU but denies ETOH abuse. 1 PPD smoker for 20 years, says she recently stopped. Currently living at a substance abuse program (UMMIS). Has two children aged 19 and 13 who are in [**Doctor Last Name **] care. ### Response: {'Occlusion and stenosis of carotid artery with cerebral infarction,Human immunodeficiency virus [HIV] disease,Cocaine abuse, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hemiplegia, unspecified, affecting unspecified side,Aphasia,Chronic sphenoidal sinusitis,Asthma, unspecified type, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin'}

CHIEF COMPLAINT: Fever, cellulitis, adenitis and hypotension. PRESENT ILLNESS: A 51-year-old male, without any significant past medical history, who was transferred from an outside hospital for cellulitis and adenitis that was not responsive to antibiotics, resulting in hypotension. The patient stated that he was in his usual state of health until Tuesday, [**2167-7-14**] when he first noted some left upper groin pain. The groin pain became progressively worse over the next several days, and also he noted an area of erythema. He developed fevers on [**2167-7-19**]. He went to an outside hospital Emergency Department the following day. At that time, he was diagnosed with cellulitis and adenitis, and was given 2 gm of ceftriaxone, and was discharged to home. He continued to have persistent fevers to 103 and returned the following morning to the outside hospital Emergency Department where he was admitted for cellulitis and adenitis. He was started on Ancef, but developed a diffuse erythroderma rash the day after initiation of Ancef therapy, which was felt to be due to a drug rash. On [**2167-7-22**], the day of transfer to [**Hospital6 256**], the patient was still persistently spiking fevers, had an elevated white blood cell count with a bandemia, and became hypotensive despite IV antibiotics, including vancomycin, clindamycin and Levaquin. His blood pressure dropped to 70 systolic, and he was given IV fluids and started on peripheral dopamine. At this time, arrangements were made to transfer the patient to [**Hospital6 256**]. On arrival to [**Hospital6 1760**], the patient was no longer on the dopamine drip and was normotensive with blood pressure's in the 100's to 110's/60's to 70's. MEDICAL HISTORY: History of prior wrist and hand surgery. MEDICATION ON ADMISSION: ALLERGIES: Possible allergy to Ancef causing a rash. PHYSICAL EXAM: FAMILY HISTORY: No family history of early coronary artery disease, or diabetes. SOCIAL HISTORY: The patient has a remote tobacco history. He quit smoking in the [**2133**]'s. He drinks occasionally only socially. The patient lives in [**Location (un) 3844**] with his wife and children. He has a dog and lives in a heavily wooded area.

Unspecified septicemia,Cellulitis and abscess of leg, except foot,Lyme Disease,Unspecified disease of pericardium,Lymphadenitis, unspecified, except mesenteric,Sepsis

Septicemia NOS,Cellulitis of leg,Lyme disease,Pericardial disease NOS,Lymphadenitis NOS,Sepsis

Admission Date: [**2167-7-22**] Discharge Date: [**2167-7-26**] Date of Birth: [**2115-11-9**] Sex: M Service: MED INTERIM SUMMARY DATE OF DISCHARGE FROM INTENSIVE CARE UNIT: [**2167-7-26**]. CHIEF COMPLAINT: Fever, cellulitis, adenitis and hypotension. HISTORY OF PRESENT ILLNESS: A 51-year-old male, without any significant past medical history, who was transferred from an outside hospital for cellulitis and adenitis that was not responsive to antibiotics, resulting in hypotension. The patient stated that he was in his usual state of health until Tuesday, [**2167-7-14**] when he first noted some left upper groin pain. The groin pain became progressively worse over the next several days, and also he noted an area of erythema. He developed fevers on [**2167-7-19**]. He went to an outside hospital Emergency Department the following day. At that time, he was diagnosed with cellulitis and adenitis, and was given 2 gm of ceftriaxone, and was discharged to home. He continued to have persistent fevers to 103 and returned the following morning to the outside hospital Emergency Department where he was admitted for cellulitis and adenitis. He was started on Ancef, but developed a diffuse erythroderma rash the day after initiation of Ancef therapy, which was felt to be due to a drug rash. On [**2167-7-22**], the day of transfer to [**Hospital6 256**], the patient was still persistently spiking fevers, had an elevated white blood cell count with a bandemia, and became hypotensive despite IV antibiotics, including vancomycin, clindamycin and Levaquin. His blood pressure dropped to 70 systolic, and he was given IV fluids and started on peripheral dopamine. At this time, arrangements were made to transfer the patient to [**Hospital6 256**]. On arrival to [**Hospital6 1760**], the patient was no longer on the dopamine drip and was normotensive with blood pressure's in the 100's to 110's/60's to 70's. The patient reported that 3 to 4 days prior to the onset of his symptoms on [**7-14**], he had been doing work at a family member's house and had been trying to close-off openings that rodents were using to get into a house. He also, at that time, removed a dead squirrel from the chimney. He noted that during his work that day there were a lot of bugs and spiders. He, however, does not remember being bitten by any insect. The patient lives in a heavily wooded area, has deer in his backyard, and also has a pet dog. He has not had any recent travel outside of [**Location (un) 3844**]. He has had no sick contacts. PAST MEDICAL HISTORY: History of prior wrist and hand surgery. ALLERGIES: Possible allergy to Ancef causing a rash. MEDICATIONS: None. MEDICATIONS ON TRANSFER: 1. Vancomycin. 2. Clindamycin. 3. Levaquin. 4. Zofran. 5. Vicodin. FAMILY HISTORY: No family history of early coronary artery disease, or diabetes. SOCIAL HISTORY: The patient has a remote tobacco history. He quit smoking in the [**2133**]'s. He drinks occasionally only socially. The patient lives in [**Location (un) 3844**] with his wife and children. He has a dog and lives in a heavily wooded area. PHYSICAL EXAM ON ARRIVAL: Temperature 98.6, heart rate 106, blood pressure 108/67, respiratory rate 24, oxygen saturation 96 percent on 2 liters. GENERAL: In no acute distress, alert and oriented x 3. HEENT: Pupils equal, round and reactive to light. Supple neck. Clear oropharynx. No cervical lymphadenopathy. Anicteric sclerae. Extraocular muscles intact. No facial asymmetry. LUNGS: Clear to auscultation bilaterally. CARDIOVASCULAR EXAM: Tachycardic, irregular. ABDOMEN: Soft, nontender, normoactive bowel sounds, no hepatosplenomegaly. EXTREMITIES: No lower extremity edema. 2 plus dorsalis pedis pulses and posterior tibialis pulses bilaterally. LEFT GROIN: With several large, palpable subcutaneous nodules and an erythema over the left upper thigh extending from several inches above the knee to just below the inguinal crease. The area of erythema was warm and tender to palpation. The subcutaneous nodules were nontender to palpation. NEUROLOGIC EXAM: Cranial nerves II through XII intact bilaterally. Strength 5/5 in upper and lower extremities bilaterally. LABORATORY DATA: White blood cell count 19.8 with 94 percent polys, 0 bands, 3 percent lymphs, hematocrit 35.3, platelets 201, INR 1.3, PTT 30.7, ESR 100, reticulocyte count 1.7, sodium 137, potassium 3.8, chloride 103, bicarbonate 21, BUN 12, creatinine 0.7, ALT 64, AST 27, LDH 81, CK 153, alkaline phosphatase 127, amylase 12, total bilirubin 1.7, direct bilirubin 1.0, lipase 12, troponin-T less than 0.01, albumin 3.3, uric acid 3.0, haptoglobin 328, TSH 0.36, Lyme serology 160:[**2167**], negative. CHEST X-RAY: Showed increased interstitial markings, possibly suggesting fluid overload. EKG: Showed sinus tachycardia with first degree AV block with a PR interval of 0.218. HOSPITAL COURSE: 1. GROIN ERYTHEMA AND SUBCUTANEOUS NODULES: The patient's groin erythema was clinically consistent with a cellulitis. Given the patient's possible allergy to Ancef, he was continued on IV vancomycin and clindamycin. Blood cultures were sent which did not reveal any organism. The patient remained hemodynamically stable and did not require any further pressors. The subcutaneous nodules had been previously ultrasounded and sampled with fine needle aspiration at the outside hospital on the day of admission. The ultrasound at the outside hospital revealed only lymphadenopathy. The Gram stain showed 2 plus polys but no organisms. A repeat ultrasound at [**Hospital6 256**] showed only left groin enlarged lymph nodes. No evidence of an abscess or fluid collection. The surgical service was consulted for biopsy of the left upper thigh lymph nodes, as the patient continued to spike fevers and had a persistently elevated white blood cell count despite vancomycin and clindamycin. An excisional biopsy was attempted; however, no lymph node was obtained. After approximately 3 to 4 days, the patient's cellulitis was clinically improving, he was no longer spiking fevers, and his white blood cell count was decreasing. Given his extremely low risk for MRSA, and the fact that his cultures did not reveal any organisms, the patient's antibiotic coverage was changed to PO clindamycin. There was also concern for possible streptococcal infection with his diffuse erythroderma rash, possibly representing the rash seen as scarlet fever. The patient never reported any pharyngitis, but given his complaints of diffuse arthralgias, myalgias, migrating neuropathic pain, there was some concern of rheumatic fever, as the patient had 2 ASO screens performed which were both negative. 1. MYALGIAS, ARTHRALGIAS AND NEUROPATHIC PAIN: The patient complained of bilateral shooting neuropathic-like pain, migrating arthralgias, swelling in the fingers and toes, and pleuritic chest pain. Given the patient's exposure to multiple insects and animals, there was initially concern over tick-borne illnesses, including Lyme disease and tularemia. Tularemia titers were sent to the State Lab and were pending at the time of transfer out of the intensive care unit. The patient was started on doxycycline to cover tularemia and Lyme disease. However, with the patient's clinical improvement on antibiotics, it was felt that his clinical course was not consistent with tularemia. The patient did develop a significant amount of pleuritic chest pain that was relieved with NSAIDS and IV Toradol. He also developed a pericardial friction rub. An echocardiogram revealed a normal ejection fraction and no pericardial effusion, and Lyme titers were initially negative. However, given the patient's clinical evidence of pericarditis, newly prolonged PR interval, and migratory arthralgias and neuropathic pain, there was a significant concern for Lyme disease and Lyme carditis despite lack of serologic evidence. Therefore, the decision was made to complete a 1 month course of doxycycline, and to repeat Lyme serologies in [**2-6**] weeks. On [**2167-7-26**], the patient was transferred out of the intensive care unit to the general medical floor. The remainder of this discharge summary will be dictated by the covering intern on the general medicine floor. [**First Name11 (Name Pattern1) 122**] [**Last Name (NamePattern4) 24325**], [**MD Number(1) 24326**] Dictated By:[**Last Name (NamePattern1) 18139**] MEDQUIST36 D: [**2167-7-27**] 12:52:10 T: [**2167-7-27**] 13:58:13 Job#: [**Job Number 55595**] Admission Date: [**2167-7-22**] Discharge Date: [**2167-7-27**] Date of Birth: [**2115-11-9**] Sex: M Service: MED HISTORY OF PRESENT ILLNESS: The patient is a 51 year old, Caucasian male who was admitted to the [**Hospital Unit Name 153**] with fever, rash and subcutaneous nodules with hypotension from an outside hospital on [**2167-7-22**]. The patient was at an outside hospital on [**2167-7-14**], eight days prior to admission with groin pain, left greater than right, and then presented again on [**7-19**], which was three days prior to admission, with a rash and painful subcutaneous nodules in the left inguinal area. The patient spiked a temperature to 103 degrees and received IV ceftriaxone 2 gm in the E.D. and sent home. After no improvement, he presented again and received IV Ancef and developed a diffuse, macular, nonpustular, nonbullous, nonpruritic, whole body rash except above his collar, but he does note that the rash was on his palms, but did not affect the soles of his feet, that had been attributed to a drug rash from Ancef. The patient then presented to [**Hospital1 18**], spiked a fever and dropped systolic to 70, but responded to IV fluids and dopamine. The patient continued to state groin pain and rash, macular, blanching, nonpruritic, painful, but without drainage in the left groin area and medial thigh that the patient states responded somewhat to the previous antibiotics at the outside hospital. The patient presented without any history of sick contacts, travel outside of [**Location (un) **], ingestion of raw or undercooked food, no history of pharyngitis or any people in his family with pharyngitis, but did state recent exposure to numerous wildlife including dead chipmunks, aerosolizer on feces and because of recent work in the forest, had positive exposure to all the classic vectors known in [**Location (un) 511**] including ticks, spiders and mosquitos. The patient also presented with arthralgias in bilateral shoulders which migrated down his arm into his phalangeal joints, a dry, hacking, intermittent cough and urge to move his lower legs, running in place because it tingled. The patient was also admitted with the diagnosis of sepsis secondary to hypotension and fever with an unknown source. PAST MEDICAL HISTORY: None. ALLERGIES: Presumed rash allergy to Ancef. MEDICATIONS: Meds at home none. Meds at outside hospital were vanc, clinda and Levaquin times one day and Zofran. FAMILY HISTORY: Rheumatoid arthritis in his father. SOCIAL HISTORY: The patient states he quit tobacco in [**2141**]. Lives in a small, [**Location 55596**]with his wife and kids. Denies polygamous sexual contacts. HOSPITAL COURSE: The patient was admitted to the [**Hospital Unit Name 153**] with the initial diagnoses of fever, rash, subcutaneous nodules. Lyme titers were sent which were not positive for either IgM or IgG. The patient's systolic blood pressure dropped to 70, but he responded to IV fluids and dopamine. The patient continued to spike fevers. Titers were sent for tularemia as well as blood cultures being sent for Ehrlichia, Yersinia and other rickettsial diseases. The patient had significant leukocytosis upon admission which was as high as 25.2, which came down to less than 12. He continued to have the subcutaneous nodule which was firm, moveable, without cystic palpation and not compressible. It was about 2 to 3 cm. He denied continued pain at the inguinal rash site or the nodule site. Once he was hemodynamically stable, the patient was started on vanc and clinda for questionable staph strep cellulitis and doxycycline was later added on for rickettsial coverage. The patient had improved since admission, although it was not known if this was from the antibiotics that were started or from his pathology running its course. The patient also developed a new complaint of a band of chest tightness across his chest from left to right in an nondermatomal pattern, although essentially across the pectorals that was provocated by deep breaths and palliated by sitting forward. EKG showed some diffuse ST segment elevations and prolonged PR interval. Motrin was started for pericarditis. Vanc IV was discontinued and the patient was put on p.o. clinda. Throughout the hospital course the rash became smaller and not painful. The nodule did not change in size, although when surgery did I&D of the area, they did not find anything but PMNs, but nothing growing out on culture and no cystic fluid aspirated. The patient also had throughout his body questionable remnants of a red, macular, reticular or streaking rash which he described as the same appearance of what was throughout his whole body which is still remnant on his arms and legs toward the anterior sides. Of note, this is not the same and his current inguinal rash and pertinent negatives included negative sore throat, facial palsy, central clearing rash, confusion or lethargy, ulceration or eschar around the rash or any uncontrolled upper extremity movements. Labs upon transfer to the floor were white count 12.2 which was down from 25.2, hematocrit 34.1, thrombocytosis of 411 which was up from 201 on admission. Differential had 86.7 percent neutrophils which was down from 93.8 percent on admission, with no bands. Sodium 141, potassium 3.7, chloride 103, bicarb 27, BUN 10, creatinine 0.5, glucose 155. CK 30. MRSA swabs were taken of his rectal and nasopharyngeal areas. ASO was less than 200. Blood cultures were negative for growth times two. Urine was dark amber in color with large blood, but only 2 RBC, positive for urobilinogen and trace protein. Tularemia [**Doctor First Name **] is still pending, although we expect it to be back on [**2167-7-28**]. Lyme IgG and IgM antibodies are negative. ESR times two has been greater than 100. Lower extremity Doppler of the area showed enlarged lymph nodes in the left groin area that are probably reactive, but no fluid collections. Chest x-ray showed a small right pleural effusion, otherwise within normal limits. EKG on [**7-23**] showed borderline first degree AV block which was resolved by [**7-26**], but had an increased PR interval and multiple lead ST changes. Echo also done in-house showed LVEF greater than 55 percent with no vegetations, no pericardial effusion. On physical exam vital signs t-max 98.5, t-current 97.4, pulse 101 ranging from 77 to 101, blood pressure 126/67 with systolic ranging from 109 to 126, respirations 24 ranging from 21 to 34, O2 sat 94 to 99 percent on 2 liters nasal cannula. In general, this is an alert and oriented times three patient who is appropriate, in no acute distress, pleasant. HEENT shows no rashes or lesions on his head or neck. Moist mucous membranes. White patches without exudate at the back of his throat. Oropharynx clear. Pupils equally reactive to light and accommodation. Extraocular muscles intact. No sensation deficits on his face. No exophthalmos. No rhinorrhea, nares are clear. Cardiovascular was very significant for a friction rub, regular rate and rhythm without murmur, S1, S2, no gallop. Pulmonary clear to auscultation bilaterally, no wheezes, rales or rhonchi. Abdomen soft, nondistended, nontender, positive bowel sounds, no rash, lesions or nodules visualized on his anterior abdomen or lower back. Extremities left inguinal and medial macular red rash that is blanching without drainage that has been marked with a pen. It is warm with a 2 to 3 cm subcutaneous nodule that is palpated underneath the rash which is firm, noncystic on palpation. No similar findings on the right side. Lower extremities without venous stasis changes, without edema or erythema distal to the site. Lower leg and distal arm have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], reticular, red rash which is very faint. The patient attributes this to remnants of his whole body rash. No other trunk, abdomen, back or extremity lesions, incisions, punctures, rashes, nodules that are palpable on inspection. Neurologic exam cranial nerves II- XII grossly intact. No facial palsy. No focal sensation or motor deficits in his upper extremities, lower extremities, head or neck. [**Hospital **] hospital course, much of which has been covered in the HPI, 51 year old with multiple infectious exposures with resolving fever, who was transferred out of the [**Hospital Unit Name 153**] once hemodynamically stable, who shows a resolving rash and a stable, palpable nodule in his left inguinal area. Because of his multiple exposures the differential diagnosis for this presentation was quite large. Blood cultures were sent including instructions for growing out rickettsial diseases, which in this area would include ehrlichiosis, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9880**] spotted fever and Lyme disease. The patient denied any recent trauma to the area, denied finding any bites, ticks in the inguinal area. He stated a very monogamous sexual history. Denied preceding pharyngitis or sick contacts, no signs of upper respiratory viral illness, no other nodules throughout his body, no preceding arthralgias which reduce the differential diagnosis for the team to Lyme disease, tularemia staph strep cellulitis or acute rheumatic fever. Throughout the hospital course the patient was receiving doxycycline and clindamycin and he did improve clinically. He did not spike any more fevers, had a very stable white count and was feeling well by the day before discharge. The diagnosis of acute rheumatic fever was pursued because of evolving pericarditis, rash and subcutaneous nodules which are part of major Jones' criteria as well as this migrating polyarthritis which was most apparent in his left shoulder, radiating down his arm. The patient's ASO was negative times one, he had no signs of chorea and did have significant exposure to wild animals and vectors as well as apparent resolution with antibiotics and no aspirin or steroids, it was assumed that the etiology was more infectious than rheumatologic. The patient did well after leaving the [**Hospital Unit Name 153**] and coming to the floor. He complained of occasional, left, pinpoint shoulder pain, but did not have reduced range of motion. He did have multiple EKGs for pericarditis and for any other cardiac events because of this migrating pain/arthritis that went down his left arm, all of which were negative. The questionable first degree AV block on day of discharge was also not apparent any longer. His signs and symptoms of pericarditis as well as signs of pericarditis on EKG were also not present on day of discharge. The patient's subcutaneous nodule was not significantly smaller on the day of discharge, but did not bother the patient. It was not painful, did not have any connection to the cutaneous tissue, was freely moveable and it was considered that this was probably a reactive lymph node that would decrease in size over time. The patient was given very specific instructions on how to follow up with this questionable diagnosis of Lyme disease which was most likely the entity that is being treated, although other rickettsial diseases also could be treated with doxycycline. Streptomycin was not started for tularemia as this was lower on the differential diagnosis, although tularemia does not necessarily have to be glandular with ulcerations in the central eschar which, of note, was not present in this patient. As his ASO was negative, anti-DNase, DNA-SD, anti- DNase B and antihyaluronidase were also checked before discharge. A throat culture was done for beta strep and the primary consulted with the infectious disease team who believe that aspirin for the initial diagnosis of rheumatic fever was not necessary as this was more likely an infectious etiology. Upon discharge the patient's pericarditis was apparently resolved. Motrin was able to control his left shoulder arthralgias. He was taking a full diet, had been afebrile for at least 24 hours, had very stable white count, showed no other pertinent signs on physical exam except for an apparently resolving, [**Doctor Last Name **], reticular rash in the same left inguinal area with a very stable subcutaneous nodule that is most likely a lymph node. The patient instructed upon discharge that he will need to complete 14 days of p.o. clindamycin, 14 days of p.o. doxycycline and to follow up with his PCP [**Last Name (NamePattern4) **] 14 days. On day of discharge another Lyme titer, ESR and CRP were drawn and it was encouraged that the patient's PCP look at the results of these labs, especially at the titers to make a clinical decision on whether to complete a full 30 day course of doxycycline in the case of Lyme serology being positive. The patient was reminded to keep this appointment as it is very important to prevent further sequelae including very serious complications of disseminated Lyme disease by following up with his PCP [**Name Initial (PRE) **]. DISCHARGE DIAGNOSES: Most likely Lyme disease. Cellulitis with subcutaneous nodule. DISCHARGE MEDICATIONS: 1. Doxycycline 100 mg b.i.d. times 30 days with the option to stop after 14 days after consulting with his PCP. 2. Clindamycin 450 mg four times a day. CONDITION ON DISCHARGE: Good. DISCHARGE STATUS: To home. FOLLOWUP: The patient was given an appointment with his PCP, [**Name10 (NameIs) 1023**] is Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], in his [**Location 27224**] for [**8-12**] at 10:50 a.m. to discuss appropriateness of continuing doxycycline for a one month regimen based on Lyme titers, ESR and CRP which were drawn at [**Hospital1 18**] on the day of discharge. The patient was also asked that if this time does not work for him, to reschedule, but to try to keep that followup appointment within a two week period. The patient was also asked that if this dictation or the lab results do not make their way to Dr.[**Name (NI) 55597**] office, that he does remind Dr. [**Last Name (STitle) **] that these labs were drawn and it is very important to follow up on the Lyme serology to prevent future serious sequelae of untreated Lyme disease or improperly treated Lyme disease. The patient was also asked to be compliant with antibiotic regimen until seeing his PCP physician and to see his PCP physician before two weeks or in an E.D. if the rash is not resolving, if he experiences high fever, myalgias, chest pain, palpitations, shortness of breath or any other condition he believes needs to be seen by a medical professional. Upon discharge the patient was understanding of his diagnosis, discharge condition, discharge medications and plans for followup and states compliance with these plans. Please fax this report to the attention of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD. Fax number is [**Telephone/Fax (1) 55598**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 5617**] Dictated By:[**Doctor First Name 55599**] MEDQUIST36 D: [**2167-7-27**] 13:42:50 T: [**2167-7-27**] 16:16:16 Job#: [**Job Number 55600**] cc:[**Numeric Identifier 55601**]

038,682,088,423,289,995

{'Unspecified septicemia,Cellulitis and abscess of leg, except foot,Lyme Disease,Unspecified disease of pericardium,Lymphadenitis, unspecified, except mesenteric,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: Fever, cellulitis, adenitis and hypotension. PRESENT ILLNESS: A 51-year-old male, without any significant past medical history, who was transferred from an outside hospital for cellulitis and adenitis that was not responsive to antibiotics, resulting in hypotension. The patient stated that he was in his usual state of health until Tuesday, [**2167-7-14**] when he first noted some left upper groin pain. The groin pain became progressively worse over the next several days, and also he noted an area of erythema. He developed fevers on [**2167-7-19**]. He went to an outside hospital Emergency Department the following day. At that time, he was diagnosed with cellulitis and adenitis, and was given 2 gm of ceftriaxone, and was discharged to home. He continued to have persistent fevers to 103 and returned the following morning to the outside hospital Emergency Department where he was admitted for cellulitis and adenitis. He was started on Ancef, but developed a diffuse erythroderma rash the day after initiation of Ancef therapy, which was felt to be due to a drug rash. On [**2167-7-22**], the day of transfer to [**Hospital6 256**], the patient was still persistently spiking fevers, had an elevated white blood cell count with a bandemia, and became hypotensive despite IV antibiotics, including vancomycin, clindamycin and Levaquin. His blood pressure dropped to 70 systolic, and he was given IV fluids and started on peripheral dopamine. At this time, arrangements were made to transfer the patient to [**Hospital6 256**]. On arrival to [**Hospital6 1760**], the patient was no longer on the dopamine drip and was normotensive with blood pressure's in the 100's to 110's/60's to 70's. MEDICAL HISTORY: History of prior wrist and hand surgery. MEDICATION ON ADMISSION: ALLERGIES: Possible allergy to Ancef causing a rash. PHYSICAL EXAM: FAMILY HISTORY: No family history of early coronary artery disease, or diabetes. SOCIAL HISTORY: The patient has a remote tobacco history. He quit smoking in the [**2133**]'s. He drinks occasionally only socially. The patient lives in [**Location (un) 3844**] with his wife and children. He has a dog and lives in a heavily wooded area. ### Response: {'Unspecified septicemia,Cellulitis and abscess of leg, except foot,Lyme Disease,Unspecified disease of pericardium,Lymphadenitis, unspecified, except mesenteric,Sepsis'}

CHIEF COMPLAINT: cardiac arrest PRESENT ILLNESS: 58 yo M with h/o MI no intervention and AFib on coumadin, presented after cardiac arrest that occurred while at gym this morning. Witnesses reported that he slumped over and had labored breathing. CPR was initiated and AED placed on patient and he received shock for "wide complex tachycardia." He was combative with EMS on the scene and received valium. . Patient presented to the ED with VS: 100.6 156/97 87 20 100%. His EKG was notable for AFib with rate in 80s, PVCs, LVH with T wave inversions in aVL and V3-V5. He was emergently taken to the cath lab, where he was loaded with plavix and ASA. He received a BMS for 70% stenosis of his LAD. . On presentation to the CCU, he denied having chest pain or shortness of breath. His vitals were stable and he was in AFib with normal rate. He was given statin and started on a beta-blocker. . Review of systems positive for h/o upper GI bleed in [**2168**]. 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, or hemoptysis. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. Patient had syncopal event as described in HPI. MEDICAL HISTORY: Outpatient Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] . - HTN - question of MI in past based on [**Last Name (NamePattern1) **] results, no intervention done - atrial fibrillation, on coumadin - GI bleed-[**2168**], received 4 units PRBCs; EGD showed gastritis/esophagitis; repeat EGD in [**2173**] showed Barrett's esophagus but no gastritis - Zenker's diverticulum s/p Cricopharyngeal myotomy and diverticulopexy - hiatal hernia - L tibial fracture from MVA [**2173**] - nephrolithiasis - Raynaud's phenomenon . Cardiac Risk Factors: +Hypertension, +Dyslipidemia (LDL 125, HDL 34 in [**2166**]) . Cardiac History: no CABG, no pacemaker/ICD, no PCI in past MEDICATION ON ADMISSION: Coumadin Lopressor--pt admits he has not been taking this HCTZ Lipitor Viagra . ALLERGIES: Demerol--nausea, vomiting ALLERGIES: Demerol PHYSICAL EXAM: VS: T 97.1, BP 146/85, HR 71, RR 10, O2 100% on 2L NC Gen: Healthy-appearing middle-aged man, wearing C-spine collar in NAD, resp or otherwise. Oriented to place and time, but repeating questions and statements multiple times, unable to recount events of today. HEENT: No obvious trauma to head. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple; difficult to assess JVP with collar in place CV: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No S4, no S3. No murmur. Chest: No chest wall deformities. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. No hematoma at R groin (cath site) Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. Mother died of "old age," father of asbestosis and carcinoma. Siblings with HTN. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse; he reports he drinks on social occasions. Ex-policeman; reports he is now in construction. Works out every day and can bench press 380 pounds.

Subendocardial infarction, initial episode of care,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Long-term (current) use of anticoagulants

Subendo infarct, initial,Cardiac arrest,Crnry athrscl natve vssl,Hypertension NOS,Long-term use anticoagul

Admission Date: [**2177-9-21**] Discharge Date: [**2177-9-25**] Date of Birth: [**2118-11-18**] Sex: M Service: MEDICINE Allergies: Demerol Attending:[**Last Name (NamePattern1) 1572**] Chief Complaint: cardiac arrest Major Surgical or Invasive Procedure: Cardiac Catheterization with placement of bare metal stent to LAD. History of Present Illness: 58 yo M with h/o MI no intervention and AFib on coumadin, presented after cardiac arrest that occurred while at gym this morning. Witnesses reported that he slumped over and had labored breathing. CPR was initiated and AED placed on patient and he received shock for "wide complex tachycardia." He was combative with EMS on the scene and received valium. . Patient presented to the ED with VS: 100.6 156/97 87 20 100%. His EKG was notable for AFib with rate in 80s, PVCs, LVH with T wave inversions in aVL and V3-V5. He was emergently taken to the cath lab, where he was loaded with plavix and ASA. He received a BMS for 70% stenosis of his LAD. . On presentation to the CCU, he denied having chest pain or shortness of breath. His vitals were stable and he was in AFib with normal rate. He was given statin and started on a beta-blocker. . Review of systems positive for h/o upper GI bleed in [**2168**]. 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, or hemoptysis. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. Patient had syncopal event as described in HPI. Past Medical History: Outpatient Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] . - HTN - question of MI in past based on [**Last Name (NamePattern1) **] results, no intervention done - atrial fibrillation, on coumadin - GI bleed-[**2168**], received 4 units PRBCs; EGD showed gastritis/esophagitis; repeat EGD in [**2173**] showed Barrett's esophagus but no gastritis - Zenker's diverticulum s/p Cricopharyngeal myotomy and diverticulopexy - hiatal hernia - L tibial fracture from MVA [**2173**] - nephrolithiasis - Raynaud's phenomenon . Cardiac Risk Factors: +Hypertension, +Dyslipidemia (LDL 125, HDL 34 in [**2166**]) . Cardiac History: no CABG, no pacemaker/ICD, no PCI in past Social History: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse; he reports he drinks on social occasions. Ex-policeman; reports he is now in construction. Works out every day and can bench press 380 pounds. Family History: There is no family history of premature coronary artery disease or sudden death. Mother died of "old age," father of asbestosis and carcinoma. Siblings with HTN. Physical Exam: VS: T 97.1, BP 146/85, HR 71, RR 10, O2 100% on 2L NC Gen: Healthy-appearing middle-aged man, wearing C-spine collar in NAD, resp or otherwise. Oriented to place and time, but repeating questions and statements multiple times, unable to recount events of today. HEENT: No obvious trauma to head. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple; difficult to assess JVP with collar in place CV: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No S4, no S3. No murmur. Chest: No chest wall deformities. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. No hematoma at R groin (cath site) 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 Pertinent Results: ETT performed [**2173**] demonstrated: Good functional exercise capacity. No ECG or 2D echocardiographic evidence of inducible ischemia to achieved workload. Mild aortic regurgitation at rest. Moderate mitral regurgitation at rest. . [**Year (4 digits) **] test [**2165**] not available in OMR, but per discharge summary: "[**Year (4 digits) **] echocardiogram thallium with equivocal EKG changes, but moderate reversible defect in the apical inferior wall" . CARDIAC CATH performed on [**2177-9-21**] demonstrated: LAD with 70% stenosis; normal LMCA, mild luminal irregularities in LCx; RCA with mid 30% stenosis . HEMODYNAMICS: BP 129/75 with HR 49 . LABORATORY DATA: . Significant for K of 3.1 in ED (received 40mEq KCl) Cr 1.3 -> 1.1 Hct 45.7 and WBC 5.7 INR 2.8 CK 329 MB 7 Trop < 0.01 . CT head [**9-21**]: No acute intracranial hemorrhage or mass effect. . CT C-spine [**9-21**]: No evidence of an acute fracture. Small osseous fragment adjacent to the left C4-5 facet is likely degenerative. . ECHO [**2177-9-22**] IMPRESSION: Mild symmetric left ventricular hypertrophy with normal cavity sizes and regional/global biventricular systolic function. Mildly dilated thoracic aorta. Pulmonary artery systolic hypertension. Mild aortic regurgitation. Mild mitral regurgitation. Is there a clinical history to suggest an acute pulmonary process (e.g., pulmonary embolism?). Brief Hospital Course: 58yo man with h/o MI without intervention done, AFib on coumadin presents after cardiac arrest. . 1. s/p Cardiac arrest: Patient presented after having cardiac arrest while exercising on an elliptical machine for over 20 minutes. He has a history of a fib, and was on coumadin at the time. He had not been compliant with his beta blocker. We restarted metoprolol, and the patient remained stable, but going into sinus bradycardia. Pt also has history of Raynauds, and was started on trial of carvedilol instead of metoprolol, with no change in extremities. Patient was switched back to metoprolol 25mg the day before discharge, monitored overnight and discharged on toprol XL 50mg. Pthad 7 beat run of NSVT while in the hospital, and the importance of staying on a bblocker was stressed. Several attempts were made to get the AED recording from the [**Location (un) **] sports club gym that he collapsed at, and f/u is being attempted even on discharge. Pt is to followup with outpatient cardiologist, Dr. [**Last Name (STitle) **]. Outpatient Cardiac MR has also been ordered to evaluate the contribution of possible LV scar to arrhythmia and cardiac arrest. the patient will followup with Dr. [**Last Name (STitle) **]. . 2. CAD: Patient was cathed with the finding of a calcified stenosis of the LAD. BMS to LAD. Patient started on aspirin and plavix. Patient is to have a [**Last Name (STitle) **] test as an outpatient, scheduled for [**2177-10-10**]. . 3. HTN: Patient was hypokalemic, repleted through IV, and HCTZ stopped. Patient started on trial of lisinopril, but BP was controlled and patient discharged on Toprol XL only. 4. atrial fibrillation: patient has a long history of atrial fibrillation. [**Country **] score of 1, so coumadin was discontinued given plavix and aspirin, and history of GI bleed. . 5. h/o GI bleed: Coumadin stopped, pt on aspirin and plavix. PPI given [**Hospital1 **]. . 6. Possible head trauma: ED note concerned for head trauma during incident and patient with impaired mental status on admission to CCU, as he was alert and oriented, but frequently repeating same questions, phrases. Likely due to period of anoxia during arrhythmic arrest. No acute process on CT imaging of head. Medications on Admission: Coumadin Lopressor--pt admits he has not been taking this HCTZ Lipitor Viagra . ALLERGIES: Demerol--nausea, vomiting Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. 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* 5. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Cardiac arrest Ventricular arrhythmias Atrial fibrillation Coronary artery disease;Coronary angioplasty and stent placement Hypertension Mitral Insufficiency Raynaud's Phenomenon Discharge Condition: Stable, ambulating Discharge Instructions: You were admitted after a cardiac arrest. You had a cardiac catheterization done, and a stent was placed in one of the arteries that supplies your heart. . 1. Please take all medications as prescribed. . 2. You should never stop taking your Plavix without consulting with your cardiologist. Stopping this medication with your doctor's recommendation may be life threatening. . 3. Please call your doctor or return to the hospital if you have chest pain, palpitations, shortness of breath, fevers, or any other concerning symptom. . 4. We recommend that you refrain from exertional exercise until after your [**Hospital1 **] test is reviewed with you. This includes running or any weight lifting. Walking on the treadmill is safe. . 5. According to [**State 350**] state law you are prohibited from driving for 6 months following cardiac arrest or until you are instructed otherwise by your cardiologist. Followup Instructions: Please follow up with: Your Cardiologist within 1 week: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**] [**Telephone/Fax (1) 6937**] . We recommend that you get a [**Telephone/Fax (1) **] test: Provider: [**Name10 (NameIs) 10081**] TESTING Phone:[**Telephone/Fax (1) 1566**] Date/Time:[**2177-10-8**] 2:00 p.m. . You have been referred for an MRI of your heart. You will be contact[**Name (NI) **] by Radiology regarding the scheduling of this study. . You are recommended to undergo Cardiac Rehabilitation after your [**Name (NI) **] test. Completed by:[**2177-9-29**]

410,427,414,401,V586

{'Subendocardial infarction, initial episode of care,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,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: cardiac arrest PRESENT ILLNESS: 58 yo M with h/o MI no intervention and AFib on coumadin, presented after cardiac arrest that occurred while at gym this morning. Witnesses reported that he slumped over and had labored breathing. CPR was initiated and AED placed on patient and he received shock for "wide complex tachycardia." He was combative with EMS on the scene and received valium. . Patient presented to the ED with VS: 100.6 156/97 87 20 100%. His EKG was notable for AFib with rate in 80s, PVCs, LVH with T wave inversions in aVL and V3-V5. He was emergently taken to the cath lab, where he was loaded with plavix and ASA. He received a BMS for 70% stenosis of his LAD. . On presentation to the CCU, he denied having chest pain or shortness of breath. His vitals were stable and he was in AFib with normal rate. He was given statin and started on a beta-blocker. . Review of systems positive for h/o upper GI bleed in [**2168**]. 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, or hemoptysis. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. Patient had syncopal event as described in HPI. MEDICAL HISTORY: Outpatient Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] . - HTN - question of MI in past based on [**Last Name (NamePattern1) **] results, no intervention done - atrial fibrillation, on coumadin - GI bleed-[**2168**], received 4 units PRBCs; EGD showed gastritis/esophagitis; repeat EGD in [**2173**] showed Barrett's esophagus but no gastritis - Zenker's diverticulum s/p Cricopharyngeal myotomy and diverticulopexy - hiatal hernia - L tibial fracture from MVA [**2173**] - nephrolithiasis - Raynaud's phenomenon . Cardiac Risk Factors: +Hypertension, +Dyslipidemia (LDL 125, HDL 34 in [**2166**]) . Cardiac History: no CABG, no pacemaker/ICD, no PCI in past MEDICATION ON ADMISSION: Coumadin Lopressor--pt admits he has not been taking this HCTZ Lipitor Viagra . ALLERGIES: Demerol--nausea, vomiting ALLERGIES: Demerol PHYSICAL EXAM: VS: T 97.1, BP 146/85, HR 71, RR 10, O2 100% on 2L NC Gen: Healthy-appearing middle-aged man, wearing C-spine collar in NAD, resp or otherwise. Oriented to place and time, but repeating questions and statements multiple times, unable to recount events of today. HEENT: No obvious trauma to head. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple; difficult to assess JVP with collar in place CV: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No S4, no S3. No murmur. Chest: No chest wall deformities. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. No hematoma at R groin (cath site) Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. Mother died of "old age," father of asbestosis and carcinoma. Siblings with HTN. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse; he reports he drinks on social occasions. Ex-policeman; reports he is now in construction. Works out every day and can bench press 380 pounds. ### Response: {'Subendocardial infarction, initial episode of care,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: Transfer from [**Hospital 1562**] Hospital with seizures, fever, AMS, intubated. PRESENT ILLNESS: A 68 year-old female with history of cerebrovascular accident x 3, left tonsillar carcinoma, no known history of seizures presenting to [**Hospital 1562**] Hospital [**2113-11-30**] with new onset convulsive seizures. She was unable to protect her airway and was intubated in the ED, complicated due to her radiation for tonsillar cancer. Potassium on admission was 2.2, with magnesium 1.7 and other electrolytes within normal limits. WBC count 8.8 on admission. She had no history of head trauma and CT head x 2 showed multiple old ischemic changes but no new process. MRI was not performed. EEG x 3 showed persistent epileptiform activity in the left cerebral hemishere, however, unclear when the EEGs were performed relative to the convulsive seizures. Infectious evaluation was negative as below. She has been treated with phenobarbital, fosphenytoin, intermittent ativan, and a midazolam drip for her seizures. It is unclear when her last convulsive seizure occurred. Per her discharge summary, her dilantin has ranged 14-19 and her last phenobarbital level was 11.4. MEDICAL HISTORY: - Cerebrovascular accident x 3, last [**5-/2113**] - Left-sided squamous cell tonsillar cancer status post radiation and "a few cycles" of Erbitux - History of encephalopathy suspected secondary to Erbitux use, status post Acyctlovir for potential herpetic encephalitis [**9-/2113**] - negative EEG at that time - History of Erbitux related lung toxicity versus aspiration pneumonitis [**9-/2113**] - Hyperthyroidism on propylthiouracil - Chronic atrial fibrillation/flutter, rate-controlled with digoxin and diltiazem, on coumadin in the past but not currently MEDICATION ON ADMISSION: Medications on transfer: Linezolid 600 mg IV Q12H Zosyn 4.5 gm IV Q6H Fosphenytoin 100 mg IV Q8H Phenobarbital 120 mg IV Q12H Fentanyl drip Midazolam drop Digoxin 0.125 mg PO DAILY Diltiazem 60 mg PO Q6H Combivent INH Q6H Protonix 40 mg PO DAILY Aspirin 325 mg PO DAILY Fluconazole 200 mg PO DAILY Propylthiouracil 50 mg PO DAILY Zofran 4 mg IV Q8H:PRN nausea . Medications at home: Aspirin 81 mg PO DAILY Diltiazem CR 180 mg PO DAILY Atenolol 50 mg PO DAILY Digoxin 0.25 mg PO DAILY Combivent INH Q4H Diflucan 100 mg PO DAILY Propylthiouracil 50 mg PO DAILY Senna 8.6 mg PO DAILY Bactroban one application [**Hospital1 **] to nares for MRSA documented [**12/2112**] Coumadin (on hold for unclear duration) ALLERGIES: Erbitux PHYSICAL EXAM: On Admission: Temp: 36.7 ??????C HR: 96 BP: 120/68 RR: 15 Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 mL PS : 12 cmH2O RR (Set): 14 PEEP: 5 cmH2O FiO2: 40% SpO2: 100% ABG: 7.49/45/119 General Appearance: No acute distress Eyes / Conjunctiva: PERRL, large tongue Head, Ears, Nose, Throat: Normocephalic Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), (Murmur: No(t) Systolic, No(t) Diastolic) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Clear : ) Abdominal: Soft, Non-tender, Bowel sounds present, No(t) Distended Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t) Clubbing Skin: Warm, No(t) Rash: Neurologic: Responds to: Noxious stimuli, Movement: Non -purposeful, Tone: Increased FAMILY HISTORY: Sister with ovarian cancer. SOCIAL HISTORY: Patient was originally from [**State 622**] and moved ~3 years ago to [**Hospital2 **] [**Hospital3 **], when se re-married. She was happily living at home with husband in [**Hospital2 **] [**Hospital3 **]. She has history of severe alcohol abuse and intoxication with withdrawal and seizures. She used to be as heavy smoker as well.

Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Cerebral artery occlusion, unspecified with cerebral infarction,Atrial flutter,Other convulsions,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Malignant neoplasm of tonsil,Anemia, unspecified

Acute respiratry failure,Food/vomit pneumonitis,Crbl art ocl NOS w infrc,Atrial flutter,Convulsions NEC,Thyrotox NOS no crisis,Malignant neopl tonsil,Anemia NOS

Admission Date: [**2113-12-7**] Discharge Date: [**2113-12-22**] Date of Birth: [**2045-9-23**] Sex: F Service: MEDICINE Allergies: Erbitux Attending:[**First Name3 (LF) 613**] Chief Complaint: Transfer from [**Hospital 1562**] Hospital with seizures, fever, AMS, intubated. Major Surgical or Invasive Procedure: Endotracheal intubation at outside hospital RIJ placement at OSH and replacement at [**Hospital1 18**] Lumbar Puncture NGT placement GJ tube placement History of Present Illness: A 68 year-old female with history of cerebrovascular accident x 3, left tonsillar carcinoma, no known history of seizures presenting to [**Hospital 1562**] Hospital [**2113-11-30**] with new onset convulsive seizures. She was unable to protect her airway and was intubated in the ED, complicated due to her radiation for tonsillar cancer. Potassium on admission was 2.2, with magnesium 1.7 and other electrolytes within normal limits. WBC count 8.8 on admission. She had no history of head trauma and CT head x 2 showed multiple old ischemic changes but no new process. MRI was not performed. EEG x 3 showed persistent epileptiform activity in the left cerebral hemishere, however, unclear when the EEGs were performed relative to the convulsive seizures. Infectious evaluation was negative as below. She has been treated with phenobarbital, fosphenytoin, intermittent ativan, and a midazolam drip for her seizures. It is unclear when her last convulsive seizure occurred. Per her discharge summary, her dilantin has ranged 14-19 and her last phenobarbital level was 11.4. She was febrile to 101.4 [**11-30**], 100.8 [**12-2**], 100.6 [**12-3**] and 102 [**12-7**]. WBC count peaked at 20.4 [**12-2**]. Chest x-ray after intubation showed a developing infiltrate at the right lung base, which improved on subsequent imaging. Infectious evaluation including BAL at the time of intubation, urine, and blood cultures were negative at the time of discharge - she never underwent lumbar puncture. She was initially treated with ceftriaxone and clindamycin for aspiration pneumonia. She was on diflucan as an outpatient for a fungal urinary tract infection and this was continued during her admission. A RIJ was placed [**12-2**], and due to her fevers, a LIJ was attempted but unsuccessful; the RIJ remains in place. Her antibiotics have been changed to zosyn and linezolid at some point prior to transfer. On arrival to the ICU, she is intubated and sedated. There is no observed seizure activity when sedation is off. She responds to touch but does not follow commands. She has a gag with suction. She moves all extremities well. Review of sytems: Unable to obtain. Past Medical History: - Cerebrovascular accident x 3, last [**5-/2113**] - Left-sided squamous cell tonsillar cancer status post radiation and "a few cycles" of Erbitux - History of encephalopathy suspected secondary to Erbitux use, status post Acyctlovir for potential herpetic encephalitis [**9-/2113**] - negative EEG at that time - History of Erbitux related lung toxicity versus aspiration pneumonitis [**9-/2113**] - Hyperthyroidism on propylthiouracil - Chronic atrial fibrillation/flutter, rate-controlled with digoxin and diltiazem, on coumadin in the past but not currently - History of [**Female First Name (un) 564**] albicans urinary tract infection Social History: Patient was originally from [**State 622**] and moved ~3 years ago to [**Hospital2 **] [**Hospital3 **], when se re-married. She was happily living at home with husband in [**Hospital2 **] [**Hospital3 **]. She has history of severe alcohol abuse and intoxication with withdrawal and seizures. She used to be as heavy smoker as well. Family History: Sister with ovarian cancer. Physical Exam: On Admission: Temp: 36.7 ??????C HR: 96 BP: 120/68 RR: 15 Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 mL PS : 12 cmH2O RR (Set): 14 PEEP: 5 cmH2O FiO2: 40% SpO2: 100% ABG: 7.49/45/119 General Appearance: No acute distress Eyes / Conjunctiva: PERRL, large tongue Head, Ears, Nose, Throat: Normocephalic Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), (Murmur: No(t) Systolic, No(t) Diastolic) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Clear : ) Abdominal: Soft, Non-tender, Bowel sounds present, No(t) Distended Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t) Clubbing Skin: Warm, No(t) Rash: Neurologic: Responds to: Noxious stimuli, Movement: Non -purposeful, Tone: Increased Upon Transfer: Vitals: T: 98.2 BP: 157/97 P: 100 R: 20 SPO2 100% 21% facemask General: Alert, no acute distress, follows commands, responds Y/N questions, cachectic. HEENT: Sclera anicteric, MMM, oropharynx clear, thick secretions in mouth with dry mucous membranes. Neck: supple, JVP not elevated, no LAD Lungs: Absence of wheezes, rales, but ronchi present bilateraly CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tenderness in left flank, where PEG was recently placed, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: Adequate muscle tone in upper and lower extremities, decreased reflexes 1+/3+ in upper and lower extremities including deltoid, biceps, triceps, patelar, aquilean bilateraly. Sensitivity and propiosception not evaluable. CN [**1-27**], vestibular, 11, 12 intact. 9 & 10 normal, but with decreased gag reflex. Normal sphincter tone. Minimental not evaluable, but patient follows commands and opens eyes spontaneusly. Pertinent Results: On Admission: [**2113-12-7**] 10:07PM WBC-10.2 RBC-3.11* HGB-9.5* HCT-27.2* MCV-88 MCH-30.5 MCHC-34.9 RDW-17.4* [**2113-12-7**] 10:07PM NEUTS-82.9* LYMPHS-10.9* MONOS-3.1 EOS-2.6 BASOS-0.5 [**2113-12-7**] 10:07PM PLT COUNT-404 [**2113-12-7**] 10:07PM PT-14.3* PTT-27.0 INR(PT)-1.2* [**2113-12-7**] 10:07PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015 [**2113-12-7**] 10:07PM URINE BLOOD-SM NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-SM [**2113-12-7**] 10:07PM URINE RBC-0-2 WBC-[**2-22**] BACTERIA-FEW YEAST-NONE EPI-0 RENAL EPI-0-2 [**2113-12-7**] 10:07PM PHENOBARB-14.7 PHENYTOIN-15.0 [**2113-12-7**] 10:07PM DIGOXIN-0.7* [**2113-12-7**] 10:07PM FREE T4-0.56* [**2113-12-7**] 10:07PM TSH-1.9 [**2113-12-7**] 10:07PM ALBUMIN-2.4* CALCIUM-8.3* PHOSPHATE-3.9 MAGNESIUM-1.9 [**2113-12-7**] 10:07PM ALT(SGPT)-34 AST(SGOT)-28 ALK PHOS-119* TOT BILI-0.3 [**2113-12-7**] 10:07PM GLUCOSE-99 UREA N-14 CREAT-0.7 SODIUM-133 POTASSIUM-3.2* CHLORIDE-95* TOTAL CO2-32 ANION GAP-9 [**2113-12-7**] 10:26PM LACTATE-1.0 K+-3.0* [**2113-12-7**] 10:28PM TYPE-ART PO2-105 PCO2-48* PH-7.45 TOTAL CO2-34* BASE XS-7 [**2113-12-7**] 11:34PM CEREBROSPINAL FLUID (CSF) WBC-6 RBC-612* POLYS-53 LYMPHS-44 MONOS-3 [**2113-12-7**] 11:34PM CEREBROSPINAL FLUID (CSF) WBC-2 RBC-64* POLYS-50 LYMPHS-40 MONOS-10 [**2113-12-7**] 11:34PM CEREBROSPINAL FLUID (CSF) PROTEIN-24 GLUCOSE-60 Upon Discharge: [**2113-12-22**] 07:50AM BLOOD WBC-8.8 RBC-3.53* Hgb-11.0* Hct-31.4* MCV-89 MCH-31.1 MCHC-34.9 RDW-17.2* Plt Ct-716* [**2113-12-22**] 07:50AM BLOOD PT-13.3 PTT-67.5* INR(PT)-1.1 [**2113-12-22**] 07:50AM BLOOD Glucose-103 UreaN-14 Creat-0.7 Na-136 K-3.5 Cl-93* HCO3-30 AnGap-17 [**2113-12-19**] 07:15AM BLOOD LD(LDH)-213 TotBili-0.3 Reports: Spinal fluid: negative for malignant cells . Echocardiogram: [**2113-12-8**]: The left atrium is elongated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. CXR: [**2113-12-8**] The nasogastric tube is appropriately positioned 2.7 cm above the carina. The right internal jugular central venous line tip overlies the SVC. There is no pneumothorax. The nasogastric tube has been appropriately advanced. The cardiomediastinal silhouette is stable. There are small bilateral pleural effusions and increased retrocardiac opacity likely representing atelectasis. CXR: [**2113-12-17**] A single portable radiograph of the chest demonstrates a nasogastric tube coiled in the stomach. The left internal jugular central venous catheter seen on [**2113-12-15**] has been removed. The left basilar atelectasis seen on the previous study has resolved. The lungs are clear. No effusion is appreciated. Trachea is midline. The aorta is calcified and tortuous. MRI [**2113-12-8**]: TECHNIQUE: T1 sagittal and axial and FLAIR T2 susceptibility and diffusion axial images were obtained before gadolinium. T2 and FLAIR coronal images of the temporal lobes acquired. Following gadolinium, MP-RAGE coronal images were obtained with sagittal and axial reformats. The MP-RAGE post-gadolinium images are limited by motion. There are no prior examinations for comparison. FINDINGS: Images through the brain demonstrate mild-to-moderate brain atrophy and moderate changes of small vessel disease with a chronic cortical infarct in the left parietal lobe and chronic infarct in the right basal ganglia putaminal region. There is no mass effect, midline shift or hydrocephalus. No acute infarct. Diffusion images demonstrate a tiny area of increased signal in the left frontal cortical region which is too small to characterize on ADC map. Coronal images through the temporal lobes demonstrate hippocampal atrophy but no intrinsic signal abnormalities are seen. The post-gadolinium images are limited by motion as described above. However, no large areas of enhancement are seen. IMPRESSION: Chronic left parietal and right basal ganglia infarcts. Small vessel disease and brain atrophy. Tiny area of increased signal on diffusion in the left frontal cortical region is too small to characterize on the ADC map and could be due to either a tiny acute infarct or T2 shine through. Limited gadolinium images demonstrate no large area of enhancement. Chronic micro hemorrhages are seen in the right basal ganglia, left temporal region which could be due to previous ischemia. Video Swallow: Moderate oral and pharyngeal dysphagia resulting in penetration during the swallow and subsequent aspiration after the swallow on all consistencies. Please refer to the speech and swallow specialist's report for recommendation and for more details. Carotid USG: 1. Less than 40% stenosis in the right and left internal carotid arteries. Brief Hospital Course: 68 year-old female with history of cerebrovascular accident x 3, tonsillar carcinoma, no known history of seizures transferred from [**Hospital 1562**] Hospital with seizures and fevers. # Seizures: PT was admitted to OSH with seizures, fever, AMS. OSH EEG x 3 have shown persistent epileptiform activity from a focus in the left cerebral hemisphere, without ability for continuous EEG monitoring ?????? unclear timing of EEG with regard to convulsive episodes. Unclear etiology. Her prior CVAs may be epileptogenic foci. There were electrolyte abnormalities on admission, however, the patient persisted with seizures after correction. She had no history of head trauma and CT head x 2 showed multiple old ischemic changes but no new process. Patient has history of cancer and may have metastasis ?????? MRI was not performed at OSH. Infectious evaluation as below ?????? LP not performed at OSH, LP negative on admission here, although has been on antibiotics. Home medications not known to contribute to seizure activity. No report of toxicology screen on admission to OSH. No clot by ECHO. EEG without seizure and phenobarbital was discontinued [**12-9**]. MRI no evidence of encephalitis, so acyclovir discontinued. MRI does show what could be new embolic stroke in left frontal cortical region where OSH saw seizure activity. Patient placed on heparin gtt and transitioned to coumadin on [**12-16**], but it was stopped for PEG placement and re-started on [**2113-12-20**] at 2.5 mg Daily. Since we were having variable levels of phenytoin, pt was switched to Keppra. Please stop phenytoin in 4 days and contine Keppra at current dose. There were not any seizures at this hospital and the etiology was unknown, but thought to be multifactorial in the setting of possible infection and new embolic stroke. . # Fevers, leukocytosis: Unclear etiology - seizures versus infection vs drug related. OSH BAL from admission grew only yeast, urine and blood cultures negative. RIJ in place since [**12-2**] without erythema or discharge. Patient initially on diflucan, ceftriaxone, and clindamycin for aspiration, but changed to zosyn and linezolid at some point prior to transfer to [**Hospital1 18**]. Patient had an LP that was negative for infection, with normal protein and glucose, cultures without any growth. However, since AMS and fever made high the suspicion for infection patient was treated empirically with Vancomycin, ceftriazone, ampicillin. There was question of hospital acquired PNA and patient only grew MRSA from sputum. Antibiotics were stopped on [**2113-12-14**] and has been afebrile since then. # Respiratory failure: Intubated for airway protection in the setting of aspiration. Was treated for aspiration pneumonia with ceftriaxone and clindamycin for an unknown course. Chest x-ray on admission here with question retrocardiac opacity but excellent gas exchange and negative sputum. Patient was extubated on [**12-13**] without complications. She has been stable breathing comfortably on room air. She uses facemask only to humidify air since there is concern for thick mucus and plugging, with difficulty clearing secretions. Please keep facemask with as much humidity as possible. # Atrial flutter: Rate-controlled with digoxin and diltiazem. Titrated up diltiazem. Continued digoxin and for rate control. On heparin gtt and was started and therapeutic on 2.5 mg of coumadin, which was stopped for PEG placement. Re-started on [**2113-12-20**]. Since patient has documented chronic AFib, we do not think she will benefit from ablation at this point, and she will still require anticoagulation for secondary stroke prevention. # Anemia: Normocytic with stable HCT in the low 30s during this hospitalizaion. Patient was guaiac negative and with ferritin of 1159 suggesting anemia of chronic disease. # Hyperthyroidism: Unclear etiology - Grave's disease versus functioning nodule(s). TSH 1.9, Free T4 0.56 during this acute illness. Continued propylthiouracil. # Squamous cell tonsillar cancer: Status post chemoradiation. No acute issues. Patient was seen by ENT who did not see any mass or lession in throat. They aspirated thick secretions close to the epiglottis, and additional secretions on the right side of the glottis could not be aspirated. They could not rule out cystic lesion. She will need follow up with her oncologist within 6 months and keep air humidified. # FEN: No IVF, replete electrolytes, Tube feeds throug PEG as continuous. Can change to bolus if patient tolerates. Please continue free water flushes. . # Prophylaxis: Heparin gtt and coumadin; bowel regimen, PPI. . # Access: Peripherals. . # Code: DNR, but ok to intubate if respiratory failure. . # Communication: Husband [**Name (NI) **] Phone number: [**Telephone/Fax (1) 81945**] . # Disposition: To Rehab. Medications on Admission: Medications on transfer: Linezolid 600 mg IV Q12H Zosyn 4.5 gm IV Q6H Fosphenytoin 100 mg IV Q8H Phenobarbital 120 mg IV Q12H Fentanyl drip Midazolam drop Digoxin 0.125 mg PO DAILY Diltiazem 60 mg PO Q6H Combivent INH Q6H Protonix 40 mg PO DAILY Aspirin 325 mg PO DAILY Fluconazole 200 mg PO DAILY Propylthiouracil 50 mg PO DAILY Zofran 4 mg IV Q8H:PRN nausea . Medications at home: Aspirin 81 mg PO DAILY Diltiazem CR 180 mg PO DAILY Atenolol 50 mg PO DAILY Digoxin 0.25 mg PO DAILY Combivent INH Q4H Diflucan 100 mg PO DAILY Propylthiouracil 50 mg PO DAILY Senna 8.6 mg PO DAILY Bactroban one application [**Hospital1 **] to nares for MRSA documented [**12/2112**] Coumadin (on hold for unclear duration) Discharge Medications: 1. Propylthiouracil 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for fever, pain. 4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 5. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 6. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day) as needed. 7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 8. Diltiazem HCl 90 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 9. Atenolol 25 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 10. Phenytoin 50 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO TID (3 times a day) for 6 days. 11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 12. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 13. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Heparin Please continue Heparin Drip per protocol with target PTT 60-100. Discharge Disposition: Extended Care Facility: [**Hospital **] Hospital of [**Location (un) **] and Islands Discharge Diagnosis: Primary Diagnosis: new onset seizures Possible new stroke . Secondary Diagnosis: History of Cerebrovascular accident x 3 History of squamous cell carcinoma of the tonsil s/p radiation and chemotherapy with Erbitux (3 cycles) History of encephalopathy of [**Last Name (un) 6722**] etiology: Erbitux vs HSV Paroxismal Atrial Fibrillation / Atrial Flutter Discharge Condition: Stable, alert, obeys commands and answers Y/N questions, tolerating tube feeds. Patient needs mitts occasionaly to protect IVs and PEG since she gets very agitated occasionally. Discharge Instructions: You were transfered at [**Hospital1 18**] ICU from [**Hospital 1562**] Hospital after being admitted with alter mental status, confuson and fever. Doctors [**First Name (Titles) **] [**Last Name (Titles) 81946**] that you were not able to protect your airway, so you were intubated. You were transfered to this hospital for further care. In here you were slowly weaned off the ventilator. You had a lumbar puncture to rule out infection in the brain. You had bloot test and blood cultures done. After extensive infectious work up we did not find a source of infection. However, you were being treated with broad expectrum antibiotics and your blood test improved and you stopped having fevers. . You had an MRI of your brain that suggested a new small stroke. You had a few episodes of abnormal heart rhythm that were controlled with medications and coumadin. . You were on 3 different medications to control your seizures and you will require long therapy with Keppra as indicated below. You will need follow up with your neurology back home in [**12-22**] months. . Your thyroid funciton was checked and it was normal. . You were also seen by ENT to assess for your tonsilar cancer. Only thick secretions were seen. It is very important that you week yourself well hydrated through the PEG and your mouth humidified with the facemask. . We expect that you will be improving within the next weeks to months little by little as you did after your prior stroke. . You are being discharge to a rehab where they can follow you up. Followup Instructions: Please follow up with your PCP [**Name9 (PRE) **],[**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 33278**] within the next month. He is aware that you were here and of what it has been happening. . Please follow with your neurologist within the next 1-2 months. [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

518,507,434,427,780,242,146,285

{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Cerebral artery occlusion, unspecified with cerebral infarction,Atrial flutter,Other convulsions,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Malignant neoplasm of tonsil,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: Transfer from [**Hospital 1562**] Hospital with seizures, fever, AMS, intubated. PRESENT ILLNESS: A 68 year-old female with history of cerebrovascular accident x 3, left tonsillar carcinoma, no known history of seizures presenting to [**Hospital 1562**] Hospital [**2113-11-30**] with new onset convulsive seizures. She was unable to protect her airway and was intubated in the ED, complicated due to her radiation for tonsillar cancer. Potassium on admission was 2.2, with magnesium 1.7 and other electrolytes within normal limits. WBC count 8.8 on admission. She had no history of head trauma and CT head x 2 showed multiple old ischemic changes but no new process. MRI was not performed. EEG x 3 showed persistent epileptiform activity in the left cerebral hemishere, however, unclear when the EEGs were performed relative to the convulsive seizures. Infectious evaluation was negative as below. She has been treated with phenobarbital, fosphenytoin, intermittent ativan, and a midazolam drip for her seizures. It is unclear when her last convulsive seizure occurred. Per her discharge summary, her dilantin has ranged 14-19 and her last phenobarbital level was 11.4. MEDICAL HISTORY: - Cerebrovascular accident x 3, last [**5-/2113**] - Left-sided squamous cell tonsillar cancer status post radiation and "a few cycles" of Erbitux - History of encephalopathy suspected secondary to Erbitux use, status post Acyctlovir for potential herpetic encephalitis [**9-/2113**] - negative EEG at that time - History of Erbitux related lung toxicity versus aspiration pneumonitis [**9-/2113**] - Hyperthyroidism on propylthiouracil - Chronic atrial fibrillation/flutter, rate-controlled with digoxin and diltiazem, on coumadin in the past but not currently MEDICATION ON ADMISSION: Medications on transfer: Linezolid 600 mg IV Q12H Zosyn 4.5 gm IV Q6H Fosphenytoin 100 mg IV Q8H Phenobarbital 120 mg IV Q12H Fentanyl drip Midazolam drop Digoxin 0.125 mg PO DAILY Diltiazem 60 mg PO Q6H Combivent INH Q6H Protonix 40 mg PO DAILY Aspirin 325 mg PO DAILY Fluconazole 200 mg PO DAILY Propylthiouracil 50 mg PO DAILY Zofran 4 mg IV Q8H:PRN nausea . Medications at home: Aspirin 81 mg PO DAILY Diltiazem CR 180 mg PO DAILY Atenolol 50 mg PO DAILY Digoxin 0.25 mg PO DAILY Combivent INH Q4H Diflucan 100 mg PO DAILY Propylthiouracil 50 mg PO DAILY Senna 8.6 mg PO DAILY Bactroban one application [**Hospital1 **] to nares for MRSA documented [**12/2112**] Coumadin (on hold for unclear duration) ALLERGIES: Erbitux PHYSICAL EXAM: On Admission: Temp: 36.7 ??????C HR: 96 BP: 120/68 RR: 15 Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 mL PS : 12 cmH2O RR (Set): 14 PEEP: 5 cmH2O FiO2: 40% SpO2: 100% ABG: 7.49/45/119 General Appearance: No acute distress Eyes / Conjunctiva: PERRL, large tongue Head, Ears, Nose, Throat: Normocephalic Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), (Murmur: No(t) Systolic, No(t) Diastolic) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Clear : ) Abdominal: Soft, Non-tender, Bowel sounds present, No(t) Distended Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t) Clubbing Skin: Warm, No(t) Rash: Neurologic: Responds to: Noxious stimuli, Movement: Non -purposeful, Tone: Increased FAMILY HISTORY: Sister with ovarian cancer. SOCIAL HISTORY: Patient was originally from [**State 622**] and moved ~3 years ago to [**Hospital2 **] [**Hospital3 **], when se re-married. She was happily living at home with husband in [**Hospital2 **] [**Hospital3 **]. She has history of severe alcohol abuse and intoxication with withdrawal and seizures. She used to be as heavy smoker as well. ### Response: {'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Cerebral artery occlusion, unspecified with cerebral infarction,Atrial flutter,Other convulsions,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Malignant neoplasm of tonsil,Anemia, unspecified'}

CHIEF COMPLAINT: CODE STROKE PRESENT ILLNESS: 86M h/o colon CA, atrial fibrillation on anticoagulation, HTN, hyperchol, anemia presents as CODE STROKE. Pt originally presented to OSH on [**5-26**] with exertional dyspnea and unstable angina. Found to also be in mild CHF. Called at 4:30pm at bedside within minutes. Went to diagnostic catherization on [**2188-5-29**] showing severe R-coronary and L-anterior descending artery disease, diffusely diseased circumflex. S/p angioplasty and 2 DES to RCA and 1 DES to LAD with residual moderate cardiomyopathy with LVEF 35-45%. Baby aspirin dc'd per OSH notes [**12-28**] concomitant Coumadin and Plavix Rx. Trop peak ~9. MEDICAL HISTORY: - h/o R sided colon CA (adenocarcinoma) 7cm through to mesentery 0/14 lymph nodes involved, no mets R s/p R hemicolectomy ([**6-28**]) - HTN - restless leg syndrome - anxiety - pulsation left ear with left carotid bruit refused eval [**2184-9-15**] with carotids, sxs resolved [**2185-8-29**] - hyperchol - BPH - Atrial fibrillation (EF 50% 08/04 mild global hypokinesis) - Anemia - Post-herpetic neuraglia - R hemicolectomy as above - s/p b/l cataract surgery MEDICATION ON ADMISSION: Plavix 75mg QD Lopressor 50mg [**Hospital1 **] Coumadin 5mg QHS Diltiazem 120mg QD Lipitor 20mg QHS Lisinopril 10mg QD Elavil 12.5mg QHS Seroquel 25mg QHS Lopressor 5mg Q4hrs:PRN tachycardia Following meds were dc'd [**5-30**]: Lanoxin 0.25mg QD ASA 81mg QD Elavil 25mg [**Hospital1 **] Morphine sulfate 4mg Q1H:PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- AF BP- 148/88 HR- 120 afib RR- 18 98 O2Sat RA 149 lbs Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: supple CV: irreg irreg, Nl S1 and S2 Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: Sister w/DM SOCIAL HISTORY: Married and care for wife with [**Name (NI) 11964**], 2 children, retired school maintenance worker. Quit tobacco [**2166**], no ETOH. [**Telephone/Fax (1) 73535**]

Cerebral embolism with cerebral infarction,Subendocardial infarction, initial episode of care,Atrial fibrillation,Unspecified pleural effusion,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Hypoxemia,Personal history of malignant neoplasm of large intestine,Restless legs syndrome (RLS),Anxiety state, unspecified,Alzheimer's disease,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction

Crbl emblsm w infrct,Subendo infarct, initial,Atrial fibrillation,Pleural effusion NOS,Pneumonia, organism NOS,Urin tract infection NOS,Hypoxemia,Hx of colonic malignancy,Restless legs syndrome,Anxiety state NOS,Alzheimer's disease,Enterococcus group d,Anemia NOS,Ocl crtd art wo infrct

Admission Date: [**2188-5-31**] Discharge Date: [**2188-6-8**] Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 618**] Chief Complaint: CODE STROKE Major Surgical or Invasive Procedure: None. History of Present Illness: 86M h/o colon CA, atrial fibrillation on anticoagulation, HTN, hyperchol, anemia presents as CODE STROKE. Pt originally presented to OSH on [**5-26**] with exertional dyspnea and unstable angina. Found to also be in mild CHF. Called at 4:30pm at bedside within minutes. Went to diagnostic catherization on [**2188-5-29**] showing severe R-coronary and L-anterior descending artery disease, diffusely diseased circumflex. S/p angioplasty and 2 DES to RCA and 1 DES to LAD with residual moderate cardiomyopathy with LVEF 35-45%. Baby aspirin dc'd per OSH notes [**12-28**] concomitant Coumadin and Plavix Rx. Trop peak ~9. Notes from [**2188-5-30**] at 12:30pm report pt adamant about going home. Oriented to self and day. Able to attend. Last seen well @ 10am today Onset of symptoms @ 1pm today OSH staff was noted patient having difficulty seeing, not talking and right hemiparesis. As patient outside of 3 hour window for IV TPA, patient was transferred to [**Hospital1 18**] for possible IA TPA or clot retrieval. NIHSS 1a. alert 0 1b. LOC questions 2 1c. LOC commands 2 2. Gaze 1 3. Visual 2 4. Facial palsy 1 5. Motor L arm 0 5. Motor R arm 4 6. Motor L leg 0 6. Motor R leg 4 7. Limb ataxia X 8. Sensory 2 9. Best language 3 10. Dysarthria 2 11. Extinction X NIHSS Total 23 OSH head CT noncontrast: Left dense MCA sign and loss of [**Doctor Last Name 352**]-white matter differentiation in left basal ganglia and frontal lobe. No bleed. Past Medical History: - h/o R sided colon CA (adenocarcinoma) 7cm through to mesentery 0/14 lymph nodes involved, no mets R s/p R hemicolectomy ([**6-28**]) - HTN - restless leg syndrome - anxiety - pulsation left ear with left carotid bruit refused eval [**2184-9-15**] with carotids, sxs resolved [**2185-8-29**] - hyperchol - BPH - Atrial fibrillation (EF 50% 08/04 mild global hypokinesis) - Anemia - Post-herpetic neuraglia - R hemicolectomy as above - s/p b/l cataract surgery Social History: Married and care for wife with [**Name (NI) 11964**], 2 children, retired school maintenance worker. Quit tobacco [**2166**], no ETOH. [**Telephone/Fax (1) 73535**] Family History: Sister w/DM Physical Exam: T- AF BP- 148/88 HR- 120 afib RR- 18 98 O2Sat RA 149 lbs Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: supple CV: irreg irreg, Nl S1 and S2 Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema Neurologic examination: Mental status: Awake and alert. Mute and not following commands. Will sustain extremities antigravity if lifted by examiner. Cranial Nerves: Pupils equally round and reactive to light, 4 to 2 mm bilaterally. Decreased blink to threat from right with left gaze deviation. Crosses midline with oculocephalic maneuvers. Mild right nasolabial flattening. Palate elevation symmetrical. Sternocleidomastoid and trapezius normal bilaterally. Tongue midline, movements intact. Motor: Normal bulk bilaterally. Decreased tone on the right. No observed myoclonus or tremor. Right no spontaneous or purposeful movement on the right. Left side spontaneous and purposeful. Sensation: Decreased sensation to noxious stim on the right side. Reflexes: +2 slightly increased on the right throughout. Right toe upgoing and left toe downgoing. Coordination: unable Gait: unable Romberg: unable Pertinent Results: [**2188-5-31**] 04:45PM PT-20.8* PTT-30.8 INR(PT)-2.0* [**2188-5-31**] 04:45PM PLT COUNT-353 [**2188-5-31**] 04:45PM WBC-8.1 RBC-4.02* HGB-13.4* HCT-40.0 MCV-99* MCH-33.3* MCHC-33.5 RDW-14.1 [**2188-5-31**] 04:45PM DIGOXIN-0.8* [**2188-5-31**] 04:45PM TSH-4.5* [**2188-5-31**] 04:45PM CK-MB-3 cTropnT-0.49* [**2188-5-31**] 04:45PM LIPASE-33 [**2188-5-31**] 04:45PM ALT(SGPT)-31 AST(SGOT)-44* CK(CPK)-65 ALK PHOS-143* AMYLASE-35 TOT BILI-0.7 [**2188-5-31**] 04:45PM estGFR-Using this [**2188-5-31**] 04:45PM UREA N-19 CREAT-0.8 [**2188-5-31**] 04:54PM GLUCOSE-105 NA+-140 K+-4.7 CL--110 TCO2-24 [**2188-5-31**] 04:54PM COMMENTS-GREEN TOP [**2188-5-31**] 08:00PM URINE RBC-0-2 WBC-[**1-28**] BACTERIA-MANY YEAST-NONE EPI-<1 [**2188-5-31**] 08:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-7.0 LEUK-TR [**2188-5-31**] 08:00PM URINE COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.017 [**2188-6-1**] 01:30AM BLOOD Triglyc-97 HDL-38 CHOL/HD-3.7 LDLcalc-85 [**2188-5-31**] 04:45PM BLOOD TSH-4.5* [**2188-5-31**] 04:45PM BLOOD Digoxin-0.8* . Non-contrast head CT 7/7/7 FINDINGS: There is no evidence of hemorrhage, mass lesion, shift of normally midline structures, hydrocephalus, or infarction. Mild confluent periventricular hypoattenuation consistent with chronic microvascular ischemic changes. There is coarse calcification within the visualized portion of the left vertebral artery and basilar artery as well as cavernous carotid arteries. The orbits are grossly unremarkable. Within the left sphenoid sinus, there is a soft tissue density most consistent with an inclusion cyst. There is also opacification within the right frontal sinus which may also represent an inclusion cyst. IMPRESSION: No evidence of hemorrhage or infarction. . Chest X-ray 7/7/7 IMPRESSION: Small bilateral pleural effusions. Increased airspace opacities involving the bilateral lungs represents pulmonary edema. Radiopaque tubing projecting over the soft tissues of the lateral right neck is of uncertain clinical significance. Clinical correlation is requested. Carotid Dopplers: 70-79% right ICA stenosis. Likely distal left ICA significant stenosis. Echo: The left atrium is mildly dilated. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). The estimated right atrial pressure is 5-10 mmHg. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>50%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. No mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion ECG: [**6-7**] Atrial fibrillation with rapid ventricular response. ST segment depressions in the anterior leads suggestive of anterior ischemia. There are also T wave inversions in the inferior leads. Compared to the prior tracing of [**2188-6-1**] the T wave inversions in the anterior leads are slightly less prominent Brief Hospital Course: Mr. [**Known lastname **] is an 86-year-old man with a history of atrial fibrillation who was status post recent NSTEMI. He was admitted for acute onset right sided weakness. His exam was initially notable for complete right sided hemiplegia, with aphasia and eyes looking to left side. MRI showed acute infarction in the L MCA distribution, likely embolic. Unfortunately, the patient arrived at [**Hospital1 18**] 6.5 hours after he was last seen normal, making IA tPA not possible. IV tPA had not been possible at [**Location (un) 12017**] since he was already outside the 3 hour window. He was admitted to the Neuro ICU for close monitoring. He was given IVF to maintain his pressure with goal SBP 120-160. Echo was performed that showed EF of 50% and no thrombus or ASD. Carotid U/S showed a 70-79% stenosis in the R ICA, but no intervention was desired. A1c was < 7, LDL was 85. His exam slowly improved. He was maintained euglycemic and normothermic. His Atrial fibrillation was rate-controlled with digoxin and metoprolol. The metoprolol dosage was increased to 37.5 mg TID (from 25mg [**Hospital1 **]). His warfarin was held given concern for hemorrhagic conversion of his large stroke. This should be restarted around [**6-14**], if his family accepts the risks of bleeding. His recent NSTEMI had been stented and he was continued on Plavix. Aspirin was also held given concern for possible bleeding. During his hospital course, he was never intubated, but did require significant suctioning initially. After 3 days in the ICU, he was stable on room air. He was found to have an enterococcal UTI and was switched from levo to ampicillin after sensitivities were available. Once stable, he was evaluated by Speech & Swallow, who felt he should remain NPO. The family requested a PEG which was placed. In the early morning of [**6-7**] he was noted to be hypoxic with O2 sats at 88 and borderline hypotensive, SPB 90-100. A stat CXR, ECG and cardiac enzymes were drawn and he was placed on a face mask. His O2 sats improved to the 93%. The ECG showed ST depression in V1-V4 concerning for an NSTEMI which was confirmed with postive cardiac enzymes. His CXR showed pulmonary edema. Given his BP, lasix was held and he was maintainted on the face-mask and given Aspirin 325. 4 Hours after the initial event he became increasingly hypoxic and hypotensive. His family was contact[**Name (NI) **] to discuss the goals of care. He had been DNR/DNI up to this point. They requested he be made CMO. He was treated with morphine as needed and died the following day. Medications on Admission: Plavix 75mg QD Lopressor 50mg [**Hospital1 **] Coumadin 5mg QHS Diltiazem 120mg QD Lipitor 20mg QHS Lisinopril 10mg QD Elavil 12.5mg QHS Seroquel 25mg QHS Lopressor 5mg Q4hrs:PRN tachycardia Following meds were dc'd [**5-30**]: Lanoxin 0.25mg QD ASA 81mg QD Elavil 25mg [**Hospital1 **] Morphine sulfate 4mg Q1H:PRN Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1) injection Injection three times a day: subcutaneous. 2. Acetaminophen 325 mg Tablet [**Hospital1 **]: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain or fever. 3. Atorvastatin 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 4. Clopidogrel 75 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 5. Digoxin 250 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 6. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: Ten (10) ml PO BID (2 times a day). 7. Insulin Regular Human 100 unit/mL Solution [**Hospital1 **]: One (1) dose Injection ASDIR (AS DIRECTED): per sliding scale. . 8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 9. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO BID (2 times a day). Discharge Disposition: Expired Discharge Diagnosis: Stroke. Left MCA stroke. Discharge Condition: Expiried Discharge Instructions: NA Followup Instructions: NA [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

434,410,427,511,486,599,799,V100,333,300,331,041,285,433

{"Cerebral embolism with cerebral infarction,Subendocardial infarction, initial episode of care,Atrial fibrillation,Unspecified pleural effusion,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Hypoxemia,Personal history of malignant neoplasm of large intestine,Restless legs syndrome (RLS),Anxiety state, unspecified,Alzheimer's disease,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral 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: CODE STROKE PRESENT ILLNESS: 86M h/o colon CA, atrial fibrillation on anticoagulation, HTN, hyperchol, anemia presents as CODE STROKE. Pt originally presented to OSH on [**5-26**] with exertional dyspnea and unstable angina. Found to also be in mild CHF. Called at 4:30pm at bedside within minutes. Went to diagnostic catherization on [**2188-5-29**] showing severe R-coronary and L-anterior descending artery disease, diffusely diseased circumflex. S/p angioplasty and 2 DES to RCA and 1 DES to LAD with residual moderate cardiomyopathy with LVEF 35-45%. Baby aspirin dc'd per OSH notes [**12-28**] concomitant Coumadin and Plavix Rx. Trop peak ~9. MEDICAL HISTORY: - h/o R sided colon CA (adenocarcinoma) 7cm through to mesentery 0/14 lymph nodes involved, no mets R s/p R hemicolectomy ([**6-28**]) - HTN - restless leg syndrome - anxiety - pulsation left ear with left carotid bruit refused eval [**2184-9-15**] with carotids, sxs resolved [**2185-8-29**] - hyperchol - BPH - Atrial fibrillation (EF 50% 08/04 mild global hypokinesis) - Anemia - Post-herpetic neuraglia - R hemicolectomy as above - s/p b/l cataract surgery MEDICATION ON ADMISSION: Plavix 75mg QD Lopressor 50mg [**Hospital1 **] Coumadin 5mg QHS Diltiazem 120mg QD Lipitor 20mg QHS Lisinopril 10mg QD Elavil 12.5mg QHS Seroquel 25mg QHS Lopressor 5mg Q4hrs:PRN tachycardia Following meds were dc'd [**5-30**]: Lanoxin 0.25mg QD ASA 81mg QD Elavil 25mg [**Hospital1 **] Morphine sulfate 4mg Q1H:PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- AF BP- 148/88 HR- 120 afib RR- 18 98 O2Sat RA 149 lbs Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: supple CV: irreg irreg, Nl S1 and S2 Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: Sister w/DM SOCIAL HISTORY: Married and care for wife with [**Name (NI) 11964**], 2 children, retired school maintenance worker. Quit tobacco [**2166**], no ETOH. [**Telephone/Fax (1) 73535**] ### Response: {"Cerebral embolism with cerebral infarction,Subendocardial infarction, initial episode of care,Atrial fibrillation,Unspecified pleural effusion,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Hypoxemia,Personal history of malignant neoplasm of large intestine,Restless legs syndrome (RLS),Anxiety state, unspecified,Alzheimer's disease,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction"}

CHIEF COMPLAINT: Hip and patellar fracture PRESENT ILLNESS: Briefly, Mr. [**Known lastname 1104**] is a 78 year old male with extensive medical history, who uses a RLE prosthesis for ambulation s/p R BKA from PVD, who presents s/p fall when his prosthesis slipped out of place, found to have R patellar and non-displaced fracture of the R femoral neck, here for possible orthopedic surgery. His medical problems notably include CAD s/p CABG in [**2117**], MI [**2123**], MIBI with fixed and reversible defects in [**2129**], CHF with EF 20%, PVD s/p R BKA with b/l iliac stents, AAA found to be 5.4 x 5.0 cm on recent abdominal US, paroxysmal atrial fibrillation, bovine AVR, and CRI, on coumadin for his iliac stents and PAF. MEDICAL HISTORY: 1) CAD s/p CABG [**2117**], MI [**2123**] 2) AS s/p AVR [**2123**] (bovine) 3) PVD s/p R BKA and b/l iliac artery stents 4) Carotid stenosis s/p R CEA 5) h/o C. Diff 6) h/o MRSA 7) CHF class [**Last Name (LF) 1105**], [**First Name3 (LF) **] 30% 8) AAA 5 x 5.4 cm 9) S/P AICD 10) Hypercholesterolemia 11) CRI (baseline approx. 1.3) 12) PAF MEDICATION ON ADMISSION: Coumadin Lipitor 10 mg daily Lasix 20 mg alternating with 40 mg folate Toprol 25 mg daily Zestril 2.5 mg daily Tylenol PRN ALLERGIES: Levaquin PHYSICAL EXAM: 98.2, 68, 100/48, RR15, 98% on RA Gen: Cachectic appearing elderly male, resting comfortably in bed, appearing in pain with movement. Neck: No JVD. Cor: RR, normal rate, no m/r/g. Lungs: CTA b/l. Abd: NABS, soft, NT/ND Extr: No c/c/e. R BKA. Swollen, erythematous R knee, exquisitely tender. Trace PT on the L. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at home alone, independent. Quite smoking 8 years ago but 50 pack year smoking hx.

Closed fracture of unspecified part of neck of femur,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Heart valve replaced by transplant,Atrial fibrillation,Closed fracture of patella,Unspecified fall,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Below knee amputation status,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery

Fx neck of femur NOS-cl,Acute kidney failure NOS,CHF NOS,Heart valve transplant,Atrial fibrillation,Fracture patella-closed,Fall NOS,DMII wo cmp nt st uncntr,Periph vascular dis NOS,Abn react-surg proc NEC,Status amput below knee,Abdom aortic aneurysm,Crnry athrscl natve vssl

Admission Date: [**2132-3-28**] Discharge Date: [**2132-4-9**] Date of Birth: [**2054-2-21**] Sex: M Service: ORTHOPAEDICS Allergies: Levaquin Attending:[**First Name8 (NamePattern2) 1103**] Chief Complaint: Hip and patellar fracture Major Surgical or Invasive Procedure: ORIF of right patella fx ORIF of right femoral neck fracture History of Present Illness: Briefly, Mr. [**Known lastname 1104**] is a 78 year old male with extensive medical history, who uses a RLE prosthesis for ambulation s/p R BKA from PVD, who presents s/p fall when his prosthesis slipped out of place, found to have R patellar and non-displaced fracture of the R femoral neck, here for possible orthopedic surgery. His medical problems notably include CAD s/p CABG in [**2117**], MI [**2123**], MIBI with fixed and reversible defects in [**2129**], CHF with EF 20%, PVD s/p R BKA with b/l iliac stents, AAA found to be 5.4 x 5.0 cm on recent abdominal US, paroxysmal atrial fibrillation, bovine AVR, and CRI, on coumadin for his iliac stents and PAF. Patient reports that at baseline he is able to walk about 2 blocks, and activity is limited by SOB. He feels SOB getting out of bed in the morning. He is able to climb a flight of stairs without difficulty. He denies orthopnea or LE edema. No recent weight gain. Past Medical History: 1) CAD s/p CABG [**2117**], MI [**2123**] 2) AS s/p AVR [**2123**] (bovine) 3) PVD s/p R BKA and b/l iliac artery stents 4) Carotid stenosis s/p R CEA 5) h/o C. Diff 6) h/o MRSA 7) CHF class [**Last Name (LF) 1105**], [**First Name3 (LF) **] 30% 8) AAA 5 x 5.4 cm 9) S/P AICD 10) Hypercholesterolemia 11) CRI (baseline approx. 1.3) 12) PAF Social History: Lives at home alone, independent. Quite smoking 8 years ago but 50 pack year smoking hx. Family History: Non-contributory Physical Exam: 98.2, 68, 100/48, RR15, 98% on RA Gen: Cachectic appearing elderly male, resting comfortably in bed, appearing in pain with movement. Neck: No JVD. Cor: RR, normal rate, no m/r/g. Lungs: CTA b/l. Abd: NABS, soft, NT/ND Extr: No c/c/e. R BKA. Swollen, erythematous R knee, exquisitely tender. Trace PT on the L. Pertinent Results: [**3-28**] AP, LATERAL AND SUNRISE VIEWS OF THE PATELLA: No prior studies are available for comparison. There is a horizontal fracture through the patella with 1.2 cm of displacement of the fragments anteriorly. There is a small joint effusion. There are changes from prior BKA, and extensive [**Month/Year (2) 1106**] calcifications are present. IMPRESSION: Horizontal patellar fracture with 1.2 cm of displacement anteriorly. [**3-28**] PELVIS AND RIGHT HIP, THREE VIEWS: There is a transverse lucency through the femoral neck, which may represent a nondisplaced fracture. No other fractures or dislocations are identified. Degenerative changes of the SI and hip joints are noted. There is diffuse demineralization. Extensive [**Month/Year (2) 1106**] calcifications and iliac stents are noted. IMPRESSION: Transverse lucency through the femoral neck, which may represent a nondisplaced fracture. [**3-28**] CT PELVIS: There is a nondisplaced fracture of the proximal right femoral neck. No other fractures or dislocations are identified. There is diffuse osteopenia. There is a small amount of high attenuation fluid within the right hip joint space, which may represent a small amount of hemorrhage. Extensive [**Month/Year (2) 1106**] calcifications are seen as are bilateral iliac stents. Visualized portions of the pelvis are unremarkable. Soft tissue structures are within normal limits. IMPRESSION: Nondisplaced fracture of the right femoral neck. Brief Hospital Course: 78 year old male with extensive medical history, notably including CAD s/p CABG in [**2117**], MI [**2123**], MIBI with fixed and reversible defects in [**2129**], CHF with EF 20%, PVD s/p R BKA with b/l iliac stents, AAA found to be 5.4 x 5.0 cm on recent abdominal US, paroxysmal atrial fibrillation, who uses a RLE prosthesis for ambulation s/p R BKA, who presents s/p mechanical fall with R patellar and R femoral neck fractures, here for orthopedic surgery. 1) Ortho: Patient is high risk for surgery, however per ortho, surgery will not be extensive, could be completed in relatively short time frame, possibly under spinal anesthesia only. Awaiting cardiolgy consult for estimate of operative risk given recent MIBI with reversible defects in all territories, and cath with 3VD. Patient willing to accept 25-30% chance of operative mortality. [**Year (4 digits) **] has seen patient and says o.k. for surgery. Limiting factor may be INR, as still 2.9 with 5 mg Vitamin K. Another 5 mg given, but may need FFP/platelets, and given EF 30%, would likely need to be done under controlled setting in ICU in case of respiratory distress. [**Month (only) 116**] defer until tomorrow. Needs patellar surgery one way or another in order to ever be able to use prosthesis again. 2) AAA: Seen by [**Month (only) 1106**]. Will try to get CTA during hospitalization at some point, though not now in setting of worsened creatinine. [**Month (only) 116**] just be able to get abdominal US. Appreciate [**Month (only) 1106**] consult. Outpatient repair of AAA. 3) CHF: Class [**Last Name (LF) 1105**], [**First Name3 (LF) **] 20% in past, though 30% on most recent cath, currently dry on exam, therefore holding lasix. If patient doesn't go to surgery tonight, will order food and will likely order lasix then. Also will need lasix with any FFP/platelets. -Coumadin for goal INR [**1-10**] 4) PVD: Bilateral iliac stents, on coumadin, therefore once INR below 2, will have to start heparin drip. --recheck INR post second dose of vitamin K, if < 2.0, will start heparin, and d/c prior to surgery 5) A-fib: As above, holding coumadin. 6) CRI: Slightly above baseline. Holding ACE-I. 7) FEN: K borerline therefore holding ACE-I. No fluids. Will order food if pt. doesn't go to OR. 8) Code: Full. 9) PPx: Heparin drip then transfer to coumadin, senna, colace. Removed RIJ CVL and placed peripheral IV on [**2132-4-9**]. Hct 29.7 on discharge. Needs daily Hct and INR. Transfuse Hct<28 and keep INR [**1-10**]. Medications on Admission: Coumadin Lipitor 10 mg daily Lasix 20 mg alternating with 40 mg folate Toprol 25 mg daily Zestril 2.5 mg daily Tylenol PRN Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED): Per slide scale. 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 6. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**12-9**] Sprays Nasal QID (4 times a day) as needed. 7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 10. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Oxycodone HCl 5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain. 13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed. 14. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day: Please adjust dose to keep INR 2.0-3.0. Tablet(s) Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at [**Hospital6 1109**] - [**Location (un) 1110**] Discharge Diagnosis: Right Patella fracture Right femoral neck fracture Post-op anemia AAA CHF ARF DM PVD Discharge Condition: stable Discharge Instructions: Please cont with non-weight bearing left leg. Coumadin for anti-coagulation goal INR 2.0-3.0. Oral pain medication as needed. Please keep incision clean/dry. Please call/return if any fevers, increased discharg from incision, or trouble breathing. Please check Hct, coags on arrival. Check daily Hct. If Hct <28, then transfuse. Last Hct [**2132-4-8**] 29.7. Followup Instructions: Provider: [**Name10 (NameIs) 1111**],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY Where: [**Last Name (NamePattern4) **] SURGERY Date/Time:[**2132-8-4**] 11:00 Follow-up with Dr.[**First Name (STitle) **] 2weeks after discharge, please call this week for appt. [**Telephone/Fax (1) 1113**] Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1114**], M.D. Where: [**Hospital6 29**] [**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2132-5-28**] 10:00

820,584,428,V422,427,822,E888,250,443,E878,V497,441,414

{'Closed fracture of unspecified part of neck of femur,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Heart valve replaced by transplant,Atrial fibrillation,Closed fracture of patella,Unspecified fall,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Below knee amputation status,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Hip and patellar fracture PRESENT ILLNESS: Briefly, Mr. [**Known lastname 1104**] is a 78 year old male with extensive medical history, who uses a RLE prosthesis for ambulation s/p R BKA from PVD, who presents s/p fall when his prosthesis slipped out of place, found to have R patellar and non-displaced fracture of the R femoral neck, here for possible orthopedic surgery. His medical problems notably include CAD s/p CABG in [**2117**], MI [**2123**], MIBI with fixed and reversible defects in [**2129**], CHF with EF 20%, PVD s/p R BKA with b/l iliac stents, AAA found to be 5.4 x 5.0 cm on recent abdominal US, paroxysmal atrial fibrillation, bovine AVR, and CRI, on coumadin for his iliac stents and PAF. MEDICAL HISTORY: 1) CAD s/p CABG [**2117**], MI [**2123**] 2) AS s/p AVR [**2123**] (bovine) 3) PVD s/p R BKA and b/l iliac artery stents 4) Carotid stenosis s/p R CEA 5) h/o C. Diff 6) h/o MRSA 7) CHF class [**Last Name (LF) 1105**], [**First Name3 (LF) **] 30% 8) AAA 5 x 5.4 cm 9) S/P AICD 10) Hypercholesterolemia 11) CRI (baseline approx. 1.3) 12) PAF MEDICATION ON ADMISSION: Coumadin Lipitor 10 mg daily Lasix 20 mg alternating with 40 mg folate Toprol 25 mg daily Zestril 2.5 mg daily Tylenol PRN ALLERGIES: Levaquin PHYSICAL EXAM: 98.2, 68, 100/48, RR15, 98% on RA Gen: Cachectic appearing elderly male, resting comfortably in bed, appearing in pain with movement. Neck: No JVD. Cor: RR, normal rate, no m/r/g. Lungs: CTA b/l. Abd: NABS, soft, NT/ND Extr: No c/c/e. R BKA. Swollen, erythematous R knee, exquisitely tender. Trace PT on the L. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at home alone, independent. Quite smoking 8 years ago but 50 pack year smoking hx. ### Response: {'Closed fracture of unspecified part of neck of femur,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Heart valve replaced by transplant,Atrial fibrillation,Closed fracture of patella,Unspecified fall,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Below knee amputation status,Abdominal aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery'}

CHIEF COMPLAINT: seizure and hematemesis PRESENT ILLNESS: 47 L handed male with PMH sig for transverse myelitis dx [**12-8**] undergoing tx with 6mo of steroids presents from OSH with hematemesis, gastric ulcer with visible vessel s/p EGD and cauterization here on [**2-14**]. MEDICAL HISTORY: HTN gout hypercholesterolemia asthma C4-C6 spinal stenosis (recent dx) eczema MEDICATION ON ADMISSION: theophylline 200mg po bid beclovent 5qid prednisone 60mg po q24h allopurinol 300mg po qd zocor 40mg po qd enalapril 20mg po qd pepcid 20mg po bid bactrim 1tab po bid iron PO supplement ALLERGIES: Penicillins / Peanut / Egg PHYSICAL EXAM: Vitals: 97.3 110-138/70-90 HR68-90 RR16-18 O2 Sat 95-100%. Gen: sitting in chair, NAD. HEENT: supple neck Pulmonary: CTA bilaterally Cardiovascular: RRR, S1/S2 no murmur Abd: +BS, soft NT/ND Ext: no edema FAMILY HISTORY: non-contributory no history of neurologic or CT disease SOCIAL HISTORY: non-smoker Former EtOH user [**2-4**] drinks per night no h/o IVDU married x 8yrs works as computer analyst

Other convulsions,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Pure hypercholesterolemia,Gout, unspecified

Convulsions NEC,Chr duoden ulcer w hem,Chr blood loss anemia,Hypertension NOS,Pure hypercholesterolem,Gout NOS

Admission Date: [**2124-2-14**] Discharge Date: [**2124-2-20**] Date of Birth: [**2077-2-5**] Sex: M Service: NEUROLOGY Allergies: Penicillins / Peanut / Egg Attending:[**First Name3 (LF) 57490**] Chief Complaint: seizure and hematemesis Major Surgical or Invasive Procedure: EGD History of Present Illness: 47 L handed male with PMH sig for transverse myelitis dx [**12-8**] undergoing tx with 6mo of steroids presents from OSH with hematemesis, gastric ulcer with visible vessel s/p EGD and cauterization here on [**2-14**]. In [**2123-11-3**], he started developing severe lower back pain with weakness in his legs and numbness in his hands. He had been diagnosed by his PCP as having back arthritis. He was progressively getting worse and one day he fell and could not stand up. His symptoms did not improve and he presented to [**Hospital1 2025**] on [**2123-11-18**] with worsened hand/LE weakness 1/5 strength, hyperreflexia. Full spine MRI at [**Hospital1 2025**] revealed questionable mass and intramedullary T2 hyperintense from C2-L2 with cord expansion and patchy enhancement. Further workup for malignancies included negative abd/chest CT and brain MRI. CSF analysis revealed WBC 8 [L 97% M 3%], glucose 85, protein 38. [**Doctor First Name **], RF, HSV; mycoplasma PCR, VRDL pending; Gram stain, cx showed NG. He was started on solu-medrol 1g IV daily x5d with considerable improvement of LE strength. Repeat MRI showed diminished T2 hyperintesities. He was discharged to home on [**2123-11-27**] and arranged for solu-medrol taper. He was also started on balcofen for spasticity, and told to f/u as outpatient in [**Hospital 878**] clinic. Shortly after d/c of steroids, symptoms relapsed. Presented here [**12-6**] with bacteremia, septic right knee and weakness. At that time pt was found to have a septic joint and gout which was treated appropriately with antibiotics and NSAIDs. He was later transfered to the neurology service for w/u of his weakness. An MRI of the head was normal, but MRIs of the spine revealed edema and enhancement C3-C6 suggestive for lymphoma vs sarcoid vs myelitis. A chest CT revealed pulmonary nodules. A biopsy of the nodules were performed, which showed only lung parenchyma, however it is uncertain that the nodules were truly biopsied. An LP revealed increased protein, though tap was traumatic and many RBCs were present. CSF viral studies-->+VZV, -EBV, and -HSV PCR. ACE normal. He was started on a second course of high dose steroids 1gm soulmedrol x5days to be followed by a 6 month course of PO steroids. Pt was d/c'd home on [**12-30**] with improving exam. Pt had been doing well at home with PT/OT until [**2124-2-8**], when pt's wife noticed pt undergo a possible seizure followed by coffee ground emesis. The pt's body stiffened. He then began having a rhythmic shaking of the LUE for about 30 seconds. Pt was then unresponsive for 5-10 minutes, after which he had coffee ground emesis. He was taken to OSH, where an EGD showed a gastric ulcer with a visible vessel and a Hct was 26. Pt was treated with H2 blocker and d/c'd home on [**2-13**]. The following day, pt developed a second episode, which per the wife, was exactly like the first, and was followed by a large amount of hematemesis. Pt taken to OSH and then transferred to [**Hospital1 18**], where a HCT on admission was 24.3. He was admitted to the MICU for UGIB. Past Medical History: HTN gout hypercholesterolemia asthma C4-C6 spinal stenosis (recent dx) eczema Social History: non-smoker Former EtOH user [**2-4**] drinks per night no h/o IVDU married x 8yrs works as computer analyst Family History: non-contributory no history of neurologic or CT disease Physical Exam: Vitals: 97.3 110-138/70-90 HR68-90 RR16-18 O2 Sat 95-100%. Gen: sitting in chair, NAD. HEENT: supple neck Pulmonary: CTA bilaterally Cardiovascular: RRR, S1/S2 no murmur Abd: +BS, soft NT/ND Ext: no edema Mental status: Awake and alert, cooperative with exam, normal affect. Oriented to person, place, and date. Is attentive says [**Doctor Last Name 1841**] backwards. Able to relay coherent history. Speech is fluent with normal comprehension and repetition; naming intact. Registers [**2-3**], Recalls [**2-3**]. No evidence of apraxia or neglect. No right-left agnosia. Cranial Nerves: Pupils equally round and reactive to light, 4 to 2mm bilaterally. Visual fields are full to confrontation. Extraocular movements intact bilaterally without nystagmus. ?subtle right lid ptosis. Sensation intact V1-V3. No facial movements symmetric. Hearing intact to finger rub bilaterally. Palate elevation symmetrical shoulder shrug normal bilaterally. Tongue midline without fasciculations, intact movements Motor: Normal bulk bilaterally. Tone normal. [**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IO APB IP H Q DF PF TE TF R 4+ 5 5- 5 5 5 5 4 4 4 5- 5 5- 5 5- 5 L 5 5 5- 5 5 5 5 4 4 5- 5- 5 5- 5 5- 5 Sensation: Decreased vibration bilaterally. Impaired JPS in toes bilaterally. Decreased sensation to pin R>L, patchy, no level. Reflexes: B T Br Pa Ach Right 2 2 2 2 2 Left 2 2 2 2 2 BRISK THROUGHOUT +crossed adductors Toes were upgoing bilaterally Coordination: Intact FNF task Gait: slow, narrow based, uses walker Pertinent Results: [**2124-2-14**] 11:05PM WBC-10.7 RBC-3.13* HGB-9.1* HCT-26.7* MCV-85 MCH-29.0 MCHC-34.0 RDW-18.1* [**2124-2-14**] 11:05PM PLT COUNT-155 [**2124-2-14**] 06:21PM WBC-9.0 RBC-2.91* HGB-8.4* HCT-24.2* MCV-83 MCH-28.8 MCHC-34.6 RDW-18.4* [**2124-2-14**] 06:21PM NEUTS-88.7* LYMPHS-6.1* MONOS-4.8 EOS-0.3 BASOS-0.2 [**2124-2-14**] 06:21PM PLT COUNT-188 [**2124-2-14**] 03:08PM GLUCOSE-145* UREA N-28* CREAT-0.8 SODIUM-142 POTASSIUM-3.8 CHLORIDE-110* TOTAL CO2-23 ANION GAP-13 [**2124-2-17**] 10:48AM BLOOD WBC-10.3 RBC-3.96* Hgb-11.6* Hct-33.1* MCV-84 MCH-29.3 MCHC-35.0 RDW-16.8* Plt Ct-239 [**2124-2-14**] 06:21PM BLOOD Neuts-88.7* Lymphs-6.1* Monos-4.8 Eos-0.3 Baso-0.2 [**2124-2-17**] 10:48AM BLOOD Plt Ct-239 [**2124-2-17**] 10:48AM BLOOD Glucose-93 UreaN-18 Creat-0.7 Na-138 K-4.2 Cl-102 HCO3-27 AnGap-13 [**2124-2-15**] 04:49AM BLOOD CK(CPK)-57 MRI (brain) No abnormalities noted MRI (c-spine) Compared to the previous examination, there is decreased abnormal signal within the cervical cord, largely confined to the region of C3 and C4. There does not appear to be abnormal cord swelling at the present time. There is still some contrast enhancement but this also appears to be reduced compared to the previous examination. Degenerative disease is again seen involving C3- C4, C4-C5, and C5-C6, and C6-C7 essentially unchanged compared to the previous examination. For details, see that report. EEG pending Brief Hospital Course: 1. NEURO- His last seizure was in [**2122-9-2**]. Based on his history, probably had additional seizures before admission. Here, he was started on Trileptal and has remained seizure free. MRI showed no evidence of intracranial pathology that may have led to his recent seizures. C-Spine MRI showed similar, though decreased region of enhancement in the cervical cord at C3/4. The etiology of his his cord pathology is not yet clear. Was thought to be neurosarcoid due to presence of pulmonary nodules, but no clear evidence of granulomas or elevated ACE was seen. Repeat CT of his chest here was normal, with no LAD and clear lungs. He has been on chronic steroids for several months though, so his initial findings may have cleared in this setting. In terms of malignancy, biopsy of the lung nodules was non diagnostic in the past and the CSF cytology did not contain adequate cells to rule this out as a possible cause. Infectious causes seem unlikley, but VZV was positive (pt never had clinic varicella). Had a repeat LP here with essentially normal cell count, glucose, and very mildly elevated protein at 50. This was sent for TB-PCR and cytology. Both pending at D/C. He has been on prednisone 60 mg for several months and apparently worsened when they tried to taper him off this medication. We decreased him to 40 mg here and he will f/u with neurology where they can continue to taper this as he tolerates. He had EEG here with no evidence of seizure activity, but his episodes do sound suspicious for seizure. Given this, will continue his Trileptal as an outpt. Etiology of his neurological dysfunction still unclear, but ddx includes TB, lymphoma, neurosarcoid(less likely), MS. Apparently had diffuse enhancement of spinal cord on past MRI, which is not classic for any of the above. Repeat scan here is much improved as above. Will f/u on CSF studies. 2. GI - UGIB likely secondary to vessel in ulcer as seen on EGD. Received 2 units PRBCs. This vessel was cauterized during this admission and his Hct remained stable afterwards. His diet was slowly advanced and he was tolerating solids without issue by discharge. He did have 1 episode of heme positive stool while here, but would expect this given his recent bleed and fact that it was first BM since this. No drop in his Hct with this. Started on iron. Also started on Protonix 40 mg [**Hospital1 **]. WIll continue this as outpt and f/u with his PCP [**Last Name (NamePattern4) **] 10 days. 3. CV - He was ruled out for MI here. He did have tachycardia on telemetry with activity at times, but wasn't orthostatic. Unclear etiology, but didn't suspect PE, dehydration, arrhythmia. Encouraged PO intake. Held his ACE-I for the majority of admission, but restarted when he was stable. BP was in 140s systolic without medication. 4.Gout:Continued his home allopurinol. No issues. Told pt to avoid NSAIDS. 5.Pulm:Pt was continued on theophylline. COuld have been contributing to tachycardia, but has been on this for a long time, so decided to continue it. 6.ID:Continued Bactrim for ppx as he is on high dose steroids. Medications on Admission: theophylline 200mg po bid beclovent 5qid prednisone 60mg po q24h allopurinol 300mg po qd zocor 40mg po qd enalapril 20mg po qd pepcid 20mg po bid bactrim 1tab po bid iron PO supplement Discharge Medications: 1. Pantoprazole Sodium 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. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Theophylline 200 mg Capsule, Sust. Release 12HR Sig: One (1) Capsule, Sust. Release 12HR PO BID (2 times a day). Disp:*60 Capsule, Sust. Release 12HR(s)* Refills:*2* 4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). Disp:*1 MDI* Refills:*2* 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 9. Oxcarbazepine 300 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 10. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 2255**] [**Name (NI) 2256**] Discharge Diagnosis: Seizure Myelitis Upper GI bleed/duodenal ulcer Discharge Condition: Improved-Hct stable, no seizures, weakness at baseline Discharge Instructions: Please continue to take your medications as directed. Your dose of prednisone has been decreased to 40mg daily, you should continue on this dose until your follow up appointment with Dr. [**Last Name (STitle) 1206**]. You have been started on a new medication called Trileptal to prevent seizures, please continue to take this medication. If you have another seizure, or develop new or increasing weakness or numbness, please call Dr. [**Last Name (STitle) 1206**] or Dr. [**Last Name (STitle) 7994**] or come to the emergency room for evaluation. Followup Instructions: 1. NEUROLOGY: Provider: [**Name10 (NameIs) 540**],[**Name11 (NameIs) **] Where: CC CLINICAL CENTER NEUROLOGY Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2124-3-1**] 2:30 2. Primary Care: Dr. [**Last Name (STitle) 58756**] [**Telephone/Fax (1) 58757**] [**2124-2-28**] 1:20PM

780,532,280,401,272,274

{'Other convulsions,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Pure hypercholesterolemia,Gout, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: seizure and hematemesis PRESENT ILLNESS: 47 L handed male with PMH sig for transverse myelitis dx [**12-8**] undergoing tx with 6mo of steroids presents from OSH with hematemesis, gastric ulcer with visible vessel s/p EGD and cauterization here on [**2-14**]. MEDICAL HISTORY: HTN gout hypercholesterolemia asthma C4-C6 spinal stenosis (recent dx) eczema MEDICATION ON ADMISSION: theophylline 200mg po bid beclovent 5qid prednisone 60mg po q24h allopurinol 300mg po qd zocor 40mg po qd enalapril 20mg po qd pepcid 20mg po bid bactrim 1tab po bid iron PO supplement ALLERGIES: Penicillins / Peanut / Egg PHYSICAL EXAM: Vitals: 97.3 110-138/70-90 HR68-90 RR16-18 O2 Sat 95-100%. Gen: sitting in chair, NAD. HEENT: supple neck Pulmonary: CTA bilaterally Cardiovascular: RRR, S1/S2 no murmur Abd: +BS, soft NT/ND Ext: no edema FAMILY HISTORY: non-contributory no history of neurologic or CT disease SOCIAL HISTORY: non-smoker Former EtOH user [**2-4**] drinks per night no h/o IVDU married x 8yrs works as computer analyst ### Response: {'Other convulsions,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Pure hypercholesterolemia,Gout, unspecified'}

CHIEF COMPLAINT: Hypotension. PRESENT ILLNESS: The pt. is a 85 year-old male with multiple medical problems who was found unresponsive at his [**Hospital3 **] facility. Per notes, the pt. was found lying on the floor by his neighbor the morning of admission. He was noted to be cyanotic and his blood pressure was noted to be 80/40. MEDICAL HISTORY: 1) Congestive heart failure, EF 35% 2) CAD s/p 4 vessel CABG 3) Atrial fibrillation. 4) Aortic stenosis 5) Hypertension. 6) Hypercholesterolemia. 7)History of cerebral vascular accident, s/p bilateral CEA 10) History of upper gastrointestinal bleed s/p EGD [**2121-6-10**] showing gastritis 11) Cecal adenoma x2 [**29**]) S/P laproscopic right hemicolectomy [**2121-7-16**] 13) Diverticulosis 14) S/P cholecystectomy [**32**]) Prostate cancer, s/p XRT 16) Hypothyroidism. 17) S/P L THR 18) Mitral regurgitation MEDICATION ON ADMISSION: -lasix 20mg po daily -protonix 40mg po daily -ipratropium 2puffs ih [**Hospital1 **] -lisinopril 15mg po daily -atorvastatin 10mg po daily -metoprolol 12.5mg po daily -ASA 325mg po daily -FeSO4 325mg po daily -MVI -aldactone 25mg po daily -synthroid 125mcg po daily -trazodone 50mg po daily -remeron 30mg po daily -seroquel 30mg po daily -colace 100mg po bid -senna 2 tabs po bid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 100.4F P: 110 R: 28 BP: 119/69 SaO2: 100% on 3L O2 via NC General: Elderly male, awake, alert, NAD HEENT: PERRL, + cataract of L eye, EOMI, sclerae anicteric, dry MM, clear OP Neck: supple, JVD to 10cm Pulm: bibasilar rales 1/3 up lung fields Cardiac: tachycardic, irregularly irregular rhythm, S1S2, III/VI SEM at LSB Abdomen: +fluid wave, soft, NT/ND, active BS Extremities: 1+ bilateral LE pitting edema, 2+ DP pulses bilaterally Neurologic: Alert and oriented x 3. Moving all four extremities. Uncooperative with the remainder of exam. Skin: no rashes noted. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The pt. lives in an assisted-living facility. He is widowed and has a daughter who lives in the area. He denied use of tobacco or alcohol.

Systolic heart failure, unspecified,Urinary tract infection, site not specified,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status

Systolic hrt failure NOS,Urin tract infection NOS,Prim cardiomyopathy NEC,Atrial fibrillation,Hypertension NOS,Hypothyroidism NOS,Pure hypercholesterolem,Anemia NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass

Admission Date: [**2122-1-13**] Discharge Date: [**2122-1-23**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 9569**] Chief Complaint: Hypotension. Major Surgical or Invasive Procedure: None. History of Present Illness: The pt. is a 85 year-old male with multiple medical problems who was found unresponsive at his [**Hospital3 **] facility. Per notes, the pt. was found lying on the floor by his neighbor the morning of admission. He was noted to be cyanotic and his blood pressure was noted to be 80/40. He was originally treated at an OSH ED where he was determined to be in rapid atrial fibrillation and found to be hypotensive (systolic BP in the 60's). A chest X-ray was performed which was suggestive of CHF and a urinalysis was sent which was consistent with a urinary tract infection. He was also found to be hyperkalemic and was treated with insulin, D50, and bicarbonate. He was given 500cc of normal saline and was started on levofloxacin and gentamicin. A head CT was performed and was negative for any acute intracranial process. A CK and troponin were noted to be "negative." He was subsequently transferred to [**Hospital1 18**] for further care. In the ED, his blood pressure was 70/40 on arrival. His temperature was 100.4 rectally. He was initiated on the sepsis protocol and he underwent placement of a central venous catheter and received 250cc of IV fluid. A lactate was found to be 2.2. He was given one unit of PRBCs for a hematocrit of 28. He was also started on a levophed drip. He was admitted to the ICU for treatment of a CHF exacerbation, atrial fibrillation and possible urosepsis. On presentation to the MICU, the pt. offered no specific complaints other than fatigue. He was unable to recall the events surrounding the fall which led to his admission. He stated that he has not felt well over the last week, specifically that he has been experiencing increasing dyspnea and PND. He denied orthopnea. He also c/o dysuria over the past week. He denied chest pain, nausea, vomiting, diarrhea, BRBPR, melena. He denied dietary indiscretion. He has been taking all of his medications as prescribed. Past Medical History: 1) Congestive heart failure, EF 35% 2) CAD s/p 4 vessel CABG 3) Atrial fibrillation. 4) Aortic stenosis 5) Hypertension. 6) Hypercholesterolemia. 7)History of cerebral vascular accident, s/p bilateral CEA 10) History of upper gastrointestinal bleed s/p EGD [**2121-6-10**] showing gastritis 11) Cecal adenoma x2 [**29**]) S/P laproscopic right hemicolectomy [**2121-7-16**] 13) Diverticulosis 14) S/P cholecystectomy [**32**]) Prostate cancer, s/p XRT 16) Hypothyroidism. 17) S/P L THR 18) Mitral regurgitation Social History: The pt. lives in an assisted-living facility. He is widowed and has a daughter who lives in the area. He denied use of tobacco or alcohol. Family History: Noncontributory. Physical Exam: T: 100.4F P: 110 R: 28 BP: 119/69 SaO2: 100% on 3L O2 via NC General: Elderly male, awake, alert, NAD HEENT: PERRL, + cataract of L eye, EOMI, sclerae anicteric, dry MM, clear OP Neck: supple, JVD to 10cm Pulm: bibasilar rales 1/3 up lung fields Cardiac: tachycardic, irregularly irregular rhythm, S1S2, III/VI SEM at LSB Abdomen: +fluid wave, soft, NT/ND, active BS Extremities: 1+ bilateral LE pitting edema, 2+ DP pulses bilaterally Neurologic: Alert and oriented x 3. Moving all four extremities. Uncooperative with the remainder of exam. Skin: no rashes noted. Pertinent Results: [**2122-1-13**] 10:07PM WBC-4.8 RBC-3.14* HGB-9.0* HCT-28.1* MCV-90# MCH-28.6 MCHC-32.0 RDW-16.3* [**2122-1-13**] 10:07PM PLT COUNT-258 [**2122-1-13**] 10:07PM NEUTS-71.1* LYMPHS-19.1 MONOS-7.1 EOS-2.1 BASOS-0.7 [**2122-1-13**] 10:07PM HYPOCHROM-3+ ANISOCYT-1+ POIKILOCY-1+ [**2122-1-13**] 10:07PM GLUCOSE-81 UREA N-43* CREAT-1.3* SODIUM-143 POTASSIUM-4.6 CHLORIDE-107 TOTAL CO2-28 ANION GAP-13 [**2122-1-13**] 10:47PM CALCIUM-8.4 PHOSPHATE-2.9 MAGNESIUM-2.2 [**2122-1-13**] 10:47PM ALT(SGPT)-7 AST(SGOT)-14 CK(CPK)-30* ALK PHOS-114 TOT BILI-1.1 [**2122-1-13**] 10:51PM LACTATE-2.2* [**2122-1-13**] 10:47PM CK-MB-NotDone cTropnT-0.04* [**2122-1-13**] 11:01PM PT-15.1* PTT-31.6 INR(PT)-1.4 [**2122-1-13**] 11:10PM URINE COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.015 [**2122-1-13**] 11:10PM URINE BLOOD-LG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-8* PH-6.5 LEUK-MOD [**2122-1-13**] 11:10PM URINE RBC-[**7-17**]* WBC->50 BACTERIA-MANY YEAST-NONE EPI-0 Brief Hospital Course: Mr. [**Name13 (STitle) **] is an 85 year-old man with a history of CAD s/p CABG, left ventricular systolic dysfunction with EF of 25%, history of atrial fibrillation admitted from an OSH after being found unresponsive at [**Hospital3 **] facility. On transfer he was hypotensive with low grade fever. He was initially admitted to the [**Hospital Ward Name 332**] ICU. The following issues were addressed on this admission. Concerning his cardiovascular disease: Concerning ischemic disease. He has a history of CAD s/p CABG and was ruled out here. Troponins and CK's remained flat. OSH reported no elevation in enzymes. His troponins were from 0.04-0.06 attributed to demand from heart failure and rapid atrial fibrillation. He was maintained on aspirin, statin. ACE inhibition was added once patient's pressures stabilized. Unable to add beta-blockade given low pressures. Concerning his pump function: Patient with depressed EF estimated 25%. Echo here demonstrated echo less than 20% but this was in setting of decompensation. Also has 3+MR/ moderate to severe AS. Patient admitted with low pressures and RVR to afib. In ICU low pressures felt likely due to urosepsis vs. heart failure. Patient first treated for urosepsis with sepsis protocol with pressors. He was not diuresed and other load medications could not be initiated with continued low pressors. Never with swan placed. Once he was stabilized in ICU and felt not to be septic, weaned from pressors, patient transferred to floor afebrile, but still with low pressures. Felt to be decompensated heart failure. Patient initially placed on lasix and dopamine but patient had lots of increased ectopy and continued low pressures so both were stopped. As pressures came up with no intervention, lasix iv and ace were added. Patient then diuresed and drastically improved. Patient's oxygen requirement resolved and now satting 99% room air. Also with no orthopnea, creatinine rising slightly (in normal range), and exam greatly improved with decreaed edema and only minimal basilar crackles. Patient transitioned to current ACE/lasix levels. His pressures continue to run low (high 80's-low 90's systolic) and these pressures should be tolerated. The patient needs afterload reduction with ACE inhibition and daily lasix to remain euvolemic, esp. given 3+MR and AS. His actual EF is very low given MR/AS. Should continue lasix, ace and add beta-blocker as blood pressures/heart rates can tolerate. Also titrate ace as possible, down-titrate lasix as needed if patient becoming dry, especially if creatinine rising and add beta-blocker (was at 12.5 metoprolol [**Hospital1 **] on admit and lisinopril 15 on admit.) Patient also should be maintained on spirinolactone. Concerning his rhythm: The patient admitted in afib with RVR. No attempts made to cardiovert given large atrium and long history of afib, veyr unlikely that he could be cardioverted. Beta-blockade and calcium channel inhibition could not be utilized due to low pressures. Digixon was maintained with good rate control. OF NOTE: The patient had runs of SVT with aberrancy vs. Vtach on telemetry. EP was consulted numerous times to evaluate these rhythms. All were felt to due to SVT with aberrancy. We will attach copies of tele strips for comparison. Continue to monitor dig levels, they have been around 0.8 to low 1.0's here. Goal is right around 1.0. Normal TSH and free T4. Concerning anticoag: holding coumadin for afib given guiaic positive stools. Patient was not on coumadin previously, with known afib because of history of gastritis, guiaic positive stools. Had colonoscopy in [**Month (only) 205**] which showed diverticulosis of the ascending colon and sigmoid colon Anastomosis site visualized in ascending colon without any evidence of bleeding Otherwise normal colonoscopy to ascending colon. Discussed issue with PCP. [**Name10 (NameIs) **] defer decision to start coumadin to PCP. [**Name10 (NameIs) **] not been on coumadin since [**Month (only) 205**] with GI bleeding. Will defer coloscopy now given history of recent polyp removal, no other lesions found and known gastritis by EGD. Concerning history of ischemia/depressed ef: Given that patient wishes to be DNR/DNI, placement of AICD deferred. Concerning ? of sepsis/UTI: Patient admitted to ICU with concern for urosepsis given low grade fevers, hypotension. Originally on pressors, quickly weaned and transferred to floor. Patient with E. Coli UTI by [**1-13**] urine culture, originally on levaquin, but sensitivities came back negative once on floor so changed to ceftriaxone. Received 7 days of ceftriaxone and then switched to cefpodoxime for d/c. Repeat urine cultures came back negative on [**1-18**]. Given that he improved with inadequate treatment, and negative blood cultures, unlikely that patient was actually septic. Pressures likely low due to CHF. All blood and sputum cultures remained negative. Patient afebrile with normal WBC for 7 days before discharge. Patient with history of anemia: Felt to be secondary to gastritis. Colonoscopies in [**Month (only) 116**] and [**Month (only) 205**] of this year, and has been off coumadin since gastritis and polyp removal. Also guiaic positive on this admission. Crit stable throughout course but patient remains anemic. Patient needs outpatient colonoscopy. Will hold iron at this time for better diagnostic accuracy with anticipated colonoscopy. Crit on discharge is 31. Continue to monitor. We are holding coumadin for afib given history of recent history of GI bleeding. PCP and cardiologist can made decision to re-add. Of note, had upper GI bleed in [**6-10**], had polyp removal in [**8-10**] colonoscopy with no evidence of bleeding. Concerning his hypothyroidism: TSH and free T4 normal here. Continued current synthroid dosing. Patient discharged in stable condition to rehab facility. The patient is DNR/DNI and does not wish to be admitted to CCU/ICU level care. Medications on Admission: -lasix 20mg po daily -protonix 40mg po daily -ipratropium 2puffs ih [**Hospital1 **] -lisinopril 15mg po daily -atorvastatin 10mg po daily -metoprolol 12.5mg po daily -ASA 325mg po daily -FeSO4 325mg po daily -MVI -aldactone 25mg po daily -synthroid 125mcg po daily -trazodone 50mg po daily -remeron 30mg po daily -seroquel 30mg po daily -colace 100mg po bid -senna 2 tabs po bid Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Levothyroxine Sodium 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 6. Cefpodoxime Proxetil 200 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 7 days. 7. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Trazodone HCl 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. 10. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 11. Quetiapine Fumarate 25 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 12. Ipratropium Bromide 0.06 % Aerosol, Spray Sig: Two (2) puffs Nasal twice a day. 13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 15. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 16. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 17. Haloperidol 2 mg Tablet Sig: 1.5-2.5 Tablets PO HS (at bedtime) as needed for agitation. 18. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: congestive heart failure, UTI, anemia Discharge Condition: stable Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: 2 liters Take all medications as prescribed. Call your doctor if you have any chest pain or have increasing shortness of breath. If you become light-headed or dizzy, call your doctor. Followup Instructions: Patient has appointment with Dr. [**Last Name (STitle) **] at 12:30 on Thursday, [**1-29**]. Provider: [**Name10 (NameIs) 7476**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7476**] AND [**Doctor Last Name 9613**] Where: [**Doctor Last Name 7476**] AND [**Doctor Last Name 9613**] Date/Time:[**2122-1-29**] 12:30 [**Telephone/Fax (1) 7477**]

428,599,425,427,401,244,272,285,414,V458

{'Systolic heart failure, unspecified,Urinary tract infection, site not specified,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,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: Hypotension. PRESENT ILLNESS: The pt. is a 85 year-old male with multiple medical problems who was found unresponsive at his [**Hospital3 **] facility. Per notes, the pt. was found lying on the floor by his neighbor the morning of admission. He was noted to be cyanotic and his blood pressure was noted to be 80/40. MEDICAL HISTORY: 1) Congestive heart failure, EF 35% 2) CAD s/p 4 vessel CABG 3) Atrial fibrillation. 4) Aortic stenosis 5) Hypertension. 6) Hypercholesterolemia. 7)History of cerebral vascular accident, s/p bilateral CEA 10) History of upper gastrointestinal bleed s/p EGD [**2121-6-10**] showing gastritis 11) Cecal adenoma x2 [**29**]) S/P laproscopic right hemicolectomy [**2121-7-16**] 13) Diverticulosis 14) S/P cholecystectomy [**32**]) Prostate cancer, s/p XRT 16) Hypothyroidism. 17) S/P L THR 18) Mitral regurgitation MEDICATION ON ADMISSION: -lasix 20mg po daily -protonix 40mg po daily -ipratropium 2puffs ih [**Hospital1 **] -lisinopril 15mg po daily -atorvastatin 10mg po daily -metoprolol 12.5mg po daily -ASA 325mg po daily -FeSO4 325mg po daily -MVI -aldactone 25mg po daily -synthroid 125mcg po daily -trazodone 50mg po daily -remeron 30mg po daily -seroquel 30mg po daily -colace 100mg po bid -senna 2 tabs po bid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 100.4F P: 110 R: 28 BP: 119/69 SaO2: 100% on 3L O2 via NC General: Elderly male, awake, alert, NAD HEENT: PERRL, + cataract of L eye, EOMI, sclerae anicteric, dry MM, clear OP Neck: supple, JVD to 10cm Pulm: bibasilar rales 1/3 up lung fields Cardiac: tachycardic, irregularly irregular rhythm, S1S2, III/VI SEM at LSB Abdomen: +fluid wave, soft, NT/ND, active BS Extremities: 1+ bilateral LE pitting edema, 2+ DP pulses bilaterally Neurologic: Alert and oriented x 3. Moving all four extremities. Uncooperative with the remainder of exam. Skin: no rashes noted. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The pt. lives in an assisted-living facility. He is widowed and has a daughter who lives in the area. He denied use of tobacco or alcohol. ### Response: {'Systolic heart failure, unspecified,Urinary tract infection, site not specified,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}

CHIEF COMPLAINT: Vomiting PRESENT ILLNESS: HPI: 63 yo W with PMH of ETOH cirrhosis, breast CA s/p lumpectomy and XRT, presents with nausea and vomiting. Had been in her USOH over the last week. She was very busy with errands for the week and started to feel run down. She notes she felt worsening stress and had 2 vodka tonics on Friday and Saturday. On Sunday she began to feel unwell at Supermarket. She drank some OJ and returned home at which time she vomited. She continued to vomit and presented to the ED. She otherwise denied abdominal pain, diarrhea, fevers, chills, SOB or chest pain. She does have chronic cough since [**Month (only) 958**] that pt attributes to recent diagnosis of GERD. In the ED, VS: 98.6 126 160/87 16 93RA. Pt given IVF and Zofran. Guaiac negative. On CIWA and received 2 doses of valium and 5L of fluid including 1 banana bag and D51/2NS. EKG wnl. Labs were notable for pH of 7.18/33/99, lactate 6.5 improved to 5.1 after fluid administration. Patient was transferred to the ICU for further management. MEDICAL HISTORY: Breast cancer s/p lumpectomy and XRT completing [**2151-12-21**], 4000cGy total dose EtOH cirrhosis Hypokalemia History acute hepatitis History salmonella BCC and AK s/p cryosurgery Depression Migraine headaches Alcohol use PNA x 2 in [**2150**] h/o Hepatitis A MEDICATION ON ADMISSION: Aromasin 25mg daily (started [**2152-1-25**]) Thiamine 100 mg daily Vitamin b12 [**2142**] mcg daily Potassium Cl 20 mEq daily Folic acid 1 mg daily Multivitamin daily ALLERGIES: Prochlorperazine / Levaquin / Iodine; Iodine Containing PHYSICAL EXAM: ICU VS: T97.9 137/53 108 95%RA GEN: Elderly female appearing older than stated age and ill HEENT: EOMI, PERRL, anicteric NECK: Supple no [**Doctor First Name **] CHEST: CTABL no w/r/r CV: Tachycardic, RR, ii/vi systolic murmur at LUSB, nonradiating FAMILY HISTORY: Mother died of lung cancer. 2 brothers died of lung cancer. Father died with CAD, colon cancer. 1 sister with breast cancer, osteoarthritis. 2 paternal aunts with breast cancer. No hx of liver disease. SOCIAL HISTORY: Lives alone and not currently working. She previously worked as director of publications for a museum. She has never married and has no kids. She has no family in the area. She is a life-long non-smoker but endorses former heavy EtOH user. Her EtOH intake is now markedly decreased but not abstinent. She has about 2 drinks, 2x weekly.

Acidosis,Intestinal infection due to other organism, not elsewhere classified,Esophageal reflux,Alcoholic cirrhosis of liver,Personal history of malignant neoplasm of breast

Acidosis,Viral enteritis NOS,Esophageal reflux,Alcohol cirrhosis liver,Hx of breast malignancy

Admission Date: [**2152-8-28**] Discharge Date: [**2152-8-30**] Date of Birth: [**2088-12-23**] Sex: F Service: MEDICINE Allergies: Prochlorperazine / Levaquin / Iodine; Iodine Containing Attending:[**First Name3 (LF) 800**] Chief Complaint: Vomiting Major Surgical or Invasive Procedure: None History of Present Illness: HPI: 63 yo W with PMH of ETOH cirrhosis, breast CA s/p lumpectomy and XRT, presents with nausea and vomiting. Had been in her USOH over the last week. She was very busy with errands for the week and started to feel run down. She notes she felt worsening stress and had 2 vodka tonics on Friday and Saturday. On Sunday she began to feel unwell at Supermarket. She drank some OJ and returned home at which time she vomited. She continued to vomit and presented to the ED. She otherwise denied abdominal pain, diarrhea, fevers, chills, SOB or chest pain. She does have chronic cough since [**Month (only) 958**] that pt attributes to recent diagnosis of GERD. In the ED, VS: 98.6 126 160/87 16 93RA. Pt given IVF and Zofran. Guaiac negative. On CIWA and received 2 doses of valium and 5L of fluid including 1 banana bag and D51/2NS. EKG wnl. Labs were notable for pH of 7.18/33/99, lactate 6.5 improved to 5.1 after fluid administration. Patient was transferred to the ICU for further management. ROS: Otherwise negative Past Medical History: Breast cancer s/p lumpectomy and XRT completing [**2151-12-21**], 4000cGy total dose EtOH cirrhosis Hypokalemia History acute hepatitis History salmonella BCC and AK s/p cryosurgery Depression Migraine headaches Alcohol use PNA x 2 in [**2150**] h/o Hepatitis A Social History: Lives alone and not currently working. She previously worked as director of publications for a museum. She has never married and has no kids. She has no family in the area. She is a life-long non-smoker but endorses former heavy EtOH user. Her EtOH intake is now markedly decreased but not abstinent. She has about 2 drinks, 2x weekly. Family History: Mother died of lung cancer. 2 brothers died of lung cancer. Father died with CAD, colon cancer. 1 sister with breast cancer, osteoarthritis. 2 paternal aunts with breast cancer. No hx of liver disease. Physical Exam: ICU VS: T97.9 137/53 108 95%RA GEN: Elderly female appearing older than stated age and ill HEENT: EOMI, PERRL, anicteric NECK: Supple no [**Doctor First Name **] CHEST: CTABL no w/r/r CV: Tachycardic, RR, ii/vi systolic murmur at LUSB, nonradiating ABD: Soft, obese, NT, hyperactive BS EXT: no c/c/e SKIN: No rashes or ecchymoses NEURO: AAOX3, CN ii-xii intact, no focal deficits, answers questions appropriately Floor VS: T: 100.4 BP: 135/77 HR: 99 R: 18 O2sat: 98%RA GEN: NAD, pleasant HEENT: EOMI, PERRL, anicteric NECK: Supple no [**Doctor First Name **] CHEST: CTAB L no w/r/r CV: Tachycardic, RR, ii/vi systolic murmur at LUSB, nonradiating ABD: Soft, obese, NT, hyperactive BS, no rebound tenderness, no hepatosplenomegaly. EXT: no c/c/e SKIN: No rashes or ecchymoses NEURO: AOX3, CN II-XII intact, No focal deficits, Normal sensation to light touch in upper/lower extremity. , answers questions appropriately Pertinent Results: Labs: [**8-27**]: WBC-9.1# RBC-3.64* Hgb-11.0* Hct-35.6* MCV-98# MCH-30.1 MCHC-30.8* [**8-30**]: WBC-3.4* RBC-3.77* Hgb-11.7* Hct-34.5* MCV-92 MCH-31.1 MCHC-34.0 RDW-16.7* Plt Ct-87* [**8-27**]: Glucose-121* UreaN-27* Creat-0.8 Na-147* K-3.8 Cl-103 HCO3-10* AnGap-38* [**8-30**]: Glucose-119* UreaN-11 Creat-0.5 Na-139 K-3.5 Cl-101 HCO3-28 AnGap-14 [**8-27**]: ALT-22 AST-36 AlkPhos-71 TotBili-1.2 [**8-27**]: ASA-NEG Ethanol-118* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**8-28**]: Lactate-6.5* [**8-28**]: Lactate-2.6* Studies: CHEST, TWO VIEWS: Heart size is top normal. The aorta is again tortuous. There is no focal consolidation, pleural effusion or pneumothorax. Linear atelectasis at the left base is again seen. There is mild elevation of the right hemidiaphragm. No free air. There are spinal degenerative changes. IMPRESSION: No radiographic evidence for pneumonia. No free air. KUB IMPRESSION: Probably nonobstructed bowel gas [**Doctor Last Name 5926**] with curvilinear structure in the left upper abdomen likely gastric antrum. (CXR demonstrates no free air.) Microbiology: Blood Cultures: NGTD ([**8-30**]) CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2152-8-30**]): Feces negative for C.difficile toxin A & B by EIA. (Reference Range-Negative). Brief Hospital Course: A/P: 63 yo W with PMH of breast ca, ETOH cirrhosis presents with nausea/vomiting and mixed anion gap acidosis. . AG metabolic acidosis: Pt taking poor PO with significant emesis. Lactate elevated to 6.5. Also with positive ketones in urine. Serum osms elevated, but osmolar gap -1. Elevated serum glucose 287 and glucosuria likely secondary to D5 received in ED which was running at fast rate. Most probable diagnosis is mixed lactic and starvation/alcoholic ketoacidosis. Had diarrhea on second day, raising concern for gastroenteritis. Pt improved with IVFs. Lactate trended down to 2.5. Started on clear diet and advancing as tolerated. On the floor patient's diet continued to be advanced. Electrolytes were repleted and anion gap acidosis resolved. Pt had no other episodes nausea, vomiting, and diarrhea. Hypernatremia: Sodium on presentation elevated to 147. Likely secondary to dehydration from poor PO intake. Free water deficit was 1.7L. Improved after IVFs. . ETOH: Level 115. Admits to drinks on Saturday and Sunday. Does not drink daily. Has no hx of withdrawal or seizures per pt. Monitored on CIWA though denied daily drinking history. Did not require any valium in the unit. On the floor pt was continued on the CIWA scale and did not require any valium. Pt meet with social work and they gave pt contact information of programs if she feels like they are needed at anytime. . GERD: Patient noted dry cough over the past few weeks. Pt started on PPI during admission. Pt will follow up with PCP in regards to cough and determine in PPI has resolved cough. Breast CA: On aromatase inhibitor. This was held during admission. Restarted on discharge. Medications on Admission: Aromasin 25mg daily (started [**2152-1-25**]) Thiamine 100 mg daily Vitamin b12 [**2142**] mcg daily Potassium Cl 20 mEq daily Folic acid 1 mg daily Multivitamin daily Discharge Medications: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 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. Aromasin 25 mg Tablet Sig: One (1) Tablet PO once a day. 6. Vitamin B-12 2,000 mcg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day. 8. Multivitamin Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary: Viral Gastroenteritis Discharge Condition: stable. afebrile. sating 99% on room air. Discharge Instructions: You were admitted to the hospital after you experienced multiple days of nausea and vomiting with decreased food and fluid intake. On admission you were found to have major electrolyte abnormalities. You went to the ICU were your electrolytes were replaced and you were given intravenous fluids. After you left the ICU you continued to be monitored on a general medicine floor and had no problems. The following changes were made to your medicine regimen. - Start taking pantoprazole 40mg Daily Only drink one alcoholic beverage a day. Be sure to eat three meals a day and drink plenty of fluid. Please return to the ED if you develop chest pain, shortness of breath, recurrent nausea, vomiting, dizziness, or fever. Followup Instructions: Please follow up with your PCP: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**], [**Telephone/Fax (1) 2205**], on [**2153-9-4**]:00am. During this visit you should have blood work to check your electrolytes. . Please follow up in regards to the following: - Electrolyte levels - FU in regards to your recent nausea and vomiting. Other appointments: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4286**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2152-10-24**] 2:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2152-11-24**] 9:20 Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2153-5-18**] 9:55 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]

276,008,530,571,V103

{'Acidosis,Intestinal infection due to other organism, not elsewhere classified,Esophageal reflux,Alcoholic cirrhosis of liver,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: Vomiting PRESENT ILLNESS: HPI: 63 yo W with PMH of ETOH cirrhosis, breast CA s/p lumpectomy and XRT, presents with nausea and vomiting. Had been in her USOH over the last week. She was very busy with errands for the week and started to feel run down. She notes she felt worsening stress and had 2 vodka tonics on Friday and Saturday. On Sunday she began to feel unwell at Supermarket. She drank some OJ and returned home at which time she vomited. She continued to vomit and presented to the ED. She otherwise denied abdominal pain, diarrhea, fevers, chills, SOB or chest pain. She does have chronic cough since [**Month (only) 958**] that pt attributes to recent diagnosis of GERD. In the ED, VS: 98.6 126 160/87 16 93RA. Pt given IVF and Zofran. Guaiac negative. On CIWA and received 2 doses of valium and 5L of fluid including 1 banana bag and D51/2NS. EKG wnl. Labs were notable for pH of 7.18/33/99, lactate 6.5 improved to 5.1 after fluid administration. Patient was transferred to the ICU for further management. MEDICAL HISTORY: Breast cancer s/p lumpectomy and XRT completing [**2151-12-21**], 4000cGy total dose EtOH cirrhosis Hypokalemia History acute hepatitis History salmonella BCC and AK s/p cryosurgery Depression Migraine headaches Alcohol use PNA x 2 in [**2150**] h/o Hepatitis A MEDICATION ON ADMISSION: Aromasin 25mg daily (started [**2152-1-25**]) Thiamine 100 mg daily Vitamin b12 [**2142**] mcg daily Potassium Cl 20 mEq daily Folic acid 1 mg daily Multivitamin daily ALLERGIES: Prochlorperazine / Levaquin / Iodine; Iodine Containing PHYSICAL EXAM: ICU VS: T97.9 137/53 108 95%RA GEN: Elderly female appearing older than stated age and ill HEENT: EOMI, PERRL, anicteric NECK: Supple no [**Doctor First Name **] CHEST: CTABL no w/r/r CV: Tachycardic, RR, ii/vi systolic murmur at LUSB, nonradiating FAMILY HISTORY: Mother died of lung cancer. 2 brothers died of lung cancer. Father died with CAD, colon cancer. 1 sister with breast cancer, osteoarthritis. 2 paternal aunts with breast cancer. No hx of liver disease. SOCIAL HISTORY: Lives alone and not currently working. She previously worked as director of publications for a museum. She has never married and has no kids. She has no family in the area. She is a life-long non-smoker but endorses former heavy EtOH user. Her EtOH intake is now markedly decreased but not abstinent. She has about 2 drinks, 2x weekly. ### Response: {'Acidosis,Intestinal infection due to other organism, not elsewhere classified,Esophageal reflux,Alcoholic cirrhosis of liver,Personal history of malignant neoplasm of breast'}

CHIEF COMPLAINT: Dyspnea on exertion PRESENT ILLNESS: 58 year old male with extensive past medical history including coronary artery disease, severe cardiomyopathy, congestive heart failure, and severe mitral regurgitaion. He underwent a coronary artery bypass graft x 3 in [**2152-6-24**]. Repeat cardiac cath on [**2152-9-18**] showed elevated right heart pressures, three-vessel coronary disease, and occluded vein graft to obtuse marginal. His other vein grafts were patent. An echo in [**2153-1-29**] showed dilated left ventricle with an EF of 20%, moderate TR, severe MR and right ventricular systolic pressure of 58mmHg. He currently complains of persistent dyspnea on exertion- although this has improved in the past month following a decrease in Carvedilol dose. Presents for surgical evaluation for Redo-sternotomy, MVR +/- TVR. MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft x [**2152-6-26**] Myocardial infarction Congestive heart failure Severe mitral regurgitation Severe cardiomyopathy Dyslipidemia Pulmonary hypertension ? Urethral stricture (difficulty with removal of Foley catheter post CABG) MEDICATION ON ADMISSION: Carvedilol 3.125mg [**Hospital1 **] Lovastatin 10mg daily Aspirin 81mg daily Lisinopril 2.5mg daily Furosemide 40mg daily prn Amitriptyline 10mg daily Magnesium oxide 400 daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 91 Resp: 16 O2 sat: 96% B/P Right: Left: 99/70 Height: 5'9" Weight: 146 lbs FAMILY HISTORY: Family History: non-contributory SOCIAL HISTORY: Lives with: wife Occupation: part-time Tobacco: former smoker (quit >1 yr ago after 1ppd x 40 yrs) ETOH: denies

Mitral valve disorders,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Acute posthemorrhagic anemia,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Urethral stricture, unspecified,Other specified disorders of biliary tract

Mitral valve disorder,Acute respiratry failure,Prim cardiomyopathy NEC,Chr systolic hrt failure,Ac posthemorrhag anemia,Jaundice NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Chr pulmon heart dis NEC,Urethral stricture NOS,Dis of biliary tract NEC

Admission Date: [**2153-8-27**] Discharge Date: [**2153-9-5**] Date of Birth: [**2095-5-31**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2153-8-27**] 1. Mitral valve repair with a 26-mm [**Company 1543**] Profile 3-D ring annuloplasty, serial #[**Serial Number 87447**]. 2. Tricuspid valvuloplasty with a 32-mm [**Doctor Last Name **] MC cubed annuloplasty ring, model #4900, serial #[**Serial Number 87448**]. History of Present Illness: 58 year old male with extensive past medical history including coronary artery disease, severe cardiomyopathy, congestive heart failure, and severe mitral regurgitaion. He underwent a coronary artery bypass graft x 3 in [**2152-6-24**]. Repeat cardiac cath on [**2152-9-18**] showed elevated right heart pressures, three-vessel coronary disease, and occluded vein graft to obtuse marginal. His other vein grafts were patent. An echo in [**2153-1-29**] showed dilated left ventricle with an EF of 20%, moderate TR, severe MR and right ventricular systolic pressure of 58mmHg. He currently complains of persistent dyspnea on exertion- although this has improved in the past month following a decrease in Carvedilol dose. Presents for surgical evaluation for Redo-sternotomy, MVR +/- TVR. Past Medical History: Coronary Artery Disease s/p Coronary Artery Bypass Graft x [**2152-6-26**] Myocardial infarction Congestive heart failure Severe mitral regurgitation Severe cardiomyopathy Dyslipidemia Pulmonary hypertension ? Urethral stricture (difficulty with removal of Foley catheter post CABG) Social History: Lives with: wife Occupation: part-time Tobacco: former smoker (quit >1 yr ago after 1ppd x 40 yrs) ETOH: denies Family History: Family History: non-contributory Physical Exam: Pulse: 91 Resp: 16 O2 sat: 96% B/P Right: Left: 99/70 Height: 5'9" Weight: 146 lbs General: Well-developed male in no acute distress Skin: Dry [X] intact [X] well healed incision of median sternotomy HEENT: PERRLA [X] EOMI [X] Neck: Supple [X] Full ROM [X] Chest: Lungs clear bilaterally [X] Heart: RRR [X] Irregular [] Murmur 2/6 systolic murmur Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds + [X] small umbilical hernia Extremities: Warm [X], well-perfused [X] Edema: - Varicosities: None [X] 2 incisions well-healed on LLE 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 Right: - Left: - Pertinent Results: [**2153-9-4**] 04:15AM BLOOD WBC-8.9 RBC-3.49* Hgb-10.6* Hct-31.8* MCV-91 MCH-30.4 MCHC-33.4 RDW-18.4* Plt Ct-212 [**2153-9-3**] 05:46AM BLOOD WBC-10.0 RBC-3.66* Hgb-11.0* Hct-32.6* MCV-89 MCH-30.1 MCHC-33.7 RDW-18.6* Plt Ct-200 [**2153-9-4**] 04:15AM BLOOD Glucose-117* UreaN-15 Creat-0.8 Na-135 K-4.0 Cl-99 HCO3-30 AnGap-10 [**2153-9-3**] 05:46AM BLOOD Glucose-112* UreaN-19 Creat-0.8 Na-136 K-4.1 Cl-101 HCO3-29 AnGap-10 [**2153-9-1**] 03:37AM BLOOD ALT-21 AST-55* LD(LDH)-276* AlkPhos-150* TotBili-17.2* DirBili-13.2* IndBili-4.0 [**2153-9-2**] 04:28AM BLOOD ALT-17 AST-40 LD(LDH)-242 AlkPhos-191* TotBili-13.2* [**2153-9-3**] 05:46AM BLOOD TotBili-10.1* Intra-Op TEE [**2153-8-27**] Pre-CPB: No spontaneous echo contrast is seen in the left atrial appendage. The left ventricular cavity is severely dilated. Overall left ventricular systolic function is severely depressed (LVEF= 15 - 20 %). with severe global free wall hypokinesis. The ascending, transverse and descending thoracic aorta are normal in diameter. There is grade 1 atheroma of the descending aorta.. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are mildly thickened. Severe (4+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is no pericardial effusion. Post-CPB: The patient is AV-Paced, on high dose epi, norepi and milrinone. Severe RV and moderate LV systolic dysfxn. There are ring annuloplasties of the MV and TV with no leak or regurgitation. Peak mitral gradient is 12, peak tricuspid gradient is 3 mmHg. Aorta intact. Echo [**2153-9-3**] Conclusions The left atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. There is severe regional left ventricular systolic dysfunction with only the anterolateral wall having relatively normal function. All the other segments are akinetic. There is an anteroapical left ventricular aneurysm. Diastolic function could not be assessed. There is no ventricular septal defect. The right ventricular cavity is dilated with moderate global free wall hypokinesis. There is abnormal septal motion/position. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. A mitral valve annuloplasty ring is present. Mild (1+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The tricuspid valve leaflets are mildly thickened. A tricuspid valve annuloplasty ring is present. [Due to acoustic shadowing, the severity of tricuspid regurgitation may be significantly UNDERestimated.] There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Moderately dilated LV with severe systolic dysfunction. Dilated and hypokinetic right ventricle with evidence of pressure/volume overload. Mitral and annuloplasty rings in position with mild regurgitation. Compared with the prior study (images reviewed) of [**2153-8-28**], the right ventricle is more dilated on the current study (was described as normal in size on prior but was probably mildly dilated then). The other findings are similar. Brief Hospital Course: The patient was brought to the operating room on [**2153-8-27**] where the patient underwent redo sternotomy, MVrepair (26mm [**Company 1543**] Profile 3D Ring), and TV repair (32mm [**Doctor Last Name **] MC3 Ring). Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU on epinephrine, milrinone, and levophed drips, as well as nitric oxide. He was in critical but stable condition. Cefazolin was used for surgical antibiotic prophylaxis. He did require escalating inotropic support and nitric oxide overnight as PA pressures remained elevated. Dr. [**First Name (STitle) 437**] was consulted from the heart failure service. Inotropic and vasopressor support was weaned over the following days. PICC was placed for access on [**2153-8-31**]. Hepatology was consulted for hyperbilirubinemia, which was believed to be a result of hepatic congestion. Total bili peaked at 17.2mg/dL, then would trend down. RUQ ultrasound revealed gall bladder sludge without cholecystitis. The patient was weaned from the ventilator and extubated on POD 4. Coreg 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. [**2153-9-4**] By the time of discharge on POD **** the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged ***** in good condition with appropriate follow up instructions. Medications on Admission: Carvedilol 3.125mg [**Hospital1 **] Lovastatin 10mg daily Aspirin 81mg daily Lisinopril 2.5mg daily Furosemide 40mg daily prn Amitriptyline 10mg daily Magnesium oxide 400 daily Discharge Disposition: Home With Service Facility: [**Hospital1 1376**] cape Discharge Diagnosis: Mitral Regurgitation Tricuspid Regurgitation Chronic Systolic Heart Failure s/p CABG [**2152-6-24**] PMH: Coronary Artery Disease s/p Coronary Artery Bypass Graft x [**2152-6-26**] Myocardial infarction Congestive heart failure Severe mitral regurgitation Severe cardiomyopathy Dyslipidemia Pulmonary hypertension ? Urethral stricture (difficulty with removal of Foley catheter post CABG) Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage 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 and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: Dr. [**First Name4 (NamePattern1) 518**] [**Last Name (NamePattern1) 58124**]: [**2153-10-5**] at 9:30am Provider: [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2153-9-25**] 2:00 Please call to schedule the following: Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] L. [**Telephone/Fax (1) 40732**] in [**2-26**] weeks Completed by:[**2153-9-5**]

424,518,425,428,285,782,414,V458,416,598,576

{'Mitral valve disorders,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Acute posthemorrhagic anemia,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Urethral stricture, unspecified,Other specified disorders of biliary 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: Dyspnea on exertion PRESENT ILLNESS: 58 year old male with extensive past medical history including coronary artery disease, severe cardiomyopathy, congestive heart failure, and severe mitral regurgitaion. He underwent a coronary artery bypass graft x 3 in [**2152-6-24**]. Repeat cardiac cath on [**2152-9-18**] showed elevated right heart pressures, three-vessel coronary disease, and occluded vein graft to obtuse marginal. His other vein grafts were patent. An echo in [**2153-1-29**] showed dilated left ventricle with an EF of 20%, moderate TR, severe MR and right ventricular systolic pressure of 58mmHg. He currently complains of persistent dyspnea on exertion- although this has improved in the past month following a decrease in Carvedilol dose. Presents for surgical evaluation for Redo-sternotomy, MVR +/- TVR. MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft x [**2152-6-26**] Myocardial infarction Congestive heart failure Severe mitral regurgitation Severe cardiomyopathy Dyslipidemia Pulmonary hypertension ? Urethral stricture (difficulty with removal of Foley catheter post CABG) MEDICATION ON ADMISSION: Carvedilol 3.125mg [**Hospital1 **] Lovastatin 10mg daily Aspirin 81mg daily Lisinopril 2.5mg daily Furosemide 40mg daily prn Amitriptyline 10mg daily Magnesium oxide 400 daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 91 Resp: 16 O2 sat: 96% B/P Right: Left: 99/70 Height: 5'9" Weight: 146 lbs FAMILY HISTORY: Family History: non-contributory SOCIAL HISTORY: Lives with: wife Occupation: part-time Tobacco: former smoker (quit >1 yr ago after 1ppd x 40 yrs) ETOH: denies ### Response: {'Mitral valve disorders,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Acute posthemorrhagic anemia,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Urethral stricture, unspecified,Other specified disorders of biliary tract'}

CHIEF COMPLAINT: SOB and Fever PRESENT ILLNESS: 61yo M with COPD on home O2, Type II DM, and obesity who presents with acute onset of SOB. The pt reports he was in his USOH until this AM when he awoke with a [**First Name3 (LF) **]. The [**First Name3 (LF) **] is non-productive but pt believes there is sputum "deep down". Since this AM, the pt has not been able to "catch his breath". He has not appreciated on any wheezing himself but tried his PRN medications without success. In addition, the pt also reports subjective fevers with chills as well. The pt denies any cp, palpitations, LE edema, PND, orthopnea (one pillow), he also denies any abd pain, n/v/d. He reports he has received his flu vaccine this year. MEDICAL HISTORY: 1. COPD- on home O2 (3L), FEV 590, FEV1 20% predicted, FEV1/FVC MEDICATION ON ADMISSION: 1. Prednisone 10mg QOD 2. Combivent 2 puffs [**Hospital1 **] 3. Advair [**Hospital1 **] 4. Albuterol PRN 5. Metformin 1000mg [**Hospital1 **] 6. Glyburide 5mg QOD 7. Aspirin 325mg once daily 8. Lisinopril 20mg once daily 9. Furosemide 20mg once daily 10. Ferrous Sulfate 325mg once daily 11. Docusate TID and Senna 12. Protonix 40mg [**Hospital1 **] 13. Mag Oxide 400mg once daily 14. Ranitidine 300mg once daily 15. Ibuprofen 600mg TID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: T: 101, HR: 80, BP: 139/56, RR: 23, SaO2: 95% 3L GEN: obese caucasian male in NAD, conversing fluently in full sentences. HEENT: EOMI, anicteric, mmm CV: distant heart sounds, RRR, S1, S2, no m/r/g Chest: diffuse wheezing throughout, poor air movement ABD: obese, soft, NT, ND, BS+ Ext: wwp, no c/c/e FAMILY HISTORY: Father, mother died of lung cancer in their 60's. SOCIAL HISTORY: Pt is married and lives with wife and 3 children. He is currently umemployed- former restaurant manager Tob: smokes 6 cig 2-3x/week. He used to smoke [**4-17**] ppd for 40+ years but has been cutting back recently. EtOH: last drink was last X-mas.

Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Chronic systolic heart failure,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Influenza with other respiratory manifestations,Anemia, unspecified,Other B-complex deficiencies,Esophageal reflux,Tobacco use disorder,Obesity, unspecified

Obs chr bronc w(ac) exac,Acute respiratry failure,Chr systolic hrt failure,Acidosis,DMII wo cmp uncntrld,Flu w resp manifest NEC,Anemia NOS,B-complex defic NEC,Esophageal reflux,Tobacco use disorder,Obesity NOS

Admission Date: [**2117-5-2**] Discharge Date: [**2117-5-13**] Date of Birth: [**2056-4-16**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 613**] Chief Complaint: SOB and Fever Major Surgical or Invasive Procedure: Intubation History of Present Illness: 61yo M with COPD on home O2, Type II DM, and obesity who presents with acute onset of SOB. The pt reports he was in his USOH until this AM when he awoke with a [**First Name3 (LF) **]. The [**First Name3 (LF) **] is non-productive but pt believes there is sputum "deep down". Since this AM, the pt has not been able to "catch his breath". He has not appreciated on any wheezing himself but tried his PRN medications without success. In addition, the pt also reports subjective fevers with chills as well. The pt denies any cp, palpitations, LE edema, PND, orthopnea (one pillow), he also denies any abd pain, n/v/d. He reports he has received his flu vaccine this year. In the ED, the pt was found to be febrile to 101, tachycardic and hypertensive. His physical exam was significant for diffuse wheezing throughout the lung fields. He was given Ceftriaxone and Azithromycin as well as Solumedrol and combivent nebulizers with some improvement in his SOB. Past Medical History: 1. COPD- on home O2 (3L), FEV 590, FEV1 20% predicted, FEV1/FVC ratio 38% predicted, multiple previous intubations. followed by Pulm 2. Tobacco Abuse 3. DM II 4. Diverticulosis 5. h/o SBO 6. C6-C7 HERNITATION 7. B12 Deficiency- on monthly injections 8. Obesity Social History: Pt is married and lives with wife and 3 children. He is currently umemployed- former restaurant manager Tob: smokes 6 cig 2-3x/week. He used to smoke [**4-17**] ppd for 40+ years but has been cutting back recently. EtOH: last drink was last X-mas. Family History: Father, mother died of lung cancer in their 60's. Physical Exam: PHYSICAL EXAMINATION: VS: T: 101, HR: 80, BP: 139/56, RR: 23, SaO2: 95% 3L GEN: obese caucasian male in NAD, conversing fluently in full sentences. HEENT: EOMI, anicteric, mmm CV: distant heart sounds, RRR, S1, S2, no m/r/g Chest: diffuse wheezing throughout, poor air movement ABD: obese, soft, NT, ND, BS+ Ext: wwp, no c/c/e Pertinent Results: LLE US: IMPRESSION: No evidence of left lower extremity deep venous thrombus. Spirometry [**4-22**]: Actual Pred %Pred FVC 1.77 4.11 43 FEV1 0.52 2.92 18 MMF 0.20 2.90 7 FEV1/FVC 29 71 41 [**2117-5-13**] 07:10AM BLOOD WBC-11.1* RBC-4.34* Hgb-12.5* Hct-38.7* MCV-89 MCH-28.9 MCHC-32.4 RDW-14.0 Plt Ct-222 [**2117-5-2**] 05:45PM BLOOD WBC-9.4 RBC-4.41* Hgb-13.2* Hct-39.6* MCV-90 MCH-29.9 MCHC-33.3 RDW-13.9 Plt Ct-166 [**2117-5-6**] 08:14PM BLOOD Neuts-85.5* Lymphs-7.2* Monos-6.3 Eos-0.9 Baso-0.2 [**2117-5-13**] 07:10AM BLOOD Plt Ct-222 [**2117-5-11**] 03:00AM BLOOD PT-12.5 PTT-28.3 INR(PT)-1.1 [**2117-5-13**] 07:10AM BLOOD Glucose-147* UreaN-23* Creat-0.7 Na-139 K-4.4 Cl-98 HCO3-35* AnGap-10 [**2117-5-2**] 05:45PM BLOOD Glucose-147* UreaN-19 Creat-0.8 Na-146* K-4.1 Cl-103 HCO3-34* AnGap-13 [**2117-5-7**] 04:50AM BLOOD CK(CPK)-108 [**2117-5-6**] 08:14PM BLOOD CK(CPK)-101 [**2117-5-7**] 04:50AM BLOOD CK-MB-3 cTropnT-<0.01 [**2117-5-6**] 08:14PM BLOOD CK-MB-4 cTropnT-<0.01 [**2117-5-13**] 07:10AM BLOOD Calcium-9.3 Phos-2.3* Mg-1.8 [**2117-5-10**] 06:17AM BLOOD Type-ART Temp-36.2 pO2-96 pCO2-75* pH-7.36 calHCO3-44* Base XS-13 [**2117-5-6**] 12:02PM BLOOD Type-ART FiO2-91 pO2-82* pCO2-94* pH-7.22* calHCO3-41* Base XS-6 AADO2-487 REQ O2-81 Brief Hospital Course: 61yo M with COPD on home oxygen (3L) and DM p/w progressive SOB and fevers. Pt had episode of desat to 60's 2 days ago, treated with nebs, solumedrol, and 100% NRB. O2 sat then recovered to >90% on 3L. Pt now with increasing oxygen requirement, although he "feels about the same." Very poor air movement and wheezy on exam. . #) COPD exacerbation: In the ED, the pt was found to be febrile to 101, tachycardic and hypertensive. His physical exam was significant for diffuse wheezing throughout the lung fields. He was given Ceftriaxone and Azithromycin as well as Solumedrol and combivent nebulizers with some improvement in his SOB. Admitted to the floor until [**5-6**], when he desaturated and had ABG of 7.22/94/82. Pt was mentating and plyaing solitaire. Given two nebs with some improvement in exam. Over the next 15 mins, he became more somnolent, refused noninvasive ventialtion. A code blue was called for intubation. . Admitted to the ICU for hypercarbic resp failure. His influenza A DFA returned positive and was started on tamiflu. His IUC course was signficant for IV solumedrol, antibiotics (7 days azithromycin) and positive pressure ventilation. He was extubated [**5-10**] without complication, when his azithro stopped also. Finished day #[**6-18**] of tamiflu. Was on 6 days of IV solumedrol, now on oral prednisone. In ICU, he did not require his baseline ACE while on the vent, now needs BP meds. Will send patient to rehab on the following oral prednisone taper: 60mg X 7 days, 40 mg X 7 days, 30mg X 7 days, 20mg X 7 days, 10mg X 7 days, then 10mg every other day thereafter. Will continue nebs. Smoking cessation. Low carbohydrate diet, if possible. Pt will follow up with Dr.[**Last Name (STitle) **] as an outpt. . #) DM: cont. outpt regimen of Metformin 1000mg [**Hospital1 **]. Pt says he does not take glyburide [**3-18**] hypoglycemia. Pt has had elevated FS, likely secondary to steroids. He never had any episodes of hypoglycemia, DKA or NK hyperglycemia. Will send to rehab with metformin 1000mg [**Hospital1 **] and ISS. . #) CV: A. CAD: The pt has multiple risk factors for CAD including age, sex, tob, HTN and DM. However, his mortality is limited by critical COPD, not coronary disease. Will continue ASA. ACE inhibition will protect his kidneys from diabetic nephropathy. No beta-blocker. . #) Anemia: Hct stable. the pt is on Ferrous Sulfate 325mg once daily and IV Vit B 12 injections. Continue outpt ferrous sulfate. Medications on Admission: 1. Prednisone 10mg QOD 2. Combivent 2 puffs [**Hospital1 **] 3. Advair [**Hospital1 **] 4. Albuterol PRN 5. Metformin 1000mg [**Hospital1 **] 6. Glyburide 5mg QOD 7. Aspirin 325mg once daily 8. Lisinopril 20mg once daily 9. Furosemide 20mg once daily 10. Ferrous Sulfate 325mg once daily 11. Docusate TID and Senna 12. Protonix 40mg [**Hospital1 **] 13. Mag Oxide 400mg once daily 14. Ranitidine 300mg once daily 15. Ibuprofen 600mg TID Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Upper respiratory infections COPD Secondary: Type II diabetes mellitus obesity viamin B12 deficiency Discharge Condition: Patient had a [**Location (un) **], but O2 sat was >93% on baseline 3LNC and felt better. Discharge Instructions: You may return home. Please continue your previous medications, and take prednisone in a tapering fashion as outlined below. If you have recurrent problems breathing, [**Name2 (NI) **], shortness of breath, or other concerns, please call your PCP or return to the ED. Followup Instructions: Dr[**Doctor Last Name **] office will call you with an appointment. If they do not call your house by [**2117-5-20**], call them at ([**Telephone/Fax (1) 513**]. Please follow up with: Provider: [**First Name8 (NamePattern2) 1409**] [**Last Name (NamePattern1) **], NP Date/Time:[**2117-5-17**] 2:20 as scheduled. You also have these follow up appointments previously scheduled: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2117-6-10**] 11:20 Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2117-8-16**] 11:40 [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**] Completed by:[**2117-5-13**]

491,518,428,276,250,487,285,266,530,305,278

{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Chronic systolic heart failure,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Influenza with other respiratory manifestations,Anemia, unspecified,Other B-complex deficiencies,Esophageal reflux,Tobacco use disorder,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: SOB and Fever PRESENT ILLNESS: 61yo M with COPD on home O2, Type II DM, and obesity who presents with acute onset of SOB. The pt reports he was in his USOH until this AM when he awoke with a [**First Name3 (LF) **]. The [**First Name3 (LF) **] is non-productive but pt believes there is sputum "deep down". Since this AM, the pt has not been able to "catch his breath". He has not appreciated on any wheezing himself but tried his PRN medications without success. In addition, the pt also reports subjective fevers with chills as well. The pt denies any cp, palpitations, LE edema, PND, orthopnea (one pillow), he also denies any abd pain, n/v/d. He reports he has received his flu vaccine this year. MEDICAL HISTORY: 1. COPD- on home O2 (3L), FEV 590, FEV1 20% predicted, FEV1/FVC MEDICATION ON ADMISSION: 1. Prednisone 10mg QOD 2. Combivent 2 puffs [**Hospital1 **] 3. Advair [**Hospital1 **] 4. Albuterol PRN 5. Metformin 1000mg [**Hospital1 **] 6. Glyburide 5mg QOD 7. Aspirin 325mg once daily 8. Lisinopril 20mg once daily 9. Furosemide 20mg once daily 10. Ferrous Sulfate 325mg once daily 11. Docusate TID and Senna 12. Protonix 40mg [**Hospital1 **] 13. Mag Oxide 400mg once daily 14. Ranitidine 300mg once daily 15. Ibuprofen 600mg TID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: T: 101, HR: 80, BP: 139/56, RR: 23, SaO2: 95% 3L GEN: obese caucasian male in NAD, conversing fluently in full sentences. HEENT: EOMI, anicteric, mmm CV: distant heart sounds, RRR, S1, S2, no m/r/g Chest: diffuse wheezing throughout, poor air movement ABD: obese, soft, NT, ND, BS+ Ext: wwp, no c/c/e FAMILY HISTORY: Father, mother died of lung cancer in their 60's. SOCIAL HISTORY: Pt is married and lives with wife and 3 children. He is currently umemployed- former restaurant manager Tob: smokes 6 cig 2-3x/week. He used to smoke [**4-17**] ppd for 40+ years but has been cutting back recently. EtOH: last drink was last X-mas. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Chronic systolic heart failure,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Influenza with other respiratory manifestations,Anemia, unspecified,Other B-complex deficiencies,Esophageal reflux,Tobacco use disorder,Obesity, unspecified'}

CHIEF COMPLAINT: Pedestrian struck by car. PRESENT ILLNESS: Ms [**Known lastname 26438**] is a 28 y/o woman who was a pedestrian struck by an automobile. She was seen at [**Hospital 1474**] Hospital, stabalized, and transferred to [**Hospital1 18**]. On presentation at [**Hospital1 1474**], she was c/o left leg pain. Per report the car was travelling at 30 mph and clipped her in the leg. ? LOC. She apparently admitted to the use of crack cocaine prior to the accident. She was intubated at [**Hospital 1474**] Hospital for agitation and failure to follow commands. MEDICAL HISTORY: 1) s/p pituitary adenoma resection w/ resulting panhypopituitarism, on hydrocortisone, levothyroxin and DDAVP at home. 2) s/p colon resection as a child 3) hx of crack cocaine abuse MEDICATION ON ADMISSION: Cortef 15mg AM/5mg PM, levoxyl 150 mcg', DDAVP 0.2tid. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission in the ED: Afebrile, HR 150, BP 122/63, RR 22, SPO2 97% RA. GCS 12, in c-collar. Cor reg Chest CTA, equal BS. Abd soft, NT, vertical surgical scar, well healed. Foley in place. Ext warm, palp DP/PT bil. L leg splint. LLE: SILT @ DP/SP, warm toes, + [**Last Name (un) 938**]/FHL. Spine non-tender, no abrasions, no step-offs FAMILY HISTORY: N/C. SOCIAL HISTORY: + crack cocaine, + tobacco, + EtOH.

Closed fracture of upper end of fibula with tibia,Diabetes insipidus,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Other specified acquired hypothyroidism,Personal history of noncompliance with medical treatment, presenting hazards to health,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anxiety state, unspecified,Other and unspecified special symptoms or syndromes, not elsewhere classified

Fx up tibia w fibula-cl,Diabetes insipidus,Cocaine abuse-unspec,Urin tract infection NOS,Acquired hypothyroid NEC,Hx of past noncompliance,Mv coll w pedest-pedest,Other alter consciousnes,Oth gram negatv bacteria,Anxiety state NOS,Special symptom NEC/NOS

Admission Date: [**2127-4-13**] Discharge Date: [**2127-4-30**] Date of Birth: [**2098-12-4**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1556**] Chief Complaint: Pedestrian struck by car. Major Surgical or Invasive Procedure: s/p IM nail L tibia History of Present Illness: Ms [**Known lastname 26438**] is a 28 y/o woman who was a pedestrian struck by an automobile. She was seen at [**Hospital 1474**] Hospital, stabalized, and transferred to [**Hospital1 18**]. On presentation at [**Hospital1 1474**], she was c/o left leg pain. Per report the car was travelling at 30 mph and clipped her in the leg. ? LOC. She apparently admitted to the use of crack cocaine prior to the accident. She was intubated at [**Hospital 1474**] Hospital for agitation and failure to follow commands. Past Medical History: 1) s/p pituitary adenoma resection w/ resulting panhypopituitarism, on hydrocortisone, levothyroxin and DDAVP at home. 2) s/p colon resection as a child 3) hx of crack cocaine abuse Social History: + crack cocaine, + tobacco, + EtOH. Family History: N/C. Physical Exam: On admission in the ED: Afebrile, HR 150, BP 122/63, RR 22, SPO2 97% RA. GCS 12, in c-collar. Cor reg Chest CTA, equal BS. Abd soft, NT, vertical surgical scar, well healed. Foley in place. Ext warm, palp DP/PT bil. L leg splint. LLE: SILT @ DP/SP, warm toes, + [**Last Name (un) 938**]/FHL. Spine non-tender, no abrasions, no step-offs Pertinent Results: [**2127-4-13**] 04:30AM URINE RBC-<1 WBC-<1 BACTERIA-FEW YEAST-NONE EPI-<1 [**2127-4-13**] 04:30AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2127-4-13**] 04:30AM PT-12.3 PTT-20.2* INR(PT)-1.1 [**2127-4-13**] 04:30AM WBC-13.7* RBC-4.69 HGB-13.4 HCT-39.2 MCV-84 MCH-28.5 MCHC-34.1 RDW-14.1 [**2127-4-13**] 04:30AM PLT COUNT-409 [**2127-4-13**] 04:30AM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS cocaine-POS amphetmn-NEG mthdone-NEG [**2127-4-13**] 04:30AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2127-4-13**] 04:30AM GLUCOSE-92 UREA N-3* CREAT-1.0 SODIUM-156* POTASSIUM-3.5 CHLORIDE-120* TOTAL CO2-22 ANION GAP-18 [**2127-4-13**] 04:43AM GLUCOSE-100 LACTATE-2.5* NA+-159* K+-3.6 CL--118* TCO2-22 [**2127-4-13**] 09:56AM OSMOLAL-352* [**2127-4-13**] 09:56AM SODIUM-172* CHLORIDE-139* [**2127-4-13**] 04:08PM SODIUM-177* CHLORIDE-146* *** Last several sodium checks, all on DDAVP 0.2/0.1/0.2 mg: *** [**4-28**]: 136 [**4-29**]: 138 [**4-30**]: 137 Brief Hospital Course: The pt was admitted and resuscitated in the Trauma ICU. Her most immediate complication was her DI. Her sodium levels quickly rose, and it was unclear how long the pt had gone without DDAVP (per mother the pt had been away from home and using drugs consistently for a few days prior to the accident). The endocrine service was consulted, and her sodium levels were carefully followed as she was given free water and DDAVP, correcting her sodium slowly enough to avoid CPM. On HD 3 she was stable enough to go to the OR for an IM nail of her left tibia. She tolerated this well, without complication. Please see the dictated operative note for details. She was extubated and transferred to the floor [**2127-4-17**] without event. The [**Hospital **] hospital course was further complicated by delirium: the pt took several days to return to her baseline mental status, probably due to her waxing and [**Doctor Last Name 688**] sodium. The pt became quite agitated on HD 11, which was possibly related to friends [**Name (NI) 66175**] attempting to bring narcotics into the patient's room. Urgent psychiatric and neurologic evaluations were obtained. She was started on haldol on the recommendation of psychiatry, and an MRI was obtained on the recommendation of neurology. The pt remained calm with haldol, which was slowly weaned and finally switched to PO, then stopped prior to discharge. The brain MRI was only remarkable for post-operative changes, c/w her hx of pituitary adenoma resection. The pt slowly returned to her baseline mental status as her sodium level was [**Last Name (un) 4662**] under control by adjusting her DDAVP dose. She was cleared by the speech and swallow team for restarting a PO diet, which she tolerated well. Her cervical collar was cleared once she was lucid. The pt was evaluated by social work, and she was interested in drug rehabilitation. However, as the the PT service recommended physical rehabilitation for the patients left leg, a suitable facility was found that could provide both. She was discharged on the dose of DDAVP that kept her Na level the most stable (0.2/0.1/0.2 mg), and she was tolerating a regular diet with her pain controlled. She was A+O x 3 for the last several days of her hospitalization, remaining off sitter supervision for several days before discharge. Please see the results section for her last few sodium levels. Medications on Admission: Cortef 15mg AM/5mg PM, levoxyl 150 mcg', DDAVP 0.2tid. Discharge Medications: 1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) syringe Subcutaneous Q12H (every 12 hours) for 3 weeks. Disp:*42 syringe* Refills:*0* 2. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Hydrocortisone 5 mg Tablet Sig: Three (3) Tablet PO QAM (once a day (in the morning)). 4. Hydrocortisone 5 mg Tablet Sig: One (1) Tablet PO QPM (once a day (in the evening)). 5. Clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly Transdermal QTUES (every Tuesday). 6. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 7. Desmopressin 0.1 mg Tablet Sig: 1-2 Tablets PO three times a day: Take 0.2 mg AM, 0.1 mg midday, and 0.2 mg PM. 8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 10. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for anxiety. Discharge Disposition: Extended Care Facility: [**Hospital6 2222**] - [**Location (un) 538**] Discharge Diagnosis: 1) Proximal left tibia/fibula fracture, closed. 2) s/p pituitary adenoma resection w/ panhypopituitarism Discharge Condition: Good. Discharge Instructions: 1) Call or return to the ED if you have any of the following symptoms: ** fevers > 101.4 degrees ** increasing headaches, dizziness or blurred vision ** increasing drainage or redness around your incision 2) Keep the knee brace on when walking or standing on your left leg or when using crutches. 3) Take all medications as prescribed. Followup Instructions: 1) 2 weeks in trauma clinic-- call [**Telephone/Fax (1) 6439**] to schedule an appointment. 2) 4 weeks in orthopaedic clinic-- call [**Telephone/Fax (1) 1228**] to schedule an appointment. Tell the secretary you will also need x-rays taken just before your appointment. 3) Call you PCP to schedule an appointment in [**2-17**] weeks. Completed by:[**2127-4-30**] Name: [**Known lastname 11561**],[**Known firstname 11562**] J Unit No: [**Numeric Identifier 11563**] Admission Date: [**2127-4-13**] Discharge Date: [**2127-4-30**] Date of Birth: [**2098-12-4**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3524**] Addendum: Urinalysis obtained [**4-29**] because of compalints of urinary frequency by patient; came back postive for nitrites and WBC's; culture pending at time of dictation. She will be started on Cipro 500 mg po BID for 5 days. Discharge Disposition: Extended Care Facility: [**Hospital6 4356**] - [**Location (un) 164**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2207**] MD [**MD Number(1) 3525**] Completed by:[**2127-4-30**]

823,253,305,599,244,V158,E814,780,041,300,307

{'Closed fracture of upper end of fibula with tibia,Diabetes insipidus,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Other specified acquired hypothyroidism,Personal history of noncompliance with medical treatment, presenting hazards to health,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anxiety state, unspecified,Other and unspecified special symptoms or syndromes, 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: Pedestrian struck by car. PRESENT ILLNESS: Ms [**Known lastname 26438**] is a 28 y/o woman who was a pedestrian struck by an automobile. She was seen at [**Hospital 1474**] Hospital, stabalized, and transferred to [**Hospital1 18**]. On presentation at [**Hospital1 1474**], she was c/o left leg pain. Per report the car was travelling at 30 mph and clipped her in the leg. ? LOC. She apparently admitted to the use of crack cocaine prior to the accident. She was intubated at [**Hospital 1474**] Hospital for agitation and failure to follow commands. MEDICAL HISTORY: 1) s/p pituitary adenoma resection w/ resulting panhypopituitarism, on hydrocortisone, levothyroxin and DDAVP at home. 2) s/p colon resection as a child 3) hx of crack cocaine abuse MEDICATION ON ADMISSION: Cortef 15mg AM/5mg PM, levoxyl 150 mcg', DDAVP 0.2tid. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission in the ED: Afebrile, HR 150, BP 122/63, RR 22, SPO2 97% RA. GCS 12, in c-collar. Cor reg Chest CTA, equal BS. Abd soft, NT, vertical surgical scar, well healed. Foley in place. Ext warm, palp DP/PT bil. L leg splint. LLE: SILT @ DP/SP, warm toes, + [**Last Name (un) 938**]/FHL. Spine non-tender, no abrasions, no step-offs FAMILY HISTORY: N/C. SOCIAL HISTORY: + crack cocaine, + tobacco, + EtOH. ### Response: {'Closed fracture of upper end of fibula with tibia,Diabetes insipidus,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Other specified acquired hypothyroidism,Personal history of noncompliance with medical treatment, presenting hazards to health,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anxiety state, unspecified,Other and unspecified special symptoms or syndromes, not elsewhere classified'}

CHIEF COMPLAINT: Unresponsiveness PRESENT ILLNESS: Pt is a 61yo RHF with SCA-3 who was admitted to [**Hospital1 18**] after an episode on unresponsiveness. She was in her usual state of health on Tuesday when she slumpt down in her wheelchair. She claims she was aware of what was going on during this entire event but unable to open her eyes or talk. Nursing staff tried to get her to respond but she could not. EMS arrived and performed sternal rubs, which she claims to remember, again she was not responding. She remembers the EMT's placing an IV en route to the OSH. At [**Hospital3 4107**] FS 193, She received Narcan without effect. CT head was negative for bleed. Tox screen was withinl normal. CXR was negative. She was intubated for airway protection and transferred to [**Hospital1 18**] for further management. In the MICU she was following commands but initially only breathing when encouraged to do so. After sedation was weaned, she self-extubated. She was responsive, verbal, and cooperative thereafter. Her only complaint was a sensation of a sensation of falling to the left. Today she feels pretty much back to baseline and has a fairly clear recolection of all the recent events. She denies any recent HA's, worsening vision symptoms, N/V, etc... She denies ever havinng a seizure or similar event in the past. She saw her outpateient neurology, Dr [**Last Name (STitle) **] on [**11-22**] at which time pt appeared much worse than baseline to her. Dr. [**Last Name (STitle) 3675**] checking CBC, UA to look for possible infection and also increased her Sinemet dose. UA was not performed at that time. Also of note, pt apparently was in the [**Hospital1 756**] ER s/p MVA on [**11-27**]. She apparently hit her head during that time. MEDICAL HISTORY: SCA3 - [**Last Name (un) 32665**]-[**Doctor Last Name 122**]-Azorean disease - baseline findings per primary neurologist include nystagmus, slow speech, dystonic face, distal weakness, ataxia L>R - Depression - Psychosis - Anxiety - UTI causing altered mental status [**1-23**] at [**Hospital1 112**] - HTN - HLD MEDICATION ON ADMISSION: Lactulose 30 mL PO/NG DAILY:PRN constipation - Carbidopa-Levodopa (25-100) 1.5 TAB PO/NG 9AM AND 1PM - Carbidopa-Levodopa (25-100) 1 TAB PO/NG 5AM, 9AM, 5PM, 9PM - Multivitamins 1 TAB PO/NG DAILY - FoLIC Acid 1 mg PO/NG DAILY - Comtan *NF* 200 mg Oral 5x/day - Simvastatin 40 mg PO/NG QHS - BuPROPion 100 mg PO QPM - Lisinopril 10 mg PO/NG DAILY - Tolterodine 2 mg PO QHS - Baclofen 5 mg PO QAM - Atenolol 50 mg PO/NG DAILY - Citalopram Hydrobromide 20 mg PO/NG DAILY - Quetiapine Fumarate 50 mg PO/NG [**Hospital1 **] - Gabapentin 100 mg PO/NG TID - Lactulose PRN - Senna PRN - Colace PRN - Tylenol PRN - Compazine PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: BP 103/85 HR 89 100RA GEN: Alert, following commands, in NAD HEENT: MMM, no cervical, supraclavicular, or axillar LAD, neck is supple, no JVD CV: RRR, NL S1S2 no S3S4 MRG PULM: CTABL, no wheezes or ronchi ABD: soft, nontender, nondistended, no masses or HSM, + BS EXT: contraction of right 1st finger at DIP; no clubbing, tremors, or cyanosis, no edema, pulses 2+ SKIN: No skin breakdown, no rashes, no petechiae; healing excoriations on knees bilaterally NEURO: Pupils are symmetric and reactive to light, Unable to perform upgaze bilaterally, horizontal nystagmus noted, remaining CNs intact though facial movement is slow; full visual fields; Strength 5/5 at biceps; 5-/5 at triceps; [**4-18**] grip strength bilaterally; trace reflexes in upper extremities; LEs: legs are splayed outward in flexion at the knee; strength is [**2-16**] at HFs bilaterally and KF; DF/PF is [**4-18**]; reflexes are trace at knee and ankle; Babinski's are mute Sensation intact to light touch throughout FAMILY HISTORY: SOCIAL HISTORY:

Urinary tract infection, site not specified,Other spinocerebellar diseases,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Dysthymic disorder,Anemia of other chronic disease

Urin tract infection NOS,Spinocerebellar dis NEC,Other alter consciousnes,Oth gram negatv bacteria,Hypertension NOS,Hyperlipidemia NEC/NOS,Dysthymic disorder,Anemia-other chronic dis

Admission Date: [**2102-12-5**] Discharge Date: [**2102-12-8**] Date of Birth: [**2040-12-29**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: Unresponsiveness Major Surgical or Invasive Procedure: Intubation History of Present Illness: Pt is a 61yo RHF with SCA-3 who was admitted to [**Hospital1 18**] after an episode on unresponsiveness. She was in her usual state of health on Tuesday when she slumpt down in her wheelchair. She claims she was aware of what was going on during this entire event but unable to open her eyes or talk. Nursing staff tried to get her to respond but she could not. EMS arrived and performed sternal rubs, which she claims to remember, again she was not responding. She remembers the EMT's placing an IV en route to the OSH. At [**Hospital3 4107**] FS 193, She received Narcan without effect. CT head was negative for bleed. Tox screen was withinl normal. CXR was negative. She was intubated for airway protection and transferred to [**Hospital1 18**] for further management. In the MICU she was following commands but initially only breathing when encouraged to do so. After sedation was weaned, she self-extubated. She was responsive, verbal, and cooperative thereafter. Her only complaint was a sensation of a sensation of falling to the left. Today she feels pretty much back to baseline and has a fairly clear recolection of all the recent events. She denies any recent HA's, worsening vision symptoms, N/V, etc... She denies ever havinng a seizure or similar event in the past. She saw her outpateient neurology, Dr [**Last Name (STitle) **] on [**11-22**] at which time pt appeared much worse than baseline to her. Dr. [**Last Name (STitle) 3675**] checking CBC, UA to look for possible infection and also increased her Sinemet dose. UA was not performed at that time. Also of note, pt apparently was in the [**Hospital1 756**] ER s/p MVA on [**11-27**]. She apparently hit her head during that time. ROS: Gen: No fevers/chills/sweats, CP, SOB, palpitations, N/V, URI, cough, abd pain, dysuria, melena, BRBPR, rash, travel Past Medical History: SCA3 - [**Last Name (un) 32665**]-[**Doctor Last Name 122**]-Azorean disease - baseline findings per primary neurologist include nystagmus, slow speech, dystonic face, distal weakness, ataxia L>R - Depression - Psychosis - Anxiety - UTI causing altered mental status [**1-23**] at [**Hospital1 112**] - HTN - HLD Physical Exam: VS: BP 103/85 HR 89 100RA GEN: Alert, following commands, in NAD HEENT: MMM, no cervical, supraclavicular, or axillar LAD, neck is supple, no JVD CV: RRR, NL S1S2 no S3S4 MRG PULM: CTABL, no wheezes or ronchi ABD: soft, nontender, nondistended, no masses or HSM, + BS EXT: contraction of right 1st finger at DIP; no clubbing, tremors, or cyanosis, no edema, pulses 2+ SKIN: No skin breakdown, no rashes, no petechiae; healing excoriations on knees bilaterally NEURO: Pupils are symmetric and reactive to light, Unable to perform upgaze bilaterally, horizontal nystagmus noted, remaining CNs intact though facial movement is slow; full visual fields; Strength 5/5 at biceps; 5-/5 at triceps; [**4-18**] grip strength bilaterally; trace reflexes in upper extremities; LEs: legs are splayed outward in flexion at the knee; strength is [**2-16**] at HFs bilaterally and KF; DF/PF is [**4-18**]; reflexes are trace at knee and ankle; Babinski's are mute Sensation intact to light touch throughout Pertinent Results: [**2102-12-5**] 05:55PM WBC-6.0 RBC-3.52* HGB-11.2* HCT-35.0* MCV-100* MCH-31.9 MCHC-32.1 RDW-12.8 [**2102-12-5**] 05:55PM NEUTS-64.1 LYMPHS-30.6 MONOS-3.7 EOS-1.5 BASOS-0.1 [**2102-12-5**] 05:55PM PLT COUNT-210 [**2102-12-5**] 05:55PM PT-11.3 PTT-28.0 INR(PT)-0.9 [**2102-12-5**] 05:55PM TSH-1.3 [**2102-12-5**] 05:55PM T4-4.7 [**2102-12-5**] 05:55PM GLUCOSE-113* UREA N-15 CREAT-0.7 SODIUM-142 POTASSIUM-3.8 CHLORIDE-111* TOTAL CO2-22 ANION GAP-13 [**2102-12-5**] 05:55PM CK-MB-4 cTropnT-0.01 [**2102-12-5**] 05:55PM ALT(SGPT)-10 AST(SGOT)-22 LD(LDH)-213 CK(CPK)-189* ALK PHOS-83 TOT BILI-0.3 [**2102-12-5**] 05:55PM LIPASE-14 [**2102-12-5**] 05:55PM VIT B12-648 [**2102-12-5**] 06:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-0.2 PH-7.0 LEUK-NEG [**2102-12-5**] 06:00PM URINE RBC-0-2 WBC-[**5-24**]* BACTERIA-OCC YEAST-NONE EPI-[**5-24**] [**2102-12-5**] 06:00PM URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2102-12-5**] 07:00PM TYPE-ART PO2-453* PCO2-39 PH-7.42 TOTAL CO2-26 BASE XS-1 [**2102-12-6**] 02:19AM BLOOD CK-MB-4 cTropnT-0.02* [**2102-12-5**] 05:55PM BLOOD ALT-10 AST-22 LD(LDH)-213 CK(CPK)-189* AlkPhos-83 TotBili-0.3 [**2102-12-7**] 06:25AM BLOOD cTropnT-<0.01 [**2102-12-5**] 05:55PM BLOOD CK-MB-4 cTropnT-0.01 URINE CULTURE (Final [**2102-12-7**]): GRAM NEGATIVE ROD(S). ~4000/ML. MRSA SCREEN (Final [**2102-12-8**]): No MRSA isolated. FINDINGS: There are innumerable, nearly punctate foci of elevated T2 signal within the white matter of both cerebral hemispheres, with some coalescence in the periatrial white matter and along the ependymal surface of the left lateral ventricle posteriorly. A vague, somewhat flame-shaped area of slightly elevated T2 signal also is present in the left frontal cortical and subcortical white matter posteriorly (see image 18, series 15). None of these areas undergo pathological enhancement, or exhibit diffusion or susceptibility abnormalities. The etiology is nonspecific, although the left frontal cortical lesion could certainly represent an area of infarction, as could the punctate regions of T2 hyperintensity. There is moderate cerebellar atrophy, as well as the visualized cervical cord, which presumably corresponds to the stated diagnosis of spinocerebellar atrophy. MR angiography of the head, using a 3D time-of-flight imaging protocol, appears to be within normal limits. The study is somewhat suboptimal, in that there is substantial obscuration of the posterior circulation vasculature on the projected images by what is likely fat within the skull base. The MR angiography of the neck arterial vasculature is of very poor quality due to gross venous contamination, secondary to an injection timing error. Within the severe limitations, no overt abnormality is seen although there is essentially no imaging of the vertebral arteries, which may also reflect lack of inclusion of a portion of this vascular territory within the imaging volume. If this information regarding vascular status is of clinical importance, the study should either be repeated or, alternatively a CT angiogram could be performed. CONCLUSION: Findings suggestive of chronic infarcts. Inflammatory disease could be considered, though less likely, given the absence of contrast enhancement of the lesions. Atrophy of the cerebellum and spinal cord. See above report for additional observations. [**2102-12-6**] CXR FINDINGS: As compared to the previous examination, the endotracheal tube and the nasogastric tube have been removed. Lung volumes are unchanged. The pre-existing small left pleural effusion and the retrocardiac atelectasis have resolved. Mild retrocardiac areas of bronchiectasis are now visible. Overall, the lung volumes remain small. The size of the cardiac silhouette is at the upper range of normal. However, no evidence of pulmonary edema is seen. No focal parenchymal opacity suggesting pneumonia. No hilar or mediastinal lymphadenopathies. [**2102-12-7**] Neurophysiology EEG Not Finalized Brief Hospital Course: bA/P: 61 yo W with PMH of spinocerebellar ataxia here with episode of unresponsiveness. . . # Unresponsiveness: Pt was found to be non-repsponsive at her home. Etiology is unclear. [**Name2 (NI) **] hx of prior seizures. No clear new focal deficits on exam. She does have UTI which may be underlying cause. CT at outside hospital negative for bleed or midline shift. She was intubated at outside hospital for airway protection. She was transferred to [**Hospital1 18**] for further evaluation. Sedation was weaned and patient self extubated. According to patient and family, pt was close to her baseline the following morning. EEG, MRI/MRA head and neck were performed to evaluate for seizure or stroke as possible etiology. Neurology inpatient team was consulted. CRP and homocysteine level were checked. Homocysteine was pending at time of d/c. CRP was very elevated for unclear reasons. Fasting lipid panel was checked to evaluate stroke risk, though patient was on simvastatin 40mg daily. Aspirin 81mg daily was added to her regimen. CRP was ordered as requested by neurology. Although the level was elevated to 91, the utility of this information for further management is unclear. Similarly for homocysteine, there is currently no data to suggest B12 or folate alters risk for stroke and likely this does not add value to management of her cardiovascular risk. # Anemia: Baseline unknown. Iron studies consistent with anemia of chronic disease. B12, folate normal. . # Communication: Daughter [**Name (NI) 84282**] [**Telephone/Fax (1) 84283**] HCP # Code: Full Medications on Admission: Lactulose 30 mL PO/NG DAILY:PRN constipation - Carbidopa-Levodopa (25-100) 1.5 TAB PO/NG 9AM AND 1PM - Carbidopa-Levodopa (25-100) 1 TAB PO/NG 5AM, 9AM, 5PM, 9PM - Multivitamins 1 TAB PO/NG DAILY - FoLIC Acid 1 mg PO/NG DAILY - Comtan *NF* 200 mg Oral 5x/day - Simvastatin 40 mg PO/NG QHS - BuPROPion 100 mg PO QPM - Lisinopril 10 mg PO/NG DAILY - Tolterodine 2 mg PO QHS - Baclofen 5 mg PO QAM - Atenolol 50 mg PO/NG DAILY - Citalopram Hydrobromide 20 mg PO/NG DAILY - Quetiapine Fumarate 50 mg PO/NG [**Hospital1 **] - Gabapentin 100 mg PO/NG TID - Lactulose PRN - Senna PRN - Colace PRN - Tylenol PRN - Compazine PRN Discharge Disposition: Extended Care Facility: [**Hospital **] Health Care - [**Hospital1 **] Discharge Diagnosis: Primary: Unresponsiveness Urinary tract infection Anemia of chronic disease Secondary: Spinocerebellar ataxia Hypertension Hyperlipidemia 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 were admitted to the hospital after an episode of unresponsiveness. You appear to be back to your baseline. The reason for this episode is still unclear. [**Name2 (NI) **] had an EEG and MRI for evaluation and were seen by our neurologists. The MRI did not show any signs of recent stroke to explain this event. The EEG was preliminarily normal. Our team will follow up the official report of this study and contact you with anything abnormal. Your lipid panel was within normal and You also had a small amount of bacteria in your urine. You received 3 days of antibiotics to treat this. You were started on a daily baby aspirin. Please follow up with your neurologist Dr [**Last Name (STitle) **], in the next two weeks. Please contact your doctor or return to the emergency room with any concerning symptoms. Followup Instructions: Please contact Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 63931**] to set up a follow up appointment in [**12-16**] weeks.

599,334,780,041,401,272,300,285

{'Urinary tract infection, site not specified,Other spinocerebellar diseases,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Dysthymic disorder,Anemia of other chronic 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: Unresponsiveness PRESENT ILLNESS: Pt is a 61yo RHF with SCA-3 who was admitted to [**Hospital1 18**] after an episode on unresponsiveness. She was in her usual state of health on Tuesday when she slumpt down in her wheelchair. She claims she was aware of what was going on during this entire event but unable to open her eyes or talk. Nursing staff tried to get her to respond but she could not. EMS arrived and performed sternal rubs, which she claims to remember, again she was not responding. She remembers the EMT's placing an IV en route to the OSH. At [**Hospital3 4107**] FS 193, She received Narcan without effect. CT head was negative for bleed. Tox screen was withinl normal. CXR was negative. She was intubated for airway protection and transferred to [**Hospital1 18**] for further management. In the MICU she was following commands but initially only breathing when encouraged to do so. After sedation was weaned, she self-extubated. She was responsive, verbal, and cooperative thereafter. Her only complaint was a sensation of a sensation of falling to the left. Today she feels pretty much back to baseline and has a fairly clear recolection of all the recent events. She denies any recent HA's, worsening vision symptoms, N/V, etc... She denies ever havinng a seizure or similar event in the past. She saw her outpateient neurology, Dr [**Last Name (STitle) **] on [**11-22**] at which time pt appeared much worse than baseline to her. Dr. [**Last Name (STitle) 3675**] checking CBC, UA to look for possible infection and also increased her Sinemet dose. UA was not performed at that time. Also of note, pt apparently was in the [**Hospital1 756**] ER s/p MVA on [**11-27**]. She apparently hit her head during that time. MEDICAL HISTORY: SCA3 - [**Last Name (un) 32665**]-[**Doctor Last Name 122**]-Azorean disease - baseline findings per primary neurologist include nystagmus, slow speech, dystonic face, distal weakness, ataxia L>R - Depression - Psychosis - Anxiety - UTI causing altered mental status [**1-23**] at [**Hospital1 112**] - HTN - HLD MEDICATION ON ADMISSION: Lactulose 30 mL PO/NG DAILY:PRN constipation - Carbidopa-Levodopa (25-100) 1.5 TAB PO/NG 9AM AND 1PM - Carbidopa-Levodopa (25-100) 1 TAB PO/NG 5AM, 9AM, 5PM, 9PM - Multivitamins 1 TAB PO/NG DAILY - FoLIC Acid 1 mg PO/NG DAILY - Comtan *NF* 200 mg Oral 5x/day - Simvastatin 40 mg PO/NG QHS - BuPROPion 100 mg PO QPM - Lisinopril 10 mg PO/NG DAILY - Tolterodine 2 mg PO QHS - Baclofen 5 mg PO QAM - Atenolol 50 mg PO/NG DAILY - Citalopram Hydrobromide 20 mg PO/NG DAILY - Quetiapine Fumarate 50 mg PO/NG [**Hospital1 **] - Gabapentin 100 mg PO/NG TID - Lactulose PRN - Senna PRN - Colace PRN - Tylenol PRN - Compazine PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: BP 103/85 HR 89 100RA GEN: Alert, following commands, in NAD HEENT: MMM, no cervical, supraclavicular, or axillar LAD, neck is supple, no JVD CV: RRR, NL S1S2 no S3S4 MRG PULM: CTABL, no wheezes or ronchi ABD: soft, nontender, nondistended, no masses or HSM, + BS EXT: contraction of right 1st finger at DIP; no clubbing, tremors, or cyanosis, no edema, pulses 2+ SKIN: No skin breakdown, no rashes, no petechiae; healing excoriations on knees bilaterally NEURO: Pupils are symmetric and reactive to light, Unable to perform upgaze bilaterally, horizontal nystagmus noted, remaining CNs intact though facial movement is slow; full visual fields; Strength 5/5 at biceps; 5-/5 at triceps; [**4-18**] grip strength bilaterally; trace reflexes in upper extremities; LEs: legs are splayed outward in flexion at the knee; strength is [**2-16**] at HFs bilaterally and KF; DF/PF is [**4-18**]; reflexes are trace at knee and ankle; Babinski's are mute Sensation intact to light touch throughout FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Urinary tract infection, site not specified,Other spinocerebellar diseases,Other alteration of consciousness,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Dysthymic disorder,Anemia of other chronic disease'}

CHIEF COMPLAINT: PRESENT ILLNESS: This 47-year-old gentleman was seen by a Cardiac Surgery consult on [**2118-10-28**] prior to his admission with a history of a silent myocardial infarction approximately two years earlier. He reported only occasional episodes of chest discomfort attributed to acid reflux and not related to activity that lasted only seconds with rare heaviness in his chest. He denied any shortness of breath. He had an exercise tolerance test on [**2118-9-23**] in preparation for a scuba diving trip. His electrocardiogram showed ST depressions in leads V3-6 as well as a large mixed inferolateral defect and an ejection fraction of 50 percent with an inferior hypokinesis. He was referred for cardiac catheterization at [**Hospital6 256**]. His catheterization showed three-vessel disease with a 40 percent left main lesion, 40-50 percent proximal left anterior descending coronary artery lesion, 90 percent distal left anterior descending coronary artery lesion, circumflex coronary artery 80 percent mid lesion, 100 percent occluded obtuse marginal two and 100 percent occluded proximal right coronary artery with an ejection fraction of 50 percent. MEDICAL HISTORY: Myocardial infarction. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He is married with three grown children. He had a 30 pack year history. He quit smoking 13 years ago. He admits to [**3-8**] alcoholic drinks per day.

Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Esophageal reflux

Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hypertension NOS,Esophageal reflux

Admission Date: [**2118-11-1**] Discharge Date: [**2118-11-7**] Date of Birth: [**2071-3-23**] Sex: M Service: CSU HISTORY OF PRESENT ILLNESS: This 47-year-old gentleman was seen by a Cardiac Surgery consult on [**2118-10-28**] prior to his admission with a history of a silent myocardial infarction approximately two years earlier. He reported only occasional episodes of chest discomfort attributed to acid reflux and not related to activity that lasted only seconds with rare heaviness in his chest. He denied any shortness of breath. He had an exercise tolerance test on [**2118-9-23**] in preparation for a scuba diving trip. His electrocardiogram showed ST depressions in leads V3-6 as well as a large mixed inferolateral defect and an ejection fraction of 50 percent with an inferior hypokinesis. He was referred for cardiac catheterization at [**Hospital6 256**]. His catheterization showed three-vessel disease with a 40 percent left main lesion, 40-50 percent proximal left anterior descending coronary artery lesion, 90 percent distal left anterior descending coronary artery lesion, circumflex coronary artery 80 percent mid lesion, 100 percent occluded obtuse marginal two and 100 percent occluded proximal right coronary artery with an ejection fraction of 50 percent. PAST MEDICAL HISTORY: Myocardial infarction. Gastroesophageal reflux disease. Hypertension. PAST SURGICAL HISTORY: He had no prior surgeries. ALLERGIES: No known drug allergies. MEDICATIONS: 1. Aspirin 81 mg p.o. once daily. 2. Prevacid 30 mg p.o. twice daily. 3. Lopid 600 mg p.o. twice daily. 4. Atenolol 50 mg p.o. once daily. 5. Lipitor 40 mg p.o. once daily. 6. Flogard 2.2 mg p.o. once daily. 7. Lisinopril. 8. Fish oil daily. 9. Calcium 1,000 mg p.o. once daily. 10. Niacin 100 mg p.o. twice daily. 11. Multivitamin. SOCIAL HISTORY: He is married with three grown children. He had a 30 pack year history. He quit smoking 13 years ago. He admits to [**3-8**] alcoholic drinks per day. PHYSICAL EXAMINATION: He is 5'9" tall weighing approximately 209 pounds, sinus rhythm in the 60s with a blood pressure of 108/82, respiratory rate 21, saturation of 97 percent on room air. He was lying flat in bed in no apparent distress. He is alert and oriented times three and appropriate and grossly neurologically intact. His lungs were clear bilaterally. He had good breath sounds with a heart at regular rate and rhythm with good heart tones. S1 and S2 with no murmur, rub or gallop. His abdomen was soft, round, nontender, nondistended with positive bowel sounds. His extremities were warm and well perfused with no edema or varicosities. His right groin site from catheterization appeared to be clean, dry and intact. His pulses were on the right side, radial two plus, dorsalis pedis two plus, PT two plus, femoral one plus. On the left side, radial two plus, dorsalis pedis one plus, PT one plus, femoral one plus. LABORATORY DATA: White blood cell count 5.2, hematocrit 35.0, platelet count 241,000, sodium 136, potassium 4.1, chloride 105, CO2 of 21, BUN 20, creatinine 0.9 with a blood sugar of 111. PT 13.2, PTT 20.5, INR 1.1, ALT 23, AST 28, alkaline phosphatase 44, amylase 46, total bilirubin 0.5, albumin 4.5. Preoperative chest x-ray showed that his lungs were clear with no evidence of consolidation or effusion, an old healed fracture of the left rib and no active lung disease. Preoperative electrocardiogram showed sinus rhythm at 62 with a left atrial abnormality and a possible prior IMI. Please refer to the electrocardiogram report from [**10-28**]. HOSPITAL COURSE: The patient was referred to [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 56947**], M.D. of Cardiac Surgery to have the patient return several days later to have coronary artery bypass graft done. The patient did return for surgery on [**11-1**]. He had a coronary artery bypass graft times four performed by Dr. [**Last Name (STitle) **] with the left internal mammary artery to the left anterior descending coronary artery, a vein graft to the posterior descending coronary artery, a vein graft to the posterolateral branch of the right coronary artery and a vein graft to the obtuse marginal. He was transferred to the Cardiothoracic Intensive Care Unit in stable condition on the Neo-Synephrine drip at 1 mcg/kg/min and a titrated propofol drip. On postoperative day one, the patient was on Neo-Synephrine for some hypotension. He had been extubated overnight. He was in sinus tachycardia of 103, blood pressure 98/53, respiratory rate 28 and saturation of 92 percent on two liters nasal cannula. Postoperative labs are as follows. White blood cell count 13.7, hematocrit 25.8, platelet count 257,000, potassium 4.4, BUN 18, creatinine 0.9 with a blood sugar of 97. He was in no apparent distress. He was tachycardiac but in a regular rhythm. He had clear breath sounds bilaterally. His incisions were unremarkable. The plan was to wean the Neo-Synephrine during the day. His chest tubes remained in for some drainage. He received one unit of packed red blood cells overnight on postoperative day two for a hematocrit that dropped to 22. His Neo-Synephrine was at 2.5 at that time. His blood pressure was 124/70 so the plan was to decrease his Neo-Synephrine requirement. His examination was unremarkable. His chest tubes were discontinued. The patient was out of bed. The patient was also seen by Case Management. The patient was transferred to the floor on [**11-5**] in stable condition and was seen by Physical Therapy to continue working on his ambulation. He was receiving Percocet for incisional pain. Labs on [**11-6**] were as follows. White blood cell count 5.8, hematocrit 26.5, potassium 4.0, BUN 14, creatinine 0.8 with a blood sugar of 98. The patient had completed his perioperative antibiotics, was ambulating and using his incentive spirometer. On postoperative day six, he had no events. He was very anxious to go home. His hematocrit was 26 percent and Dr. [**Last Name (STitle) **] discussed this with him with the plan to be able to discharge him. His examination was as follows. Blood pressure 100/68 in sinus rhythm at 81, respiratory rate 20, room air saturation 94 percent. He was down 1.6 kg from his preoperative weight. He was alert and oriented with no apparent deficits. Lungs were clear bilaterally with decreased breath sounds over the left base. His heart was regular rate and rhythm. His abdomen was soft, nontender, nondistended. His extremities were warm with trace pedal edema bilaterally. His sternal incision was clean, dry and intact with intact staples. His bilateral leg incisions were clean, dry and intact with Steri-Strips. He was stable and discharged to home on [**11-7**] with the following discharge diagnoses. DISCHARGE DIAGNOSES: Status post coronary artery bypass graft times four. Status post myocardial infarction. Gastroesophageal reflux disease. Hypertension. DISCHARGE MEDICATIONS: 1. Plavix 75 mg p.o. once daily times three months. 2. Percocet 5/325 1-2 tablets p.o. p.r.n. q 4-6 hours for pain. 3. Enteric coated aspirin 325 mg p.o. once daily. 4. Vitamin C 500 mg p.o. twice daily. 5. Polysaccharide-iron complex 150 mg p.o. once daily. 6. Atenolol 25 mg p.o. once daily. 7. Lipitor 40 mg p.o. once daily. 8. Lasix 20 mg p.o. twice daily times seven days. 9. Prevacid enteric coated 30 mg p.o. once daily. FOLLOW UP: The patient was instructed to follow-up with Dr. [**Last Name (STitle) 56948**] in [**3-8**] weeks postoperatively, with Dr. [**Known firstname **] [**Last Name (NamePattern1) 5686**], his cardiologist, in approximately 2-3 weeks postoperatively and to follow-up with Dr. [**Last Name (STitle) **] in the office at four weeks for his postoperative surgical visit. DISPOSITION: The patient was discharged to home with services in stable condition on [**2118-11-7**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2118-11-30**] 11:37:58 T: [**2118-11-30**] 12:05:58 Job#: [**Job Number 56949**]

414,413,401,530

{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,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 47-year-old gentleman was seen by a Cardiac Surgery consult on [**2118-10-28**] prior to his admission with a history of a silent myocardial infarction approximately two years earlier. He reported only occasional episodes of chest discomfort attributed to acid reflux and not related to activity that lasted only seconds with rare heaviness in his chest. He denied any shortness of breath. He had an exercise tolerance test on [**2118-9-23**] in preparation for a scuba diving trip. His electrocardiogram showed ST depressions in leads V3-6 as well as a large mixed inferolateral defect and an ejection fraction of 50 percent with an inferior hypokinesis. He was referred for cardiac catheterization at [**Hospital6 256**]. His catheterization showed three-vessel disease with a 40 percent left main lesion, 40-50 percent proximal left anterior descending coronary artery lesion, 90 percent distal left anterior descending coronary artery lesion, circumflex coronary artery 80 percent mid lesion, 100 percent occluded obtuse marginal two and 100 percent occluded proximal right coronary artery with an ejection fraction of 50 percent. MEDICAL HISTORY: Myocardial infarction. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He is married with three grown children. He had a 30 pack year history. He quit smoking 13 years ago. He admits to [**3-8**] alcoholic drinks per day. ### Response: {'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Esophageal reflux'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 30-year-old right-handed woman who presented to an outside hospital with acute onset of right-sided weakness and inability to speak. She had no previous medical history; and according to the 3 a.m. on the morning of admission when she was suddenly distressed, started pointing frantically to her right side and was unable to speak. Her right side seemed weaker. MEDICAL HISTORY: 1. Headaches treated with over-the-counter medications. 2. A tubal ligation. MEDICATION ON ADMISSION: Tylenol as needed. ALLERGIES: Allergy to PENICILLIN. PHYSICAL EXAM: FAMILY HISTORY: A family history of hypertension. No history of deep venous thromboses or miscarriages. SOCIAL HISTORY: She smokes several cigarettes per day. She drinks alcohol occasionally. She was abused as a child. No battery for the past 25 years.

Cerebral artery occlusion, unspecified with cerebral infarction

Crbl art ocl NOS w infrc

Admission Date: [**2157-1-9**] Discharge Date: [**2157-1-14**] Date of Birth: [**2126-3-18**] Sex: F HISTORY OF PRESENT ILLNESS: This is a 30-year-old right-handed woman who presented to an outside hospital with acute onset of right-sided weakness and inability to speak. She had no previous medical history; and according to the 3 a.m. on the morning of admission when she was suddenly distressed, started pointing frantically to her right side and was unable to speak. Her right side seemed weaker. She was brought to [**Hospital3 3765**] within eight minutes after the onset. A CT of the head was done, and their impression was that of a subarachnoid hemorrhage; and she was [**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **]. On arrival here, it became clear that the patient had a left middle cerebral artery syndrome and the head CT was read as a dense left middle cerebral artery sign. PAST MEDICAL HISTORY: 1. Headaches treated with over-the-counter medications. 2. A tubal ligation. MEDICATIONS ON ADMISSION: Tylenol as needed. ALLERGIES: Allergy to PENICILLIN. SOCIAL HISTORY: She smokes several cigarettes per day. She drinks alcohol occasionally. She was abused as a child. No battery for the past 25 years. FAMILY HISTORY: A family history of hypertension. No history of deep venous thromboses or miscarriages. REVIEW OF SYSTEMS: According to the family, the patient did complain of right-sided numbness for several hours that occurred several weeks prior to admission. PHYSICAL EXAMINATION ON PRESENTATION: Temperature was 98, blood pressure was 100/60, heart rate was 79, oxygen saturation was 100% on ventilation. On presentation she was intubated, and sedated, and paralyzed. Her lungs were clear to auscultation. Heart sounds were regular. There were no carotid bruits. She did not follow any commands. She did grimace to pain bilaterally. Pupils were symmetrically reactive. Dolls eye reflex was intact. Off of sedation, she did move her left arm and leg off the bed spontaneously. There was no spontaneous movement in the right side, but she did extend the right arm and triple flexed the right leg to pain. There was a right extensor plantar response. Stroke scale score was 21. PERTINENT LABORATORY DATA ON PRESENTATION: Laboratories showed a white blood cell count of 9.1, hematocrit was 36. Coagulations were normal as well as electrolytes. RADIOLOGY/IMAGING: A CT of the head from the outside hospital showed a hyperdense left middle cerebral artery intracranial internal carotid artery. A magnetic resonance imaging with magnetic resonance angiography showed restricted diffusion in almost the entire left middle cerebral artery territory. The magnetic resonance angiography showed occlusion of the distal left internal carotid artery and proximal middle cerebral artery. No hemorrhage was observed on the initial magnetic resonance imaging/magnetic resonance angiography. HOSPITAL COURSE: Because the patient vomited several times at [**Hospital3 3765**], she was intubated there. She was also loaded with 1 g of Dilantin and sedated during transport. After arrival here and confirmation of an ischemic event on magnetic resonance imaging, she was just within that 6-hour window after the beginning of symptoms. The risks and benefits of treating with intravenous t-PA was thoroughly discussed with the mother, sister, and fiance; in particular the fact that the use of t-PA at such a time point would be under investigational protocol. Given the probable dire consequences of not treating, the family agreed to treat with t-PA. She was given an initial 8-mg bolus and then a 72-mg infusion over one hour subsequently. She had no immediate complications. She was transferred to the Neurology Intensive Care Unit for close monitoring. She was also given Neo-Synephrine to maintain her mean arterial pressure at around 90 to support cerebral perfusion. She was given maintenance intravenous fluids at 70% to keep her on the dry side. A second magnetic resonance imaging with magnetic resonance angiography was performed on the following day which showed increased mass effect, with a midline shift of 10 mm, and two small areas of hemorrhage; one in the left basoganglia and left inferior temporal lobe. There appeared to be some compression on the left cerebral peduncle. She was hyperventilated for a goal PCO2 of 25 and started on mannitol to decrease the mass effect from cerebral edema. The second magnetic resonance angiography showed recanalization of the left middle cerebral artery. Over the course of her hospitalization, she showed little change in her neurologic examination. There was some slight asymmetry of the pupils, but in general her brain stem function was maintained. A transthoracic echocardiogram was obtained to investigate the cause of the stroke. A patent foramen ovale was revealed. There was normal chamber size and function otherwise. There was no sign of a dissection on the second magnetic resonance angiography. A hypercoagulability workup was sent which included antiphospholipid antibody, protein C and protein S, factor [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5244**], homocystine, prothrombin gene mutation, and antithrombin III. The option of performing a hemicraniectomy to decompress her brain because of the effected increase in brain edema was offered to the family. The likely neurologic outcome, if the patient survived, was also discussed with the family. In particular, the fact that she would likely have moderate-to-severe difficulty in communication, would have a significant right-sided weakness, and would probably be dependent on mobility and feeding herself. After some thought, the family decided to forego the hemicraniectomy feeling that the patient would not have wanted to live with the changes of such an outcome. By [**1-13**], it was felt that the maximum amount of brain swelling had occurred; however, she had only mild signs of uncal herniation on examination. A family meeting was called to again thoroughly discuss the likely outcome if the patient survived, and a discussion of further management with regard to withdrawing care including extubation or aggressive treatment leading to a tracheostomy, long-term ventilation, and a feeding tube. The possible outcome that the patient might survive and continue breathing on her own even after extubation was also presented. After considering all of the possible outcomes from different management course actions, and considering the patient's preferences and wish to not live on in such a state, the patient's family decided to extubate the patient which was performed at 10:30 p.m. on [**1-14**]. Approximately 10 minutes after extubation, she became asystolic, and her blood pressure dropped to 0. She was declared deceased at 10:48 p.m. on [**1-14**]. Her fiance was at the bedside, and her family was notified. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 12114**] Dictated By:[**Last Name (NamePattern1) 36331**] MEDQUIST36 D: [**2157-6-19**] 15:15 T: [**2157-6-25**] 03:44 JOB#: [**Job Number 37962**]

434

{'Cerebral artery occlusion, unspecified with cerebral 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 30-year-old right-handed woman who presented to an outside hospital with acute onset of right-sided weakness and inability to speak. She had no previous medical history; and according to the 3 a.m. on the morning of admission when she was suddenly distressed, started pointing frantically to her right side and was unable to speak. Her right side seemed weaker. MEDICAL HISTORY: 1. Headaches treated with over-the-counter medications. 2. A tubal ligation. MEDICATION ON ADMISSION: Tylenol as needed. ALLERGIES: Allergy to PENICILLIN. PHYSICAL EXAM: FAMILY HISTORY: A family history of hypertension. No history of deep venous thromboses or miscarriages. SOCIAL HISTORY: She smokes several cigarettes per day. She drinks alcohol occasionally. She was abused as a child. No battery for the past 25 years. ### Response: {'Cerebral artery occlusion, unspecified with cerebral infarction'}

CHIEF COMPLAINT: I guess the blood in my head and my left leg hurts PRESENT ILLNESS: Asked to see this 77 year old white female who was on the [**Hospital Ward Name **] today for Holter monitoring and coagulation clinic. Pt reports that she is on Coumadin for afib and "a flutter in my heart". Pt states today that she tripped and stubbed her toe causing her to fall. She fell forward and rolled to her right striking her face. She denies syncope before or after the fall. She was immediately aware of her surroundings. The Holter monitor is also for dizziness and sob since her afib was diagnosed 3 yrs ago MEDICAL HISTORY: -paroxysmal atrial fibrillation, not on anticoagulation -hypertension -hypercholesterolemia -hypothyroidism -low back pain -depression/anxiety -history of basal cell carcinoma removed from left cheek -history of multiple skeletal fractures -history of left hip fracture, status post left ORIF MEDICATION ON ADMISSION: Amlodipine 2.5mg Qd Levothyroxine 88mcg Qd Metoprolol Tartrate 50mg [**Hospital1 **] Paroxetine HCl 10mg Qd Propafenone 225mg TID Quinapril 20mg [**Hospital1 **] Warfarin 1-3mg Qd- dependent on INR ASA 81mg Qd, Calcium carbonate w/D3 MVI Omega 3 fatty Acid Miralax PRN ALLERGIES: Urispas / Atorvastatin / Nsaids PHYSICAL EXAM: : T:98 BP:138 /60 HR:60 R18 O2Sats100 Gen: WD/WN, comfortable, NAD. HEENT: Pupils: [**4-12**] EOMi / left cerumen impaction noted / no battles sign / + right periorbital ecchymosis and swelling / eye still able to open easily. Neck: Supple. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Multiple family members with cardiac disease. SOCIAL HISTORY: She lives at home with her husband. She is a former hospital secretary at [**Hospital1 18**]. She has a distant but brief history of tobacco use. Denied alcohol or illicit drug use.

Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Closed fracture of upper end of fibula alone,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of orbital floor (blow-out),Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Dysthymic disorder,Lumbago,Diverticulosis of colon (without mention of hemorrhage),Hip joint replacement,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,Fall from other slipping, tripping, or stumbling

Subarachnoid hem-no coma,Atrial flutter,Fx upper end fibula-clos,Brain hem NEC w/o coma,Fx orbital floor-closed,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Dysthymic disorder,Lumbago,Dvrtclo colon w/o hmrhg,Joint replaced hip,Hx-skin malignancy NEC,History of tobacco use,Fall from slipping NEC

Admission Date: [**2107-11-17**] Discharge Date: [**2107-11-19**] Date of Birth: [**2030-9-2**] Sex: F Service: NEUROSURGERY Allergies: Urispas / Atorvastatin / Nsaids Attending:[**First Name3 (LF) 3227**] Chief Complaint: I guess the blood in my head and my left leg hurts Major Surgical or Invasive Procedure: None History of Present Illness: Asked to see this 77 year old white female who was on the [**Hospital Ward Name **] today for Holter monitoring and coagulation clinic. Pt reports that she is on Coumadin for afib and "a flutter in my heart". Pt states today that she tripped and stubbed her toe causing her to fall. She fell forward and rolled to her right striking her face. She denies syncope before or after the fall. She was immediately aware of her surroundings. The Holter monitor is also for dizziness and sob since her afib was diagnosed 3 yrs ago Past Medical History: -paroxysmal atrial fibrillation, not on anticoagulation -hypertension -hypercholesterolemia -hypothyroidism -low back pain -depression/anxiety -history of basal cell carcinoma removed from left cheek -history of multiple skeletal fractures -history of left hip fracture, status post left ORIF Social History: She lives at home with her husband. She is a former hospital secretary at [**Hospital1 18**]. She has a distant but brief history of tobacco use. Denied alcohol or illicit drug use. Family History: Multiple family members with cardiac disease. Physical Exam: : T:98 BP:138 /60 HR:60 R18 O2Sats100 Gen: WD/WN, comfortable, NAD. HEENT: Pupils: [**4-12**] EOMi / left cerumen impaction noted / no battles sign / + right periorbital ecchymosis and swelling / eye still able to open easily. Neck: Supple. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light,3 to2 mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**6-15**] throughout. No pronator drift Sensation: Intact to light touch Pertinent Results: [**2107-11-17**] 10:05PM GLUCOSE-114* UREA N-22* CREAT-1.5* SODIUM-137 POTASSIUM-3.7 CHLORIDE-100 TOTAL CO2-27 ANION GAP-14 [**2107-11-17**] 10:05PM CALCIUM-9.0 PHOSPHATE-3.4 MAGNESIUM-2.1 [**2107-11-17**] 10:05PM WBC-9.6 RBC-3.81* HGB-11.8* HCT-34.9* MCV-92 MCH-30.9 MCHC-33.7 RDW-13.8 [**2107-11-17**] 10:05PM PLT COUNT-244 [**2107-11-17**] 10:05PM PT-16.2* PTT-29.3 INR(PT)-1.4* [**2107-11-17**] 05:15PM URINE HOURS-RANDOM [**2107-11-17**] 05:15PM URINE GR HOLD-HOLD [**2107-11-17**] 05:15PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007 [**2107-11-17**] 05:15PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-TR [**2107-11-17**] 05:15PM URINE RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE EPI-0-2 [**2107-11-17**] 03:00PM GLUCOSE-115* UREA N-28* CREAT-1.7* SODIUM-138 POTASSIUM-4.1 CHLORIDE-100 TOTAL CO2-26 ANION GAP-16 [**2107-11-17**] 03:00PM estGFR-Using this [**2107-11-17**] 03:00PM WBC-13.0*# RBC-4.29 HGB-13.2 HCT-39.3 MCV-92 MCH-30.8 MCHC-33.7 RDW-14.0 [**2107-11-17**] 03:00PM NEUTS-86.4* LYMPHS-9.0* MONOS-2.8 EOS-1.6 BASOS-0.2 [**2107-11-17**] 03:00PM PLT COUNT-260 [**2107-11-17**] 03:00PM PT-24.4* PTT-34.0 INR(PT)-2.3* Brief Hospital Course: IPH/SAH: Patient was admitted to the hospital after a fall (on coumadin and aspirin) and was found to have a L traumatic SAH and a R intraparenchymal hemorrhage. Her INR was reversed with 2 doses of 5 mg of Vitamin K to 1.1 on discharge. She received 6 packs of platelets. She was transfused w/ one unit of FFP. The first repeat CT revealed interval progression of the right frontal IPH. Subseuqent two CTs revealed stabilization of the IPH. She remained non-focal throughout her hospitalization. She was cleared by PT for DC with home PT. Afib: She was on coumadin for her Atrial Fibrillation. She required rapid reversal of her INR and was still in AFib on discharge. She will need to remain off of coumadin and aspirin for one month due to the intraparenchymal hemorrhage. She will need to follow-up with her PCP/Cardiologist within 1-2 weeks to discuss her atrial fibrillation. Medications on Admission: Amlodipine 2.5mg Qd Levothyroxine 88mcg Qd Metoprolol Tartrate 50mg [**Hospital1 **] Paroxetine HCl 10mg Qd Propafenone 225mg TID Quinapril 20mg [**Hospital1 **] Warfarin 1-3mg Qd- dependent on INR ASA 81mg Qd, Calcium carbonate w/D3 MVI Omega 3 fatty Acid Miralax PRN Discharge Medications: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain fever. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. [**Hospital1 **]:*30 Tablet(s)* Refills:*0* 4. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. propafenone 225 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 9. quinapril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Traumatic Right Intraparenchymal hemorrhage Traumatic Left Subarachnoid hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: - Take your oxycodone as prescribed. - Exercise should be limited to walking; no lifting, straining, or excessive bending. - Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. - Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. - you may safely resume taking your aspirin and coumadin on [**2107-12-19**] (one month after event). - please contact your PCP regarding your Atrial Fibrillation and to let them know that you have stopped taking coumadin and aspirin. Followup Instructions: - Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**First Name (STitle) **] to be seen in 4 weeks. - You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. Completed by:[**2107-11-19**]

852,427,823,853,802,401,272,244,300,724,562,V436,V108,V158,E885

{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Closed fracture of upper end of fibula alone,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of orbital floor (blow-out),Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Dysthymic disorder,Lumbago,Diverticulosis of colon (without mention of hemorrhage),Hip joint replacement,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,Fall from other slipping, tripping, or stumbling'}

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: I guess the blood in my head and my left leg hurts PRESENT ILLNESS: Asked to see this 77 year old white female who was on the [**Hospital Ward Name **] today for Holter monitoring and coagulation clinic. Pt reports that she is on Coumadin for afib and "a flutter in my heart". Pt states today that she tripped and stubbed her toe causing her to fall. She fell forward and rolled to her right striking her face. She denies syncope before or after the fall. She was immediately aware of her surroundings. The Holter monitor is also for dizziness and sob since her afib was diagnosed 3 yrs ago MEDICAL HISTORY: -paroxysmal atrial fibrillation, not on anticoagulation -hypertension -hypercholesterolemia -hypothyroidism -low back pain -depression/anxiety -history of basal cell carcinoma removed from left cheek -history of multiple skeletal fractures -history of left hip fracture, status post left ORIF MEDICATION ON ADMISSION: Amlodipine 2.5mg Qd Levothyroxine 88mcg Qd Metoprolol Tartrate 50mg [**Hospital1 **] Paroxetine HCl 10mg Qd Propafenone 225mg TID Quinapril 20mg [**Hospital1 **] Warfarin 1-3mg Qd- dependent on INR ASA 81mg Qd, Calcium carbonate w/D3 MVI Omega 3 fatty Acid Miralax PRN ALLERGIES: Urispas / Atorvastatin / Nsaids PHYSICAL EXAM: : T:98 BP:138 /60 HR:60 R18 O2Sats100 Gen: WD/WN, comfortable, NAD. HEENT: Pupils: [**4-12**] EOMi / left cerumen impaction noted / no battles sign / + right periorbital ecchymosis and swelling / eye still able to open easily. Neck: Supple. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Multiple family members with cardiac disease. SOCIAL HISTORY: She lives at home with her husband. She is a former hospital secretary at [**Hospital1 18**]. She has a distant but brief history of tobacco use. Denied alcohol or illicit drug use. ### Response: {'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial flutter,Closed fracture of upper end of fibula alone,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of orbital floor (blow-out),Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Dysthymic disorder,Lumbago,Diverticulosis of colon (without mention of hemorrhage),Hip joint replacement,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,Fall from other slipping, tripping, or stumbling'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 77-year-old female with a past medical history significant for squamous cell carcinoma of the mouth with T2 N0 staging, status post interstitial catheter placement in [**2188-7-18**] for brachy therapy for recurrent cancer, status post resection, now presenting with postoperative osteoradionecrosis of the mandible which had previously been treated with 30 sessions with hyperbaric oxygen. MEDICAL HISTORY: Past Medical History significant for hypothyroidism and reflux disease. MEDICATION ON ADMISSION: Medications included Levoxyl. ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Acute osteomyelitis, other specified sites,Pathologic fracture of other specified site,Acute posthemorrhagic anemia,Pneumonia due to Pseudomonas,Other specified diseases of the jaws,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx

Ac osteomyelitis NEC,Path fx oth specif site,Ac posthemorrhag anemia,Pseudomonal pneumonia,Jaw disease NEC,Hx-oral/pharynx malg NEC

Admission Date: [**2190-9-20**] Discharge Date: [**2190-10-6**] Date of Birth: [**2113-3-5**] Sex: F Service: Plastic Surgery HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old female with a past medical history significant for squamous cell carcinoma of the mouth with T2 N0 staging, status post interstitial catheter placement in [**2188-7-18**] for brachy therapy for recurrent cancer, status post resection, now presenting with postoperative osteoradionecrosis of the mandible which had previously been treated with 30 sessions with hyperbaric oxygen. However, the patient was still left with a large defect which was initially closed with a inferior based FAMM flap; but ultimately the patient developed a right pathologic mandibular fracture with osteonecrosis of the right mandible. She presents for free fibular graft to repair the resected necrotic mandible. PAST MEDICAL HISTORY: Past Medical History significant for hypothyroidism and reflux disease. PAST SURGICAL HISTORY: As above. She has also had a jejunostomy tube placed. ALLERGIES: She has no known drug allergies. MEDICATIONS ON ADMISSION: Medications included Levoxyl. PHYSICAL EXAMINATION ON PRESENTATION: On examination, she was afebrile with stable vital signs. The remainder of the physical examination was notable for a shift of the mandibular midline secondary to loss of support of the right mandibular body with a large separation of the fracture region with concomitant buckle and facial swelling overlying the area. HOSPITAL COURSE: The patient was admitted on [**9-20**] for planned free fibular graft. Please see the Operative Note (per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13797**]) for details of this operation. She was monitored in the initial 24-hour period with every two hour flap checks by Cook catheter for venous pulsations as well as arterial Doppler flows. Her graft remained stable during this time. She was ultimately changed to every four hour checks and eventually to every eight hour checks. Immediately following the surgery, she was transferred to the Intensive Care Unit for the above-stated monitoring of her flap. She was started on trophic gastrojejunostomy tube feeds at 10 cc per hour and was maintained on Kefzol and Flagyl for postoperative infectious prophylaxis. Her postoperative Intensive Care Unit stay was complicated by post surgical anemia as well as Pseudomonas pneumonia without clinical evidence; requiring treatment with ciprofloxacin. During her Intensive Care Unit stay, the patient was maintained in a flat position to prevent development of fistula as gravity would pull the saliva to the back of her throat, and a flat position opposed to the floor of her mouth in an upright or partially upright position. The patient was ultimately transferred to the floor on [**2190-9-29**]. She did extremely well on the floor. She also had a swallow study obtained just prior to her discharge; the results of which indicated poor oral transit with aspiration; however, there was no evidence of fistula. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE STATUS: Discharge status was to home with [**Hospital6 3429**] services. MEDICATIONS ON DISCHARGE: (Discharge medications included) 1. Aspirin 325 mg per gastrojejunostomy tube q.d. 2. Levothyroxine 50 mcg per gastrojejunostomy tube q.d. 3. Sertraline 50 mg per gastrojejunostomy tube q.d. 4. Famotidine 20 mg per gastrojejunostomy tube b.i.d. 5. Roxicet 5 cc to 10 cc per gastrojejunostomy tube q.4-6h. as needed. DISCHARGE INSTRUCTIONS: 1. The patient was also instructed to cycle her tube feeds with ProMod with fiber full strength at 120 cc per hour from 8 p.m. to 8 a.m. 2. Per [**Hospital6 407**] she would receive dressing changes as well as assistance with medication and her tube feeds. DISCHARGE FOLLOWUP: Follow-up plans were scheduled with Dr. [**Last Name (STitle) 13797**] as well as with Otolaryngology. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 19095**], M.D. [**MD Number(1) 19096**] Dictated By:[**Last Name (NamePattern1) 1752**] MEDQUIST36 D: [**2190-10-7**] 16:31 T: [**2190-10-9**] 04:44 JOB#: [**Job Number **]

730,733,285,482,526,V100

{'Acute osteomyelitis, other specified sites,Pathologic fracture of other specified site,Acute posthemorrhagic anemia,Pneumonia due to Pseudomonas,Other specified diseases of the jaws,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx'}

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 77-year-old female with a past medical history significant for squamous cell carcinoma of the mouth with T2 N0 staging, status post interstitial catheter placement in [**2188-7-18**] for brachy therapy for recurrent cancer, status post resection, now presenting with postoperative osteoradionecrosis of the mandible which had previously been treated with 30 sessions with hyperbaric oxygen. MEDICAL HISTORY: Past Medical History significant for hypothyroidism and reflux disease. MEDICATION ON ADMISSION: Medications included Levoxyl. ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Acute osteomyelitis, other specified sites,Pathologic fracture of other specified site,Acute posthemorrhagic anemia,Pneumonia due to Pseudomonas,Other specified diseases of the jaws,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx'}

CHIEF COMPLAINT: Fevers PRESENT ILLNESS: Mr. [**Known lastname 57203**] is a 50 yo male with metastatic cholangiocarcinoma who p/w fever and elevated bilirubin level. Last week he reports that he had a temp to 102.3 and again last night to ~101. He tells us he had a temperature last Wed of 102.4 along with a sinus headache with no other associated symptoms. He took Tylenol and felt better the next day. He did not call with the temperature. He reports that last night "I felt hot all over." He has had recurrent episodes of dry heaves which he attributes to the chemotherapy. He has had alternating constipation and diarrhea recently. He denies any abdominal pain. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. Laminectomy secondary to ruptured disc in [**2173**] 2. Chronic low back pain . ONCOLOGIC HISTORY: He was in his usual state of health until [**10/2186**] when he experienced the onset of headache with associated diarrhea, chalky-white stools, sinus tenderness, nausea, and dark urine. Ultrasound followed by CT scan showed a soft tissue mass at the confluence of biliary duct. ERCP and MRCP showed dilation of the intrahepatic bile duct, which extended from the common hepatic duct to the bifurcation. This presentation was felt to be most consistent with cholangiocarcinoma. Mr. [**Known lastname 57203**] was then transferred to [**Hospital3 14659**] where he underwent en bloc right hepatectomy, cholecystectomy, resection of extrahepatic bile ducts, regional lymph node dissection and Roux-en-Y hepatic jejunostomy. Postoperatively, he recovered well. Pathology revealed no positive lymph nodes, 10 were sampled. The tumor measured 2.4 x 2.3 x 2.0 cm and was grade [**12-30**] cholangiocarcinoma with extension to the liver and periductal structures including the source of the gallbladder. The procedure was uncomplicated with the exception of a bilateral chylous pleural effusion. His postoperative CA [**99**]-9 decreased to 120, however, by [**4-/2187**] it had increased to 812 and by [**Month (only) 216**] it was 15,999. He had multiple PET/CT scans, which showed stable appearance of pulmonary nodules that were not FDG avid. However, his most recent PET scan showed findings that were consistent with metastatic cholangiocarcinoma and local site recurrence in the surgical bed. In light of disease recurrence in this young patient, it was decided to proceed with treatment and he was started on a clinical trial 05-349 and received bevacizumab, gemcitabine, and oxaliplatin. To date, he has received 8 full cycles. His interval CT scan after cycle #4 showed evidence of stable disease that was confirmed by a follow up CT scan one month later. His CA [**99**]-9 was last 6964 on [**2188-3-13**]. MEDICATION ON ADMISSION: OxyContin 30 mg PO qAM Vicodin [**11-27**] pills every 4 hours as needed for pain Ativan .5 mg take every 4-6 hours PRN nausea Compazine 10 mg take every 6-8 hours PRN nausea Zofran 8 mg twice a day as necessary PRN nausea Protonix 40 mg every day Norvasc 10 mg every day Emend 125 mg Day 1 of chemo, Day 2 80 mg ,Day 3 80 mg Decadron 8 mg twice a day starting Day 2 after chemo to Day 5 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: No apparent distress. Karnofsky performance status equals 90. ECOG performance status equals 1. Vital Signs: Blood Pressure: 138/98, Heart Rate: 76, Weight: 177.4 Lbs, BMI: 25.5 kg/m2, Temperature: 97.2, Resp. Rate: 16, O2 Saturation%: 98. LYMPHATICS: No epitrochlear, occipital, submandibular, axillary or supraclavicular [**Doctor First Name **]. HEENT: Normocephalic, atraumatic. No icterus, no tonsillar erythema or exudate. Sclerae are clear. NECK: Supple. No lymphadenopathy, no JVD, no thyromegaly. CHEST: Moving air comfortably. Clear to auscultation bilaterally. Decreased breath sounds, right base. No wheezes, rhonchi, or rales. CARDIOVASCULAR: S1, S2, normal intensity. No murmurs, rubs, or gallops. ABDOMEN: Positive bowel sounds, soft, nontender, nondistended, no palpable masses. Well-healed midline scar from umbilicus to epigastrium. Mild tenderness to palpation along the scar. No RUQ tenderness No splenomegaly EXTREMITIES: Warm, well perfused. No lower extremity edema, no calf tenderness. FAMILY HISTORY: He has an elder sister and a younger brother both who are in excellent health. Both his parents are alive; however, his mom has had myocardial infarction and is obese. His paternal grandfather died of a myocardial infarction. His paternal grandmother died of myocardial infarction. His maternal grandfather of died of MI and his maternal grandmother is still alive with [**Name (NI) 2481**] disease and is currently age 86. SOCIAL HISTORY: The patient grew up in [**State 2690**]. He has been in the Marine Corps x 25 years and is currently at the Naval War College in [**Location (un) 7188**], RI. He is married. He has 3 children, 2 children that are teenagers and one daughter with a grandchild. He is a lifelong nonsmoker and nondrinker.

Cholangitis,Malignant neoplasm of intrahepatic bile ducts,Secondary malignant neoplasm of skin,Malignant neoplasm of liver, secondary,Disruption of external operation (surgical) wound,Iron deficiency anemia secondary to blood loss (chronic),Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Unspecified protein-calorie malnutrition,Unspecified essential hypertension

Cholangitis,Mal neo intrahepat ducts,Secondary malig neo skin,Second malig neo liver,Disrup-external op wound,Chr blood loss anemia,Food/vomit pneumonitis,Paralytic ileus,Protein-cal malnutr NOS,Hypertension NOS

Admission Date: [**2188-3-27**] Discharge Date: [**2188-5-8**] Date of Birth: [**2137-9-10**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 148**] Chief Complaint: Fevers Major Surgical or Invasive Procedure: ERCP Exploratory Laparotomy Revision Roux Limb Entero-enterostomy x 2 Repair of Abdominal Wall, Wound Dehiscence PICC line VAC History of Present Illness: Mr. [**Known lastname 57203**] is a 50 yo male with metastatic cholangiocarcinoma who p/w fever and elevated bilirubin level. Last week he reports that he had a temp to 102.3 and again last night to ~101. He tells us he had a temperature last Wed of 102.4 along with a sinus headache with no other associated symptoms. He took Tylenol and felt better the next day. He did not call with the temperature. He reports that last night "I felt hot all over." He has had recurrent episodes of dry heaves which he attributes to the chemotherapy. He has had alternating constipation and diarrhea recently. He denies any abdominal pain. Past Medical History: PAST MEDICAL HISTORY: 1. Laminectomy secondary to ruptured disc in [**2173**] 2. Chronic low back pain . ONCOLOGIC HISTORY: He was in his usual state of health until [**10/2186**] when he experienced the onset of headache with associated diarrhea, chalky-white stools, sinus tenderness, nausea, and dark urine. Ultrasound followed by CT scan showed a soft tissue mass at the confluence of biliary duct. ERCP and MRCP showed dilation of the intrahepatic bile duct, which extended from the common hepatic duct to the bifurcation. This presentation was felt to be most consistent with cholangiocarcinoma. Mr. [**Known lastname 57203**] was then transferred to [**Hospital3 14659**] where he underwent en bloc right hepatectomy, cholecystectomy, resection of extrahepatic bile ducts, regional lymph node dissection and Roux-en-Y hepatic jejunostomy. Postoperatively, he recovered well. Pathology revealed no positive lymph nodes, 10 were sampled. The tumor measured 2.4 x 2.3 x 2.0 cm and was grade [**12-30**] cholangiocarcinoma with extension to the liver and periductal structures including the source of the gallbladder. The procedure was uncomplicated with the exception of a bilateral chylous pleural effusion. His postoperative CA [**99**]-9 decreased to 120, however, by [**4-/2187**] it had increased to 812 and by [**Month (only) 216**] it was 15,999. He had multiple PET/CT scans, which showed stable appearance of pulmonary nodules that were not FDG avid. However, his most recent PET scan showed findings that were consistent with metastatic cholangiocarcinoma and local site recurrence in the surgical bed. In light of disease recurrence in this young patient, it was decided to proceed with treatment and he was started on a clinical trial 05-349 and received bevacizumab, gemcitabine, and oxaliplatin. To date, he has received 8 full cycles. His interval CT scan after cycle #4 showed evidence of stable disease that was confirmed by a follow up CT scan one month later. His CA [**99**]-9 was last 6964 on [**2188-3-13**]. Social History: The patient grew up in [**State 2690**]. He has been in the Marine Corps x 25 years and is currently at the Naval War College in [**Location (un) 7188**], RI. He is married. He has 3 children, 2 children that are teenagers and one daughter with a grandchild. He is a lifelong nonsmoker and nondrinker. Family History: He has an elder sister and a younger brother both who are in excellent health. Both his parents are alive; however, his mom has had myocardial infarction and is obese. His paternal grandfather died of a myocardial infarction. His paternal grandmother died of myocardial infarction. His maternal grandfather of died of MI and his maternal grandmother is still alive with [**Name (NI) 2481**] disease and is currently age 86. Physical Exam: GENERAL: No apparent distress. Karnofsky performance status equals 90. ECOG performance status equals 1. Vital Signs: Blood Pressure: 138/98, Heart Rate: 76, Weight: 177.4 Lbs, BMI: 25.5 kg/m2, Temperature: 97.2, Resp. Rate: 16, O2 Saturation%: 98. LYMPHATICS: No epitrochlear, occipital, submandibular, axillary or supraclavicular [**Doctor First Name **]. HEENT: Normocephalic, atraumatic. No icterus, no tonsillar erythema or exudate. Sclerae are clear. NECK: Supple. No lymphadenopathy, no JVD, no thyromegaly. CHEST: Moving air comfortably. Clear to auscultation bilaterally. Decreased breath sounds, right base. No wheezes, rhonchi, or rales. CARDIOVASCULAR: S1, S2, normal intensity. No murmurs, rubs, or gallops. ABDOMEN: Positive bowel sounds, soft, nontender, nondistended, no palpable masses. Well-healed midline scar from umbilicus to epigastrium. Mild tenderness to palpation along the scar. No RUQ tenderness No splenomegaly EXTREMITIES: Warm, well perfused. No lower extremity edema, no calf tenderness. Pertinent Results: CT C/A/P [**2188-3-27**]: 1. Afferent loop syndrome with dilatation of the afferent loop up to 4.4 cm until a transition point at the Roux-en-Y anastomosis. This obstruction may be due to stricture/inflammation at the anastomotic site or adhesions from prior surgery. 2. Stable appearance to multiple post-surgical changes including ill-defined soft tissue in the surgical bed and nodularity along the mid anterior abdominal wall. 3. Perirectal soft tissue prominence most likely due to lack of distention. To better evaluate this lesion, recommend contrast on future CT torso, with water or barium, to fully distend the rectal vault. 4. Stable small right pleural effusion and right lower lobe soft tissue lesion. . [**2188-4-5**] 04:13AM BLOOD WBC-11.5* RBC-3.41* Hgb-11.2* Hct-34.1* MCV-100* MCH-32.9* MCHC-32.8 RDW-17.7* Plt Ct-470* [**2188-4-7**] 06:00AM BLOOD Glucose-103 UreaN-6 Creat-0.4* Na-133 K-4.1 Cl-102 HCO3-26 AnGap-9 [**2188-4-1**] 05:40AM BLOOD ALT-100* AST-83* AlkPhos-735* TotBili-2.8* [**2188-4-5**] 04:13AM BLOOD Calcium-8.7 Phos-3.4 Mg-1.7 Test Result Reference Range/Units CA [**99**]-9 4216 H 0-37 SEE NOTE . ABDOMEN (SUPINE & ERECT) [**2188-4-30**] 10:42 AM [**Hospital 93**] MEDICAL CONDITION: 50 year old man s/p entero-enterostomy X 2 and s/p wound exploration and re-closure with retention sutures SUPINE AND ERECT ABDOMEN: No abnormally dilated loops of bowel are seen and gas is noted throughout much of the colon with gas and stool in the rectum. Multiple nonspecific small bowel air fluid levels are identified on the decubitus view. There is no evidence of free air. Surrounding osseous structures are unremarkable. IMPRESSION: Multiple small bowel air fluid levels may suggest ileus without evidence of obstruction. [**2188-5-3**] 08:07AM BLOOD WBC-11.0# RBC-2.61*# Hgb-8.1*# Hct-26.2* MCV-100*# MCH-31.1 MCHC-31.0 RDW-17.7* Plt Ct-578* [**2188-5-3**] 05:31AM BLOOD WBC-7.2 RBC-1.94*# Hgb-6.1*# Hct-21.2* MCV-109*# MCH-31.2 MCHC-28.6*# RDW-18.1* Plt Ct-436 [**2188-5-7**] 05:01AM BLOOD Glucose-117* UreaN-15 Creat-0.4* Na-134 K-4.0 Cl-105 HCO3-25 AnGap-8 [**2188-5-6**] 12:54AM BLOOD Glucose-105 UreaN-13 Creat-0.3* Na-134 K-3.9 Cl-103 HCO3-25 AnGap-10 [**2188-4-27**] 01:00AM BLOOD ALT-49* AST-60* LD(LDH)-177 AlkPhos-388* TotBili-0.7 [**2188-4-26**] 03:18AM BLOOD ALT-44* AST-66* AlkPhos-390* TotBili-0.7 [**2188-4-23**] 02:07AM BLOOD Lipase-55 [**2188-4-20**] 03:50AM BLOOD Lipase-31 [**2188-5-7**] 05:01AM BLOOD Calcium-8.0* Phos-3.3 Mg-1.9 [**2188-4-14**] 05:00AM BLOOD calTIBC-137* Ferritn-371 TRF-105* [**2188-5-5**] 04:43AM BLOOD Triglyc-97 . CTA CHEST W&W/O C&RECONS, NON-CORONARY [**2188-4-17**] 3:39 PM IMPRESSION: 1. No evidence of pulmonary embolism. 2. New, widespread multifocal dense ground-glass opacities, predominantly within the right lung. While this appearance could be consistent with asymmetric pulmonary edema, no secondary sign of volume overload is seen. Infectious processes should be considered, including bacterial pneumomonia as well as opportunistic pathogens such as PCP, [**Name10 (NameIs) **] this patient receiving chemotherapy. 3. Unchanged appearance of the anterior abdominal wall, with abnormalities related to previous wound dehiscence, and continued evidence of small foci of air, fluid, and abnormally enhancing tissue, which may represent inflammatory change or, possibly, metastatic seeding of incision tract. 4. Diffuse anasarca, ascites, and small right pleural effusion. . CT ABDOMEN W/CONTRAST [**2188-4-11**] 12:47 PM IMPRESSION: 1. No clear evidence of adhesion of bowel to anterior abdominal wall, as clinically questioned. Cannot confirm that the anterior peritoneal wall is intact in this patient with history of wound dehiscence and subsequent repair. 2. Interval resolution of previous small-bowel obstruction. 3. Anasarca, ascites, and massive scrotal edema. 4. Moderate right pleural effusion with interval increase in size. . Pathology Examination Name Birthdate Age Sex Pathology # [**Hospital1 18**] [**Known lastname 69548**],[**Known firstname 396**] LORRY [**2137-9-10**] 50 Male [**Numeric Identifier 69549**] [**Numeric Identifier 69550**] Report to: DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] Gross Description by: DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] GOODELL/mtd SPECIMEN SUBMITTED: ABDOMINAL WALL FASCIA. Procedure date Tissue received Report Date Diagnosed by [**2188-4-4**] [**2188-4-5**] [**2188-4-9**] DR. [**Last Name (STitle) **]. [**Doctor Last Name **]/cma?????? DIAGNOSIS: Abdominal wall fascia: Well-differentiated invasive adenocarcinoma; . . Brief Hospital Course: A/P: Mr. [**Known lastname 57203**] is a 50 yo male with metastatic cholangiocarcinoma who presents with fevers and elevated bilirubin . 1) Hyperbilirubinemia: Concerning for biliary obstruction due to stricture vs. tumor progression. Fevers and elevated WBC (11.5 today, up for ~5 previously) raises concern for ascending cholangitis; will start Zosyn empirically. -f/u abd CT (RUQ unlikely useful d/t anatomy) -contact GI/ERCP for possible stent placement -blood cultures x 2 . 2) Metastatic cholangiocarcinoma: He is currently enrolled in Phase II trial of Gemcitabine, Oxaliplatin in combination with Bevacizumab, protocol #05-349. This is cycle 9 Day 1. - Hold further chemotherapy until acute illness resolved - Anti-emetics PRN . 3) Pain control: Continue his current regimen of Oxycontin 30 mg qAM. Will discontinue PRN vicodin given the acetaminophen component in the setting of elevated transaminases. . 4) HTN: Continue Norvasc. . 5) Prophylaxis: Continue PPI per home regimen. Ambulation as DVT prophylaxis. . 6) FEN: Regular diet. NPO after midnight. . 7) Code status: Full code. = = = = = = = = = = = = = = = = = = = = ================================================================ He was admitted to surgery after an ERCP in which they were unable to relieve obstruction with stent placement. He went to the OR on [**3-31**] with a diagnosis of: 1. Cholangiocarcinoma. 2. Obstructed Roux-en-Y limb causing cholangitis. 3. Obstruction from Roux limb from metastatic cancer. NAME OF OPERATION: 1. Exploratory laparotomy. 2. Revision of Roux-en-Y anastomosis with 2 enteroenterostomies. Pain:He had a PCA and epidural for pain control and was having much pain. Toradol was added and he seemed better. After getting his pain under control, he was doing quite well and able to get up and ambulate. After the take back to the OR, he continued to use his PCA for pain control. Pain control continued to be an issue and it took some time to wean him from his PCA. Motrin 800mg q6h was also added. We consulted Chronic Pain and we added Tizantidine 4 tid and then transitioned him to PO Dilaudid. GI/ABD: He was NPO with IVF. His abdomen was intact and dry initially. His Post-operative course was complicated by a wound dehiscence requiring a return to the OR for abdominal wound repair. On Friday evening, he began gushing salmon colored fluid from his drain and required take back to the OR on [**4-5**] for wound exploration and re-closure with retention sutures. His abdomen was C/D/I with retention sutures in place. The edges were well approximated. He was allowed sips of clears. We advanced his diet slowly and he was tolerating rgeulat food on POD [**7-30**]. His drain was D/C on POD [**7-30**]. He continued to drain from the drain site and an ostomy appliance was attached. His staple line was intact, with a minimal amount of spotty drainage at the midpoint. = = = = = = = = = = = = = = = = = = ================================================================ On the early morning of [**2188-4-16**], he had acute desaturation, was found to be hypoxic with a O2 sat in the 60%'s and HR of 140. and a fever to 102. His Abd wound explored at bedside, salmon-colored fluid draining. His Pathology of Abdominal wall fascia: Well-diffn invasive adenocarcinoma. He was transferred to the the ICU and was placed on a 100% non-rebreather facemask. His WBC was 37K, His HCT fell to 22.7, he was hyponatremic with Na 132, BUN 23, Cr 1.3, and cTrop rose to .11, and he was oliguric. He was not looking good and we discussed code status with the patient and his wife given his metastatic cancer and abitlity to recover from this event. The patient and family wanted us to do everything possible. He did recover somewhat the next day and began to make urine. He receive PRBC for his blood loss anemia. He was still requiring O2 by facemask. The wound was held together with retention sutures and several staples were removed and the site was packed with gauze. His abdomen was likely not going to heal with the widespread cancer in his abdomen. We were able to obtain a CT on [**4-17**], once his Cr had recovered, to assess for a PE. He was intubated for the CT. He remained intubated for several days. Pneumonia: The CT showed no evidence of a PE, but he likely aspirated and developed multifocal pneumonia: RUL, RML, LUL. Centrilobular ground glass appearance suggestive of atypical infection. Remained intubated for many days with fever. On [**4-24**] extubated. Now weaned to 4L N/C. Has received 9 days (approx) of Vanco/[**Last Name (un) **]/Fluc. Fluc was stopped after 9 days Cont. Vanco/[**Last Name (un) **] to complete [**9-7**] days. Micro: [**4-16**] Abd wound: coag neg staph - sparse; ANAEROBIC: BACTEROIDES FRAGILIS - mod, beta lact positive 5/26,[**4-21**] Sput: sparse yeast [**4-24**]: Extubated, 6 [**4-18**]: Bronched; hypotension responsive to fluid boluses (x2) [**4-20**]: tube feeds started, JP fluid replaced 1/2 cc:cc [**4-23**]: TF w/ 1.5g protein, 30 kcal/kg; TPN stopped [**4-24**] Extubated [**4-25**] : passed speech and swallow He remained in the ICU for several days and made it out to the floor on [**2188-4-27**]. Once on the floor, he continued to do well. He was eating and drinking and PT worked with him to ambulate. He was deconditioned after his prolonged ICU stay. He was motivated to rehab and get OOB. . Pain Management: Palative care was consulted for help with pain manageent. He was being treated with Fentanyl patch, Dilaudid, Tizanidine, Neurontin. . GI: On [**4-30**], HD 35, he was more distended, yet still reporting +flatus. He was made NPO and started on IVF. A KUB was ordered and showed air fluid levels suggestive of an ileus. He received a suppository for a post-op Ileus. He was kept NPO for 2 days and then restarted on a diet. He had slightly less distension and reported +BM and +flatus. He was only tolerating small amounts of food and contiued to need antiemetics. He was started on TPN and this was then cycled. . A wound VAC was placed on his abdomen and was helping to keep him dry. He will require VAC change q2d. His retension sutures remained in place. There was skin breakdown around each retension suture. He was having some fluid drainage near the inferior portion of the wound. He continued to have near 2 liters of clear, ascitic fluid draining from the wound. VAC changes required Aquacell dressing under each retention suture, Adaptic dressing covering each retention suture, Adaptic dressing within the opening against the fascia, stoma adhesive around the inferior midline site and around the drain site in the LLQ. Then black sponge to the three sites mentioned above. The skin around the retention sutures was breaking down and macerated. Hyponatremia: He required salt tabs for hyponatremia. Hypovolemia: He was requiring Albumin for low vascular volume and for his ascities. Edema: He had +[**12-29**] lower extremity edema and excessive scrotal swelling. Medications on Admission: OxyContin 30 mg PO qAM Vicodin [**11-27**] pills every 4 hours as needed for pain Ativan .5 mg take every 4-6 hours PRN nausea Compazine 10 mg take every 6-8 hours PRN nausea Zofran 8 mg twice a day as necessary PRN nausea Protonix 40 mg every day Norvasc 10 mg every day Emend 125 mg Day 1 of chemo, Day 2 80 mg ,Day 3 80 mg Decadron 8 mg twice a day starting Day 2 after chemo to Day 5 Discharge Medications: 1. Dilaudid-5 1 mg/mL Liquid [**Month/Day (2) **]: 20-25 mg PO q2-3 hours as needed for pain. Disp:*1500 mL* Refills:*0* 2. Docusate Sodium 100 mg Capsule [**Month/Day (2) **]: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Tizanidine 2 mg Tablet [**Month/Day (2) **]: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 4. Senna 8.6 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*60 Tablet(s)* Refills:*2* 5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Month/Day (2) **]: One (1) Adhesive Patch, Medicated Topical HS (at bedtime): Apply to Intact Skin. On for 12 hours, then off for 12 hours. Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2* 6. Mirtazapine 15 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO HS (at bedtime) as needed for insomnia. Disp:*30 Tablet(s)* Refills:*0* 7. Acetaminophen 325 mg Tablet [**Month/Day (2) **]: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever. Tablet(s) 8. Metoprolol Tartrate 25 mg Tablet [**Month/Day (2) **]: 0.5 Tablet PO TID (3 times a day). Disp:*45 Tablet(s)* Refills:*2* 9. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). Disp:*30 Tablet,Rapid Dissolve, DR(s)* Refills:*2* 10. Ferrous Sulfate 325 (65) mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Gabapentin 250 mg/5 mL Solution [**Last Name (STitle) **]: Ten (10) mL PO Q8H (every 8 hours). Disp:*qs mL* Refills:*2* 12. Sodium Chloride 1 g Tablet [**Last Name (STitle) **]: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 13. Prochlorperazine 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H (every 6 hours) as needed. Disp:*90 Tablet(s)* Refills:*0* 14. Metoclopramide 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). Disp:*120 Tablet(s)* Refills:*2* 15. Bisacodyl 10 mg Suppository [**Last Name (STitle) **]: One (1) Suppository Rectal HS (at bedtime) as needed. Disp:*30 Suppository(s)* Refills:*0* 16. Fentanyl 100 mcg/hr Patch 72 hr [**Last Name (STitle) **]: Two (2) Transdermal Q72H (every 72 hours). Disp:*30 * Refills:*2* 17. Spironolactone 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 18. Simethicone 80 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable PO QID (4 times a day) as needed for Gas. Disp:*120 Tablet, Chewable(s)* Refills:*0* 19. Ondansetron HCl (PF) 4 mg/2 mL Solution [**Last Name (STitle) **]: One (1) Injection Q6H (every 6 hours). Disp:*120 * Refills:*2* 20. Heparin Lock Flush (Porcine) 100 unit/mL Syringe [**Last Name (STitle) **]: Two (2) ML Intravenous DAILY (Daily) as needed: After TPN and when Hep locking. Disp:*90 ML(s)* Refills:*0* 21. Sodium Chloride 0.9 % 0.9 % Syringe [**Last Name (STitle) **]: Ten (10) mL Injection four times a day: Before and After meds and TPN. Disp:*300 * Refills:*2* 22. Outpatient Lab Work Weekly Chem 10, CBC. 23. PICC PICC line care per protocol Discharge Disposition: Home With Service Facility: VNS of RI Discharge Diagnosis: Obstructed Roux Limb Wound Dehiscence Metastatic cholangioCA hypoxia/tachycardia. Lower BAck Pain Aspiration Pneumonia R pleural effusion Malnutrition Post-op Ileus Discharge Condition: Poor Incision with VAC Tolerating minimal PO diet TPN Discharge Instructions: Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomitting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomitting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your skin, or the whites of your eyes become yellow. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. . Please take any new meds as ordered. . Continue to ambulate several times per day. . Continue with VAC change twice/week. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) **] in [**1-27**] weeks. Call ([**Telephone/Fax (1) 15807**] to schedule an appointment. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD Phone:[**0-0-**] Provider: [**First Name11 (Name Pattern1) 14497**] [**Last Name (NamePattern1) 25880**], MD Phone:[**Telephone/Fax (1) 22**] Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], RN Phone:[**Telephone/Fax (1) 3241**] Completed by:[**2188-5-8**]

576,155,198,197,998,280,507,560,263,401

{'Cholangitis,Malignant neoplasm of intrahepatic bile ducts,Secondary malignant neoplasm of skin,Malignant neoplasm of liver, secondary,Disruption of external operation (surgical) wound,Iron deficiency anemia secondary to blood loss (chronic),Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Unspecified protein-calorie malnutrition,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: Fevers PRESENT ILLNESS: Mr. [**Known lastname 57203**] is a 50 yo male with metastatic cholangiocarcinoma who p/w fever and elevated bilirubin level. Last week he reports that he had a temp to 102.3 and again last night to ~101. He tells us he had a temperature last Wed of 102.4 along with a sinus headache with no other associated symptoms. He took Tylenol and felt better the next day. He did not call with the temperature. He reports that last night "I felt hot all over." He has had recurrent episodes of dry heaves which he attributes to the chemotherapy. He has had alternating constipation and diarrhea recently. He denies any abdominal pain. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. Laminectomy secondary to ruptured disc in [**2173**] 2. Chronic low back pain . ONCOLOGIC HISTORY: He was in his usual state of health until [**10/2186**] when he experienced the onset of headache with associated diarrhea, chalky-white stools, sinus tenderness, nausea, and dark urine. Ultrasound followed by CT scan showed a soft tissue mass at the confluence of biliary duct. ERCP and MRCP showed dilation of the intrahepatic bile duct, which extended from the common hepatic duct to the bifurcation. This presentation was felt to be most consistent with cholangiocarcinoma. Mr. [**Known lastname 57203**] was then transferred to [**Hospital3 14659**] where he underwent en bloc right hepatectomy, cholecystectomy, resection of extrahepatic bile ducts, regional lymph node dissection and Roux-en-Y hepatic jejunostomy. Postoperatively, he recovered well. Pathology revealed no positive lymph nodes, 10 were sampled. The tumor measured 2.4 x 2.3 x 2.0 cm and was grade [**12-30**] cholangiocarcinoma with extension to the liver and periductal structures including the source of the gallbladder. The procedure was uncomplicated with the exception of a bilateral chylous pleural effusion. His postoperative CA [**99**]-9 decreased to 120, however, by [**4-/2187**] it had increased to 812 and by [**Month (only) 216**] it was 15,999. He had multiple PET/CT scans, which showed stable appearance of pulmonary nodules that were not FDG avid. However, his most recent PET scan showed findings that were consistent with metastatic cholangiocarcinoma and local site recurrence in the surgical bed. In light of disease recurrence in this young patient, it was decided to proceed with treatment and he was started on a clinical trial 05-349 and received bevacizumab, gemcitabine, and oxaliplatin. To date, he has received 8 full cycles. His interval CT scan after cycle #4 showed evidence of stable disease that was confirmed by a follow up CT scan one month later. His CA [**99**]-9 was last 6964 on [**2188-3-13**]. MEDICATION ON ADMISSION: OxyContin 30 mg PO qAM Vicodin [**11-27**] pills every 4 hours as needed for pain Ativan .5 mg take every 4-6 hours PRN nausea Compazine 10 mg take every 6-8 hours PRN nausea Zofran 8 mg twice a day as necessary PRN nausea Protonix 40 mg every day Norvasc 10 mg every day Emend 125 mg Day 1 of chemo, Day 2 80 mg ,Day 3 80 mg Decadron 8 mg twice a day starting Day 2 after chemo to Day 5 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: No apparent distress. Karnofsky performance status equals 90. ECOG performance status equals 1. Vital Signs: Blood Pressure: 138/98, Heart Rate: 76, Weight: 177.4 Lbs, BMI: 25.5 kg/m2, Temperature: 97.2, Resp. Rate: 16, O2 Saturation%: 98. LYMPHATICS: No epitrochlear, occipital, submandibular, axillary or supraclavicular [**Doctor First Name **]. HEENT: Normocephalic, atraumatic. No icterus, no tonsillar erythema or exudate. Sclerae are clear. NECK: Supple. No lymphadenopathy, no JVD, no thyromegaly. CHEST: Moving air comfortably. Clear to auscultation bilaterally. Decreased breath sounds, right base. No wheezes, rhonchi, or rales. CARDIOVASCULAR: S1, S2, normal intensity. No murmurs, rubs, or gallops. ABDOMEN: Positive bowel sounds, soft, nontender, nondistended, no palpable masses. Well-healed midline scar from umbilicus to epigastrium. Mild tenderness to palpation along the scar. No RUQ tenderness No splenomegaly EXTREMITIES: Warm, well perfused. No lower extremity edema, no calf tenderness. FAMILY HISTORY: He has an elder sister and a younger brother both who are in excellent health. Both his parents are alive; however, his mom has had myocardial infarction and is obese. His paternal grandfather died of a myocardial infarction. His paternal grandmother died of myocardial infarction. His maternal grandfather of died of MI and his maternal grandmother is still alive with [**Name (NI) 2481**] disease and is currently age 86. SOCIAL HISTORY: The patient grew up in [**State 2690**]. He has been in the Marine Corps x 25 years and is currently at the Naval War College in [**Location (un) 7188**], RI. He is married. He has 3 children, 2 children that are teenagers and one daughter with a grandchild. He is a lifelong nonsmoker and nondrinker. ### Response: {'Cholangitis,Malignant neoplasm of intrahepatic bile ducts,Secondary malignant neoplasm of skin,Malignant neoplasm of liver, secondary,Disruption of external operation (surgical) wound,Iron deficiency anemia secondary to blood loss (chronic),Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Unspecified protein-calorie malnutrition,Unspecified essential hypertension'}

CHIEF COMPLAINT: Aortic stenosis/ regurgitation PRESENT ILLNESS: This 86 year old white female has known aortic stenosis with progressive dyspnea on exertion and fatigue over 7 months. She has previously undergone catheterization to demonstrate clean coronaries, despite a prior anterior infaction in [**2173**]. She is admitted now for valve replacement. MEDICAL HISTORY: Coronary artery disease s/p AMI '[**73**] Ischemic cardiomyopathy (EF 35-40%) Aortic stenosis/insufficiency Hypertension Hyperlipidemia Diverticulitis Past Surgical History: Right hip replacement s/p fracture(MVA)'[**78**] Bowel resection(diverticular dz)-'[**72**] Incisional hernia repair '[**73**] Bilat cataract removal Ovarian cyst removal MEDICATION ON ADMISSION: Metoprolol ER 25 daily Simvastatin 40 daily Zetia 10 daily NTG-sl-prn Aspirin 325 daily Diovan 320 daily Fish Oil Vitamin E 400IU daily Vitamin D 500mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 54 Resp: 16 O2 sat: 98%-RA B/P Right: 160/72 Left: Height: 65 in Weight: 176 lbs FAMILY HISTORY: non-contributory SOCIAL HISTORY: Race: Caucasian Last Dental Exam: 1 month ago Lives with: Husband Occupation: Retired college professor/[**Male First Name (un) **]-Education([**University/College **]) Tobacco:Quit 40 yrs ago, previously smoked 1ppwk x20yrs ETOH:1 drink every other month

Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Hip joint replacement,Acquired absence of intestine (large) (small),Personal history of tobacco use,Other and unspecified angina pectoris

Aortic valve disorder,Crnry athrscl natve vssl,Fluid overload NEC,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Old myocardial infarct,Joint replaced hip,Acquire absnce intestine,History of tobacco use,Angina pectoris NEC/NOS

Admission Date: [**2190-10-20**] Discharge Date: [**2190-10-25**] Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Aortic stenosis/ regurgitation Major Surgical or Invasive Procedure: aortic valve replacement (21mm St. [**Male First Name (un) 923**] porcine) [**2190-10-20**] History of Present Illness: This 86 year old white female has known aortic stenosis with progressive dyspnea on exertion and fatigue over 7 months. She has previously undergone catheterization to demonstrate clean coronaries, despite a prior anterior infaction in [**2173**]. She is admitted now for valve replacement. Past Medical History: Coronary artery disease s/p AMI '[**73**] Ischemic cardiomyopathy (EF 35-40%) Aortic stenosis/insufficiency Hypertension Hyperlipidemia Diverticulitis Past Surgical History: Right hip replacement s/p fracture(MVA)'[**78**] Bowel resection(diverticular dz)-'[**72**] Incisional hernia repair '[**73**] Bilat cataract removal Ovarian cyst removal Social History: Race: Caucasian Last Dental Exam: 1 month ago Lives with: Husband Occupation: Retired college professor/[**Male First Name (un) **]-Education([**University/College **]) Tobacco:Quit 40 yrs ago, previously smoked 1ppwk x20yrs ETOH:1 drink every other month Family History: non-contributory Physical Exam: Pulse: 54 Resp: 16 O2 sat: 98%-RA B/P Right: 160/72 Left: Height: 65 in Weight: 176 lbs General: Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] MMM, normal oropharynx Neck: Supple [x] Full ROM [x], no JVD or lymphadenopathy Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur: [**2-20**] blowing murmur Abdomen: Soft[x] non-distended[x] non-tender [x] +bowel sounds[x] Extremities: Warm [x], well-perfused [x] Edema: none Varicosities: minimal Neuro: Grossly intact, A&O x3-MAE, nonfocal exam Pulses: Femoral Right: 2+ Left: 2+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 1+ Left: 1+ Radial Right: 2+ Left: 2+ Carotid Bruit: radiated murmur Right: Left: Pertinent Results: [**2190-10-22**] 02:10AM BLOOD WBC-13.1* RBC-3.41* Hgb-10.1* Hct-30.2* MCV-89 MCH-29.7 MCHC-33.4 RDW-14.4 Plt Ct-126* [**2190-10-24**] 06:20AM BLOOD Na-135 K-4.5 Cl-101 [**2190-10-23**] 06:40AM BLOOD WBC-10.0 RBC-3.32* Hgb-9.9* Hct-29.6* MCV-89 MCH-29.9 MCHC-33.5 RDW-14.0 Plt Ct-122* [**2190-10-20**] 12:30PM BLOOD WBC-6.9 RBC-2.57*# Hgb-7.7*# Hct-22.4*# MCV-87 MCH-29.9 MCHC-34.2 RDW-13.4 Plt Ct-122*# [**2190-10-23**] 06:40AM BLOOD Glucose-113* UreaN-26* Creat-1.1 Na-138 K-4.2 Cl-103 HCO3-28 AnGap-11 [**2190-10-20**] 01:35PM BLOOD UreaN-10 Creat-0.7 Na-141 K-4.3 Cl-115* HCO3-22 AnGap-8 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 87732**] (Complete) Done [**2190-10-20**] at 11:46:35 AM FINAL 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: [**2103-12-5**] Age (years): 86 F Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: AVR ICD-9 Codes: 786.05, 786.51, 424.1, 424.0 Test Information Date/Time: [**2190-10-20**] at 11:46 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2010AW-1: Machine: [**Doctor Last Name **] Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Inferolateral Thickness: 1.1 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: *6.0 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 45% to 50% >= 55% Aortic Valve - Peak Gradient: *56 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 35 mm Hg Aortic Valve - Valve Area: *0.6 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. LEFT VENTRICLE: Mildly depressed LVEF. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending aorta diameter. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: ?# aortic valve leaflets. Severely thickened/deformed aortic valve leaflets. Critical AS (area <0.8cm2). Moderate (2+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) MR. TRICUSPID VALVE: Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: 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. The TEE probe was passed with assistance from the anesthesioology staff using a laryngoscope. No TEE related complications. Conclusions Pre-CPB: No spontaneous echo contrast is seen in the left atrial appendage. Overall left ventricular systolic function is mildly depressed (LVEF= 45 - 50 %). Right ventricular chamber size and free wall motion are normal. There are complex (>4mm) atheroma in the descending thoracic aorta. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are severely thickened/deformed. There is critical aortic valve stenosis (valve area <0.8cm2). Moderate (2+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. Post-CPB: The patient is A-Paced, on no inotropes. Preserved biventricular systolic fxn. There is a prosthetic aortic valve with no leak and no regurgitation. Mean residual gradient = 10 mmHg. No MR. [**First Name (Titles) **] [**Last Name (Titles) **]. Aorta intact. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2190-10-20**] 13:01 Brief Hospital Course: Following admission she went to the Operating Room where aortic valve replacement was undertaken. She operative note for details. She weaned from bypass easily on Propofol alone. She awoke anxious but intact, requiring nitroglycerin intravenously for BP control. She was extubated on POD 1 and oral agents (Valsartan and Lopressor). Diuresis towards her preoperative weight was begun and she transferred to the floor on POD 2. Physical Therapy worked with her for strength and mobility. CTs and temporary pacing wires were removed per protocols. She had a brief episode of atrial fibrillation in the 140s on POD 4, which was well tolerated. This was treated with IV Lopressor and amiodarone with restoration of sinus rhythm. She remained volume overloaded and was discharged to rehab on IV lasix for 1 week. On POD 5 she was ready for discharge and went TO [**Hospital 38**] Rehab a MWMC in [**Location (un) 1110**]. Medications on Admission: Metoprolol ER 25 daily Simvastatin 40 daily Zetia 10 daily NTG-sl-prn Aspirin 325 daily Diovan 320 daily Fish Oil Vitamin E 400IU daily Vitamin D 500mg daily Discharge Medications: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 2. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 6. valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 8. amiodarone 200 mg Tablet Sig: as directed Tablet PO BID (2 times a day): 1 tab(200mg) [**Hospital1 **] for two weeks then one tab(200mg) daily. 9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 10. psyllium Packet Sig: One (1) Packet PO BID (2 times a day) as needed for constipation. 11. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 12. furosemide 10 mg/mL Solution Sig: Four (4) Injection twice a day for 1 weeks: 40mg IV lasix [**Hospital1 **] x 1 week, then re-evaluate. 13. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 1 weeks. Discharge Disposition: Extended Care Facility: tba Discharge Diagnosis: Aortic stenosis/reguritation hypertension s/p aortic valve replacement s/p right total hip arthroplasty ischemic cardiomyopathy coronary artery disease s/p colon resection for diverticular disease s/p herniorraphy s/p cataract extractions hyperlipidemia s/p ovarian cystectomy Discharge Condition: Alert and oriented x3, nonfocal Ambulating with steady gait Incisional pain managed with Ultram Incisions: Sternal - healing well, no erythema or drainage Edema: 1+ bilateral LEs 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. [**Last Name (STitle) **] ([**Telephone/Fax (1) 6256**]) at [**Hospital1 **] on [**11-18**] at 9:00am Cardiologist:Dr. [**First Name8 (NamePattern2) 3924**] [**Last Name (NamePattern1) 20222**] ([**Telephone/Fax (1) 6256**]) on [**2190-12-20**] at 2:30pm Please call to schedule appointments with: Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4640**] ([**Telephone/Fax (1) 20221**]) in [**3-22**] 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:[**2190-10-25**]

424,414,276,427,401,272,412,V436,V457,V158,413

{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Hip joint replacement,Acquired absence of intestine (large) (small),Personal history of tobacco use,Other and unspecified angina pectoris'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Aortic stenosis/ regurgitation PRESENT ILLNESS: This 86 year old white female has known aortic stenosis with progressive dyspnea on exertion and fatigue over 7 months. She has previously undergone catheterization to demonstrate clean coronaries, despite a prior anterior infaction in [**2173**]. She is admitted now for valve replacement. MEDICAL HISTORY: Coronary artery disease s/p AMI '[**73**] Ischemic cardiomyopathy (EF 35-40%) Aortic stenosis/insufficiency Hypertension Hyperlipidemia Diverticulitis Past Surgical History: Right hip replacement s/p fracture(MVA)'[**78**] Bowel resection(diverticular dz)-'[**72**] Incisional hernia repair '[**73**] Bilat cataract removal Ovarian cyst removal MEDICATION ON ADMISSION: Metoprolol ER 25 daily Simvastatin 40 daily Zetia 10 daily NTG-sl-prn Aspirin 325 daily Diovan 320 daily Fish Oil Vitamin E 400IU daily Vitamin D 500mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 54 Resp: 16 O2 sat: 98%-RA B/P Right: 160/72 Left: Height: 65 in Weight: 176 lbs FAMILY HISTORY: non-contributory SOCIAL HISTORY: Race: Caucasian Last Dental Exam: 1 month ago Lives with: Husband Occupation: Retired college professor/[**Male First Name (un) **]-Education([**University/College **]) Tobacco:Quit 40 yrs ago, previously smoked 1ppwk x20yrs ETOH:1 drink every other month ### Response: {'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Old myocardial infarction,Hip joint replacement,Acquired absence of intestine (large) (small),Personal history of tobacco use,Other and unspecified angina pectoris'}

CHIEF COMPLAINT: Transferred for ARDS PRESENT ILLNESS: Ms. [**Known lastname 15685**] is a 48yo female patient who is intubated at the time of transfer from [**Hospital3 **]. All information is per OSH records. MEDICAL HISTORY: -hypertension -anxiety disorder -depression -PTSD -alcohol abuse s/p detox one month ago- during which she had a seizure MEDICATION ON ADMISSION: based on medication brought in by the family [**2108-5-23**] - gabapentin 300 mg cap, 1 cap. TID - Thiamine 100 mg 1 tab daily - folic acid 1 mg tab, 1 tab daily - Buspirone 10 mg tab, 1 tab, TID - Losartan 50 mg tab, 1 tab, daily - diphenhydramine 50 mg cap, 1 cap, qHS prn for sleep - clonidine 0.1 mg tab, 1 tab, TID prn - trazadone 50 mg tab, 1 tab, qHS - omeprazole 20 mg cap, 1 cap, daily - HCTZ 25 mg tab, 1 tab, daily - Fluoxetine 40 mg cap, 1 cap, daily - ibuprofen 800 mg tab, 1 tab, TID prn - Baclofen 20 mg tab, 1 tab, TID prn ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Arrival to [**Hospital Unit Name 153**] Vitals: T100.2 axillary P107 BP121/61 R19 O2 sat92% on100%GENERAL: patient is sedated, intubated, unresponsive 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, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: father had CAD, also alcoholism SOCIAL HISTORY: 1ppd smoker but no current alcohol or IVDA

Other pulmonary insufficiency, not elsewhere classified,Bacterial pneumonia, unspecified,Acute kidney failure with lesion of tubular necrosis,Toxic encephalopathy,Hyperosmolality and/or hypernatremia,Paralytic ileus,Backache, unspecified,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Benign neoplasm of pituitary gland and craniopharyngeal duct,Posttraumatic stress disorder,Dysthymic disorder,Ptosis of eyelid, unspecified,Other dissociated deviation of eye movements

Other pulmonary insuff,Bacterial pneumonia NOS,Ac kidny fail, tubr necr,Toxic encephalopathy,Hyperosmolality,Paralytic ileus,Backache NOS,Hypertension NOS,Alcoh dep NEC/NOS-unspec,Anemia NOS,Benign neo pituitary,Posttraumatic stress dis,Dysthymic disorder,Ptosis of eyelid NOS,Skew deviation, eye

Admission Date: [**2108-5-22**] Discharge Date: [**2108-6-7**] Date of Birth: [**2059-11-25**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2108**] Chief Complaint: Transferred for ARDS Major Surgical or Invasive Procedure: - Left IJ Quad lumen CVL - A-line History of Present Illness: Ms. [**Known lastname 15685**] is a 48yo female patient who is intubated at the time of transfer from [**Hospital3 **]. All information is per OSH records. This 48yoF has a history of alcoholism with recent detox, HTN, depression, anxiety/PTSD who presented to [**Hospital1 **] yesterday after about 24 hours of worsening shortness of breath, headache, non-productive cough, and subjective fevers and chills. She presented in severe respiratory distress with a room air saturation of 73% and subsequently was placed on BiPap. Her respiratory distress persisted with tachypnea into the 30s and so she was electively intubated. Her WBC count was noted to be 19.3 (83%PMN) with a CXR showing patchy bilateral infiltrates consistent with pneumonia. She was treated with vancomycin, moxifloxacin, tamiflu. ID recommended addition of ertapenem, however it is unclear if she received this prior to transfer. She required high doses of propofol for sedation, and eventually became hypotensive, requiring pressor support. Upon arrival to [**Hospital1 18**], her initial VS were, initial vs were: T100.2 axillary P107 BP121/61 R19 O2 sat92% on100%Fi02. Her vent was set to CMV Vt420, Rate20, PEEP12, Fi02100%. She was sedated, no ROS could be elicited. Past Medical History: -hypertension -anxiety disorder -depression -PTSD -alcohol abuse s/p detox one month ago- during which she had a seizure Social History: 1ppd smoker but no current alcohol or IVDA Family History: father had CAD, also alcoholism Physical Exam: Physical Exam on Arrival to [**Hospital Unit Name 153**] Vitals: T100.2 axillary P107 BP121/61 R19 O2 sat92% on100%GENERAL: patient is sedated, intubated, unresponsive 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, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: Imaging: [**2108-5-22**] - CXR: Supine positioning increases the cardiomediastinal caliber and causes pleural effusions to obscure large areas of lung. Nevertheless there appear to be both widespread interstitial pulmonary abnormality as well as bibasilar consolidation, cardiomegaly, vascular engorgement and an indeterminate volume of pleural effusion. All this would be better evaluated with upright radiographs, when feasible. ET tube tip with the chin down is less than 15 mm from the carina, approximately 2 cm below optimal placement. Right internal jugular line passes at least as far as the upper right atrium but the tip is obscured. Nasogastric tube ends in the upper stomach. No pneumothorax. [**2108-5-24**] - Echocardiogram: The left atrium and right atrium are normal in cavity size. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. There is no aortic valve stenosis. No aortic regurgitation is seen. Trivial mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Vigorous biventricular systolic function. Mild pulmonary hypertension. [**2108-5-24**] - CT head w/o contrast: No acute intracranial process, although this study is limited due to patient motion. - CT chest/abd/pelvis: 1. Moderate-to-severe pulmonary edema and small bilateral pleural effusions. 2. Left lower lobe consolidation, concerning for pneumonia. 3. Within the limitations of this non-contrast CT, no acute intra-abdominal or intrapelvic process. [**2108-5-29**] MR head w/o contrast: 1. T1-hyperintensity of the pituitary, without enlargement or a fluid level, which may indicate either mild hemorrhage or a small lesion, such as an adenoma. Correlation with endocrinologic labs could be helpful. Dedicated MRI of the pituitary is suggested when the patient is stable. 2. No evidence of significant abnormalities in the brain parenchyma or along the cranial nerves on noncontrast evaluation. [**2108-6-6**] MRI of the pituitary with contrast: 1. Completely unremarkable appearance to the pituitary gland with no evidence of hemorrhage, micro- or macro-adenoma, or other lesion. The apparent findings involving the gland on the prompting study were likely technical/artifactual in nature. 2. No acute intracranial process. 3. No pathologic focus of enhancement elsewhere in the brain. 4. Fluid-opacification of numerous mastoid air cells, which may relate to previous intubated status but should be correlated clinically. [**2108-6-3**] 06:05AM BLOOD WBC-5.0 RBC-3.00* Hgb-9.3* Hct-27.9* MCV-93 MCH-31.1 MCHC-33.4 RDW-13.7 Plt Ct-240 [**2108-5-22**] 07:57PM BLOOD WBC-11.8* RBC-3.43* Hgb-11.2* Hct-32.8* MCV-96 MCH-32.7* MCHC-34.1 RDW-13.3 Plt Ct-134* [**2108-5-22**] 07:57PM BLOOD Neuts-80.6* Lymphs-12.8* Monos-3.0 Eos-3.4 Baso-0.2 [**2108-6-3**] 06:05AM BLOOD Neuts-37.2* Lymphs-50.3* Monos-7.2 Eos-4.8* Baso-0.5 [**2108-5-28**] 04:40AM BLOOD PT-15.7* PTT-27.5 INR(PT)-1.4* [**2108-5-24**] 03:40AM BLOOD PT-14.3* PTT-29.5 INR(PT)-1.2* [**2108-6-6**] 05:45AM BLOOD UreaN-19 Creat-1.3* Na-145 K-4.4 Cl-108 [**2108-6-5**] 06:10AM BLOOD Glucose-130* UreaN-17 Creat-1.4* Na-142 K-3.2* Cl-105 HCO3-27 AnGap-13 [**2108-5-22**] 07:57PM BLOOD Glucose-112* UreaN-7 Creat-0.6 Na-140 K-3.6 Cl-109* HCO3-22 AnGap-13 [**2108-5-24**] 03:40AM BLOOD ALT-17 AST-31 TotBili-0.3 [**2108-5-22**] 07:57PM BLOOD ALT-17 AST-44* CK(CPK)-495* AlkPhos-84 Amylase-59 TotBili-0.4 [**2108-5-22**] 07:57PM BLOOD Lipase-13 [**2108-5-22**] 07:57PM BLOOD CK-MB-5 cTropnT-<0.01 [**2108-6-6**] 05:45AM BLOOD Mg-2.3 [**2108-6-5**] 06:10AM BLOOD Mg-1.5* [**2108-6-3**] 06:05AM BLOOD Calcium-8.4 Phos-5.3* Mg-1.5* [**2108-5-22**] 07:57PM BLOOD Albumin-3.1* Calcium-7.9* Phos-3.1 Mg-2.5 Iron-9* [**2108-5-22**] 07:57PM BLOOD calTIBC-157* Ferritn-369* TRF-121* [**2108-5-25**] 08:18AM BLOOD Vanco-23.1* [**2108-5-29**] 04:20PM BLOOD Type-ART Temp-37.0 Rates-/28 Tidal V-400 FiO2-40 pO2-96 pCO2-46* pH-7.43 calTCO2-32* Base XS-4 Intubat-INTUBATED Vent-SPONTANEOU Brief Hospital Course: This is a 48 year old woman who presented to [**Hospital3 4107**] with presumed multifocal pneumonia and subsequently developed acute hypoxic respiratory distress consistent with ARDS. She was then transferred to [**Hospital1 18**] for further management. Her initial presentation to [**Hospital1 18**] was consistent with [**Doctor Last Name **]/ARDS with very poor oxygenation. It is thought that this was related to an underlying pneumonia. She initially required heavy sedation as well as paralytics to allow proper ventilation setting. She was also started on very broad spectrum antibiotics, including vancomycin, ceftriaxone, azithromycin, levofloxacin, Flagyl (for aspiration), and Tamiflu (for possible viral etiology). She was eventually narrowed to cefepime and finished 8-day course. Sputum culture was negative. Esophageal balloon was used to allow better estimation of the need for her PEEP. She improved with PEEP of 18-20 initially. Ultimately, she was able to tolerate off paralytics and then extubated successfully. She did have septic shock with hypotension and tachycardia on presentation. She presented on norepinephrine support for hypotension. It was thought that her hypotension and tachycardia was from septic shock from the pulmonary infection. A line was placed for better monitoring and then eventually removed. She was weaned off norepinephrine and was able to maintain her BP with good urine output. She developed acute renal failure from ATN with admission Creatinine of 0.6. Her urine sediment showed muddy brown casts consistent with ATN. Nephrology was consulted. She was managed conservatively. Her urine output improved over time. She was noted to have right eye ptosis and disconjugate gaze; MRI of the head was performed which did not show lesions to explain symptoms. No visual field cut and intact extraocular movements. This did improve but her altered mental status much worsened. The MRI of the head showed high signal in pituitary likely hemorrhage vs. adenoma, 1 week later a dedicated MRI of the pituitary with contrast revealed no abnormalities and the radiologist thought the initial findings were most likely artifact. No other electrolyte or vital sign abnormalities were noted so we held off further workup and she improved. Of note, after extubation, she had clear delirium and toxic metabolic encephalopathy from all medications used for sedation during her prolonged intubation. In addition, she had significant alcohol abuse and we questioned the diagnosis of Wernicke-Korsakoff encephalopathy as she had disconjugate gaze, memory loss, confusions, and other consistent elements. I then placed her on high dose Thiamine. She had elevated AST with normal ALT that was thought to be from alcoholism but repeat LFTs returned to [**Location 213**]. Home antihypertensives (losartan and HCTZ) were held given initialy hypotension. She suffered acute kidney injury from ATN with a peak creatinine of 2.2, this improved to 1.3 upon discharge. When this normalizes or at least stabilizes she can be restarted on losartan, but while recovering from ATN she was placed on norvasc 5mg po daily in replacement of her home antihypertensive regimen. She has proteinuria with a protein/creatinine ratio of 0.9 so when her creatinine reaches baseline or a new baseline the [**Last Name (un) **] would be indicated. We continued on home Buspar 10 mg daily and prozac 40 mg daily. We held clonidine. She was continued folic acid while in the hospital, this was discontinued at the time of discharge. She should continue thiamine for an additional 1 month. There was no signs of withdrawal. OT was consulted for cognitive evaluation and recommended outpatient occupational therapy. She was ambulating well at the time of discharge and does not require physical therapy. She also was treated with gabapentin and baclofen for chronic low back pain, tramadol was added given worsened back pain in the area of a decubitus ulcer. The ulcer has a scab and is healing well without any evidence of infection. Communication: Patient HCP Sister [**Name (NI) **] [**Name (NI) 58659**] [**Telephone/Fax (1) 88732**] Medications on Admission: based on medication brought in by the family [**2108-5-23**] - gabapentin 300 mg cap, 1 cap. TID - Thiamine 100 mg 1 tab daily - folic acid 1 mg tab, 1 tab daily - Buspirone 10 mg tab, 1 tab, TID - Losartan 50 mg tab, 1 tab, daily - diphenhydramine 50 mg cap, 1 cap, qHS prn for sleep - clonidine 0.1 mg tab, 1 tab, TID prn - trazadone 50 mg tab, 1 tab, qHS - omeprazole 20 mg cap, 1 cap, daily - HCTZ 25 mg tab, 1 tab, daily - Fluoxetine 40 mg cap, 1 cap, daily - ibuprofen 800 mg tab, 1 tab, TID prn - Baclofen 20 mg tab, 1 tab, TID prn Discharge Medications: 1. gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours). Disp:*90 Capsule(s)* Refills:*2* 2. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 1 months. Disp:*30 Tablet(s)* Refills:*0* 3. buspirone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. Disp:*30 Tablet(s)* Refills:*2* 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 9. fluoxetine 40 mg Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* 10. baclofen 20 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 11. Outpatient Occupational Therapy Discharge Disposition: Home Discharge Diagnosis: acute hypoxic respiratory distress pneumonia delirium Wernicke-Korsakoff encephalopathy. Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Confused - sometimes. Discharge Instructions: You required intubation and ICU care for acute hypoxic respiratory distress from pneumonia. You received antibiotics and recovered. You also suffered kidney injury and are recovering from this. Please avoid alcohol. Followup Instructions: Please call your PCP [**Last Name (LF) **],[**Name9 (PRE) **] [**Name Initial (PRE) **] [**Telephone/Fax (1) 20479**] for follow up within 2 weeks of your discharge from the hospital.

518,482,584,349,276,560,724,401,303,285,227,309,300,374,378

{'Other pulmonary insufficiency, not elsewhere classified,Bacterial pneumonia, unspecified,Acute kidney failure with lesion of tubular necrosis,Toxic encephalopathy,Hyperosmolality and/or hypernatremia,Paralytic ileus,Backache, unspecified,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Benign neoplasm of pituitary gland and craniopharyngeal duct,Posttraumatic stress disorder,Dysthymic disorder,Ptosis of eyelid, unspecified,Other dissociated deviation of eye movements'}

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: Transferred for ARDS PRESENT ILLNESS: Ms. [**Known lastname 15685**] is a 48yo female patient who is intubated at the time of transfer from [**Hospital3 **]. All information is per OSH records. MEDICAL HISTORY: -hypertension -anxiety disorder -depression -PTSD -alcohol abuse s/p detox one month ago- during which she had a seizure MEDICATION ON ADMISSION: based on medication brought in by the family [**2108-5-23**] - gabapentin 300 mg cap, 1 cap. TID - Thiamine 100 mg 1 tab daily - folic acid 1 mg tab, 1 tab daily - Buspirone 10 mg tab, 1 tab, TID - Losartan 50 mg tab, 1 tab, daily - diphenhydramine 50 mg cap, 1 cap, qHS prn for sleep - clonidine 0.1 mg tab, 1 tab, TID prn - trazadone 50 mg tab, 1 tab, qHS - omeprazole 20 mg cap, 1 cap, daily - HCTZ 25 mg tab, 1 tab, daily - Fluoxetine 40 mg cap, 1 cap, daily - ibuprofen 800 mg tab, 1 tab, TID prn - Baclofen 20 mg tab, 1 tab, TID prn ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Arrival to [**Hospital Unit Name 153**] Vitals: T100.2 axillary P107 BP121/61 R19 O2 sat92% on100%GENERAL: patient is sedated, intubated, unresponsive 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, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: father had CAD, also alcoholism SOCIAL HISTORY: 1ppd smoker but no current alcohol or IVDA ### Response: {'Other pulmonary insufficiency, not elsewhere classified,Bacterial pneumonia, unspecified,Acute kidney failure with lesion of tubular necrosis,Toxic encephalopathy,Hyperosmolality and/or hypernatremia,Paralytic ileus,Backache, unspecified,Unspecified essential hypertension,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified,Benign neoplasm of pituitary gland and craniopharyngeal duct,Posttraumatic stress disorder,Dysthymic disorder,Ptosis of eyelid, unspecified,Other dissociated deviation of eye movements'}

CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: Mrs. [**Known lastname 38758**] is a 42yo woman with history of HTN, newly dx'd hyperlipidemia, back pain s/p fall [**2198-5-29**] w/ resultant disc disease, who presents to the CCU from the cath lab with an intra-aortic balloon pump, after pt found to have 3VD on cath. . Pt reports about 3-4wks of SSCP/pressure w/ asst'd R arm numbness, occuring for minutes at a time at both rest & w/ exertion. Her initial sx's were attributed to GERD. However, they persisted despite tx for GERD. Her PCP ordered [**Name Initial (PRE) **] stress test. On day of presentation, pt underwent persantine stress test at [**Hospital3 **]. The study showed 1mm STE in aVR &V1, ST depression in lead I, II, aVL, V4-6. She had severe SSCP ass'td with the EKG changes. CP & EKG improved after administration of aminophylline. She was transferred to [**Hospital1 18**] for cardiac catheterization. . In the cath, lab the patient was found to have nml LMCA, total occlusion of LAD, left circ, and RCA, as well as 90% ramus lesion. Decision made to place IABP and consult CT surgery. Dr. [**Last Name (STitle) **] evaluated patient and recommended CABG. Pt admitted to CCU for care on IABP until surgery. . On review of symptoms, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: PAST MEDICAL HISTORY: -HTN -Hyperlipidemia -Hypothyroidism -Back pain [**3-2**] fall in [**2198-5-29**], underwent back surgery in [**Month (only) **] [**2198**]; con't to have back pain. Is in process of getting referred to NEBH for further tx/care. . Cardiac Risk Factors: -Diabetes, + Dyslipidemia, + Hypertension MEDICATION ON ADMISSION: CURRENT MEDICATIONS: Diazepam 5 q6-8hr PRN back spasm Vicodin q6-8hr Levoxyl 137mct daily Nexium PRN HCTZ (dose not known) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: T afeb, BP 122/65 , HR 70, RR , O2 100% on RA Gen: WDWN, woman in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with nml JVP. CV: RR, normal S1, S2. No S4, no S3. Chest: 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. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Groin line in place for IABP Pulses: Right: 2+ DP Left: 2+ DP FAMILY HISTORY: FAMILY HISTORY: Father died of "heart disease" in his 40s, as did her aunt (brother's sister). Nature of heart disease unknown. SOCIAL HISTORY: SOCIAL HISTORY: Pt is married and has 19yo dtr. Supportive family. Is out of work due to back injury (sustained at work). Is a non-smoker and very rare drinker

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism

Crnry athrscl natve vssl,Intermed coronary synd,Ac posthemorrhag anemia,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS

Admission Date: [**2199-7-23**] Discharge Date: [**2199-7-28**] Date of Birth: [**2156-12-29**] Sex: F 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: CABG x 4 History of Present Illness: Mrs. [**Known lastname 38758**] is a 42yo woman with history of HTN, newly dx'd hyperlipidemia, back pain s/p fall [**2198-5-29**] w/ resultant disc disease, who presents to the CCU from the cath lab with an intra-aortic balloon pump, after pt found to have 3VD on cath. . Pt reports about 3-4wks of SSCP/pressure w/ asst'd R arm numbness, occuring for minutes at a time at both rest & w/ exertion. Her initial sx's were attributed to GERD. However, they persisted despite tx for GERD. Her PCP ordered [**Name Initial (PRE) **] stress test. On day of presentation, pt underwent persantine stress test at [**Hospital3 **]. The study showed 1mm STE in aVR &V1, ST depression in lead I, II, aVL, V4-6. She had severe SSCP ass'td with the EKG changes. CP & EKG improved after administration of aminophylline. She was transferred to [**Hospital1 18**] for cardiac catheterization. . In the cath, lab the patient was found to have nml LMCA, total occlusion of LAD, left circ, and RCA, as well as 90% ramus lesion. Decision made to place IABP and consult CT surgery. Dr. [**Last Name (STitle) **] evaluated patient and recommended CABG. Pt admitted to CCU for care on IABP until surgery. . On review of symptoms, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Past Medical History: PAST MEDICAL HISTORY: -HTN -Hyperlipidemia -Hypothyroidism -Back pain [**3-2**] fall in [**2198-5-29**], underwent back surgery in [**Month (only) **] [**2198**]; con't to have back pain. Is in process of getting referred to NEBH for further tx/care. . Cardiac Risk Factors: -Diabetes, + Dyslipidemia, + Hypertension Social History: SOCIAL HISTORY: Pt is married and has 19yo dtr. Supportive family. Is out of work due to back injury (sustained at work). Is a non-smoker and very rare drinker Family History: FAMILY HISTORY: Father died of "heart disease" in his 40s, as did her aunt (brother's sister). Nature of heart disease unknown. Physical Exam: PHYSICAL EXAMINATION: VS: T afeb, BP 122/65 , HR 70, RR , O2 100% on RA Gen: WDWN, woman in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with nml JVP. CV: RR, normal S1, S2. No S4, no S3. Chest: 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. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Groin line in place for IABP Pulses: Right: 2+ DP Left: 2+ DP Pertinent Results: [**2199-7-28**] 08:40AM BLOOD WBC-6.8 RBC-4.36 Hgb-13.0 Hct-38.5 MCV-88 MCH-29.8 MCHC-33.8 RDW-15.9* Plt Ct-187# [**2199-7-26**] 03:34AM BLOOD PT-17.6* PTT-46.5* INR(PT)-1.6* [**2199-7-24**] 05:55AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.022 [**2199-7-24**] 05:55AM URINE Blood-LG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG URINE RBC-21-50* WBC-0-2 Bacteri-NONE Yeast-NONE Epi-0 CHEST TWO VIEWS [**2199-7-27**] CLINICAL INFORMATION: Post-op day 3 from CABG. COMPARISON STUDY: [**2199-7-26**]. FINDINGS: Heart is mildly enlarged. Mediastinum demonstrates post-surgical changes. There are small bilateral pleural effusions and bibasilar atelectasis, which have increased since the prior study. Upper lung zones are clear. UNROE,[**Known firstname 78646**] [**Medical Record Number 78647**] F 42 [**2156-12-29**] Cardiology Report C.CATH Study Date of [**2199-7-23**] PROCEDURE: Left Heart Catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 French angled pigtail catheter, advanced to the aorta through a 5 French introducing sheath. Coronary Angiography: was performed in multiple projections using a 5 French JL4 and a 5 French JR4 catheter, with manual contrast injections. Intra-aortic balloon counterpulsation: was initiated with an introducer sheath using a Cardiac Assist 8 French 30cc wire guided catheter, inserted via the right femoral artery. Conscious Sedation: was provided with appropriate monitoring performed by a member of the nursing staff. HEMODYNAMICS RESULTS BODY SURFACE AREA: m2 HEMOGLOBIN: gms % FICK PRESSURES AORTA {s/d/m} 84/42/62 CARDIAC OUTPUT HEART RATE {beats/min} 80 RHYTHM SINUS ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM RIGHT CORONARY 1) PROXIMAL RCA DISCRETE 100 2) MID RCA NORMAL 2A) ACUTE MARGINAL NORMAL 3) DISTAL RCA NORMAL 4) R-PDA NORMAL 4A) R-POST-LAT NORMAL ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM LEFT CORONARY 5) LEFT MAIN NORMAL 6) PROXIMAL LAD DISCRETE 100 6A) SEPTAL-1 NORMAL 7) MID-LAD NORMAL 8) DISTAL LAD NORMAL 9) DIAGONAL-1 NORMAL 10) DIAGONAL-2 NORMAL 11) INTERMEDIUS NORMAL 12) PROXIMAL CX DISCRETE 100 13) MID CX NORMAL 13A) DISTAL CX NORMAL 14) OBTUSE MARGINAL-1 NORMAL 15) OBTUSE MARGINAL-2 NORMAL 17A) POSTERIOR LV NORMAL COMMENTS: 1. Selective coronary angiography of this right dominant system revealed severe 3 vessel coronary artery disease. The LMCA had no angiographically apparent flow limiting epicardial coronary artery disease. The LAD was totally occluded with left-left collaterals. The LCx was totally occluded with left-left collaterals. The ramus had a 90% stenosis. The RCA was totally occluded with left to right 2. Resting hemodynamics revealed no evidence of systemic arterial systolic or diastolic hypertension with SBP 84 mmHg and DBP 42 mmHg. 3. Successful placement of IABP via right femoral artery in anticipation of potential hypotension with anesthesia induction during planned CABG [**2199-7-24**]. FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Successful placement of IABP. Brief Hospital Course: Mr. [**Known lastname 38758**] was taken to the operating rooom where he underwent coronary artery bypass grafting to for vessels. Postoperatively she was taken to the intensive care unit for monitoring. Within 24 hours, he awoke neurologically intact and was extubated. Beta Blocker, Aspirin and a Statin were started. Postoperative day two, she was transferred to the step down unit for further recovery. She worked with physical therapy daily to improve his strength and mobility PW / CT anf foley were removed without sequele. She is cleared to go home with VNA. HCT and creat is stable. ACE and [**Last Name (un) **] not stared for low BP. To be follwed up at her PCp [**Name Initial (PRE) 3726**] Medications on Admission: CURRENT MEDICATIONS: Diazepam 5 q6-8hr PRN back spasm Vicodin q6-8hr Levoxyl 137mct daily Nexium PRN HCTZ (dose not known) Discharge Medications: 1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 6 days. Disp:*12 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. 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* 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. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed: prn. Disp:*30 Tablet(s)* Refills:*0* 6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 7. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*6* 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 9. Levothyroxine 137 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. Disp:*30 Suppository(s)* Refills:*0* Discharge Disposition: Home With Service Facility: TBA Discharge Diagnosis: CAD Discharge Condition: Good Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. In the event that you have drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 4044**]. 2) Report any fever greater then 100.5. 3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) No lotions, creams or powders to incision until it has healed. You may shower and wash incision. Gently pat the wound dry. Please shower daily. No bathing or swimming for 1 month. Use sunscreen on incision if exposed to sun. 5) No lifting greater then 10 pounds for 10 weeks. 6) No driving for 1 month. 7) Call with any questions or concerns. Followup Instructions: Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Telephone/Fax (1) 62076**] Follow-up appointment should be in 2 weeks Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 1955**] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) **] Follow-up appointment should be in 2 weeks Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 170**] Follow-up appointment should be in 1 month Completed by:[**2199-7-28**]

414,411,285,401,272,244

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,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: Chest Pain PRESENT ILLNESS: Mrs. [**Known lastname 38758**] is a 42yo woman with history of HTN, newly dx'd hyperlipidemia, back pain s/p fall [**2198-5-29**] w/ resultant disc disease, who presents to the CCU from the cath lab with an intra-aortic balloon pump, after pt found to have 3VD on cath. . Pt reports about 3-4wks of SSCP/pressure w/ asst'd R arm numbness, occuring for minutes at a time at both rest & w/ exertion. Her initial sx's were attributed to GERD. However, they persisted despite tx for GERD. Her PCP ordered [**Name Initial (PRE) **] stress test. On day of presentation, pt underwent persantine stress test at [**Hospital3 **]. The study showed 1mm STE in aVR &V1, ST depression in lead I, II, aVL, V4-6. She had severe SSCP ass'td with the EKG changes. CP & EKG improved after administration of aminophylline. She was transferred to [**Hospital1 18**] for cardiac catheterization. . In the cath, lab the patient was found to have nml LMCA, total occlusion of LAD, left circ, and RCA, as well as 90% ramus lesion. Decision made to place IABP and consult CT surgery. Dr. [**Last Name (STitle) **] evaluated patient and recommended CABG. Pt admitted to CCU for care on IABP until surgery. . On review of symptoms, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: PAST MEDICAL HISTORY: -HTN -Hyperlipidemia -Hypothyroidism -Back pain [**3-2**] fall in [**2198-5-29**], underwent back surgery in [**Month (only) **] [**2198**]; con't to have back pain. Is in process of getting referred to NEBH for further tx/care. . Cardiac Risk Factors: -Diabetes, + Dyslipidemia, + Hypertension MEDICATION ON ADMISSION: CURRENT MEDICATIONS: Diazepam 5 q6-8hr PRN back spasm Vicodin q6-8hr Levoxyl 137mct daily Nexium PRN HCTZ (dose not known) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: T afeb, BP 122/65 , HR 70, RR , O2 100% on RA Gen: WDWN, woman in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with nml JVP. CV: RR, normal S1, S2. No S4, no S3. Chest: 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. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Groin line in place for IABP Pulses: Right: 2+ DP Left: 2+ DP FAMILY HISTORY: FAMILY HISTORY: Father died of "heart disease" in his 40s, as did her aunt (brother's sister). Nature of heart disease unknown. SOCIAL HISTORY: SOCIAL HISTORY: Pt is married and has 19yo dtr. Supportive family. Is out of work due to back injury (sustained at work). Is a non-smoker and very rare drinker ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism'}

CHIEF COMPLAINT: fatigue/DOE PRESENT ILLNESS: 77 year old female who has been followed for several years for atrial fibrillation and mitral regurgitation. She has undergone PVI in [**2098**] with atrial fibrillation recurrence in [**2099**] requiring DC cardioversion. In addition, she required a pacemaker in [**1-7**] for symptomatic bradycardia. Most recent echocariogram showed worsening mitral regurgitation, now moderate to severe. In addition, she had markedly increased tricuspid regurgitation, now 3+. Referred for surgery. MEDICAL HISTORY: mitral regurgitation s/p MV repair/TV repair/res. Left atrial appendage tricuspid regurgitation - Paroxysmal atrial fibrillation status post cardioversion in [**2096**], pulmonary vein isolation on [**2098-3-11**]. Recurrent atrial fibrillation post PVI requiring DC cardioversion, [**2099-7-31**] - Prior antiarrhythmic therapy with amiodarone discontinued due to lung toxicity (increased DLCO) - Prior antiarrhythmic therapy with dofetilide discontinued due to QT prolongation - Coronary Artery Disease s/p prior MI [**2076**], - Hypertension - Hyperlipidemia - Congestive Heart Failure - Cardiomyopathy - Mild emphysema/COPD - Hypothyroidism - Anxiety Past Surgical History: - St. [**Hospital 923**] medical dual-chamber pacemaker on [**2099-1-21**], [**Hospital3 **], for symptomatic bradycardia. - s/p Back surgery - s/p Tonsillectomy - Left breast biopsy - (Benign) MEDICATION ON ADMISSION: ALLOPURINOL - (Prescribed by Other Provider) - 100 mg Tablet - 1.5 Tablet(s) by mouth daily AMLODIPINE - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth once a day AZITHROMYCIN - 500 mg Tablet - 1 Tablet(s) by mouth 1 hour prior to the dental procedure as needed BUMETANIDE - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once a day CLONIDINE - (Prescribed by Other Provider) - 0.2 mg Tablet - 1 Tablet(s) by mouth twice a day LEVOTHYROXINE - (Prescribed by Other Provider) - 75 mcg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - (Prescribed by Other Provider) - 40 mg Tablet - 1 Tablet(s) by mouth once a day METOPROLOL SUCCINATE - (Prescribed by Other Provider) - 50 mg Tablet Extended Release 24 hr - 1 Tablet(s) by mouth once daily PRAVASTATIN - (Prescribed by Other Provider) - 80 mg Tablet - 1 Tablet(s) by mouth once a day ***WARFARIN - (Prescribed by Other Provider) - 2 mg Tablet - 1 Tablet(s) by mouth once a day- LAST DOSE 11/10 ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet - 1 Tablet(s) by mouth once a day ALLERGIES: Penicillins / Amiodarone / Dofetilide PHYSICAL EXAM: Pulse: 70 Paced Resp: 16 O2 sat: 96% B/P Right: 131/77 Left: 140/86 Height: 65" Weight: 127lb FAMILY HISTORY: Denies premature coronary artery disease Father died of CAD in 70's SOCIAL HISTORY: Lives with: Husband Contact: Phone # Occupation: Retired Cigarettes: Smoked no [] yes [X] Hx: quit [**2076**] 35 pack-years Other Tobacco use: ETOH: < 1 drink/week [X] [**3-8**] drinks/week [] >8 drinks/week [] Illicit drug use: None

Mitral valve disorders,Other primary cardiomyopathies,Acidosis,Congestive heart failure, unspecified,Anemia, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other emphysema,Anxiety state, unspecified,Old myocardial infarction,Personal history of Methicillin resistant Staphylococcus aureus,Fitting and adjustment of cardiac pacemaker,Long-term (current) use of anticoagulants

Mitral valve disorder,Prim cardiomyopathy NEC,Acidosis,CHF NOS,Anemia NOS,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Emphysema NEC,Anxiety state NOS,Old myocardial infarct,Hx Methicln resist Staph,Ftng cardiac pacemaker,Long-term use anticoagul

Admission Date: [**2100-12-13**] Discharge Date: [**2100-12-20**] Date of Birth: [**2023-4-21**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / Amiodarone / Dofetilide Attending:[**First Name3 (LF) 1505**] Chief Complaint: fatigue/DOE Major Surgical or Invasive Procedure: [**2100-12-14**] MV repair (28mm [**Doctor Last Name **] ring)/ TV repair ( 28 mm [**Company 1543**] Contour 3D ring)/ res. L atrial appendage History of Present Illness: 77 year old female who has been followed for several years for atrial fibrillation and mitral regurgitation. She has undergone PVI in [**2098**] with atrial fibrillation recurrence in [**2099**] requiring DC cardioversion. In addition, she required a pacemaker in [**1-7**] for symptomatic bradycardia. Most recent echocariogram showed worsening mitral regurgitation, now moderate to severe. In addition, she had markedly increased tricuspid regurgitation, now 3+. Referred for surgery. Past Medical History: mitral regurgitation s/p MV repair/TV repair/res. Left atrial appendage tricuspid regurgitation - Paroxysmal atrial fibrillation status post cardioversion in [**2096**], pulmonary vein isolation on [**2098-3-11**]. Recurrent atrial fibrillation post PVI requiring DC cardioversion, [**2099-7-31**] - Prior antiarrhythmic therapy with amiodarone discontinued due to lung toxicity (increased DLCO) - Prior antiarrhythmic therapy with dofetilide discontinued due to QT prolongation - Coronary Artery Disease s/p prior MI [**2076**], - Hypertension - Hyperlipidemia - Congestive Heart Failure - Cardiomyopathy - Mild emphysema/COPD - Hypothyroidism - Anxiety Past Surgical History: - St. [**Hospital 923**] medical dual-chamber pacemaker on [**2099-1-21**], [**Hospital3 **], for symptomatic bradycardia. - s/p Back surgery - s/p Tonsillectomy - Left breast biopsy - (Benign) Social History: Lives with: Husband Contact: Phone # Occupation: Retired Cigarettes: Smoked no [] yes [X] Hx: quit [**2076**] 35 pack-years Other Tobacco use: ETOH: < 1 drink/week [X] [**3-8**] drinks/week [] >8 drinks/week [] Illicit drug use: None Family History: Denies premature coronary artery disease Father died of CAD in 70's Physical Exam: Pulse: 70 Paced Resp: 16 O2 sat: 96% B/P Right: 131/77 Left: 140/86 Height: 65" Weight: 127lb General: WDWN in NAD Skin: Warm, Dry, intact. Right upper chest pacer pocket. HEENT: NCAT, PERRLA, EOMI, sclera anicteric sclera. OP benign. Full dentures. Neck: Supple [X] Full ROM [X] Chest: Lungs clear bilaterally [X] Heart: AF with V-Pacing. III/VI Pansystolic blowing murmur. Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds + [X] Extremities: Warm [X], well-perfused [X] No Edema Varicosities: Right anterior varicosity over knee but GSV appears suitable on standing Neuro: Grossly intact [X] Pulses: Femoral Right:2 Left:2 DP Right:2 Left:2 PT [**Name (NI) 167**]:1 Left:1 Radial Right:2 Left:2 Carotid Bruit Question faint left vs. transmitted Pertinent Results: TEE [**2100-12-14**] Intra-op Conclusions PRE-BYPASS: -The left atrium is markedly dilated though not entirely seen. -The coronary sinus is dilated. -Mild spontaneous echo contrast is present in the left atrial appendage. -The right atrium is dilated though not entirely seen. -No atrial septal defect is seen by 2D or color Doppler. -The left ventricle is not well seen in transgastric midpapillary short- axis view. Overall left ventricular systolic function appears low normal (LVEF 50-55%) with normal free wall contractility. -There are simple atheroma in the aortic arch. There are complex (>4mm) and simple atheroma in the descending thoracic aorta. -The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. -The mitral valve leaflets are mildly thickened. There is moderate/severe anterior leaflet mitral valve prolapse. There is a cleft in the anterior mitral leaflet at A2.The mitral regurgitation vena contracta is >=0.7cm. Severe (4+) mitral regurgitation is seen. Due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (Coanda effect). -The tricuspid valve leaflets are moderately thickened. Severe [4+] tricuspid regurgitation is seen. The tricuspid regurgitation jet is eccentric and may be underestimated. -There is a trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results at the time of the study. POSTBYPASS: The patient is AV paced on low dose epinephrine and phenylephrine infusions. There is a well seated annuloplasty ring in the mitral position. There is trace mitral regurgitation. There is no mitral stenosis. There is a well seated annuloplasty ring in the tricuspid position. There is trace tricuspid regurgitation. There is no tricuspid stenosis. The Left ventricular function remains unchanged. During the initial separation from bypass, the right ventricular function was mildly depressed, but improved to normal function with time on epinephrine infusion. The aorta remains intact. I certify that I was present for this procedure in compliance with HCFA regulations. . [**2100-12-17**] 07:25PM BLOOD WBC-12.5* RBC-3.98* Hgb-10.9* Hct-33.1* MCV-83 MCH-27.4 MCHC-32.9 RDW-17.2* Plt Ct-203 [**2100-12-17**] 03:23AM BLOOD WBC-12.7* RBC-3.77* Hgb-10.5* Hct-30.9* MCV-82 MCH-27.8 MCHC-34.0 RDW-17.2* Plt Ct-159 [**2100-12-20**] 05:30AM BLOOD UreaN-23* Creat-1.1 Na-141 K-4.3 Cl-104 [**2100-12-17**] 07:25PM BLOOD Glucose-140* UreaN-19 Creat-0.9 Na-140 K-4.2 Cl-102 HCO3-28 AnGap-14 [**2100-12-20**] 05:30AM BLOOD PT-29.3* INR(PT)-2.8* [**2100-12-19**] 05:05PM BLOOD PT-29.5* INR(PT)-2.9* [**2100-12-18**] 10:40AM BLOOD PT-24.5* INR(PT)-2.3* [**2100-12-17**] 03:23AM BLOOD PT-19.6* PTT-33.2 INR(PT)-1.8* [**2100-12-16**] 02:22AM BLOOD PT-13.5* PTT-30.8 INR(PT)-1.2* [**2100-12-15**] 02:05AM BLOOD PT-13.5* PTT-33.4 INR(PT)-1.2* [**2100-12-14**] 01:47PM BLOOD PT-14.4* PTT-44.1* INR(PT)-1.2* [**2100-12-14**] 12:10PM BLOOD PT-17.6* PTT-55.4* INR(PT)-1.6* [**2100-12-13**] 07:19PM BLOOD PT-14.4* PTT-28.2 INR(PT)-1.2* [**2100-12-13**] 10:30AM BLOOD PT-15.5* INR(PT)-1.4* Brief Hospital Course: Admitted [**12-13**] to complete preop w/u while off coumadin. Underwent Mitral Valve repair (28mm [**Doctor Last Name **] ring), Tricuspid Valve repair (28mm Contour ring) and Left Atrial Appendage resection with Dr. [**Last Name (STitle) **] [**12-14**]. Transferred to the CVICU in stable condition on titrated epinephrine, propofol, and phenylephrine drips. Extubated that evening after waking neurologically intact. Transferred to the floor on POD #3 to begin increasing her activity level. Gently diuresed toward her preop weight. Beta blockade and BP meds titrated. Chest tubes removed per protocol. Coumadin restarted for A Fib. Permanent pacemaker was interrogated and temporary pacing wires discontinued. Home meds were slowly resumed for hypertension with good effect. The patient does have a history of COPD and took some extra time to wean from oxygen. She was weaned and stable with room air saturations in the high 80s to low 90s. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD 6 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged home with VNA and home PT in good condition with appropriate follow up instructions. Medications on Admission: ALLOPURINOL - (Prescribed by Other Provider) - 100 mg Tablet - 1.5 Tablet(s) by mouth daily AMLODIPINE - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth once a day AZITHROMYCIN - 500 mg Tablet - 1 Tablet(s) by mouth 1 hour prior to the dental procedure as needed BUMETANIDE - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once a day CLONIDINE - (Prescribed by Other Provider) - 0.2 mg Tablet - 1 Tablet(s) by mouth twice a day LEVOTHYROXINE - (Prescribed by Other Provider) - 75 mcg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - (Prescribed by Other Provider) - 40 mg Tablet - 1 Tablet(s) by mouth once a day METOPROLOL SUCCINATE - (Prescribed by Other Provider) - 50 mg Tablet Extended Release 24 hr - 1 Tablet(s) by mouth once daily PRAVASTATIN - (Prescribed by Other Provider) - 80 mg Tablet - 1 Tablet(s) by mouth once a day ***WARFARIN - (Prescribed by Other Provider) - 2 mg Tablet - 1 Tablet(s) by mouth once a day- LAST DOSE 11/10 ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet - 1 Tablet(s) by mouth once a day 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. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 3. 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:*1* 4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 5. allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Disp:*45 Tablet(s)* Refills:*1* 6. pravastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*1* 7. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 8. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*1* 9. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*1* 10. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 11. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*1* 12. warfarin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Dr. [**Last Name (STitle) **] to manage for goal INR 2-2.5 dx: AFib. Disp:*60 Tablet(s)* Refills:*2* 13. clonidine 0.1 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 14. Outpatient Lab Work Labs: PT/INR for Coumadin ?????? indication A Fib Goal INR 2.0-2.5 First draw Monday [**12-21**] Results to Dr. [**Last Name (STitle) **] phone [**Telephone/Fax (1) 22166**] fax [**Telephone/Fax (1) 73915**] 15. bumetanide 1 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: mitral regurgitation s/p MV repair/TV repair/res. L atrial appendage tricuspid regurgitation - Paroxysmal atrial fibrillation status post cardioversion in [**2096**], pulmonary vein isolation on [**2098-3-11**]. Recurrent atrial fibrillation post PVI requiring DC cardioversion, [**2099-7-31**] - Prior antiarrhythmic therapy with amiodarone discontinued due to lung toxicity (increased DLCO) - Prior antiarrhythmic therapy with dofetilide discontinued due to QT prolongation - Coronary Artery Disease s/p prior MI [**2076**], - Hypertension - Hyperlipidemia - Congestive Heart Failure - Cardiomyopathy - Mild emphysema/COPD - Hypothyroidism - Anxiety Past Surgical History: - St. [**Hospital 923**] medical dual-chamber pacemaker on [**2099-1-21**], [**Hospital3 **], for symptomatic bradycardia. - s/p Back surgery - s/p Tonsillectomy - Left breast biopsy - (Benign) 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 Edema trace 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. [**Last Name (STitle) **] [**Name (STitle) **] [**Hospital Unit Name **] [**1-19**] at 1:30pm Wound check on [**12-30**] at 10:00am, [**Hospital Ward Name **] [**Hospital Unit Name **] Cardiologist:Dr. [**Last Name (STitle) **] on [**1-12**] at 9:00am (patient will see Dr[**Name (NI) 73916**] nurse practitioner that day) Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) **] in [**5-4**] weeks [**Telephone/Fax (1) 22166**] **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 A Fib Goal INR 2.0-2.5 First draw Monday [**12-21**] Results to Dr. [**Last Name (STitle) **] phone [**Telephone/Fax (1) 22166**] fax [**Telephone/Fax (1) 73915**] Completed by:[**2100-12-20**]

424,425,276,428,285,427,414,401,492,300,412,V120,V533,V586

{'Mitral valve disorders,Other primary cardiomyopathies,Acidosis,Congestive heart failure, unspecified,Anemia, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other emphysema,Anxiety state, unspecified,Old myocardial infarction,Personal history of Methicillin resistant Staphylococcus aureus,Fitting and adjustment of cardiac pacemaker,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: fatigue/DOE PRESENT ILLNESS: 77 year old female who has been followed for several years for atrial fibrillation and mitral regurgitation. She has undergone PVI in [**2098**] with atrial fibrillation recurrence in [**2099**] requiring DC cardioversion. In addition, she required a pacemaker in [**1-7**] for symptomatic bradycardia. Most recent echocariogram showed worsening mitral regurgitation, now moderate to severe. In addition, she had markedly increased tricuspid regurgitation, now 3+. Referred for surgery. MEDICAL HISTORY: mitral regurgitation s/p MV repair/TV repair/res. Left atrial appendage tricuspid regurgitation - Paroxysmal atrial fibrillation status post cardioversion in [**2096**], pulmonary vein isolation on [**2098-3-11**]. Recurrent atrial fibrillation post PVI requiring DC cardioversion, [**2099-7-31**] - Prior antiarrhythmic therapy with amiodarone discontinued due to lung toxicity (increased DLCO) - Prior antiarrhythmic therapy with dofetilide discontinued due to QT prolongation - Coronary Artery Disease s/p prior MI [**2076**], - Hypertension - Hyperlipidemia - Congestive Heart Failure - Cardiomyopathy - Mild emphysema/COPD - Hypothyroidism - Anxiety Past Surgical History: - St. [**Hospital 923**] medical dual-chamber pacemaker on [**2099-1-21**], [**Hospital3 **], for symptomatic bradycardia. - s/p Back surgery - s/p Tonsillectomy - Left breast biopsy - (Benign) MEDICATION ON ADMISSION: ALLOPURINOL - (Prescribed by Other Provider) - 100 mg Tablet - 1.5 Tablet(s) by mouth daily AMLODIPINE - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth once a day AZITHROMYCIN - 500 mg Tablet - 1 Tablet(s) by mouth 1 hour prior to the dental procedure as needed BUMETANIDE - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once a day CLONIDINE - (Prescribed by Other Provider) - 0.2 mg Tablet - 1 Tablet(s) by mouth twice a day LEVOTHYROXINE - (Prescribed by Other Provider) - 75 mcg Tablet - 1 Tablet(s) by mouth once a day LISINOPRIL - (Prescribed by Other Provider) - 40 mg Tablet - 1 Tablet(s) by mouth once a day METOPROLOL SUCCINATE - (Prescribed by Other Provider) - 50 mg Tablet Extended Release 24 hr - 1 Tablet(s) by mouth once daily PRAVASTATIN - (Prescribed by Other Provider) - 80 mg Tablet - 1 Tablet(s) by mouth once a day ***WARFARIN - (Prescribed by Other Provider) - 2 mg Tablet - 1 Tablet(s) by mouth once a day- LAST DOSE 11/10 ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet - 1 Tablet(s) by mouth once a day ALLERGIES: Penicillins / Amiodarone / Dofetilide PHYSICAL EXAM: Pulse: 70 Paced Resp: 16 O2 sat: 96% B/P Right: 131/77 Left: 140/86 Height: 65" Weight: 127lb FAMILY HISTORY: Denies premature coronary artery disease Father died of CAD in 70's SOCIAL HISTORY: Lives with: Husband Contact: Phone # Occupation: Retired Cigarettes: Smoked no [] yes [X] Hx: quit [**2076**] 35 pack-years Other Tobacco use: ETOH: < 1 drink/week [X] [**3-8**] drinks/week [] >8 drinks/week [] Illicit drug use: None ### Response: {'Mitral valve disorders,Other primary cardiomyopathies,Acidosis,Congestive heart failure, unspecified,Anemia, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other emphysema,Anxiety state, unspecified,Old myocardial infarction,Personal history of Methicillin resistant Staphylococcus aureus,Fitting and adjustment of cardiac pacemaker,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 84-year-old gentleman who presented with epigastric discomfort and belching for several months which would occur with exertion and rest. He presented to his primary care physician who referred him for stress testing. Stress testing was stopped 2 minutes in after 1- to 2-mm ST depressions and hypotension. This was performed on [**5-17**]. It also showed a reversible LV chamber dilatation and ischemic inferolateral and anterior walls with anterolateral hypokinesis and an ejection fraction of 61%. He was admitted to an outside hospital after his stress test. Catheterization today showed severe 3-vessel disease and was referred here for evaluation for coronary artery bypass grafting. He reports symptoms of indigestion only. He denies any chest pain, palpitations, edema, nausea, vomiting, diaphoresis, syncope, shortness of breath, DOE, or PND. MEDICAL HISTORY: 1. Hyperlipidemia. 2. BPH. MEDICATION ON ADMISSION: Cardura 2 mg p.o. at bedtime and aspirin 81 mg p.o. every other day. ALLERGIES: Allergic to no drugs. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is retired. Walks approximately a [**1-17**] mile a day. He quit smoking 30 years ago and smoked 1 to 2 cigars a day for 10 years. He has no use of alcohol listed.

Coronary atherosclerosis of native coronary artery,Drug-induced delirium,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other persistent mental disorders due to conditions classified elsewhere,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Aortocoronary bypass status

Crnry athrscl natve vssl,Drug-induced delirium,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Mental disor NEC oth dis,BPH w/o urinary obs/LUTS,Aortocoronary bypass

Unit No: [**Numeric Identifier 61776**] Admission Date: [**2112-5-18**] Discharge Date: [**2112-5-31**] Sex: M Service: CSU HISTORY OF PRESENT ILLNESS: This is an 84-year-old gentleman who presented with epigastric discomfort and belching for several months which would occur with exertion and rest. He presented to his primary care physician who referred him for stress testing. Stress testing was stopped 2 minutes in after 1- to 2-mm ST depressions and hypotension. This was performed on [**5-17**]. It also showed a reversible LV chamber dilatation and ischemic inferolateral and anterior walls with anterolateral hypokinesis and an ejection fraction of 61%. He was admitted to an outside hospital after his stress test. Catheterization today showed severe 3-vessel disease and was referred here for evaluation for coronary artery bypass grafting. He reports symptoms of indigestion only. He denies any chest pain, palpitations, edema, nausea, vomiting, diaphoresis, syncope, shortness of breath, DOE, or PND. Cardiac catheterization performed today showed an ejection fraction of 78%, mild anterior hypokinesis, LAD lesions of 90% and 95%, mid circumflex lesion totally occluded 100%, and RCA serial lesions of 60%, 70%, and 80%. PAST MEDICAL HISTORY: 1. Hyperlipidemia. 2. BPH. PAST SURGICAL HISTORY: He has no known past surgeries. ALLERGIES: Allergic to no drugs. MEDICATIONS ON ADMISSION: Cardura 2 mg p.o. at bedtime and aspirin 81 mg p.o. every other day. SOCIAL HISTORY: The patient is retired. Walks approximately a [**1-17**] mile a day. He quit smoking 30 years ago and smoked 1 to 2 cigars a day for 10 years. He has no use of alcohol listed. REVIEW OF SYSTEMS: The patient reports overall good health and being very active. He has no history of asthma, pneumonia, bronchitis, TB, CHF, COPD, or shortness of breath. He did not admit to any angina, palpitations, edema, or claudication. He also denied any hematemesis, GERD, abdominal pain, or melena, as well as kidney disease or liver disease. He had no neurologic history and did not mention any anemia or bleeding disorders, diabetes, or thyroid disease. PHYSICAL EXAMINATION ON ADMISSION: He is 5 feet 6 inches tall, weight of 155 pounds, blood pressure of 159/69, in sinus rhythm at 68, respiratory rate of 20, saturating 98% on room air. He was sitting up in bed in no apparent distress. When he was seen in consultation he was alert, oriented, and appropriate. No carotid bruits present. His lungs were clear bilaterally. His heart was regular in rate and rhythm with S1 and S2 tones. No murmurs, rubs, or gallops. The abdomen was soft, nontender, and nondistended with positive bowel sounds. The extremities were warm and well perfused without any edema or varicosities noted. He had 2+ bilateral radial, DP, and PT pulses. PREOPERATIVE LABORATORY DATA: White count of 7.9, hematocrit of 38.8, platelet count of 196,000. PT of 13.2, PTT of 28.3, INR of 1.2. Urinalysis had a trace amount of blood, but it was otherwise unremarkable. Sodium of 142, K of 3.6, chloride of 103, bicarbonate of 27, BUN of 15, creatinine of 1.0, blood sugar of 100. ALT of 15, AST of 22, LDH of 107, alkaline phosphatase of 72, amylase of 53, total bilirubin of 0.4, lipase of 26. Anion gap of 16. Albumin of 4.3. Calcium of 9.2, phosphorous of 3.3, magnesium of 2.1. HbA1C of 5.1%. RADIOLOGIC STUDIES: Preoperative chest x-ray showed no acute cardiopulmonary abnormality but noted a bilateral distal clavicular abnormality. HOSPITAL COURSE: Later the next morning the patient was noted to have some confusion. A psychiatric consultation was requested with recommendation for a MRI and reassessment in the morning and then proceed with CABG when the patient was mentally clear. The patient was also seen by case management preoperatively. On house day 2, the patient remained on a heparin drip as well as receiving metoprolol and aspirin. He was receiving Haldol p.r.n. and a psychiatric consultation was obtained. MRI of the head was performed on [**2112-5-20**] with no evidence of recent infarction. Please refer to the final report dated [**2112-5-20**]. Final impression by psychiatry post MRI gave impression of probable underlying dementia with slight decompensation in the hospital setting. The patient was continued with Haldol therapy p.r.n. On house day 3, his confusion was much improved. He remained on a heparin drip, and he had improvement in his confusion. On the 7th the patient was appropriate but was not oriented to time and place. The family said he uses visual cues at home, as this was discussed with the family, and also the MRI had revealed some old microvessel infarctions. The patient removed on the heparin drip. Also, on house day #4, placed on monitoring over weekend prior to surgery and remained on a heparin drip. His exam was nonfocal on the 8th. Preoperative labs on the 8th also showed a creatinine of 1.0, an INR of 1.2, a white count of 7.9. Echocardiogram performed showed an ejection fraction of greater than 55% with 1+ MR. On[**Last Name (STitle) 61777**]th, the patient underwent coronary artery bypass grafting x 2 by Dr. [**Last Name (Prefixes) **] with a LIMA to the LAD and a vein graft to the OM. He was transferred to the cardiothoracic intensive care unit in stable condition on a Neo-Synephrine drip at 0.5 mcg/kg/min, a propofol drip at 40 mcg/kg/min. Later that evening, the patient was extubated successfully. His NG tube also came out after extubation. On postoperative day 1, his creatinine remained stable at 0.7. His exam was unremarkable with a blood pressure of 115/46, in sinus rhythm at 80. He remained on a Neo-Synephrine drip at 0.3 and an insulin drip at 5 units per hour for tight glucose control. His PA catheter was removed, and weaning of Neo- Synephrine was begun. Later that afternoon he was transferred out to the floor to begin work on ambulation and physical therapy with the nurses. Of note, it was Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] plan that the patient have a hybrid procedure to be returned to the cath lab when the patient was stable for stenting of a 3rd coronary vessel. On the 11th, the patient returned to the cath lab and had 2 CYPHER stents placed in the right coronary artery as per plan. He had an episode of hypotension in the cath lab and was returned to the cath lab holding area on a dopamine drip at 2.5 mcg/kg/min which was titrated up to 5 mcg/kg/min, a 300-mg dose of Plavix was given in the cath lab for coverage of his new CYPHER stents. The patient was transferred back to the CSRU from the cath lab holding area in stable condition, mentating appropriately on a dopamine drip at 5 which was switched over to Neo-Synephrine when he arrived in the unit. A 12-lead EKG taken in the cath lab holding area revealed no acute ischemia and no changes from his prior EKG. His cordis was switched over to a central venous line. Diuresis with Lasix was begun. Foley was discontinued, and his chest tubes were pulled. He was transfused 1 unit of packed cells for a hematocrit of 29.3. Later that day he was weaned off his Neo- Synephrine and was receiving Haldol p.r.n. On the 12th, the patient was transferred back out to [**Hospital Ward Name 121**] Two to start working on ambulation again with physical therapy and the nurses. On the 13th, no confusion was noted. The patient was clear and continued to improve his ambulation status. His creatinine remained stable at 0.9. The JP drain from his leg was removed, and his epicardial pacing wires were removed. Of note, the patient was much clearer on this, his postoperative day 4. He was also seen and evaluated by case management. The patient continued to have a small amount of serosanguineous drainage from his left leg post drain pull, but this dried up prior to discharge. On postoperative day 6, he had no events overnight. He continued to work with physical therapy. The patient continued to improve with physical therapy and ambulation. The serosanguineous drainage in his leg dried up, and his creatinine remained stable. His hematocrit remained at 31.1 after transfusion 2 days prior. He was saturating 98% on room air, maintaining a good blood pressure of 112/44. On the day of discharge his exam was unremarkable. The sternum was stable. His lungs were clear. His heart was regular in rate and rhythm, and he was discharged home with VNA services with the following discharge instructions. DI[**Last Name (STitle) 408**]E INSTRUCTIONS: He was to make an appointment with Dr. [**First Name (STitle) **], his primary care physician, [**Name10 (NameIs) **] be seen 1 to 2 weeks post discharge. To make an appointment with Dr. [**Last Name (Prefixes) **] in the office for his postoperative surgical visit 4 weeks post discharge. To see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1159**], his cardiologist, about 2 to 3 weeks post discharge. DISCHARGE DIAGNOSES: 1. Status post coronary artery bypass grafting x 2. 2. Status post right coronary artery CYPHER stents x 2. 3. Benign prostatic hyperplasia. 4. Hyperlipidemia. MEDICATIONS ON DISCHARGE: 1. Metoprolol 25 mg p.o. twice a day. 2. Colace 100 mg p.o. twice a day. 3. Enteric coated aspirin 81 mg p.o. once daily. 4. Plavix 75 mg p.o. once daily. 5. Lipitor 10 mg p.o. once daily. 6. Ibuprofen 400 mg to 500 mg p.o. q.6h. as needed (the patient was instructed to take ibuprofen with food). 7. Lasix 40 mg p.o. twice a day (for 7 days). 8. Potassium chloride 10 mEq p.o. twice a day (for 7 days). 9. Cardura 2 mg p.o. once daily at bedtime. CONDITION ON DISCHARGE: The patient was discharged in stable condition on [**2112-5-31**]. [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2112-5-31**] 09:52:06 T: [**2112-6-1**] 10:10:53 Job#: [**Job Number 61778**]

414,292,272,458,294,600,V458

{'Coronary atherosclerosis of native coronary artery,Drug-induced delirium,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other persistent mental disorders due to conditions classified elsewhere,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),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: PRESENT ILLNESS: This is an 84-year-old gentleman who presented with epigastric discomfort and belching for several months which would occur with exertion and rest. He presented to his primary care physician who referred him for stress testing. Stress testing was stopped 2 minutes in after 1- to 2-mm ST depressions and hypotension. This was performed on [**5-17**]. It also showed a reversible LV chamber dilatation and ischemic inferolateral and anterior walls with anterolateral hypokinesis and an ejection fraction of 61%. He was admitted to an outside hospital after his stress test. Catheterization today showed severe 3-vessel disease and was referred here for evaluation for coronary artery bypass grafting. He reports symptoms of indigestion only. He denies any chest pain, palpitations, edema, nausea, vomiting, diaphoresis, syncope, shortness of breath, DOE, or PND. MEDICAL HISTORY: 1. Hyperlipidemia. 2. BPH. MEDICATION ON ADMISSION: Cardura 2 mg p.o. at bedtime and aspirin 81 mg p.o. every other day. ALLERGIES: Allergic to no drugs. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is retired. Walks approximately a [**1-17**] mile a day. He quit smoking 30 years ago and smoked 1 to 2 cigars a day for 10 years. He has no use of alcohol listed. ### Response: {'Coronary atherosclerosis of native coronary artery,Drug-induced delirium,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other persistent mental disorders due to conditions classified elsewhere,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Aortocoronary bypass status'}

CHIEF COMPLAINT: large IPH PRESENT ILLNESS: The patient is a 70 year old man with a h/o prior stroke now presenting with a large IPH. The patient is unable to give a history so details are taken from his medical record. He was in his usual state of health until right after dinner, he arose from the table and then collapsed to the ground. He was "out of it" for about a minute. When he came to, he was agitated and confused. EMS was called and he was taken to Caritas [**Hospital 39167**]. A head CT there revealed a small amount of right parietal subarachnoid blood. During his stay there, he also vomited and was intubated for aspiration protection. He was transferred to [**Hospital1 18**] for further care. MEDICAL HISTORY: -atrial fibrillation -CAD s/p CABG -h/o rectal polyps -h/o old left parietal stroke -h/o sleep apnea MEDICATION ON ADMISSION: ASA Simvastatin Amiodarone 200 Clopidogrel 75 Furosemide Ramipril ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 98.6 155/88 88 16 General: older man, intubated Upon admission: Neck: supple Lungs: clear to auscultation CV: irregular rhythm Abdomen: non-tender, non-distended, bowel sounds present Ext: warm, no edema FAMILY HISTORY: unknown SOCIAL HISTORY: -lives with wife -no tobacco or alcohol use

Subarachnoid hemorrhage,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Atrial fibrillation,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Other and unspecified complications of medical care, not elsewhere classified,Unspecified sleep apnea,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Dermatitis due to drugs and medicines taken internally,Aortocoronary bypass status,Old myocardial infarction

Subarachnoid hemorrhage,CHF NOS,Pneumonia, organism NOS,Acute kidney failure NOS,Atrial fibrillation,Obstructiv hydrocephalus,Hyperosmolality,Complic med care NEC/NOS,Sleep apnea NOS,Hypertension NOS,Delirium d/t other cond,Elev transaminase/ldh,Drug dermatitis NOS,Aortocoronary bypass,Old myocardial infarct

Admission Date: [**2115-4-14**] Discharge Date: [**2115-5-6**] Date of Birth: [**2044-9-2**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 465**] Chief Complaint: large IPH Major Surgical or Invasive Procedure: External ventricular drain placement and removal. G-tube placement History of Present Illness: The patient is a 70 year old man with a h/o prior stroke now presenting with a large IPH. The patient is unable to give a history so details are taken from his medical record. He was in his usual state of health until right after dinner, he arose from the table and then collapsed to the ground. He was "out of it" for about a minute. When he came to, he was agitated and confused. EMS was called and he was taken to Caritas [**Hospital 39167**]. A head CT there revealed a small amount of right parietal subarachnoid blood. During his stay there, he also vomited and was intubated for aspiration protection. He was transferred to [**Hospital1 18**] for further care. Past Medical History: -atrial fibrillation -CAD s/p CABG -h/o rectal polyps -h/o old left parietal stroke -h/o sleep apnea Social History: -lives with wife -no tobacco or alcohol use Family History: unknown Physical Exam: Vitals: 98.6 155/88 88 16 General: older man, intubated Upon admission: Neck: supple Lungs: clear to auscultation CV: irregular rhythm Abdomen: non-tender, non-distended, bowel sounds present Ext: warm, no edema Neurologic Examination: awake at times, eyes open, not following simple commands, pupils 3 to 2 mm and sluggish, +corneal reflex, +gag, +localizing to pain x4, spontaneous movement x4; dtrs depressed throughout at 1 but symmetric, toes mute . Upon transfer to medicine service: Vitals: T: 101.6 BP: 131/61 P: 73 R: 20 SaO2: 94% on 35% face tent General: Elderly man lying in bed, responds to voice minimally, A&Ox1 HEENT: Not cooperative with pupillary exam, healing incision across top of head, no scleral icterus, MM dry, no lesions noted in OP Neck: no significant JVD or carotid bruits appreciated Pulmonary: noncompliant with lung exam, CTA bilaterally, no wheezes, ronchi or rales Cardiac: tachycardic, sounds irregularly irregular, no appreciable murmurs, but difficult to assess given bowel sounds and mumbling Abdomen: soft, mildly distended, not obviously tender, normoactive bowel sounds, no masses or organomegaly noted Extremities: No edema, 2+ radial, DP pulses b/l Lymphatics: No cervical, supraclavicular lymphadenopathy noted Skin: alrge rash across abdoemn and lower chest, small erythematous maculopapular rash. Neurologic: Difficult to engage. Speaking only in mumbles. able to move all extremities. Pertinent Results: [**2115-4-13**] 11:00PM PT-11.7 PTT-21.9* INR(PT)-1.0 [**2115-4-13**] 11:00PM WBC-18.8* RBC-4.40* HGB-14.1 HCT-40.9 MCV-93 MCH-31.9 MCHC-34.4 RDW-13.9 [**2115-4-13**] 11:00PM PLT COUNT-230 [**2115-4-13**] 11:00PM NEUTS-81.1* BANDS-0 LYMPHS-12.8* MONOS-4.2 EOS-1.5 BASOS-0.4 [**2115-4-13**] 11:00PM CALCIUM-8.6 PHOSPHATE-3.7 MAGNESIUM-2.5 [**2115-4-13**] 11:00PM CK-MB-4 [**2115-4-13**] 11:00PM cTropnT-<0.01 [**2115-4-13**] 11:00PM CK(CPK)-135 [**2115-4-13**] 11:00PM GLUCOSE-166* UREA N-28* CREAT-1.4* SODIUM-142 POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-23 ANION GAP-19 [**2115-4-13**] 11:38PM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2115-4-13**] 11:38PM URINE RBC->50 WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-0 [**2115-4-13**] 11:38PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.006 [**2115-4-14**] 12:18AM LACTATE-1.8 . CT C-spine [**2115-4-13**]: 1. No evidence of cervical spine fracture. 2. Multilevel degenerative changes. There is intervertebral disc space narrowing at C6-7, and mild, probably degenerative, grade I anterolisthesis of C5 on C6. 3. Nasogastric tube is coiled within the supraglottic region. 4. Evidence of pulmonary edema at the lung apices. 5. Left subclavian vascular stent. . CT head w/o contrast [**2115-4-13**]: The epicenter of hemorrhage is probably posterior to the splenium of the corpus callosum, with extension of hemorrhage into the lateral ventricles, and right ambient cistern. Subarachnoid blood is seen within right parietal sulci and there is a potential subdural component between the cerebral hemispheres and along the tentorium. Though the epicenter of the hemorrhage is somewhat unusual, the differential diagnosis includes hypertensive hemorrhage, hemorrhage related to an AVM, neoplasm, amyloid angiopathy and idiopathic. . pCXR [**2115-4-13**]: A trauma board obscures detail. An endotracheal tube is in place, with the tip approximately 7.9 cm from the carina. Of note, a nasogastric tube is not visualized, and was seen coiled within the pharynx on the accompanying cervical spine CT. There are sternotomy wires and mediastinal clips consistent with prior CABG. The heart may be mildly enlarged. The aorta is calcified. There are increased interstitial markings within the lungs, suggesting some degree of pulmonary edema. A pacer pad over the right hilar region obscures some detail. No definite pleural effusion or pneumothorax. A stent in the left apical chest is seen . ECG [**2115-4-13**]: Atrial fibrillation. Inferior/lateral ST-T wave changes. Intraventricular conduction delay. Clinical correlation is suggested. No previous tracing available for comparison. . CT head w/o contrast [**2115-4-14**]: Again noted a rounded area of hemorrhage located within the midline posterior to the level of the lateral ventricles, measuring approximately 4.3 x 3.5 cm on today's study, compared to 4.5 x 3.4 cm previously, not significantly changed in axial dimensions. Again seen extension of the hemorrhage into occipital horns of the lateral ventricles bilaterally. Today it is also seen within right and left ambient cisterns. Subarachnoid and subdural components of the hemorrhage are not changed. There is no shift of normally midline structures. There has been interval placement of a right ventriculostomy tube. There is a small focus of air in the right frontal [**Doctor Last Name 534**] of the lateral ventricle, consistent with recent manipulation. An air-fluid level is seen in the maxillary sinus on the right and the left. The mastoid air cells are well aerated. . CT head w/o contrast [**2115-4-15**]: No significant interval change in unusual location and distribution of intracranial hemorrhage. Absent a history of trauma or anticoagulation, amyloid angiopathy should be considered, though the deep white matter location and intraventricular extension would be atypical. . pCXR [**2115-4-16**]: Comparison to prior film from earlier the same day demonstrates worsening of interstitial and alveolar opacities bilaterally likely representing edema. New retrocardiac density is likely also secondary to underlying edema, however, a focal infectious consolidation cannot be excluded. Small new pleural effusions may be present bilaterally. Cardiomegaly is again noted and the remainder of mediastinal contours are unchanged. Midline sternotomy wires and surgical mediastinal clips are seen. . CT head w/o contrast [**2115-4-17**]: No change from the prior examination with a large intraparenchymal hemorrhage centered about the splenium of the corpus callosum. Unchanged amounts of intraventricular and subarachnoid blood. Encephalomalacia in the region of the left parietal lobe. . pCXR [**2115-4-17**]: Cardiomediastinal silhouette remains enlarged. There are sternotomy wires and mediastinal clips in place. There has been an interval improvement of interstitial and alveolar opacities bilaterally, likely represented CHF. Previously noted retrocardiac density has improved as well. There is no sizable left pleural effusion. Right costophrenic angle is excluded on this study. The feeding tube is seen coiled in the esophagus. . CT head w/o contrast [**2115-4-18**]: No significant short interval change. The ventricles are unchanged in configuration compared to one day ago. . CXR Pa/L [**2115-4-20**]: There is a dense alveolar infiltrate in the right upper lung greater than left upper lung with pulmonary vascular redistribution and cardiomegaly. Given the rapid change in appearance of the infiltrates over the past few days, this likely represents pulmonary edema but an underlying infectious infiltrate cannot be totally excluded. There are small bilateral effusions. . CT head w/o contrast [**2115-4-21**]: No significant change in ventricular size and shape, when compared to the series of studies dating to [**2115-4-14**], when the ventriculostomy catheter was placed. The parenchymal, intraventricular and subarachnoid hemorrhage are, overall, unchanged in appearance. . CXR Pa/L [**2115-4-21**]: When compared with the prior examination, there appears to be a slight improvement in the appearance of the airspace disease in the right upper lobe. Mild pulmonary vascular congestion persists. The left lung is not optimally evaluated since the patient's arm is overlying it. No large pleural effusions are seen in this projection. Colon interposition is seen on the right side. . CT head w/o contrast [**2115-4-23**]: Since that examination, there has been no change. There is a large hemorrhage centered about the splenium of the corpus callosum. There is intraventricular and subarachnoid blood, similar in appearance to the prior examination. The right frontal ventriculostomy catheter remains unchanged in position. There is encephalomalacia in the left parietal lobe. . CT chest w/contrast [**2115-4-24**]: 1. Widespread alveolar consolidations, most likely representing widespread infection. The differential diagnosis should include alveolar hemorrhage, but clinical correlation is recommended. The pulmonary edema is less likely due to the patchy appearance in predominantly upper lobe distribution of these findings. Aspiration should also be considered although the upper lobe predominance with relative sparing of the lower lobes is unusual. No mass seen. 2. Mediastinal and hilar lymphadenopathy most likely reactive to the lung process, but followup is recommended, especially for the right paratracheal lymph node for documentation of its decrease in size. 3. Cardiomegaly, coronary calcifications, previous CABG, and aortic atherosclerosis. 4. Hypodense right kidney lesion most likely cortical cyst. Evaluation with ultrasound is recommended. 5. Probable mixing artifact causing apparent filling defect in upper SVC, as above. Depending on the patient's clinical exam and risks for SVC thombus, an MRV is a consideration for further evaluation if indicated. . Echo [**2115-4-24**]: The left atrium is moderately dilated. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Transmitral Doppler and tissue velocity imaging are consistent with Grade II (moderate) LV diastolic dysfunction. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. There is no mass/thrombus in the right ventricle. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. . EKG [**2115-4-24**]: Afib with RVR . CT head w/o contrast [**2115-4-25**]: 1) Status post right ventriculostomy catheter removal with a new moderately- sized hypodense subdural collection causing mass effect on the adjacent parenchyma. 2) Stable appearance of the hemorrhage centered on the splenium of the corpus callosum, layering within the ventricles, and scattered within the subarachnoid spaces. 3) Study is somewhat motion limited and, especially in evaluation of the left frontal distribution . EEG [**2115-4-25**]: This is a very abnormal portable routine EEG due to the low voltage, slow background with bursts of generalized slowing suggestive of diffuse encephalopathy was well as dysfunction of the subcortical and deep midline structures. Metabolic disturbance, infection, and medications are among the most common causes of encephalopathy. No epileptiform features were seen. This study was limited by muscle artifacts during a significant portion of the recording . CT head w/o contrast [**2115-4-26**]: No significant interval change in hemorrhage centered on the body of the corpus callosum and small right frontal extra-axial collection with intracranial air. The etiology of this hemorrhage is still unclear. . RUQ u/s [**2115-4-26**]: 1. No evidence of hepatic or biliary pathology. 2. Small right pleural effusion. 3. Septated right renal cyst . pCXR [**2115-4-29**]: Comparison is made with the prior chest x-ray of [**4-23**]. Dense opacification of the right upper lobe is present consistent with right upper lobe pneumonia. Patchy infiltrates are present also in the left upper lobe consistent with pneumonia in this area as well. Elsewhere, the lung fields appear clear. No failure is seen. . CT head [**2115-5-1**]: Comparison with the prior study reveals little change in the extent of the large hemorrhage which appears centered in the body of the corpus callosum. There is a probable tiny amount of blood layering in the right occipital [**Doctor Last Name 534**]. However, there is a suggestion that there may be very slight interval increase in the size of the supratentorial ventricular system. The left parietal lobe chronic infarct is again noted. The present study also suggests that there is a lacunar infarct in the right lentiform nucleus, which I cannot clearly identify on prior studies. This lesion is arcuate in configuration, measuring approximately 1 cm in length. The right frontal subdural fluid and gas collection has undergone essentially complete regression. At this time, there is moderate mucosal thickening within the left maxillary sinus along its lateral wall (the present study does not completely image the maxillary sinuses, however). . pCXR [**2115-5-5**]: One portable view. Comparison with [**2115-4-29**]. The lung volumes are quite low. Dense consolidation and the right upper lobe consistent with pneumonia persists. There is now increased density in the lower right lung, which may represent a new infiltrate. The left lung is grossly clear. The patient is status post median sternotomy and CABG as before. A feeding tube has been withdrawn. . pAbdomen x-ray [**2115-5-5**]: One view. Comparison with [**2115-4-17**]. A feeding tube has been withdrawn. A percutaneous gastrostomy tube has been placed with its balloon tip projected in the gastric bubble. There is increased gas in nondilated bowel. Gas is present in the colon to the level of the rectum. Soft tissues are unremarkable. There is scattered atherosclerotic calcification. Degenerative arthritic changes are again noted in the spine. Brief Hospital Course: 70 yo man with CAD s/p CABG and multiple stents (last in [**2112**]), paroxysmal atrial fibrillation and h/o stroke p/w ICH an subarachnoid hemorrhage s/p ventricular shunt now transferred to medicine service for persistent fevers. . ## Fevers: The fevers were felt likely due to pneumonia vs chemical meningitis (especially given recent surgery and blood in brain). He was treated with at least 10 days of IV antibiotics (vancomycin, aztreonam, and metronidazole), after he developed a rash to piperacillin/tazobactam. Pulmonary evaluated the patient and recommended a 10 day course of antibiotics. There was also concern for drug fever from anti-epileptics; he was initially on phenytoin for anti-seizure prophylaxis, which was changed to levetiracetam, then d/c'ed altogether. All blood and urine cultures were negative (final) C. diff was considered since the patient also had diarrhea, but Cdiff toxin was negative x5. Of note, Cdiff toxin B was sent off on three stool samples, but results are still pending and need to be followed up. Finally there was concern for a biliary tree source since the patient had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], [**First Name3 (LF) **] RUQ U/S was performed and was negative. His liver enzymes normalized. All antibiotics were stopped on [**2115-5-2**], and the patient remained afebrile. On the day prior to discharge, there was concern that the patient had a new [**Last Name (LF) **], [**First Name3 (LF) **] a CXR was performed revealing a possible new RLL infiltrate. His coughing improved, he remained afebrile, and his WBC decreased, and this was more indicative of transient aspiration pneumonitis rather than pneumonia. No intervention was made. If he should spike another fever, aspiration pneumonia should be considered given his altered mental status and failure of swallowing evaluation. He is being fed by peg tube to avoid overt aspiration. He should follow up with his primary care physician. . ## s/p ICH and subarachnoid hemorrhage: The patient had a ventricular drain placed and later removed by neurosurg. He had multiple head CTs revealing stable fluid collections, as well as some dilatation of the ventricles. EEG revelaed evidence of encephalopathy, without evidence of seizure activity. He was initially on anti-seizure prophylaxis, but this was later stopped. His mental status remained altered, likely due to delirium from infection, but possibly due to defecit from the stroke. His mental status should be monitored for signs of improvement, and his goals of care re-assessed if he does not improve. The patient should follow up with Dr. [**Last Name (STitle) 548**] from neurosurgery in 4 weeks (call for an appointment), and have a repeat CT head at that time. . ## Delirium: This was felt likely secondary to fevers and infection although worrisome that the patient has permanent deficits given recent head bleed. EEG was done and revealed evidence suggestive of encephalopathy. Also his chemical meningitis from hemorrhage could be contributing, and his mental status may improve once the blood resorbs. . ## Paroxysmal atrial fibrillation: On the medicine floor, the patient was noted to be in Afib with RVR. He was given several doses of IV Metoprolol, and his dose of oral Metoprolol was increased to 100mg QID. Diltiazem 30mg QID was added for better HR and BP control. His rhythm spontaneously converted to Sinus. The diltiazem was discontinued when the patient had asymptomatic bradycardia in the 40s. Anti-coaggulation is contraindicated in this patient secondary to his intra-cranial hemorrhage. . ## L great toe erythema: The patient had some erythema of the L great toe, and there was concern for gout. NSAIDS were contraindicated due to his intracranial hemorrhage, and colchicine was not given as the patient was having loose stools. He was given tylenol, but did not seem to be experiencing pain at the toe. The erythema resolved by the time of discharge. . ## ARF: The patient's Cr improved back to baseline after he was given fluid boluses and started on tube feeds, making pre-renal the most likely etiology. If he needs further blood pressure control, an ACE inhibitor can be used. . ## HTN: His blood pressure was controlled with Metoprolol and Hydralazine. His ACE-inhibitor was held initially due to the renal failure, but can be restarted if needed. . ## Rash: The patient developed what appeared to be a drug rash, felt likely secondary to piperacillin-tazobactam. This antibiotic was stopped and his rash resolved. . ## CAD s/p CABG: While in Afib with RVR, there were mild ST depressions and new TWI in lateral leads, felt likely to be rate related. He was continued on Metoprolol, Simvastatin. Aspirin and Plavix were held due to his bleed. Aspirin may be able to be restarted in the future, and Neurosurgery should address this at the patient's follow up appointment. . ## [**Last Name (STitle) 5779**]: The patient was noted to have a mild [**Last Name (STitle) **]. RUQ U/S was performed and was unrevealing. Hep serologies were negative. His [**Last Name (STitle) **] resolved without intervention. . ## High INR: The patient received Vitamin K 5 mg PO x3, with normalization of his INR. . ## FEN/Lytes: Tube feeds, now at goal . ## Prophylaxis: No heparin given head bleed, PPI, pneumoboots . ## Code status: DNR/DNI (Decision was made in a family meeting with the patient's wife/HCP several days prior to discharge.) Medications on Admission: ASA Simvastatin Amiodarone 200 Clopidogrel 75 Furosemide Ramipril Discharge Medications: 1. Acetaminophen 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H (every 6 hours). 2. Albuterol Sulfate 0.083 % Solution [**Last Name (STitle) **]: One (1) nebulizer treatment Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. nebulizer treatment 3. Amiodarone 200 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 4. Bisacodyl 10 mg Suppository [**Last Name (STitle) **]: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 5. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: One Hundred (100) mg PO twice a day. 6. Ipratropium Bromide 0.02 % Solution [**Last Name (STitle) **]: One (1) neb Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 7. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO QID (4 times a day): hold for sbp <100 or hr <60. 8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 9. Miconazole Nitrate 2 % Powder [**Last Name (STitle) **]: One (1) Appl Topical QID (4 times a day) as needed. 10. Simvastatin 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 11. Insulin NPH Human Recomb 100 unit/mL Cartridge [**Last Name (STitle) **]: Twelve (12) units Subcutaneous every twelve (12) hours. 12. Insulin Regular Human 300 unit/3 mL Insulin Pen [**Last Name (STitle) **]: as directed per sliding scale Subcutaneous four times a day. 13. Hydralazine 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO every six (6) hours: hold for systolic blood pressure less than 120. Discharge Disposition: Extended Care Facility: [**Hospital6 1293**] - [**Location (un) **] Discharge Diagnosis: * Intracerebral hemorrhage with intraventricular extension * Hydrocephalus * Pneumonia * Altered Mental Status likely due to delirium combined with some permanent defecit from your stroke. * s/p G- tube placement Discharge Condition: Afebrile, with altered mental status. (awake, arousable, but does not follow commands; cannot take orals, G-tube feeds only) Discharge Instructions: You were admitted with a stoke caused by bleeding into your brain. You also had pneumonia, and you completed a full course of antibiotics. Since your mental status is still not clear, do not take any food or medicine by mouth; only tube feeds. You may take medications through your G-tube. . Take all medications as prescribed and keep all follow up appointments. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, aspirin, Advil, Ibuprofen etc. CALL YOUR DOCTOR IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: ?????? New onset of tremors or seizures ?????? Any change in mental status (currently you have altered mental status) ?????? Any numbness, tingling, weakness in your extremities ?????? Pain or headache that is continually increasing or not relieved by pain medication ?????? Any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? Fever greater than or equal to 101?????? F Followup Instructions: PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.[**Last Name (STitle) **] FROM NEUROSURGERY, TO BE SEEN IN 4 WEEKS. YOU WILL NEED A CAT SCAN OF THE BRAIN WITHOUT CONTRAST at that time. . Call your primary care physician for an appointment in [**1-22**] weeks. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**] Completed by:[**2115-5-6**]

430,428,486,584,427,331,276,999,780,401,293,790,693,V458,412

{'Subarachnoid hemorrhage,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Atrial fibrillation,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Other and unspecified complications of medical care, not elsewhere classified,Unspecified sleep apnea,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Dermatitis due to drugs and medicines taken internally,Aortocoronary bypass status,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: large IPH PRESENT ILLNESS: The patient is a 70 year old man with a h/o prior stroke now presenting with a large IPH. The patient is unable to give a history so details are taken from his medical record. He was in his usual state of health until right after dinner, he arose from the table and then collapsed to the ground. He was "out of it" for about a minute. When he came to, he was agitated and confused. EMS was called and he was taken to Caritas [**Hospital 39167**]. A head CT there revealed a small amount of right parietal subarachnoid blood. During his stay there, he also vomited and was intubated for aspiration protection. He was transferred to [**Hospital1 18**] for further care. MEDICAL HISTORY: -atrial fibrillation -CAD s/p CABG -h/o rectal polyps -h/o old left parietal stroke -h/o sleep apnea MEDICATION ON ADMISSION: ASA Simvastatin Amiodarone 200 Clopidogrel 75 Furosemide Ramipril ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 98.6 155/88 88 16 General: older man, intubated Upon admission: Neck: supple Lungs: clear to auscultation CV: irregular rhythm Abdomen: non-tender, non-distended, bowel sounds present Ext: warm, no edema FAMILY HISTORY: unknown SOCIAL HISTORY: -lives with wife -no tobacco or alcohol use ### Response: {'Subarachnoid hemorrhage,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Atrial fibrillation,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Other and unspecified complications of medical care, not elsewhere classified,Unspecified sleep apnea,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Dermatitis due to drugs and medicines taken internally,Aortocoronary bypass status,Old myocardial infarction'}

CHIEF COMPLAINT: Fall, nausea and vomiting secondary to alcohol use. PRESENT ILLNESS: 34 y/o gentleman with known alcohol abuse was found down in his bathroom with vomit and blood around him. His landlord called police after a water leak from his apartment. Patient was transfered to [**Hospital3 **] and was found to have two seizure episodes en route. Patient received IVF greater than 1 L NS (unclear amount), thiamine 100 mg and 1 mg folate. Patient also received 10 mEq KCl, 40 mg IV pantoprazole and Zosyn 3.375 gm IV once. CXR there showed pneumomediastimum without pneumothorax and he was transfered to [**Hospital1 18**] ED. . In [**Hospital1 18**] ED his vitals were T 98.2 HR 92 BP 124/50 RR 16 O2 sat 98%. Patient was alert and oriented times three but was a poor historian. His family saw him and thought that he was at baseline. He has had trouble giving history and recalling events at baseline per family. Patient was given metronidazole 500 mg IV, Fluconazole 200 mg IV and vancomycin 1 gram IV. He also received 1 unit of PRBC. His urine output was greater than 700 ml in ED over approx 4 hours. Thoracics was consulted who recommended a barium swallow study. Preliminary read was some distal filling defect without any extravasation. Recommended GI consult. . On arrival to the MICU his vitals were T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC. Patient denies any acute distress. He states that he was aware of EMS coming into his house. He states that he might have had a seizure this morning. He also had a seizure one week ago. He has had episodes of binge drinking. His last drink was three days ago per patient. He drank greater than 1 bottle of Vodka that night but unable to quantify. He denies any fever, chills, chest pain, shortness of breath, nausea, abdoinal pain, dysuria, diarrhea, constipation, focal numbness or weakness. He has noticed dark urine and dark colored stool in the last two days. He has depressed mood per family history after losing his job recently. Patient denies any suicidal ideation. MEDICAL HISTORY: Alcohol abuse SDH in [**2109**] secondary to fall Known alcohol withdrawl seizures Otherwise denies any medical problems MEDICATION ON ADMISSION: None Denies any OTC/herbal ALLERGIES: Clindamycin PHYSICAL EXAM: Vitals: T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC Gen: Alert and oriented x 3 (not date but month/year). Poor historian. NAD HEENT: PEERL, EOM-I, Mucous membranes are dry, bruise in lower lip, JVP not elevated Lungs: Clear to auscultate bilaterally Heart: Tender to palpate in left chest wall, S1S2 RRR, no MRG Abdomen: BS present, soft NTND Ext: WWP, DP 2+ Neuro: CN II-XII grossly intact, strength 5/5, sensation is intact, normal muscle tone. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Works in construction. 20 pack/year tobacco. Drinks ETOH in binges.

Interstitial emphysema,Gastroesophageal laceration-hemorrhage syndrome,Alcohol withdrawal,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Rhabdomyolysis,Anemia, unspecified,Other and unspecified alcohol dependence, episodic,Other convulsions,Depressive disorder, not elsewhere classified,Benign paroxysmal positional vertigo,Lack of housing

Interstitial emphysema,Mallory-weiss syndrome,Alcohol withdrawal,Acute kidney failure NOS,Hyposmolality,Rhabdomyolysis,Anemia NOS,Alcoh dep NEC/NOS-episod,Convulsions NEC,Depressive disorder NEC,Benign parxysmal vertigo,Lack of housing

Admission Date: [**2112-11-30**] Discharge Date: [**2112-12-7**] Date of Birth: [**2078-1-21**] Sex: M Service: MEDICINE Allergies: Clindamycin Attending:[**First Name3 (LF) 4654**] Chief Complaint: Fall, nausea and vomiting secondary to alcohol use. Major Surgical or Invasive Procedure: Flexible bronchosopy ([**2112-12-1**]). History of Present Illness: 34 y/o gentleman with known alcohol abuse was found down in his bathroom with vomit and blood around him. His landlord called police after a water leak from his apartment. Patient was transfered to [**Hospital3 **] and was found to have two seizure episodes en route. Patient received IVF greater than 1 L NS (unclear amount), thiamine 100 mg and 1 mg folate. Patient also received 10 mEq KCl, 40 mg IV pantoprazole and Zosyn 3.375 gm IV once. CXR there showed pneumomediastimum without pneumothorax and he was transfered to [**Hospital1 18**] ED. . In [**Hospital1 18**] ED his vitals were T 98.2 HR 92 BP 124/50 RR 16 O2 sat 98%. Patient was alert and oriented times three but was a poor historian. His family saw him and thought that he was at baseline. He has had trouble giving history and recalling events at baseline per family. Patient was given metronidazole 500 mg IV, Fluconazole 200 mg IV and vancomycin 1 gram IV. He also received 1 unit of PRBC. His urine output was greater than 700 ml in ED over approx 4 hours. Thoracics was consulted who recommended a barium swallow study. Preliminary read was some distal filling defect without any extravasation. Recommended GI consult. . On arrival to the MICU his vitals were T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC. Patient denies any acute distress. He states that he was aware of EMS coming into his house. He states that he might have had a seizure this morning. He also had a seizure one week ago. He has had episodes of binge drinking. His last drink was three days ago per patient. He drank greater than 1 bottle of Vodka that night but unable to quantify. He denies any fever, chills, chest pain, shortness of breath, nausea, abdoinal pain, dysuria, diarrhea, constipation, focal numbness or weakness. He has noticed dark urine and dark colored stool in the last two days. He has depressed mood per family history after losing his job recently. Patient denies any suicidal ideation. Past Medical History: Alcohol abuse SDH in [**2109**] secondary to fall Known alcohol withdrawl seizures Otherwise denies any medical problems Social History: Works in construction. 20 pack/year tobacco. Drinks ETOH in binges. Family History: Noncontributory. Physical Exam: Vitals: T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC Gen: Alert and oriented x 3 (not date but month/year). Poor historian. NAD HEENT: PEERL, EOM-I, Mucous membranes are dry, bruise in lower lip, JVP not elevated Lungs: Clear to auscultate bilaterally Heart: Tender to palpate in left chest wall, S1S2 RRR, no MRG Abdomen: BS present, soft NTND Ext: WWP, DP 2+ Neuro: CN II-XII grossly intact, strength 5/5, sensation is intact, normal muscle tone. Pertinent Results: Complete blood count [**2112-11-30**] 10:01PM BLOOD WBC-10.0 RBC-2.96*# Hgb-10.2*# Hct-26.0*# MCV-88 MCH-34.4* MCHC-39.1* RDW-13.0 Plt Ct-145* [**2112-12-1**] 03:07AM BLOOD WBC-9.5 RBC-3.02* Hgb-10.2* Hct-26.1* MCV-87 MCH-33.7* MCHC-38.9* RDW-13.8 Plt Ct-155 [**2112-12-2**] 05:15AM BLOOD WBC-9.2 RBC-3.05* Hgb-10.1* Hct-28.0* MCV-92 MCH-33.1* MCHC-36.0* RDW-13.4 Plt Ct-200 [**2112-12-3**] 06:05AM BLOOD WBC-6.9 RBC-2.98* Hgb-10.0* Hct-27.3* MCV-92 MCH-33.5* MCHC-36.5* RDW-13.9 Plt Ct-199 [**2112-12-4**] 05:10AM BLOOD WBC-7.2 RBC-2.99* Hgb-10.3* Hct-28.1* MCV-94 MCH-34.6* MCHC-36.8* RDW-14.0 Plt Ct-267 . Liver function and coags [**2112-11-30**] 04:25PM BLOOD ALT-52* AST-131* CK(CPK)-8404* AlkPhos-41 TotBili-1.6* [**2112-12-1**] 12:44PM BLOOD ALT-54* AST-115* AlkPhos-33* TotBili-1.0 [**2112-12-2**] 05:15AM BLOOD ALT-56* AST-130* LD(LDH)-372* CK(CPK)-2634* AlkPhos-36* TotBili-1.0 [**2112-12-4**] 05:10AM BLOOD ALT-49* AST-66* CK(CPK)-615* AlkPhos-33* TotBili-0.3 [**2112-11-30**] 04:25PM BLOOD PT-13.5* PTT-22.2 INR(PT)-1.2* [**2112-12-1**] 03:07AM BLOOD PT-12.6 PTT-20.7* INR(PT)-1.1 [**2112-12-2**] 05:15AM BLOOD PT-12.1 PTT-22.1 INR(PT)-1.0 . Renal function and electrolytes [**2112-11-30**] 04:25PM BLOOD Glucose-102 UreaN-149* Creat-3.1*# Na-126* K-2.6* Cl-72* HCO3-41* AnGap-16 [**2112-11-30**] 10:01PM BLOOD Glucose-93 UreaN-110* Creat-2.3* Na-135 K-2.8* Cl-89* HCO3-36* AnGap-13 [**2112-12-1**] 03:07AM BLOOD Glucose-93 UreaN-86* Creat-2.0* Na-140 K-3.0* Cl-95* HCO3-37* AnGap-11 [**2112-12-1**] 12:44PM BLOOD Glucose-82 UreaN-59* Creat-1.6* Na-143 K-3.0* Cl-99 HCO3-35* AnGap-12 [**2112-12-1**] 11:50PM BLOOD Glucose-80 UreaN-36* Creat-1.2 Na-139 K-2.7* Cl-97 HCO3-33* AnGap-12 [**2112-12-2**] 05:15AM BLOOD Glucose-75 UreaN-27* Creat-1.2 Na-138 K-2.9* Cl-98 HCO3-32 AnGap-11 [**2112-12-2**] 12:48PM BLOOD Glucose-87 UreaN-19 Creat-1.0 Na-134 K-3.4 Cl-98 HCO3-29 AnGap-10 [**2112-12-3**] 06:05AM BLOOD Glucose-92 UreaN-10 Creat-1.1 Na-137 K-3.0* Cl-101 HCO3-30 AnGap-9 [**2112-12-4**] 05:10AM BLOOD Glucose-134* UreaN-6 Creat-1.0 Na-137 K-3.9 Cl-107 HCO3-25 AnGap-9 [**2112-11-30**] 10:01PM BLOOD Albumin-2.8* Calcium-6.6* Phos-2.5*# Mg-3.1* [**2112-12-1**] 03:07AM BLOOD Albumin-3.0* Calcium-7.2* Phos-1.8* Mg-3.3* [**2112-12-4**] 05:10AM BLOOD Calcium-7.9* Phos-1.6* Mg-1.8 . Cardiac enzymes [**2112-11-30**] 04:25PM BLOOD CK-MB-19* MB Indx-0.2 [**2112-11-30**] 04:25PM BLOOD cTropnT-0.05* [**2112-11-30**] 10:01PM BLOOD CK-MB-14* MB Indx-0.2 cTropnT-0.04* . Anemia studies [**2112-12-1**] 03:07AM BLOOD calTIBC-291 VitB12-878 Folate-12.0 Ferritn-377 TRF-224 Iron-42* . Serum toxicology [**2112-11-30**] 04:25PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG . Electrocardiogram ([**2112-11-30**]) Sinus rhythm. Non-specific ST-T wave changes. Compared to the previous tracing ST-T wave changes are new. . Imaging Barium swallow ([**2112-11-30**]) IMPRESSION: 1. No extraluminal contrast appreciated. No evidence for esophageal perforation. 2. Filling defect in the distal esophagus persistent on all images and associated with a delay in clearance of the esophagus. This is concerning for food/other impacted material, and endoscopic evaluation is recommended. . Abdominal ultrasound ([**2112-12-1**]) IMPRESSION: No evidence of fluid or hemorrhage. . CXR pa and lateral ([**2112-12-1**]) IMPRESSION: Slight improvement in pneumomediastinum. Left lower lobe opacification remains the same and is most likely atelectasis versus aspiration. . CT chest with po contrast ([**2112-12-2**]) IMPRESSION: 1. Findings do not suggest active esophageal perforation or mediastinal infection: interval decrease in pneumomediastinum, no extravasation of oral contrast or dominant periesophageal gas collection, no mediastinal fluid collection. The presence of a small esophageal tear is better evaluated endoscopically. 2. Normal esophagus. Small hiatal hernia. 3. New bibasilar peribronchial infiltrates may represent aspiration versus atelectasis. Minimal right pleural effusion. Brief Hospital Course: A 34 year-old gentleman with alcohol abuse presents with seizure, pneumomediastinum, acute renal failure and rhabdomyolysis. . 1. Pneumomediastium / ?esophageal tear / ?mediastinitis Possibly secondary to alcohol withdrawal seizure versus esophageal tear during emesis. Distal barium filling defect on barium swallow raised concern of distal esophageal origin. . On admission to the ICU, the patient was afebrile and hemodynamically stable. Thoracic surgery was consulted in the ED and felt surgery was not indicated. Vancomycin, Zosyn and fluconazole were initiated. Interventional pulmonary performed a bronchoscopy showing normal anatomy and no evidence of tear or rupture. GI was also consulted and recommended NPO and intravenous PPI. Endoscopy was deferred in order to avoid risk of any further damage to the esophagus. A repeat CXR showed a stable pneumomediastinum. Fluconazole was discontinued after discussion with ID. . Patient spent one night in the ICU after which he underwent CT chest with po contrast showing no esophageal leak and resolving pneumomediastinum. He was then transferred to the medical floors with stable vitals. Per GI recommendations, his diet was progressed slowly to cold clears, then full clears, then solids. His antibiotics were switched to Augmentin and Flagyl for presumptive treatment of mediastinitis eventhough there was no radiographic evidence to suggest inflammation to the mediastinum. He will complete a ten day course of antibiotics. . GI has recommended that patient undergo upper endoscopy as outpatient, once stabilized, for close evaluation for esophageal tear. . 2. Rhabdomyolysis. This was felt to be secondary to his fall and seizures. He was treated with IV fluids and his CK normalized. . 3. Acute renal failure. This was felt to be secondary to dehydration and rhabdomyolysis; his admission FeNa was c/w prerenal azotemia. His creatinine normalized with IV hydration. He maintained a good urine output. . 4. Alcohol dependence and withdrawal. Per OSH report, he had seizures en route to the ED from his apartment, most likely due to alcohol withdrawl. On admission to this hospital CIWA protocol was instituted and he was monitored on telemetry. His serum toxicology was negative on admission. . Upon transfer to the floors, his CIWA scores were consistently less than 10. However, he was intermittently tachycardic and as he was 48-72 hours after his last drink, with a history of DTs and withdrawal seizures, he was started on standing Valium with a slow taper. He was monitored on telemetry and there was no seizure activity. There were no hallucinations. . He was treated with IV hydration, multivitamin, thiamine, and folate from time of admission. Social work was consulted and provided information regarding detox programs. . 5. Anemia. His hematocrit was stable in the high 20s during this admission. He was guiaic positive stool in ED and noted to have tarry stools by GI service. An abdominal ultrasound was negative for intra-abdominal bleed. His iron was 42 with a TIBC of 291 and ferritin of 277, suggestive of mild iron deficiency. B12 an folate were normal. He will need to have endoscopy and colonoscopy as outpatient to work-up GI bleed. . 6. Depression. Patient may benefit from psychiatric consult as outpatient. . 7. Dizziness. He developed dizziness after transfer to the floors from the intensive care unit. His description was consistent with BPPV, brought on with rapid head movements, position changes in bed, or shifts from supine to standing. [**Last Name (un) **]-hallpike maneuver demonstrated lateral nystagmus and reproducibility of dizziness. Epley meneuver was moderatly thereapeutic, although this did not entirely cure his symptoms. We believe he may have BPPV secondary to head trauma prior to admission. As there were no other neuorologic symptoms and CT at OSH was negative, we did not feel follow-up imaging was warranted. His dizziness quickly resolves after head movement ceases, he is able to ambulate, and overall his symptoms have been improving gradually since onset about five days prior to discharge. He has been cleared by physical therapy. . He was NPO initially and his diet progressed slowly as tolerated. Electrolytes were repleted as needed. Subcutaneous heparin was used for venous thrombosis prophylaxis. His code status is full code. Medications on Admission: None Denies any OTC/herbal Discharge Medications: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. 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* 5. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 10 days: last day [**12-17**]. Disp:*20 Tablet(s)* Refills:*0* 6. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 10 days: last day [**12-17**]. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses Alcohol withdrawal Pneumomediastinum likely secondary to small esophageal tear Rhabdomyolysis Acute renal failure . Secondary Diagnoses Alcohol dependence Discharge Condition: Vital signs stable. Afebrile. Discharge Instructions: You were hospitalized for treatment of nausea and vomiting. There was air in the space surrounding the heart, which may be due to leak from the esophagus while you were vomiting. Recent imaging shows that the air has almost entirely gone away. Furthermore, there is no leak in the esophagus seen on recent imaging. It is possible that this leak has healed. Bronchoscopy was performed while you were in the intensive care unit to look at the airways. There were no abnormalities detected. . We have started you on antibiotics to treat infection from the esophageal leak. In order to complete a ten-day course, please take clindamycin and Augmentin for 10 more days. We have also given you prescriptions for vitamins and a medicine called pantoprazole to help decrease acid secretion in the stomach. . You met with our social worker while you were in the hospital and she helped you arrange for a place to stay. You planned to go to Place of Promise on the day after leaving the hospital. . Please follow-up with your primary care provider. [**Name10 (NameIs) **] should have an upper endoscopy performed as an outpatient to look at the esophagus, stomach, and first part of the small intestine. . Please call your doctor or return to the emergency room if you have any bleeding, belly pain, or any other symptoms that are concerning to you. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) **] in the next two weeks [**0-0-**]. You need to have upper endoscopy performed as outpatient. [**First Name8 (NamePattern2) **] [**Name8 (MD) 474**] MD [**MD Number(2) 4658**] Completed by:[**2112-12-7**]

518,530,291,584,276,728,285,303,780,311,386,V600

{'Interstitial emphysema,Gastroesophageal laceration-hemorrhage syndrome,Alcohol withdrawal,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Rhabdomyolysis,Anemia, unspecified,Other and unspecified alcohol dependence, episodic,Other convulsions,Depressive disorder, not elsewhere classified,Benign paroxysmal positional vertigo,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: Fall, nausea and vomiting secondary to alcohol use. PRESENT ILLNESS: 34 y/o gentleman with known alcohol abuse was found down in his bathroom with vomit and blood around him. His landlord called police after a water leak from his apartment. Patient was transfered to [**Hospital3 **] and was found to have two seizure episodes en route. Patient received IVF greater than 1 L NS (unclear amount), thiamine 100 mg and 1 mg folate. Patient also received 10 mEq KCl, 40 mg IV pantoprazole and Zosyn 3.375 gm IV once. CXR there showed pneumomediastimum without pneumothorax and he was transfered to [**Hospital1 18**] ED. . In [**Hospital1 18**] ED his vitals were T 98.2 HR 92 BP 124/50 RR 16 O2 sat 98%. Patient was alert and oriented times three but was a poor historian. His family saw him and thought that he was at baseline. He has had trouble giving history and recalling events at baseline per family. Patient was given metronidazole 500 mg IV, Fluconazole 200 mg IV and vancomycin 1 gram IV. He also received 1 unit of PRBC. His urine output was greater than 700 ml in ED over approx 4 hours. Thoracics was consulted who recommended a barium swallow study. Preliminary read was some distal filling defect without any extravasation. Recommended GI consult. . On arrival to the MICU his vitals were T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC. Patient denies any acute distress. He states that he was aware of EMS coming into his house. He states that he might have had a seizure this morning. He also had a seizure one week ago. He has had episodes of binge drinking. His last drink was three days ago per patient. He drank greater than 1 bottle of Vodka that night but unable to quantify. He denies any fever, chills, chest pain, shortness of breath, nausea, abdoinal pain, dysuria, diarrhea, constipation, focal numbness or weakness. He has noticed dark urine and dark colored stool in the last two days. He has depressed mood per family history after losing his job recently. Patient denies any suicidal ideation. MEDICAL HISTORY: Alcohol abuse SDH in [**2109**] secondary to fall Known alcohol withdrawl seizures Otherwise denies any medical problems MEDICATION ON ADMISSION: None Denies any OTC/herbal ALLERGIES: Clindamycin PHYSICAL EXAM: Vitals: T 95.9 HR 89 BP 156/53 RR 15 100% 4LNC Gen: Alert and oriented x 3 (not date but month/year). Poor historian. NAD HEENT: PEERL, EOM-I, Mucous membranes are dry, bruise in lower lip, JVP not elevated Lungs: Clear to auscultate bilaterally Heart: Tender to palpate in left chest wall, S1S2 RRR, no MRG Abdomen: BS present, soft NTND Ext: WWP, DP 2+ Neuro: CN II-XII grossly intact, strength 5/5, sensation is intact, normal muscle tone. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Works in construction. 20 pack/year tobacco. Drinks ETOH in binges. ### Response: {'Interstitial emphysema,Gastroesophageal laceration-hemorrhage syndrome,Alcohol withdrawal,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Rhabdomyolysis,Anemia, unspecified,Other and unspecified alcohol dependence, episodic,Other convulsions,Depressive disorder, not elsewhere classified,Benign paroxysmal positional vertigo,Lack of housing'}

CHIEF COMPLAINT: AMS PRESENT ILLNESS: 54 year old male with PMH significant for HIV (on HARRT, last CD4 629), ESLD, HCV cirrhosis presents from clinic w/ AMS. . History taken from wife. Over 7-10 days, pt has been ill w/ nausea, vomiting and diarrhea. Wife thinks he's had at least 3 loose BM daily. He has had intermittent emesis, that she believes is non-bloody, non-biliary. He has had worsening abdominal distension as well, w/ very poor po intake. He was also complaining of abdominal pain. She did not take his temp, but states that he "felt hot." Per wife, pt drinking ETOH up until 2 months ago, very heavily ~ 1pint of vodka and 4-5 beers nightly. He has a h/o ivdu (heroin) but hasn't used in 2 years. . Pt was referred to Dr. [**Last Name (STitle) 497**] by his PCP. [**Name10 (NameIs) **] exam he was found to be very altered and he was referred to the ED. . In the ED, VS were T 99.0, HR 94, BP 151/95, RR 20, O2 97%. On exam, he had + asterixis, AMS, +abd distention/TTP. RUQ US showed patent portal vein, cirrhotic liver with perihepatic ascites (not seen in other quadrants), and GB sludge but no signs of cholecystitis. CT head showed no acute intracranial process. His labs were notable for a Na 127, K 5.4, Cr 1.5, t bili 25.3, ALT 212, AST 473, alb 2.6, INR 3.6, wbc 13.7, hct 35.7, plt 149. He was seen by hepatology. He received lactulose, ceftriaxone, albumin, and an amp of D5. He did not get paracentesis b/c of INR. 2 units of ffps started. He was subsequently transferred to the ICU . In the ICU, he was continued on ceftriaxone and lactulose. He was also started on D5NS for hyponatremia/hypoglycemia. For his coagulopathy, he received FFP as well as IV vitamin K. IR-guided paracentesis was performed performed but did not show any signs of SBP, but this was in the setting of having received IV antibiotics. . Review of systems: unable to obtain as pt altered. (+) 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 nausea, vomiting, 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: HIV on HARRT HCV cirrhosis Polysubstance abuse MEDICATION ON ADMISSION: Home meds (confirmed with girlfriend who read off of pill bottles) -Epzicom 1 tab q day -Prezista 800 mg daily -Norvir 100 mg softgel 1 q day -Lisinopril 10 mg daily -Ondansetron 4 mg 1 tab up to TID -Omeprazole-20 mg [**Hospital1 **] -Fluoxetine 10 mg daily -amlodipine 5 mg daily -ibuprofen 800 mg 3x daily ALLERGIES: Heparin Agents PHYSICAL EXAM: Admission Exam: General: Thin appearing male, jaundice HEENT: Sclera icteric, dry MM, oropharynx clear Neck: supple, JVP elevated above mandible, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Distended, tense, minimally ttp, no spider angiomata GU: no foley Ext: warm, well perfused, 2+ pulses, no edema Neuro: Oriented to self, able to state that he at [**Hospital3 **] Deaconness. States the year is [**2195**] initially, then [**2194**], but cannot state the month. FAMILY HISTORY: Unable to obtain SOCIAL HISTORY: - Tobacco: "heavy" [**Last Name (LF) 1818**], [**First Name3 (LF) **] wife - Alcohol: 1pint of vodka and 4-5 beers nightly last drank 2 mo ago - Illicits: h/o ivdu (heroin), last used (per wife) ~ 2 yrs ago

Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Opioid type dependence, continuous,Other ascites,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Other and unspecified alcohol dependence, in remission,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Disorders of phosphorus metabolism,Hypoglycemia, unspecified,Unspecified disorder of kidney and ureter,Anemia, unspecified,Abnormal coagulation profile,Thrombocytopenia, unspecified

Spontan bact peritonitis,Hpt C w hepatic coma NOS,Opioid dependence-contin,Ascites NEC,Hyposmolality,Cirrhosis of liver NOS,Alcoh dep NEC/NOS-remiss,Asymp hiv infectn status,Chr airway obstruct NEC,Hypertension NOS,Dis phosphorus metabol,Hypoglycemia NOS,Renal & ureteral dis NOS,Anemia NOS,Abnrml coagultion prfile,Thrombocytopenia NOS

Admission Date: [**2195-3-20**] Discharge Date: [**2195-3-31**] Date of Birth: [**2141-1-15**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**First Name3 (LF) 949**] Chief Complaint: AMS Major Surgical or Invasive Procedure: Paracentesis History of Present Illness: 54 year old male with PMH significant for HIV (on HARRT, last CD4 629), ESLD, HCV cirrhosis presents from clinic w/ AMS. . History taken from wife. Over 7-10 days, pt has been ill w/ nausea, vomiting and diarrhea. Wife thinks he's had at least 3 loose BM daily. He has had intermittent emesis, that she believes is non-bloody, non-biliary. He has had worsening abdominal distension as well, w/ very poor po intake. He was also complaining of abdominal pain. She did not take his temp, but states that he "felt hot." Per wife, pt drinking ETOH up until 2 months ago, very heavily ~ 1pint of vodka and 4-5 beers nightly. He has a h/o ivdu (heroin) but hasn't used in 2 years. . Pt was referred to Dr. [**Last Name (STitle) 497**] by his PCP. [**Name10 (NameIs) **] exam he was found to be very altered and he was referred to the ED. . In the ED, VS were T 99.0, HR 94, BP 151/95, RR 20, O2 97%. On exam, he had + asterixis, AMS, +abd distention/TTP. RUQ US showed patent portal vein, cirrhotic liver with perihepatic ascites (not seen in other quadrants), and GB sludge but no signs of cholecystitis. CT head showed no acute intracranial process. His labs were notable for a Na 127, K 5.4, Cr 1.5, t bili 25.3, ALT 212, AST 473, alb 2.6, INR 3.6, wbc 13.7, hct 35.7, plt 149. He was seen by hepatology. He received lactulose, ceftriaxone, albumin, and an amp of D5. He did not get paracentesis b/c of INR. 2 units of ffps started. He was subsequently transferred to the ICU . In the ICU, he was continued on ceftriaxone and lactulose. He was also started on D5NS for hyponatremia/hypoglycemia. For his coagulopathy, he received FFP as well as IV vitamin K. IR-guided paracentesis was performed performed but did not show any signs of SBP, but this was in the setting of having received IV antibiotics. . Review of systems: unable to obtain as pt altered. (+) 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 nausea, vomiting, 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: HIV on HARRT HCV cirrhosis Polysubstance abuse Social History: - Tobacco: "heavy" [**Last Name (LF) 1818**], [**First Name3 (LF) **] wife - Alcohol: 1pint of vodka and 4-5 beers nightly last drank 2 mo ago - Illicits: h/o ivdu (heroin), last used (per wife) ~ 2 yrs ago Family History: Unable to obtain Physical Exam: Admission Exam: General: Thin appearing male, jaundice HEENT: Sclera icteric, dry MM, oropharynx clear Neck: supple, JVP elevated above mandible, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Distended, tense, minimally ttp, no spider angiomata GU: no foley Ext: warm, well perfused, 2+ pulses, no edema Neuro: Oriented to self, able to state that he at [**Hospital3 **] Deaconness. States the year is [**2195**] initially, then [**2194**], but cannot state the month. Pertinent Results: Admission Labs: [**2195-3-20**] 11:20AM PLT COUNT-149* [**2195-3-20**] 11:20AM NEUTS-69.5 LYMPHS-24.4 MONOS-5.7 EOS-0.1 BASOS-0.3 [**2195-3-20**] 11:20AM WBC-13.7* RBC-3.43* HGB-12.6* HCT-35.7* MCV-104* MCH-36.7* MCHC-35.2* RDW-16.2* [**2195-3-20**] 11:20AM ASA-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2195-3-20**] 11:20AM AFP-29.0* [**2195-3-20**] 11:20AM ALBUMIN-2.6* [**2195-3-20**] 11:20AM LIPASE-42 [**2195-3-20**] 11:20AM ALT(SGPT)-212* AST(SGOT)-473* ALK PHOS-250* TOT BILI-25.3* DIR BILI-15.0* INDIR BIL-10.3 [**2195-3-20**] 11:20AM estGFR-Using this [**2195-3-20**] 11:20AM GLUCOSE-48* UREA N-16 CREAT-1.5* SODIUM-127* POTASSIUM-5.4* CHLORIDE-97 TOTAL CO2-24 ANION GAP-11 [**2195-3-20**] 12:41PM PT-35.3* PTT-43.1* INR(PT)-3.6* [**2195-3-20**] 03:00PM AMMONIA-115* [**2195-3-20**] 10:22PM PT-40.3* PTT-46.2* INR(PT)-4.2* [**2195-3-20**] 10:22PM PLT COUNT-119* [**2195-3-20**] 10:22PM WBC-10.1 RBC-2.86* HGB-10.6* HCT-30.0* MCV-105* MCH-37.0* MCHC-35.3* RDW-16.2* [**2195-3-20**] 10:22PM ETHANOL-NEG [**2195-3-20**] 10:22PM CALCIUM-8.7 PHOSPHATE-2.0* MAGNESIUM-2.5 [**2195-3-20**] 10:22PM GLUCOSE-64* UREA N-14 CREAT-1.2 SODIUM-130* POTASSIUM-3.4 CHLORIDE-100 TOTAL CO2-26 ANION GAP-7* [**2195-3-20**] 11:30PM URINE MUCOUS-RARE [**2195-3-20**] 11:30PM URINE HYALINE-4* [**2195-3-20**] 11:30PM URINE RBC-1 WBC-3 BACTERIA-FEW YEAST-NONE EPI-<1 [**2195-3-20**] 11:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-LG UROBILNGN-4* PH-5.5 LEUK-NEG [**2195-3-20**] 11:30PM URINE COLOR-DkAmb APPEAR-Hazy SP [**Last Name (un) 155**]-1.012 [**2195-3-20**] 11:30PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-POS [**2195-3-20**] 11:30PM URINE OSMOLAL-389 [**2195-3-20**] 11:30PM URINE HOURS-RANDOM UREA N-578 CREAT-98 SODIUM-26 POTASSIUM-34 CHLORIDE-27 [**2195-3-21**] 15:05 ASCITES WBC RBC Polys Lymphs Monos Mesothe Macroph 171* 93* 41* 6* 7* 3* 43* PERITONEAL FLUID TotPro Glucose Creat LD(LDH) Amylase 0.5 77 0.9 38 15 TotBili Albumin 2.3 LESS THAN 1 Discharge labs: [**2195-3-31**] 05:30AM BLOOD WBC-7.6 RBC-2.62* Hgb-9.8* Hct-28.6* MCV-109* MCH-37.5* MCHC-34.3 RDW-16.8* Plt Ct-76* [**2195-3-25**] 05:00AM BLOOD WBC-10.9 Lymph-33 Abs [**Last Name (un) **]-3597 CD3%-95 Abs CD3-3408* CD4%-30 Abs CD4-1095 CD8%-56 Abs CD8-[**2200**]* CD4/CD8-0.5* [**2195-3-31**] 05:30AM BLOOD Glucose-99 UreaN-8 Creat-0.8 Na-134 K-3.7 Cl-103 HCO3-25 AnGap-10 [**2195-3-31**] 05:30AM BLOOD ALT-88* AST-179* AlkPhos-156* TotBili-21.7* [**2195-3-21**] 01:45PM BLOOD calTIBC-129* Ferritn-1686* TRF-99* [**2195-3-21**] 05:25AM BLOOD VitB12-GREATER TH Folate-9.0 [**2195-3-22**] 07:30AM BLOOD Cortsol-6.7 [**2195-3-21**] 01:45PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE HBcAb-NEGATIVE IgM HBc-NEGATIVE [**2195-3-21**] 01:45PM BLOOD [**Doctor First Name **]-POSITIVE * Titer-1:40 [**2195-3-20**] 11:20AM BLOOD AFP-29.0* [**2195-3-21**] 01:45PM BLOOD IgG-2387* Test Result Reference Range/Units HCV GENOTYPE, LIPA 1a [**2195-3-24**] 06:25 CA [**02**]-9 Test Result Reference Range/Units CA [**02**]-9 14 <37 U/mL Microbiology: [**2195-3-20**] Blood cultures x 2 NEGATIVE [**2195-3-20**] MRSA Screen NEGATIVE [**2195-3-20**] VRE Screen NEGATIVE [**2195-3-20**] Urine Culture NEGATIVE [**2195-3-20**] C. Diff Toxin NEGATIVE [**2195-3-21**] HCV Viral Load 2,260 IU/mL. [**2195-3-21**] 3:05 pm PERITONEAL FLUID PERITONEAL FLUID. **FINAL REPORT [**2195-3-27**]** GRAM STAIN (Final [**2195-3-21**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2195-3-24**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2195-3-27**]): NO GROWTH. [**2195-3-25**] RPR NONREACTIVE [**2195-3-25**] 11:40 am IMMUNOLOGY HIV-1 RNA is not detected. [**2195-3-31**] 12:20 pm URINE Source: CVS. **FINAL REPORT [**2195-4-3**]** URINE CULTURE (Final [**2195-4-3**]): ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. YEAST. 10,000-100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ <=2 S NITROFURANTOIN-------- <=16 S TETRACYCLINE---------- <=1 S VANCOMYCIN------------ 1 S Imaging: CT HEAD NON-CON [**2195-3-20**]: Some motion through the inferior most images. Otherwise, no evidence of acute intracranial process. Please note that MRI is more sensitive in detecting small intracranial lesions. RUQ ULTRASOUND [**2195-3-20**]: 1. Doppler assessment of the main portal vein and their branches shows patency and hepatopetal flow. 2. Cirrhotic liver and ascites. 3. Distended gallbladder with sludge without gallbladder wall edema or pericholecystic fluid. Cholecystitis cannot be entirely excluded based on this study, if there is high clinical concern. If high clinical concern for cholecystitis, could further evaluate with a HIDA scan. CHEST XR [**2195-3-20**]: Small bilateral effusions with associated atelectasis. Mild pulmonary edema PELVIS (AP ONLY) Study Date of [**2195-3-23**] 10:38 PM FINDINGS: There is an apparent urinary catheter in the urethra and bladder. The tip of this is not well visualized. No metallic radiopaque foreign body is seen. No bone lesion or fracture is seen. - LIVER OR GALLBLADDER US (SINGLE ORGAN) Study Date of [**2195-3-25**] 1:57 PM ABDOMINAL ULTRASOUND: Again noted is a heterogeneous nodular shrunken liver consistent with a known history of cirrhosis. The largest hypovascular nodule noted on MRI in segment2 was poorly seen despite multiple attempts at positioning at visualizing this segment of the liver. The lesion within segment [**Doctor First Name 690**] next to the gallbladder is slightly hypoechoic in comparison to the surrounding parenchyma measuring 2.5 x 2.5 x 3.8 cm and is in close proximity to the main hepatic artery and the main portal vein. The other peripheral lesion within segment VI, abutting the hepatorenal space is also seen and hypoechoic in comparison to the surrounding parenchyma measuring 2.1 x 2.6 x 3.7 cm. One additional echogenic nodule within segment VII/VIII is noted with no clear correlate on the MRI, measuring 7 x 11 x 14 mm. The other lesions within segment V on the MRI are not clearly seen. Moderate amount of ascites remains. IMPRESSION: 1. Unchanged appearance to known cirrhotic liver. The segment [**Doctor First Name 690**] and segment VI lesions are son[**Name (NI) 5326**] visible and could be attempted for percutaneous biopsy. The lesion locations would make the procedure technically challenging and high risk given the proximity to surrounding vessels, gallbladder and kidney. The segment II and V lesions are not clearly seen. A moderate amount of ascites persists and a paracentesis would have to be done prior to the procedure to minimize any risk of capsular bleeding. 2. 1 cm hyperechoic nodule, likely within segment VII or VIII without clear MRI correlate. - CT ABD W&W/O C Study Date of [**2195-3-30**] 3:26 PM IMPRESSION: 1. Four lesions displaying mild arterial enhancement and washout meet imaging criteria for HCC within segment V/VIII (one lesion), segment VI (two lesions), and segment [**Doctor First Name 690**] (one lesion). None is greater then 3 cm. 2. Two lesions within segment II display only washout but without increased arterial enhancement. The smaller more posterior lesion is more concerning as it shows washout to surrounding liver on portal and delayed venous phases with a more vague larger anterior lesion of uncertain significance only seen on most delayed phase. Both are hyperdense on non-contrast CT. Additional small segment VIII lesion also only seen on most delayed images without arterial enhancement. These may represent dysplastic nodules or hypovascular HCC's. 3. Known cirrhotic-appearing liver with sequelae of portal hypertension including abdominal/esophageal varices and splenomegaly as well as mild-to-moderate amount of ascites. Edema within the large bowel presumably related to congestive enteropathy. 4. Biliary sludge and gallstones as seen on prior MRI. Small pancreatic head cyst is of doubtful significance for this patient and can be watched on future exams. 5. Small left pleural effusion. Brief Hospital Course: 54 year old male with PMH significant for HIV (on HARRT, last CD4 629), ESLD, HCV cirrhosis w/ possible left lobe liver cancer, who was being admitted to the ICU w/ AMS # Cirrhosis: The patient has known Hepatitis C, both by history as well as by viral load in hospital, as well as a reported heavy history of EToH use. On admission, given reported episodes of fevers at home as well as abdominal pain, there was serious concern for SBP, and the patient was started on empiric antibiotics with ceftrixaone. RUQ U/S showed a cirrhotic liver and ascities, but without evidence of cholecystitis or PVT. Additionally, there was no evidence of GI bleed. Subsequent diagnostic tap did not reveal any evidence of SBP, however, as noted above, this was in the setting of having already received antibiotics. The patient completed a course of Ceftrixaone for presumed SBP, and subsequently started SBP prophylaxis with Cipro. The patient underwent an MRCP secondary to concerns from patient's PCP about [**Name Initial (PRE) **] possible liver lesions. MRCP discovered five liver lesions of various sizes, detailed in the results section of this report. Two of these lesions were amenable to biopsy, but given the patient's history, multiple lesions, and potential complications of biopsy, the patient in consultation with physicians here elected not to performed the biopsy, as the results were felt to be almost certain to reveal malignancy (perhaps HCC versus cholangiocarcinoma) that would not be amenable to treatment; the patient indicated he did not want to know if this were the case. Palliative care was consulted, and provided counseling regarding resources for palliative care. The patient was made DNR/DNI. A repeat triphasic CT confirmed that the pattern of filling of the lesions in the liver was consistent with HCC. Prior to discharge, the patient received a therapeutic tap and was discharged on 20 mg of Furosemide as well as 50 mg Spironolactone. # AMS: On admission, the patient was noted to be altered. AMS was felt to be secondary to decompensated liver failure as well as a component of SBP. Some of the patient's alteration in mental status was also presumed to medication effect, and initially the patient's home dose of methadone was decreased; however, this was up-titrated back to his home dose on discharge. The patient also received hepatic encephalopathy prophylaxis with lactulose and rifaximin. On discharge, the patient was noted to be AAOx3, follwoing commands, and conversant, and without any asterixis (he had had very prominent asterixis on admission). # HIV: The patient's HAART therapy was discontinued in house secondary to concerns for liver toxicity, specifically from abacavir. On discharge, the patient was noted to have a CD4 count in in the 1000s, with an undetectable viral load. HAART therapy was not restarted on discharge, and was deferred to the outpatient setting. The ID team indicated that the patient's HAART could safely be restarted once the LFTs were less than 2 x the ULN. # HTN: The patient's amlodipine and lisinopril on hold given initially the concern for the patient's illness in the setting of presumed infection; he was not restarted on these medications upon discharge as he had been normotensive in house. # EtOH Abuse: Per wife's report, the patient has not had alcohol in over two months. Patient did not exhibit any signs/symptoms of withdrawal, and was discharged from the hospital on a multivitamin. # Renal Insufficiency: The patient's creatinine appeared to normalize over the course of his admission with albumin and IV fluid. # HypoNa: The patient was noted to be hyponatremic on admission, likely secondary to dehydration, which resolved with hydration. # Hypoglycemia: The patient on inital admission to ICU was noted to be hypoglycemic requiring a D5W gtt. This hypoglycemia was presumed secondary to acute infection with SBP; the patient remained normoglycemic throughout the remainder of his admission. An AM cortisol was sent off to rule out adrenal insuffiency as a cause of hypoglycemia, but AM cortisol was within normal limits. # Chest Pain: Not currently bothersome to patient. However, he does describe a long history of intermittent chest pressure with may require outpatient follow-up. Medications on Admission: Home meds (confirmed with girlfriend who read off of pill bottles) -Epzicom 1 tab q day -Prezista 800 mg daily -Norvir 100 mg softgel 1 q day -Lisinopril 10 mg daily -Ondansetron 4 mg 1 tab up to TID -Omeprazole-20 mg [**Hospital1 **] -Fluoxetine 10 mg daily -amlodipine 5 mg daily -ibuprofen 800 mg 3x daily Discharge Medications: 1. fluoxetine 10 mg Capsule Sig: One (1) Capsule PO once a day. 2. omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. 3. ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO three times a day as needed for nausea. 4. lactulose 10 gram/15 mL Solution Sig: Thirty (30) ml PO three times a day. Disp:*1 quantity sufficient* Refills:*2* 5. rifaximin 550 mg Tablet Sig: One (1) Tablet PO twice a day: Please take this medication for hepatic encephalopathy prophylaxis. Disp:*60 Tablet(s)* Refills:*2* 6. multivitamin Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 7. methadone 10 mg Tablet Sig: Fifteen (15) Tablet PO once a day. 8. Cipro 250 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. methadone 10 mg Tablet Sig: Fifteen (15) Tablet PO DAILY (Daily). 11. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital6 **] Discharge Diagnosis: Primary Diagnosis: - Spontaneous Bacterial Peritonitis Secondary Diagnosis: - Multiple Liver Lesions 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: Mr. [**Last Name (Titles) 13309**], it was a pleasure taking care of you in the hospital. You were admitted to the hospital because you had been having some abdominal pain and had some alteration in your mental status. After performing some images, we believes that you had an infection in the fluid which had accumulated in your abdomen, and treated you with an appropriate course of antibotics. When you finished these antibiotics, we started you on an antibiotic you will need to take indefinitely to prevent you from getting another infection. Our HIV specialists saw you and indicated that your current liver disease made it very dangerous for you to continue taking your HIV medications, all of which have been stopped. You should not restart these medications until you have consulted with your HIV physician and your provider [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 66037**]. We also performed some imaging of your liver; your primary physician had noted that one of the lobes of your liver had a lesion on it. When we took more pictures of of your liver, we saw that your liver had five different lesions on it. After discussions with you, you elected not to have us perform a biopsy. We got a CT scan which showed that this is likely to be liver cancer, however after discussion with you we decided that treating it would likely not make your life better and potentially make it worse. When you leave the hospital: - STOP Epzicom 1 tab DAILY (discuss with your primary care doctor when and if to restart this) - STOP Prezista 800 mg DAILY (discuss with your primary care doctor when and if to restart this) - STOP Norvir 100 mg DAILY (discuss with your primary care doctor when and if to restart this) - STOP Lisinopril 10 mg daily (discuss with your primary care doctor when and if to restart this) - STOP Amlodipine 5 mg daily (discuss with your primary care doctor when and if to restart this) - STOP Ibuprofen 800 mg 3x daily - START Furosemide 40 mg Daily (this is for the fluid in your abdomen and legs) - START Spironolactone 100 mg Daily (this is for the fluid in in your abdomen and legs) - START Ciprofloxacin 250 mg Daily (you will need this to prevent you from getting infections in the future) - START Lactulose 30 ml three times a day; take this as needed in order to have 3 bowel movements a day - START rifaximin 550 mg Tablet twice a day - START multivitamin Daily We did not make any other changes to your medications, so please continue to take them as you normally have been. Followup Instructions: Name: PA- [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 66037**] Location: [**Hospital1 **] FAMILY HEALTH CENTER Address: [**Street Address(2) **], [**Hospital1 **],[**Numeric Identifier 66038**] Phone: [**Telephone/Fax (1) 66039**] Appointment: Wednesday [**2195-4-1**] 2:30pm Department: LIVER CENTER When: FRIDAY [**2195-4-17**] at 3:00 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD [**Telephone/Fax (1) 2422**] Building: LM [**Hospital Unit Name **] [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage

567,070,304,789,276,571,303,V08,496,401,275,251,593,285,790,287

{'Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Opioid type dependence, continuous,Other ascites,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Other and unspecified alcohol dependence, in remission,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Disorders of phosphorus metabolism,Hypoglycemia, unspecified,Unspecified disorder of kidney and ureter,Anemia, unspecified,Abnormal coagulation profile,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: AMS PRESENT ILLNESS: 54 year old male with PMH significant for HIV (on HARRT, last CD4 629), ESLD, HCV cirrhosis presents from clinic w/ AMS. . History taken from wife. Over 7-10 days, pt has been ill w/ nausea, vomiting and diarrhea. Wife thinks he's had at least 3 loose BM daily. He has had intermittent emesis, that she believes is non-bloody, non-biliary. He has had worsening abdominal distension as well, w/ very poor po intake. He was also complaining of abdominal pain. She did not take his temp, but states that he "felt hot." Per wife, pt drinking ETOH up until 2 months ago, very heavily ~ 1pint of vodka and 4-5 beers nightly. He has a h/o ivdu (heroin) but hasn't used in 2 years. . Pt was referred to Dr. [**Last Name (STitle) 497**] by his PCP. [**Name10 (NameIs) **] exam he was found to be very altered and he was referred to the ED. . In the ED, VS were T 99.0, HR 94, BP 151/95, RR 20, O2 97%. On exam, he had + asterixis, AMS, +abd distention/TTP. RUQ US showed patent portal vein, cirrhotic liver with perihepatic ascites (not seen in other quadrants), and GB sludge but no signs of cholecystitis. CT head showed no acute intracranial process. His labs were notable for a Na 127, K 5.4, Cr 1.5, t bili 25.3, ALT 212, AST 473, alb 2.6, INR 3.6, wbc 13.7, hct 35.7, plt 149. He was seen by hepatology. He received lactulose, ceftriaxone, albumin, and an amp of D5. He did not get paracentesis b/c of INR. 2 units of ffps started. He was subsequently transferred to the ICU . In the ICU, he was continued on ceftriaxone and lactulose. He was also started on D5NS for hyponatremia/hypoglycemia. For his coagulopathy, he received FFP as well as IV vitamin K. IR-guided paracentesis was performed performed but did not show any signs of SBP, but this was in the setting of having received IV antibiotics. . Review of systems: unable to obtain as pt altered. (+) 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 nausea, vomiting, 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: HIV on HARRT HCV cirrhosis Polysubstance abuse MEDICATION ON ADMISSION: Home meds (confirmed with girlfriend who read off of pill bottles) -Epzicom 1 tab q day -Prezista 800 mg daily -Norvir 100 mg softgel 1 q day -Lisinopril 10 mg daily -Ondansetron 4 mg 1 tab up to TID -Omeprazole-20 mg [**Hospital1 **] -Fluoxetine 10 mg daily -amlodipine 5 mg daily -ibuprofen 800 mg 3x daily ALLERGIES: Heparin Agents PHYSICAL EXAM: Admission Exam: General: Thin appearing male, jaundice HEENT: Sclera icteric, dry MM, oropharynx clear Neck: supple, JVP elevated above mandible, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachy, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Distended, tense, minimally ttp, no spider angiomata GU: no foley Ext: warm, well perfused, 2+ pulses, no edema Neuro: Oriented to self, able to state that he at [**Hospital3 **] Deaconness. States the year is [**2195**] initially, then [**2194**], but cannot state the month. FAMILY HISTORY: Unable to obtain SOCIAL HISTORY: - Tobacco: "heavy" [**Last Name (LF) 1818**], [**First Name3 (LF) **] wife - Alcohol: 1pint of vodka and 4-5 beers nightly last drank 2 mo ago - Illicits: h/o ivdu (heroin), last used (per wife) ~ 2 yrs ago ### Response: {'Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Opioid type dependence, continuous,Other ascites,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Other and unspecified alcohol dependence, in remission,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Disorders of phosphorus metabolism,Hypoglycemia, unspecified,Unspecified disorder of kidney and ureter,Anemia, unspecified,Abnormal coagulation profile,Thrombocytopenia, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 73-year-old male who was admitted with a significant history of coronary artery disease who was admitted for cardiac evaluation prior to surgery for an apple core lesion in the transverse colon. One month prior to admission the patient presented to his primary care physician with abdominal fullness and abdominal pain. A CT and barium enema revealed an apple core lesion in the transverse colon. The patient was not have any bright red blood per rectum, or melena, or hematemesis, or nausea or vomiting. He did not have any weight loss initially but over the last month he has lost eight pounds. MEDICAL HISTORY: (Significant for) 1. Hypertension. 2. Increased cholesterol. 3. Coronary artery disease. 4. Myocardial infarction. MEDICATION ON ADMISSION: 1. Cartia XT 120 mg p.o. b.i.d. 2. Atenolol 25 mg p.o. q.d. 3. Lipitor 10 mg p.o. q.d. 4. Aspirin 325 mg p.o. q.d. 5. [**Doctor First Name **] 100 mg p.o. q.d. 6. Zantac 150 mg p.o. b.i.d. ALLERGIES: PENICILLIN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is an ex-smoker. Occasional ethanol. He is married.

Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Malignant neoplasm of other specified sites of large intestine,Hemorrhage of rectum and anus,Benign neoplasm of colon,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension

Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Malignant neo colon NEC,Rectal & anal hemorrhage,Benign neoplasm lg bowel,Dvrtclo colon w/o hmrhg,Hypertension NOS

Admission Date: [**2196-10-11**] Discharge Date: [**2196-10-21**] Date of Birth: [**2123-10-9**] Sex: M Service: Surgery ADMISSION DIAGNOSIS: Apple core lesion in transverse colon. DISCHARGE DIAGNOSIS: Apple core lesion in transverse colon. HISTORY OF PRESENT ILLNESS: The patient is a 73-year-old male who was admitted with a significant history of coronary artery disease who was admitted for cardiac evaluation prior to surgery for an apple core lesion in the transverse colon. One month prior to admission the patient presented to his primary care physician with abdominal fullness and abdominal pain. A CT and barium enema revealed an apple core lesion in the transverse colon. The patient was not have any bright red blood per rectum, or melena, or hematemesis, or nausea or vomiting. He did not have any weight loss initially but over the last month he has lost eight pounds. The patient was admitted on [**2196-10-11**], and was taken to the cardiac catheterization laboratory where he had a percutaneous transluminal coronary angioplasty. This revealed an ejection fraction of 25% as well as 80% narrowing in the left anterior descending artery, graft and circumflex graft. The patient is status post a 3-vessel coronary artery bypass graft times two in [**2172**] and [**2181**]. The patient also underwent a colonoscopy on [**2196-10-13**] which revealed a mass in the transverse colon of 70 cm from the anal verge as well as mass in the descending colon 25 cm from the anal verge. The patient was cleared by Cardiology, and it was decided that he would be taken to the operating room on [**2196-10-14**]. PAST MEDICAL HISTORY: (Significant for) 1. Hypertension. 2. Increased cholesterol. 3. Coronary artery disease. 4. Myocardial infarction. PAST SURGICAL HISTORY: 1. Three vessel coronary artery bypass graft times two in [**2172**] and [**2181**]. Percutaneous transluminal coronary angioplasty on [**2196-10-11**]. 2. Right inguinal hernia repair times three. 3. Left inguinal hernia repair times one. 4. Appendectomy. 5. Umbilical hernia. 6. Partial colectomy. 7. Diverticulitis in [**2163**] with a colostomy and takedown of colostomy in [**2164**]. ALLERGIES: PENICILLIN. MEDICATIONS ON ADMISSION: 1. Cartia XT 120 mg p.o. b.i.d. 2. Atenolol 25 mg p.o. q.d. 3. Lipitor 10 mg p.o. q.d. 4. Aspirin 325 mg p.o. q.d. 5. [**Doctor First Name **] 100 mg p.o. q.d. 6. Zantac 150 mg p.o. b.i.d. SOCIAL HISTORY: The patient is an ex-smoker. Occasional ethanol. He is married. RADIOLOGY/IMAGING: On [**10-11**], the patient underwent a catheterization which revealed severe 3-vessel disease with a right-dominant system, showing stent occlusions of all venous grafts with a patent left internal mammary artery. Successful percutaneous transluminal coronary angioplasty of the middle first diagonal branch was obtained. Barium enema revealed apple core lesion in the transverse colon. PERTINENT LABORATORY DATA ON ADMISSION: White blood cell count of 7.2, hematocrit of 32.2, platelets 210. PT 12.1, PTT 18.1, INR 1. Potassium 4.1, BUN 14, creatinine 1.1. PHYSICAL EXAMINATION ON PRESENTATION: The patient was afebrile, blood pressure 121/38, heart rate 92, 96% on room air. He was awake and alert, in no apparent distress. His lungs were clear to auscultation bilaterally. Heart had a regular rhythm with slight bradycardia. His abdomen was soft and nondistended with minimal tenderness in the left lower quadrant. He also had a reducible umbilical hernia. He had no calf tenderness and no guarding. On rectal, there was frank blood with no masses (per Gastrointestinal). Extremities were warm, soft, nontender. No cyanosis, clubbing or edema. HOSPITAL COURSE: The patient was admitted on [**2196-10-11**], and he was taken to the catheterization laboratory on [**2196-10-12**] for percutaneous transluminal coronary angioplasty. The patient had some bright red blood per rectum times three after the percutaneous transluminal coronary angioplasty which was probably secondary to the Integrilin that he was placed on. The patient was then taken for a colonoscopy on [**2196-10-13**] which revealed two lesions in his colon. On [**2196-10-24**], the patient was taken to the operating room and underwent a subtotal colectomy. The patient tolerated the procedure well and was transferred to the Postanesthesia Care Unit in stable condition. Considering the patient's significant cardiac history, he remained intubated and was transferred from the Postanesthesia Care Unit to the Intensive Care Unit where he stayed overnight. On postoperative day one the patient remained stable. As his hematocrit dropped slightly he was given 1 unit of packed red blood cells, considering his cardiac history. On postoperative day two, the patient was extubated and transferred from the Intensive Care Unit to the floor. His nasogastric tube remained in place. The patient's vital signs remained stable, as did his laboratories. His nasogastric tube output was replaced cc per cc, and his electrolytes were repleted. He received several doses of Lasix as his breath sounds were quite coarse, and he was bringing up significant amounts of phlegm. He remained on intravenous Lopressor as well as p.o. Lopressor to keep his heart rate and blood pressure under control. He was also ruled out for a myocardial infarction; although his troponin did bump slightly. It was checked again and trended downward. There was no evidence for a myocardial infarction. The patient did well on postoperative day two. He had several bowel movements. On postoperative day three, his diet was advanced. That evening, the patient became quite nauseous and did not respond to antiemetics. He vomited several times. An nasogastric tube was replaced. His was made n.p.o., and all of his intravenous medications were restarted. On postoperative day four, the patient continued to remain n.p.o. with a nasogastric tube in place, and he was not having any flatus, although he did have bowel movement. His vital signs remained stable. On postoperative day five, the patient reported flatus and he was started on sips. His diet was advanced. He was seen by Physical Therapy early in his postoperative course. The patient was doing well and was ambulating. On postoperative day six, as the patient was tolerating a regular diet, was ambulating, and feeling good, it was decided that he would be discharged home. DISCHARGE STATUS: The patient was discharged to home. CONDITION AT DISCHARGE: In stable condition. MEDICATIONS ON DISCHARGE: 1. Dilaudid 2 mg to 4 mg p.o. q.4-6h. p.r.n. for pain 2. Iron sulfate 325 mg p.o. q.d. 3. Cartia XT 120 mg p.o. b.i.d. 4. Atenolol 25 mg p.o. q.d. 5. Lipitor 10 mg p.o. q.d. 6. Aspirin 325 mg p.o. q.d. 7. [**Doctor First Name **] 100 mg p.o. q.d. 8. Zantac 150 mg p.o. b.i.d. DISCHARGE FOLLOWUP: He was told to follow up with Dr. [**Last Name (STitle) **] in the office in one week for staple removal and to call or return with any questions or problems. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 6066**] Dictated By:[**Last Name (NamePattern1) 4985**] MEDQUIST36 D: [**2196-10-21**] 18:10 T: [**2196-10-25**] 09:11 JOB#: [**Job Number 103120**] (cclist)

414,413,153,569,211,562,401

{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Malignant neoplasm of other specified sites of large intestine,Hemorrhage of rectum and anus,Benign neoplasm of colon,Diverticulosis of colon (without mention of hemorrhage),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: PRESENT ILLNESS: The patient is a 73-year-old male who was admitted with a significant history of coronary artery disease who was admitted for cardiac evaluation prior to surgery for an apple core lesion in the transverse colon. One month prior to admission the patient presented to his primary care physician with abdominal fullness and abdominal pain. A CT and barium enema revealed an apple core lesion in the transverse colon. The patient was not have any bright red blood per rectum, or melena, or hematemesis, or nausea or vomiting. He did not have any weight loss initially but over the last month he has lost eight pounds. MEDICAL HISTORY: (Significant for) 1. Hypertension. 2. Increased cholesterol. 3. Coronary artery disease. 4. Myocardial infarction. MEDICATION ON ADMISSION: 1. Cartia XT 120 mg p.o. b.i.d. 2. Atenolol 25 mg p.o. q.d. 3. Lipitor 10 mg p.o. q.d. 4. Aspirin 325 mg p.o. q.d. 5. [**Doctor First Name **] 100 mg p.o. q.d. 6. Zantac 150 mg p.o. b.i.d. ALLERGIES: PENICILLIN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is an ex-smoker. Occasional ethanol. He is married. ### Response: {'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Malignant neoplasm of other specified sites of large intestine,Hemorrhage of rectum and anus,Benign neoplasm of colon,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension'}

CHIEF COMPLAINT: enterocutaneous fistula PRESENT ILLNESS: 65 y/o man with systolic heart failure (LVEF 30%), h/o stable ventricular tachycardia, h/o stomach cancer, appendiceal cancer [**2174**], presented for elective right flank wound debridement. The procedure was complicated given colocutaneous fistula and bowel involvement. He underwent exploratory laprotomy, small bowel resection, fistulogram and revision of ileocolic anastomosis. EBL was 100 ml. He recieved 1300 crystolloid during the procedure. Post op, his BP decreased from 110/70 to 70s/40s with UOP decreasing from 20-30 ml/hr to 15 ml/hr. His HR increased from 90s to 100-110s. He recieved two boluses of 500 ml LR overnight. He was transfered to [**Hospital Unit Name 153**] for further care. . He denies any chest pain, SOB, lower extremity edema, fever, chills, nightsweats, change in bowel habits, headache, dysuria, hematuria. No weakness of numbness. He feels 'great' and does not have any other complaints. Patient was able to walk three miles without limiting symptoms one week ago. MEDICAL HISTORY: 1. CAD RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CABG: Never -PERCUTANEOUS CORONARY INTERVENTIONS: Never -PACING/ICD: Never 3. OTHER PAST MEDICAL HISTORY: Gastric Cancer Adenocarcinoma of the colon, appendix and Gall bladder Hypertension Gout Ventricular tachycardia Left ventricular systolic heart failure (LVEF 30% in [**Month (only) **] [**2175**]) Vancomycin resistant Enterococcus (VRE) Equivocal HIT antibody PSH: s/p gastrectomy, s/p right colectomy, s/p cholecystectomy MEDICATION ON ADMISSION: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Zocor 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day ALLERGIES: Aspirin / Morphine / Ambien PHYSICAL EXAM: GENERAL: Pleasant, well appearing in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. EOMI. MMM. OP clear. Neck Supple. CARDIAC: Normal S1, S2. Tachycardic. Flat JVP LUNGS: CTAB, good air movement biaterally. ABDOMEN: Soft NT, dressing c/d/i EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis NEURO: A&Ox3. Appropriate. spontaneously moves all 4 ext. . At Discharge: Vitals: _________________ FAMILY HISTORY: Father with DM, CHF, MI SOCIAL HISTORY: Former physics teacher. He does not smoke or drink. -Tobacco history: Never -ETOH: Denies -Illicit drugs: Denies

Fistula of intestine, excluding rectum and anus,Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Other shock without mention of trauma,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Peritoneal adhesions (postoperative) (postinfection),Hypovolemia,Gout, unspecified,Personal history of malignant neoplasm of large intestine,Unspecified essential hypertension

Intestinal fistula,Peritoneal abscess,Ac kidny fail, tubr necr,Shock w/o trauma NEC,Prim cardiomyopathy NEC,Parox ventric tachycard,Peritoneal adhesions,Hypovolemia,Gout NOS,Hx of colonic malignancy,Hypertension NOS

Admission Date: [**2177-10-10**] Discharge Date: [**2177-10-17**] Date of Birth: [**2112-1-29**] Sex: M Service: SURGERY Allergies: Aspirin / Morphine / Ambien Attending:[**First Name3 (LF) 3376**] Chief Complaint: enterocutaneous fistula Major Surgical or Invasive Procedure: 1. Wound exploration and debridement. 2. On-table fistulogram. 3. Laparotomy and lysis of adhesions. 4. Small-bowel resection. 5. Resection of ileocolic anastomosis History of Present Illness: 65 y/o man with systolic heart failure (LVEF 30%), h/o stable ventricular tachycardia, h/o stomach cancer, appendiceal cancer [**2174**], presented for elective right flank wound debridement. The procedure was complicated given colocutaneous fistula and bowel involvement. He underwent exploratory laprotomy, small bowel resection, fistulogram and revision of ileocolic anastomosis. EBL was 100 ml. He recieved 1300 crystolloid during the procedure. Post op, his BP decreased from 110/70 to 70s/40s with UOP decreasing from 20-30 ml/hr to 15 ml/hr. His HR increased from 90s to 100-110s. He recieved two boluses of 500 ml LR overnight. He was transfered to [**Hospital Unit Name 153**] for further care. . He denies any chest pain, SOB, lower extremity edema, fever, chills, nightsweats, change in bowel habits, headache, dysuria, hematuria. No weakness of numbness. He feels 'great' and does not have any other complaints. Patient was able to walk three miles without limiting symptoms one week ago. Past Medical History: 1. CAD RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CABG: Never -PERCUTANEOUS CORONARY INTERVENTIONS: Never -PACING/ICD: Never 3. OTHER PAST MEDICAL HISTORY: Gastric Cancer Adenocarcinoma of the colon, appendix and Gall bladder Hypertension Gout Ventricular tachycardia Left ventricular systolic heart failure (LVEF 30% in [**Month (only) **] [**2175**]) Vancomycin resistant Enterococcus (VRE) Equivocal HIT antibody PSH: s/p gastrectomy, s/p right colectomy, s/p cholecystectomy Social History: Former physics teacher. He does not smoke or drink. -Tobacco history: Never -ETOH: Denies -Illicit drugs: Denies Family History: Father with DM, CHF, MI Physical Exam: GENERAL: Pleasant, well appearing in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. EOMI. MMM. OP clear. Neck Supple. CARDIAC: Normal S1, S2. Tachycardic. Flat JVP LUNGS: CTAB, good air movement biaterally. ABDOMEN: Soft NT, dressing c/d/i EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis NEURO: A&Ox3. Appropriate. spontaneously moves all 4 ext. . At Discharge: Vitals: _________________ Pertinent Results: [**2177-10-13**] 04:32AM BLOOD WBC-13.8* RBC-2.70* Hgb-7.9* Hct-23.9* MCV-88 MCH-29.4 MCHC-33.2 RDW-14.1 Plt Ct-88* [**2177-10-11**] 06:40AM BLOOD WBC-28.3*# RBC-4.17* Hgb-12.3* Hct-36.2* MCV-87 MCH-29.5 MCHC-34.0 RDW-14.0 Plt Ct-204 [**2177-10-11**] 06:40AM BLOOD Neuts-92.8* Lymphs-3.4* Monos-3.2 Eos-0.4 Baso-0.1 [**2177-10-13**] 04:32AM BLOOD PT-14.6* PTT-33.5 INR(PT)-1.3* [**2177-10-11**] 10:57AM BLOOD PT-16.4* PTT-31.1 INR(PT)-1.5* [**2177-10-13**] 04:32AM BLOOD Glucose-93 UreaN-23* Creat-1.3* Na-141 K-4.4 Cl-111* HCO3-26 AnGap-8 [**2177-10-11**] 06:40AM BLOOD Glucose-99 UreaN-28* Creat-1.6* Na-139 K-4.8 Cl-106 HCO3-22 AnGap-16 [**2177-10-11**] 03:22PM BLOOD ALT-7 AST-16 LD(LDH)-135 AlkPhos-68 TotBili-0.7 [**2177-10-11**] 10:57AM BLOOD CK(CPK)-80 [**2177-10-11**] 06:40AM BLOOD CK(CPK)-72 [**2177-10-11**] 10:57AM BLOOD CK-MB-3 cTropnT-<0.01 [**2177-10-11**] 06:40AM BLOOD CK-MB-3 cTropnT-<0.01 [**2177-10-11**] 06:40AM BLOOD Calcium-8.1* Phos-4.1 Mg-1.8 [**2177-10-11**] 10:57AM BLOOD Cortsol-22.4* [**2177-10-12**] 06:16PM BLOOD Vanco-19.5 [**2177-10-11**] 10:10AM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.012 [**2177-10-11**] 10:10AM URINE Blood-TR Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR [**2177-10-11**] 10:10AM URINE RBC-7* WBC-4 Bacteri-FEW Yeast-NONE Epi-1 [**2177-10-11**] 10:10AM URINE Eos-NEGATIVE [**2177-10-11**] 10:10AM URINE Osmolal-379 . Microbiology: Urine culture [**2177-10-11**]: no growth Blood cultures x 2 [**2177-10-11**]: pending MRSA screen: negative . Echocardiogram [**2177-10-13**]: The left atrium is elongated. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with basal to mid inferior and infero-lateral akinesis. 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. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild to moderate ([**12-20**]+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. An eccentric jet of mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2177-7-7**], the LV size is smaller and LV systolic function has improved. The degree of mitral regurgitation seen has significantly decreased. . Fistulogram [**2177-10-10**]: Small bowel loop opacification with no definitive evidence of contrast extravasation; see comments above. . CXR (portable AP) [**2177-10-11**]: Cardiomediastinal silhouette is unchanged including cardiomegaly and tortuous aorta. Lungs are essentially clear except for left basal opacity that appears to be grossly unchanged and most likely represents atelectasis, may be with a combination with a small pleural effusion. There is no pneumothorax. There are no overt consolidations worrisome for current infectious process. . CXR (portable AP) [**2177-10-12**]: The left subclavian line tip is at the level of junction of left brachiocephalic vein and SVC. The cardiomediastinal silhouette is stable. The left basal atelectasis is unchanged. There is no evidence of pneumothorax, apical hematoma after insertion of the central venous line. Brief Hospital Course: The patient presented for an elective right flank wound debridement, but the procedure was complicated given colocutaneous fistula and bowel involvement. He underwent Exploratory Laparotomy, small bowel resection, fistulogram and revision of ileocolic anastomosis. EBL was 100 ml. He recieved 1300 crystolloid during the procedure. Post operatively, his BP decreased from 110/70 to 70s/40s with urine output decreasing from 20-30 ml/hr to 15 ml/hr. His HR increased from 90s to 100-110s. He recieved two boluses of 500 ml LR overnight. He was transfered to the ICU in the setting of hypotension. . Brief ICU Course: # Hypotension: A left subclavian central line was placed for CVP monitoring and fluid resuscitation. The patient's hypotension responded well to 7L of IV fluid boluses. The patient was started on Vancomycin and Zosyn for broad spectrum coverage for possible sepsis in the setting of a WBC elevated to 28. Blood and urine cultures were drawn but showed no growth. # Acute Renal Failure: The patient had elevated BUN and creatinine, possibly due to ATN in the setting of hypotension with some prerenal component. His renal function improved slowly with IV fluids. Urine output adequate. # Chronic systolic and diastolic heart failure: - TTE to look for change in cardiac function (refer to Echo report) Cardiac enzymes were negative - Baby aspirin was restarted . The patient was anticoagulated with fondaparinux, given concern for HIT per surgical team. His pain was controlled with a dilaudid PCA pump. General Surgery course: Transferred from ICU to floor on POD3. Blood pressure and urine output stable. Remained NPO until return of bowel function, at which time his diet was slowly advanced. IV Reglan started. Central IV access removed. Continued on empiric treatment of IV Vanco and Zosyn until final blood culture results showed no growth. Labwork and vitals remained stable. Of note, his platlets fell to 88. They then increased from 88 to 103 and then to 121 with the removal of the central line. . At the time of discharge, his pain was well controlled, he was ambulating, and tolerating a po diet. Medications on Admission: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Zocor 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day Discharge Medications: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. Zocor 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 5. Fondaparinux 2.5 mg/0.5 mL Syringe Sig: One (1) Subcutaneous DAILY (Daily). 6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain for 2 weeks. Disp:*30 Tablet(s)* Refills:*0* 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation for 1 months. Disp:*60 Capsule(s)* Refills:*0* 8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Enterocutaneous fistula post-op hypotension-likely related to hypovolemia vs. transient bacteremia post-op acute renal failure post-op heart failure Discharge Condition: Stable Tolerating a regular diet Adequate pain control with oral medication Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: not applicable . Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *Avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *Avoid driving or operating heavy machinery while taking pain medications. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. * Continue to ambulate several times per day. . Incision Care: -Your staples will be removed at your follow-up appointment. Steri strips will be applied. -Your steri-strips will fall off on their own. Please remove any remaining strips 7-10 days after surgery. -You may shower, and wash surgical incisions. -Avoid swimming and baths until your follow-up appointment. -Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. Followup Instructions: 1. Please follow-up with Dr. [**Last Name (STitle) 1120**] [**Telephone/Fax (1) 160**] in [**12-20**] weeks for removal of your incisional staples.

569,567,584,785,425,427,568,276,274,V100,401

{'Fistula of intestine, excluding rectum and anus,Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Other shock without mention of trauma,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Peritoneal adhesions (postoperative) (postinfection),Hypovolemia,Gout, unspecified,Personal history of malignant neoplasm of large intestine,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: enterocutaneous fistula PRESENT ILLNESS: 65 y/o man with systolic heart failure (LVEF 30%), h/o stable ventricular tachycardia, h/o stomach cancer, appendiceal cancer [**2174**], presented for elective right flank wound debridement. The procedure was complicated given colocutaneous fistula and bowel involvement. He underwent exploratory laprotomy, small bowel resection, fistulogram and revision of ileocolic anastomosis. EBL was 100 ml. He recieved 1300 crystolloid during the procedure. Post op, his BP decreased from 110/70 to 70s/40s with UOP decreasing from 20-30 ml/hr to 15 ml/hr. His HR increased from 90s to 100-110s. He recieved two boluses of 500 ml LR overnight. He was transfered to [**Hospital Unit Name 153**] for further care. . He denies any chest pain, SOB, lower extremity edema, fever, chills, nightsweats, change in bowel habits, headache, dysuria, hematuria. No weakness of numbness. He feels 'great' and does not have any other complaints. Patient was able to walk three miles without limiting symptoms one week ago. MEDICAL HISTORY: 1. CAD RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CABG: Never -PERCUTANEOUS CORONARY INTERVENTIONS: Never -PACING/ICD: Never 3. OTHER PAST MEDICAL HISTORY: Gastric Cancer Adenocarcinoma of the colon, appendix and Gall bladder Hypertension Gout Ventricular tachycardia Left ventricular systolic heart failure (LVEF 30% in [**Month (only) **] [**2175**]) Vancomycin resistant Enterococcus (VRE) Equivocal HIT antibody PSH: s/p gastrectomy, s/p right colectomy, s/p cholecystectomy MEDICATION ON ADMISSION: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Zocor 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day ALLERGIES: Aspirin / Morphine / Ambien PHYSICAL EXAM: GENERAL: Pleasant, well appearing in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. EOMI. MMM. OP clear. Neck Supple. CARDIAC: Normal S1, S2. Tachycardic. Flat JVP LUNGS: CTAB, good air movement biaterally. ABDOMEN: Soft NT, dressing c/d/i EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis NEURO: A&Ox3. Appropriate. spontaneously moves all 4 ext. . At Discharge: Vitals: _________________ FAMILY HISTORY: Father with DM, CHF, MI SOCIAL HISTORY: Former physics teacher. He does not smoke or drink. -Tobacco history: Never -ETOH: Denies -Illicit drugs: Denies ### Response: {'Fistula of intestine, excluding rectum and anus,Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Other shock without mention of trauma,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Peritoneal adhesions (postoperative) (postinfection),Hypovolemia,Gout, unspecified,Personal history of malignant neoplasm of large intestine,Unspecified essential hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname **] is a 71-year-old gentleman that fell from a standing height of approximately two stairs hitting his head and losing consciousness, sustaining a 2 cm laceration of his right eye. He recovered consciousness and was brought by the paramedics to the [**Hospital1 **] [**First Name (Titles) 2142**] [**Last Name (Titles) **] complaining of head pain for evaluation. Once in the Emergency Room, the patient was alert, awake and oriented but due to the loss of consciousness a head CT was obtained and it revealed a small intraparenchymal hemorrhage. The patient was admitted to the Intensive Care Unit for frequent neurologic checks. MEDICAL HISTORY: 1. Bilateral hip replacement 2. Status post hernia repair x2 3. History of glaucoma 4. History of deafness using hearing aid MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: VITAL SIGNS: The patient's temperature was 96.3??????, pulse in the 80s and sinus, blood pressure 180/60, respiratory rate of 18, 100% on a face mask. [**Location (un) 2611**] coma scale was 15. HEAD, EARS, EYES, NOSE AND THROAT: There was a 2 cm laceration of the right eyebrow with no significant bleeding. Pupils were equal, round and reactive to light and accommodation. Extraocular muscles were fine and full. Tongue was in the midline. Mid face was stable. Patient admitted on a C-spine collar. HEART: Regular rate and rhythm. No murmurs, thrills or rubs. LUNGS: Clear to auscultation bilaterally. ABDOMEN: Soft, nontender, nondistended. PELVIS: Stable. EXTREMITIES: No evidence of bony deformity, palpable pulses bilaterally. RECTAL: Normal tone, normal prostate, guaiac negative. FAMILY HISTORY: SOCIAL HISTORY: History of polysubstance abuse, as well as alcohol abuse in the recent past.

Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Open wound of forehead, without mention of complication,Other complications due to genitourinary device, implant, and graft,Accidental fall on or from other stairs or steps,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Unspecified hearing loss,Other, mixed, or unspecified drug abuse, in remission

Brain hem NEC-brief coma,Open wound of forehead,Comp-genitourin dev/grft,Fall on stair/step NEC,DMII wo cmp nt st uncntr,Joint replaced hip,Hearing loss NOS,Drug abuse NEC-in remiss

Admission Date: [**2124-7-15**] Discharge Date: [**2124-7-18**] Date of Birth: [**2053-2-13**] Sex: M Service: ADDENDUM: Please make note that this discharge summary needs to be mailed to the patient's primary care physician on [**Name9 (PRE) 26532**]. The primary care physician's name is Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] from the Medicine Associates Limited at [**Street Address(2) 41815**], [**Hospital1 789**], [**Numeric Identifier 41816**]. The business phone is [**Telephone/Fax (1) 41817**]. The patient is supposed to follow up with him in [**Doctor Last Name 792**]and just come back to the Trauma Clinic prn. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D. [**MD Number(1) 2214**] Dictated By:[**Last Name (NamePattern4) 26544**] MEDQUIST36 D: [**2124-7-18**] 08:55 T: [**2124-7-18**] 09:07 JOB#: [**Job Number **] Admission Date: [**2124-7-15**] Discharge Date: [**2124-7-18**] Date of Birth: [**2053-2-13**] Sex: M Service: TRAUMA SURGERY HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname **] is a 71-year-old gentleman that fell from a standing height of approximately two stairs hitting his head and losing consciousness, sustaining a 2 cm laceration of his right eye. He recovered consciousness and was brought by the paramedics to the [**Hospital1 **] [**First Name (Titles) 2142**] [**Last Name (Titles) **] complaining of head pain for evaluation. Once in the Emergency Room, the patient was alert, awake and oriented but due to the loss of consciousness a head CT was obtained and it revealed a small intraparenchymal hemorrhage. The patient was admitted to the Intensive Care Unit for frequent neurologic checks. PAST MEDICAL HISTORY: 1. Bilateral hip replacement 2. Status post hernia repair x2 3. History of glaucoma 4. History of deafness using hearing aid MEDICATIONS: 1. Glucophage 2. Betoptic drops for the glaucoma. ALLERGIES: The patient has no known drug allergies. SOCIAL HISTORY: History of polysubstance abuse, as well as alcohol abuse in the recent past. PHYSICAL EXAM: VITAL SIGNS: The patient's temperature was 96.3??????, pulse in the 80s and sinus, blood pressure 180/60, respiratory rate of 18, 100% on a face mask. [**Location (un) 2611**] coma scale was 15. HEAD, EARS, EYES, NOSE AND THROAT: There was a 2 cm laceration of the right eyebrow with no significant bleeding. Pupils were equal, round and reactive to light and accommodation. Extraocular muscles were fine and full. Tongue was in the midline. Mid face was stable. Patient admitted on a C-spine collar. HEART: Regular rate and rhythm. No murmurs, thrills or rubs. LUNGS: Clear to auscultation bilaterally. ABDOMEN: Soft, nontender, nondistended. PELVIS: Stable. EXTREMITIES: No evidence of bony deformity, palpable pulses bilaterally. RECTAL: Normal tone, normal prostate, guaiac negative. LABS: He had a white count of 8.7, hematocrit of 38 and platelet count of 244. His PT was 13, INR 1.2 and a PTT of 27.5. His sodium was 139, potassium 4.2, chloride 103, CO2 26, BUN 20 with a creatinine of 0.9. His ETOH and toxic screen was negative. His initial trauma series were negative and a head CT revealed a small right frontal intraparenchymal bleed with no midline shift. A CT of the spine was performed in order to rule out bone fractures and this was also negative. HOSPITAL COURSE: With the results of the head CT, the patient was admitted to the Trauma Intensive Care Unit for frequent neurologic checks. A neurosurgery consult was obtained and upon evaluation the recommendation was to continue neurologic checks overnight and repeat a head CT in the morning. By hospital day #2, the patient was stable. His C-spine was cleared clinically and the hard collar was removed. New head CT was obtained almost 24 hours later and showed no significant interval change in appearance of the small focal area for the intraparenchymal hemorrhage on the right frontal lobe. There were two other tiny focal areas of increased attenuation on the left frontal lobe that at that time the radiologist thought it might have represented a small bleed. The recommendation was continue to follow up the patient clinically and obtain a new head CT examination prn. That same day, the patient was transferred to the floor in stable condition. By hospital day #2 and once on the floor, the patient self discontinued his Foley catheter and approximately 30 minutes later he started passing blood clots with his urine. The remainder of the urine output became pretty hematuric and a three-way Foley catheter was placed for irrigation. The irrigation was kept overnight until the urine cleared up and was subsequently discontinued the next morning. The patient was able to urinate without any problems. His hematuria dramatically improved. By hospital day #4, the patient remained stable, afebrile with vital signs stable as well. He was much more awake and oriented than prior days and was cleared by physical therapy, as well as occupational therapy to be discharged home with his wife. The patient already scheduled a follow up appointment with his primary care physician in [**Name9 (PRE) **]. He is supposed to follow up this coming [**Last Name (LF) 2974**], [**7-21**], with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. The patient does not need to follow up with neurosurgery at this point, but it is recommended that in the near future he should have a new head CT just to assess the size of that intraparenchymal hemorrhage. DISCHARGE CONDITION: Stable DISCHARGE INSTRUCTIONS: He was instructed to follow up with the trauma clinic prn, but definitely follow up with his primary care physician as stated above. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D. [**MD Number(1) 2214**] Dictated By:[**Last Name (NamePattern4) 26544**] MEDQUIST36 D: [**2124-7-18**] 08:52 T: [**2124-7-18**] 09:01 JOB#: [**Job Number 42017**]

853,873,996,E880,250,V436,389,305

{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Open wound of forehead, without mention of complication,Other complications due to genitourinary device, implant, and graft,Accidental fall on or from other stairs or steps,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Unspecified hearing loss,Other, mixed, or unspecified drug abuse, in remission'}

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: Mr. [**Known lastname **] is a 71-year-old gentleman that fell from a standing height of approximately two stairs hitting his head and losing consciousness, sustaining a 2 cm laceration of his right eye. He recovered consciousness and was brought by the paramedics to the [**Hospital1 **] [**First Name (Titles) 2142**] [**Last Name (Titles) **] complaining of head pain for evaluation. Once in the Emergency Room, the patient was alert, awake and oriented but due to the loss of consciousness a head CT was obtained and it revealed a small intraparenchymal hemorrhage. The patient was admitted to the Intensive Care Unit for frequent neurologic checks. MEDICAL HISTORY: 1. Bilateral hip replacement 2. Status post hernia repair x2 3. History of glaucoma 4. History of deafness using hearing aid MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: VITAL SIGNS: The patient's temperature was 96.3??????, pulse in the 80s and sinus, blood pressure 180/60, respiratory rate of 18, 100% on a face mask. [**Location (un) 2611**] coma scale was 15. HEAD, EARS, EYES, NOSE AND THROAT: There was a 2 cm laceration of the right eyebrow with no significant bleeding. Pupils were equal, round and reactive to light and accommodation. Extraocular muscles were fine and full. Tongue was in the midline. Mid face was stable. Patient admitted on a C-spine collar. HEART: Regular rate and rhythm. No murmurs, thrills or rubs. LUNGS: Clear to auscultation bilaterally. ABDOMEN: Soft, nontender, nondistended. PELVIS: Stable. EXTREMITIES: No evidence of bony deformity, palpable pulses bilaterally. RECTAL: Normal tone, normal prostate, guaiac negative. FAMILY HISTORY: SOCIAL HISTORY: History of polysubstance abuse, as well as alcohol abuse in the recent past. ### Response: {'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Open wound of forehead, without mention of complication,Other complications due to genitourinary device, implant, and graft,Accidental fall on or from other stairs or steps,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Unspecified hearing loss,Other, mixed, or unspecified drug abuse, in remission'}

CHIEF COMPLAINT: s/p fall PRESENT ILLNESS: Ms. [**Known lastname 19130**] is an 87 year old female who had an unwitnessed fall at her [**Hospital3 **] (reported trip and fall with no LOC). She was initially placed in a chair by the staff and later daughter was concern for pain and confusion. She was then transferred to the [**Hospital1 18**] for further evaluation and care. MEDICAL HISTORY: -Siezure disorder on Keppra (initial seizure [**2-/2179**]) -Multiple TIA and possible stroke with R side residual last [**Month (only) **] -Hyperlipidemia -Hypertension -Colon CA s/p partial colon resection 6 years ago -Hypothyroidism -Bursitis -Glaucoma -Rheumatic fever during childhood -Dementia: alzheimer's vs. vascular, was on aricpet but this was MEDICATION ON ADMISSION: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every ALLERGIES: Penicillins PHYSICAL EXAM: Upon admission FAMILY HISTORY: n/a SOCIAL HISTORY: Comes from [**Hospital3 **]. Has recently had stays in [**Hospital 100**] Rehab. Previously worked as a secretary. Has 5 children, one of whom is deceased. Denies tobacco, etoh, IVDU. Has a son, [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 19126**] who is her HCP and is an endocrinologist in [**Name (NI) **]. Daughter, [**Name (NI) **], who lives close by and is readily avalible.

Closed fracture of unspecified part of neck of femur,Delirium due to conditions classified elsewhere,Fall from other slipping, tripping, or stumbling,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Unspecified acquired hypothyroidism,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Esophageal reflux,Anxiety state, unspecified,Congestive heart failure, unspecified,Osteoporosis, unspecified

Fx neck of femur NOS-cl,Delirium d/t other cond,Fall from slipping NEC,Epilep NOS w/o intr epil,Hyperlipidemia NEC/NOS,Hypertension NOS,Hx of colonic malignancy,Hypothyroidism NOS,Vascular dementia,uncomp,Cerebral atherosclerosis,Alzheimer's disease,Dementia w/o behav dist,Esophageal reflux,Anxiety state NOS,CHF NOS,Osteoporosis NOS

Admission Date: [**2179-8-23**] Discharge Date: [**2179-8-30**] Service: ORTHOPAEDICS Allergies: Penicillins Attending:[**First Name3 (LF) 8587**] Chief Complaint: s/p fall Major Surgical or Invasive Procedure: [**2179-8-24**]: Right hip cemented hemiarthroplasty History of Present Illness: Ms. [**Known lastname 19130**] is an 87 year old female who had an unwitnessed fall at her [**Hospital3 **] (reported trip and fall with no LOC). She was initially placed in a chair by the staff and later daughter was concern for pain and confusion. She was then transferred to the [**Hospital1 18**] for further evaluation and care. Past Medical History: -Siezure disorder on Keppra (initial seizure [**2-/2179**]) -Multiple TIA and possible stroke with R side residual last [**Month (only) **] -Hyperlipidemia -Hypertension -Colon CA s/p partial colon resection 6 years ago -Hypothyroidism -Bursitis -Glaucoma -Rheumatic fever during childhood -Dementia: alzheimer's vs. vascular, was on aricpet but this was thought to be contributing to syncopal events so was d/c -GERD -anxiety -pelvic prolapse: has pessary Social History: Comes from [**Hospital3 **]. Has recently had stays in [**Hospital 100**] Rehab. Previously worked as a secretary. Has 5 children, one of whom is deceased. Denies tobacco, etoh, IVDU. Has a son, [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 19126**] who is her HCP and is an endocrinologist in [**Name (NI) **]. Daughter, [**Name (NI) **], who lives close by and is readily avalible. Family History: n/a Physical Exam: Upon admission Alert and oriented Cardiac: Regular rate rhythm Chest: Lungs clear bilaterally Abdomen: Soft non-tender non-distended Extremities: RLE, shortended roatated, +pulses/sensation/movement Pertinent Results: [**2179-8-23**] 02:25PM WBC-14.3*# RBC-4.65 HGB-13.6 HCT-40.8 MCV-88 MCH-29.3 MCHC-33.4 RDW-13.9 [**2179-8-23**] 04:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG [**2179-8-23**] 02:25PM PT-12.5 PTT-23.4 INR(PT)-1.1 Brief Hospital Course: Ms. [**Known lastname 19130**] presented to the [**Hospital1 18**] on [**2179-8-23**] after a fall at her [**Hospital3 **]. She was evaluated by the orthopaedic surgery service and found to have a right hip fracture. She was admitted, consented, and prepped for surgery. On [**2180-8-23**] she was taken to the operating room and underwent a right hip hemiarthroplasty. She tolerated the procedure well, was extubated, transferred to the recovery room, and then to the floor. On the floor she was seen by physical therapy to improve her strength and mobility. On [**2179-8-27**] she was seen by speech/swallow evaluation and recommended a thin liquid with moist ground solids and meds creshed with purees. Geriatrics was consulted for help in the post operative periods as Ms. [**Known lastname 19130**] was refusing to take food. The decreased oral intake was thought to be due to delirum and dementia. On the day of discharge she was taking good PO intake and was up out of bed and into a chair most of the day. The rest of her hospital stay was uneventful with her lab data and vital sings within normal limits and her pain controlled. She is being discharged today in stable condition. Medications on Admission: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for fever/pain. 4. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 12. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Medications: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 4. Cyanocobalamin (Vitamin B-12) 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 6. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO BID (2 times a day) as needed for Constipation. Disp:*300 ML(s)* Refills:*0* 9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Disp:*100 Tablet(s)* Refills:*2* 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 12. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day) as needed for Constipation. Disp:*30 Tablet(s)* Refills:*2* 13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). Disp:*60 Tablet, Chewable(s)* Refills:*2* 14. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous DAILY (Daily) for 4 weeks. Disp:*28 syringes* Refills:*0* 15. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for Pain. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Location (un) 582**] at [**Location (un) 620**] Discharge Diagnosis: s/p fall Right hip 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: Continue to be weight bearing as toleratd on your right leg Continue to take your lovenox injections for a total of 4 weeks after surgery Please take all your medication as prescribed If you have any increased redness, draiange, or swelling, or if you have a temperature greater than 101.5, please call the office or come to the emergency department. Physical Therapy: Activity: Ambulate twice daily if patient able Right lower extremity: Full weight bearing Treatments Frequency: Staples out 14 days after surgery Followup Instructions: Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2 months, please call [**Telephone/Fax (1) 1228**] to schedule that appointment Appointments made at the [**Hospital1 18**] prior to your admission: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 658**], M.D. Phone:[**Telephone/Fax (1) 1690**] Date/Time:[**2179-8-31**] 1:30 Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 2574**] Date/Time:[**2179-9-13**] 1:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**], MD Phone:[**Telephone/Fax (1) 142**] Date/Time:[**2179-9-21**] 11:00

820,293,E885,345,272,401,V100,244,290,437,331,294,530,300,428,733

{"Closed fracture of unspecified part of neck of femur,Delirium due to conditions classified elsewhere,Fall from other slipping, tripping, or stumbling,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Unspecified acquired hypothyroidism,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Esophageal reflux,Anxiety state, unspecified,Congestive heart failure, unspecified,Osteoporosis, 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: s/p fall PRESENT ILLNESS: Ms. [**Known lastname 19130**] is an 87 year old female who had an unwitnessed fall at her [**Hospital3 **] (reported trip and fall with no LOC). She was initially placed in a chair by the staff and later daughter was concern for pain and confusion. She was then transferred to the [**Hospital1 18**] for further evaluation and care. MEDICAL HISTORY: -Siezure disorder on Keppra (initial seizure [**2-/2179**]) -Multiple TIA and possible stroke with R side residual last [**Month (only) **] -Hyperlipidemia -Hypertension -Colon CA s/p partial colon resection 6 years ago -Hypothyroidism -Bursitis -Glaucoma -Rheumatic fever during childhood -Dementia: alzheimer's vs. vascular, was on aricpet but this was MEDICATION ON ADMISSION: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every ALLERGIES: Penicillins PHYSICAL EXAM: Upon admission FAMILY HISTORY: n/a SOCIAL HISTORY: Comes from [**Hospital3 **]. Has recently had stays in [**Hospital 100**] Rehab. Previously worked as a secretary. Has 5 children, one of whom is deceased. Denies tobacco, etoh, IVDU. Has a son, [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 19126**] who is her HCP and is an endocrinologist in [**Name (NI) **]. Daughter, [**Name (NI) **], who lives close by and is readily avalible. ### Response: {"Closed fracture of unspecified part of neck of femur,Delirium due to conditions classified elsewhere,Fall from other slipping, tripping, or stumbling,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Unspecified acquired hypothyroidism,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Esophageal reflux,Anxiety state, unspecified,Congestive heart failure, unspecified,Osteoporosis, unspecified"}

CHIEF COMPLAINT: Melena PRESENT ILLNESS: Mr. [**Known lastname **] is an 81 y/o gentleman with CHF (EF 45%), porcine AV replacement, severe MR/TR, AFib, pacemaker, diverticulosis s/p bleed [**2171**], who was transferred from [**Hospital **] Hospital to [**Hospital1 18**] yesterday ([**4-13**]) due to melena. MEDICAL HISTORY: Hypercholesterolemia CHF (EF 45% on [**2172-4-14**]) Atrial fibrillation (previously on coumadin until [**2171-5-12**]) GI bleed [**5-/2171**] with 6 unit transfusion d/t Diverticulosis Decubitus ulcer Anemia - baseline hct 28-30 Pacemaker [**2-/2170**] Dr. [**Last Name (STitle) 4455**] Diverticulosis Hemorrhoids Hepatic cysts Obesity Colonic adenoma Prostate cancer Cataract Acute on chronic renal insufficency - baseline Cr 1.6 Gout MEDICATION ON ADMISSION: Home Medications: ALBUTEROL SULFATE 90 mcg HFA Aerosol Inhaler 2 puffs inh prn ALLOPURINOL 300 mg Tablet daily FLUTICASONE-SALMETEROL [ADVAIR DISKUS] 250 mcg-50 mcg/Dose Disk ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: VS: Tm98.2 Tc97.6 BP 89/64 (87-94/58-72) HR 90 RR 18 O2 sat 94% FAMILY HISTORY: Non contributory. SOCIAL HISTORY: Most recently has been staying at [**Hospital 5682**] Nursing Home, prior to [**Month (only) **] lived at home w/ wife. Pt is a retired court officer security guard. Pt last smoked in the 60s (20-30 pack years), and occasionally smokes a cigar. The patient w/ h/o drinking moderate to heavily, with > 8 drinks per week.

Atrophic gastritis, with hemorrhage,Acute on chronic systolic heart failure,Mitral valve disorders,Diseases of tricuspid valve,Other severe protein-calorie malnutrition,Acute kidney failure with lesion of tubular necrosis,Cardiogenic shock,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Ulcer of other part of lower limb,Cachexia,Atrial fibrillation,Benign neoplasm of colon,Pure hypercholesterolemia,Chronic kidney disease, Stage III (moderate),Diverticulosis of colon (without mention of hemorrhage),Thrombocytopenia, unspecified,Unspecified cataract,Other specified disorders of stomach and duodenum,Hypovolemia,Cirrhosis of liver without mention of alcohol,Venous (peripheral) insufficiency, unspecified,Heart valve replaced by transplant,Do not resuscitate status,Cardiac pacemaker in situ,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of colonic polyps,Body Mass Index 25.0-25.9, adult,Anticoagulants causing adverse effects in therapeutic use

Atrph gastritis w hmrhg,Ac on chr syst hrt fail,Mitral valve disorder,Tricuspid valve disease,Oth severe malnutrition,Ac kidny fail, tubr necr,Cardiogenic shock,Ac posthemorrhag anemia,Prim cardiomyopathy NEC,Ulcer oth part low limb,Cachexia,Atrial fibrillation,Benign neoplasm lg bowel,Pure hypercholesterolem,Chr kidney dis stage III,Dvrtclo colon w/o hmrhg,Thrombocytopenia NOS,Cataract NOS,Gastroduodenal dis NEC,Hypovolemia,Cirrhosis of liver NOS,Venous insufficiency NOS,Heart valve transplant,Do not resusctate status,Status cardiac pacemaker,Hx-prostatic malignancy,Long-term use of aspirin,History of tobacco use,Prsnl hst colonic polyps,BMI 25.0-25.9,adult,Adv eff anticoagulants

Admission Date: [**2172-4-13**] Discharge Date: [**2172-4-29**] Date of Birth: [**2090-5-31**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1711**] Chief Complaint: Melena Major Surgical or Invasive Procedure: EGD Colonoscopy Tagged RBC scan CTA abdomen Central venous line placement History of Present Illness: Mr. [**Known lastname **] is an 81 y/o gentleman with CHF (EF 45%), porcine AV replacement, severe MR/TR, AFib, pacemaker, diverticulosis s/p bleed [**2171**], who was transferred from [**Hospital **] Hospital to [**Hospital1 18**] yesterday ([**4-13**]) due to melena. Initially, there had been plans for MVR/TVR in 3/[**2172**]. The pt was admitted to [**Hospital **] Hospital from [**Date range (1) 94558**] w/ refractory peripheral edema [**2-13**] chronic right sided heart failure and was diuresed; he was also developed pneumococcal pneumonia/bacteremia so was treated with two weeks of CTX which he completed in rehab. While at rehab, warfarin was restarted for Afib (this had been discontinued in [**5-/2171**] [**2-13**] a large diverticular bleed) and 3 days later he had dark/tarry stools in the setting of INR of 3.4 and hct of 27.5 (from 30 on [**2172-3-26**]). He was sent to [**Hospital **] Hospital on [**4-9**] where he was found to have hct of 28.3 which dropped to 25.8 on repeat. INR was 2.31. He was given at least 2 units of FFP and 10 mg vitamin K which brought his INR down to 1.9. Per wife, pt received 1 unit pRBCs. He underwent EGD which showed only a small amount of blood in the stomach and signs of congestive gastropathy with multiple hemorrhagic changes. He was transferred to [**Hospital1 18**] on [**4-13**] because his cardiac care has been here. On the cardiac surgery service, GI was consulted given his recent GI bleed and plan were made for colonscopy on [**4-15**]. He was also seen by vascular surgery for his b/l LE ulcers. Per Cardiac Surgery, he is not a candidate for surgery at this time due to GI bleed and various other issues (see below) so a transfer to Medicine was requested. Past Medical History: Hypercholesterolemia CHF (EF 45% on [**2172-4-14**]) Atrial fibrillation (previously on coumadin until [**2171-5-12**]) GI bleed [**5-/2171**] with 6 unit transfusion d/t Diverticulosis Decubitus ulcer Anemia - baseline hct 28-30 Pacemaker [**2-/2170**] Dr. [**Last Name (STitle) 4455**] Diverticulosis Hemorrhoids Hepatic cysts Obesity Colonic adenoma Prostate cancer Cataract Acute on chronic renal insufficency - baseline Cr 1.6 Gout PSH: s/p Yag Laser Caps - OS [**2172-2-13**] s/p cataract surgery s/p Pacemaker for tachy-brady syndrome [**2170-2-23**] Social History: Most recently has been staying at [**Hospital 5682**] Nursing Home, prior to [**Month (only) **] lived at home w/ wife. Pt is a retired court officer security guard. Pt last smoked in the 60s (20-30 pack years), and occasionally smokes a cigar. The patient w/ h/o drinking moderate to heavily, with > 8 drinks per week. Family History: Non contributory. Physical Exam: ADMISSION EXAM: VS: Tm98.2 Tc97.6 BP 89/64 (87-94/58-72) HR 90 RR 18 O2 sat 94% General: Pleasant, alert, oriented, no acute distress, prominent temporal wasting HEENT: Sclera anicteric, MM dry, oropharynx clear, no scleral lesions Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, III/VI holosystolic murmur heard throughout precordium, but best in LLSB Abdomen: soft, non-distended, bowel sounds present, liver palpable 3cm below the costal margin, no tenderness to palpation or percussion Ext: wrapped w/ ACE bandages; fingers w/ some deformities Neuro: CNs2-12 intact, motor function grossly normal Skin: skin breakdown covered w/ dressings DISCHARGE EXAM: Gen: Chronically ill, cachectic man in NAD speaking in full sentences, A+Ox3, appears to be SOB intermittently HEENT: MMM, JVD to mandible Heart: irregularly regular, 3/6 systolic murmur best LLSB radiating into axilla, RV heave Lungs: dim b/l base Abdomen: BSx4, soft, non-tender Ext: [**2-14**]+ pitting edema b/l LE Skin: marked venous stasis ulcerations b/l LE Neuro: Non-focal, AAO x3 Pertinent Results: ADMISSION LABS: [**2172-4-14**] 04:30AM BLOOD WBC-4.6 RBC-3.91* Hgb-9.4* Hct-32.0* MCV-82 MCH-24.2* MCHC-29.6* RDW-21.4* Plt Ct-66* [**2172-4-14**] 04:30AM BLOOD PT-22.2* PTT-35.5 INR(PT)-2.1* [**2172-4-14**] 04:30AM BLOOD Glucose-108* UreaN-69* Creat-1.6* Na-140 K-3.0* Cl-102 HCO3-27 AnGap-14 [**2172-4-14**] 04:30AM BLOOD ALT-38 AST-43* LD(LDH)-351* AlkPhos-94 TotBili-1.5 [**2172-4-14**] 04:30AM BLOOD Albumin-2.6* Calcium-9.1 Phos-3.0 Mg-1.9 Iron-20* [**2172-4-14**] 04:30AM BLOOD calTIBC-282 VitB12-GREATER TH Ferritn-84 TRF-217 [**2172-4-14**] 07:55AM BLOOD %HbA1c-6.0* eAG-126* [**2172-4-14**] 04:30AM BLOOD TSH-3.8 STUDIES: [**2172-4-21**] TTE: Left ventricular wall thicknesses are normal. The left ventricular cavity is severely dilated. There is moderate to severe reduction of the left ventricular ejection fraction at least partially due to ventricular interaction (LVEF = 30 %). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] The right ventricular free wall is hypertrophied. The right ventricular cavity is markedly dilated with severe global free wall hypokinesis. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. 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. The mitral valve leaflets do not fully coapt. Severe (4+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. [Due to acoustic shadowing, the severity of tricuspid regurgitation may be significantly UNDERestimated.] There is at least moderate pulmonary artery systolic hypertension. [In the setting of at least moderate to severe tricuspid regurgitation, the estimated pulmonary artery systolic pressure may be underestimated due to a very high right atrial pressure.] The main pulmonary artery is dilated. The branch pulmonary arteries are dilated. There is no pericardial effusion. [**2172-4-14**] CXR: The left pectoral pacemaker lead terminates in the region of the base of the right ventricle. There is severe cardiomegaly with surrounding atelectasis. There is opacification in the right lower lobe with air bronchograms that likely represents pneumonia. There is no pulmonary vascular congestion or pneumothorax. There are probably small pleural effusions. IMPRESSION: Right lower lobe pneumonia. [**2172-4-14**] TTE: The left atrium is markedly dilated. The right atrium is markedly dilated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is at least 15 mmHg. Left ventricular wall thicknesses are normal. The left ventricular cavity is severely dilated. There is mild to moderate global left ventricular hypokinesis (LVEF = 45 %). No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. The right ventricular cavity is markedly dilated with severe global free wall hypokinesis. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The ascending aorta is mildly dilated. 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. An eccentric, posteriorly directed jet of severe (4+) mitral regurgitation is seen. The left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. [**2172-4-15**] EGD: Mottled erythema (giraffe skin pattern) and atrophy in the antrum compatible with atrophic gastritis (biopsy) Fundic gland polyps Otherwise normal EGD to third part of the duodenum. [**2172-4-15**] Colonoscopy: Polyp at 65cm in the transverse colon (polypectomy). Diverticulosis of the mid-ascending colon and sigmoid colon. Otherwise normal colonoscopy to cecum and terminal ileum. [**2172-4-15**] Non-invasive arterial studies: 1. Mild inflow arterial disease to the right lower extremity, likely located at the iliac level. 2. No evidence of arterial insufficiency to the left lower extremity. [**2172-4-15**] Abd U/S: 1. Exaggerated phasicity within the portal vein; dilated hepatic veins and IVC; pleural effusion and ascites; findings all consistent with changes of congestive heart failure and valvular regurgitation. 2. Gallbladder wall edema, also compatible with congestive heart failure. 3. Left lobe hepatic cyst. [**2172-4-24**] GI BLEEDING STUDY: Intermittent GI bleeding localized to the ascending colon, just proximal to the hepatic flexure. [**2172-4-24**] CTA Abdomen FINDINGS: 1. Tortuous, rotated and atherosclerotic aorta was demonstrated. 2. Multiple digital subtraction angiograms from the superior mesenteric artery did not demonstrate any active extravasation. 3. Inferior mesenteric artery was not identified. IMPRESSION: Uncomplicated mesenteric arteriogram of the superior mesenteric artery with no active extravasation demonstrated. PATHOLOGY: [**2172-4-15**] A) Antrum, biopsy: Fundic/antral mucosa with scattered dilated gastric pits. Some of the fragments of tissue may represent (portions of) fundic gland polyps. B) Colon, transverse, polypectomy: Adenoma. Brief Hospital Course: 81 yo M w/ h/o CHF (EF 45%), porcine AV replacement, severe MR/TR, AFib, tachy-brady syndrome s/p pacemaker, diverticulosis s/p bleed in [**2171**], transferred from [**Hospital **] Hospital to [**Hospital1 18**] on [**4-13**] for evaluation of melena. . #) Goals of care: During the course of Mr. [**Known lastname 94559**] hospitalization, the decision was made to transition the goals of his care to focus on his comfort. The decision was made after his second GI bleed. Although an unsuccessful attempt was made to stop the bleed via interventional radiology, the patient did not want to undergo a repeat colonoscopy and it was felt that the risks of this procedure in light of his comorbid conditions outweighed the benefits. Multiple discussions were had with the patient, his longtime girlfriend, and his sons, including his health care proxy, and the decision was made to treat his GI bleed conservatively and to transition his code status to "DNR/DNI". The patient reported that he simply wanted to go home or at least to a hospice setting. He will be continued on diuretic therapy for comfort and is to be discharged to a hospice facility. #) GIB: Pt had hx of melena with hct drop to 25 in setting of anticoagulation with coumadin at rehab. EGD at OSH showed congestive gastropathy, repeat EGD at [**Hospital1 18**] showed atrophic gastritis. Colonoscopy showed diverticulosis of mid-ascending colon and sigmoid w/o any active bleeding; a polyp was also noted in the transverse colon which was removed, pathology c/w adenoma. The GI team felt that given his history of large amounts of bloody and black stool neither of these findings might account for his bleed. His initial bleeding was ultimately attributed to his gastritis/gastropathy in the setting of a supratherapeutic INR. The patient again had a GI bleed on [**4-24**], this time with BRBPR. He underwent a tagged RBC scan which revealed a bleeding near the hepatic flexure, unfortunately IR was unable localize the source for an intervention. A colonoscopy was consider however, given the patients poor functional status, significant comorbidities, and shift in the patient's goals of care, the decision was made to treat his bleed conservatively. He was given multiple transfusions and his hematocrit gradually stabilized. He continues to have maroonish stools. #) Acute on chronic systolic congestive heart failure secondary to severe MR [**First Name (Titles) **] [**Last Name (Titles) **]: The patient was initially evaluated for the possibility of valve replacement, however it was felt he was a very poor surgical candidate. He had an episode of respiratory distress and hypotension prompting transfer to the CCU. He was aggressively diuresed with a lasix drip, and transitioned to oral torsemide. He continues to have LE edema and slight pulmonary edema. The patient is to continues on his diuretic regimen to comfort. #) Severe Malnutrition: The patient reported 70 pounds weight loss in the last 3 years and is cachetic. He was evaluated by nutrition and began taking supplements with his meals. He is to continue with these supplements, but should be mindful of his total fluid intake given his sCHF. . #) Atrial fibrillation: The patient remained in atrial fibrillation throughout his hospital stay. All of his anticoagulation has been stopped given both his GI bleed and his new goals of care. . #) Coagulopathy: Initialy was secondary to warfarin and was reversed at OSH with FFP and vitamin K 10 mg from 3.4 to 1.9. Concern that coagulopathy may be secondary to impaired hepatic function given CHF with evidence of congestive hepatopathy on ultrasound. He is no longer being anticoagulated as above. . #) Thrombocytopenia: On admission to [**Hospital1 18**], plts were around 60. This was a drop from baseline of 146 on [**4-9**] (160 in 12/[**2172**]). The plts had already started to trend down by [**4-11**] when they were documented at 64 at [**Hospital **] Hospital. During his hospitalization at [**Hospital1 18**], platelets remained stable around 60. The etiology of the thrombocytopenia was unclear but may have been reactive in the setting of illness vs. related to evolving liver disease. #) Acute on chronic kidney disease: Pt with stage III CKD with baseline creatinine of 1.6. On admission patient was at his baseline but creatinine bumped to 2.2 on [**4-17**] after several days of NPO status in setting continued diuresis. Blood pressures also dropped in this setting so ATN was a possible contributor. He was given fluids and creatinine trend back to his baseline. #) RLL infiltrate on CXR: Pt found to have RLL infiltrate on CXR on admission. He was recently treated with CTX and azithro for strep pneumo pna/bacteremia in [**Month (only) 958**] so this was felt to be residual infiltrate vs. new aspiration pneumonitis. Patient had no active cough, fever or leukocytosis and antibiotics were not started. #) LE ulcers: Pt's ulcers were likely [**2-13**] blistering from chronic LE edema. Pulses were intact so arterial disease was felt less likely to be etiology. Vascular was consulted and ABIs performed which showed low level R LE disease at iliac level. Vascular was not concerned about mild arterial disease and patient was managed with leg elevation, ABM foam dressings, and ACE wrap bandaging. #) Unstageable sacral decub: Pt with pre-existing sacral decubitus ulcer. Wound care was consulted and made recommendations for management. Nutrition was addressed as above and patient was frequently moved. Medications on Admission: Home Medications: ALBUTEROL SULFATE 90 mcg HFA Aerosol Inhaler 2 puffs inh prn ALLOPURINOL 300 mg Tablet daily FLUTICASONE-SALMETEROL [ADVAIR DISKUS] 250 mcg-50 mcg/Dose Disk with Device - 1 puff inh twice a day FUROSEMIDE 80 mg po BID METOLAZONE 2.5 mg Tablet po BID POTASSIUM CHLORIDE 20 mEq 2 Tablet(s) by mouth three times a day SIMVASTATIN 20 mg Tablet daily Coumadin - 4 mg daily - held [**4-7**] ASPIRIN 81 mg Tablet daily Tiotroprium 18 mcg daily Omeprazole 20 mg daily Mucinex 600 mg [**Hospital1 **] Oxycodone 2.5 mg PRN . Medications on Transfer from [**Hospital1 **]: Fluticasone 250 salmeterol 50 Lasix 40 mg PO daily Mucinex 600 mg PO BID Metolazone 2.5 mg Po daily Omeprazole 20 mg [**Hospital1 **] Potassium 20 mEq PO daily Discharge Medications: 1. guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q4H (every 4 hours) as needed for cough. 2. metolazone 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. torsemide 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. potassium chloride 10 mEq Tablet Extended Release Sig: Four (4) Tablet Extended Release PO DAILY (Daily). 5. morphine 10 mg/5 mL Solution Sig: 5-10 mg PO Q4H (every 4 hours) as needed for pain/dypsnea. 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 8. lorazepam 1 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for shortness of breath or wheezing. 9. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital1 **] house Discharge Diagnosis: Primary: Acute on chronic systolic congestive heart failure Lower gastrointestinal bleeding Secondary Atrial fibrillation Severe malnutrition Acute on chronic kidney injury Coagulopathy Thrombocytopenia. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Mr. [**Known lastname **], It was a pleasure taking part in your care during this hospitalization. You were admitted as you were bleeding in to your intestines. You also had an exacerbation of your heart failure. You were diuresed to help remove fluid from your lungs and your body. You developed a second episode of bleeding in to your intestines, which were were unable to stop. Upon discussions with you and your family, it became clear that you wished to transition to focus of your care to comfort. You are being transferred to a hospice facilitiy. It was wonderful meeting you. Followup Instructions: Please speak with the physician at the hospice facility within 1-2 days of your arrival

535,428,424,397,262,584,785,285,425,707,799,427,211,272,585,562,287,366,537,276,571,459,V422,V498,V450,V104,V586,V158,V127,V852,E934

{'Atrophic gastritis, with hemorrhage,Acute on chronic systolic heart failure,Mitral valve disorders,Diseases of tricuspid valve,Other severe protein-calorie malnutrition,Acute kidney failure with lesion of tubular necrosis,Cardiogenic shock,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Ulcer of other part of lower limb,Cachexia,Atrial fibrillation,Benign neoplasm of colon,Pure hypercholesterolemia,Chronic kidney disease, Stage III (moderate),Diverticulosis of colon (without mention of hemorrhage),Thrombocytopenia, unspecified,Unspecified cataract,Other specified disorders of stomach and duodenum,Hypovolemia,Cirrhosis of liver without mention of alcohol,Venous (peripheral) insufficiency, unspecified,Heart valve replaced by transplant,Do not resuscitate status,Cardiac pacemaker in situ,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of colonic polyps,Body Mass Index 25.0-25.9, adult,Anticoagulants 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: Melena PRESENT ILLNESS: Mr. [**Known lastname **] is an 81 y/o gentleman with CHF (EF 45%), porcine AV replacement, severe MR/TR, AFib, pacemaker, diverticulosis s/p bleed [**2171**], who was transferred from [**Hospital **] Hospital to [**Hospital1 18**] yesterday ([**4-13**]) due to melena. MEDICAL HISTORY: Hypercholesterolemia CHF (EF 45% on [**2172-4-14**]) Atrial fibrillation (previously on coumadin until [**2171-5-12**]) GI bleed [**5-/2171**] with 6 unit transfusion d/t Diverticulosis Decubitus ulcer Anemia - baseline hct 28-30 Pacemaker [**2-/2170**] Dr. [**Last Name (STitle) 4455**] Diverticulosis Hemorrhoids Hepatic cysts Obesity Colonic adenoma Prostate cancer Cataract Acute on chronic renal insufficency - baseline Cr 1.6 Gout MEDICATION ON ADMISSION: Home Medications: ALBUTEROL SULFATE 90 mcg HFA Aerosol Inhaler 2 puffs inh prn ALLOPURINOL 300 mg Tablet daily FLUTICASONE-SALMETEROL [ADVAIR DISKUS] 250 mcg-50 mcg/Dose Disk ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: VS: Tm98.2 Tc97.6 BP 89/64 (87-94/58-72) HR 90 RR 18 O2 sat 94% FAMILY HISTORY: Non contributory. SOCIAL HISTORY: Most recently has been staying at [**Hospital 5682**] Nursing Home, prior to [**Month (only) **] lived at home w/ wife. Pt is a retired court officer security guard. Pt last smoked in the 60s (20-30 pack years), and occasionally smokes a cigar. The patient w/ h/o drinking moderate to heavily, with > 8 drinks per week. ### Response: {'Atrophic gastritis, with hemorrhage,Acute on chronic systolic heart failure,Mitral valve disorders,Diseases of tricuspid valve,Other severe protein-calorie malnutrition,Acute kidney failure with lesion of tubular necrosis,Cardiogenic shock,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Ulcer of other part of lower limb,Cachexia,Atrial fibrillation,Benign neoplasm of colon,Pure hypercholesterolemia,Chronic kidney disease, Stage III (moderate),Diverticulosis of colon (without mention of hemorrhage),Thrombocytopenia, unspecified,Unspecified cataract,Other specified disorders of stomach and duodenum,Hypovolemia,Cirrhosis of liver without mention of alcohol,Venous (peripheral) insufficiency, unspecified,Heart valve replaced by transplant,Do not resuscitate status,Cardiac pacemaker in situ,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of colonic polyps,Body Mass Index 25.0-25.9, adult,Anticoagulants causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Transfer from OSH for management airway in the setting of of progressive cervical LAD PRESENT ILLNESS: 51 year old female with h/o thyroid CA s/p thyroidectomy and head and neck CA with a 6 week history of progressive cervical lymphadenopathy. She reports 6 weeks of left ear pain and left submandibular lymphadenopathy. Initially this was treated as otitis 3 courses of antibiotics, the last course accompanied by a prednisone taper (within 3 weeks of biopsy). There was some improvement in ear pain with each course, but the lymphadenopathy progressed. Last Wednesday she had a lymph node biopsy and left myringotomy and tube insertion by Dr. [**Last Name (STitle) 73708**] in [**Hospital3 **]. Since the operation she has had worsening pain in the back of her throat, dysphagia, and dyspnea. She presented to [**Hospital3 **] ER the night prior to transfer here with dyspnea which was treated and improved with decadron and ceftriaxone. A CT of the neck was also obtained at [**Hospital3 **] which showed a 2.5 x 2.0 mass within the base of the tongue posteriorly on the right and numerous necrotic lymph nodes and opacified bilateral mastoid air cells. She was then transferred to [**Hospital1 18**] for further evaluation. . In the ED, she was seen by ENT, who performed fiberoptic laryngoscopy revealing whitish masses in the nasopharynx and at the base of the tongue, and no supra-glottic edema. Heme-Onc also consulted in ED, who contact[**Name (NI) **] OSH for preliminary results of OSH Ln Bx which were non-diagnostic. MEDICAL HISTORY: # Thyroid cancer s/p total tyroidectomy ([**2165**]). # Lymphocytic Interstitial Pneumonitis (dx by VATS bx, followed by Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 410**] at [**Hospital1 2025**]) treated with steroids in past and continues on azathioprine. # Normal mammograms, no colonoscopy. # negative HIV test in [**2170**] MEDICATION ON ADMISSION: # Azathioprine 50mg daily # Levoxyl 175mcg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 96.9F HR 71 BP 113/58 RR 24 97% 10L shovel mask General: Middle aged woman in NAD HEENT: PERRL, EOMI, telangectasias on cheeks, small tube in left ear, right TM intact, non erythematous, OP with diffuse soft tissue swelling but no erythema. Lymph Nodes: left submandibular surgical incision, diffuse congruent hard, somewhat tender lymphadenopathy in submandibular region extending across mandible to parotid region. No superclavicular, axillary LAD; 1 shoddy node in right inguinal region. Chest: No stridor. Lungs with scattered inspiratory crackles, not cleared with coughing. Cardiac: RRR no m/r/g, 2+ pulses in all extremities ABD: +BS, NTND, no HSM Ext: no e/c/c Neuro: AAOx3, 5/5 strength FAMILY HISTORY: Uncle with [**Name2 (NI) 499**] cancer. No other cancers. Extensive cardiac history. SOCIAL HISTORY: Moved to [**Hospital3 **] ~6 years ago, where she lives with wife [**Name (NI) **] [**Name (NI) 73709**] ([**Telephone/Fax (1) 73710**]). Has two grown children who live in [**Location (un) 73711**]. Smoker until 2 weeks ago; ~20pk-years. EtOH 6-12 beers per week, + occassional wine and liquour. +DUI, no blackouts, no prior withdrawl. Last drink was ~3 weeks ago. Denies recreational/IV drug use.

Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified alveolar and parietoalveolar pneumonopathies,Intestinal infection due to Clostridium difficile,Other postoperative infection,Cellulitis and abscess of trunk,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use

Oth lymp unsp xtrndl org,Alveol pneumonopathy NEC,Int inf clstrdium dfcile,Other postop infection,Cellulitis of trunk,Hx of thyroid malignancy,Postsurgical hypothyroid,Pancreatic disorder NEC,Adv eff corticosteroids

Admission Date: [**2173-7-7**] Discharge Date: [**2173-7-20**] Date of Birth: [**2121-9-20**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3326**] Chief Complaint: Transfer from OSH for management airway in the setting of of progressive cervical LAD Major Surgical or Invasive Procedure: 1. fine needle aspiration of cervical lymph node 2. tracheostomy 3. excisional biopsy of cervical lymph node History of Present Illness: 51 year old female with h/o thyroid CA s/p thyroidectomy and head and neck CA with a 6 week history of progressive cervical lymphadenopathy. She reports 6 weeks of left ear pain and left submandibular lymphadenopathy. Initially this was treated as otitis 3 courses of antibiotics, the last course accompanied by a prednisone taper (within 3 weeks of biopsy). There was some improvement in ear pain with each course, but the lymphadenopathy progressed. Last Wednesday she had a lymph node biopsy and left myringotomy and tube insertion by Dr. [**Last Name (STitle) 73708**] in [**Hospital3 **]. Since the operation she has had worsening pain in the back of her throat, dysphagia, and dyspnea. She presented to [**Hospital3 **] ER the night prior to transfer here with dyspnea which was treated and improved with decadron and ceftriaxone. A CT of the neck was also obtained at [**Hospital3 **] which showed a 2.5 x 2.0 mass within the base of the tongue posteriorly on the right and numerous necrotic lymph nodes and opacified bilateral mastoid air cells. She was then transferred to [**Hospital1 18**] for further evaluation. . In the ED, she was seen by ENT, who performed fiberoptic laryngoscopy revealing whitish masses in the nasopharynx and at the base of the tongue, and no supra-glottic edema. Heme-Onc also consulted in ED, who contact[**Name (NI) **] OSH for preliminary results of OSH Ln Bx which were non-diagnostic. Past Medical History: # Thyroid cancer s/p total tyroidectomy ([**2165**]). # Lymphocytic Interstitial Pneumonitis (dx by VATS bx, followed by Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 410**] at [**Hospital1 2025**]) treated with steroids in past and continues on azathioprine. # Normal mammograms, no colonoscopy. # negative HIV test in [**2170**] Social History: Moved to [**Hospital3 **] ~6 years ago, where she lives with wife [**Name (NI) **] [**Name (NI) 73709**] ([**Telephone/Fax (1) 73710**]). Has two grown children who live in [**Location (un) 73711**]. Smoker until 2 weeks ago; ~20pk-years. EtOH 6-12 beers per week, + occassional wine and liquour. +DUI, no blackouts, no prior withdrawl. Last drink was ~3 weeks ago. Denies recreational/IV drug use. Family History: Uncle with [**Name2 (NI) 499**] cancer. No other cancers. Extensive cardiac history. Physical Exam: VS: 96.9F HR 71 BP 113/58 RR 24 97% 10L shovel mask General: Middle aged woman in NAD HEENT: PERRL, EOMI, telangectasias on cheeks, small tube in left ear, right TM intact, non erythematous, OP with diffuse soft tissue swelling but no erythema. Lymph Nodes: left submandibular surgical incision, diffuse congruent hard, somewhat tender lymphadenopathy in submandibular region extending across mandible to parotid region. No superclavicular, axillary LAD; 1 shoddy node in right inguinal region. Chest: No stridor. Lungs with scattered inspiratory crackles, not cleared with coughing. Cardiac: RRR no m/r/g, 2+ pulses in all extremities ABD: +BS, NTND, no HSM Ext: no e/c/c Neuro: AAOx3, 5/5 strength Pertinent Results: ADMISSION LABS: [**2173-7-7**] WBC-15.0 HGB-12.7 HCT-36.3 MCV-87 MCH-30.4 PLT COUNT-363 NEUTS-94.3 BANDS-0 LYMPHS-4.7 MONOS-0.8 EOS-0.1 BASOS-0.1 [**2173-7-7**] GLUCOSE-130* UREA N-9 CREAT-0.6 SODIUM-140 POTASSIUM-4.7 CHLORIDE-101 TOTAL CO2-29 [**2173-7-7**] CALCIUM-9.4 PHOSPHATE-4.6 MAGNESIUM-2.1 URIC ACID-2.3 LDH-245 . [**7-7**] CT CHEST: 1. 5-mm noncalficied left lower lobe nodule may be post-inflammatory or could presumably represent a solitary metastasis. Followup in a minimum of three months is recommended. . 2. Small right pleural effusion with associated mild pleural thickening suggests exudate or subacute/chronic duration. . 3. Calcified right pleural plaque may reflect previous asbestosis exposure, previous complex effusion, or pleurodesis. . . [**7-7**] CT NECK: Large ill-defined mass at the base of the tongue extending into the right lingual tonsil and obliterating the right vallecula. Multiple large enhancing and necrotic lymph nodes. Findings are concerning for malignancy with metastatic spread, likely squamous cell in origin. Lymphoma would be less likely given the necrotic appearance of the lymph nodes. . Fiberoptic laryngoscopy by ENT: White obstructing mass in nasopharynx, base of tongue/lateral pharyngeal walls with mass effect and narrowing, moderate secretions with pooling, no supra-glottic edema, mild R true vocal cord paresis, airway patent no masses, piriform sinuses clear . 7/26 L submandibular LN biopsy/ L nasal pharynx incisional biopsy: Involvement by B-cell Non-Hodgkin lymphoma, best classified as diffuse large B-cell type . [**7-12**] CT ABD/PELVIS for staging: No abdominal or pelvic lymphadenopathy. A few scattered small subcentimeter retroperitoneal and mesenteric lymph nodes are however noted. . [**7-12**] ECHO: EF > 55%.Normal global and regional biventricular systolic function. Mild pulmonary hypertension. Brief Hospital Course: Brief Hospital Course by Problem: . # Large B cell lymphoma: She presented with cervical lymphadenopathy, biopsy here revealed large B cell lymphoma. She underwent tracheostomy on [**7-8**] for airway protection. She also had a bone marrow biopsy for staging on [**7-13**], report was still pending on discharge. She was transferred to the MICU for close observation and continuous O2 monitoring s/p trach placement. She began CHOP therapy while still in the MICU, which she tolerated well. She was transferred back to the floor for completion of CHOP cycle. No complications. Her trach was capped on [**7-19**] and she was observed overnight in the MICU with no events and O2 sats stable. Trach was decannulated on [**7-20**] just prior to discharge. . # Clostridium difficile: Her hospital course was complicated by infection with clostridium difficile. She was treated with a course of metronidazole. . # Lymphocytic interstitial pneumonitis: --Her LIP had been well-controlled with azathioprine until early [**Month (only) **] when she developed a new infiltrate in her R middle and lower lobes, per outpatient pulmonologist Dr. [**Last Name (STitle) **]. Azathioprine was held during chemo with the thought that the chemo should control her LIP as well. Plan was to re-assess re-starting azathioprine after chemo was completed. . # Thyroid cancer s/p thyroidectomy: -- continued thyroid replacement. . # Elevated Glucose: Pt is without history of diabetes but did have elevated serum glucose on this admission. Likely secondary to steroid use. She was covered with sliding scale insulin. . # CODE: She was full code for this admission . Medications on Admission: # Azathioprine 50mg daily # Levoxyl 175mcg daily Discharge Medications: 1. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*20 Tablet(s)* Refills:*0* 2. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 4 days. Disp:*12 Tablet(s)* Refills:*0* 3. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane QID (4 times a day). Disp:*120 Troche(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: . Primary: Large B cell Non-Hodgkin's Lymphoma, s/p cycle CHOP . Other: Clostridium difficile Cellulitis around surgical incision (resolved) Lymphocytic Interstitial Pneumonitis Thyroid cancer, s/p thytoidectomy . Discharge Condition: . Stable without airway compromise s/p trach decannulation. . Discharge Instructions: . You were tranferred to [**Hospital1 18**] for neck mass and were found to have Large B Cell Non Hodgkin's Lymphoma. You underwent tracheostomy placement prior to chemotherapy for airway protection. Oncology evaluated you and you underwent CHOP chemotherapy which you tolerated well. Your tracheostomy was decannulated prior to discharge. . Please be sure to discuss with your pulmonologist and oncologist the reinitiation of your azathioprine upon discharge as this is important for your Lymphocytic Interstitial Pneumonitis. . Please be sure to complete your full course of antibiotics for C. difficile infection (4 days left). . As outlined to you by ENT, be sure to avoid water in stoma while it is still open. You can change your dressing as needed. Please be sure to follow up with Dr. [**Last Name (STitle) 73712**] as below. . Call your doctor or return to the emergency department if you have any trouble breathing, bleeding from your stoma, fevers, chills, cough productive of sputum or any other symptoms that concern you. . Followup Instructions: . Please follow up with Dr. [**Last Name (STitle) **] on Thursday, [**7-22**] at 12pm. . Please also follow up with ENT [**Doctor Last Name 1837**] [**Telephone/Fax (1) 7732**], on [**8-3**] at 12:45pm. If changes are made to this appointment, his office will contact you. .

202,516,008,998,682,V108,244,251,E932

{'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified alveolar and parietoalveolar pneumonopathies,Intestinal infection due to Clostridium difficile,Other postoperative infection,Cellulitis and abscess of trunk,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids 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: Transfer from OSH for management airway in the setting of of progressive cervical LAD PRESENT ILLNESS: 51 year old female with h/o thyroid CA s/p thyroidectomy and head and neck CA with a 6 week history of progressive cervical lymphadenopathy. She reports 6 weeks of left ear pain and left submandibular lymphadenopathy. Initially this was treated as otitis 3 courses of antibiotics, the last course accompanied by a prednisone taper (within 3 weeks of biopsy). There was some improvement in ear pain with each course, but the lymphadenopathy progressed. Last Wednesday she had a lymph node biopsy and left myringotomy and tube insertion by Dr. [**Last Name (STitle) 73708**] in [**Hospital3 **]. Since the operation she has had worsening pain in the back of her throat, dysphagia, and dyspnea. She presented to [**Hospital3 **] ER the night prior to transfer here with dyspnea which was treated and improved with decadron and ceftriaxone. A CT of the neck was also obtained at [**Hospital3 **] which showed a 2.5 x 2.0 mass within the base of the tongue posteriorly on the right and numerous necrotic lymph nodes and opacified bilateral mastoid air cells. She was then transferred to [**Hospital1 18**] for further evaluation. . In the ED, she was seen by ENT, who performed fiberoptic laryngoscopy revealing whitish masses in the nasopharynx and at the base of the tongue, and no supra-glottic edema. Heme-Onc also consulted in ED, who contact[**Name (NI) **] OSH for preliminary results of OSH Ln Bx which were non-diagnostic. MEDICAL HISTORY: # Thyroid cancer s/p total tyroidectomy ([**2165**]). # Lymphocytic Interstitial Pneumonitis (dx by VATS bx, followed by Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 410**] at [**Hospital1 2025**]) treated with steroids in past and continues on azathioprine. # Normal mammograms, no colonoscopy. # negative HIV test in [**2170**] MEDICATION ON ADMISSION: # Azathioprine 50mg daily # Levoxyl 175mcg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 96.9F HR 71 BP 113/58 RR 24 97% 10L shovel mask General: Middle aged woman in NAD HEENT: PERRL, EOMI, telangectasias on cheeks, small tube in left ear, right TM intact, non erythematous, OP with diffuse soft tissue swelling but no erythema. Lymph Nodes: left submandibular surgical incision, diffuse congruent hard, somewhat tender lymphadenopathy in submandibular region extending across mandible to parotid region. No superclavicular, axillary LAD; 1 shoddy node in right inguinal region. Chest: No stridor. Lungs with scattered inspiratory crackles, not cleared with coughing. Cardiac: RRR no m/r/g, 2+ pulses in all extremities ABD: +BS, NTND, no HSM Ext: no e/c/c Neuro: AAOx3, 5/5 strength FAMILY HISTORY: Uncle with [**Name2 (NI) 499**] cancer. No other cancers. Extensive cardiac history. SOCIAL HISTORY: Moved to [**Hospital3 **] ~6 years ago, where she lives with wife [**Name (NI) **] [**Name (NI) 73709**] ([**Telephone/Fax (1) 73710**]). Has two grown children who live in [**Location (un) 73711**]. Smoker until 2 weeks ago; ~20pk-years. EtOH 6-12 beers per week, + occassional wine and liquour. +DUI, no blackouts, no prior withdrawl. Last drink was ~3 weeks ago. Denies recreational/IV drug use. ### Response: {'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified alveolar and parietoalveolar pneumonopathies,Intestinal infection due to Clostridium difficile,Other postoperative infection,Cellulitis and abscess of trunk,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: Mr [**Known lastname **] is a 22M w SCZ x1 year, stable on clozapine, who now p/w AMS. . Per MICU admission note, pt was in his USOH until the day of admission, when at 4am he experienced insomnia [**2-27**] racing thoughts. He called his mother and told her that he has not taken his meds since moving to [**Location (un) 86**] 2-3 days ago. She told him to take his usual nighttime meds-- clozapine 200mg and sertraline. He called her back at 4:30am and informed her that he took 7 clozapine 100mg tabs in an attempt to "stop the racing thoughts". His mother called poison control who recommended calling EMS. . Per mother, pt took overdose of clonopin (9 tabs) about one year ago for similar reason. Also has history of [**4-29**] psych hospitalizations, at least one for suicidal ideation. . In the ED, was persistently tachy to 120-140s. BP remained stable. Satting well on RA. Was agitated, mumbling, slurring speech. EKG with slightly prolonged QTc, concern for TCA toxicity, however no change with amp of bicarb x 2. Serum and urine tox negative. Admitted to MICU for close monitoring. . Toxicology consult thought findings were consistent with clozapine OD, recommended serial EKGs, supportive care and benzos for agitation. Pt had a reported episode of priapism, which resolved without intervention. Pt remained tachycardic in the 112-139 range x 24 hours, mental status improved. . On transfer to the medicine floor, pt reports continued "racing thoughts" and feeling tired. Denies F/C, CP/SOB, abd pain, N/V/D or urinary sxs. Denies hearing voices or suicidal ideation. MEDICAL HISTORY: -Schizophrenia- hospitalized 4-5 times, was being followed by Dr. [**Last Name (STitle) 82193**] ([**Location (un) 82194**], ME [**Telephone/Fax (1) 82195**]), CSI counseling service ([**Telephone/Fax (1) 82196**]) -Anxiety MEDICATION ON ADMISSION: Clozaril 100mg qAM, 200mg qPM Zoloft (unclear dose) ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: T: 96.1, BP: 131/69, P: 137, R: 14, O2: 99% on RA General: alternating between somnolence and agitation with any provocation, non-verbal, mumbling occasionally, moving all extremities HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Grandmother with anxiety. Maternal uncles with depression. Paternal grandmother also with psychiatric problems SOCIAL HISTORY: Recently moved from [**State 1727**] to [**Location (un) 86**] to start college. Smoking: occasional (last cigarette 1 month ago) EtOH: social (3-5 drinks/day 2-3x per week) Drugs: h/o marijuana in the past

Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Altered mental status,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other specified cardiac dysrhythmias,Unspecified schizophrenia, unspecified,Anxiety state, unspecified,Tobacco use disorder

Poison-antipsychotic NEC,Altered mental status,Poison-psychotropic agt,Cardiac dysrhythmias NEC,Schizophrenia NOS-unspec,Anxiety state NOS,Tobacco use disorder

Admission Date: [**2108-6-4**] Discharge Date: [**2108-6-7**] Date of Birth: [**2086-5-3**] Sex: M Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 9415**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: none History of Present Illness: Mr [**Known lastname **] is a 22M w SCZ x1 year, stable on clozapine, who now p/w AMS. . Per MICU admission note, pt was in his USOH until the day of admission, when at 4am he experienced insomnia [**2-27**] racing thoughts. He called his mother and told her that he has not taken his meds since moving to [**Location (un) 86**] 2-3 days ago. She told him to take his usual nighttime meds-- clozapine 200mg and sertraline. He called her back at 4:30am and informed her that he took 7 clozapine 100mg tabs in an attempt to "stop the racing thoughts". His mother called poison control who recommended calling EMS. . Per mother, pt took overdose of clonopin (9 tabs) about one year ago for similar reason. Also has history of [**4-29**] psych hospitalizations, at least one for suicidal ideation. . In the ED, was persistently tachy to 120-140s. BP remained stable. Satting well on RA. Was agitated, mumbling, slurring speech. EKG with slightly prolonged QTc, concern for TCA toxicity, however no change with amp of bicarb x 2. Serum and urine tox negative. Admitted to MICU for close monitoring. . Toxicology consult thought findings were consistent with clozapine OD, recommended serial EKGs, supportive care and benzos for agitation. Pt had a reported episode of priapism, which resolved without intervention. Pt remained tachycardic in the 112-139 range x 24 hours, mental status improved. . On transfer to the medicine floor, pt reports continued "racing thoughts" and feeling tired. Denies F/C, CP/SOB, abd pain, N/V/D or urinary sxs. Denies hearing voices or suicidal ideation. Past Medical History: -Schizophrenia- hospitalized 4-5 times, was being followed by Dr. [**Last Name (STitle) 82193**] ([**Location (un) 82194**], ME [**Telephone/Fax (1) 82195**]), CSI counseling service ([**Telephone/Fax (1) 82196**]) -Anxiety Social History: Recently moved from [**State 1727**] to [**Location (un) 86**] to start college. Smoking: occasional (last cigarette 1 month ago) EtOH: social (3-5 drinks/day 2-3x per week) Drugs: h/o marijuana in the past Family History: Grandmother with anxiety. Maternal uncles with depression. Paternal grandmother also with psychiatric problems Physical Exam: Vitals: T: 96.1, BP: 131/69, P: 137, R: 14, O2: 99% on RA General: alternating between somnolence and agitation with any provocation, non-verbal, mumbling occasionally, moving all extremities HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: LABS: [**2108-6-4**] 05:50AM BLOOD WBC-9.3 RBC-4.89 Hgb-14.3 Hct-41.1 MCV-84 MCH-29.3 MCHC-34.8 RDW-13.7 Plt Ct-271 [**2108-6-4**] 05:50AM BLOOD Neuts-54.2 Lymphs-35.3 Monos-6.2 Eos-3.7 Baso-0.5 [**2108-6-4**] 05:50AM BLOOD Glucose-149* UreaN-15 Creat-1.0 Na-136 K-5.0 Cl-101 HCO3-26 AnGap-14 [**2108-6-5**] 05:32AM BLOOD ALT-22 AST-22 CK(CPK)-179* AlkPhos-121* TotBili-0.3 [**2108-6-5**] 05:32AM BLOOD TSH-1.9 . TOX: [**2108-6-4**] 05:50AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2108-6-4**] 06:25AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG . URINE: [**2108-6-4**] 06:25AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.023 [**2108-6-4**] 06:25AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR [**2108-6-4**] 06:25AM URINE RBC-0.2 WBC-[**3-29**] Bacteri-FEW Yeast-NONE Epi-0 . CARDIOLOGY: [**6-4**] - EKG: Sinus tachycardia. Normal tracing except for the rate. No previous tracing available for comparison. Intervals Axes Rate PR QRS QT/QTc P QRS T 105 140 110 348/426 64 68 46 . [**6-6**] - EKG: Normal sinus rhythm. No ST/TW changes. QTc wnl. . RADIOLOGY: CXR ([**6-4**]): IMPRESSION: Within normal limits. Brief Hospital Course: In short, Mr [**Known lastname **] is a 22M w SCZ on clozapine, who p/w AMS [**2-27**] clozapine overdose. . # CLOZAPINE OVERDOSE: Clinical picture was consistent with atypical antipsychotic medication toxidrome: anti-alpha1-adrenergic effects (sinus tachycardia 110s-130s), anti-histaminic effects (sedation), anti-cholinergic effects (confusion, flushing, dry mouth). Also mild prolongation in QTc on admission. No electrolyte abnormalities. Tox screens negative. Pt received supportive care and was monitored in the CCU in the first 24 hrs. He was seen by toxicology and psychiatry. Pt denies suicidal ideation, acknowledges that he should not have taken more than the prescribed number of clozapine pills. He is discharged with his mother present on his prior home regimen with outpatient followup with his psychiatrist in [**State 1727**]. Follow-up appointments in [**State 350**] pending insurance paperwork (BEST referral for psychiatry, [**Company 191**] appointment for primary care). Contracted for safety. . # ERECTION: Reported to have a 2-3 hour episode of erection in the ED, which could have been [**2-27**] clozapine (case reports of associated priapism). Urology consulted, recommended conservative measures. Erection resolved. . # SCHIZOPHRENIA: Pt currently denies positive sxs. Seen by psychiatry. Restarted on clozapine 100qam, 200qpm. Needs outpatient followup. . # CONTACT: mother [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 82197**] (home) in [**State 1727**] Medications on Admission: Clozaril 100mg qAM, 200mg qPM Zoloft (unclear dose) Discharge Medications: 1. Clozapine 100 mg Tablet Sig: Two (2) Tablet PO at bedtime. 2. Zoloft 100 mg Tablet Sig: One (1) Tablet PO once a day. 3. Clozapine 100 mg Tablet Sig: One (1) Tablet PO qam. Discharge Disposition: Home Discharge Diagnosis: clozapine overdose . schizophrenia anxiety Discharge Condition: improved, alert, oriented x3, hemodynamically stable Discharge Instructions: You were admitted to the hospital for taking too much of your clozapine. We monitored you for possible toxic side-effects and provided supportive care. Your condition has now improved. . Please take your medications as directed in the future. 1. clozapine 100mg in the morning, 200mg in the evening 2. sertraline 100mg in the morning . If you have any fevers, chills, shortness of breath, chest pain, palpitations, confusion, dizziness, lightheadedness, abdominal pain, or any other concerning symptoms, please call your physician [**Name Initial (PRE) 2227**]. Followup Instructions: Please call [**Hospital3 **] at [**Hospital1 18**] for primary care appointment within a week of your discharge: [**Telephone/Fax (1) 250**]. . You were given extensive information regarding BEST referral for psychiatry followup in [**Location (un) 86**]. Until an appointment can be made, please follow up with your psychiatrist in [**State 1727**]: Dr. [**Last Name (STitle) 82193**] ([**Location (un) 82194**], ME [**Telephone/Fax (1) 82195**]). Completed by:[**2108-6-7**]

969,780,E950,427,295,300,305

{'Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Altered mental status,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other specified cardiac dysrhythmias,Unspecified schizophrenia, unspecified,Anxiety state, 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: altered mental status PRESENT ILLNESS: Mr [**Known lastname **] is a 22M w SCZ x1 year, stable on clozapine, who now p/w AMS. . Per MICU admission note, pt was in his USOH until the day of admission, when at 4am he experienced insomnia [**2-27**] racing thoughts. He called his mother and told her that he has not taken his meds since moving to [**Location (un) 86**] 2-3 days ago. She told him to take his usual nighttime meds-- clozapine 200mg and sertraline. He called her back at 4:30am and informed her that he took 7 clozapine 100mg tabs in an attempt to "stop the racing thoughts". His mother called poison control who recommended calling EMS. . Per mother, pt took overdose of clonopin (9 tabs) about one year ago for similar reason. Also has history of [**4-29**] psych hospitalizations, at least one for suicidal ideation. . In the ED, was persistently tachy to 120-140s. BP remained stable. Satting well on RA. Was agitated, mumbling, slurring speech. EKG with slightly prolonged QTc, concern for TCA toxicity, however no change with amp of bicarb x 2. Serum and urine tox negative. Admitted to MICU for close monitoring. . Toxicology consult thought findings were consistent with clozapine OD, recommended serial EKGs, supportive care and benzos for agitation. Pt had a reported episode of priapism, which resolved without intervention. Pt remained tachycardic in the 112-139 range x 24 hours, mental status improved. . On transfer to the medicine floor, pt reports continued "racing thoughts" and feeling tired. Denies F/C, CP/SOB, abd pain, N/V/D or urinary sxs. Denies hearing voices or suicidal ideation. MEDICAL HISTORY: -Schizophrenia- hospitalized 4-5 times, was being followed by Dr. [**Last Name (STitle) 82193**] ([**Location (un) 82194**], ME [**Telephone/Fax (1) 82195**]), CSI counseling service ([**Telephone/Fax (1) 82196**]) -Anxiety MEDICATION ON ADMISSION: Clozaril 100mg qAM, 200mg qPM Zoloft (unclear dose) ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: T: 96.1, BP: 131/69, P: 137, R: 14, O2: 99% on RA General: alternating between somnolence and agitation with any provocation, non-verbal, mumbling occasionally, moving all extremities HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Grandmother with anxiety. Maternal uncles with depression. Paternal grandmother also with psychiatric problems SOCIAL HISTORY: Recently moved from [**State 1727**] to [**Location (un) 86**] to start college. Smoking: occasional (last cigarette 1 month ago) EtOH: social (3-5 drinks/day 2-3x per week) Drugs: h/o marijuana in the past ### Response: {'Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Altered mental status,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other specified cardiac dysrhythmias,Unspecified schizophrenia, unspecified,Anxiety state, unspecified,Tobacco use disorder'}

CHIEF COMPLAINT: Syncope after Dialysis PRESENT ILLNESS: Ms. [**Known lastname 22437**] is a 84 year-old female with a history of diabetes and ESRD on dialysis who presented with syncope post-dialysis. MEDICAL HISTORY: 1. End-stage renal disease, dialysis T, Th, Sat 2. Diabetes mellitus 3. Hypertension 4. s/p hip fracture with surgical repair ([**2172**]); currently bed-bound 5. G-tube feeds x6 months 6. s/p colostomy for perforated bowel, thought to be secondary to diverticulitis 7. Chronic foley 8. Seizure disorder, in the setting of renal failure. No recent seizures. 9. Back pain 10. Bed sore MEDICATION ON ADMISSION: 1. Ambien 5mg daily 2. Sucralfate 1gram QID 3. Vitamin C 500mg [**Hospital1 **] 4. Keppra 500mg [**Hospital1 **] 5. Lantus 24 units daily 6. Hydroxyzine 25mg [**Hospital1 **] PRN 7. Hydralazine 10mg Q8H PRN 8. Nystatin [**Hospital1 **] 9. Triamcinolone topical 10. Tylenol 650mg Q4H 11. Metoprolol 50mg [**Hospital1 **] 12. Procel oral powder [**Hospital1 **] 13. Omeprazole 20mg [**Hospital1 **] 14. Remeron 15mg daily 15. Renax daily 16. Oxycodone 5mg Q4H PRN 17. Warfarin 1.5mg QHS ALLERGIES: Cephalosporins / Macrodantin / Sulfa (Sulfonamides) / Penicillins PHYSICAL EXAM: vitals - T96.8, HR 67, BP 113/46, RR 20, 100% on 2 liters. gen - Awake and alert. Oriented to person, "[**Hospital3 **]" and "[**2176-8-30**]". Occasionally grimaces with pain. heent - Anicteric. No palor. cv - Regular. Distant heart sounds. pulm - Clear anteriorly. abd - Soft. G-tube and colostomy in place. Non-tender. ext - Warm. Trace to 1+ edema. FAMILY HISTORY: Non-Contributory SOCIAL HISTORY: Lives with husband and son. Bed-bound since hip fracture. Has health aid assistance at home.

Unspecified septicemia,End stage renal disease,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Sepsis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled

Septicemia NOS,End stage renal disease,Urin tract infection NOS,React-oth vasc dev/graft,Hyp kid NOS w cr kid V,Pleural effusion NOS,Hyposmolality,Pressure ulcer, low back,Protein-cal malnutr NOS,Sepsis,Pseudomonas infect NOS,Abn react-renal dialysis,Accident in place NOS,Epilep NOS w/o intr epil,DMII wo cmp uncntrld

Admission Date: [**2175-9-29**] Discharge Date: [**2175-10-10**] Service: MEDICINE Allergies: Cephalosporins / Macrodantin / Sulfa (Sulfonamides) / Penicillins Attending:[**First Name3 (LF) 1162**] Chief Complaint: Syncope after Dialysis Major Surgical or Invasive Procedure: new tunneled catheter placement History of Present Illness: Ms. [**Known lastname 22437**] is a 84 year-old female with a history of diabetes and ESRD on dialysis who presented with syncope post-dialysis. Patient reported that she was at dialysis and completed her session but does not remember any further details. She denied head trauma or prior episodes of syncope as well as fevers, chills, rigors, chest pain or shortness of breath. She was transferred to [**Hospital1 18**] where her blood pressures were in the 90s systolic. Labs showed an elevated alk phos, troponin I of 0.07 with a CK of 23. WBC was 15.6 with 84% neutrophils. INR of 4.6 Given ativan 0.5mg IV, dilaudid 0.5mg IV and 250cc of NS. In the ED, noted to be 101.0 rectally. BPs were noted to be as low as 88/41. One liter of NS was given with improvement to the 90s and low 100s. Given levaquin 750mg IV and vancomycin 1gram IV; for pain, given 1mg IV morphine. . Upon arriving to to the ICU patient complained of back pain. She denied any nausea/vomiting, chest pains, or shortness of breath. Past Medical History: 1. End-stage renal disease, dialysis T, Th, Sat 2. Diabetes mellitus 3. Hypertension 4. s/p hip fracture with surgical repair ([**2172**]); currently bed-bound 5. G-tube feeds x6 months 6. s/p colostomy for perforated bowel, thought to be secondary to diverticulitis 7. Chronic foley 8. Seizure disorder, in the setting of renal failure. No recent seizures. 9. Back pain 10. Bed sore Social History: Lives with husband and son. Bed-bound since hip fracture. Has health aid assistance at home. Family History: Non-Contributory Physical Exam: vitals - T96.8, HR 67, BP 113/46, RR 20, 100% on 2 liters. gen - Awake and alert. Oriented to person, "[**Hospital3 **]" and "[**2176-8-30**]". Occasionally grimaces with pain. heent - Anicteric. No palor. cv - Regular. Distant heart sounds. pulm - Clear anteriorly. abd - Soft. G-tube and colostomy in place. Non-tender. ext - Warm. Trace to 1+ edema. Pertinent Results: [**2175-9-28**] 11:40PM WBC-11.7* RBC-3.75* HGB-10.3* HCT-33.4* MCV-89 MCH-27.5 MCHC-30.8* RDW-17.1* [**2175-9-28**] 11:40PM ALT(SGPT)-38 AST(SGOT)-34 CK(CPK)-15* ALK PHOS-625* AMYLASE-31 TOT BILI-0.4 [**2175-9-28**] 11:40PM GLUCOSE-149* UREA N-49* CREAT-1.6* SODIUM-139 POTASSIUM-4.1 CHLORIDE-99 TOTAL CO2-29 ANION GAP-15 [**2175-9-29**] 06:10AM cTropnT-0.18* [**2175-9-29**] 06:10AM CK(CPK)-15* [**2175-9-29**] 12:53PM WBC-14.3* RBC-3.63* HGB-9.7* HCT-32.4* MCV-89 MCH-26.6* MCHC-29.8* RDW-16.1* [**2175-9-29**] 12:53PM ALBUMIN-2.5* CALCIUM-9.3 PHOSPHATE-3.0 MAGNESIUM-2.1 [**2175-9-29**] 12:53PM GLUCOSE-88 UREA N-61* CREAT-2.0* SODIUM-130* POTASSIUM-4.5 CHLORIDE-95* TOTAL CO2-24 ANION GAP-16 [**2175-9-29**] 12:53PM ALT(SGPT)-42* AST(SGOT)-43* ALK PHOS-580* TOT BILI-0.4 Urine cx: URINE CULTURE (Final [**2175-10-3**]): MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH FECAL CONTAMINATION. PSEUDOMONAS AERUGINOSA. >100,000 ORGANISMS/ML.. PREDOMINATING ORGANISM. INTERPRET RESULTS WITH CAUTION. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PSEUDOMONAS AERUGINOSA | CEFEPIME-------------- 8 S CEFTAZIDIME----------- 4 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ 4 S IMIPENEM-------------- <=1 S MEROPENEM------------- 0.5 S PIPERACILLIN---------- 8 S PIPERACILLIN/TAZO----- 8 S TOBRAMYCIN------------ <=1 S WOUND CULTURE (Final [**2175-10-8**]): Due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for Pseudomonas aeruginosa, Staphylococcus aureus and beta streptococcus). [**Female First Name (un) **] ALBICANS, PRESUMPTIVE IDENTIFICATION. MODERATE GROWTH. STAPH AUREUS COAG +. SPARSE 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 PENICILLIN------------ =>0.5 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- 2 S TRIMETHOPRIM/SULFA---- <=0.5 S VANCOMYCIN------------ <=1 S Brief Hospital Course: 1. Syncope: Likely in the setting of low BP after dialysis. Pt was persistently hypotensive early in hospitalization. She was found to have both a pseudomonas UTI and an infected dialysis line, either or both of which could have caused sepsis leading to hypotension. Her anti-hypertensives were initially held and her beta blocker has been added back to her regimen as of discharge. She will need to follow up with her PCP regarding [**Name9 (PRE) 35455**] titration of her meds. 2. Sepsis: Pt with fevers and hypotension early in hospital course. Found to have pseudomonas UTI and also infected dialysis line with [**Female First Name (un) **] and MRSA cultured from drained exuded from insertion site. Sensitivities listed above. She is to receive a total 14 day course of both meropenem and vancomycin to be administered after HD with her last dose on [**10-17**]. The patient's prior HD cath was removed and a new line was placed 48 hour later by our interventional radiology group. Subsequent cultures have been NGTD. 3. ESRD: Dialysis T/Th/Sat, last dialysis at [**Hospital1 18**] was on [**10-10**]. 4. Pseudomonas UTI: Sensitive to Meropenem which was used given penicillin and cephalosporin allergies, and resistance of organism to quinolones. She will receive meropenem for 14 days. 5. Diabetes: Lantus regimen from home caused marked hypoglycemia, her most recent Lantus dose is 8 units at bed time with a RISS. Her BG on this regimen and with her tube feeds has been well controlled. 6. Seizure d/o: Continued Keppra. 7. Anticoagulation: On warfarin for DVT treatment, this has been held until below therapuetic level so that new dialysis line could be placed. This will need to be restarted on discharge with close follow up. 8. Hemodialysis line infection: [**Female First Name (un) 564**] and MSSA cx'd from discharge exuding from insertion site. Line pulled from RIG on [**2175-10-7**] and new tunnelled line placed by IR on [**10-9**]. ---Code: DNR/DNI Medications on Admission: 1. Ambien 5mg daily 2. Sucralfate 1gram QID 3. Vitamin C 500mg [**Hospital1 **] 4. Keppra 500mg [**Hospital1 **] 5. Lantus 24 units daily 6. Hydroxyzine 25mg [**Hospital1 **] PRN 7. Hydralazine 10mg Q8H PRN 8. Nystatin [**Hospital1 **] 9. Triamcinolone topical 10. Tylenol 650mg Q4H 11. Metoprolol 50mg [**Hospital1 **] 12. Procel oral powder [**Hospital1 **] 13. Omeprazole 20mg [**Hospital1 **] 14. Remeron 15mg daily 15. Renax daily 16. Oxycodone 5mg Q4H PRN 17. Warfarin 1.5mg QHS Discharge Medications: 1. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 2. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 4. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2* 6. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 7. Meropenem 500 mg Recon Soln Sig: One (1) Recon Soln Intravenous after hemodialysis: Last dose to be given on [**10-17**]. 8. Vancomycin 1000 mg IV AT HEMODIALYSIS 9. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 11. Lopressor 50 mg Tablet Sig: One (1) Tablet PO twice a day. 12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 13. RENAX 35-2.5-70-20 unit-mg-mcg-mg Tablet Sig: One (1) Tablet PO once a day. 14. Lantus 100 unit/mL Solution Sig: One (1) Subcutaneous at bedtime: 8 units SC qhs. 15. med Continue with regular insulin sliding scale and checking BG qAC, qHS. Please see attached sheet for sliding scale. 16. Insulin Syringe 0.3 mL 28 x 1 Syringe Sig: One (1) Miscellaneous four times a day. Disp:*30 1 box* Refills:*6* 17. Lancets Regular Misc Sig: One (1) Miscellaneous four times a day. Disp:*60 1 box* Refills:*2* 18. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection four times a day: Per sliding scale. Disp:*1 1 bottle* Refills:*6* 19. Warfarin to be restarted by PCP as outpatient. Discharge Disposition: Home With Service Facility: [**Hospital3 3765**] Home Care Discharge Diagnosis: UTI hypotension ESRD on HD dialysis line infection Discharge Condition: stable Discharge Instructions: You were admitted with hypotension and found to have low blood glucose and a urinary tract infection. Later in the hospital it was seen that your dialysis line was infected and so it was removed and a new line placed. You should call your PCP or return to the ER if you develop fevers, chills, nausea, vomiting or any new symptoms. You should continue your tube feeds at the previous rate. Patient has 24 hour established care already. Followup Instructions: You will need to follow up with Dr. [**Last Name (STitle) 9063**] from nephrology at [**Telephone/Fax (1) 75785**] ([**Hospital3 3765**]) as well as your PCP, [**Name10 (NameIs) **] [**Last Name (STitle) **] in [**Location (un) 11269**] at [**Telephone/Fax (1) 33980**]. Please make an appointment for next week. You will also need to continue antibiotics with hemodialysis (Th,Th,Sat) to receive a total 14 day course. Your last dose of antibiotics should be administered on [**10-17**]. You will need to have your INR drawn on [**10-11**] with results sent to your PCP.

038,585,599,996,403,511,276,707,263,995,041,E879,E849,345,250

{'Unspecified septicemia,End stage renal disease,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Sepsis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, 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: Syncope after Dialysis PRESENT ILLNESS: Ms. [**Known lastname 22437**] is a 84 year-old female with a history of diabetes and ESRD on dialysis who presented with syncope post-dialysis. MEDICAL HISTORY: 1. End-stage renal disease, dialysis T, Th, Sat 2. Diabetes mellitus 3. Hypertension 4. s/p hip fracture with surgical repair ([**2172**]); currently bed-bound 5. G-tube feeds x6 months 6. s/p colostomy for perforated bowel, thought to be secondary to diverticulitis 7. Chronic foley 8. Seizure disorder, in the setting of renal failure. No recent seizures. 9. Back pain 10. Bed sore MEDICATION ON ADMISSION: 1. Ambien 5mg daily 2. Sucralfate 1gram QID 3. Vitamin C 500mg [**Hospital1 **] 4. Keppra 500mg [**Hospital1 **] 5. Lantus 24 units daily 6. Hydroxyzine 25mg [**Hospital1 **] PRN 7. Hydralazine 10mg Q8H PRN 8. Nystatin [**Hospital1 **] 9. Triamcinolone topical 10. Tylenol 650mg Q4H 11. Metoprolol 50mg [**Hospital1 **] 12. Procel oral powder [**Hospital1 **] 13. Omeprazole 20mg [**Hospital1 **] 14. Remeron 15mg daily 15. Renax daily 16. Oxycodone 5mg Q4H PRN 17. Warfarin 1.5mg QHS ALLERGIES: Cephalosporins / Macrodantin / Sulfa (Sulfonamides) / Penicillins PHYSICAL EXAM: vitals - T96.8, HR 67, BP 113/46, RR 20, 100% on 2 liters. gen - Awake and alert. Oriented to person, "[**Hospital3 **]" and "[**2176-8-30**]". Occasionally grimaces with pain. heent - Anicteric. No palor. cv - Regular. Distant heart sounds. pulm - Clear anteriorly. abd - Soft. G-tube and colostomy in place. Non-tender. ext - Warm. Trace to 1+ edema. FAMILY HISTORY: Non-Contributory SOCIAL HISTORY: Lives with husband and son. Bed-bound since hip fracture. Has health aid assistance at home. ### Response: {'Unspecified septicemia,End stage renal disease,Urinary tract infection, site not specified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Unspecified protein-calorie malnutrition,Sepsis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}

CHIEF COMPLAINT: S/P VFib arrest PRESENT ILLNESS: 87 y/o F with PMH significant for CAD s/p CABG ([**2129**]), HTN,HL, afib (on coumadin and dofetilide initially) presents from the MICU for increasing Cr (ARF) and supratherapeutic INR. Pt. initially p/w a [**1-9**] day headache to the ED triage where she went into V-fib arrest. Her SBP was in the 200s. She was defibrillated 200 J once, went into a junctional rhythm for 1 minute and then into sinus rhythm. She did not require chest compressions. She was intubated without sedation but was started on propofol shortly afterwards dur to agitation. Head CT was done which showed no acute intracranial process and neurology ruled out seizures and cooling was not needed. . Post-defib EKGs with normal sinus rhythm was neg for ischemia and echo was nl. She was given 2g Mg and cardiology thought her v-fib was a primary arrythmatic event [**1-8**] dofetilide rather than ischemia. Also, she continued to be hypertensive w/ SBPs in the 200s post arrest on 80mcg of propofol with other notable lab values being K 5.3, INR 3.6, Lactate 5.0. She was then transfered to the MICU on ventilation with the settings: 100% 400 x 18 PEEP 5. . In the MICU, her hypertension w/ SPB 200s persisted so was started on nipride gtt which dropped SBP to 40-50s hence propofol and nipride gtt was stopped. She was bolused 1L and SBP rose to >190-200. She was then placed on nimodipine and then switched to her home hypertensives: valsartan 80 mg [**Hospital1 **], Amlodipine 10 mg QD, metoprolol 25mg [**Hospital1 **] and maintained at SBP goal of 140s. . In the MICU, she was given IV Mg 1g Q6H and transitioned to amiodarone and plavix for her afib. Her course complicated by MSSA VAP with lots of respiratory distress for which she got nafcillin/vanc/cefepime, improved and was extubated and placed on Bipap for 2 days. She was made DNR/DNI (daughter is health care proxy). Respiratory distress improved with abx and was weaned from Bipap to breathing room air. . On arrival to the floor pt. has been afebrile, breathing 100% on 4L O2, comfortable. Denies fevers/chills/night sweats, SOB/chest pain, nausea/vomiting, diarrhea/constipation/melena/hematochezia, dysuria, headache, fatigue, myalgias, light-headedness. MEDICAL HISTORY: HTN HLD CAD s/p PCI in [**2129**] with stents to [**Female First Name (un) **] and x3 to RCA AF on coumadin Anemia MEDICATION ON ADMISSION: 1. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) ALLERGIES: Ace Inhibitors PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Tmax: 37.1 ??????C (98.7 ??????F) Tcurrent: 36.8 ??????C (98.2 ??????F) HR: 67 (51 - 67) bpm BP: 178/63(98) {178/63(-6) - 202/80(114)} mmHg RR: 18 (15 - 19) insp/min SpO2: 100% Heart rhythm: SR (Sinus Rhythm) O2 Delivery Device: Endotracheal tube Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 (400 - 400) mL RR (Set): 18 RR (Spontaneous): 0 PEEP: 5 cmH2O FiO2: 100% . Physical Examination: General: Intubated, sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: PEERLA, unresponsive while sedated, withdraws to pain FAMILY HISTORY: Maternal: mother- Cardiac disease, sister-breast cancer at 87yrs SOCIAL HISTORY: Pt. lives alone in [**Location (un) 86**] and her boyfriend/companion lives next door. Daughter lives in [**Location 3146**] and is very involved with her care. However, daughter reports pt. is very indepedent. Although pt. moved to the US from [**Country 532**] 20 years ago, pt speaks very little English- has been trying to learn. Denies EtOH and tobacco, illicits.

Ventricular fibrillation,Toxic encephalopathy,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Ventilator associated pneumonia,Hyperosmolality and/or hypernatremia,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Headache,Other alteration of consciousness,Abnormal coagulation profile,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Hematuria, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other sedatives and hypnotics causing adverse effects in therapeutic use

Ventricular fibrillation,Toxic encephalopathy,Acute respiratry failure,Ac kidny fail, tubr necr,Ventltr assoc pneumonia,Hyperosmolality,Adv eff card rhyth regul,Hypertension NOS,Mth sus Stph aur els/NOS,Hyperlipidemia NEC/NOS,Headache,Other alter consciousnes,Abnrml coagultion prfile,Crnry athrscl natve vssl,Status-post ptca,Long-term use anticoagul,Hematuria NOS,Adv eff benzodiaz tranq,Abn react-procedure NEC,Adv eff sedat/hypnot NEC

Admission Date: [**2138-5-3**] Discharge Date: [**2138-5-14**] Service: MEDICINE Allergies: Ace Inhibitors Attending:[**First Name3 (LF) 783**] Chief Complaint: S/P VFib arrest Major Surgical or Invasive Procedure: Intubation, Central Line Insertion History of Present Illness: 87 y/o F with PMH significant for CAD s/p CABG ([**2129**]), HTN,HL, afib (on coumadin and dofetilide initially) presents from the MICU for increasing Cr (ARF) and supratherapeutic INR. Pt. initially p/w a [**1-9**] day headache to the ED triage where she went into V-fib arrest. Her SBP was in the 200s. She was defibrillated 200 J once, went into a junctional rhythm for 1 minute and then into sinus rhythm. She did not require chest compressions. She was intubated without sedation but was started on propofol shortly afterwards dur to agitation. Head CT was done which showed no acute intracranial process and neurology ruled out seizures and cooling was not needed. . Post-defib EKGs with normal sinus rhythm was neg for ischemia and echo was nl. She was given 2g Mg and cardiology thought her v-fib was a primary arrythmatic event [**1-8**] dofetilide rather than ischemia. Also, she continued to be hypertensive w/ SBPs in the 200s post arrest on 80mcg of propofol with other notable lab values being K 5.3, INR 3.6, Lactate 5.0. She was then transfered to the MICU on ventilation with the settings: 100% 400 x 18 PEEP 5. . In the MICU, her hypertension w/ SPB 200s persisted so was started on nipride gtt which dropped SBP to 40-50s hence propofol and nipride gtt was stopped. She was bolused 1L and SBP rose to >190-200. She was then placed on nimodipine and then switched to her home hypertensives: valsartan 80 mg [**Hospital1 **], Amlodipine 10 mg QD, metoprolol 25mg [**Hospital1 **] and maintained at SBP goal of 140s. . In the MICU, she was given IV Mg 1g Q6H and transitioned to amiodarone and plavix for her afib. Her course complicated by MSSA VAP with lots of respiratory distress for which she got nafcillin/vanc/cefepime, improved and was extubated and placed on Bipap for 2 days. She was made DNR/DNI (daughter is health care proxy). Respiratory distress improved with abx and was weaned from Bipap to breathing room air. . On arrival to the floor pt. has been afebrile, breathing 100% on 4L O2, comfortable. Denies fevers/chills/night sweats, SOB/chest pain, nausea/vomiting, diarrhea/constipation/melena/hematochezia, dysuria, headache, fatigue, myalgias, light-headedness. Past Medical History: HTN HLD CAD s/p PCI in [**2129**] with stents to [**Female First Name (un) **] and x3 to RCA AF on coumadin Anemia Social History: Pt. lives alone in [**Location (un) 86**] and her boyfriend/companion lives next door. Daughter lives in [**Location 3146**] and is very involved with her care. However, daughter reports pt. is very indepedent. Although pt. moved to the US from [**Country 532**] 20 years ago, pt speaks very little English- has been trying to learn. Denies EtOH and tobacco, illicits. Family History: Maternal: mother- Cardiac disease, sister-breast cancer at 87yrs Paternal: father-died at World war 2 Children: Son died of pancreatic cancer at 55yrs 10 years ago. Physical Exam: ADMISSION PHYSICAL EXAM: Tmax: 37.1 ??????C (98.7 ??????F) Tcurrent: 36.8 ??????C (98.2 ??????F) HR: 67 (51 - 67) bpm BP: 178/63(98) {178/63(-6) - 202/80(114)} mmHg RR: 18 (15 - 19) insp/min SpO2: 100% Heart rhythm: SR (Sinus Rhythm) O2 Delivery Device: Endotracheal tube Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 (400 - 400) mL RR (Set): 18 RR (Spontaneous): 0 PEEP: 5 cmH2O FiO2: 100% . Physical Examination: General: Intubated, sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: PEERLA, unresponsive while sedated, withdraws to pain DISCHARGE PHYSICAL EXAM: Vitals: Tm:98.4, Tc:98.2, HR:81 (60-80), BP:144/60(140-160/60-70), RR:18, O2 sat:94% on RA GEN: Comfortable in bed, NAD, alert and oriented HEENT: Atraumatic, normocephalic, No scleral icterus, MMM, oropharynx clear NECK: no thyromegaly, no tenderness CV: Regular rate and nl rhythm, nl S1/S2, no murmurs, gallops/Rubs, PULM: CTAB, non-labored breathing, no crackles/ronchi/wheezes ABD:Soft, +BS, non-tender, non-distended, no rebound, guarding EXT: Warm and well perfused, 2+ peripheral pulses, no edema or cyanosis NEURO: With Russian interpreter: Alert and oriented to self/place/date, could name days of the week forward, months of the year backwards,CN II-[**Doctor First Name 81**] grossly intact, 5/5 strength bilaterally UE and LE. Pertinent Results: [**2138-5-3**] 10:00PM URINE COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.020 [**2138-5-3**] 10:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-NEG [**2138-5-3**] 10:00PM URINE RBC-4* WBC-1 BACTERIA-FEW YEAST-NONE EPI-0 [**2138-5-3**] 10:00PM URINE AMORPH-RARE [**2138-5-3**] 10:00PM URINE MUCOUS-OCC [**2138-5-3**] 09:20PM TYPE-ART TEMP-36.8 RATES-18/0 TIDAL VOL-400 PEEP-5 O2-100 PO2-296* PCO2-35 PH-7.39 TOTAL CO2-22 BASE XS--2 AADO2-402 REQ O2-68 -ASSIST/CON INTUBATED-INTUBATED [**2138-5-3**] 09:20PM LACTATE-1.3 [**2138-5-3**] 06:57PM GLUCOSE-140* UREA N-22* CREAT-1.3* SODIUM-137 POTASSIUM-5.0 CHLORIDE-100 TOTAL CO2-24 ANION GAP-18 [**2138-5-3**] 06:57PM CK(CPK)-106 [**2138-5-3**] 06:57PM CK-MB-4 cTropnT-0.02* [**2138-5-3**] 06:57PM CALCIUM-9.2 PHOSPHATE-3.3# MAGNESIUM-2.6 [**2138-5-3**] 03:22PM TYPE-ART TEMP-38.0 TIDAL VOL-400 O2-100 PO2-95 PCO2-47* PH-7.29* TOTAL CO2-24 BASE XS--3 AADO2-591 REQ O2-94 -ASSIST/CON INTUBATED-INTUBATED [**2138-5-3**] 02:19PM GLUCOSE-122* LACTATE-5.0* NA+-138 K+-5.0 CL--99* TCO2-22 [**2138-5-3**] 02:15PM GLUCOSE-125* UREA N-22* CREAT-1.3* SODIUM-136 POTASSIUM-5.3* CHLORIDE-100 TOTAL CO2-22 ANION GAP-19 [**2138-5-3**] 02:15PM estGFR-Using this [**2138-5-3**] 02:15PM CK(CPK)-88 [**2138-5-3**] 02:15PM CK-MB-3 cTropnT-<0.01 [**2138-5-3**] 02:15PM WBC-16.2* RBC-4.60# HGB-13.5# HCT-40.0# MCV-87 MCH-29.4 MCHC-33.8 RDW-13.3 [**2138-5-3**] 02:15PM NEUTS-44.2* LYMPHS-50.9* MONOS-3.4 EOS-0.7 BASOS-0.8 [**2138-5-3**] 02:15PM PLT COUNT-278 [**2138-5-3**] 02:15PM PT-36.0* PTT-28.8 INR(PT)-3.6* [**2138-5-3**] 02:20AM URINE HOURS-RANDOM [**2138-5-3**] 02:20AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2138-5-3**] 02:20AM URINE COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.010 [**2138-5-3**] 02:20AM URINE RBC-4* WBC-4 BACTERIA-MOD YEAST-NONE EPI-0 [**2138-5-3**] 02:20AM URINE AMORPH-M [**2138-5-3**] 02:20AM URINE MUCOUS-RARE [**2138-5-13**] 05:38AM BLOOD WBC-7.5 RBC-3.43* Hgb-10.3* Hct-30.4* MCV-89 MCH-30.1 MCHC-34.0 RDW-14.3 Plt Ct-352 [**2138-5-10**] 04:18AM BLOOD WBC-9.3 RBC-3.70* Hgb-11.2* Hct-32.2* MCV-87 MCH-30.2 MCHC-34.7 RDW-13.7 Plt Ct-296 [**2138-5-9**] 02:42AM BLOOD WBC-10.1 RBC-3.33* Hgb-10.1* Hct-28.8* MCV-87 MCH-30.3 MCHC-35.1* RDW-13.4 Plt Ct-258 [**2138-5-6**] 03:20AM BLOOD WBC-15.1* RBC-3.04* Hgb-9.2* Hct-27.0* MCV-89 MCH-30.4 MCHC-34.3 RDW-13.3 Plt Ct-198 [**2138-5-8**] 03:22AM BLOOD WBC-11.8* RBC-3.19* Hgb-9.8* Hct-27.8* MCV-87 MCH-30.7 MCHC-35.1* RDW-13.3 Plt Ct-239 [**2138-5-7**] 04:21AM BLOOD Neuts-76.1* Lymphs-17.2* Monos-5.3 Eos-1.0 Baso-0.4 [**2138-5-10**] 04:18AM BLOOD PT-61.7* PTT-38.7* INR(PT)-6.8* [**2138-5-10**] 04:18AM BLOOD Plt Ct-296 [**2138-5-10**] 01:52PM BLOOD PT-46.5* PTT-40.6* INR(PT)-4.9* [**2138-5-11**] 05:15AM BLOOD PT-23.2* PTT-30.7 INR(PT)-2.2* [**2138-5-11**] 05:15AM BLOOD Plt Ct-330 [**2138-5-12**] 05:59AM BLOOD PT-16.2* PTT-28.3 INR(PT)-1.4* [**2138-5-12**] 05:59AM BLOOD Plt Ct-335 [**2138-5-3**] 02:15PM BLOOD Glucose-125* UreaN-22* Creat-1.3* Na-136 K-5.3* Cl-100 HCO3-22 AnGap-19 [**2138-5-4**] 03:40AM BLOOD Glucose-168* UreaN-20 Creat-1.0 Na-136 K-3.4 Cl-99 HCO3-28 AnGap-12 [**2138-5-6**] 03:20AM BLOOD Glucose-122* UreaN-22* Creat-1.3* Na-137 K-4.3 Cl-101 HCO3-26 AnGap-14 [**2138-5-7**] 04:21AM BLOOD Glucose-104* UreaN-38* Creat-1.9* Na-139 K-3.9 Cl-103 HCO3-23 AnGap-17 [**2138-5-8**] 04:15PM BLOOD UreaN-48* Creat-1.8* Na-137 K-3.2* Cl-99 HCO3-27 AnGap-14 [**2138-5-9**] 05:35PM BLOOD Glucose-135* UreaN-53* Creat-2.4* Na-141 K-3.7 Cl-101 HCO3-29 AnGap-15 [**2138-5-10**] 04:18AM BLOOD Glucose-81 UreaN-49* Creat-2.6* Na-140 K-3.3 Cl-98 HCO3-28 AnGap-17 [**2138-5-10**] 01:52PM BLOOD Glucose-166* UreaN-47* Creat-2.4* Na-138 K-3.8 Cl-99 HCO3-25 AnGap-18 [**2138-5-11**] 05:15AM BLOOD Glucose-105* UreaN-42* Creat-2.3* Na-140 K-3.6 Cl-99 HCO3-26 AnGap-19 [**2138-5-13**] 05:38AM BLOOD Glucose-120* UreaN-29* Creat-2.3* Na-140 K-4.1 Cl-102 HCO3-25 AnGap-17 [**2138-5-8**] 04:15PM BLOOD Phos-2.8 Mg-2.3 [**2138-5-9**] 05:35PM BLOOD Calcium-8.3* Phos-2.6* Mg-2.2 [**2138-5-10**] 01:52PM BLOOD Calcium-8.8 Phos-2.5* Mg-2.0 [**2138-5-11**] 05:15AM BLOOD Calcium-8.0* Phos-2.2* Mg-1.9 [**2138-5-12**] 05:59AM BLOOD Calcium-8.2* Phos-2.9 Mg-2.2 [**2138-5-13**] 05:38AM BLOOD Calcium-8.2* Phos-3.6 Mg-2.1 Brief Hospital Course: #. VENTRICULAR FIBRILLATION ARREST: Initially presented with a [**1-9**] day headache to the ED triage where she went into ventricular fibrillation arrest. Her SBP was in the 200s. Was defibrillated 200 J once, went into a junctional rhythm for one minute and then into sinus rhythm without chest compressions. Was intubated without sedation but was started on propofol shortly afterwards due to agitation. Head CT was done which showed no acute intracranial process and neurology ruled out seizures and cooling was not needed. Post-defib EKGs with normal sinus rhythm was negative for ischemia and echocardiogram was normal. She was given 2g Magnesium and cardiology thought her ventricular fibrillation arrest was a primary arrythmatic event (prolonged QTc) secondary to dofetilide rather than ischemia. An electrophysiology consultation was obtained, resulting in the decision to initiate amiodarone. No focus was found on electrophysiology study and she did not arrest on the floor over the course of her hospitalization. She will follow up with her outpatient cardiologist in [**Month (only) 205**]. . #. HYPOXEMIA/RESPIRATORY FAILURE: Her MICU course complicated by methicillin sensitive staph aureus (confirmed by sputum cultures) ventilator associated pneumonia with lots of respiratory distress for which she started on nafcillin/vancomycin/cefepime. Her respiratory status improved, was extubated and placed on Bipap for 2 days, weaned off and sent to the general medical floor ([**2138-5-10**]). She was made DNR/DNI (daughter is health care proxy). On the floor, her respiratory status continued to improve with oxygyen (for a day) until she breathing room air with normal lung exam for the rest of the hospital course. Etiology was thought to be pulmonary edema and peumonia. Her sputum cultures have grown MSSA. She was initiated on cefepime and vancomycin for healthcare associated pneumonia, which was narrowed to nafcillin after her sputum grew MSSA. Initially, she was intubated for respiratory support. She was subsequently transitioned to non-invasive ventilation and later to high flow shovel mask and nasal cannula. She completed an 8 day course of antibiotics for her pneumonia. She was afebrile and on room air at the time of discharge. . #.ACUTE KIDNEY INJURY : Her [**Last Name (un) **] was thought to be due to hypoperfusion. She did not have evidence of ATN or AIN. Her urine showed hyaline casts but no wbc or rbc. FEUrea on [**5-8**] was 24%. Her urine eosinophils were negative. Her Creatinine improved to baseline of [**1-8**].3 at discharge from the MICU. On the floor, her Cr. was stable in the 2s and on discharge, it was 1.9. . #.ATRIAL FIBRILLATION: Her dofetilide was discontinued since it can precipitate ventricular fibrillation. She was started on amiodarone (initially IV then changed to PO) and was maintained in sinus rhythm. Her INR initially was supratherapeutic with a peak of 6.8 likely secondary to nutritional deficiency. She received oral vitamin K. She was then restarted on coumadin and had an INR of 1.5 at discharge. She was not bridged with heparin because her CHADS2 score is 2. Her goal INR is [**1-9**]. . #.ALTERED MENTAL STATUS DUE TO TOXIC/METABOLIC ENCEPHALOPATHY: She became slightly sedated after benzodiazepime and narcotic administration, but this resolved after 24 hours without any intervention. On the floor, she was observed to be confused as the night progressed and likely sun-downs at night as observed by nurses. She has no known history of dementia and sun-downing is likely from old age. Per her outpatient pyschiatrist, Dr. [**Last Name (STitle) 29696**], she has a history of visual hallucinations at night with confusion which is resolved with Olanzapine 2.5mg QHS. Her hallucinations and confusion at night was better with psychiatrist recommendation. At discharge, she continued to be alert and interactive and back to her baseline per family. She has been asked to follow-up with her psychiatrist if this continues to be a problem. . #.CORONARY ARTERY DISEASE: No signs of active ischemia. Continued statin, beta blocker. Investigate why on Plavix. . #HYPERTENSION: On admission, patient was very hypertensive with SBP > 200. Because she was bardycardic, there was initial concern for ruptured aneurysm/subarachnoid bleed,; however, head CT, head CTA, and MRI were all negative. Patient was initially maintained on a nicardipine drip, which was weaned off once SBPs reached 140-160. She was then restarted on amlodipine and labetalol was started as well with adequate blood pressure control. On the floor BPs continue to be stable with some fluctuations to 180 SBPs. Her metoprolol was changed to Labetolol 200mg TID and then Labetolol 400mg [**Hospital1 **] on discharge to keep the BP within goal of <140 SBP. . Medications on Admission: 1. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 3. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. dofetilide 250 mcg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 5. Calcium 600 with Vitamin D3 600 mg(1,500mg) -200 unit Tablet Sig: One (1) Tablet PO twice a day. 6. amlodipine 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. valsartan 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Centrum 0.4-162-18 mg Tablet Oral 10. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO once a day as needed for anxiety. 11. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. famotidine 40 mg Tablet Sig: One (1) Tablet PO at bedtime. 13. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. Calcium 500 500 mg (1,250 mg) Tablet Sig: One (1) Tablet PO three times a day. 15. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO three times a day as needed for dizziness. 16. citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Discharge Medications: x 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 6. labetalol 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 8. olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for anxiety, visual hallucinations. 9. warfarin 1 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 PM. 10. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO once a day. 12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO once a day as needed for constipation. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - [**Location (un) 550**] Discharge Diagnosis: Ventricular Fibrillation Arrest Pneumonia Acute kidney injury 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 were seen in the hospital for a cardiac arrest. Your heart returned to a normal rhythm after a shock. You were evaluated by cardiology. Your arrhythmia medication was changed. An outpatient cardiology appointment was made for you. You were continued on your coumadin although your level will need to be closely monitored. . You were also treated for a pneumonia and had to be intubated to help with your breathing. You were treating with antibiotics (Naficillin) for 8 days to treat the pneumonia which helped your breathing. . Over the hospital course, your blood pressure also went high with systolic blood pressures in the 200 (goal blood pressure is systolic <140). Your blood pressure medications were changed and your blood pressure control improved. . You were also noticed to be more confused with visual hallucinations in the late evenings with some difficulty to sleep at night. We talked to your outpatient psychiatrist, Dr. [**Last Name (STitle) 29696**], who confirmed a history of visual hallucinations in the past which is controlled with zyprexa just before bed so we resumed that medication. . We made the following changes to your medications: STOPPED Dofetilide STOPPED Valsartan STOPPED Metoprolol STARTED Amoidarone STARTED Amlodipine STARTED Labetolol Followup Instructions: Please follow up with the following providers: . EYE DOCTOR Dr. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], [**Telephone/Fax (1) 253**] at [**Hospital3 **] Center in the SC [**Hospital Ward Name 23**] Clinical Ctr, [**Location (un) **], [**Hospital Ward Name 516**] on TUESDAY [**2138-10-7**] at 10:30 AM . CARDIOLOGY Dr. [**Last Name (STitle) 29697**] at [**Hospital6 **] on Tuesday, [**2138-6-10**] at 4pm. . RADIOLOGY Radiology Department, [**Telephone/Fax (1) 327**] on, MONDAY [**2138-10-20**] at 1:15 PM in the SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 861**], [**Hospital Ward Name 516**]. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

427,349,518,584,997,276,E942,401,041,272,784,780,790,414,V458,V586,599,E939,E879,E937

{'Ventricular fibrillation,Toxic encephalopathy,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Ventilator associated pneumonia,Hyperosmolality and/or hypernatremia,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Headache,Other alteration of consciousness,Abnormal coagulation profile,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Hematuria, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other sedatives and hypnotics 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: S/P VFib arrest PRESENT ILLNESS: 87 y/o F with PMH significant for CAD s/p CABG ([**2129**]), HTN,HL, afib (on coumadin and dofetilide initially) presents from the MICU for increasing Cr (ARF) and supratherapeutic INR. Pt. initially p/w a [**1-9**] day headache to the ED triage where she went into V-fib arrest. Her SBP was in the 200s. She was defibrillated 200 J once, went into a junctional rhythm for 1 minute and then into sinus rhythm. She did not require chest compressions. She was intubated without sedation but was started on propofol shortly afterwards dur to agitation. Head CT was done which showed no acute intracranial process and neurology ruled out seizures and cooling was not needed. . Post-defib EKGs with normal sinus rhythm was neg for ischemia and echo was nl. She was given 2g Mg and cardiology thought her v-fib was a primary arrythmatic event [**1-8**] dofetilide rather than ischemia. Also, she continued to be hypertensive w/ SBPs in the 200s post arrest on 80mcg of propofol with other notable lab values being K 5.3, INR 3.6, Lactate 5.0. She was then transfered to the MICU on ventilation with the settings: 100% 400 x 18 PEEP 5. . In the MICU, her hypertension w/ SPB 200s persisted so was started on nipride gtt which dropped SBP to 40-50s hence propofol and nipride gtt was stopped. She was bolused 1L and SBP rose to >190-200. She was then placed on nimodipine and then switched to her home hypertensives: valsartan 80 mg [**Hospital1 **], Amlodipine 10 mg QD, metoprolol 25mg [**Hospital1 **] and maintained at SBP goal of 140s. . In the MICU, she was given IV Mg 1g Q6H and transitioned to amiodarone and plavix for her afib. Her course complicated by MSSA VAP with lots of respiratory distress for which she got nafcillin/vanc/cefepime, improved and was extubated and placed on Bipap for 2 days. She was made DNR/DNI (daughter is health care proxy). Respiratory distress improved with abx and was weaned from Bipap to breathing room air. . On arrival to the floor pt. has been afebrile, breathing 100% on 4L O2, comfortable. Denies fevers/chills/night sweats, SOB/chest pain, nausea/vomiting, diarrhea/constipation/melena/hematochezia, dysuria, headache, fatigue, myalgias, light-headedness. MEDICAL HISTORY: HTN HLD CAD s/p PCI in [**2129**] with stents to [**Female First Name (un) **] and x3 to RCA AF on coumadin Anemia MEDICATION ON ADMISSION: 1. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) ALLERGIES: Ace Inhibitors PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Tmax: 37.1 ??????C (98.7 ??????F) Tcurrent: 36.8 ??????C (98.2 ??????F) HR: 67 (51 - 67) bpm BP: 178/63(98) {178/63(-6) - 202/80(114)} mmHg RR: 18 (15 - 19) insp/min SpO2: 100% Heart rhythm: SR (Sinus Rhythm) O2 Delivery Device: Endotracheal tube Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 (400 - 400) mL RR (Set): 18 RR (Spontaneous): 0 PEEP: 5 cmH2O FiO2: 100% . Physical Examination: General: Intubated, sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: PEERLA, unresponsive while sedated, withdraws to pain FAMILY HISTORY: Maternal: mother- Cardiac disease, sister-breast cancer at 87yrs SOCIAL HISTORY: Pt. lives alone in [**Location (un) 86**] and her boyfriend/companion lives next door. Daughter lives in [**Location 3146**] and is very involved with her care. However, daughter reports pt. is very indepedent. Although pt. moved to the US from [**Country 532**] 20 years ago, pt speaks very little English- has been trying to learn. Denies EtOH and tobacco, illicits. ### Response: {'Ventricular fibrillation,Toxic encephalopathy,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Ventilator associated pneumonia,Hyperosmolality and/or hypernatremia,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Headache,Other alteration of consciousness,Abnormal coagulation profile,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Hematuria, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other sedatives and hypnotics causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: complete heart block PRESENT ILLNESS: Pt is a 72 yo woman with a history of CAD (s/p PCI [**2198-12-6**]), diastolic dysfunction, ESRD on HD, DM and a pancreatic mass who originally presented to [**Hospital3 3583**] ([**2199-1-2**]) s/p a fall c/o lightheadedness of several days duration. On the day of admission, Pt describes feeling dizzy and then falling to the ground without LOC or head trauma but with a right humeral head fracture. At [**Hospital3 **], ROS was negative for CP/SOB, F/C/S, dysarthria/visual changes, N/V/D. Pt reports no recent medication changes and has taken all as prescribed. Upon arrival to [**Hospital3 3583**], ECG was significant for a reported 2' AV block-Mobitz II, however; most likely was actually a 2' AV block-Mobitz I (Wenckebach). Subsequently external pcaer pads placed and nodal agents held. Pt hemodynamically stable. Exact course unclear, but a temporary pacer wire was placed last evening. This AM, Pt reportedly found to be in CHB with pacer not capturing. SBP subsequently decreased to 80's with bradycardia to the 20's. Atropine given and external pacers replaced. For airway protection, Pt was electively intubated. Lastly pacer wire was repositioned until it was sucessful in capturing. Pt transfered to [**Hospital1 18**] for further management and evaluation for permanent pacemaker. MEDICAL HISTORY: chronic renal failure - has HD every Mon/Wed/Friday CHF CAD, s/p PCI to LAD/RCA ([**2198-12-5**]) DM2 hypothyroidism s/p thyroidectomy neuropathy pancreatic lesion with planned distal pancreatectomy in [**Month (only) **]. cholecystectomy legally blind MEDICATION ON ADMISSION: ASA 325 Plavix 75 renagel 1600 TID Clonidine 0.1 qAM Accupril 40 qAM Diovan 160 qAM Synthroid 150 mcg Phos-lo 667 [**Hospital1 **] Ativan 0.5 TID Zoloft 50 NPH 10 qAM, 5 qHS ALLERGIES: Codeine / Elavil PHYSICAL EXAM: VS: 99.0, 133/46, 80 V-paced Vent: PSV 15/5, 0.50, rr 14, VT 320, 99% FAMILY HISTORY: Sister with CAD. Father deceased [**3-12**] MI. Extensive DM FHx. SOCIAL HISTORY: Lives w/ Husband and has 10 children. No tobacco, EtOH, drug abuse.

Mobitz (type) II atrioventricular block,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Pneumonia, organism unspecified,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Postsurgical hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Closed fracture of surgical neck of humerus,Unspecified fall

Atrioven block-mobitz ii,Hyp kid NOS w cr kid V,Chr diastolic hrt fail,Pneumonia, organism NOS,Mitral valve disorder,Tricuspid valve disease,Crnry athrscl natve vssl,Status-post ptca,Postsurgical hypothyroid,DMII wo cmp nt st uncntr,Fx surg nck humerus-clos,Fall NOS

Admission Date: [**2199-1-3**] Discharge Date: [**2199-1-9**] Date of Birth: [**2126-7-7**] Sex: F Service: MEDICINE Allergies: Codeine / Elavil Attending:[**First Name3 (LF) 106**] Chief Complaint: complete heart block Major Surgical or Invasive Procedure: temporary pacer intubation History of Present Illness: Pt is a 72 yo woman with a history of CAD (s/p PCI [**2198-12-6**]), diastolic dysfunction, ESRD on HD, DM and a pancreatic mass who originally presented to [**Hospital3 3583**] ([**2199-1-2**]) s/p a fall c/o lightheadedness of several days duration. On the day of admission, Pt describes feeling dizzy and then falling to the ground without LOC or head trauma but with a right humeral head fracture. At [**Hospital3 **], ROS was negative for CP/SOB, F/C/S, dysarthria/visual changes, N/V/D. Pt reports no recent medication changes and has taken all as prescribed. Upon arrival to [**Hospital3 3583**], ECG was significant for a reported 2' AV block-Mobitz II, however; most likely was actually a 2' AV block-Mobitz I (Wenckebach). Subsequently external pcaer pads placed and nodal agents held. Pt hemodynamically stable. Exact course unclear, but a temporary pacer wire was placed last evening. This AM, Pt reportedly found to be in CHB with pacer not capturing. SBP subsequently decreased to 80's with bradycardia to the 20's. Atropine given and external pacers replaced. For airway protection, Pt was electively intubated. Lastly pacer wire was repositioned until it was sucessful in capturing. Pt transfered to [**Hospital1 18**] for further management and evaluation for permanent pacemaker. Of note, CXR at OSH was significant for LLL PNA along with left shirft leukocystosis for which Pt receieved one dose of Zosyn. Past Medical History: chronic renal failure - has HD every Mon/Wed/Friday CHF CAD, s/p PCI to LAD/RCA ([**2198-12-5**]) DM2 hypothyroidism s/p thyroidectomy neuropathy pancreatic lesion with planned distal pancreatectomy in [**Month (only) **]. cholecystectomy legally blind Social History: Lives w/ Husband and has 10 children. No tobacco, EtOH, drug abuse. Family History: Sister with CAD. Father deceased [**3-12**] MI. Extensive DM FHx. Physical Exam: VS: 99.0, 133/46, 80 V-paced Vent: PSV 15/5, 0.50, rr 14, VT 320, 99% PE: Minimally sedated but respnsive, intubated NC/AT, anicteric, conjuctiva wnl, WTT neck suple, RIJ, JVP not appreciated course BS through out with rales at left base RRR, nl S1/S2, [**4-14**] SM RUSB Abd soft, NT, ND, NABS 1+ LLE edema, right arm immobilized without deformity A&O Pertinent Results: [**2199-1-3**] 07:10PM BLOOD WBC-11.9* RBC-3.33* Hgb-10.6* Hct-32.2* MCV-97 MCH-31.9 MCHC-33.0 RDW-16.6* Plt Ct-297 [**2199-1-4**] 03:52AM BLOOD WBC-12.1* RBC-3.12* Hgb-9.8* Hct-30.9* MCV-99* MCH-31.6 MCHC-31.8 RDW-17.1* Plt Ct-274 [**2199-1-5**] 07:20AM BLOOD WBC-12.4* RBC-3.34* Hgb-11.0* Hct-33.7* MCV-101* MCH-32.9* MCHC-32.7 RDW-17.0* Plt Ct-272 [**2199-1-6**] 06:30AM BLOOD WBC-9.1 RBC-3.07* Hgb-9.9* Hct-30.6* MCV-100* MCH-32.1* MCHC-32.2 RDW-17.0* Plt Ct-256 [**2199-1-3**] 07:10PM BLOOD Neuts-86.4* Bands-0 Lymphs-8.1* Monos-4.9 Eos-0.3 Baso-0.2 [**2199-1-3**] 07:10PM BLOOD PT-14.2* PTT-29.9 INR(PT)-1.3 [**2199-1-3**] 07:10PM BLOOD Plt Ct-297 [**2199-1-4**] 03:52AM BLOOD Plt Ct-274 [**2199-1-5**] 07:20AM BLOOD Plt Ct-272 [**2199-1-6**] 06:30AM BLOOD Plt Ct-256 [**2199-1-3**] 07:10PM BLOOD Glucose-119* UreaN-31* Creat-5.1* Na-139 K-5.2* Cl-98 HCO3-29 AnGap-17 [**2199-1-4**] 03:52AM BLOOD Glucose-108* UreaN-34* Creat-5.4* Na-135 K-5.0 Cl-97 HCO3-28 AnGap-15 [**2199-1-5**] 07:20AM BLOOD Glucose-122* UreaN-20 Creat-3.8*# Na-136 K-4.4 Cl-94* HCO3-30* AnGap-16 [**2199-1-6**] 06:30AM BLOOD Glucose-94 UreaN-31* Creat-4.5* Na-133 K-4.5 Cl-94* HCO3-29 AnGap-15 [**2199-1-3**] 07:10PM BLOOD CK(CPK)-43 [**2199-1-3**] 07:10PM BLOOD CK-MB-NotDone cTropnT-0.19* [**2199-1-4**] 03:52AM BLOOD CK(CPK)-66 [**2199-1-4**] 03:52AM BLOOD CK-MB-NotDone cTropnT-0.20* [**2199-1-3**] 07:10PM BLOOD Calcium-8.5 Phos-6.0*# Mg-1.9 [**2199-1-4**] 03:52AM BLOOD Calcium-8.4 Phos-6.6* Mg-1.9 Cholest-168 [**2199-1-5**] 07:20AM BLOOD Calcium-9.0 Phos-4.4# Mg-1.8 [**2199-1-6**] 06:30AM BLOOD Calcium-8.6 Phos-5.5* Mg-1.9 [**2199-1-4**] 03:52AM BLOOD Triglyc-126 HDL-52 CHOL/HD-3.2 LDLcalc-91 [**2199-1-4**] 03:52AM BLOOD TSH-9.8* [**2199-1-4**] 03:42AM BLOOD Lactate-1.4 [**2199-1-3**] 10:02PM BLOOD Type-ART PEEP-5 pO2-134* pCO2-47* pH-7.40 calHCO3-30 Base XS-3 -ASSIST/CON Intubat-INTUBATED [**2199-1-4**] 03:42AM BLOOD Type-ART pO2-47* pCO2-55* pH-7.38 calHCO3-34* Base XS-5 CXR: IMPRESSION: CHF with possible pneumonia involving the left lower lobe. Superimposed pneumonia in the left lower lobe. XR: IMPRESSION: 1. Anterior dislocation of the humerus. 2. Humeral head and neck fracture. 3-View IMPRESSION: Comminuted subcapital fracture of the right humerus. ECHO: The left atrium is moderately dilated. The right atrium is markedly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF 60-70%). No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. The right ventricular free wall is hypertrophied. The right ventricular cavity is dilated. Right ventricular systolic function appears depressed. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is at least moderate pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. Brief Hospital Course: 72 yo female with history CAD s/p PCI, CHF, DM, ESRD on HD who presents to [**Hospital1 18**] from OSH with CHB requiring pacing. 1) Rhythm: Pt with an initial 2'- AV block (most likely Mobitz I) on ECG followed by reported CHB. The OSH hospital reported Mobitz II however at [**Hospital1 18**] patient was persistently in Mobitz I and conversion from Mobitz II to Mobitz I not common because area of conduction block are two totally different locations. Pt stable upon transfer with temporary pacer placed. Pt ventricular paced at 80; HD stable. Upon close evaluation of ECG it appears as though block as at the AV node most likely secondary to medications. By the AM, pacer was turned down and her native rhythm became obvious; with a HR 70-80's with a prolonged PR and occasional Wenckebach. During stay, BB were held. Given pt's lack of symptoms and current infection and humerus fracture, felt it was best to delay a formal EPS until stable. The patient continued to have Wenckebach rhythm with occasional pauses however these were totally asymptomatic. EP consulted and felt that pt did not warrant immediate pacemaker placement. Pt would require right sided pacemaker placement in light of AV fistula in left arm. Since she has right shoulder fracture, right subclavian line in place, and is being treated for a pneumonia it was deemed that these issues should be settled and she would then be evaluated as an outpatient. She was discharged to rehab with [**Doctor Last Name **] of hearts monitor for ant continued symptoms she experienced post hospitalization. Pt is to follow up with Dr [**Last Name (STitle) 96254**] in clinic in the next month at [**Telephone/Fax (1) 5518**]; to discus the possibility of a permanent pacemaker. 2) CAD: Pt with known 2VD s/p recent PCI. Pt without obvious cardiac complaint. ECG at OSH without acute ischemic changes and initial cardiac enzymes negative. Pt continued on ACEi, ASA, Plavix, [**Last Name (un) **]. Pt with history of CAD by diagnostic cath but without a MI, so BB not essential in her medical treatment. Therefore, on discharge Pt to resume her ACEi, [**Last Name (un) **], ASA and Plavix while stopping her BB. 3) Pump: Echo in [**2196**] with EF 50% and global hypokinesis. Pt in mild CHF on presentation, but saturating well post extubation. Pt was maintained on her ACEi, [**Last Name (un) **] and clonidine; with BB held as per above. Pt remained normotensive during stay and will be discharged home on her usual dosing of ACEi, [**Last Name (un) **] and clonidine. 4) Renal: Pt with ESRD who gets HD three times a week. Pt seem by the renal service and underwent hemodialysis as per her outpatient regimen of q Mon/Wed/[**Doctor First Name **]. 5) ID: Pt with LLL consolidate on CXR. Started on Ceftriaxone and Azithromycin for presumed community acquired PNA. Sputum gram stain with gram + cocci and gram - rods without and growth by culture. Blood cultures remained without growth. Pt to be discharged home to complete a total 10 day course of antibiotics. 6) Resp: Pt electively intubated at OSH for airway protection. Upon arrival to [**Hospital1 18**], Pt stable on SIMV. Pt quickly weaned to PSV which she tolerated well. Pt extubated that evening without difficulty and for the remaining hospitalization was stable. 7) Ortho: Pt with right humeral head fracture without dislocation by CT. Ortho consulted who recommended sling for immobilization and follow-up in two weeks as out-patient with Dr [**First Name (STitle) 4223**] [**Telephone/Fax (1) 96255**]). Medications on Admission: ASA 325 Plavix 75 renagel 1600 TID Clonidine 0.1 qAM Accupril 40 qAM Diovan 160 qAM Synthroid 150 mcg Phos-lo 667 [**Hospital1 **] Ativan 0.5 TID Zoloft 50 NPH 10 qAM, 5 qHS Discharge Medications: 1. medication Regular Insulin Sliding Scale 2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. Clonidine HCl 0.1 mg Tablet Sig: One (1) Tablet PO twice a day. 6. Sertraline HCl 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 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. 9. Valsartan 160 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 11. Calcium Acetate 667 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 12. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 13. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 14. Azithromycin 250 mg Capsule Sig: One (1) Capsule PO Q24H (every 24 hours) for 5 days: last dose 12/3. 15. Psyllium 58.6 % Packet Sig: One (1) Packet PO TID (3 times a day) as needed. 16. Levothyroxine Sodium 100 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 17. Quinapril HCl 40 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 18. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 19. Cefpodoxime Proxetil 200 mg Tablet Sig: One (1) Tablet PO QHD (each hemodialysis) for 10 days: Please give last dose on [**1-13**] and then stop. Discharge Disposition: Extended Care Facility: Life Care Center - [**Location (un) 3320**] Discharge Diagnosis: secondary heart block right humerus fracture CAD community acquired pnuemonia HTN Discharge Condition: good Discharge Instructions: Please call your physician if you experience chest pain, tingling in arms or jaw, heart palpiations, shortness of breath, fever, shaking chills, confusion. Followup Instructions: please follow up with cardiologist Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 5518**]) in two to four weeks in regards to possible pacemaker. please follow up with orthopaedic surgeon Dr [**First Name (STitle) 4223**] ([**Telephone/Fax (1) 1228**]) in two weeks in regards to your right humerus fracture. please follow up with your PCP Dr [**Last Name (STitle) 18998**] ([**Telephone/Fax (1) 20264**]) in the next month.

426,403,428,486,424,397,414,V458,244,250,812,E888

{'Mobitz (type) II atrioventricular block,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Pneumonia, organism unspecified,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Postsurgical hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Closed fracture of surgical neck of humerus,Unspecified fall'}

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: complete heart block PRESENT ILLNESS: Pt is a 72 yo woman with a history of CAD (s/p PCI [**2198-12-6**]), diastolic dysfunction, ESRD on HD, DM and a pancreatic mass who originally presented to [**Hospital3 3583**] ([**2199-1-2**]) s/p a fall c/o lightheadedness of several days duration. On the day of admission, Pt describes feeling dizzy and then falling to the ground without LOC or head trauma but with a right humeral head fracture. At [**Hospital3 **], ROS was negative for CP/SOB, F/C/S, dysarthria/visual changes, N/V/D. Pt reports no recent medication changes and has taken all as prescribed. Upon arrival to [**Hospital3 3583**], ECG was significant for a reported 2' AV block-Mobitz II, however; most likely was actually a 2' AV block-Mobitz I (Wenckebach). Subsequently external pcaer pads placed and nodal agents held. Pt hemodynamically stable. Exact course unclear, but a temporary pacer wire was placed last evening. This AM, Pt reportedly found to be in CHB with pacer not capturing. SBP subsequently decreased to 80's with bradycardia to the 20's. Atropine given and external pacers replaced. For airway protection, Pt was electively intubated. Lastly pacer wire was repositioned until it was sucessful in capturing. Pt transfered to [**Hospital1 18**] for further management and evaluation for permanent pacemaker. MEDICAL HISTORY: chronic renal failure - has HD every Mon/Wed/Friday CHF CAD, s/p PCI to LAD/RCA ([**2198-12-5**]) DM2 hypothyroidism s/p thyroidectomy neuropathy pancreatic lesion with planned distal pancreatectomy in [**Month (only) **]. cholecystectomy legally blind MEDICATION ON ADMISSION: ASA 325 Plavix 75 renagel 1600 TID Clonidine 0.1 qAM Accupril 40 qAM Diovan 160 qAM Synthroid 150 mcg Phos-lo 667 [**Hospital1 **] Ativan 0.5 TID Zoloft 50 NPH 10 qAM, 5 qHS ALLERGIES: Codeine / Elavil PHYSICAL EXAM: VS: 99.0, 133/46, 80 V-paced Vent: PSV 15/5, 0.50, rr 14, VT 320, 99% FAMILY HISTORY: Sister with CAD. Father deceased [**3-12**] MI. Extensive DM FHx. SOCIAL HISTORY: Lives w/ Husband and has 10 children. No tobacco, EtOH, drug abuse. ### Response: {'Mobitz (type) II atrioventricular block,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Pneumonia, organism unspecified,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Postsurgical hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Closed fracture of surgical neck of humerus,Unspecified fall'}

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 59-year-old gentleman diagnosed with metastatic renal cell cancer in [**2127-7-5**]. He underwent a debulking left nephrectomy with Dr. [**Last Name (STitle) **] on [**2127-8-25**], and was diagnosed with metastatic kidney cancer by thyroidectomy in [**2127-7-5**]. This revealed high grade renal cell carcinoma that was metastatic to the adrenal gland. Following debulking nephrectomy, he was found to be presented with severe bone pain. Location of his pain was in the right shoulder. Given that the pain did not resolve, he underwent a MRI which showed ultimately a lytic lesion in the right shoulder and was treated with radiation therapy to the shoulder as well as ultimately undergoing treatment with chemotherapy. He did not respond to chemotherapy and developed a large lytic lesion in the left femur requiring an operative embolization and rod placement in 02/[**2128**]. Following that, he had multiple radiation therapies to the spine as well as right scapula as well as left femur. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of other digestive organs and spleen,Myelopathy in other diseases classified elsewhere,Personal history of malignant neoplasm of kidney,Retention of urine, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified

Secondary malig neo bone,Sec mal neo GI NEC,Myelopathy in oth dis,Hx of kidney malignancy,Retention urine NOS,Hypothyroidism NOS,Constipation NOS

Admission Date: [**2128-9-29**] Discharge Date: [**2128-10-9**] Date of Birth: [**2069-6-26**] Sex: M Service: HISTORY OF PRESENT ILLNESS: Patient is a 59-year-old gentleman diagnosed with metastatic renal cell cancer in [**2127-7-5**]. He underwent a debulking left nephrectomy with Dr. [**Last Name (STitle) **] on [**2127-8-25**], and was diagnosed with metastatic kidney cancer by thyroidectomy in [**2127-7-5**]. This revealed high grade renal cell carcinoma that was metastatic to the adrenal gland. Following debulking nephrectomy, he was found to be presented with severe bone pain. Location of his pain was in the right shoulder. Given that the pain did not resolve, he underwent a MRI which showed ultimately a lytic lesion in the right shoulder and was treated with radiation therapy to the shoulder as well as ultimately undergoing treatment with chemotherapy. He did not respond to chemotherapy and developed a large lytic lesion in the left femur requiring an operative embolization and rod placement in 02/[**2128**]. Following that, he had multiple radiation therapies to the spine as well as right scapula as well as left femur. He was seen on multiple occasions over the last several weeks complaining of increasing pain in the right shoulder. CT scan revealed a large lytic lesion. Given that this area had been radiated twice, tentatively booked to see Dr. [**First Name (STitle) **] in Radiology for radiofrequency ablation for pain relief. He has been on OxyContin 40 mg p.o. b.i.d. and Morphine elixir for breakthrough pain, and he has been a little better over the last few days. He has not moved his bowels in three days, and also had difficulty urinating. This initially felt to be related to the increase in narcotic, but now he describes difficulty feeling a full bladder, and had been voiding very little over the last day. He was admitted to the Oncology service for workup of this urinary retention. He is also complaining of leg weakness. PHYSICAL EXAMINATION: He was a gentleman in no acute distress. HEENT: Pupils are equal, round, and reactive to light. EOMs full. Cardiovascular: Regular, rate, and rhythm, no murmurs, rubs, or gallops. Abdomen is soft, nondistended, positive bowel sounds. Neurologically, cranial nerves II through XII intact. His motor strength is [**5-8**] in the right upper extremity, [**6-7**] in the left upper extremity, and [**6-7**] on bilateral lower extremities. His reflexes in the upper extremities and lower extremities is symmetric, and sensation to cold and pin prick and light touch bilaterally, gait are normal. There is no saddle anesthesia. He was admitted now with urinary retention and bowel retention likely due to increased pain medication, but will rule out cord compression. He had a MRI of his cervical spine, which showed evidence of tumor at the T1-T3 level with moderate-to-severe cord compression. Also disease at the T1 level causing some deformity of the spinal cord. Therefore Neurosurgery was consulted. The patient was taken to the Neurosurgery service and brought to the operating room for decompression laminectomy of the thoracic and cervical spine. First on [**2128-10-3**], underwent a thoracic embolization of the tumor, and then was taken to the operating room on [**2128-10-4**], and underwent T2-T3 resection of metastatic lesions, spinal cord decompression with segmental C7-T4 stabilization. Postoperative, his vital signs were stable. He was afebrile. His motor strength was [**6-7**] in all muscle groups. He had no pronator drift. His laboratories were within normal limits. He was neurologically stable and transferred to the regular floor. He has had two drains in place, which stayed in until postoperative day #5. He had minimal output of both drains on day five, and they were pulled. Continued on IV antibiotic treatment while drains were in place. His incisions were clean, dry, and intact. He was seen by Physical Therapy and Occupational Therapy, and was thought to possibly acquire rehab, although made significant improvement over his hospital stay, and opted for discharge to home with followup with Dr. [**Last Name (STitle) 1132**] in two weeks for staple removal. DISCHARGE MEDICATIONS: 1. Diazepam 5 mg p.o. q.6h. 2. Gentamicin ophthalmic solution one drop OU q.4h. 3. Protonix 40 mg p.o. q.d. 4. Lactulose 30 cc p.o. q.4h. prn. 5. OxyContin 40 mg p.o. b.i.d. 6. Morphine 5-10 mg p.o. q.4-6h. for breakthrough pain. 7. Senna one tablet p.o. b.i.d. 8. Colace 100 mg p.o. b.i.d. 9. Levothyroxine 125 mcg p.o. q.d. CONDITION ON DISCHARGE: Stable. He has a figure-of-eight brace, which he should wear at all times until his followup with Dr. [**Last Name (STitle) 1327**] in two weeks for staple removal. His incisions was clean, dry, and intact. He ambulation was improved. His sensation and strength in his lower extremities is intact. He will follow up also with his oncologist in [**Month (only) **]. His vital signs are stable at the time of discharge. [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D. [**MD Number(1) 1341**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2128-10-8**] 11:37 T: [**2128-10-8**] 11:36 JOB#: [**Job Number 6345**]

198,197,336,V105,788,244,564

{'Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of other digestive organs and spleen,Myelopathy in other diseases classified elsewhere,Personal history of malignant neoplasm of kidney,Retention of urine, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 59-year-old gentleman diagnosed with metastatic renal cell cancer in [**2127-7-5**]. He underwent a debulking left nephrectomy with Dr. [**Last Name (STitle) **] on [**2127-8-25**], and was diagnosed with metastatic kidney cancer by thyroidectomy in [**2127-7-5**]. This revealed high grade renal cell carcinoma that was metastatic to the adrenal gland. Following debulking nephrectomy, he was found to be presented with severe bone pain. Location of his pain was in the right shoulder. Given that the pain did not resolve, he underwent a MRI which showed ultimately a lytic lesion in the right shoulder and was treated with radiation therapy to the shoulder as well as ultimately undergoing treatment with chemotherapy. He did not respond to chemotherapy and developed a large lytic lesion in the left femur requiring an operative embolization and rod placement in 02/[**2128**]. Following that, he had multiple radiation therapies to the spine as well as right scapula as well as left femur. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of other digestive organs and spleen,Myelopathy in other diseases classified elsewhere,Personal history of malignant neoplasm of kidney,Retention of urine, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified'}

CHIEF COMPLAINT: S/p elective Fidelis lead extraction PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old male with complex medical history including CAD s/p remote MI, s/p CABG and PCI, ischemic CMP, s/p dual chamber pacemaker implant for high grade AV block and later upgrade to dual chamber ICD. A recent interrogation in [**Month (only) 216**] revealed noise with inhibition of ventricular pacing with his fidelis RV lead. Patient denied palpitations, lightheadedness, near syncope, syncope or ICD discharge to the CNP who spoke with him on the phone a couple days ago. He was electively admitted for lead extraction. . Patient was found to have hyperglycemia to 400s this AM when presenting to the OR with initial ABG showing 7.17/43/328/17. He had a hyperchloremic, non-anion gap metabolic acidosis and had a normal lactate. During the case, he received 1 unit of pRBCs, 3L NS and calcium with a couple amps of bicarb to help his acid/base. Patient became hypotensive during the case requiring vasopressin and levophed for pressure support. He received a BiV pacer with improvement in his EF by TEE. . In the CCU, he is intubated and sedated. . Per wife, he has had no complaints and has been feeling well. He has had AM hyperglycemia after night time snacks. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (+) Diabetes, (+) Dyslipidemia, (+) Hypertension 2. CARDIAC HISTORY: - CABG: S/p MI and CABG in [**2112**] ([**Hospital3 **]), unknown anatomy. - PERCUTANEOUS CORONARY INTERVENTIONS: S/p stenting, unknown anatomy. - PACING/ICD: History of complete heart block, dual chamber placement for high grade AV block in [**2123**]; upgrade to dual chamber [**Company 2267**] model T165 ICD [**5-/2129**] - Ischemic cardiomyopathy . 3. OTHER PAST MEDICAL HISTORY: - Status post left inguinal herniorrhaphy - Status post remote excision of melanoma from his back MEDICATION ON ADMISSION: Amlodipine 5mg daily Clopidogrel 75mg daily Ezetimibe 10mg daily Gemfibrozil 600mg [**Hospital1 **] Lantus 66U QHS Lispro SC Losartan 50mg daily Metoprolol Tartrate 50mg [**Hospital1 **] Simvastatin 20mg daily ASA 325mg daily MOV daily ALLERGIES: Demerol PHYSICAL EXAM: ON ADMISSION: VS: T= 97 BP= 145/55 HR= 68 RR= 15 O2 sat= 99% GENERAL: Intubated and sedated HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple. Unable to assess JVD given supine. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB with coarse bilateral vent breath sounds. ABDOMEN: Soft, mildly distended, no organomegaly appreciated. EXTREMITIES: No c/c/e. SKIN: Scattered tattoos. No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ FAMILY HISTORY: not pertinant to current admission SOCIAL HISTORY: SOCIAL HISTORY: Per notes, unable to confirm with patient as intubated. Lives with and 2 sons, ages 20 & 17. [**Name2 (NI) **] care Services: None

Mechanical complication of automatic implantable cardiac defibrillator,Alkalosis,Chronic systolic heart failure,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other specified forms of chronic ischemic heart disease,Chronic airway obstruction, not elsewhere classified,Other specified disorders resulting from impaired renal function,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other iatrogenic hypotension,Personal history of malignant melanoma of skin,Old myocardial infarction

Mch cmp autm mplnt dfbrl,Alkalosis,Chr systolic hrt failure,Hemorrhage complic proc,Ac posthemorrhag anemia,Prim cardiomyopathy NEC,Thrombocytopenia NOS,Chr ischemic hrt dis NEC,Chr airway obstruct NEC,Impair ren funct dis NEC,Abn react-artif implant,Accid in resident instit,Aortocoronary bypass,DMII wo cmp nt st uncntr,Long-term use of insulin,Iatrogenc hypotnsion NEC,Hx-malig skin melanoma,Old myocardial infarct

Admission Date: [**2133-10-29**] Discharge Date: [**2133-11-1**] Date of Birth: [**2068-12-16**] Sex: M Service: MEDICINE Allergies: Demerol Attending:[**First Name3 (LF) 2901**] Chief Complaint: S/p elective Fidelis lead extraction Major Surgical or Invasive Procedure: Pacemaker lead extraction and replacement Intubation History of Present Illness: Mr. [**Known lastname **] is a 64 year old male with complex medical history including CAD s/p remote MI, s/p CABG and PCI, ischemic CMP, s/p dual chamber pacemaker implant for high grade AV block and later upgrade to dual chamber ICD. A recent interrogation in [**Month (only) 216**] revealed noise with inhibition of ventricular pacing with his fidelis RV lead. Patient denied palpitations, lightheadedness, near syncope, syncope or ICD discharge to the CNP who spoke with him on the phone a couple days ago. He was electively admitted for lead extraction. . Patient was found to have hyperglycemia to 400s this AM when presenting to the OR with initial ABG showing 7.17/43/328/17. He had a hyperchloremic, non-anion gap metabolic acidosis and had a normal lactate. During the case, he received 1 unit of pRBCs, 3L NS and calcium with a couple amps of bicarb to help his acid/base. Patient became hypotensive during the case requiring vasopressin and levophed for pressure support. He received a BiV pacer with improvement in his EF by TEE. . In the CCU, he is intubated and sedated. . Per wife, he has had no complaints and has been feeling well. He has had AM hyperglycemia after night time snacks. Past Medical History: 1. CARDIAC RISK FACTORS: (+) Diabetes, (+) Dyslipidemia, (+) Hypertension 2. CARDIAC HISTORY: - CABG: S/p MI and CABG in [**2112**] ([**Hospital3 **]), unknown anatomy. - PERCUTANEOUS CORONARY INTERVENTIONS: S/p stenting, unknown anatomy. - PACING/ICD: History of complete heart block, dual chamber placement for high grade AV block in [**2123**]; upgrade to dual chamber [**Company 2267**] model T165 ICD [**5-/2129**] - Ischemic cardiomyopathy . 3. OTHER PAST MEDICAL HISTORY: - Status post left inguinal herniorrhaphy - Status post remote excision of melanoma from his back Social History: SOCIAL HISTORY: Per notes, unable to confirm with patient as intubated. Lives with and 2 sons, ages 20 & 17. [**Name2 (NI) **] care Services: None Family History: not pertinant to current admission Physical Exam: ON ADMISSION: VS: T= 97 BP= 145/55 HR= 68 RR= 15 O2 sat= 99% GENERAL: Intubated and sedated HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple. Unable to assess JVD given supine. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB with coarse bilateral vent breath sounds. ABDOMEN: Soft, mildly distended, no organomegaly appreciated. EXTREMITIES: No c/c/e. SKIN: Scattered tattoos. No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ ON DISCHARGE: T= 97 BP= 122/60 P=67 RR=15 O2 sat= 97% GENERAL: Alert and oriented x3 NAD HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple. JVP of 5cm CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB with coarse bilateral vent breath sounds. ABDOMEN: Soft, mildly distended, no organomegaly appreciated. EXTREMITIES: No c/c/e. SKIN: Scattered tattoos. No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ Pertinent Results: ON ADMISSION: [**2133-10-29**] 06:03PM BLOOD WBC-17.8* RBC-3.40* Hgb-10.7* Hct-30.5* MCV-90 MCH-31.3 MCHC-34.9 RDW-15.4 Plt Ct-131* [**2133-10-29**] 06:03PM BLOOD PT-17.0* PTT-29.5 INR(PT)-1.5* [**2133-10-29**] 03:37PM BLOOD UreaN-18 Creat-1.1 Na-139 K-4.2 Cl-113* HCO3-21* AnGap-9 [**2133-10-29**] 03:37PM BLOOD ALT-44* AST-46* AlkPhos-120 TotBili-0.7 [**2133-10-29**] 06:03PM BLOOD TotProt-5.3* Albumin-3.1* Globuln-2.2 Calcium-8.3* Phos-5.6* Mg-2.0 [**2133-10-30**] 09:00PM BLOOD Hapto-108 ECHO [**10-29**]: The left atrium is mildly dilated. No mass/thrombus is seen in the left atrium or left atrial appendage. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. There are simple atheroma in the ascending aorta. 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. The tricuspid valve leaflets fail to fully coapt. Moderate to severe [3+] tricuspid regurgitation is seen. There is no pericardial effusion. Initial LV systolic function was depressed with LVEF = 30-35%, this improved to LVEF 35-45% with dual ventriular pacing. No PFO seen. No clot in LAA seen. CXR [**10-29**]: The patient is intubated, the tip of the endotracheal tube projects 3 cm above the carina. Normal placement of a right internal jugular vein catheter without evidence of complications. Left pectoral pacemaker in situ. No nasogastric tube. No evidence of pneumothorax. Borderline size of the cardiac silhouette without evidence of pulmonary edema. Minimal pleural effusion. Moderate retrocardiac atelectasis. = = = = = = = = ================================================================ ON DISCHARGE: [**2133-11-1**] 05:56AM BLOOD WBC-3.9* RBC-3.34* Hgb-10.4* Hct-29.2* MCV-87 MCH-31.1 MCHC-35.6* RDW-16.4* Plt Ct-43* [**2133-11-1**] 05:56AM BLOOD Glucose-189* UreaN-11 Creat-0.8 Na-138 K-3.4 Cl-107 HCO3-21* AnGap-13 ECHO [**10-30**]: The left atrium is mildly dilated. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is moderate regional left ventricular systolic dysfunction with inferior/inferolateral/basal inferoseptal akinesis, as well as hypokinesis of the apex (multivessel CAD) . The remaining segments contract normally (LVEF = 30%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. Mild (1+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is no pericardial effusion. IMPRESSION: Moderate regional left ventricular systolic dysfunction, most c/w multivessel CAD. Mild mitral regurgitation. Significant residual intraventricular LV dyssynchrony by visual inspection. Brief Hospital Course: ASSESSMENT AND PLAN: Mr. [**Known lastname **] is a 64 year old male with complex medical history including CAD s/p remote MI, s/p CABG and PCI, ischemic CMP, s/p dual chamber pacemaker implant/ICD for high grade AV block who presented for elective BiV/ICD complicated by acidosis and hypotension. . # Pacemaker/ICD Placement: Patient presented for elective BiV/ICD, while in the OR patient became hypotensive requiring levophed and vasopressin in the setting of large volume blood loss. Patient stablized and was weaned from pressors. He has followup in device clinic with Dr. [**Last Name (STitle) **] [**Name (STitle) 1944**]. . # Hypotension: Patient became hypotensive during OR case requiring use of levophed and vasopressin. Patient reportedly had large blood loss during procedure and received total of 4 units of pRBC. Other etiologies including cardiogenic, septic and adrenal insufficency were evaluated and ruled out as cause. He was weaned from pressors quickly once sedation was weaned and he received blood. . # RTA: On admission, patient appeared to have combined non-gap metabolic acidosis with respiratory acidosis in setting of ventilatory support. Patient had persistant hyperchloremic, non-gap metabolic acidosis post-extubation with an elevated urine pH and urine anion gap suggesting a distal renal tubular acidosis. Patient was started on bicarb (1-2 mg/kg or 7g/day) and potassium supplementation prior to discharge. He will follow up with his PCP this week and will need to be seen by a nephrologist as well. Patient prefered a nephrologist closer to his home in [**Hospital1 1562**] rather than travelling to [**Hospital1 18**]. He will have labs drawn two days after discharge to ensure electrolyte stability. . # Chronic systolic CHF: He just received replacement BiV pacemaker and his EF improved from 30-35% on admisison to LVEF 35-45% post-procedurely. He was continued on [**Last Name (un) **]. . # Thrombocytopenia: Patient's platelet count was 131K at the time of presentation and had fallen to 40K post ICD placement. It was felt that this was a dilutional effect in the setting of recieving 4 units of pRBC with no additional platelets. Hemolysis labs were negative, and there were no signs of bleeding. Platelets were stable for 36 hours at time of discharge. . # CAD: He has h/o CABG in the [**2112**] but no reported recent CP. He was continued on his plavix, aspirin and statin. Metoprolol and losartan were held initially, but restarted at home dose prior to discharge. . # HTN: Patient's metoprolol and losartan were held initially due to hypotension, but were restarted at his home dose when he was hemodynamically stable. # HLD: Patient was continued on home statin, Zetia and Gemfibrozil. . # DM: Patient's home dose of lantus was reduced to 40 from 66 as patient was NPO for procedure and put on sliding scale humalog. He was restarted on his home dose of lantus and sliding scale with good glycemic control through out his hospital course. TRANSLATIONAL ISSUES: -patient needs to establish care with a nephrologist closer to his home in [**Hospital1 **]. -patient will need his electrolytes closely monitored as an outpatient -patient will need his CBC and platelet count checked in [**4-11**] days. Medications on Admission: Amlodipine 5mg daily Clopidogrel 75mg daily Ezetimibe 10mg daily Gemfibrozil 600mg [**Hospital1 **] Lantus 66U QHS Lispro SC Losartan 50mg daily Metoprolol Tartrate 50mg [**Hospital1 **] Simvastatin 20mg daily ASA 325mg daily MOV daily Discharge Medications: 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Lantus 100 unit/mL Solution Sig: Sixty Six (66) units Subcutaneous at bedtime. 6. insulin lispro 100 unit/mL Solution Sig: ASDIR Subcutaneous four times a day: [**First Name8 (NamePattern2) **] [**Last Name (un) **] Sliding Scale. 7. losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 10. amlodipine 5 mg Tablet Sig: One (1) Tablet PO once a day. 11. sodium bicarbonate 650 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*0* 12. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: Two (2) Tablet, ER Particles/Crystals PO once a day. Disp:*60 Tablet, ER Particles/Crystals(s)* Refills:*0* 13. famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 14. Outpatient Lab Work Please draw CBC and chem 7 on Tuesday, [**11-3**] and fax results to PCP [**Last Name (NamePattern4) **]. [**First Name (STitle) **] at [**Telephone/Fax (1) 91356**]. Discharge Disposition: Home Discharge Diagnosis: Pacemaker revision complicated by bleeding Acute blood loss anemia Chronic acidosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted to the hospital following a pacemaker lead replacement, which was complicated by bleeding. You received blood transfusions and your blood counts stabilized. Additionally, you were found to have a kidney disorder that causes your blood to become very acidic, and you were started on medications to treat this. We made the following changes to your medications: -START sodium bicarbonate -START Potassium Chloride 40 daily -CHANGED your heart burn medication to Famotidine to lessen interaction with plavix Please have blood drawn on Tuesday and have the results faxed to your PCP and Dr. [**Last Name (STitle) **]. Followup Instructions: Please call your PCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 49260**] on monday, and make an appointment to be seen this week. Please also have labs drawn on Tuesday, and the results sent to your PCP. Department: CARDIAC SERVICES When: THURSDAY [**2133-11-5**] at 11:30 AM 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: FRIDAY [**2133-11-27**] at 3:00 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Please call the [**Hospital1 18**] renal clinic at ([**Telephone/Fax (1) 10135**] to make an appointment regarding your kidney condition. They will help to manage your electrolytes and your new medications. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]

996,276,428,998,285,425,287,414,496,588,E878,E849,V458,250,V586,458,V108,412

{'Mechanical complication of automatic implantable cardiac defibrillator,Alkalosis,Chronic systolic heart failure,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other specified forms of chronic ischemic heart disease,Chronic airway obstruction, not elsewhere classified,Other specified disorders resulting from impaired renal function,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other iatrogenic hypotension,Personal history of malignant melanoma of skin,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: S/p elective Fidelis lead extraction PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old male with complex medical history including CAD s/p remote MI, s/p CABG and PCI, ischemic CMP, s/p dual chamber pacemaker implant for high grade AV block and later upgrade to dual chamber ICD. A recent interrogation in [**Month (only) 216**] revealed noise with inhibition of ventricular pacing with his fidelis RV lead. Patient denied palpitations, lightheadedness, near syncope, syncope or ICD discharge to the CNP who spoke with him on the phone a couple days ago. He was electively admitted for lead extraction. . Patient was found to have hyperglycemia to 400s this AM when presenting to the OR with initial ABG showing 7.17/43/328/17. He had a hyperchloremic, non-anion gap metabolic acidosis and had a normal lactate. During the case, he received 1 unit of pRBCs, 3L NS and calcium with a couple amps of bicarb to help his acid/base. Patient became hypotensive during the case requiring vasopressin and levophed for pressure support. He received a BiV pacer with improvement in his EF by TEE. . In the CCU, he is intubated and sedated. . Per wife, he has had no complaints and has been feeling well. He has had AM hyperglycemia after night time snacks. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (+) Diabetes, (+) Dyslipidemia, (+) Hypertension 2. CARDIAC HISTORY: - CABG: S/p MI and CABG in [**2112**] ([**Hospital3 **]), unknown anatomy. - PERCUTANEOUS CORONARY INTERVENTIONS: S/p stenting, unknown anatomy. - PACING/ICD: History of complete heart block, dual chamber placement for high grade AV block in [**2123**]; upgrade to dual chamber [**Company 2267**] model T165 ICD [**5-/2129**] - Ischemic cardiomyopathy . 3. OTHER PAST MEDICAL HISTORY: - Status post left inguinal herniorrhaphy - Status post remote excision of melanoma from his back MEDICATION ON ADMISSION: Amlodipine 5mg daily Clopidogrel 75mg daily Ezetimibe 10mg daily Gemfibrozil 600mg [**Hospital1 **] Lantus 66U QHS Lispro SC Losartan 50mg daily Metoprolol Tartrate 50mg [**Hospital1 **] Simvastatin 20mg daily ASA 325mg daily MOV daily ALLERGIES: Demerol PHYSICAL EXAM: ON ADMISSION: VS: T= 97 BP= 145/55 HR= 68 RR= 15 O2 sat= 99% GENERAL: Intubated and sedated HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple. Unable to assess JVD given supine. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB with coarse bilateral vent breath sounds. ABDOMEN: Soft, mildly distended, no organomegaly appreciated. EXTREMITIES: No c/c/e. SKIN: Scattered tattoos. No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ FAMILY HISTORY: not pertinant to current admission SOCIAL HISTORY: SOCIAL HISTORY: Per notes, unable to confirm with patient as intubated. Lives with and 2 sons, ages 20 & 17. [**Name2 (NI) **] care Services: None ### Response: {'Mechanical complication of automatic implantable cardiac defibrillator,Alkalosis,Chronic systolic heart failure,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other specified forms of chronic ischemic heart disease,Chronic airway obstruction, not elsewhere classified,Other specified disorders resulting from impaired renal function,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other iatrogenic hypotension,Personal history of malignant melanoma of skin,Old myocardial infarction'}

CHIEF COMPLAINT: code stroke transfer from OSH PRESENT ILLNESS: Patient is a 50 yo man with h/o Hep C, Vocal Cord Ca s/p resection and 6 mo radiation [**2146**], who had sudden onset aphasia, right sided weakness and facial droop at 11:45PM [**2158-4-24**]. According to wife, first symptoms were on [**4-24**] at 0200 in the middle of the night when he had about 20 minutes of slurred speech. He was able to produce purposeful speech, but was slurred. Then resolved completely after 20 minutes and was at baseline all day [**4-24**] until late evening. MEDICAL HISTORY: Hep C Vocal cord cancer s/p resection and 6 mo radiation in [**2146**]. no prior strokes MEDICATION ON ADMISSION: 81 ASA daily Percocet PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- 97.6 BP-128/69 HR-100 RR- 16 O2Sat 94 RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: no strokes SOCIAL HISTORY: lives with wife. Previous heavy ETOH, but not recently. Quit smoking [**2146**]. Smokes marajuana but no recent cocaine or IVDA.

Cerebral artery occlusion, unspecified with cerebral infarction,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of larynx

Crbl art ocl NOS w infrc,Chrnc hpt C wo hpat coma,Tobacco use disorder,Hx of irradiation,Hx-laryngeal malignancy

Admission Date: [**2158-5-26**] Discharge Date: [**2158-5-31**] Date of Birth: [**2108-3-13**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 618**] Chief Complaint: code stroke transfer from OSH Major Surgical or Invasive Procedure: Status intravenous alteplase VIDEO OROPHARYNGEAL SWA Cardiology ECHO CT HEAD W/O CONTRAST CHEST (PA & LAT) CT HEAD W/O CONTRAST Cardiology ECG CTA HEAD W&W/O C & RECO CTA NECK W&W/OC & RECON CT BRAIN PERFUSION History of Present Illness: Patient is a 50 yo man with h/o Hep C, Vocal Cord Ca s/p resection and 6 mo radiation [**2146**], who had sudden onset aphasia, right sided weakness and facial droop at 11:45PM [**2158-4-24**]. According to wife, first symptoms were on [**4-24**] at 0200 in the middle of the night when he had about 20 minutes of slurred speech. He was able to produce purposeful speech, but was slurred. Then resolved completely after 20 minutes and was at baseline all day [**4-24**] until late evening. Wife and patient were getting into their camper and she noted that he was struggling to open the door to the camper. Then took a few deep breaths as if he couldn't catch his breath and reached out to grab ahold of something. He then crumbled to the ground. At this point, she noted his right side was weak and he was unable to speak. He was taken to an OSH in [**Location (un) **] NH where he was noted to be aphasic and with a flacid hemiplegia on the right. Stroke scale undocumented. At 0145 he recieved TPA 7mg IV for bolus, then 62.9 mg IV over next 60 minutes. At 0200 there is written report that there was some slight improvement with the right foot moving some now. Then at 0230 there is report that hadn moved slightly but patient remained non-verbal. ROS: has not reported anything to wife recently. [**Name2 (NI) **] fevers or chills. No wt loss. Occasional night sweats. Past Medical History: Hep C Vocal cord cancer s/p resection and 6 mo radiation in [**2146**]. no prior strokes Social History: lives with wife. Previous heavy ETOH, but not recently. Quit smoking [**2146**]. Smokes marajuana but no recent cocaine or IVDA. Family History: no strokes Physical Exam: T- 97.6 BP-128/69 HR-100 RR- 16 O2Sat 94 RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema Neurologic examination: NIHSS: 20 ( 2-questions, 1 commands, 1 best gaze, 2 field cut, 2 facial palsy, 3 right arm, 2 sensory, 3 language, 2 dysarthria, 2 neglect). Mental status: Awake and appears alert. Unable to follow commands. Globally aphasic. Perhaps follows 2 commands out of greater than 5. (was able to maintain antigravity but had significant coaxing. Also squeezed adn released correctly with stroke scale.) Makes expressions as if he is very anxious and wants to communicate. Aphonic. Spontaneously moving left arm/leg purposefully. Appears not to regard right side of room. Cranial Nerves: Pupils equally round and reactive to light, 3 to 2 mm bilaterally. Appears to have right field cut on threat. Does not cross midline to right. Moves eyes spontaneously and conjugately in to left, no nystagmus. Sensation on face unclear. [**Name2 (NI) 167**] facial droop/complete paraplegia invovling lower > upper. Hearing unknown. Palate, tongue and shoulders unknown. Motor: Normal bulk bilaterally. Tone flacid right, normal left. No observed myoclonus or tremor Strength seems grossly full on left. RUE is flaccid and without withdrawl to pain. RLE is sustained antigravity for > 5 seconds. Patient unable to follow formal strength testing, but RLE appears to be weaker than LLE. Sensation: Nods head intermittently to questions re: sensation, but unclear what his sensory deficits are. Does not withdraw to noxious stim either side. Reflexes: +2 and symmetric throughout. Toes mute right and withdrawl left. Coordination: could not test formally but purposeful movements in LUE coordinated. Gait: NA Romberg: NA Pertinent Results: WBC-9.4 RBC-4.17* Hgb-14.2 Hct-40.3 MCV-97 MCH-34.1* MCHC-35.3* RDW-13.3 Plt Ct-168 PT-12.1 PTT-24.3 INR(PT)-1.0 Glucose-138* UreaN-19 Creat-0.8 Na-137 K-3.5 Cl-104 HCO3-25 AnGap-12 Calcium-8.7 Phos-2.4* Mg-2.0 ALT-234* AST-102* CK(CPK)-195* AlkPhos-66 Amylase-163* TotBili-0.5 Repeat ALT-135* AST-50* LD(LDH)-197 AlkPhos-63 Amylase-107* TotBili-0.8 Albumin-3.8 [**2158-5-26**] 10:55AM BLOOD CK(CPK)-235* cTropnT-<0.01 [**2158-5-26**] 03:22PM BLOOD CK(CPK)-240* cTropnT-<0.01 [**2158-5-27**] 12:48AM BLOOD CK(CPK)-217* CK-MB-5 cTropnT-<0.01 [**2158-5-26**] 05:55AM BLOOD CK-MB-5 cTropnT-<0.01 Cholest-187 Triglyc-98 HDL-39 CHOL/HD-4.8 LDLcalc-128 %HbA1c-5.4 BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.032 Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG UCx neg IMAGING: CT PERFUSION HEAD: FINDINGS: A non-contrast examination displays diffuse hypoattenuation and edema involving the left frontal, temporal and parietal lobes with loss of [**Doctor Last Name 352**]- white matter differentiation and a hyperdense left middle cerebral artery within the sylvian fissure. There is no evidence of significant shift of normally midline structures, though there is mild surrounding mass effect. No intracranial hemorrhage or hydrocephalus is identified. Contrast-enhanced imaging displays matched abnormalities, in blood volume, blood flow and mean transit time in a left middle cerebral artery distribution. CTA OF THE HEAD AND NECK FINDINGS: There are severe stenoses noted at the origins of the vertebral arteries bilaterally. Additionally, the right common carotid artery displays a complete occlusion within its mid portion extending superiorly where it recanalizes via branches of the right external carotid artery. No significant stenosis is noted at the right common carotid artery bifurcation. The left common carotid artery bifurcation displays a high-grade stenosis involving the proximal left internal carotid artery, which appears to recanalize somewhat distally near its entrance into the carotid canal, where a small "string" lumen is present. Intracranially, there is marked pruning of many of the branches of the left middle cerebral artery, consistent with a focal filling defect involving the M2 segment with multiple smaller filling defects not definitely visualized but present based on reconstructed images, all suggesting dispersion of embolic fragments. There is no evidence of aneurysmal dilatation or AV malformation. Soft tissues and osseous structures appear unremarkable. The patient is noted to have a congenitally hypoplastic left maxillary sinus. IMPRESSION: 1. Large left middle cerebral artery distribution infarct with no evidence of ischemic penumbra by perfusion imaging. Large filling defect of left M2 segment with numerous distal defects. No hemmorhage seen. 2. High-grade bilateral stenoses of the vertebral arteries at their origin with mid-to-distal occlusion of the right common carotid artery and recanalization by branches of the right external carotid artery. Near complete occlusion involving the proximal left internal carotid artery until area of distal recanalization, as noted above. EKG: Sinus rhythm, rate 88. Minor ST-T wave abnormalities are present. No previous tracing available for comparison. Intervals Axes Rate PR QRS QT/QTc P QRS T 88 134 92 390/435.57 56 56 8 PA/LAT: No active disease Repeat NCHCT [**5-28**]: Evolving large left MCA stroke. No evidence of intracranial hemorrhage. Video swallow: The patient demonstrated oral dysphagia with delay in the oral phase of swallowing. The patient also had mild pharyngeal dysphagia as evidenced by delayed laryngeal elevation and delayed pharyngoesophageal valve closure. The patient demonstrated aspiration with thin barium after consumption of solid consistency material. No penetration was identified. IMPRESSION: 1. Mild oral and pharyngeal dysphagia due to delay in oral phase of swallow and impaired laryngeal elevation. 2. Aspiration is noted with thin liquid after consumption of the solid material. ECHO: The left atrium is normal in size. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers (cannot definitively exclude). Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is a trivial/physiologic pericardial effusion. Brief Hospital Course: Patient is a 50 yo man with Left MCA stroke s/p TPA at 2 hours at OSH and arrival to [**Hospital1 18**] at 6 hours 5 minutes time. Had perhaps some slight improvement but continues to be globally aphasic and with right face/arm>leg hemiparesis. Onset of current symptoms was 11:45 PM last night, but wife notes that early yesterday morning(0200 on [**4-24**]) patient had 20 minutes of slurred speech which completely resolved. Given that his 20 minute episode resolved completely to baseline, we are considering 11:45 last night as his time of onset. Despite this however, he is still outside of a viable window for IA TPA. . CT perfusion and CTA head and neck vessels were performed with the hope that the patient might be a candidate for the Merci device. His case was discussed with the neuroendovascular team and it was decided that the risk of bleeding was too high to justify the procedure. The concordance of images on CT perfusion, mean transit time and mean volume suggest that any intervention would both be dangerous and unlikely to yield any recovery in this patient. . Neuro: A repeat CT head at 24 hours from TPA showed evolving MCA infarct but otherwise unchanged, no new infarct or bleed. Neurosurgery was following. Tox screens were negative. HgbA1c 5.4% and fasting lipids with total 187, trig 80s, HDL 39, LCL 128. Statin was started. Echo with bubble study showed normal EF without atrial septal defect or patent foramen ovale or interatrial aneurysm. Patient was started in Aspirin ~24 hours out from IV TPA after repeat head CT was performed. Etiology of the stroke was likely due to pre-existing vascular disease from his course of radiation in [**2146**]. Patient will follow-up in [**Hospital 4038**] Clinic as an outpatient. . 2. Cards: Allowed BP to autoregulate and monitored on cardiac tele for associated arrhythmias without events. Ruled out myocardial infarct by cardiac enzyme x 3. ECHO was unrevealing as mentioned above. Started Aspirin and statin. . 3. Endo: Tight glycemic control with insulin sliding scale coverage. . 4. GI: Initially noted to have a transaminitis on [**5-26**] labs which trended downward throughout hospital coures. On exam, nontender abdomen without nausea or vomiting, tolerating PO. Video swallow cleared for puree solids, nectar thick liquids, pills crushed, 1:1 supervision. . 5. ID: U/a and cx negative. CXR negative. . 6. Other: PT/OT consulted, will also need intensive speech therapy. Medications on Admission: 81 ASA daily Percocet PRN Discharge Medications: 1. Acetaminophen 325 mg Tablet [**Month/Year (2) **]: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain, fever. 2. Insulin Regular Human 100 unit/mL Solution [**Month/Year (2) **]: PER SLIDING SCALE UNITS Injection ASDIR (AS DIRECTED). 3. Simvastatin 10 mg Tablet [**Month/Year (2) **]: Two (2) Tablet PO DAILY (Daily). 4. Aspirin 325 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily). 5. Thiamine HCl 100 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily). 6. Folic Acid 1 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily). 7. Hexavitamin Tablet [**Month/Year (2) **]: One (1) Cap PO DAILY (Daily). 8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). Discharge Disposition: Extended Care Facility: Hospital for Special Care Discharge Diagnosis: primary diagnosis: Left middle cerebral artery stroke secondary diagnosis: History of vocal cord cancer status post radiation to neck Hepatitis C Smoker Discharge Condition: Awake, alert. Mute. Globally aphasic. Right upper motor neuron facial weakness and flaccid right arm. Able to ambulate with three person assist only. Discharge Instructions: You have had a stroke. You have been started on Aspirin and a cholesterol lowering medication (Simvastatin) for stroke prevention. You will need to follow-up with a stroke neurologist. Please take medications as prescribed and keep your follow-up appointments. You have had a speech and swallow evaluation and should take pureed solids and nectar thickened liquids with 1:1 assist only. Pills should be crushed. You will need speech therapy and should practice writing with your left hand/or pointing to words. Followup Instructions: Please follow-up with your primary care physician as an outpatient within 2 weeks of discharge. Stroke neurologist: [**Name6 (MD) **] [**Name8 (MD) **], MD Phone: [**Telephone/Fax (1) 2574**] Date/Time: [**2158-8-1**] 3:30pm Please call the office to confirm your appointment. [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] Completed by:[**2158-5-31**]

434,070,305,V153,V102

{'Cerebral artery occlusion, unspecified with cerebral infarction,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of larynx'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: code stroke transfer from OSH PRESENT ILLNESS: Patient is a 50 yo man with h/o Hep C, Vocal Cord Ca s/p resection and 6 mo radiation [**2146**], who had sudden onset aphasia, right sided weakness and facial droop at 11:45PM [**2158-4-24**]. According to wife, first symptoms were on [**4-24**] at 0200 in the middle of the night when he had about 20 minutes of slurred speech. He was able to produce purposeful speech, but was slurred. Then resolved completely after 20 minutes and was at baseline all day [**4-24**] until late evening. MEDICAL HISTORY: Hep C Vocal cord cancer s/p resection and 6 mo radiation in [**2146**]. no prior strokes MEDICATION ON ADMISSION: 81 ASA daily Percocet PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- 97.6 BP-128/69 HR-100 RR- 16 O2Sat 94 RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: no strokes SOCIAL HISTORY: lives with wife. Previous heavy ETOH, but not recently. Quit smoking [**2146**]. Smokes marajuana but no recent cocaine or IVDA. ### Response: {'Cerebral artery occlusion, unspecified with cerebral infarction,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of larynx'}

CHIEF COMPLAINT: Nausea, vomiting, diarrhea, bloating, extreme fatigue x 5 weeks PRESENT ILLNESS: Ms. [**Known lastname **] is a 71 year-old postmenopausal Gravida 0 who presented w/ complaints of persistent nausea, occasional vomiting, anorexia, early satiety,bloating, and overall extreme fatigue making it difficult to carry on any normal activities for the last 5 weeks. She has lost ~10 pounds. Her primary care physician ordered [**Name Initial (PRE) **] CT of the abdomen that showed massive ascites and omental caking, concerning for possible metastatic ovarian cancer, however the pelvis was not imaged. Her CA-125 level was elevated at 483 U/mL. MEDICAL HISTORY: OB History: Gravida 0 MEDICATION ON ADMISSION: Nifed 60', Atenolol 25 qD, Omeprazole 20mg ER',Flovent 220mcg, Lorazepam 0.5mg, Albuterol PRN, Aspirin 325mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: Vital Signs: T 97.8 HR 70 BP 182/97 -> 170/76 RR 18 O2 sat 97% on RA HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or [**Last Name (un) 549**] however heart sounds very distant. JVP=6cm LUNGS: CTAB except for decreased BS at bases b/l ABDOMEN: Firm and distended, NT, +BS EXTREMITIES: No edema. 2+ dorsalis pedis/ posterior tibial pulses. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. FAMILY HISTORY: Aunt- unknown type of cancer cousin- b/l breast cancer Mother/ father- heart disease SOCIAL HISTORY: Independent, lives at home alone and her husband recently passed away. Has brothers, nieces and nephews that live in the area. Denies tobacco, etoh or drug use.

Malignant neoplasm of ovary,Malignant ascites,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes,Secondary malignant neoplasm of other urinary organs,Adult failure to thrive,Nausea with vomiting,Unspecified essential hypertension,Other iatrogenic hypotension,Oliguria and anuria,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Osteoporosis, unspecified,Asthma, unspecified type, unspecified,Palpitations,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia,Other nonspecific abnormal serum enzyme levels

Malign neopl ovary,Malignant ascites,Second malig neo liver,Mal neo lymph-intrapelv,Sec malig neo urin NEC,Failure to thrive-adult,Nausea with vomiting,Hypertension NOS,Iatrogenc hypotnsion NEC,Oliguria & anuria,Osteoarthros NOS-unspec,Osteoporosis NOS,Asthma NOS,Palpitations,Hx TIA/stroke w/o resid,Joint replaced knee,Ocl crtd art wo infrct,Pure hypercholesterolem,Abn serum enzy level NEC

Admission Date: [**2174-9-26**] Discharge Date: [**2174-10-17**] Date of Birth: [**2103-2-25**] Sex: F Service: OBSTETRICS/GYNECOLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Attending Info 65513**] Chief Complaint: Nausea, vomiting, diarrhea, bloating, extreme fatigue x 5 weeks Major Surgical or Invasive Procedure: exploratory laparotomy, debulking of advanced ovarian cancer including drainage of ascites, TAH-BSO, omentectomy, rectosigmoid resection and colostomy, appendectomy, resection of small bowel tumor, and ablation of diaphragmatic tumor. History of Present Illness: Ms. [**Known lastname **] is a 71 year-old postmenopausal Gravida 0 who presented w/ complaints of persistent nausea, occasional vomiting, anorexia, early satiety,bloating, and overall extreme fatigue making it difficult to carry on any normal activities for the last 5 weeks. She has lost ~10 pounds. Her primary care physician ordered [**Name Initial (PRE) **] CT of the abdomen that showed massive ascites and omental caking, concerning for possible metastatic ovarian cancer, however the pelvis was not imaged. Her CA-125 level was elevated at 483 U/mL. Past Medical History: OB History: Gravida 0 Gynecologic History: - Postmenopausal since age 55, no postmenopausal bleeding - Reports ? abnormal Pap ~20 years ago followed by negative biopsies, no Paps since - Denies any history of ovarian cysts, fibroids, endometriosis Past Medical History: - TIA after her knee surgery in [**2172**] - Hypertension - Hypercholesterolemia - Osteoarthritis - Osteoporosis - Asthma - Last colonoscopy [**2169**], for next in [**2179**] - Last mammogram [**2174-5-19**] - Denies history of heart/valve disease or thrombosis Past Surgical History: - Right knee replacement [**2172**] Social History: Independent, lives at home alone and her husband recently passed away. Has brothers, nieces and nephews that live in the area. Denies tobacco, etoh or drug use. Family History: Aunt- unknown type of cancer cousin- b/l breast cancer Mother/ father- heart disease Physical Exam: On admission: Vital Signs: T 97.8 HR 70 BP 182/97 -> 170/76 RR 18 O2 sat 97% on RA HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or [**Last Name (un) 549**] however heart sounds very distant. JVP=6cm LUNGS: CTAB except for decreased BS at bases b/l ABDOMEN: Firm and distended, NT, +BS EXTREMITIES: No edema. 2+ dorsalis pedis/ posterior tibial pulses. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. On discharge: Pertinent Results: [**2174-9-26**] 12:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG [**2174-9-26**] 12:34PM LACTATE-1.4 [**2174-9-26**] 12:30PM CEA-2.2, CA-125 743 [**2174-9-26**] 12:30PM WBC-6.0 RBC-4.15* HGB-11.0* HCT-34.0* MCV-82 MCH-26.6* MCHC-32.5 RDW-14.3 TEE: Normal biventricular cavity sizes with preserved global and regional biventricular systolic function CT Pelvis: Extensive omental disease and ascites noted within the pelvis. A single omental deposit is identified anterior to the right external iliac artery and vein measuring 1.2 x 1.4 cm. Further peritoneal deposits are identified along the posterior aspect of the wall of the bladder measuring maximum thickness of 7 mm. There is a bulky uterus with a large fibroid identified off the fundus measuring 4.5 x 4.0 cm. There are bilateral adnexal lesions. The right side measures 3.0 x 3.3 cm and on the left side measuring 3.1 x 3.9 cm. Pathology: ovaries/ tubes/ uterus/ appendex/ omentum/ bowel/ pleural fluid/ ascites with evid of high grade serous carcinoma Brief Hospital Course: Ms. [**Known lastname **] was admitted to the GYN Onc service [**2174-9-26**] secondary to suspicious for advanced ovarian malignancy with preoperative CT scan demonstrating marked omental caking, ascites, and bilateral adnexal masses. Her CA 125 was 743. Preoperatively she was evaluated by medicine. A TEE was done which was within normal limits. A therapeutic thoracentesis was performed and cytology revealed malignant disease. VATs procedure did not demonstrate any visible pulmonary disease. She had an exploratory laparotomy with optimal tumor debulking. Please see operative report for full details. She was transferred to the [**Hospital Unit Name 153**] immediately postop given extensive procedure, pleural effusions, intraop hypotension and anticipated fluid shifts. She was monitored closely, given fluids/ pRBC's for hypotension/ oliguria, and sucessfully extubated on POD 1. Given extensive bowel surgery, she remained NPO after surgery and was started on TPN on POD 2. She remained stable and was transferred from the ICU to the floor on POD 2. She continued on TPN until her diet was advanced and she was able to tolerate PO's. Her ostomy appeared healthy throughout her hospitalization and put out both gas and stool prior to discharge. She was weaned from oxygen on POD [**12-23**]. PleurX was in place on left for intermittent thoracentesis as needed for pulmonary effusions. She remained on flovent and albuterol as needed. She was discharged on POD 17 in stable condition. She was ambulating, voiding spontaneously, pain well controlled. Plan in place for chemotherapy. Medications on Admission: Nifed 60', Atenolol 25 qD, Omeprazole 20mg ER',Flovent 220mcg, Lorazepam 0.5mg, Albuterol PRN, Aspirin 325mg Discharge Medications: 1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 2. ipratropium bromide 0.02 % Solution Sig: One (1) neb Inhalation every six (6) hours as needed for shortness of breath or wheezing. 3. nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO DAILY (Daily). 4. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for insomnia, nausea. 6. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 7. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Discharge Disposition: Extended Care Facility: Life Care Center at [**Location (un) 2199**] Discharge Diagnosis: ovarian cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Call your doctor for: * fever > 100.4 * severe abdominal pain * difficulty urinating * vaginal bleeding requiring >1 pad/hr * abnormal vaginal discharge * redness or drainage from incision * nausea/vomiting where you are unable to keep down fluids/food or your medication General instructions: * Take your medications as prescribed. * Do not drive while taking narcotics. * No strenuous activity, nothing in the vagina (no tampons, no douching, no sex), no heavy lifting of objects >10lbs for 6 weeks. * You may eat a regular diet. Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No bath tubs for 6 weeks. * If you have staples, they will be removed at your follow-up visit. Followup Instructions: Followup with Dr. [**Last Name (STitle) 5797**] on [**10-24**] @ 1pm. Phone: [**Telephone/Fax (1) 5777**] Provider: [**First Name8 (NamePattern2) 828**] [**Name11 (NameIs) 829**], MD (Interventional pulmonology) Phone:[**0-0-**] Date/Time:[**2174-10-20**] 9:30 Followup with Dr. [**Last Name (STitle) **] (oncology). Dr.[**Name (NI) 50760**] office should be in touch with an appointment time. The office phone number is [**Telephone/Fax (1) 65559**]. [**Name6 (MD) 35354**] [**Name8 (MD) **] MD [**MD Number(2) 65515**] Completed by:[**2174-10-17**]

183,789,197,196,198,783,787,401,458,788,715,733,493,785,V125,V436,433,272,790

{'Malignant neoplasm of ovary,Malignant ascites,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes,Secondary malignant neoplasm of other urinary organs,Adult failure to thrive,Nausea with vomiting,Unspecified essential hypertension,Other iatrogenic hypotension,Oliguria and anuria,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Osteoporosis, unspecified,Asthma, unspecified type, unspecified,Palpitations,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia,Other nonspecific abnormal serum enzyme levels'}

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, diarrhea, bloating, extreme fatigue x 5 weeks PRESENT ILLNESS: Ms. [**Known lastname **] is a 71 year-old postmenopausal Gravida 0 who presented w/ complaints of persistent nausea, occasional vomiting, anorexia, early satiety,bloating, and overall extreme fatigue making it difficult to carry on any normal activities for the last 5 weeks. She has lost ~10 pounds. Her primary care physician ordered [**Name Initial (PRE) **] CT of the abdomen that showed massive ascites and omental caking, concerning for possible metastatic ovarian cancer, however the pelvis was not imaged. Her CA-125 level was elevated at 483 U/mL. MEDICAL HISTORY: OB History: Gravida 0 MEDICATION ON ADMISSION: Nifed 60', Atenolol 25 qD, Omeprazole 20mg ER',Flovent 220mcg, Lorazepam 0.5mg, Albuterol PRN, Aspirin 325mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: Vital Signs: T 97.8 HR 70 BP 182/97 -> 170/76 RR 18 O2 sat 97% on RA HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or [**Last Name (un) 549**] however heart sounds very distant. JVP=6cm LUNGS: CTAB except for decreased BS at bases b/l ABDOMEN: Firm and distended, NT, +BS EXTREMITIES: No edema. 2+ dorsalis pedis/ posterior tibial pulses. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. FAMILY HISTORY: Aunt- unknown type of cancer cousin- b/l breast cancer Mother/ father- heart disease SOCIAL HISTORY: Independent, lives at home alone and her husband recently passed away. Has brothers, nieces and nephews that live in the area. Denies tobacco, etoh or drug use. ### Response: {'Malignant neoplasm of ovary,Malignant ascites,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes,Secondary malignant neoplasm of other urinary organs,Adult failure to thrive,Nausea with vomiting,Unspecified essential hypertension,Other iatrogenic hypotension,Oliguria and anuria,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Osteoporosis, unspecified,Asthma, unspecified type, unspecified,Palpitations,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia,Other nonspecific abnormal serum enzyme levels'}

CHIEF COMPLAINT: lightheadedness PRESENT ILLNESS: 55 M h/o HTN, DM, dyslipidemia, CAD. Was in USOH until day of admit. States that he went to the bathroom to urinated, felt lightheaded. Sat on the ground. Denied head trauma or LOC. Summoned EMS who found him pale and diaphoretic, and with 1-2 seconds or jerking movements. FS in the field 543. Transferred to [**Hospital1 18**]. . In ED, noted to be tachycardic with a HR 122, BP 157/82. Initial ECG reportedly showed STD with TWI in v3-v5. First set of labs were remarkable for hyperglycemia and a mildly elevated WBC at 11.9, but without left shift. At 21:45, was noted to be hypotensive to the 60s. Dopamine was started and central venous access obtained. . Given concern for a primary cardiac process, a bedside TTE by ED staff was performed with concern for LV systolic dysfunction. Cardiology was called to repeat a bedside TTE. This examination showed no new WMA and overall preserved EF. A later echo [**Hospital1 3780**] RV pressure overload. . His early hospital course was notable for gradual slowing of his sinus tach in the low 100s down to sinus brady of high 40s with subsequent sinus arrest with junctional escape in 40s. He sustains this for a little over 1 minute and then a wide complex rhythm at a rate of 70s, and ultimately PEA arrest. . On ROS, pt states he has had 2 weeks of a nonproductive dry cough. No CP, SOB, n/v. Since earlier today, has had a "funny" feeling on left side, under rib cage. . MEDICAL HISTORY: 1) Coronary artery disease - medium, severe reversible defect on ETT-MIBI in [**2099-11-12**]; Subsequent cath showed TO in mid RCA, but failed PCI; Medically managed 2) Diabetes, Type 2 - Seen by Dr. [**Last Name (STitle) **] at the [**Hospital **] [**Hospital 982**] Clinic. 3) Hypertension 4) Hypercholesterolemia/hypertriglyceridemia 5) Sleep apnea - CPAP at 11 cm H2O overnight 6) Exercise-induced asthma 7) Gout 8) Erectile dysfunction 9) Obesity . <b>Past Surgical History 1) s/p R facial cystectomy (a sinus cyst), [**2092**] 2) s/p surgical removal bone spur (left fifth digit), [**2078**] 3) s/p surgery to correct dental overbite ca. [**2070**] 4) s/p appendectomy age 14 (of note, patient did not actually have appendicitis, but an infection of part of the bowel near the appendix that had the appearance of appendicitis on exam) MEDICATION ON ADMISSION: Actos 30 po qd Albuterol 2 puffs qid prn Aspirin 81mg qd Flovent 2 puffs [**Hospital1 **] Metformin 1000 po bid Glucotrol XL 10 po qd Metoprolol 12.5 po bid Prinivil 20 po qd Zocor 10 po qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission PE: VS - T 95.2, BP 111/84, HR 103, RR 27, O2 sat 100% NRB, Wt 105.5 kg General - middle-aged male, tachypneic, somnolent, but easily awakens to voice HEENT - PERRL, OP clr, no LAD CV - tachy, reg, no m/r/g Chest - CTAB Abdomen - soft; palpation over area of "funny feeling" without g/r; no CVAT Extremities - cool, no edema FAMILY HISTORY: Mother and father both had CAD and DM. Grandmother had DM. Father had prostate cancer. Two siblings, one with asthma and one with hyperthyroidism. No depression or alcoholism in the family. Other than what was described above, no known family history. SOCIAL HISTORY: Patient denies tobacco, alcohol, and illicit drug use. He admits to dietary indiscretion. He lives with his wife and daughter in [**Name (NI) 701**], MA. He works in the film industry; he retired from the company he worked for ten years ago and does freelance work now.

Other pulmonary embolism and infarction,Phlebitis and thrombophlebitis of deep veins of lower extremities, other,Pneumonia, organism unspecified,Pulmonary collapse,Cardiac arrest,Acidosis,Unspecified septicemia,Severe sepsis,Septic shock,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hematoma complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Tricuspid valve disorders, specified as nonrheumatic,Anemia of other chronic disease,Other and unspecified coagulation defects,Essential thrombocythemia,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Dysmetabolic syndrome X,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Gout, unspecified,Obesity, unspecified,Asthma, unspecified type, unspecified,Impotence of organic origin,Family history of ischemic heart disease,Family history of diabetes mellitus

Pulm embol/infarct NEC,Deep phlebitis-leg NEC,Pneumonia, organism NOS,Pulmonary collapse,Cardiac arrest,Acidosis,Septicemia NOS,Severe sepsis,Septic shock,Acute necrosis of liver,Ac kidny fail, tubr necr,Urin tract infection NOS,Hematoma complic proc,DMII wo cmp uncntrld,Nonrheum tricusp val dis,Anemia-other chronic dis,Coagulat defect NEC/NOS,Essntial thrombocythemia,Hypertension NOS,Long-term use anticoagul,Dysmetabolic syndrome x,Pure hypercholesterolem,Crnry athrscl natve vssl,Obstructive sleep apnea,Gout NOS,Obesity NOS,Asthma NOS,Impotence, organic orign,Fam hx-ischem heart dis,Fam hx-diabetes mellitus

Admission Date: [**2101-10-5**] Discharge Date: [**2101-10-29**] Date of Birth: [**2046-10-16**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 10370**] Chief Complaint: lightheadedness Major Surgical or Invasive Procedure: Resusitation with Advanced Cardiac Life Support Protocol Intubation Central line placement History of Present Illness: 55 M h/o HTN, DM, dyslipidemia, CAD. Was in USOH until day of admit. States that he went to the bathroom to urinated, felt lightheaded. Sat on the ground. Denied head trauma or LOC. Summoned EMS who found him pale and diaphoretic, and with 1-2 seconds or jerking movements. FS in the field 543. Transferred to [**Hospital1 18**]. . In ED, noted to be tachycardic with a HR 122, BP 157/82. Initial ECG reportedly showed STD with TWI in v3-v5. First set of labs were remarkable for hyperglycemia and a mildly elevated WBC at 11.9, but without left shift. At 21:45, was noted to be hypotensive to the 60s. Dopamine was started and central venous access obtained. . Given concern for a primary cardiac process, a bedside TTE by ED staff was performed with concern for LV systolic dysfunction. Cardiology was called to repeat a bedside TTE. This examination showed no new WMA and overall preserved EF. A later echo [**Hospital1 3780**] RV pressure overload. . His early hospital course was notable for gradual slowing of his sinus tach in the low 100s down to sinus brady of high 40s with subsequent sinus arrest with junctional escape in 40s. He sustains this for a little over 1 minute and then a wide complex rhythm at a rate of 70s, and ultimately PEA arrest. . On ROS, pt states he has had 2 weeks of a nonproductive dry cough. No CP, SOB, n/v. Since earlier today, has had a "funny" feeling on left side, under rib cage. . Past Medical History: 1) Coronary artery disease - medium, severe reversible defect on ETT-MIBI in [**2099-11-12**]; Subsequent cath showed TO in mid RCA, but failed PCI; Medically managed 2) Diabetes, Type 2 - Seen by Dr. [**Last Name (STitle) **] at the [**Hospital **] [**Hospital 982**] Clinic. 3) Hypertension 4) Hypercholesterolemia/hypertriglyceridemia 5) Sleep apnea - CPAP at 11 cm H2O overnight 6) Exercise-induced asthma 7) Gout 8) Erectile dysfunction 9) Obesity . <b>Past Surgical History 1) s/p R facial cystectomy (a sinus cyst), [**2092**] 2) s/p surgical removal bone spur (left fifth digit), [**2078**] 3) s/p surgery to correct dental overbite ca. [**2070**] 4) s/p appendectomy age 14 (of note, patient did not actually have appendicitis, but an infection of part of the bowel near the appendix that had the appearance of appendicitis on exam) Social History: Patient denies tobacco, alcohol, and illicit drug use. He admits to dietary indiscretion. He lives with his wife and daughter in [**Name (NI) 701**], MA. He works in the film industry; he retired from the company he worked for ten years ago and does freelance work now. Family History: Mother and father both had CAD and DM. Grandmother had DM. Father had prostate cancer. Two siblings, one with asthma and one with hyperthyroidism. No depression or alcoholism in the family. Other than what was described above, no known family history. Physical Exam: Admission PE: VS - T 95.2, BP 111/84, HR 103, RR 27, O2 sat 100% NRB, Wt 105.5 kg General - middle-aged male, tachypneic, somnolent, but easily awakens to voice HEENT - PERRL, OP clr, no LAD CV - tachy, reg, no m/r/g Chest - CTAB Abdomen - soft; palpation over area of "funny feeling" without g/r; no CVAT Extremities - cool, no edema Pertinent Results: ADMISSION HEMATOLOGY [**2101-10-5**] 09:40PM BLOOD WBC-11.9* RBC-5.52# Hgb-15.7# Hct-44.2# MCV-80* MCH-28.3 MCHC-35.4* RDW-14.0 Plt Ct-261 [**2101-10-6**] 09:14AM BLOOD WBC-12.0* RBC-5.04 Hgb-13.9* Hct-41.4 MCV-82 MCH-27.5 MCHC-33.5 RDW-14.1 Plt Ct-169 [**2101-10-6**] 01:50PM BLOOD WBC-16.2* RBC-4.51* Hgb-12.7* Hct-36.9* MCV-82 MCH-28.1 MCHC-34.3 RDW-14.7 Plt Ct-174 COAGULATION [**2101-10-5**] 09:40PM BLOOD PT-13.1 PTT-25.0 INR(PT)-1.1 [**2101-10-6**] 09:14AM BLOOD PT-16.8* PTT-31.9 INR(PT)-1.5* [**2101-10-6**] 01:50PM BLOOD PT-24.2* PTT-61.4* INR(PT)-2.4* CHEMISTRY [**2101-10-5**] 09:40PM BLOOD Glucose-514* UreaN-14 Creat-1.2 Na-135 K-4.2 Cl-97 HCO3-23 AnGap-19 [**2101-10-6**] 02:25AM BLOOD Glucose-734* UreaN-17 Creat-1.3* Na-134 K-6.1* Cl-102 HCO3-9* AnGap-29* [**2101-10-6**] 09:14AM BLOOD Glucose-546* UreaN-19 Creat-1.6* Na-136 K-5.6* Cl-108 HCO3-9* AnGap-25* [**2101-10-6**] 01:50PM BLOOD Glucose-523* UreaN-22* Creat-1.9* Na-142 K-4.3 Cl-108 HCO3-17* AnGap-21 LIVER TESTS [**2101-10-6**] 02:25AM BLOOD ALT-72* AST-168* LD(LDH)-325* CK(CPK)-82 AlkPhos-170* Amylase-20 TotBili-0.9 [**2101-10-6**] 01:50PM BLOOD ALT-799* AST-2063* LD(LDH)-2087* AlkPhos-140* Amylase-41 TotBili-1.1 [**2101-10-6**] 05:35PM BLOOD ALT-1331* AST-4240* LD(LDH)-2845* CK(CPK)-184* AlkPhos-132* Amylase-42 TotBili-0.9 [**2101-10-6**] 10:58PM BLOOD ALT-1480* AST-5072* LD(LDH)-3300* CK(CPK)-231* AlkPhos-123* Amylase-49 TotBili-0.6 [**2101-10-7**] 03:45AM BLOOD ALT-1461* AST-4434* CK(CPK)-298* AlkPhos-115 TotBili-0.6 CARDIAC ENZYMES [**2101-10-5**] 09:40PM BLOOD cTropnT-0.06* [**2101-10-6**] 02:25AM BLOOD CK-MB-NotDone cTropnT-0.16* [**2101-10-6**] 09:14AM BLOOD CK-MB-9 cTropnT-0.24* [**2101-10-6**] 05:35PM BLOOD CK-MB-8 cTropnT-0.56* [**2101-10-6**] 10:58PM BLOOD CK-MB-8 cTropnT-0.70* ARTERIAL BLOOD GAS [**2101-10-5**] 11:20PM BLOOD Type-ART pO2-192* pCO2-32* pH-7.23* calTCO2-14* Base XS--13 [**2101-10-6**] 02:35AM BLOOD Type-ART Temp-35.3 pO2-239* pCO2-33 pH-7.13* calTCO2-12* Base XS--17 [**2101-10-6**] 11:08AM BLOOD Type-ART pO2-72* pCO2-92* pH-6.97* calTCO2-23 Base XS--13 [**2101-10-6**] 11:30AM BLOOD Type-ART Rates-30/ Tidal V-650 PEEP-5 FiO2-100 pO2-79* pCO2-61* pH-6.99* calTCO2-16* Base XS--18 AADO2-596 REQ O2-95 -ASSIST/CON Intubat-INTUBATED [**2101-10-6**] 12:18PM BLOOD Type-ART Temp-37.3 Rates-34/ Tidal V-700 PEEP-5 FiO2-100 pO2-124* pCO2-45 pH-7.14* calTCO2-16* Base XS--13 AADO2-567 REQ O2-91 -ASSIST/CON Intubat-INTUBATED LACTATE [**2101-10-5**] 10:56PM BLOOD Lactate-4.5* [**2101-10-5**] 11:20PM BLOOD Lactate-5.1* [**2101-10-6**] 02:35AM BLOOD Lactate-8.3* [**2101-10-6**] 04:08AM BLOOD Lactate-7.3* SPEP [**2101-10-21**] 08:46AM BLOOD PEP-TRACE ABNO IgG-1440 IgA-393 IgM-82 IFE-TRACE MONO URINE [**2101-10-20**] 02:09PM URINE RBC-21-50* WBC-[**2-14**] Bacteri-OCC Yeast-NONE Epi-0-2 [**2101-10-6**] 05:36PM URINE RBC-[**2-14**]* WBC-[**5-22**]* Bacteri-MANY Yeast-NONE Epi-0 DISCHARGE [**2101-10-29**] 06:58AM BLOOD WBC-6.5 RBC-3.16* Hgb-8.8* Hct-25.6* MCV-81* MCH-27.7 MCHC-34.2 RDW-15.1 Plt Ct-462* [**2101-10-29**] 06:58AM BLOOD Glucose-106* UreaN-18 Creat-1.8* Na-140 K-4.0 Cl-105 HCO3-22 AnGap-17 [**2101-10-24**] 06:45AM BLOOD ALT-20 AST-17 AlkPhos-112 TotBili-0.6 [**2101-10-29**] 06:58AM BLOOD Calcium-9.3 Phos-4.1 Mg-1.8 PERTINENT STUDIES ECHO [**2101-10-5**] The left atrium is normal in size. There is severe symmetric left ventricular hypertrophy. The left ventricular cavity is unusually small. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricular cavity is moderately dilated. There is focal basal right ventricular free wall hypokinesis with preservation of apical motion ([**Last Name (un) **] sign is present). There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The descending thoracic aorta is moderately dilated. The mitral valve leaflets are mildly thickened. There is no systolic anterior motion of the mitral valve leaflets. Mild (1+) mitral regurgitation is seen. Moderate to severe [3+] tricuspid regurgitation is seen. There is a trivial/physiologic pericardial effusion. IMPRESSION: Right ventricular basal hypokinesis with pressure and volume overload, consistent with hemodynamically significant PE. Severe left ventricular hypertrophy and small chamber size indicate decreased preload. CTA [**2101-10-7**] FINDINGS: Endotracheal tube tip is positioned at the carina. There is a left-sided central venous catheter terminating in the mid SVC. Orogastric tube courses through the field of view to terminate below the diaphragm. There are bilateral large central pulmonary emboli involving left upper, left lower, right upper, and right lower lobes. There is also collapse of the apical segment of the right upper lobe. Focal area of parenchymal airspace density is seen within the left upper lobe, which may reflect a developing pneumonia. There are small bibasilar pleural effusions and associated atelectasis as well. The heart is enlarged. No pneumothorax. There is extensive subcutaneous edema and enlargement of the pectoralis muscles anteriorly, right greater than left. This may be due to recent attempted line placement. No focal hematoma is seen. IMPRESSION: Large burden of pulmonary emboli involving all major segmental arteries. Segmental collapse of the apical segment/right upper lobe. Bronchoscopy may be of assistance in re-aeration. Possible small area of developing pneumonia in the left upper lobe. MRI [**2101-10-25**] OF BRACHIAL PLEXUS MRI OF THE BRACHIAL PLEXUS: A marker was placed on the skin overlying the site of palpable abnormality in the region of the right mid clavicle. Abnormal ill-defined heterogeneous signal is seen within the subcutaneous tissues immediately underlying the skin marker, and surrounding the mid right clavicle. This signal abnormality is isointense with respect to the skeletal muscle on T1-weighted images, and minimally hyperintense with respect to the skeletal muscle on T2-weighted images. This abnormal signal nearly completely surrounds the mid clavicle, including the anterior and posterior aspects, and likely represents resolving hematoma and scarring. There is apparent associated tethering of adjacent tissue structures by the resolving hematoma and scarring, most pronounced in the mid-retroclavicular area, where the right brachial plexus structures appear to be focally tethered anteriorly and somewhat kinked (series 9, image 19). The brachial plexus fibers otherwise are intact and unremarkable, without nodularity, clumping, or abnormal signal within the fibers themselves. The left brachial plexus structures are normal. No clumping, nodularity, deformity, or extrinsic mass effect is seen upon the fibers of the left brachial plexus. Within the left inferior sternocleidomastoid muscle (series 8, image 15), abnormal foci of high signal on T1- and T2-weighted images spanning an area of 2.1 x 1.4 cm are [**Month/Day/Year 3780**] within the muscle, likely represent resolving hemorrhage. Aorta and visualized vascular structures appear normal. No other mediastinal lesions are [**Month/Day/Year 3780**]. Visualized osseous structures are normal in signal intensity and morphology. No right clavicular fracture is identified. IMPRESSION: 1. Abnormal signal surrounding the mid right clavicle likely represents resolving hematoma and early scarring. There is adjacent focal tethering of the right brachial plexus structures as a result of this resolving hematoma/scarring, but the remainder of the brachial plexus appears intact and unremarkable. 2. Resolving small intramuscular hematoma within the left inferior sternocleidomastoid muscle Brief Hospital Course: PULMONARY EMBOLUS / SHOCK Pt with suspected PE as shown by RV dilation on Echo with decreased LF volume. Further supported by L [**Doctor Last Name **] thrombus shown on LENI. Was given thrombolysis with TPA during PEA arrest, and EKG shows subsequent improvment. After arrest, pt recieved artic sun, which ended on [**10-7**]. PE was confirmed with chest CT. Cardiac Enzymes were initially elevated after arrest, but began to trend down. In concern for septic shock given residual low blood pressures, antibiotics were initially given, and stopped after diagnosis of PE was confirmed. They were restarted out of concern for penumonia, and then stoped again after 3-5 days when no cultures were positive. Pulmonary was consulted and did not recommend an IVC filter at this time as his clot burden was predominantly pulmonary. The patient will need a repeat ECHO in 6 months. A hypercoagulability workup could be considered in the future, but given likely continuous anticoagulation, it is not expected to change management. Lupus AC and Anti Cardiolipin AB were wnl. The patient was anticoagulated with heparin and bridged to coumadin with an INR goal of [**1-15**]. His hematocrit and coagulation factors were followed daily, but with discontinuation of heparin his INR became subtherapeutic. He was then continued on an increased dose of coumadin along with lovenox. At the time of discharge, the INR was 1.7 while taking lovenox. He was instructed to continue with the coumadin and lovenox at home. A plan was made for follow-up in [**Hospital 191**] [**Hospital **] clinic. . RESPIRATORY FAILURE The patient was intubated secondary to metabolic acidosis, VQ mismatch and hypotension. Over time, he showed signs of improving pulmonary perfusion and decreasing dead space. Serial chest x-rays were performed showing improvement of a collapsed lung and decreasing pulmonary infiltrate. The patient was extubated on [**10-11**] and weaned from supplemental oxygen on [**10-16**]. For the remainder of his stay, the patient was provided Albuterol and Ipratropium nebulizers as needed for chest tightness and encouraged to use incentive spirometry. Pulmonary followed him throughout his hospitalization. . ACUTE RENAL FAILURE The patient experienced acute kindey injury secondary to shock. He was temporarily oliguric, with a Creatinine peak to 5.8. Renal was consulted, his urine increased output and renal function was monitored daily, and all of his medications were renally dosed. His creatinine fell to 1.8 at the time of discharge. . ALTERED MENTAL STATUS Post arrest, the patient had minimal return of cognition with sedation ween. A CT of the head was negative. During extubation, sedatives were weened from fentanyl and midazolam to propofol. The patient continued to have delay in return to baseline mental status until transfer to the floor at which point he became increasingly more alert, focused and attentive. Based on close observation, the patient does not demonstrate any cognitive or behavioral sequelae from his anoxic period. The patient received a perfect score on the mini-mental status exam on [**10-21**]. . COAGULOPATHY The patient experienced coagulopathy and thrombocytopenia secondary to tPA and heparin in the MICU. Hematology was consulted and platelets improved. His PT and PTT continue to be prolonged in the context of heparin/coumadin therapy. . HYPERTENSION The patient's systolic blood pressure was initially elevated in the MICU secondary to sedation ween and extubation. It was controlled with IV metoprolol and hydralazine. After arriving on the floor, the patient was switched to oral Labetalol in the context of continued hypertension, reaching relatively stable blood pressure control at 400mg [**Hospital1 **]. Given desire to transition the patient back to his home medication, he was transitioned to oral Metoprolol 50mg [**Hospital1 **] per pharmacy's suggestion on [**10-20**] and Amlodipine 10mg/day. If and when the patient's kidney function returns to baseline or stabilizes at a new one, one could consider adding an ACE inibitor given his diabetes. DIABETES The patient has had diabetes for over 15 years and has managed his blood sugars at home with glucophage, actos, and glucotrol. He is seen by Dr. [**Last Name (STitle) **] at the [**Hospital **] [**Hospital 982**] Clinic. As an inpatient, Mr. [**Known lastname 100510**] [**Last Name (Titles) 3780**] elevated blood glucose values likely due to acute on chronic insulin resistance. Initially, he was treated with an insulin drip and transitioned to Lantus nightly with sliding scale [**First Name8 (NamePattern2) **] [**Last Name (un) 9718**] recommendations. He was discharged on insulin and not on his oral agents. . LEUKOCYTOSIS ?UTI The patient's white blood cell count became elevated after transfer to the floor, peaking at 15.0 on [**10-18**]. He was also found to have a positive urine analysis at this time and was placed on Augmentin 500 [**Hospital1 **] for 1 week given concern for urinary tract infection and the effect of conventional UTI therapy on INR levels. A final urine culture was found to be negative and there were no signs of infection at discharge. . ANEMIA The patient has had a low hematocrit since admission, reaching a low of 23.6 on [**10-27**]. His mean corpuscular volume was borderline low and iron studies were consistent with a mixed iron deficiency anemia and anemia of inflammation. A reticulocyte count was found to be appropriate for his anemia and the patient was placed on supplemental iron. His hematocrit is currently stable. CAD MANAGEMENT The patient had a cardiac catheterization in [**11-16**] that showed total occlusion in the mid-right coronary artery and an angioplasty attempt during procedure was unsuccessful. The patient has been medically managed since then on Metoprolol, Aspirin, Zocor, and Prinivil and despite the pathology seen on cardiac cath, has remained clinically stable. The patient's statin was held in the context of shock liver. His liver enzymes returned to [**Location 213**] on [**10-20**] and his Zocor was resumed at that time. GOUT FLARE The patient has a history of gout that has been exacerbated by aspirin that he takes for his heart. He takes ibuprofen, naproxen, and indomethacin for pain control. As an inpatient, Mr. [**Known lastname 100510**] experienced new foot and ankle pain and was initially given Prednisone 30mg daily with resolution of the pain. His home regimen was held in the context of renal dysfunction. After two days, Mr. [**Known lastname 100510**] was then transitioned to Colchicine, renally dosed and finally to Allopurinol. His pain remained well-controlled for the remainder of his stay. OBSTRUCTIVE SLEEP APNEA The patient was diagnosed with obstructive sleep apnea in [**2099**] [**4-17**] and maintained on CPAP at 11 cm of water pressure using a ResMed UltraMirage full facemask. Patient uses CPAP nightly at home. His CPAP was initially held in the hospital per pt request, but patient resumed CPAP on [**10-26**] until discharge. ** FOR OUTPATIENT FOLLOW-UP ** CTA OR V/Q in 6 mo ECHOCARDIGRAM in 6 mo ([**4-19**]) Medications on Admission: Actos 30 po qd Albuterol 2 puffs qid prn Aspirin 81mg qd Flovent 2 puffs [**Hospital1 **] Metformin 1000 po bid Glucotrol XL 10 po qd Metoprolol 12.5 po bid Prinivil 20 po qd Zocor 10 po qd Discharge Medications: 1. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. Disp:*1 * Refills:*0* 2. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. Disp:*1 * Refills:*0* 3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 6. Sevelamer 400 mg Tablet Sig: Three (3) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet(s)* Refills:*2* 7. Lantus 100 unit/mL Solution Sig: Sixteen (16) units nightly Subcutaneous at bedtime. Disp:*2 vials* Refills:*0* 8. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itching. Disp:*1 bottle* Refills:*1* 9. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 11. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 12. Warfarin 5 mg Tablet Sig: Two (2) Tablet PO at bedtime. Disp:*60 Tablet(s)* Refills:*2* 13. Humalog 100 unit/mL Solution Sig: Sliding Scale units Subcutaneous qAC+HS. Disp:*2 vials* Refills:*2* 14. Enoxaparin 100 mg/mL Syringe Sig: One Hundred (100) mg Subcutaneous Q12H (every 12 hours) for 7 days. Disp:*1400 mg* Refills:*1* 15. Outpatient [**Name (NI) **] Work PT/INR Daily or [**Name8 (MD) **] MD 16. Omeprazole 20 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* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: Primary: Pulmonary Embolism/Venothromboembolic Disease, Respiratory Failure Secondary: Acute Renal Failure, Coronary Artery Disease, Hypercholesterolemia, Hypertension, Diabetes, Gout, Urinary Tract Infection, Anemia, Obstructive Sleep Apnea, Asthma Discharge Condition: Improved, with stable vital signs and O2 sat >98% on room air. Discharge Instructions: You were admitted on [**2101-10-5**] for lightheadedness, and found to have a pulmonary embolism, a blood clot that had traveled from your leg to your lung. You were treated in the intensive care unit, where you had a cardiac arrest requiring resuscitation. You developed kidney problems as a result of this, with some degree of recovery at discharge. The treatment of the blood clot consisted of blood thinners called heparin and coumadin. Heparin was changed to Enoxaparin and you will remain on both Coumadin and Enoxaparin. . Your medications have changed. Please review your list carefully. Your actos, metformin, glucotrol XL were replaced by insulin. Your metoprolol was increased to 50mg three times daily. You were also started amlodipine 10.0mg daily for blood pressure. Your prinivil (lisinopril) was stopped while your kidneys are recovering. You were started on coumadin and enoxaparin for blood thinning, and will need to follow-up with the [**Hospital3 **] at [**Hospital3 **] after your discharge from rehab. You were started on sevelamer to protect against a high phosphate concentration in your blood. . If you develop repeat shortness of breath, similar lightheadedness, fever, decreased urine volume, or other concerning symptoms, please return to the hospital. Followup Instructions: CT Angiogram or V/Q scan in 6 months Pulmonary Follow-up: Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2101-11-29**] 9:40 Provider: [**Name10 (NameIs) 1570**],INTERPRET W/[**Name10 (NameIs) **] NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION BILLING Date/Time:[**2101-11-29**] 10:00 Provider: [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2101-11-29**] 10:00 [**Hospital **] [**Hospital 982**] Clinic, Dr. [**Last Name (STitle) 978**] & Dr. [**Last Name (STitle) **] Primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5717**] [**Telephone/Fax (1) 250**]

415,451,486,518,427,276,038,995,785,570,584,599,998,250,424,285,286,238,401,V586,277,272,414,327,274,278,493,607,V173,V180

{'Other pulmonary embolism and infarction,Phlebitis and thrombophlebitis of deep veins of lower extremities, other,Pneumonia, organism unspecified,Pulmonary collapse,Cardiac arrest,Acidosis,Unspecified septicemia,Severe sepsis,Septic shock,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hematoma complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Tricuspid valve disorders, specified as nonrheumatic,Anemia of other chronic disease,Other and unspecified coagulation defects,Essential thrombocythemia,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Dysmetabolic syndrome X,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Gout, unspecified,Obesity, unspecified,Asthma, unspecified type, unspecified,Impotence of organic origin,Family history of ischemic heart disease,Family history of diabetes mellitus'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: lightheadedness PRESENT ILLNESS: 55 M h/o HTN, DM, dyslipidemia, CAD. Was in USOH until day of admit. States that he went to the bathroom to urinated, felt lightheaded. Sat on the ground. Denied head trauma or LOC. Summoned EMS who found him pale and diaphoretic, and with 1-2 seconds or jerking movements. FS in the field 543. Transferred to [**Hospital1 18**]. . In ED, noted to be tachycardic with a HR 122, BP 157/82. Initial ECG reportedly showed STD with TWI in v3-v5. First set of labs were remarkable for hyperglycemia and a mildly elevated WBC at 11.9, but without left shift. At 21:45, was noted to be hypotensive to the 60s. Dopamine was started and central venous access obtained. . Given concern for a primary cardiac process, a bedside TTE by ED staff was performed with concern for LV systolic dysfunction. Cardiology was called to repeat a bedside TTE. This examination showed no new WMA and overall preserved EF. A later echo [**Hospital1 3780**] RV pressure overload. . His early hospital course was notable for gradual slowing of his sinus tach in the low 100s down to sinus brady of high 40s with subsequent sinus arrest with junctional escape in 40s. He sustains this for a little over 1 minute and then a wide complex rhythm at a rate of 70s, and ultimately PEA arrest. . On ROS, pt states he has had 2 weeks of a nonproductive dry cough. No CP, SOB, n/v. Since earlier today, has had a "funny" feeling on left side, under rib cage. . MEDICAL HISTORY: 1) Coronary artery disease - medium, severe reversible defect on ETT-MIBI in [**2099-11-12**]; Subsequent cath showed TO in mid RCA, but failed PCI; Medically managed 2) Diabetes, Type 2 - Seen by Dr. [**Last Name (STitle) **] at the [**Hospital **] [**Hospital 982**] Clinic. 3) Hypertension 4) Hypercholesterolemia/hypertriglyceridemia 5) Sleep apnea - CPAP at 11 cm H2O overnight 6) Exercise-induced asthma 7) Gout 8) Erectile dysfunction 9) Obesity . <b>Past Surgical History 1) s/p R facial cystectomy (a sinus cyst), [**2092**] 2) s/p surgical removal bone spur (left fifth digit), [**2078**] 3) s/p surgery to correct dental overbite ca. [**2070**] 4) s/p appendectomy age 14 (of note, patient did not actually have appendicitis, but an infection of part of the bowel near the appendix that had the appearance of appendicitis on exam) MEDICATION ON ADMISSION: Actos 30 po qd Albuterol 2 puffs qid prn Aspirin 81mg qd Flovent 2 puffs [**Hospital1 **] Metformin 1000 po bid Glucotrol XL 10 po qd Metoprolol 12.5 po bid Prinivil 20 po qd Zocor 10 po qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission PE: VS - T 95.2, BP 111/84, HR 103, RR 27, O2 sat 100% NRB, Wt 105.5 kg General - middle-aged male, tachypneic, somnolent, but easily awakens to voice HEENT - PERRL, OP clr, no LAD CV - tachy, reg, no m/r/g Chest - CTAB Abdomen - soft; palpation over area of "funny feeling" without g/r; no CVAT Extremities - cool, no edema FAMILY HISTORY: Mother and father both had CAD and DM. Grandmother had DM. Father had prostate cancer. Two siblings, one with asthma and one with hyperthyroidism. No depression or alcoholism in the family. Other than what was described above, no known family history. SOCIAL HISTORY: Patient denies tobacco, alcohol, and illicit drug use. He admits to dietary indiscretion. He lives with his wife and daughter in [**Name (NI) 701**], MA. He works in the film industry; he retired from the company he worked for ten years ago and does freelance work now. ### Response: {'Other pulmonary embolism and infarction,Phlebitis and thrombophlebitis of deep veins of lower extremities, other,Pneumonia, organism unspecified,Pulmonary collapse,Cardiac arrest,Acidosis,Unspecified septicemia,Severe sepsis,Septic shock,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hematoma complicating a procedure,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Tricuspid valve disorders, specified as nonrheumatic,Anemia of other chronic disease,Other and unspecified coagulation defects,Essential thrombocythemia,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Dysmetabolic syndrome X,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Gout, unspecified,Obesity, unspecified,Asthma, unspecified type, unspecified,Impotence of organic origin,Family history of ischemic heart disease,Family history of diabetes mellitus'}

CHIEF COMPLAINT: Difficulty Breathing PRESENT ILLNESS: This is a 70 year-old male with a history of prostate cancer who presents with rapid onset of difficulty breathing with c/o tight neck starting at the morning of the day of admission. Given progressive worsening of symptoms, pt called EMS who brought him to the ED on 100% NRB mask. In the [**Name (NI) **] pt got Benadryl, steroids and H2 blocker, with initial improvement of symptoms (subjective and stridor) but than during HPI/PE sudden deterioration with respiratory arrest (lenght 1 min per ED resident). He was intubated ( was difficult intubation, cords not visualized, bujy was used, desated to 80s). During his stay worsening neck edema with obviouse swelling. He Had CT done, prelim verbal report consistent with multifocal PNA, vs aspiration PNA. CT neck w/o contrast and not revieling. He was given vanco/zosyn. and send to ICU. . ROS: limited given pt intubated: denies recent fever or cough, never had an episode like this no food allergies, started new blood pressure medication 2 weeks ago MEDICAL HISTORY: HTN Prostate ca MEDICATION ON ADMISSION: Lisinopril 10 mg Verapamil 240mg XR ALLERGIES: Lisinopril PHYSICAL EXAM: Vitals: T: BP: 135/85 HR: 70 RR: 21 O2Sat: 100% on AC GEN: intubated and sedated, dishelved HEENT: sclera anicteric, no epistaxis or rhinorrhea, MMM, poor status and loose dentition. NECK: No JVD, no bruits, no cervical lymphadenopathy, trachea, edematouse with keloid around neck, no obviouse trauma. COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords, old surgical scars, ? fused ankle FAMILY HISTORY: Unable to obtain on admission SOCIAL HISTORY: Unable to obtain on admission

Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acidosis,Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate

Acute respiratry failure,Food/vomit pneumonitis,Acidosis,Angioneurotic edema,Adv eff cardiovasc NEC,Cardiac dysrhythmias NEC,Hypertension NOS,Hx-prostatic malignancy

Admission Date: [**2203-10-29**] Discharge Date: [**2203-11-3**] Date of Birth: [**2133-10-11**] Sex: M Service: MEDICINE Allergies: Lisinopril Attending:[**First Name3 (LF) 1257**] Chief Complaint: Difficulty Breathing Major Surgical or Invasive Procedure: Mechanical Ventillation History of Present Illness: This is a 70 year-old male with a history of prostate cancer who presents with rapid onset of difficulty breathing with c/o tight neck starting at the morning of the day of admission. Given progressive worsening of symptoms, pt called EMS who brought him to the ED on 100% NRB mask. In the [**Name (NI) **] pt got Benadryl, steroids and H2 blocker, with initial improvement of symptoms (subjective and stridor) but than during HPI/PE sudden deterioration with respiratory arrest (lenght 1 min per ED resident). He was intubated ( was difficult intubation, cords not visualized, bujy was used, desated to 80s). During his stay worsening neck edema with obviouse swelling. He Had CT done, prelim verbal report consistent with multifocal PNA, vs aspiration PNA. CT neck w/o contrast and not revieling. He was given vanco/zosyn. and send to ICU. . ROS: limited given pt intubated: denies recent fever or cough, never had an episode like this no food allergies, started new blood pressure medication 2 weeks ago Past Medical History: HTN Prostate ca Social History: Unable to obtain on admission Family History: Unable to obtain on admission Physical Exam: Vitals: T: BP: 135/85 HR: 70 RR: 21 O2Sat: 100% on AC GEN: intubated and sedated, dishelved HEENT: sclera anicteric, no epistaxis or rhinorrhea, MMM, poor status and loose dentition. NECK: No JVD, no bruits, no cervical lymphadenopathy, trachea, edematouse with keloid around neck, no obviouse trauma. COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords, old surgical scars, ? fused ankle Pertinent Results: Admission Labs: [**2203-10-29**] 01:50AM WBC-10.9 RBC-4.56* HGB-13.0* HCT-38.4* MCV-84 MCH-28.5 MCHC-33.9 RDW-15.0 [**2203-10-29**] 01:50AM NEUTS-56.8 LYMPHS-34.2 MONOS-4.5 EOS-4.1* BASOS-0.4 [**2203-10-29**] 01:50AM PLT COUNT-370 [**2203-10-29**] 02:50AM PT-13.9* PTT-29.1 INR(PT)-1.2* [**2203-10-29**] 01:50AM GLUCOSE-94 UREA N-15 CREAT-0.8 SODIUM-140 POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-22 ANION GAP-16 [**2203-10-29**] 03:00AM LACTATE-4.5* [**2203-10-29**] 10:22AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2203-10-29**] 10:22AM ALT(SGPT)-11 AST(SGOT)-18 LD(LDH)-180 ALK PHOS-104 TOT BILI-0.4 . CT NECK: ([**10-29**]) IMPRESSION: 1. No abscess or fluid collection in the neck. 2. Multifocal airspace opacification; see separately reported chest CT. 3. Ethmoidal sinus opacification likely due to underlying mucosal sinus disease. . CT CHEST: ([**10-29**]) IMPRESSION: 1. No pulmonary embolus or aortic dissection. 2. Multifocal pneumonia or aspiration in both upper and lower lobes bilaterally. Brief Hospital Course: 70 year-old male with a history of prostate cancer, HTN, and recent addition of lisinopril to verapamil presents with acute airway obstruction related to angioedema. Once intubated the patient responded to the combination of steroids/benadryl/H2 blocker over the course of a few days. He was then extubated and transferred to floor. At the time of dischgarge from the hospital the C1 Esterase was still pending. . # Aspiration PNA: While the pateint was afebrile without leuckocytosis or apparent increase in sputum production, the patient's CT was very suggestive of aspiration PNA. The team decided to empirically treat based on the CT findings with Ceftaz/Flagyl, this was later changed to Clindamycin for better anaerobic coverage. He will finish additional 3 days of Clindamycin. . # Bradycardia: His HR was in mid 40's with stable SBP once placed on propofol. EKG with QTc 487. This improved to HR to 50s-70s once extubated and the propofol was d/c'd. The patient was placed on his home dose of Verapamil SR 240mg q day the night following extubation and once again became bradycardiac to the 50s. This was stopped and he was placed on HCTZ AND NORVASC. Heart rate is better. He is completely asymptomatic even with activity with PT/OT. . # HTN: Held ace and verapamil initially, and following extubation the patient was restarted on his home verapamil dose. Howeve,r in the setting of bradycardia this was transitioned to PO Amlodipine and HCTZ. . # Dentition: Pt with extremely poor dentition and noted to have teeth found in the patients bed upon arrival to the floor. No evidence of tooth aspiration on imaging. . . . . total discharge time 67 minutes. Medications on Admission: Lisinopril 10 mg Verapamil 240mg XR Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) for 3 days. Disp:*24 Capsule(s)* Refills:*0* 4. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 2 days. Disp:*2 Tablet(s)* Refills:*0* 5. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) for 1 months. Disp:*30 Tablet(s)* Refills:*1* 6. Hydrochlorothiazide 12.5 mg Tablet Sig: One (1) Tablet PO once a day for 1 months. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Angioedema related to Lisinopril. acute respiratory failure related to angioedema aspiration pneumonia Discharge Condition: Excellent Discharge Instructions: Avoid group of medications called ACEi including lisinopril as you are allergic to it. We stopped your Verapamil as well because of slow heart beats. we started nw blood pressure medications. please see your PCP to adjust them soon. Followup Instructions: [**Last Name (LF) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 6820**]

518,507,276,995,E942,427,401,V104

{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acidosis,Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Difficulty Breathing PRESENT ILLNESS: This is a 70 year-old male with a history of prostate cancer who presents with rapid onset of difficulty breathing with c/o tight neck starting at the morning of the day of admission. Given progressive worsening of symptoms, pt called EMS who brought him to the ED on 100% NRB mask. In the [**Name (NI) **] pt got Benadryl, steroids and H2 blocker, with initial improvement of symptoms (subjective and stridor) but than during HPI/PE sudden deterioration with respiratory arrest (lenght 1 min per ED resident). He was intubated ( was difficult intubation, cords not visualized, bujy was used, desated to 80s). During his stay worsening neck edema with obviouse swelling. He Had CT done, prelim verbal report consistent with multifocal PNA, vs aspiration PNA. CT neck w/o contrast and not revieling. He was given vanco/zosyn. and send to ICU. . ROS: limited given pt intubated: denies recent fever or cough, never had an episode like this no food allergies, started new blood pressure medication 2 weeks ago MEDICAL HISTORY: HTN Prostate ca MEDICATION ON ADMISSION: Lisinopril 10 mg Verapamil 240mg XR ALLERGIES: Lisinopril PHYSICAL EXAM: Vitals: T: BP: 135/85 HR: 70 RR: 21 O2Sat: 100% on AC GEN: intubated and sedated, dishelved HEENT: sclera anicteric, no epistaxis or rhinorrhea, MMM, poor status and loose dentition. NECK: No JVD, no bruits, no cervical lymphadenopathy, trachea, edematouse with keloid around neck, no obviouse trauma. COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords, old surgical scars, ? fused ankle FAMILY HISTORY: Unable to obtain on admission SOCIAL HISTORY: Unable to obtain on admission ### Response: {'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acidosis,Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}

CHIEF COMPLAINT: Left cerebellar stroke PRESENT ILLNESS: The patient is a 52 year-old male with a h/o HTN, diabetes transferred from [**Hospital3 **] intubated with a diagnosis of left cerebellar hemorrhage. Per transfer report, he presented to the emergency room per EMS after vomiting at home coffee ground emesis with sudden onset severe occipital headache. During transport, he was noted to have SBPs in the 200s. While in the emergency room, he vomited coffee ground emesis and an NGT was placed with return of 200cc of coffee ground emesis. He was noted to have difficulty controlling his left arm, unable to do LUE finger to nose with expressive aphasia and left sided facial droop. Following a CT scan of the head which demonstrated a large cerebellar hemorrhage with mass effect on the 4th ventricle, the patient became increasing dyspneic and agitated and was intubated for blood pressure control and airway control. Tox screen was negative. In the emergency room on presentation, he had spontaneous movement of his LUE and withdrawal to noxious stimuli of BLE without movement of his RUE. Gag reflex intact. He was transfered to the ICU. MEDICAL HISTORY: - HTN - DM - Asthma - Alcoholism (although pt's brother does not think he has had anything to drink for years, unaware of whether pt had DTs, szs, etc) - Chronic abdominal distress MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: BP:151/100 HR:111 RR:21 O2Sats: 100 on vent Gen: NAD, intubated and sedated on propofol. HEENT: Pupils: PERL, EOMs unable to be assessed. Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Unable to assess. Orientation: Unable to assess. Recall: Unable to assess. Language: Unable to assess. Naming intact. Unable to assess. FAMILY HISTORY: FAMILY HISTORY: - negative for seizure, stroke - positive for heart disease, DM (father) SOCIAL HISTORY: 7SOCIAL HISTORY: - lives with wife who is Chinese (speaks [**Name (NI) 8230**]) and their 3 year-old son [**Name (NI) **] - serves as a boss of parking garages

Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Aphasia,Hematemesis,Chronic obstructive asthma with (acute) exacerbation,Disruption of external operation (surgical) wound,Lack of coordination,Dysphagia, oropharyngeal phase,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Esophagitis, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Alcohol abuse, in remission

Intracerebral hemorrhage,Compression of brain,Acute respiratry failure,Aphasia,Hematemesis,Ch obst asth w (ac) exac,Disrup-external op wound,Lack of coordination,Dysphagia, oropharyngeal,Muscskel sympt limb NEC,Hypertension NOS,DMII wo cmp uncntrld,Long-term use of insulin,Esophagitis, unspecified,Abn react-surg proc NEC,Alcohol abuse-in remiss

Admission Date: [**2201-2-13**] Discharge Date: [**2201-2-23**] Date of Birth: [**2139-8-7**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1271**] Chief Complaint: Left cerebellar stroke Major Surgical or Invasive Procedure: [**2201-2-13**]: Emergent Suboccipital decompressive craniotomy [**2201-2-20**]: PEG History of Present Illness: The patient is a 52 year-old male with a h/o HTN, diabetes transferred from [**Hospital3 **] intubated with a diagnosis of left cerebellar hemorrhage. Per transfer report, he presented to the emergency room per EMS after vomiting at home coffee ground emesis with sudden onset severe occipital headache. During transport, he was noted to have SBPs in the 200s. While in the emergency room, he vomited coffee ground emesis and an NGT was placed with return of 200cc of coffee ground emesis. He was noted to have difficulty controlling his left arm, unable to do LUE finger to nose with expressive aphasia and left sided facial droop. Following a CT scan of the head which demonstrated a large cerebellar hemorrhage with mass effect on the 4th ventricle, the patient became increasing dyspneic and agitated and was intubated for blood pressure control and airway control. Tox screen was negative. In the emergency room on presentation, he had spontaneous movement of his LUE and withdrawal to noxious stimuli of BLE without movement of his RUE. Gag reflex intact. He was transfered to the ICU. Past Medical History: - HTN - DM - Asthma - Alcoholism (although pt's brother does not think he has had anything to drink for years, unaware of whether pt had DTs, szs, etc) - Chronic abdominal distress Social History: 7SOCIAL HISTORY: - lives with wife who is Chinese (speaks [**Name (NI) 8230**]) and their 3 year-old son [**Name (NI) **] - serves as a boss of parking garages Family History: FAMILY HISTORY: - negative for seizure, stroke - positive for heart disease, DM (father) Physical Exam: On Admission: BP:151/100 HR:111 RR:21 O2Sats: 100 on vent Gen: NAD, intubated and sedated on propofol. HEENT: Pupils: PERL, EOMs unable to be assessed. Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Unable to assess. Orientation: Unable to assess. Recall: Unable to assess. Language: Unable to assess. Naming intact. Unable to assess. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, to [**2-10**] and 3-2 mm bilaterally. Unable to assess visual fields. III, IV, VI: Unable to assess. V, VII: Unable to assess. VIII: Unable to assess. IX, X: Palatal elevation symmetrical. Gag reflex intact. [**Doctor First Name 81**]: Unable to assess. XII: Unable to assess. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Unable to assess strength. Sensation: Unable to assess. On Discharge: Alert and oriented x3. Left facial droop. PERRL, EOM intact. At times a slight left pronator drift and dysmetria is noted. MAE [**4-15**]. Pertinent Results: Labs on Admission: [**2201-2-12**] 10:23PM BLOOD WBC-21.9* RBC-5.66 Hgb-15.2 Hct-45.1 MCV-80* MCH-26.9* MCHC-33.8 RDW-13.7 Plt Ct-318 [**2201-2-12**] 10:23PM BLOOD PT-12.5 PTT-18.4* INR(PT)-1.1 [**2201-2-12**] 10:23PM BLOOD UreaN-12 Creat-0.7 [**2201-2-12**] 10:23PM BLOOD ALT-39 AST-30 AlkPhos-127 TotBili-0.8 [**2201-2-13**] 08:12AM BLOOD CK(CPK)-163 [**2201-2-12**] 10:23PM BLOOD Albumin-4.1 [**2201-2-13**] 08:12AM BLOOD CK-MB-4 cTropnT-<0.01 Labs on Discharge: [**2201-2-23**] 06:05AM BLOOD WBC-10.7 RBC-5.10 Hgb-13.7* Hct-40.9 MCV-80* MCH-26.8* MCHC-33.5 RDW-13.2 Plt Ct-445* [**2201-2-23**] 06:05AM BLOOD Plt Ct-445* [**2201-2-23**] 06:05AM BLOOD Glucose-248* UreaN-17 Creat-0.9 Na-137 K-3.7 Cl-100 HCO3-27 AnGap-14 [**2201-2-23**] 06:05AM BLOOD Calcium-9.2 Phos-4.3 Mg-2.0 ------------- IMAGING: ------------- NCHCT [**2-12**]: IMPRESSION: Large space-occupying process in the left posterior fossa with mass effect on the fourth ventricle, perimesencephalic cisterns, and possible mild left tonsillar herniation. Given the heterogeneity of the lesion, subacute blood products are not excluded, but no definite acute blood products are identified. [**Month (only) 116**] represent subacute infarct, hemorrhage, underlying mass lesion or infection is not excluded and an MRI is recommended for further evaluation if there is no contraindication. MRI HEAD [**2-13**](Post-op): Area of restricted diffusion with blood products in the left cerebellum with enhancement along the folia. The differential diagnosis includes a disease such as intravascular lymphoma vs. an acute infarct. The enhancement along the brainstem and internal auditory canal could be due to leptomeningeal disease or due to blood products within the subarachnoid space. There is tonsillar herniation seen due to mass effect from the fourth ventricular swelling and compression of the cerebellum and hydrocephalus identified. Correlation with CSF findings when the mass effect has reduced would help for further assessment. NCHCT [**2-13**](Post-op): Expected post-surgical changes of left occipital craniectomy with residual blood products and air within the resection bed. Persistent but mild improvement of effacement of fourth ventricle and foramen magnum crowding. No new hemorrhage. No midline shift. Echo [**2201-2-14**]: Normal global biventricular systolic function. No pulmonary hypertension or clinically-significant valvular disease seen. Limited study. MRA Brain [**2201-2-17**]: 1. Mild intracranial atherosclerotic disease. No vascular malformation or aneurysm. 2. Asymmetric nonvisualization of the left AICA and superior cerebellar arteries and nonvisualization of the PICA bilaterally. Video Swallow eval [**2201-2-18**]: SWALLOWING VIDEO FLUOROSCOPY: Oropharyngeal swallowing video fluoroscopy was performed in conjunction with the speech and swallow division. Multiple consistencies of barium were administered. Barium passed freely through the oropharynx and esophagus without evidence of obstruction. There was evidence of penetration and gross aspiration with thin liquids and nectar. IMPRESSION: Gross aspiration with thin liquids and nectar. KUB [**2201-2-22**]: FINDINGS: Oral contrast is visualized in the large bowel, demonstrating diverticulosis and a filled appendix. While there is a paucity of air in the small bowel, I do not see dilated loops nor abnormal air-fluid levels. The psoas margins are sharply delineated. There is no evidence for pneumatosis or free air. A PEG tube is seen, with the balloon component just to the left of the L1 vertebral body pedicle. IMPRESSION: Nonspecific nonobstructed bowel gas pattern. Brief Hospital Course: Mr. [**Name13 (STitle) 449**] was admitted to [**Hospital1 18**] intubated and was brought emergently to the OR with Dr. [**Last Name (STitle) 739**]. He had a posterior decompressive craniectomy. He returned to the SICU intubated and post-op CT head was satisfactory. Off sedation he was following commands with all 4 extremities, right grasp was weaker. He was on a PPI drip for his coffee ground emesis per GI. His SBP goal was <140 per Stroke Team. He was being weaned toward sedation in the afternoon on [**2201-2-13**]. He was extubated on the [**2-14**], his Protonix drip was transitioned to Po bid, neurologically he was intact with a left facial and some serosanguinous drainage from wound. He required frequent pulmonary toilet including deep nasal suctioning which required him to remain in the ICU. SQH was started on [**2-17**]. Neurology recommended an MRA and this was ordered. The patient removed his NG tube twice. A Dobbhoff was placed. He had tachycardia requiring IV Lopressor throughout the day. His oral metoprolol was not able to be given during day due to difficulty with Dobbhoff placement. The pm dose will be given. He continued to have some serous drainage at his incision. A small leak was noted at the superior aspect of his incision and 2 staples were placed at the bedside in the pm of [**2201-2-17**]. He removed his Dobhoff. He was getting prn Lopressor for tachycardia. He did not get any medication sthrough dobhoff before he pulled it out. He had no further respiratory or wound issues overnight. On [**2-18**] transfer orders for the floor with telemetry were ordered. A Sp/Swallow re-eval was performed with video study on [**2-18**]. They recommended a PEG with modified [**Month/Year (2) **] for pleasure. He was cleared for nectar thick piquids, purees, meds in puree, strict aspiration precuations., Will all po's he needs to utilize a left head turn and chin tuck. GI was called with these recommendations. They scheduled him for a PEG and this was done on [**2201-2-20**]. SQH was being held. His Foley was discontinued on [**2201-2-19**]. On [**2-21**] he had an episode of coffee grain emesis a KUB was done which was unremarkable but did show diverticulosis. PT/OT was consulted. They recommended rehab and the patient was cleared for discharge on [**2201-2-23**]. Medications on Admission: Unknown Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for no bm 48 hrs. 2. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheeze. 4. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 5. Enalapril Maleate 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 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. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain/temp>100/HA. 9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 11. Pantoprazole 40 mg Recon Soln Sig: One (1) Recon Soln Intravenous Q24H (every 24 hours). 12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for HTN. 13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for indigestion. Discharge Disposition: Extended Care Facility: [**Hospital 38**] Rehab Discharge Diagnosis: Left cerebellar infarct Discharge Condition: Neurologically Stable Discharge Instructions: GENERAL INSTRUCTIONS WOUND CARE ?????? You or a family member should inspect your wound every day and report any of the following problems to your physician. ?????? Keep your incision clean and dry. ?????? You may wash your hair with a mild shampoo ?????? Do NOT apply any lotions, ointments or other products to your incision. ?????? DO NOT DRIVE until you are seen at the first follow up appointment. ?????? Do not lift objects over 10 pounds until approved by your physician. [**Name10 (NameIs) **] Usually no special [**Name10 (NameIs) **] is prescribed after a craniotomy. A normal well balanced [**Name10 (NameIs) **] is recommended for recovery, and you should resume any specially prescribed [**Name10 (NameIs) **] you were eating before your surgery. MEDICATIONS: ?????? Take all of your medications as ordered. You do not have to take pain medication unless it is needed. It is important that you are able to cough, breathe deeply, and is comfortable enough to walk. ?????? Do not use alcohol while taking pain medication. ?????? Medications that may be prescribed include: -Narcotic pain medication such as Dilaudid (hydromorphone). -An over the counter stool softener for constipation (Colace or Docusate). If you become constipated, try products such as Dulcolax, Milk of Magnesia, first, and then Magnesium Citrate or Fleets enema if needed). Often times, pain medication and anesthesia can cause constipation. ?????? If you were on a medication such as Coumadin (Warfarin), or Plavix (clopidogrel), or Aspirin, prior to your injury, you may safely resume taking this on after clearance from Dr. [**Last Name (STitle) 739**]. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc, as this can increase your chances of bleeding. ACTIVITY: The first few weeks after you are discharged you may feel tired or fatigued. This is normal. You should become a little stronger every day. Activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. In general: ?????? Follow the activity instructions given to you by your doctor and therapist. ?????? Increase your activity slowly; do not do too much because you are feeling good. ?????? You may resume sexual activity as your tolerance allows. ?????? If you feel light headed or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? DO NOT DRIVE until you speak with your physician. ?????? Do not lift objects over 10 pounds until approved by your physician. ?????? Do your breathing exercises every two hours. ?????? Use your incentive spirometer 10 times every hour that you are awake. Followup Instructions: Follow-Up Appointment Instructions ?????? Please follow-up with Dr. [**Last Name (STitle) 739**] 4 weeks after discharge. You will need a Head CT w/o contrast. Please call Paresa to set up this appointment [**Telephone/Fax (1) 1272**] ?????? Please follow-up with your PCP after discharge. You should also set up a outpatient GI appointment as your KUB showed Diverticulosis. [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**] Completed by:[**2201-2-23**]

431,348,518,784,578,493,998,781,787,729,401,250,V586,530,E878,305

{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Aphasia,Hematemesis,Chronic obstructive asthma with (acute) exacerbation,Disruption of external operation (surgical) wound,Lack of coordination,Dysphagia, oropharyngeal phase,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Esophagitis, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Alcohol abuse, in remission'}

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 cerebellar stroke PRESENT ILLNESS: The patient is a 52 year-old male with a h/o HTN, diabetes transferred from [**Hospital3 **] intubated with a diagnosis of left cerebellar hemorrhage. Per transfer report, he presented to the emergency room per EMS after vomiting at home coffee ground emesis with sudden onset severe occipital headache. During transport, he was noted to have SBPs in the 200s. While in the emergency room, he vomited coffee ground emesis and an NGT was placed with return of 200cc of coffee ground emesis. He was noted to have difficulty controlling his left arm, unable to do LUE finger to nose with expressive aphasia and left sided facial droop. Following a CT scan of the head which demonstrated a large cerebellar hemorrhage with mass effect on the 4th ventricle, the patient became increasing dyspneic and agitated and was intubated for blood pressure control and airway control. Tox screen was negative. In the emergency room on presentation, he had spontaneous movement of his LUE and withdrawal to noxious stimuli of BLE without movement of his RUE. Gag reflex intact. He was transfered to the ICU. MEDICAL HISTORY: - HTN - DM - Asthma - Alcoholism (although pt's brother does not think he has had anything to drink for years, unaware of whether pt had DTs, szs, etc) - Chronic abdominal distress MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: BP:151/100 HR:111 RR:21 O2Sats: 100 on vent Gen: NAD, intubated and sedated on propofol. HEENT: Pupils: PERL, EOMs unable to be assessed. Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Unable to assess. Orientation: Unable to assess. Recall: Unable to assess. Language: Unable to assess. Naming intact. Unable to assess. FAMILY HISTORY: FAMILY HISTORY: - negative for seizure, stroke - positive for heart disease, DM (father) SOCIAL HISTORY: 7SOCIAL HISTORY: - lives with wife who is Chinese (speaks [**Name (NI) 8230**]) and their 3 year-old son [**Name (NI) **] - serves as a boss of parking garages ### Response: {'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Aphasia,Hematemesis,Chronic obstructive asthma with (acute) exacerbation,Disruption of external operation (surgical) wound,Lack of coordination,Dysphagia, oropharyngeal phase,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Esophagitis, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Alcohol abuse, in remission'}

CHIEF COMPLAINT: Chest pain for three weeks PRESENT ILLNESS: Ms. [**Known lastname 42865**] is a 58-year-old woman with a long smoking history who was transferred from [**Hospital 1474**] Hospital with chest pain and a troponin of 5.0. She has had these escalating episodes of chest pain for three weeks which radiate to her armpits. She has had shortness of breath with these episodes. She visited an outside Emergency Department two weeks ago and was given sublingual nitroglycerin which she has been taking with some relief. She was subsequently transferred to [**Hospital1 **] for further evaluation for chest pain. Cardiac catheterization was performed which revealed LAD 90% calcified origin, left circumflex 40% proximal, RCA 80% mid, ejection fraction 45% with apical hypokinesis. Ms. [**Known lastname 42865**] was then evaluated for cardiac surgery. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease 2. Hyperlipidemia 3. Tobacco abuse 4. Carotid occlusion MEDICATION ON ADMISSION: ALLERGIES: AMOXICILLIN PHYSICAL EXAM: VITAL SIGNS: Heart rate 82, blood pressure 156/86, O2 saturation 99% on room air. GENERAL: The patient is a 58-year-old woman who is thin, appearing older than her stated age in no apparent distress. HEART: Regular in rate and rhythm. Breath sounds are decreased bilaterally with wheezing. ABDOMEN: Soft, nontender, nondistended with normoactive bowel sounds. EXTREMITIES: Remarkable for 2+ pulses bilaterally with no cyanosis, clubbing or edema. FAMILY HISTORY: Her father had a myocardial infarction in his 40s. SOCIAL HISTORY: Ms. [**Known lastname 42865**] [**Last Name (Titles) 42866**] two packs per day. She does not consume alcohol.

Subendocardial infarction, initial episode of care,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of bone and bone marrow,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Tobacco use disorder

Subendo infarct, initial,Mal neo upper lobe lung,Mal neo lymph-intrathor,Secondary malig neo bone,Chr airway obstruct NEC,Ocl crtd art wo infrct,Crnry athrscl natve vssl,Atrial fibrillation,Tobacco use disorder

Admission Date: [**2175-7-5**] Discharge Date: [**2175-7-14**] Date of Birth: [**2116-8-21**] Sex: F Service: CARDIAC SURGERY CHIEF COMPLAINT: Chest pain for three weeks HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname 42865**] is a 58-year-old woman with a long smoking history who was transferred from [**Hospital 1474**] Hospital with chest pain and a troponin of 5.0. She has had these escalating episodes of chest pain for three weeks which radiate to her armpits. She has had shortness of breath with these episodes. She visited an outside Emergency Department two weeks ago and was given sublingual nitroglycerin which she has been taking with some relief. She was subsequently transferred to [**Hospital1 **] for further evaluation for chest pain. Cardiac catheterization was performed which revealed LAD 90% calcified origin, left circumflex 40% proximal, RCA 80% mid, ejection fraction 45% with apical hypokinesis. Ms. [**Known lastname 42865**] was then evaluated for cardiac surgery. PAST MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease 2. Hyperlipidemia 3. Tobacco abuse 4. Carotid occlusion SOCIAL HISTORY: Ms. [**Known lastname 42865**] [**Last Name (Titles) 42866**] two packs per day. She does not consume alcohol. FAMILY HISTORY: Her father had a myocardial infarction in his 40s. MEDICATIONS: 1. Lovenox 2. Aggrastat 3. Nitropaste The previous three medications were started in the outside Emergency Room. OUTPATIENT MEDICATION: Aspirin 325 mg qd ALLERGIES: AMOXICILLIN PHYSICAL EXAM: VITAL SIGNS: Heart rate 82, blood pressure 156/86, O2 saturation 99% on room air. GENERAL: The patient is a 58-year-old woman who is thin, appearing older than her stated age in no apparent distress. HEART: Regular in rate and rhythm. Breath sounds are decreased bilaterally with wheezing. ABDOMEN: Soft, nontender, nondistended with normoactive bowel sounds. EXTREMITIES: Remarkable for 2+ pulses bilaterally with no cyanosis, clubbing or edema. LABORATORY DATA: CK 156, troponin 5.0. Electrocardiogram significant for inverted T-waves in leads V1 through V5. Echocardiogram reveals an ejection fraction of 40% with anterior septal akinesis and sclerotic aortic structure with 1+ mitral regurgitation. Cardiac catheterization results as above. HOSPITAL COURSE: Ms. [**Known lastname 42865**] was taken to the Operating Room on [**2175-7-7**] for coronary artery bypass graft x3. Grafts included a left internal mammary artery to LAD which was performed off pump. Also, RSVG to RCA and RSVG to circumflex. The operation was performed without complication. However, a large mass in the left upper lobe of her lung was discovered during the procedure. A mediastinal node was biopsied at this time. Pathology results revealed poorly differentiated metastatic lung cancer at this time. Following the procedure, Ms. [**Known lastname 42865**] was transferred to the Cardiothoracic Intensive Care Unit where she was extubated and weaned off drips. She was transfused 2 units of blood and hemodynamically stabilized. While in the unit, had several episodes of atrial fibrillation which were successfully treated with intravenous and oral amiodarone. Condition continued to improve and she was subsequently transferred to the floor. Ms. [**Known lastname 42865**] continued to recover well on the floor with no further episodes of atrial fibrillation. She was tolerating oral diet and her pain was controlled with oral medications. She was ambulating well although her oxygen requirement remained high. On [**2175-7-14**], Ms. [**Known lastname 42865**] was felt stable for discharge home with home oxygen and visiting nurse assistance. Ms. [**Known lastname 42865**] was made aware of her diagnosis of lung cancer which was discovered during the procedure. Prior to her discharge, she underwent chest CT which was remarkable for a 2 cm spiculated left upper lobe mass. There were also enlarged lymph nodes concerning for metastatic disease. Head CT was negative for evidence of metastasis. She also underwent a bone scan which was remarkable for increased tracer activity on the right first rib and a focal area on anterior right second rib which was considered consistent with early metastasis or possibility of postsurgical changes. Ms. [**Known lastname 42865**] will be followed by oncology and thoracic surgery for this new diagnosis. DISCHARGE PHYSICAL EXAM: VITAL SIGNS: Temperature 100.3??????, pulse 70, blood pressure 142/71, respirations 20, O2 saturation 95% on 2 liters. HEART: Regular rate and rhythm. LUNGS: Clear to auscultation bilaterally. Incision was clean, dry and intact. ABDOMEN: Soft, nontender, nondistended with normoactive bowel sounds. EXTREMITIES: Without cyanosis, clubbing or edema. DISCHARGE MEDICATIONS: 1. Amiodarone 400 mg qd 2. Albuterol 3. Ipratropium 1 to 2 puffs ih q6h 4. Captopril 50 mg tid 5. Plavix 75 mg qd 6. Aspirin 325 mg qd 7. Docusate 100 mg [**Hospital1 **] prn 8. Percocet 1 to 2 tablets q 4 to 6 hours prn 9. Ibuprofen 400 mg q6h prn 10. Ativan 0.5 mg q6h prn 11. Nicotine patch one per day FOLLOW UP: Ms. [**Known lastname 42865**] should follow up with Dr. [**Last Name (STitle) 1537**] in four weeks. DISCHARGE CONDITION: Stable DISCHARGE STATUS: Ms. [**Known lastname 42865**] is to be discharged home with home oxygen and visiting nurse assistance. DISCHARGE DIAGNOSIS: Status post coronary artery bypass graft x3 with newly discovered metastatic lung cancer [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**First Name (STitle) 42867**] MEDQUIST36 D: [**2175-7-15**] 13:59 T: [**2175-7-15**] 14:03 JOB#: [**Job Number 42868**]

410,162,196,198,496,433,414,427,305

{'Subendocardial infarction, initial episode of care,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of bone and bone marrow,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,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: Chest pain for three weeks PRESENT ILLNESS: Ms. [**Known lastname 42865**] is a 58-year-old woman with a long smoking history who was transferred from [**Hospital 1474**] Hospital with chest pain and a troponin of 5.0. She has had these escalating episodes of chest pain for three weeks which radiate to her armpits. She has had shortness of breath with these episodes. She visited an outside Emergency Department two weeks ago and was given sublingual nitroglycerin which she has been taking with some relief. She was subsequently transferred to [**Hospital1 **] for further evaluation for chest pain. Cardiac catheterization was performed which revealed LAD 90% calcified origin, left circumflex 40% proximal, RCA 80% mid, ejection fraction 45% with apical hypokinesis. Ms. [**Known lastname 42865**] was then evaluated for cardiac surgery. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease 2. Hyperlipidemia 3. Tobacco abuse 4. Carotid occlusion MEDICATION ON ADMISSION: ALLERGIES: AMOXICILLIN PHYSICAL EXAM: VITAL SIGNS: Heart rate 82, blood pressure 156/86, O2 saturation 99% on room air. GENERAL: The patient is a 58-year-old woman who is thin, appearing older than her stated age in no apparent distress. HEART: Regular in rate and rhythm. Breath sounds are decreased bilaterally with wheezing. ABDOMEN: Soft, nontender, nondistended with normoactive bowel sounds. EXTREMITIES: Remarkable for 2+ pulses bilaterally with no cyanosis, clubbing or edema. FAMILY HISTORY: Her father had a myocardial infarction in his 40s. SOCIAL HISTORY: Ms. [**Known lastname 42865**] [**Last Name (Titles) 42866**] two packs per day. She does not consume alcohol. ### Response: {'Subendocardial infarction, initial episode of care,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of bone and bone marrow,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Tobacco use disorder'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 82-year-old woman with a past medical history of cardiomyopathy, nonischemic, CHF, A fib, admitted to the CCU from [**Hospital Unit Name 196**] for V tach at approximately 180 beats per minute at roughly 1:30 a.m. on [**2140-3-4**]. The patient began at midnight. She received a bolus of 150 mg of Amiodarone beginning at 12:20 a.m. and then had an Amiodarone drip placed in the unit. Her systolic blood pressure dropped to 75. She complained of being sweaty, shortness of breath. A fluid bolus was given. She was 94% on 2 liters nasal cannula. The patient converted from V tach to a paced rhythm at roughly 90 beats per minute spontaneously while bearing down prior to second dose of Amiodarone and prior to paging Anesthesia for conscious sedation for cardioversion. MEDICAL HISTORY: 1. Nonischemic cardiomyopathy. 2. CHF. 3. A fib. 4. Hypercholesterolemia. 5. Squamous cell skin cancer, status post removal on left arm. MEDICATION ON ADMISSION: ALLERGIES: She has an intolerance to statin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Sixty-year pack history of one alcohol drink per week and no drugs. She is a widow. She has one son who is involved in her care. We discussed her case with her PCP who said that the patient was unable to tolerate an ACE inhibitor and had trouble tolerating beta blockers in the past.

Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other primary cardiomyopathies,Peripheral vascular complications, not elsewhere classified,Pure hypercholesterolemia,Aneurysm of artery of lower extremity

Parox ventric tachycard,CHF NOS,Prim cardiomyopathy NEC,Surg comp-peri vasc syst,Pure hypercholesterolem,Lower extremity aneurysm

Admission Date: [**2140-3-3**] Discharge Date: [**2140-3-9**] Service: HISTORY OF THE PRESENT ILLNESS: The patient is an 82-year-old woman with a past medical history of cardiomyopathy, nonischemic, CHF, A fib, admitted to the CCU from [**Hospital Unit Name 196**] for V tach at approximately 180 beats per minute at roughly 1:30 a.m. on [**2140-3-4**]. The patient began at midnight. She received a bolus of 150 mg of Amiodarone beginning at 12:20 a.m. and then had an Amiodarone drip placed in the unit. Her systolic blood pressure dropped to 75. She complained of being sweaty, shortness of breath. A fluid bolus was given. She was 94% on 2 liters nasal cannula. The patient converted from V tach to a paced rhythm at roughly 90 beats per minute spontaneously while bearing down prior to second dose of Amiodarone and prior to paging Anesthesia for conscious sedation for cardioversion. Her symptoms resolved which returned to her baseline rhythm. Initially in the afternoon of [**2140-3-3**], the patient complained of palpitations. She called EMS and was found to be in V tach by the EMS team. In route to the hospital, her rhythm remained in V tach despite 13 shocks at 100 joules. The patient converted to sinus rhythm, bundle branch block, conduction delay. She was loaded with Amiodarone during the cardioversion. She also received 100 mg of lidocaine, Adenosine 6 mg prior to Amiodarone. At [**Hospital1 18**], she went to the EP Laboratory where V tach was noninducible and she was found to have an infra HIS block. A DDD pacer was placed. The patient complained of shoulder pain secondary to shocks. In the CCU she was stable and loaded with Amiodarone on 1 mg per minute IV. PAST MEDICAL HISTORY: 1. Nonischemic cardiomyopathy. 2. CHF. 3. A fib. 4. Hypercholesterolemia. 5. Squamous cell skin cancer, status post removal on left arm. AT-HOME MEDICATIONS: 1. Digoxin 0.125 mg q.d. 2. Lasix by weight, baseline dry weight; she normally takes Lasix when her weight is greater than 145 pounds. Cardiologist is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. ALLERGIES: She has an intolerance to statin. SOCIAL HISTORY: Sixty-year pack history of one alcohol drink per week and no drugs. She is a widow. She has one son who is involved in her care. We discussed her case with her PCP who said that the patient was unable to tolerate an ACE inhibitor and had trouble tolerating beta blockers in the past. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Status post the episode of VT on [**2140-3-4**], in the morning, roughly at 2:00 a.m., the patient's vital signs revealed a pulse of 91, blood pressure 120/53, 98% on 2 liters nasal cannula, breathing at 15-22, not in any acute distress. General: The patient was elderly, younger appearing than stated age. HEENT: EOMI. PERRLA. Anicteric. JVD approximately 9 cm. Heart: Regular rate and rhythm. There was a III/VI holosystolic murmur at the apex. Lateral PMI. Crackles at the left base laterally and anteriorly. Abdomen: Soft, no distention, no tenderness, normoactive bowel sounds. Extremities: There was [**12-20**] dorsalis pedis pulses bilaterally. No clubbing, cyanosis or edema. Neurologic: A&O times three. Cranial nerves II through XII intact. Pleasant. Right groin bruit, slightly ecchymotic. HOSPITAL COURSE: The patient is an 82-year-old woman with a history of nonischemic cardiomyopathy, CHF, who presents to the CCU status post an episode of V tach, status post multiple shocks that were unable to resolve the V tach, status post EP study without inducibility of the rhythm, although the patient was found to have an infra HIS block resulting in a DDD pacer being placed. The patient received boluses of Amiodarone 150 mg times one and was loaded on IV Amiodarone for the V tach. 1. CARDIOLOGY: Rhythm/V tach: After the load of 1 mg per minute and vagal bang down broke into normal sinus rhythm. The Amiodarone was initially decreased to 0.5 mg per minute. She was converted to Amiodarone 400 mg p.o. q.d. and the Amiodarone was discontinued after the patient had been loaded sufficiently. The patient was started on low-dose of beta blocker 25 p.o. b.i.d. The patient had a run of sustained V tach on [**2140-3-5**] at approximately 4:00 p.m. and was given IV 2.5 Lopressor and the rhythm spontaneously reverted back to normal sinus rhythm. She had a 50 plus beat run of V tach at 8:55 a.m. on [**2140-3-6**], again nonsymptomatic and then the ectopy tended to decrease, having three to four beats of NSVT on [**2140-3-7**] and four beats on [**2140-3-8**]. The Lopressor was converted to Toprol XL 50 mg q.d. at discharge. Of note, the patient received Amiodarone 400 mg b.i.d. for one week and then was transitioned to 400 q.d. Hemodynamics: On the morning of [**2140-3-4**], when she first presented to the CCU, roughly 45 minutes after going into normal sinus rhythm, the patient's blood pressure dropped into the 70s. She was bolused IV fluid with her blood pressure going up to the 90s and then would drop again to the 70s when her IV fluid was not running. She received approximately 600-700 cc with her blood pressure going to 90-100, heart rate in the 70s, pulsus paradoxus at the time was 5 mmHg. Repeat hematocrit showed 31.2. It had been 37 the day before. Therefore, she received 1 liter of IV fluid. Repeat hematocrit was 31.8, stable. The Cardiology fellow was called. He did an echocardiogram at the bedside which showed none/trace pericardial effusion, global LVHK. The left ventricle was very enlarged, more so than the right ventricle. No RA collapse. The blood pressure, status post 1 liter of IV fluid, was stabilized in the 110s/50s with heart rate in the 70s and afebrile at 98.2 and breathing at 14-21, 97% on 2 liters nasal cannula. 2. CONGESTIVE HEART FAILURE: The patient has the cardiomyopathy considered to be nonischemic. She had a repeat echocardiogram done on a nonemergent setting with an ejection fraction of 20%. TR gradient of approximately 30 mmHg. The left atrium was mildly dilated. The right atrium was normal in size. Left ventricular wall thickness was normal. Left ventricular cavity was mildly dilated with severe global LVHK. No resting LV outflow tract obstruction. No mass or thrombi seen in the left ventricle. Right ventricular wall thickness was normal. Right ventricular chamber size was normal. Right ventricular systolic function appeared depressed. Aortic root was normal in diameter. There were focal calcifications in the aortic root. The aortic valve was mildly thickened and not stenotic. Mitral valve leaflets were mildly thickened. No MVP. Mild annular calcification. There was mild thickening of the mitral valve chordae. There was a systolic anterior motion on mitral valve leaflets. There was no significant mitral stenosis, moderate to severe 3+ MR was seen. Tricuspid valves were mildly thickened. Mild tricuspid regurgitation was seen, +1. Mild pulmonary systolic hypertension. The patient's weight rose to 147. Normally, her Lasix was initiated with a weight greater than 145. She received actually 80 mg p.r.n. We started her on 20 mg p.o. q.d. dose for more even diuresis and fluid shifts. She had very good urine output and negative 1.6 liters on the first day of this regimen. Her weight went from 147 to 143. [**First Name8 (NamePattern2) 6**] [**Last Name (un) **], Losartan, was also added for afterload reduction as the patient was unable to tolerate an ACE inhibitor as an outpatient. [**Last Name (un) **] 25 q.i.d. was started. The patient initially had reported some orthopnea and PND when her weight was higher and dyspnea on mild exertion with the physical therapist at the scene. On the date of discharge on this regimen, she was able to ambulate in the hallway without any complaints, any shortness of breath, and her PND was reduced from earlier in the week. She was placed on a 2 gram sodium diet. 3. INFRA-HIS BLOCK: The patient had a DDD pacer placed as previously mentioned. Status post her pacemaker placement, the patient developed a right groin bruit secondary to a pseudoaneurysm. An ultrasound of the pseudoaneurysm showed it to be greater than 2 cm. Interventional Radiology embolized the aneurysm with good result. 4. HEMATOLOGY: The patient's hematocrit was 35 on admission. Status post vigorous hydration and blood draws, it dropped to 31.2 and then was stable, roughly 31 throughout her stay. 5. ELECTROLYTES: Her electrolytes, especially her potassium, magnesium, and calcium, were vigorously monitored and supplemented secondary to the VT. [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. [**MD Number(1) 25755**] Dictated By:[**Last Name (NamePattern1) 1659**] MEDQUIST36 D: [**2140-4-29**] 11:24 T: [**2140-5-4**] 16:01 JOB#: [**Job Number 39502**] Name: [**Known lastname 7124**], [**Known firstname 4497**] Unit No: [**Numeric Identifier 7125**] Admission Date: [**2140-3-3**] Discharge Date: [**2140-3-9**] Date of Birth: Sex: F Service: ADDENDUM: CONDITION AT DISCHARGE: Good. DISCHARGE DIAGNOSES: 1. Ventricular tachycardia. 2. Ischemic cardiomyopathy. 3. Heart failure. DISCHARGE INSTRUCTIONS: 1. The patient is advised to follow-up on [**2140-3-14**], appointment was made with Dr. [**Last Name (STitle) **] (appointment was made). 2. To follow-up with Dr. [**Last Name (STitle) **], his Cardiologist, [**2140-3-19**], appointment again was made for the patient status post placement of DDD pacemaker. 3. The patient was discharged with a Holter Monitor and was explained how to use it. The results are being sent to the Electrophysiology Service team that was following the patient in the hospital. DISCHARGE MEDICATIONS: 1. Losartan 25 mg q. day. 2. Metoprolol succinate 50 mg q. day. 3. Amiodarone 400 mg q. day. 4. Furosemide 20 mg q. day. 5. Potassium chloride 20 mg p.o. q. day. [**Name6 (MD) 116**] [**Last Name (NamePattern4) 2879**], M.D. [**MD Number(1) 5308**] Dictated By:[**Last Name (NamePattern1) 2497**] MEDQUIST36 D: [**2140-4-29**] 11:28 T: [**2140-5-4**] 18:02 JOB#: [**Job Number 7126**]

427,428,425,997,272,442

{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other primary cardiomyopathies,Peripheral vascular complications, not elsewhere classified,Pure hypercholesterolemia,Aneurysm of artery of lower extremity'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 82-year-old woman with a past medical history of cardiomyopathy, nonischemic, CHF, A fib, admitted to the CCU from [**Hospital Unit Name 196**] for V tach at approximately 180 beats per minute at roughly 1:30 a.m. on [**2140-3-4**]. The patient began at midnight. She received a bolus of 150 mg of Amiodarone beginning at 12:20 a.m. and then had an Amiodarone drip placed in the unit. Her systolic blood pressure dropped to 75. She complained of being sweaty, shortness of breath. A fluid bolus was given. She was 94% on 2 liters nasal cannula. The patient converted from V tach to a paced rhythm at roughly 90 beats per minute spontaneously while bearing down prior to second dose of Amiodarone and prior to paging Anesthesia for conscious sedation for cardioversion. MEDICAL HISTORY: 1. Nonischemic cardiomyopathy. 2. CHF. 3. A fib. 4. Hypercholesterolemia. 5. Squamous cell skin cancer, status post removal on left arm. MEDICATION ON ADMISSION: ALLERGIES: She has an intolerance to statin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Sixty-year pack history of one alcohol drink per week and no drugs. She is a widow. She has one son who is involved in her care. We discussed her case with her PCP who said that the patient was unable to tolerate an ACE inhibitor and had trouble tolerating beta blockers in the past. ### Response: {'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other primary cardiomyopathies,Peripheral vascular complications, not elsewhere classified,Pure hypercholesterolemia,Aneurysm of artery of lower extremity'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 60 year old gentleman with recent chest pain on exertion. Stress test was abnormal and he was scheduled for cath. Chest pain developed during cath today which revealed left main and multi-vessel coronary artery disease. He is now brought to the operating room urgently for CABG. MEDICAL HISTORY: osteoarthritis lumbar disc disease hypercholesterolemia MEDICATION ON ADMISSION: Toprol 50 daily SL nitroglycerin simvastatin 20 daily Ascorbic acid 1000mg daily aspirin 325mg daily B complex vitamins Vit. D2 Folic acid MVI Omega 3 FA saw [**Location (un) 6485**] Vit E ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 65 Resp: 18 O2 sat: B/P Right: 121/72 Left: Height: Weight: 74.8kg FAMILY HISTORY: Father died at 62 of heart disease SOCIAL HISTORY: Lives with: wife, works at library Occupation: Tobacco: 1ppd x 30yrs, quit 13yrs ago ETOH: quit years ago

Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Other and unspecified disc disorder, lumbar region,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic use,Osteoarthrosis, unspecified whether generalized or localized, lower leg,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

Crnry athrscl natve vssl,Iatrogenic pneumothorax,Intermed coronary synd,Hyperlipidemia NEC/NOS,Disc dis NEC/NOS-lumbar,Drug dermatitis NOS,Adv eff diuretics NEC,Osteoarthros NOS-l/leg,Abn react-anastom/graft

Admission Date: [**2119-7-14**] Discharge Date: [**2119-7-20**] Date of Birth: [**2059-5-24**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2119-7-14**] - Cardiac Catheterization and placement of an IABP [**2119-7-14**] - 1. Emergent coronary bypass grafting x3 on intra-aortic balloon pump with left internal mammary artery to left anterior descending coronary artery; reverse saphenous vein single graft from the aorta to the ramus intermedius coronary artery; as well as reverse saphenous vein single graft from aorta to posterior left ventricular coronary artery. 2. Endoscopic left greater saphenous vein harvesting. History of Present Illness: 60 year old gentleman with recent chest pain on exertion. Stress test was abnormal and he was scheduled for cath. Chest pain developed during cath today which revealed left main and multi-vessel coronary artery disease. He is now brought to the operating room urgently for CABG. Past Medical History: osteoarthritis lumbar disc disease hypercholesterolemia Social History: Lives with: wife, works at library Occupation: Tobacco: 1ppd x 30yrs, quit 13yrs ago ETOH: quit years ago Family History: Father died at 62 of heart disease Physical Exam: Pulse: 65 Resp: 18 O2 sat: B/P Right: 121/72 Left: Height: Weight: 74.8kg General: slightly anxious, but NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] 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] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities: None [x] Neuro: Grossly intact x Pulses: Femoral Right: IABP Left: 2+ DP Right: 2+ Left: 2+ PT [**Name (NI) 167**]: 2+ Left: 2+ Radial Right: 2+ Left: 2+ Carotid Bruit Right: Left: none Pertinent Results: [**2119-7-14**] ECHO 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. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. IABP seen in the descending aorta with tip 2 cm below the left subclavian artery. Post-bypass: The patient is A paced. IABP remains in good position. Preserved Biventricular function. Aortic contours intact. Remaining exam is unchanged. All findings discussed with surgeons at the time of the exam. [**2119-7-19**] 05:05AM BLOOD WBC-4.9 RBC-2.86* Hgb-8.6* Hct-25.4* MCV-89 MCH-30.3 MCHC-34.1 RDW-12.7 Plt Ct-209# [**2119-7-14**] 10:40AM BLOOD WBC-5.1 RBC-4.34* Hgb-13.0* Hct-37.7* MCV-87 MCH-30.0 MCHC-34.5 RDW-12.5 Plt Ct-208 [**2119-7-15**] 07:58AM BLOOD PT-14.0* PTT-33.2 INR(PT)-1.2* [**2119-7-14**] 10:40AM BLOOD PT-14.5* PTT-150* INR(PT)-1.3* [**2119-7-19**] 05:05AM BLOOD Na-140 K-4.5 Cl-101 [**2119-7-17**] 05:10AM BLOOD Glucose-110* UreaN-12 Creat-0.7 Na-136 K-4.2 Cl-101 HCO3-28 AnGap-11 [**2119-7-14**] 10:40AM BLOOD Glucose-134* UreaN-12 Creat-0.8 Na-138 K-3.6 Cl-106 HCO3-24 AnGap-12 Brief Hospital Course: Mr. [**Known lastname 101426**] was admitted to the [**Hospital1 18**] on [**2119-7-14**] for a cardiac catheterization. This revealed significant left main and three vessel coronary artery disease. As he developed chest pain during his catheterization, an intra-aortic balloon pump was placed. The cardiac surgical service was urgently consulted and surgical revascularization was recommended. Mr. [**Known lastname 101426**] was taken urgently to the operating room where he underwent coronary artery bypass grafting to three vessels. Please see operative note for details. Postoperatively he was taken to the intensive care unit for monitoring. The next morning, his intra-aortic balloon pump was weaned off and removed without incident. He then awoke neurologically intact and was extubated. On postoperative day two, he developed a right pneumothorax following removal of his chest tubes. A right pleural tube was thus placed with resolution of his pneumothorax. Later on postoperative day two, he was transferred to the step down unit for further recovery. He was gently diuresed towards his preoperative weight. After a water seal trial, the right pleural chest tube was removed and he subsequently developed a large right pneumothorax that required a chest tube to be reinserted. Follow up chest X-Ray revealed right lung rexpanded. This chest tube wsa pulled [**7-19**] without incident after clamping and serial CXR. The physical therapy service was consulted for assistance with his postoperative strength and mobility. Beta blockade, aspirin and a statin were resumed. Mr. [**Known lastname 101426**] continued to make steady progress and was cleared by Dr.[**Last Name (STitle) 914**] for discharge to home. He was in normal sinus rhythm and his chest xray showed a small pleural effusion with stable bilateral apical pneumothoraces. He will follow-up with Dr. [**Last Name (STitle) 914**], his cardiologist and his primary care physician as an outpatient. All follow up appointments were advised. Medications on Admission: Toprol 50 daily SL nitroglycerin simvastatin 20 daily Ascorbic acid 1000mg daily aspirin 325mg daily B complex vitamins Vit. D2 Folic acid MVI Omega 3 FA saw [**Location (un) 6485**] Vit E Discharge Medications: 1. 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* 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:*0* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 4. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 5. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*0* 6. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itching . Disp:*qs qs* Refills:*0* 7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 9. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: Centrus Home Care Discharge Diagnosis: Coronary artery disease Hyperlipidemia 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, with ecchymosis at knee and inner aspect of thigh Rash on Buttock, posterior thigh red and raised, resolving on back chest and groin area Discharge Instructions: 1) 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 2) Please NO lotions, cream, powder, or ointments to incisions 3) Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart 4) No driving for approximately one month until follow up with surgeon 5) No lifting more than 10 pounds for 10 weeks 6) Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Appointment already scheduled [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2119-8-15**] 2:30 Please call to schedule appointments. Please follow-up with Dr. [**Last Name (STitle) 33746**] in 2 weeks. [**Telephone/Fax (1) 56771**] Please follow-up with Dr. [**Last Name (STitle) 101427**] in 2 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:[**2119-7-20**]

414,512,411,272,722,693,E944,715,E878

{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Other and unspecified disc disorder, lumbar region,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic use,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 60 year old gentleman with recent chest pain on exertion. Stress test was abnormal and he was scheduled for cath. Chest pain developed during cath today which revealed left main and multi-vessel coronary artery disease. He is now brought to the operating room urgently for CABG. MEDICAL HISTORY: osteoarthritis lumbar disc disease hypercholesterolemia MEDICATION ON ADMISSION: Toprol 50 daily SL nitroglycerin simvastatin 20 daily Ascorbic acid 1000mg daily aspirin 325mg daily B complex vitamins Vit. D2 Folic acid MVI Omega 3 FA saw [**Location (un) 6485**] Vit E ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 65 Resp: 18 O2 sat: B/P Right: 121/72 Left: Height: Weight: 74.8kg FAMILY HISTORY: Father died at 62 of heart disease SOCIAL HISTORY: Lives with: wife, works at library Occupation: Tobacco: 1ppd x 30yrs, quit 13yrs ago ETOH: quit years ago ### Response: {'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Other and unspecified disc disorder, lumbar region,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic use,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: abdominal distention after tripping/hitting head, increased abdominal distension PRESENT ILLNESS: The patient is a 78 year old female transferred from an outside hospital for possible liver laceration after a fall. Upon presentation, she had been intubated at the OSH, she had massive abdominal distention and was taken to the operating room for emergent laparotomy at which point a large intrabdominal mass was discovered and perforation of the sigmoid colon. MEDICAL HISTORY: TIA Open hysterectomy MEDICATION ON ADMISSION: Plavix Aspirin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon arrival to ED: intubated, sedated Vitals: 101, 122/72, 99% on vent equal breath sounds severe abdominal distension FAMILY HISTORY: SOCIAL HISTORY:

Unspecified septicemia,Perforation of intestine,Septic shock,Unspecified peritonitis,Acute kidney failure, unspecified,Injury to liver without mention of open wound into cavity laceration, unspecified,Acidosis,Other ascites,Severe sepsis,Atrial fibrillation,Neoplasm of unspecified nature of other genitourinary organs,Unspecified noninflammatory disorder of ovary, fallopian tube, and broad ligament,Urinary tract infection, site not specified,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypoglycemia, unspecified,Other ill-defined conditions,Other diseases of spleen,Hernia of other specified sites without mention of obstruction or gangrene,Examination of participant in clinical trial,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Septicemia NOS,Perforation of intestine,Septic shock,Peritonitis NOS,Acute kidney failure NOS,Liver lacerat unspcf cls,Acidosis,Ascites NEC,Severe sepsis,Atrial fibrillation,Other gu neoplasm NOS,Noninfl dis ova/adnx NOS,Urin tract infection NOS,Hypertension NOS,Fall from slipping NEC,Abn react-surg proc NEC,Hypoglycemia NOS,Ill-define condition NEC,Spleen disease NEC,Hernia NEC,Exam-clincal trial,Hx TIA/stroke w/o resid

Admission Date: [**2120-1-27**] Discharge Date: [**2120-2-15**] Date of Birth: [**2057-7-15**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 598**] Chief Complaint: abdominal distention after tripping/hitting head, increased abdominal distension Major Surgical or Invasive Procedure: 1. ExLap 2. Sigmoid resection 3. Splenectomy 4. Left Pelvic Mass resection 5. End colostomy 6. GJ tube 7. Right chest tube 1. Exploratory laparotomy 2. Sigmoid resection 3. Splenectomy 4. Left Pelvic Mass resection 5. End colostomy 6. GJ tube 7. Right chest tube History of Present Illness: The patient is a 78 year old female transferred from an outside hospital for possible liver laceration after a fall. Upon presentation, she had been intubated at the OSH, she had massive abdominal distention and was taken to the operating room for emergent laparotomy at which point a large intrabdominal mass was discovered and perforation of the sigmoid colon. Past Medical History: TIA Open hysterectomy Physical Exam: Upon arrival to ED: intubated, sedated Vitals: 101, 122/72, 99% on vent equal breath sounds severe abdominal distension On discharge: afebrile, avss nad RRR + 2/6 systolic murmur CTAB belly non tender, non distended, wound vac in place with 125mmHg suction, wound with healthy granulation b/l lower extrem with decreased edema Pertinent Results: Initial labs: [**2120-1-27**] 12:40AM FIBRINOGE-283 [**2120-1-27**] 12:40AM PT-15.4* PTT-28.4 INR(PT)-1.4* [**2120-1-27**] 12:40AM PLT COUNT-221 [**2120-1-27**] 12:40AM WBC-1.2* RBC-4.79 HGB-13.3 HCT-41.3 MCV-86 MCH-27.7 MCHC-32.1 RDW-14.6 [**2120-1-27**] 12:40AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2120-1-27**] 12:40AM LIPASE-24 [**2120-1-27**] 12:40AM UREA N-19 CREAT-0.8 [**2120-1-27**] 12:48AM freeCa-1.42* [**2120-1-27**] 12:48AM HGB-14.2 calcHCT-43 O2 SAT-97 CARBOXYHB-2 MET HGB-0 [**2120-1-27**] 12:48AM GLUCOSE-126* LACTATE-2.9* NA+-143 K+-3.8 CL--108 TCO2-18* [**2120-1-27**] 12:48AM PH-7.12* Brief Hospital Course: The patient is a 62 year old female who tripped on rug and bumped into a wall. One hour later, she had increasing abdominal pain, distention, with nausea and vomiting. She presented to [**Hospital **] Hospital with hypotension in the 70's. A CT scan showed free air with large amounts of free fluid in her abdomen. She was transferred to [**Hospital1 18**] over concern for liver avulsion with hemoperitoneum. Hct at OSH was 37. Pt medflighted over to [**Hospital1 18**] recieving 6 PRBC and 4 FFP. On arrival to [**Hospital1 18**], the patient was intubated, with a systolic blood pressure in the 100's on Levaphed gtt. Our radiologists read the scan and did not think the fluid was consistent with blood. Her abdomen became increasingly distended and she became hypertensive to the 200's despite coming off levaphed. She recieved 1 bag of platelets and was rushed into the OR. Intraoperatively, pt had large perforation of the sigmoid colon and approximately 22 Liters of succus. After washout, it was discovered that the patient had a large ovarian mass (septated) fistulizing into her sigmoid colon causing the perforation. After abdominal decompression, she became normotensive, ultimately requiring levaphed near the end of the case. She returned to the OR two separate times to re-explore the abdomen, debulk her tumor, remove the spleen, and resect the distal sigmoid colon. She had a diverting colostomy and gastrojejunostomy. She also had a left oophorectomy. She returned to the OR on [**1-29**] for controol of bleeding and underwent exploratory laparotomy and colostomy, gastrojejunostomy, secondary abdominal closure and right chest tube placement. An abdominal wound wound vac was applied. Her pathology was remarkable for Ovarian mucinous borderline tumor, intestinal type, measuring up to 25 cm. Peritoneal fluid was sent for cytology which was negative for malignant cells. Post-operatively, she remained intubated in critical condition, on levophed (until [**2-1**]) and with recurring atrial fibrillation (on amio gtt). She was covered with vanc and zosyn due to her grossly contaminated abdomen. She was diuresed with lasix and diamox. Tube feeds were initiated. Wound vac changes were done every 3-4 days continually throughout her hospitalization. She was extubated on [**2-2**]. Diuresis continued which she tolerated well. On [**2-4**], she was off pressors and stable enough to be transferred to the floor. On the floor, she continued to be diuresed. She was started on clear liquids and advanced to regular diet which she tolerated with some intermittent nausea. Her wound vac was changed twice per week, and continued to demonstrate good healing and shrinking of wound. Her nutrition status was not optimal and she was intermittantly requiring cycled tube feeds at night, which were stopped once she demonstrated improved nutrition intake. Twice she spiked fevers. On [**2120-2-7**] she had a UTI diagnosed by UA, treated with ciprofloxacin x 3 days. She had blood cultures, c diff toxin assays, and peritoneal fluid gram stain and culture which were negative. At the time of discharge, she was afebrile with stable vital signs. She was taking in adequate po nutrition and supplementing with ensure shakes. She was discharged in stable condition. Medications on Admission: Plavix Aspirin Discharge Medications: 1. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler [**Date Range **]: Six (6) Puff Inhalation Q4H (every 4 hours) as needed for wheeze. 2. Heparin (Porcine) 5,000 unit/mL Solution [**Date Range **]: 5000 (5000) units Injection TID (3 times a day). 3. Docusate Sodium 100 mg Capsule [**Date Range **]: One (1) Capsule PO BID (2 times a day) as needed for constipation. 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 5. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a day): hold for SBP<100, HR<50. 6. Amiodarone 200 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a day). 7. Oxycodone 5 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain: hold for sedation, rr<12. 8. Aspirin 325 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 9. Multivitamin Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 10. Ondansetron 4 mg Tablet, Rapid Dissolve [**Last Name (STitle) **]: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea. 11. Furosemide 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a day). 12. Ferrous Sulfate 300 mg (60 mg Iron) Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 13. Acetaminophen 500 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO q 8 hours as needed for pain, fever: do not excede 3g tylenol in 24 hours (including oxycodone). 14. Bisacodyl 10 mg Suppository [**Last Name (STitle) **]: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. Discharge Disposition: Extended Care Facility: [**Hospital6 1293**] - [**Location (un) **] Discharge Diagnosis: 1. perforation of sigmoid colon 2. ascites 3. ovarian mass 4. urinary tract infection 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 perforation of your colon. You underwent exploratory laparotomy with splenectomy, resection of a pelvic mass, and resection of your sigmoid colon with creation of an end colostomy. You also had a GJ tube placed for nutrition. You will need to have your abdominal wound vac changed every 3 days. You were admitted to the hospital for perforation of your colon. You underwent exploratory laparotomy with splenectomy, resection of a pelvic mass, and resection of your sigmoid colon with creation of an end colostomy. You also had a GJ tube placed for nutrition. You will need to have your abdominal wound vac changed every 3 days. Followup Instructions: Follow up with Dr. [**Last Name (STitle) **] in general surgery clinic in 2 weeks. Call ([**Telephone/Fax (1) 22750**] for an appointment. Follow up with Dr. [**Last Name (STitle) 2028**] in clinic. [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

038,569,785,567,584,864,276,789,995,427,239,620,599,401,E885,E878,251,799,289,553,V707,V125

{'Unspecified septicemia,Perforation of intestine,Septic shock,Unspecified peritonitis,Acute kidney failure, unspecified,Injury to liver without mention of open wound into cavity laceration, unspecified,Acidosis,Other ascites,Severe sepsis,Atrial fibrillation,Neoplasm of unspecified nature of other genitourinary organs,Unspecified noninflammatory disorder of ovary, fallopian tube, and broad ligament,Urinary tract infection, site not specified,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypoglycemia, unspecified,Other ill-defined conditions,Other diseases of spleen,Hernia of other specified sites without mention of obstruction or gangrene,Examination of participant in clinical trial,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: abdominal distention after tripping/hitting head, increased abdominal distension PRESENT ILLNESS: The patient is a 78 year old female transferred from an outside hospital for possible liver laceration after a fall. Upon presentation, she had been intubated at the OSH, she had massive abdominal distention and was taken to the operating room for emergent laparotomy at which point a large intrabdominal mass was discovered and perforation of the sigmoid colon. MEDICAL HISTORY: TIA Open hysterectomy MEDICATION ON ADMISSION: Plavix Aspirin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon arrival to ED: intubated, sedated Vitals: 101, 122/72, 99% on vent equal breath sounds severe abdominal distension FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Unspecified septicemia,Perforation of intestine,Septic shock,Unspecified peritonitis,Acute kidney failure, unspecified,Injury to liver without mention of open wound into cavity laceration, unspecified,Acidosis,Other ascites,Severe sepsis,Atrial fibrillation,Neoplasm of unspecified nature of other genitourinary organs,Unspecified noninflammatory disorder of ovary, fallopian tube, and broad ligament,Urinary tract infection, site not specified,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypoglycemia, unspecified,Other ill-defined conditions,Other diseases of spleen,Hernia of other specified sites without mention of obstruction or gangrene,Examination of participant in clinical trial,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

CHIEF COMPLAINT: Dypnea PRESENT ILLNESS: 50yo woman with breast cancer metastatic to bone and lung presenting with shortness of breath that started 1-2 weeks prior to admission. The patient reports feeling "lousy" for several days with nonproductive cough and fever to 101.8. Primary care physisician diagnosed her with viral URI one week prior to admission. Symptoms continued to progress. She was evaluated by her oncologist on the day of admission and was found to have oxygen saturation 68% on room air, increasing to 93% on 4L, then worsening again to the low 90s and requiring NRB. She was treated with 1 dose iv Bactrim after CXR appeared consistent with PCP, [**Name10 (NameIs) **] transferred to ED. In the ED she received a dose of CTX/Azithro, and was transferred to the ICU. MEDICAL HISTORY: Breast cancer, diagnosed [**2143**] s/p masectomy with reconstruction, mets ot lung and vertebrae, on weekly Gemzar chemotherapy MEDICATION ON ADMISSION: Gemzar- weekly Zometra ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.7 HR 95 BP 112/57 RR 27 92%NRB Gen: pleasant, speaking in full sentences, NRB HEENT: PERRL, anicteric, MMM, OP clear Neck: supple, no LAD, no JVP CV: RRR, no m/r/g, nml s1s2 Pulm: rales bilaterally, good air movement Abd: +BS, soft, NT, ND, well healed scar Ext: no c/c/e, 2+ DP pulses B FAMILY HISTORY: mother d. cancer of unknown etiology SOCIAL HISTORY: lives alone, brother in [**Name (NI) **] no tob [**12-29**] glasses wine/day no illicits

Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Anemia, unspecified,Personal history of malignant neoplasm of breast

Pneumonia, organism NOS,Secondary malig neo bone,Secondary malig neo lung,Anemia NOS,Hx of breast malignancy

Admission Date: [**2148-11-25**] Discharge Date: [**2148-11-29**] Date of Birth: [**2098-3-4**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3326**] Chief Complaint: Dypnea Major Surgical or Invasive Procedure: Bronchoscopy History of Present Illness: 50yo woman with breast cancer metastatic to bone and lung presenting with shortness of breath that started 1-2 weeks prior to admission. The patient reports feeling "lousy" for several days with nonproductive cough and fever to 101.8. Primary care physisician diagnosed her with viral URI one week prior to admission. Symptoms continued to progress. She was evaluated by her oncologist on the day of admission and was found to have oxygen saturation 68% on room air, increasing to 93% on 4L, then worsening again to the low 90s and requiring NRB. She was treated with 1 dose iv Bactrim after CXR appeared consistent with PCP, [**Name10 (NameIs) **] transferred to ED. In the ED she received a dose of CTX/Azithro, and was transferred to the ICU. Past Medical History: Breast cancer, diagnosed [**2143**] s/p masectomy with reconstruction, mets ot lung and vertebrae, on weekly Gemzar chemotherapy Social History: lives alone, brother in [**Name (NI) **] no tob [**12-29**] glasses wine/day no illicits Family History: mother d. cancer of unknown etiology Physical Exam: T 98.7 HR 95 BP 112/57 RR 27 92%NRB Gen: pleasant, speaking in full sentences, NRB HEENT: PERRL, anicteric, MMM, OP clear Neck: supple, no LAD, no JVP CV: RRR, no m/r/g, nml s1s2 Pulm: rales bilaterally, good air movement Abd: +BS, soft, NT, ND, well healed scar Ext: no c/c/e, 2+ DP pulses B Pertinent Results: [**2148-11-25**] 09:00PM GLUCOSE-101 [**2148-11-25**] 09:00PM CALCIUM-8.3* PHOSPHATE-3.5 MAGNESIUM-2.0 [**2148-11-25**] 09:00PM WBC-13.5* RBC-3.14* HGB-9.8* HCT-30.7* MCV-98 MCH-31.1 MCHC-31.8 RDW-21.4* [**2148-11-25**] 09:00PM NEUTS-72.9* LYMPHS-15.7* MONOS-8.4 EOS-2.0 BASOS-1.0 [**2148-11-25**] 09:00PM HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-1+ MACROCYT-3+ MICROCYT-1+ [**2148-11-25**] 09:00PM PLT COUNT-714* [**2148-11-25**] 09:00PM PT-12.6 PTT-23.3 INR(PT)-1.0 [**2148-11-25**] 07:46PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.006 [**2148-11-25**] 07:46PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG [**2148-11-25**] 12:30PM UREA N-10 CREAT-0.7 SODIUM-138 POTASSIUM-4.5 CHLORIDE-103 TOTAL CO2-26 ANION GAP-14 [**2148-11-25**] 12:30PM LD(LDH)-750* [**2148-11-25**] 12:30PM WBC-14.5*# RBC-3.35* HGB-10.6* HCT-33.3* MCV-99* MCH-31.6 MCHC-31.8 RDW-21.3* [**2148-11-25**] 12:30PM HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-OCCASIONAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-OCCASIONAL OVALOCYT-OCCASIONAL BITE-OCCASIONAL FRAGMENT-OCCASIONAL [**2148-11-25**] 12:30PM PLT SMR-VERY HIGH PLT COUNT-710*# [**2148-11-25**] 12:30PM GRAN CT-[**Numeric Identifier 15098**]* CXR: new marked bilateral diffuse interstitial opacities Chest CT: diffuse interstitial ground glass opacities, mediastinal lymphadenopathy Brief Hospital Course: 50yo woman with metastatic breast cancer presenting with dyspnea, fevers, nonproductive cough, and hypoxia. The patient was treated empirically with Bactrim for PCP given her presentation and CT findings, and CTX/Azithromycin for community acquired pneumonia. The differential diagnosis included PCP pneumonia, atypical or viral pneumonia, or pneumonitis caused by her chemotherapy. As induced sputum exam was unsuccessful, she underwent bronchoscopy and bronchoalveolar lavage. Bronchoscopy showed normal mucosa and no lesions. BAL showed no PCP infection, and sputum stain was nondiagnostic. Supplemental oxygen was weaned until the patient was saturating well on nasal canula. She was discharged to home on home oxygen, with instructions to follow-up with your primary care physician in the next week to wean the oxygen. Dr. [**Last Name (STitle) 2036**], her Oncologist, continued to follow the patient in house. She was discharged to home with instructions to complete a 14 day course of antibiotics. The ceftriaxone and azithromycin were changed to po levofloxacin prior to discharge. She is a full code. Medications on Admission: Gemzar- weekly Zometra Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Pneumonia Discharge Condition: good - sats 90% on RA at rest w/ desaturations into the low 80s w/ minimal exertion Discharge Instructions: If you develop worsening shortness of breath, recurrent fevers >101.2, or productive cough, please see your primary care physician or return to the emergency department. Make sure to take your prescribed antibiotic for the next 9 days and to keep yourself well-hydrated. Followup Instructions: Please follow up with your primary care physician and oncologist within two weeks. You will need to be evaluated by your primary care physician to determine if the supplemental oxygen can be weaned off.

486,198,197,285,V103

{'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Anemia, unspecified,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: Dypnea PRESENT ILLNESS: 50yo woman with breast cancer metastatic to bone and lung presenting with shortness of breath that started 1-2 weeks prior to admission. The patient reports feeling "lousy" for several days with nonproductive cough and fever to 101.8. Primary care physisician diagnosed her with viral URI one week prior to admission. Symptoms continued to progress. She was evaluated by her oncologist on the day of admission and was found to have oxygen saturation 68% on room air, increasing to 93% on 4L, then worsening again to the low 90s and requiring NRB. She was treated with 1 dose iv Bactrim after CXR appeared consistent with PCP, [**Name10 (NameIs) **] transferred to ED. In the ED she received a dose of CTX/Azithro, and was transferred to the ICU. MEDICAL HISTORY: Breast cancer, diagnosed [**2143**] s/p masectomy with reconstruction, mets ot lung and vertebrae, on weekly Gemzar chemotherapy MEDICATION ON ADMISSION: Gemzar- weekly Zometra ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.7 HR 95 BP 112/57 RR 27 92%NRB Gen: pleasant, speaking in full sentences, NRB HEENT: PERRL, anicteric, MMM, OP clear Neck: supple, no LAD, no JVP CV: RRR, no m/r/g, nml s1s2 Pulm: rales bilaterally, good air movement Abd: +BS, soft, NT, ND, well healed scar Ext: no c/c/e, 2+ DP pulses B FAMILY HISTORY: mother d. cancer of unknown etiology SOCIAL HISTORY: lives alone, brother in [**Name (NI) **] no tob [**12-29**] glasses wine/day no illicits ### Response: {'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Anemia, unspecified,Personal history of malignant neoplasm of breast'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 89 year old male (Russian noncommunicative) with multiple medical problems who initially presented with vomiting and loose stools as well as dyspnea at his nursing home and was admitted to [**Hospital 517**] Medical Floor for presumed aspiration pneumonia. While on the floor the patient became hypotensive and was then transferred to the [**Hospital Unit Name 153**] on [**Hospital Ward Name 516**]. The patient's hypotension resolved after intravenous fluid resuscitation. MEDICAL HISTORY: 1. Right middle cerebral artery cerebrovascular accident with residual deficits; 2. End stage renal disease secondary to nephrotic syndrome on hemodialysis started in [**2154-6-30**]; 3. Atrial fibrillation times nine years; 4. Hypertension; 5. Dementia; 6. History of Methicillin-resistant Staphylococcus aureus; 7. Questionable history of Clostridium difficile; 8. History of hepatitis B; 9. History of aspiration pneumonia; 10. Gastric polyps; 11. Status post epinephrine; 12. Status post hernia; 13. Status post prostate surgery times two; 14. Bilateral hydroceles times eight years. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: From [**Hospital 1036**] Nursing Home since [**2154-8-31**], son is [**Name (NI) **], home #[**Telephone/Fax (1) 93935**], work [**Telephone/Fax (1) 93936**].

Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Atrial fibrillation,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified late effects of cerebrovascular disease

Food/vomit pneumonitis,Pleural effusion NOS,Atrial fibrillation,Int inf clstrdium dfcile,Hyp kid NOS w cr kid V,Late effect CV dis NOS

Admission Date: [**2155-3-16**] Discharge Date: [**2155-3-22**] Service: Acove ID: This is an 89 year old male with questionable pneumonia, chronic pleural effusions and dehydration. HISTORY OF PRESENT ILLNESS: The patient is an 89 year old male (Russian noncommunicative) with multiple medical problems who initially presented with vomiting and loose stools as well as dyspnea at his nursing home and was admitted to [**Hospital 517**] Medical Floor for presumed aspiration pneumonia. While on the floor the patient became hypotensive and was then transferred to the [**Hospital Unit Name 153**] on [**Hospital Ward Name 516**]. The patient's hypotension resolved after intravenous fluid resuscitation. The patient on admission to the Medical Floor, Acove Service, [**Hospital Ward Name 516**] was day #3 of Flagyl, Ceftriaxone and Vancomycin for broad coverage for pneumonia. Antibiotics were discontinued given decreased white count, no fever and no copious sputum production, arguing against active pneumonia. However, Flagyl was continued for possible Clostridium difficile infection given that the patient was having continued loose foul-smelling diarrhea. The patient also has chronic pleural effusions with an increase in interval size. A pleural tap was performed prior to transfer to the Medical Floor. PAST MEDICAL HISTORY: 1. Right middle cerebral artery cerebrovascular accident with residual deficits; 2. End stage renal disease secondary to nephrotic syndrome on hemodialysis started in [**2154-6-30**]; 3. Atrial fibrillation times nine years; 4. Hypertension; 5. Dementia; 6. History of Methicillin-resistant Staphylococcus aureus; 7. Questionable history of Clostridium difficile; 8. History of hepatitis B; 9. History of aspiration pneumonia; 10. Gastric polyps; 11. Status post epinephrine; 12. Status post hernia; 13. Status post prostate surgery times two; 14. Bilateral hydroceles times eight years. MEDICATIONS: (On transfer) Enteric coated acetaminophen, Folate, multivitamin, Ilotycin ointment, Prevacid, heparin subcutaneously, Tylenol, Lopressor, Diltiazem, Digoxin, Nepro, tube feeds. SOCIAL HISTORY: From [**Hospital 1036**] Nursing Home since [**2154-8-31**], son is [**Name (NI) **], home #[**Telephone/Fax (1) 93935**], work [**Telephone/Fax (1) 93936**]. PHYSICAL EXAMINATION: (On admission) Vital signs revealed temperature 98.6, pulse 80s and 90s irregular, blood pressure of 90/42, oxygen saturations 96 on 100% room air with respiration rate of 24 to 26. General appearance, awake, in no acute distress, noncommunicative. Head, eyes, ears, nose and throat, slightly dry mucous membranes. Cardiovascular, irregular rhythm and rate, normal S1 and S2. No murmurs. Lungs, decreased breathsounds at the bases with no rales or wheezing. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities, contracted lower extremities bilaterally with no edema and scrotal edema present (chronic). Genitourinary, Foley catheter in place. Rectal tube in place. Guaiac positive. LABORATORY DATA: White blood count is 10.9, hematocrit is 38.8, platelets 289. Chem-7 sodium 135, potassium 3.6, chloride 98, bicarbonate 28, BUN 23, creatinine 1.9 and glucose 112, calcium 7.8, phosphate 2.4 and magnesium 1.5. Repeat guaiac times three, negative. Clostridium difficile negative times three. Fecal cultures negative, blood cultures times four with no growth. HOSPITAL COURSE: The patient is an 89 year old male with a history of cerebrovascular accident, atrial fibrillation, hypertension and end stage renal disease on hemodialysis who was transferred to the Medical Floor in medically stable condition from the Intensive Care Unit status post resolved hypotension with intravenous fluids, questionable pneumonia treated with three days of Vancomycin, Ceftriaxone and Flagyl as well as a chronic left pleural effusion, status post thoracentesis. 1. Pulmonary - Questionable pneumonia was treated with three days of broad spectrum antibiotics. Initially a left lower lobe opacity versus atelectasis versus chronic effusion was visualized on chest x-ray. White blood cell count has decreased to normal. The patient has been afebrile without sputum production, therefore after three days of broad spectrum antibiotics, all antibiotics were discontinued. The initial insult causing the hypoxia that was noted in the nursing home may have been chemical pneumonitis from transient aspiration. The patient did have a history of aspiration pneumonias. During the rest of the hospital stay the patient remained afebrile with normal white count. In addition the patient has had a history of chronic pleural effusions which had an increase in interval size since previous films. It was therefore tapped while in the Intensive Care Unit and pleural fluid studies were sent. Pleural fluid studies revealed no PMNs, no microorganisms and fluid cultures were negative for infection. No further thoracentesis were recommended at this time. 2. Cardiovascular - The patient was initially found to be hypotensive on the medical floor at the other campus and was then transferred to the Intensive Care Unit. This is most likely secondary to volume depletion from loose stools and resolved upon resuscitation with intravenous fluids. Throughout the hospital stay the patient's blood pressure has remained stable. No additional intravenous fluids were necessary. In addition the patient has a history of atrial fibrillation with good rate control using Diltiazem as well as Lopressor and Digoxin. The patient remained hemodynamically stable throughout the hospital stay and was monitored on Telemetry. No significant events were found. The patient has not been on anticoagulation due to the history of gastrointestinal bleeds. 3. Renal - The patient has a history of end stage renal disease on hemodialysis on Monday, Wednesday and Friday. The patient received hemodialysis at [**Hospital6 649**]. During the hospital stay the patient received his scheduled dialysis. Initially there was some trouble with catheter access but the access issues will be dealt with as an outpatient. 4. Gastrointestinal - The patient has reportedly had a history of diarrhea for the past few months per nutritionist that has been following him. All the cultures have been negative. The patient has been guaiac negative times three as well as Clostridium difficile negative times three. The patient was continued on Flagyl but was then discontinued. In the past fiber has been added to tube feeds with good results and continued diarrhea. Nutrition has now recommended use of Imodium. Will observe. Hematocrit has been somewhat stable during the hospital stay. Initial decrease in hematocrit was likely secondary to intravenous fluid resuscitation. Gastrojejunostomy tube became obstructed during hospital stay and was replaced with a larger tube (14 French [**Doctor Last Name 9835**] catheter) by interventional radiology, gastrojejunostomy tube now properly working, will need b.i.d. flushes to maintain patency. 5. Disposition - The patient is medically stable for return to [**Hospital 1036**] Nursing Home. The patient will return to [**Hospital6 1760**] for usual dialysis schedule. DISCHARGE CONDITION: Stable. DISCHARGE STATUS: Return to [**Hospital 1036**] Nursing Home. DISCHARGE DIAGNOSIS: 1. Left pleural effusion status post thoracentesis 2. Atrial fibrillation 3. End stage renal disease on hemodialysis 4. Cerebrovascular accident 5. Hypertension DISCHARGE MEDICATIONS: 1. Diltiazem 90 mg per gastrojejunostomy tube q.i.d. 2. Digoxin 0.125 mg per gastrojejunostomy tube q.d. 3. Lopressor 75 mg per gastrojejunostomy tube t.i.d. 4. Pepcid 20 mg per gastrojejunostomy tube q.d. 5. Ilotycin both eyes q.d. 6. Folic acid 1 mg q. gastrojejunostomy tube q.d. 7. Prenatal vitamin one tablet q. gastrojejunostomy tube q.d. 8. Imodium 4 mg times one per gastrojejunostomy tube prn and then 2 mg after each loose stool prn (16 mg per day maximum) 9. Acetaminophen 325 mg per gastrojejunostomy tube q.d. 10. Nepro tube feeds 400 cc per hour [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D. [**MD Number(1) 3475**] Dictated By:[**Last Name (NamePattern1) 1183**] MEDQUIST36 D: [**2155-3-21**] 16:40 T: [**2155-3-21**] 20:43 JOB#: [**Job Number 93937**]

507,511,427,008,403,438

{'Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Atrial fibrillation,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified late effects of cerebrovascular disease'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 89 year old male (Russian noncommunicative) with multiple medical problems who initially presented with vomiting and loose stools as well as dyspnea at his nursing home and was admitted to [**Hospital 517**] Medical Floor for presumed aspiration pneumonia. While on the floor the patient became hypotensive and was then transferred to the [**Hospital Unit Name 153**] on [**Hospital Ward Name 516**]. The patient's hypotension resolved after intravenous fluid resuscitation. MEDICAL HISTORY: 1. Right middle cerebral artery cerebrovascular accident with residual deficits; 2. End stage renal disease secondary to nephrotic syndrome on hemodialysis started in [**2154-6-30**]; 3. Atrial fibrillation times nine years; 4. Hypertension; 5. Dementia; 6. History of Methicillin-resistant Staphylococcus aureus; 7. Questionable history of Clostridium difficile; 8. History of hepatitis B; 9. History of aspiration pneumonia; 10. Gastric polyps; 11. Status post epinephrine; 12. Status post hernia; 13. Status post prostate surgery times two; 14. Bilateral hydroceles times eight years. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: From [**Hospital 1036**] Nursing Home since [**2154-8-31**], son is [**Name (NI) **], home #[**Telephone/Fax (1) 93935**], work [**Telephone/Fax (1) 93936**]. ### Response: {'Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Atrial fibrillation,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified late effects of cerebrovascular disease'}

CHIEF COMPLAINT: Primary Oncologist: [**Last Name (LF) 11309**], [**First Name3 (LF) 636**] . Primary Care Physician: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . Chief Complaint: fatigue, weak without appetite PRESENT ILLNESS: 83F with history of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**], HTN, GERD, anxiety and depression referred in from oncology clinic due to elevated WBC. . The patient presented to clinic yesterday where she was noted to have an elevated WBC to 12.6 with left shift (89% polys). She was referred in for evaluation, however she declined because she was feeling well at the time. This AM however, she awoke feeling weak and without appetite. Her urine output was normal per report. She denies headaches, vomiting, fevers. She reports no dysuria, hematuria. No vomiting, diarrhea. No cough, SOB, chest pain. . In the ED, on exam, she was noted to be awake and cooperative. RRR, no murmur. Lung CTA b/l. Abd soft, NT, ND, no HSM or masses. A UA was done and was concerning for a UTI with elevated WBC and large leukesterase. WBC 12.9. Lactate 2.8. Her initial Vitals were 99.8 55 163/75 16 100% RA. However, later she spiked to 101.4 which she did not notice. Urology and Oncology was consulted and the decision was made to admit to OMED. Towards the end of the ED stay the nurse noted the patient to have 30 seconds bilateral upper extremity shaking, her eyes rolling back, a/w tachycardia. The episode was self-resolved and the patient had no post-ictal phase. After this episode the patient was noted to have a transient episode of increased PVCs/ectopy on tele. An EKG was done that reportedly showed SR at 59bpm, normal intervals, LAD, no STE. A noncontrast head CT was done and was unremarkable. The patient was given Ceftriaxone and Tylenol. . The patient currently reports feeling well and has no complaints. She recalls the event in the ED and states that she never lost consciousness. She never had a prior episode like this. She also specifically denies any dysuria or hematuria or pain. On ROS, she only endorses some dysphagia of pills since her surgery. She denies aspiration. She also denies blood in her stool or dark stools. MEDICAL HISTORY: Past Oncologic History: Recent diagnosis of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**] . Other Past Medical History: HTN Anxiety Depression GERD MEDICATION ON ADMISSION: patient reports having stopped all meds because of dysphagia since her surgery ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Admission: 97.9 110/52 52 19 100RA GEN: AOx3, NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, supraclavicular LAD Cards: RR S1/S2 normal. [**1-31**] holosystolic murmur over precordium, no gallops/rubs. Pulm: No dullness to percussion, mild crackles L base 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, dry skin Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. Sensation grossly intact. No neck stiffness. FAMILY HISTORY: N/C SOCIAL HISTORY: lives alone, since surgery son was with her, widowed, no tobacco, occ ETOH

Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Cardiac arrest,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Sepsis,Malignant neoplasm of bladder, part unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Dysthymic disorder,Anemia, unspecified,Dysphagia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG],Mitral valve disorders

E coli septicemia,Acute respiratry failure,Cardiac arrest,Urin tract infection NOS,Acute kidney failure NOS,Sepsis,Malig neo bladder NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Esophageal reflux,Dysthymic disorder,Anemia NOS,Dysphagia NOS,Abnorm electrocardiogram,Mitral valve disorder

Admission Date: [**2190-8-27**] Discharge Date: [**2190-9-4**] Date of Birth: [**2107-4-29**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Attending Info 11308**] Chief Complaint: Primary Oncologist: [**Last Name (LF) 11309**], [**First Name3 (LF) 636**] . Primary Care Physician: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . Chief Complaint: fatigue, weak without appetite Major Surgical or Invasive Procedure: internal cardiac defibrillator implantation Temporary pacer wire implantation History of Present Illness: 83F with history of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**], HTN, GERD, anxiety and depression referred in from oncology clinic due to elevated WBC. . The patient presented to clinic yesterday where she was noted to have an elevated WBC to 12.6 with left shift (89% polys). She was referred in for evaluation, however she declined because she was feeling well at the time. This AM however, she awoke feeling weak and without appetite. Her urine output was normal per report. She denies headaches, vomiting, fevers. She reports no dysuria, hematuria. No vomiting, diarrhea. No cough, SOB, chest pain. . In the ED, on exam, she was noted to be awake and cooperative. RRR, no murmur. Lung CTA b/l. Abd soft, NT, ND, no HSM or masses. A UA was done and was concerning for a UTI with elevated WBC and large leukesterase. WBC 12.9. Lactate 2.8. Her initial Vitals were 99.8 55 163/75 16 100% RA. However, later she spiked to 101.4 which she did not notice. Urology and Oncology was consulted and the decision was made to admit to OMED. Towards the end of the ED stay the nurse noted the patient to have 30 seconds bilateral upper extremity shaking, her eyes rolling back, a/w tachycardia. The episode was self-resolved and the patient had no post-ictal phase. After this episode the patient was noted to have a transient episode of increased PVCs/ectopy on tele. An EKG was done that reportedly showed SR at 59bpm, normal intervals, LAD, no STE. A noncontrast head CT was done and was unremarkable. The patient was given Ceftriaxone and Tylenol. . The patient currently reports feeling well and has no complaints. She recalls the event in the ED and states that she never lost consciousness. She never had a prior episode like this. She also specifically denies any dysuria or hematuria or pain. On ROS, she only endorses some dysphagia of pills since her surgery. She denies aspiration. She also denies blood in her stool or dark stools. Review of Systems: (+) Per HPI (-) Review of Systems: GEN: No fever, chills, night sweats, recent weight loss or gain. HEENT: No headache, sinus tenderness, rhinorrhea or congestion. CV: No chest pain or tightness, palpitations. PULM: No cough, shortness of breath, or wheezing. GI: No nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel habits, no hematochezia or melena. GUI: No dysuria or change in bladder habits. MSK: No arthritis, arthralgias, or myalgias. DERM: No rashes or skin breakdown. NEURO: No numbness/tingling in extremities. PSYCH: No feelings of depression or anxiety. All other review of systems negative. Past Medical History: Past Oncologic History: Recent diagnosis of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**] . Other Past Medical History: HTN Anxiety Depression GERD Social History: lives alone, since surgery son was with her, widowed, no tobacco, occ ETOH denies tob 3 drinks daily Family History: N/C Physical Exam: On Admission: 97.9 110/52 52 19 100RA GEN: AOx3, NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, supraclavicular LAD Cards: RR S1/S2 normal. [**1-31**] holosystolic murmur over precordium, no gallops/rubs. Pulm: No dullness to percussion, mild crackles L base 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, dry skin Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. Sensation grossly intact. No neck stiffness. ON DISCHARGE: GEN: AOx3, NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, supraclavicular LAD Cards: RR S1/S2 normal. [**1-31**] holosystolic murmur over precordium, no gallops/rubs. Pacing device seen under left clavicle with small surrounding hematoma, no drainage from surgical site. Pulm: CTAB Abd: BS+, soft, NT, no rebound/guarding. Extremities: wwp, no edema. DPs, PTs 2+. Skin: no rashes or bruising, dry skin Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. Sensation grossly intact. No neck stiffness. Pertinent Results: [**2190-8-26**] 11:50AM PLT COUNT-658*# [**2190-8-26**] 11:50AM WBC-12.6* RBC-2.94* HGB-9.2* HCT-27.2* MCV-93 MCH-31.4 MCHC-33.9 RDW-11.9 [**2190-8-26**] 11:50AM ALT(SGPT)-29 AST(SGOT)-56* LD(LDH)-298* ALK PHOS-102 TOT BILI-0.7 [**2190-8-26**] 11:50AM ALT(SGPT)-29 AST(SGOT)-56* LD(LDH)-298* ALK PHOS-102 TOT BILI-0.7 [**2190-8-26**] 11:50AM estGFR-Using this [**2190-8-26**] 11:50AM UREA N-22* CREAT-1.5* SODIUM-137 POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-22 ANION GAP-19 [**2190-8-27**] 10:20AM URINE WBCCLUMP-FEW MUCOUS-RARE [**2190-8-27**] 10:20AM URINE RBC-18* WBC->182* BACTERIA-MOD YEAST-NONE EPI-0 [**2190-8-27**] 10:20AM URINE BLOOD-MOD NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-8* PH-6.0 LEUK-LG [**2190-8-27**] 10:20AM URINE COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.017 [**2190-8-27**] 02:10PM PLT COUNT-607* [**2190-8-27**] 02:10PM NEUTS-91.7* LYMPHS-6.3* MONOS-1.7* EOS-0.2 BASOS-0.1 [**2190-8-27**] NCHCT: FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect or major vascular territorial infarction. [**Doctor Last Name **]-white matter differentiation is preserved. There is no shift of normally midline structures. Prominence of ventricles and sulci is compatible with age-appropriate volume loss. There is no fracture. Imaged paranasal sinuses and mastoid air cells are well aerated. [**2190-9-3**] CXR: Lungs appear grossly clear. The cardiomediastinal silhouette is unremarkable. A dual-chamber pacemaker is seen with intact leads leading to the right atrium and right ventricle. [**2190-9-3**] EKG: Baseline artifact. Atrial paced rhythm with ventricular conduction. Left axis deviation. Late R wave progression with Q waves in the lateral leads and ST-T wave abnormalities. Consider related to axis or extensive infarction. Since the previous tracing of [**2190-9-2**] the rate is faster. Atrial pacing is new. ST-T wave abnormalities persist. Clinical correlation is suggested. [**2190-8-27**] EKG: Baseline artifact. Sinus rhythm with atrial premature beats and ventricular premature beats. Left axis deviation consistent with left anterior fascicular block. Compared to the previous tracing of [**2190-8-4**] low precordial lead voltage is no longer present. Ventricular premature beats are new. TRACING #1 Brief Hospital Course: 83-year-old female with a history of high grade urothelial bladder cancer with invasion s/p resection [**2190-8-3**], hypertension, GERD, anxiety, and depression referred in from oncology clinic due to elevated WBC, admitted for gram-negative rod bacteremia transferred to the ICU after a PMVT arrest. . #VT ARREST: The patient developed polymorphic VT associated with prolonged QT interval with arrest on the floor on [**2190-8-28**]. She was given CPR for two minutes and defibrillated with ROSC. She was sedated,intubated and transferred to the ICU. Her magnesium was maintained at >2.5 and potassium >4.5. Her QTC remained in 500s corrected. She had another episode of polymorphic VT in the ICU with loss of pulse that returned after brief administration of chest compressions. In consultation with cardiology, she was started on a lidocaine drip, dopamine titrated to heart rate of ~80 and patient was intubated for airway protection. She was transferred to the CCU where a temporary pacing wire was placed. Patient was ventricularly paced until a permanent dual chamber ICD was placed in the EP lab after which time patient's blood pressures normalized and was extubated. The patient appeared to have a boarder line prolonged QTc on admission suggesting a possible channelopathy, her decline into VT arrest was likely to multiple hits to her QTc from medications, poor nutrition and urosepsis. Patient remained in a paced rhythm with no further episodes of VT during her CCU course. Patient was discharged with a small hematoma at the surgical site which did not show signs of acute bleeding and to follow up in device clinic in one week's time. . #UROSEPSIS / GNR BACTEREMIA: Patient presented to the ED with fever, leukocytosis and tachypnea with urine culture growing >100,000 E.Coli. Patient was adequately fluid resuscitated and initially treated with cefepime as no history of ESBL cultures per OMR. Sequent culture data grew a pan sensitive e coli and patient was switched to amoxicillin. As patient had a foreign body pace maker installed while having SIRS physiology patient was discharged on a 2 week course of ampicillin to prevent colonization. . # Acute Renal Failure: Patient was noted to have an elevated creatinine on admission to 1.9 this was felt to be of pre-renal etiology given urine electrolytes in the setting of her VT arrest and hypotension. Her ACE inhibitors were held and patient was discharged to follow up with her PCP prior to resuming this medication. She was prescribed lab studies to be drawn on [**9-7**] prior to her PCP appointment later in the week. . #BLADDER CA: Followed by Dr. [**Last Name (STitle) 3748**] (urology) and Dr. [**Last Name (STitle) **] (onc) and has been told that the tumor is invading the muscle and at her last visit they discussed two options one being total radical cystectomy with creation of anileal conduit versus chemo and radiation therapy. In discussion with the patient's oncologists her prognosis was expected to be in the excess of several years with medical management and light of this patient had a dual chamber pace maker installed. . #ANEMIA: Patient was noted to have a diminished hematocrit on admission and no evidence of GI bleed on history or exam. Patient was noted to have substantial hematuria felt secondary to her invasive bladder cancer which likely accounted for her low crit. This was monitored and was stable while an inpatient requiring no transfusions or iron supplementation. . #DYSPHAGIA: Per the patient's son she was felt to be chocking and coughing when taking solid foods and had a decreased appetite in the weeks prior to admission. Once extubated patient was evaluated by Speech and Swallow with no evidence of aspiration and the patient was encouraged to eat and drink to her comfort. . #HTN: As patient was hypotensive on admission her antihypertensives were initially held, but restarted, save lisinopril, prior to discharge. She was normotensive at the time of discharge. . TRANSITIONAL ISSUES: -pt written for an outpatient CBC and Lytes on [**9-7**] to be faxed to patient's PCP [**Name10 (NameIs) 11310**] [**Name11 (NameIs) 11311**] as no longer concerned for QT prolongation given biventricular pacer. -held the patient's lisinopril on discharge given acute renal failure -patient discharged on a 14 day course of amoxicillin Medications on Admission: patient reports having stopped all meds because of dysphagia since her surgery Discharge Medications: 1. Outpatient Lab Work Please check CBC and Chem-7 on [**9-7**] with results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] or Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 250**]. 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. amoxicillin 500 mg Capsule Sig: One (1) Capsule PO twice a day for 14 days. Disp:*28 Capsule(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Urosepsis Ventricular tachycaridia s/p internal cardiac defibrillator implantation Hypertension Urethral bladder cancer 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: It was a pleasure taking care of you at [**Hospital1 18**]. You had an infection in your blood and in your urine and needed intravenous antibiotics to treat this. Your ECG had some changes that led to ventricular tachycardia, a dangerous heart rhythm. You had a few episodes of this and needed to be shocked out of the rhythm. An internal defibrillator was placed that will be able to shock you internally if you have the ventricular tachycardia again. This will feel like a very strong kick in the chest and you may pass out before this happens. If your ICD fires, please call Dr. [**Last Name (STitle) **] [**Last Name (STitle) 2227**]. You can take a shower after [**9-5**] and take off the covering dressing, leaving the strips of tape in place. No lifting more than 5 pounds with your left arm or lifting your left arm over your head for 6 weeks. You will have the ICD checked next thursday [**9-9**]. You did not have a heart attack during this episode. The infection in your blood and urine will be treated with an antibiotic for two weeks. . We made the following changes to your medicines: 1. Amoxicillin 500 mg by mouth twice a day for 14 days 2. stop taking your lisinopril 30 mg daily until instructed by your PCP You should make sure to keep yourself well hydrate after discharge from the hospital. Followup Instructions: Department: CARDIAC SERVICES When: THURSDAY [**2190-9-9**] at 11:30 AM 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: [**Hospital3 249**] Name: [**First Name8 (NamePattern2) 11312**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 656**], MD Specialty: Radiation Oncology Location: [**Hospital1 **] DEPT OF RADIATION ONCOLOGY Address: [**Location (un) **], [**Hospital Ward Name **] BASEMENT, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 9710**] While you were in the hospital you missed an appointment that had been scheduled for you with Dr. [**Last Name (STitle) 656**]. You need to have this appt rescheduled for within 8 days. The office of Dr. [**Last Name (STitle) 656**] will call you Monday to give you a new appointment. If you do not hear within 2 business days, please call the number above to schedule the appointment. Department: [**Hospital3 249**] When: WEDNESDAY [**2190-9-15**] at 10:10 AM With: DR [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]/[**Company 191**] POST [**Hospital 894**] CLINIC Phone: [**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** Department: CARDIAC SERVICES When: FRIDAY [**2190-10-8**] at 9:40 AM With: [**Name6 (MD) **] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Name6 (MD) **] [**Name8 (MD) 163**] MD [**MD Number(2) 11313**]

038,518,427,599,584,995,188,403,585,530,300,285,787,794,424

{'Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Cardiac arrest,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Sepsis,Malignant neoplasm of bladder, part unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Dysthymic disorder,Anemia, unspecified,Dysphagia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG],Mitral valve disorders'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Primary Oncologist: [**Last Name (LF) 11309**], [**First Name3 (LF) 636**] . Primary Care Physician: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . Chief Complaint: fatigue, weak without appetite PRESENT ILLNESS: 83F with history of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**], HTN, GERD, anxiety and depression referred in from oncology clinic due to elevated WBC. . The patient presented to clinic yesterday where she was noted to have an elevated WBC to 12.6 with left shift (89% polys). She was referred in for evaluation, however she declined because she was feeling well at the time. This AM however, she awoke feeling weak and without appetite. Her urine output was normal per report. She denies headaches, vomiting, fevers. She reports no dysuria, hematuria. No vomiting, diarrhea. No cough, SOB, chest pain. . In the ED, on exam, she was noted to be awake and cooperative. RRR, no murmur. Lung CTA b/l. Abd soft, NT, ND, no HSM or masses. A UA was done and was concerning for a UTI with elevated WBC and large leukesterase. WBC 12.9. Lactate 2.8. Her initial Vitals were 99.8 55 163/75 16 100% RA. However, later she spiked to 101.4 which she did not notice. Urology and Oncology was consulted and the decision was made to admit to OMED. Towards the end of the ED stay the nurse noted the patient to have 30 seconds bilateral upper extremity shaking, her eyes rolling back, a/w tachycardia. The episode was self-resolved and the patient had no post-ictal phase. After this episode the patient was noted to have a transient episode of increased PVCs/ectopy on tele. An EKG was done that reportedly showed SR at 59bpm, normal intervals, LAD, no STE. A noncontrast head CT was done and was unremarkable. The patient was given Ceftriaxone and Tylenol. . The patient currently reports feeling well and has no complaints. She recalls the event in the ED and states that she never lost consciousness. She never had a prior episode like this. She also specifically denies any dysuria or hematuria or pain. On ROS, she only endorses some dysphagia of pills since her surgery. She denies aspiration. She also denies blood in her stool or dark stools. MEDICAL HISTORY: Past Oncologic History: Recent diagnosis of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**] . Other Past Medical History: HTN Anxiety Depression GERD MEDICATION ON ADMISSION: patient reports having stopped all meds because of dysphagia since her surgery ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Admission: 97.9 110/52 52 19 100RA GEN: AOx3, NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, supraclavicular LAD Cards: RR S1/S2 normal. [**1-31**] holosystolic murmur over precordium, no gallops/rubs. Pulm: No dullness to percussion, mild crackles L base 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, dry skin Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. Sensation grossly intact. No neck stiffness. FAMILY HISTORY: N/C SOCIAL HISTORY: lives alone, since surgery son was with her, widowed, no tobacco, occ ETOH ### Response: {'Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Cardiac arrest,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Sepsis,Malignant neoplasm of bladder, part unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Dysthymic disorder,Anemia, unspecified,Dysphagia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG],Mitral valve disorders'}

CHIEF COMPLAINT: 30 foot fall onto tree stump PRESENT ILLNESS: This is a 40 year-old woman who was brought to the ED by [**Location (un) 1110**] EMS after a 30ft fall onto a tree stump. Initially there were concerns that the fall had been a suicide attempt. There was a failed intubation atttempt by EMS (for GCS=7 on scene) and a needle decompression of the left chest by EMS for decreased breath sounds on that side. MEDICAL HISTORY: Medical: h/o pyelonephritis h/o blackouts and head trauma h/o kidney stones while pregnant h/o alleged rape MEDICATION ON ADMISSION: ativan fluoxetine omeprazole dilantin ALLERGIES: Codeine / Demerol PHYSICAL EXAM: On discharege: FAMILY HISTORY: alcoholism in father, mother, 2 siblings, mother's maternal grandfather SOCIAL HISTORY: EtOH: long h/o EtOH abuse, with multiple hospitalizations at detox/rehabs and 6-month period of sobriety in [**2161**] drinking since age 14

Closed fracture of first cervical vertebra,Injury to liver without mention of open wound into cavity, laceration, minor,Traumatic pneumothorax without mention of open wound into thorax,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Accidental fall from or out of building or other structure,Closed fracture of shaft of tibia alone,Closed fracture of two ribs,Tobacco use disorder

Fx c1 vertebra-closed,Liver laceration, minor,Traum pneumothorax-close,Alcoh dep NEC/NOS-unspec,Alcohol withdrawal,Fall from building,Fx shaft tibia-closed,Fracture two ribs-closed,Tobacco use disorder

Admission Date: [**2168-7-9**] Discharge Date: [**2168-7-29**] Date of Birth: [**2127-7-23**] Sex: F Service: SURGERY Allergies: Codeine / Demerol Attending:[**First Name3 (LF) 3223**] Chief Complaint: 30 foot fall onto tree stump Major Surgical or Invasive Procedure: ORIF of right tibial fracture Halo vest application under fluoroscopic control History of Present Illness: This is a 40 year-old woman who was brought to the ED by [**Location (un) 1110**] EMS after a 30ft fall onto a tree stump. Initially there were concerns that the fall had been a suicide attempt. There was a failed intubation atttempt by EMS (for GCS=7 on scene) and a needle decompression of the left chest by EMS for decreased breath sounds on that side. Past Medical History: Medical: h/o pyelonephritis h/o blackouts and head trauma h/o kidney stones while pregnant h/o alleged rape Psychiatric: long h/o EtOH abuse with bings & blackouts h/o self-cutting h/o threatening violence to others, once cut husband superficially [**Name (NI) **] in [**2159**] >6 suicide attempts (cutting, attempted hanging, EtOH ingestion) Social History: EtOH: long h/o EtOH abuse, with multiple hospitalizations at detox/rehabs and 6-month period of sobriety in [**2161**] drinking since age 14 h/o cocaine and marijuana, last used in [**2151**] daily cigarettes Family History: alcoholism in father, mother, 2 siblings, mother's maternal grandfather Physical Exam: On discharege: T97.3 P90s/60s P76 R16 95% RA Gen: Alert and awake, pleasant. HEENT: Halo in place. Pin sites have no erythema, redness or swelling. Chest: Clear to auscultation bilaterally. CV: Regular rate and rhythm. Abd: Soft, nontender. Ext: Right LE surgical incision clean, dry and intact with no signs of infection. Extremities warm and well-perfused. Pertinent Results: [**2168-7-9**] 07:40PM URINE HOURS-RANDOM [**2168-7-9**] 07:40PM URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2168-7-9**] 07:40PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.005 [**2168-7-9**] 07:40PM URINE BLOOD-LG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-MOD [**2168-7-9**] 07:40PM URINE RBC-[**5-6**]* WBC-[**10-16**]* BACTERIA-OCC YEAST-NONE EPI-0-2 [**2168-7-9**] 07:40PM URINE WBCCLUMP-OCC [**2168-7-9**] 07:29PM UREA N-5* CREAT-0.5 [**2168-7-9**] 07:29PM AMYLASE-101* [**2168-7-9**] 07:29PM ASA-NEG ETHANOL-197* ACETMNPHN-NEG bnzodzpn-POS barbitrt-NEG tricyclic-NEG [**2168-7-9**] 07:29PM TYPE-[**Last Name (un) **] PH-7.27* [**2168-7-9**] 07:29PM GLUCOSE-100 LACTATE-3.2* NA+-143 K+-3.0* CL--110 TCO2-24 [**2168-7-9**] 07:29PM freeCa-1.00* [**2168-7-9**] 07:29PM HGB-11.5* calcHCT-35 [**2168-7-9**] 07:29PM WBC-8.1 RBC-3.30* HGB-11.3* HCT-32.3* MCV-98 MCH-34.3* MCHC-35.0 RDW-13.4 [**2168-7-9**] 07:29PM PT-12.6 PTT-24.2 INR(PT)-1.0 [**2168-7-9**] 07:29PM FIBRINOGE-327 Brief Hospital Course: On arrival at [**Hospital1 18**] the patient was moving all extremities and opened eyes to commands. Her initial clinical and radiographic evaluation revealed the following injuries: Fractures of C1, C8-C10 (transverse processes), T6 and T10 (vertebral bodies), multiple ribs bilaterally and right tibia (closed). Grade 2 liver laceration in segment V of the liver, with intraperitoneal hematoma in gallbladder fossa and inferior edge of the liver. Fluid in the mesentery, anterior to the pancreas, surrounding the SMV, concerning for mesenteric injury. Bilateral pneumothoraces. Small amount of pneumomediastinum. She was intubated and bilateral chest tubes were placed, and she was taken to the OR by Dr. [**Last Name (STitle) 363**] for placement of a halo vest. She was admitted to the trauma ICU and followed by Dr. [**Last Name (STitle) 2719**], who repaired her tibia fracture with an ORIF. She was monitored for alcohol withdrawal on a CIWA protocol and was watched by a sitter until there were no concerns for suicidality. She was followed by psychiatry while hospitalized and continued to deny memory of the jumping event but denied recent feelings of depression or suicidality. Ultimately it was felt that her major psychiatric issue was alcohol dependence and she was encouraged to join AA upon discharge, which she agreed to do. She was cleared psychiatrically for rehab, with no immediate concern for suicidality. She was also followed by Physical Therapy, Social Work and a case manager while hospitalized. Medications on Admission: ativan fluoxetine omeprazole dilantin Discharge Medications: 1. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). Disp:*1 tube* Refills:*0* 2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO QAM (once a day (in the morning)). Disp:*30 Capsule(s)* Refills:*0* 3. Phenytoin 50 mg Tablet, Chewable Sig: Three (3) Tablet, Chewable PO QPM (once a day (in the evening)). Disp:*90 Tablet, Chewable(s)* Refills:*0* 4. Oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*35 Tablet(s)* Refills:*0* 5. Oxycodone 40 mg Tablet Sustained Release 12HR Sig: One (1) Tablet Sustained Release 12HR PO Q12H (every 12 hours). Disp:*10 Tablet Sustained Release 12HR(s)* Refills:*0* 6. Trazodone 50 mg Tablet Sig: 0.5-1 Tablet PO HS (at bedtime) as needed for insomnia. Disp:*30 Tablet(s)* Refills:*0* 7. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: Forty (40) mg Subcutaneous DAILY (Daily) for 4 weeks. Disp:*QS mg * Refills:*0* 8. Cyclobenzaprine 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day) as needed. Disp:*90 Tablet(s)* Refills:*0* 9. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 11. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for itching. Disp:*30 Capsule(s)* Refills:*0* 12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Cervical and thoracic spine fractures Multiple rib fractures Right tibia fracture (closed) Discharge Condition: Good Discharge Instructions: You should call a physician or come to ER if you have worsening pains, fevers, chills, nausea, vomiting, shortness of breath, chest pain, redness or drainage about the wounds or pin sites, or if you have any questions or concerns. You should not drive or operate heavy machinery while on any narcotic pain medication such as percocet as it can be sedating. You may take colace to soften the stool as needed for constipation, which can be cause by narcotic pain medication. The halo should remain in place until your follow-up visit in 3 weeks. You may bear partial weight as tolerated on your right leg. Followup Instructions: Call for an appointment with Dr. [**Last Name (STitle) 363**] in 3 weeks. You will need a repeat CT scan of your C-spine at that time. Call for an appointment with Dr. [**Last Name (STitle) 2719**] (Orthopedics) in 4 weeks ([**Telephone/Fax (1) 1228**]). We encourage you to join Alcoholics Anonymous ([**Telephone/Fax (1) 6003**]) for help with staying sober. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

805,864,860,303,291,E882,823,807,305

{'Closed fracture of first cervical vertebra,Injury to liver without mention of open wound into cavity, laceration, minor,Traumatic pneumothorax without mention of open wound into thorax,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Accidental fall from or out of building or other structure,Closed fracture of shaft of tibia alone,Closed fracture of two ribs,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: 30 foot fall onto tree stump PRESENT ILLNESS: This is a 40 year-old woman who was brought to the ED by [**Location (un) 1110**] EMS after a 30ft fall onto a tree stump. Initially there were concerns that the fall had been a suicide attempt. There was a failed intubation atttempt by EMS (for GCS=7 on scene) and a needle decompression of the left chest by EMS for decreased breath sounds on that side. MEDICAL HISTORY: Medical: h/o pyelonephritis h/o blackouts and head trauma h/o kidney stones while pregnant h/o alleged rape MEDICATION ON ADMISSION: ativan fluoxetine omeprazole dilantin ALLERGIES: Codeine / Demerol PHYSICAL EXAM: On discharege: FAMILY HISTORY: alcoholism in father, mother, 2 siblings, mother's maternal grandfather SOCIAL HISTORY: EtOH: long h/o EtOH abuse, with multiple hospitalizations at detox/rehabs and 6-month period of sobriety in [**2161**] drinking since age 14 ### Response: {'Closed fracture of first cervical vertebra,Injury to liver without mention of open wound into cavity, laceration, minor,Traumatic pneumothorax without mention of open wound into thorax,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Accidental fall from or out of building or other structure,Closed fracture of shaft of tibia alone,Closed fracture of two ribs,Tobacco use disorder'}

CHIEF COMPLAINT: L rectus sheath hematoma PRESENT ILLNESS: The patient is a 43M with EtOH cirrhosis on liver transplant list p/w Hct 15.7, and an 11 cm left rectus sheath hematoma with CTA showing no extravasation, 8mm aneurysm L inf epigastric a. branch. MEDICAL HISTORY: - HTN - cholelithiasis - gout - depression - C. diff colitis - mild pulmonary artery systolic hypertension-mean PA pressure 28 - incarcerated umbilical hernia s/p repair [**2-/2170**] c/b subcutaneous hematoma and wound dehiscence . MEDICATION ON ADMISSION: 1. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. ALLERGIES: Penicillins / Vancomycin PHYSICAL EXAM: GEN: WD, WN in NAD HEENT: NCAT, EOMI, anicteric CV: RRR, +S1S2 w no M/R/G PULM: CTA B/L w no W/R/R, normal excursion, no respiratory distress BACK: no vertebral tenderness, no CVAT ABD: soft, NT, ND, no mass, no hernia PELVIS: deferred EXT: WWP, no CCE, no tenderness, 2+ B radial/DP/PT NEURO: strength intact/symmetric, sensation intact/symmetric DERM: no rashes/lesions/ulcers PSYCH: normal judgment/insight, normal memory, normal mood/affect FAMILY HISTORY: No history of liver disease or GI cancer SOCIAL HISTORY: Lives alone, divorced x2, has three children. Denies tobacco or other IV drug use. Last drink was [**2168-7-28**]. Not sexually active, has never had sex with men. No recent travel. No sick contacts.

Hematoma complicating a procedure,Hepatic encephalopathy,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other ascites,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Nontraumatic hematoma of soft tissue,Alcoholic cirrhosis of liver,Awaiting organ transplant status,Aneurysm of other visceral artery,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Gout, unspecified,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of alcoholism,Personal history of tobacco use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure

Hematoma complic proc,Hepatic encephalopathy,Acute kidney failure NOS,Hyposmolality,Esoph varice oth dis NOS,Ascites NEC,Urin tract infection NOS,Ac posthemorrhag anemia,Nontrauma hema soft tiss,Alcohol cirrhosis liver,Await organ transplnt st,Visceral aneurysm NEC,Enterococcus group d,Hypertension NOS,Gout NOS,Depressive disorder NEC,Cholelithiasis NOS,Hx of alcoholism,History of tobacco use,Abn react-procedure NEC

Admission Date: [**2170-11-14**] Discharge Date: [**2170-11-18**] Date of Birth: [**2126-12-25**] Sex: M Service: MEDICINE Allergies: Penicillins / Vancomycin Attending:[**First Name3 (LF) 4393**] Chief Complaint: L rectus sheath hematoma Major Surgical or Invasive Procedure: Paracentesis [**11-16**] History of Present Illness: The patient is a 43M with EtOH cirrhosis on liver transplant list p/w Hct 15.7, and an 11 cm left rectus sheath hematoma with CTA showing no extravasation, 8mm aneurysm L inf epigastric a. branch. Past Medical History: - HTN - cholelithiasis - gout - depression - C. diff colitis - mild pulmonary artery systolic hypertension-mean PA pressure 28 - incarcerated umbilical hernia s/p repair [**2-/2170**] c/b subcutaneous hematoma and wound dehiscence . Social History: Lives alone, divorced x2, has three children. Denies tobacco or other IV drug use. Last drink was [**2168-7-28**]. Not sexually active, has never had sex with men. No recent travel. No sick contacts. Family History: No history of liver disease or GI cancer Physical Exam: GEN: WD, WN in NAD HEENT: NCAT, EOMI, anicteric CV: RRR, +S1S2 w no M/R/G PULM: CTA B/L w no W/R/R, normal excursion, no respiratory distress BACK: no vertebral tenderness, no CVAT ABD: soft, NT, ND, no mass, no hernia PELVIS: deferred EXT: WWP, no CCE, no tenderness, 2+ B radial/DP/PT NEURO: strength intact/symmetric, sensation intact/symmetric DERM: no rashes/lesions/ulcers PSYCH: normal judgment/insight, normal memory, normal mood/affect Vitals: 97.1, 132/79, 94, 18, 99% RA GENERAL - NAD, comfortable HEENT - EOMI, mild scleral icterus, MMM, OP clear, no LAD NECK - supple, no thyromegaly, no JVD LUNGS - CTAHEART - RRR, no MRG, nl S1-S2 ABDOMEN - Distended abdomen, soft, NABS EXTREMITIES - 3+ pitting edema b/l LE, 2+ DPs SKIN - no rashes or lesions LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, asterixis present Mental status: alert, oriented x3, somewhat confused, recalls [**12-28**] objects after 5 min, can count backwards by serial 7s Pertinent Results: Labs on Admission: [**2170-11-14**] 09:17PM WBC-3.6* RBC-3.13* HGB-10.5* HCT-28.6* MCV-91 MCH-33.4* MCHC-36.5* RDW-24.4* [**2170-11-14**] 09:17PM PLT COUNT-32* [**2170-11-14**] 09:17PM PT-18.0* PTT-34.2 INR(PT)-1.7* [**2170-11-14**] 04:09PM GLUCOSE-124* UREA N-34* CREAT-1.1 SODIUM-128* POTASSIUM-4.8 CHLORIDE-95* TOTAL CO2-25 ANION GAP-13 [**2170-11-14**] 04:09PM WBC-3.8* RBC-2.83* HGB-10.1* HCT-27.1* MCV-96 MCH-35.8* MCHC-37.4* RDW-23.7* [**2170-11-14**] 04:09PM PLT COUNT-38* [**2170-11-14**] 04:09PM FIBRINOGE-165* [**2170-11-18**] 08:55AM BLOOD WBC-5.2 RBC-3.84* Hgb-12.8* Hct-37.4* MCV-97 MCH-33.3* MCHC-34.2 RDW-24.0* Plt Ct-27* [**2170-11-18**] 08:55AM BLOOD Plt Ct-27* [**2170-11-18**] 08:55AM BLOOD PT-32.6* PTT-40.6* INR(PT)-3.2* [**2170-11-18**] 08:55AM BLOOD Glucose-85 UreaN-28* Creat-1.3* Na-129* K-4.4 Cl-93* HCO3-31 AnGap-9 Labs on Discharge: [**2170-11-18**] 08:55AM BLOOD WBC-5.2 RBC-3.84* Hgb-12.8* Hct-37.4* MCV-97 MCH-33.3* MCHC-34.2 RDW-24.0* Plt Ct-27* [**2170-11-18**] 08:55AM BLOOD PT-32.6* PTT-40.6* INR(PT)-3.2* [**2170-11-18**] 08:55AM BLOOD Glucose-85 UreaN-28* Creat-1.3* Na-129* K-4.4 Cl-93* HCO3-31 AnGap-9 [**2170-11-18**] 08:55AM BLOOD ALT-22 AST-37 AlkPhos-147* TotBili-17.8* [**2170-11-18**] 08:55AM BLOOD Albumin-3.1* Calcium-8.5 Phos-3.1 Mg-1.8 Brief Hospital Course: [**Hospital 2947**] Hospital Course:The patient was admitted to the West 3 surgery service on [**2170-11-14**] and with anemia and rectus sheath hematoma. Neuro: Post-operatively, the patient received Dilaudid IV/PCA with good effect and adequate pain control. When tolerating oral intake, the patient was transitioned to oral pain medications. CV: The patient was stable from a cardiovascular standpoint; vital signs were routinely monitored. Pulmonary: Pulmonary toilet including incentive spirometry and early ambulation were encouraged. The patient was stable from a pulmonary standpoint; vital signs were routinely monitored. GI/GU: Post-operatively, the patient was given IV fluids until tolerating oral intake. His/Her diet was advanced when appropriate, which was tolerated well. Patient passed flatus on PODX and had a BM on PODX. He/She was also started on a bowel regimen to encourage bowel movement. Foley was removed on POD#1. Intake and output were closely monitored. ID: Post-operatively, the patient was started on IV cefazolin, then switched to PO cephalexin on POD#2. The patient's temperature was closely watched for signs of infection. Prophylaxis: The patient received subcutaneous heparin during this stay, and was encouraged to get up and ambulate as early as possible. At the time of discharge on POD#3, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. [**Hospital **] Hospital Course: Patient was transfered to the medical service on the day of discharge for hyponatremia and [**Last Name (un) **]. #. Elevated Creatinine: Over the past month the baseline creatinine has ranged 1.1 - 1.3 over the last month. On admission the patient creatinine was 1.2 and improved with volume. Without volume the patient's creatinine trended back up to 1.3 from 0.8 yesterday. GFR today is not far off baseline and likely represents a relative intravascular volume depletion in setting of diuretic use. Patient was given albumin 75 Grams IV and discharged with follow up in two days for repeat lytes and urine studies with Dr. [**Last Name (STitle) **]. Patient was also asked to stop Lasix/Aldactone for two days. #. Hyponatremia: Unclear if tolvaptan has been given daily during hospitalization. Sodium of 127 not far from baseline. Patients MS is normal. Patient to continue Tolvaptan and follow up with electrolytes in two days time. Medications on Admission: 1. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. 2. ciprofloxacin 250 mg PO Q24H 3. Vitamin D2 Sig: 50,000 units once a week. 4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. furosemide 20 mg Tablet Sig: Three (3) Tablet PO once a day. 6. lactulose 10 gram/15 mL Syrup 30 ML PO three times a day. 7. lidocaine 5 %(700 mg/patch) Adhesive Patch daily 8. omeprazole 20 mg Capsule po daily 9. oxycodone 5 mg Tablet 1-2 Tablets PO twice prn pain 10. rifaximin 550 mg Tablet PO BID 11. spironolactone 100 mg Tablet daily 12. tolvaptan 30 mg Tablet daily 13. zolpidem 5 mg Tablet qhs prn insomnia 14. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit PO bid 15. magnesium oxide 400 mg PO tid prn cramps 16. multivitamin daily 17. simethicone 80 mg Tablet 0.5-1 Tablet, po qid prn bloating Discharge Medications: 1. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. 2. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day). 3. rifaximin 550 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane QID (4 times a day). 5. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 6. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 7. ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for pain: do not drive or drink alcohol with medication. 9. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a week. 10. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 11. Calcium 500 + D (D3) 500-125 mg-unit Tablet Sig: One (1) Tablet PO twice a day. 12. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO three times a day as needed for cramps. 13. multivitamin Tablet Sig: One (1) Tablet PO once a day. 14. simethicone 80 mg Tablet Sig: 0.5-1 Tablet PO four times a day as needed for gas. 15. tolvaptan 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 17. Outpatient Lab Work Pleae obtain lab work on [**2170-11-21**]. Please check CBC, CMP, Urine sodium, Urine Urea Nitrogen, Urine Creatinine, Urinalysis. Discharge Disposition: Home Discharge Diagnosis: Primary: Rectus Sheath Bleed Anemia Acute Renal Failure Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 84380**], It was a pleasure caring for you at [**Hospital1 18**] while you were admitted with bleeding into your rectus sheath. You were initially monitored in the intensive care unit and given blood transfusions. Your blood counts stabilized. Prior to discharge you were found to have a rise in your creatinine (a measure of kidney function) slightly above your baseline. We felt this was secondary to dehydration and ask you to hold your diuretics (lasix/spironolactone)for two days and have lab tests done on Wednesday prior to seeing Dr. [**Last Name (STitle) **] in clinic on that day. The following changes were made to your medications: --STOP Lasix (until Dr. [**Last Name (STitle) **] instructs you to restart) --STOP Spironolactone (until Dr. [**Last Name (STitle) **] instructs you to restart) Please call on Tuesday to arrange follow up in Dr.[**Name (NI) 37751**] clinic on Wednesday [**2170-11-21**]. Followup Instructions: Please contact the transplant clinic on Tuesday [**2170-11-21**] at [**Telephone/Fax (1) 673**] to confirm and appointment with Dr. [**Last Name (STitle) **] on Wednesday [**2170-11-21**]. . Department: TRANSPLANT When: WEDNESDAY [**2170-11-28**] at 11:00 AM With: TRANSPLANT [**Hospital 1389**] CLINIC [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 4407**]

998,572,584,276,456,789,599,285,729,571,V498,442,041,401,274,311,574,V113,V158,E879

{'Hematoma complicating a procedure,Hepatic encephalopathy,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other ascites,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Nontraumatic hematoma of soft tissue,Alcoholic cirrhosis of liver,Awaiting organ transplant status,Aneurysm of other visceral artery,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Gout, unspecified,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of alcoholism,Personal history of tobacco use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: L rectus sheath hematoma PRESENT ILLNESS: The patient is a 43M with EtOH cirrhosis on liver transplant list p/w Hct 15.7, and an 11 cm left rectus sheath hematoma with CTA showing no extravasation, 8mm aneurysm L inf epigastric a. branch. MEDICAL HISTORY: - HTN - cholelithiasis - gout - depression - C. diff colitis - mild pulmonary artery systolic hypertension-mean PA pressure 28 - incarcerated umbilical hernia s/p repair [**2-/2170**] c/b subcutaneous hematoma and wound dehiscence . MEDICATION ON ADMISSION: 1. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. ALLERGIES: Penicillins / Vancomycin PHYSICAL EXAM: GEN: WD, WN in NAD HEENT: NCAT, EOMI, anicteric CV: RRR, +S1S2 w no M/R/G PULM: CTA B/L w no W/R/R, normal excursion, no respiratory distress BACK: no vertebral tenderness, no CVAT ABD: soft, NT, ND, no mass, no hernia PELVIS: deferred EXT: WWP, no CCE, no tenderness, 2+ B radial/DP/PT NEURO: strength intact/symmetric, sensation intact/symmetric DERM: no rashes/lesions/ulcers PSYCH: normal judgment/insight, normal memory, normal mood/affect FAMILY HISTORY: No history of liver disease or GI cancer SOCIAL HISTORY: Lives alone, divorced x2, has three children. Denies tobacco or other IV drug use. Last drink was [**2168-7-28**]. Not sexually active, has never had sex with men. No recent travel. No sick contacts. ### Response: {'Hematoma complicating a procedure,Hepatic encephalopathy,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other ascites,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Nontraumatic hematoma of soft tissue,Alcoholic cirrhosis of liver,Awaiting organ transplant status,Aneurysm of other visceral artery,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Unspecified essential hypertension,Gout, unspecified,Depressive disorder, not elsewhere classified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of alcoholism,Personal history of tobacco use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

CHIEF COMPLAINT: Hypotension, fever PRESENT ILLNESS: Mr. [**Known lastname 32034**] is a 63 yo M s/p cadaveric renal transplant [**3-15**] polycystic kidney disease on tacrolimus and prednisone, metastatic prostate cancer, and MGUS who presents with fevers from his rehabilitation facility. Of note, he had been recently hospitalized at [**Hospital1 18**] [**Date range (1) 111347**] for shoulder and arm pains. He developed leukocytosis and loose stools during this hospitalization for which he was treated with flagyl empirically for two weeks ending on [**3-8**]. Per his rehab records, PO vancomycin was restarted on [**3-10**]. At rehab, stool had been C diff+ as recently as 1/30 per the records available to us. MEDICAL HISTORY: Polycystic kidney disease s/p cadaveric transplant x2 [**2118**]/[**2131**] Metastatic prostate cancer (mets to spine) on Lupron Chronic LE edema SCC skin HIT MGUS Hx c. difficile RUE cellulitis UGIB [**3-15**] gastritis Gout MEDICATION ON ADMISSION: Tacrolimus 2mg PO BID Prednisone 10mg PO daily Vancomycin 250mg PO QID Lasix 100mg PO BID Humalog insulin SS Ferrous sulfate 300mg PO daily Prevacid 30mg PO Daily Hexavitamin Fluoxetine 30mg PO daily Allopurinol 100mg PO BID Neurontin 100mg PO QHS Epogen MWF Dulcolax, mylanta, tylenol prn ALLERGIES: Heparin Agents PHYSICAL EXAM: General chronically ill appearing, no acute distress HEENT sclera white conjunctiva pink, L eye a little swollen with crusting Neck supple, LIJ in place Pulm lungs clear bilaterally CV regular rate S1 S2 II/VI systolic murmur Abd soft +bowel sounds well healed scar RLQ mild discomfort to palpation RLQ, urostomy with pink stoma no exudate or erythema Extrem 2+ pitting edema bilateral LE with faint erythema of skin bilaterally, patient says this is a chronic issue for him. range of motion of LE bilaterally limited by discomfort. skin bruised, tophi present Neuro alert and oriented x3, moving all extremities FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, admitted from [**Hospital3 **]

Unspecified septicemia,Septic shock,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Intestinal infection due to Clostridium difficile,Acute systolic heart failure,Pressure ulcer, elbow,Severe sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Malignant neoplasm of prostate,Aortic valve disorders,Hypocalcemia,Other artificial opening of urinary tract status

Septicemia NOS,Septic shock,Compl kidney transplant,Acute kidney failure NOS,Hyp kid NOS w cr kid V,End stage renal disease,Urin tract infection NOS,Secondary malig neo bone,Acidosis,Int inf clstrdium dfcile,Ac systolic hrt failure,Pressure ulcer, elbow,Severe sepsis,Abn react-org transplant,Accident in place NOS,Pseudomonas infect NOS,Malign neopl prostate,Aortic valve disorder,Hypocalcemia,Urinostomy status NEC

Name: [**Known lastname 18278**],[**Known firstname 33**] G Unit No: [**Numeric Identifier 18279**] Admission Date: [**2138-3-17**] Discharge Date: [**2138-3-22**] Date of Birth: [**2075-2-22**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**Last Name (NamePattern4) 3776**] Addendum: Please note the following clarifications of the [**Hospital 1325**] hospital course. # Septic Shock: Given that the patient presented with fevers and hypotension, he clinically had evidence of septic shock. His presentation was felt to be due to either UTI or C diff infection, although it was uncertain at the time of discharge whether an infection had truly been responsible for his clinical picture. # Acute Systolic CHF: Patient was noted to have depressed EF, new as compared with Echo from [**2137**]. His heart failure may have contributed to his pulmonary edema. # Pressure Ulcers: Patient had stage 2 and stage 3 decubitis ulcers on his coccyx, right elbow, and heel. These were treated with wound care, a kinair bed, and frequent repositioning. Discharge Disposition: Home With Service Facility: [**Hospital **] Hospice [**Location (un) 18280**] East [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 593**] [**Name8 (MD) 304**] MD [**MD Number(1) 594**] Completed by:[**2138-4-4**] Admission Date: [**2138-3-17**] Discharge Date: [**2138-3-22**] Date of Birth: [**2075-2-22**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Hypotension, fever Major Surgical or Invasive Procedure: Hemodialysis, placement of a dialysis catheter History of Present Illness: Mr. [**Known lastname 32034**] is a 63 yo M s/p cadaveric renal transplant [**3-15**] polycystic kidney disease on tacrolimus and prednisone, metastatic prostate cancer, and MGUS who presents with fevers from his rehabilitation facility. Of note, he had been recently hospitalized at [**Hospital1 18**] [**Date range (1) 111347**] for shoulder and arm pains. He developed leukocytosis and loose stools during this hospitalization for which he was treated with flagyl empirically for two weeks ending on [**3-8**]. Per his rehab records, PO vancomycin was restarted on [**3-10**]. At rehab, stool had been C diff+ as recently as 1/30 per the records available to us. Per his wife, he developed a fever to 101F the evening prior to admission, without any associated chills or sweats. He also complained of left thigh pains. Review of systems is otherwise negative for headache, vision changes, neck stiffness, cough, chest or abdominal pain, rash, discharge or redness from his urostomy site. He has had loose stools, nonwatery, without any gross bleeding in ~2 weeks. In the ED, vitals were T 98.5 P 120 BP 86/54 RR 16 O2 96%. The sepsis protocol was initiated and a central line was placed. Patient initially had a CVP of 2 cm, with good response to IVF (~2L but total amount not clear from transfer notes). He received solumedrol and dexamethasone, as well as zosyn 4.5g, vancomycin 1g, and flagyl 500mg. He was also started on neosynephrine for additional blood pressure support. Past Medical History: Polycystic kidney disease s/p cadaveric transplant x2 [**2118**]/[**2131**] Metastatic prostate cancer (mets to spine) on Lupron Chronic LE edema SCC skin HIT MGUS Hx c. difficile RUE cellulitis UGIB [**3-15**] gastritis Gout Social History: Married, admitted from [**Hospital3 **] Family History: noncontributory Physical Exam: General chronically ill appearing, no acute distress HEENT sclera white conjunctiva pink, L eye a little swollen with crusting Neck supple, LIJ in place Pulm lungs clear bilaterally CV regular rate S1 S2 II/VI systolic murmur Abd soft +bowel sounds well healed scar RLQ mild discomfort to palpation RLQ, urostomy with pink stoma no exudate or erythema Extrem 2+ pitting edema bilateral LE with faint erythema of skin bilaterally, patient says this is a chronic issue for him. range of motion of LE bilaterally limited by discomfort. skin bruised, tophi present Neuro alert and oriented x3, moving all extremities Pertinent Results: [**2138-3-17**] 12:15PM BLOOD WBC-7.7 RBC-2.80*# Hgb-7.4*# Hct-24.8*# MCV-88 MCH-26.5* MCHC-30.0* RDW-16.7* Plt Ct-169 [**2138-3-21**] 04:37AM BLOOD WBC-5.1 RBC-3.26* Hgb-8.5* Hct-27.8* MCV-85 MCH-26.1* MCHC-30.6* RDW-16.3* Plt Ct-233 [**2138-3-17**] 12:15PM BLOOD PT-16.8* PTT-40.3* INR(PT)-1.5* [**2138-3-18**] 01:55PM BLOOD PT-13.9* PTT-32.0 INR(PT)-1.2* [**2138-3-17**] 07:46PM BLOOD Fibrino-399 [**2138-3-17**] 12:15PM BLOOD Glucose-141* UreaN-81* Creat-3.2* Na-146* K-3.7 Cl-122* HCO3-10* AnGap-18 [**2138-3-20**] 04:52AM BLOOD Glucose-152* UreaN-113* Creat-5.2* Na-138 K-5.2* Cl-109* HCO3-13* AnGap-21* [**2138-3-21**] 04:37AM BLOOD Glucose-173* UreaN-87* Creat-4.4* Na-143 K-4.3 Cl-111* HCO3-19* AnGap-17 [**2138-3-17**] 01:20PM BLOOD ALT-5 AST-10 CK(CPK)-12* AlkPhos-64 TotBili-0.3 [**2138-3-17**] 07:46PM BLOOD CK(CPK)-17* Amylase-45 [**2138-3-18**] 05:42AM BLOOD CK(CPK)-11* [**2138-3-18**] 01:56PM BLOOD CK(CPK)-10* [**2138-3-20**] 04:38PM BLOOD proBNP-[**Numeric Identifier **]* [**2138-3-17**] 01:20PM BLOOD CK-MB-3 cTropnT-0.47* [**2138-3-17**] 07:46PM BLOOD CK-MB-3 cTropnT-0.42* [**2138-3-18**] 05:42AM BLOOD CK-MB-4 cTropnT-0.35* [**2138-3-18**] 01:56PM BLOOD CK-MB-4 cTropnT-0.33* [**2138-3-17**] 12:15PM BLOOD Calcium-5.8* Phos-3.0 Mg-1.2* [**2138-3-21**] 04:37AM BLOOD Calcium-8.1* Phos-5.5* Mg-1.9 [**2138-3-17**] 01:20PM BLOOD Cortsol-20.9* [**2138-3-21**] 04:37AM BLOOD Vanco-26.2* [**2138-3-20**] 04:52AM BLOOD FK506-5.3 [**2138-3-17**] 12:27PM BLOOD Glucose-135* Lactate-1.2 Na-137 K-3.5 Cl-124* calHCO3-10* [**2138-3-17**] 04:40PM BLOOD Lactate-1.0 CT Abd/Pelvis/Thigh 2/4/8: 1. Interval development of bilateral pleural effusions, left greater than right, compared to the previous study of [**9-13**]. Extensive new subcutaneous stranding and fluid. While the majority of this could represent anasarca, there is a more focal area of soft tissue density in the medial right thigh (not fully evaluated given the lack of intravenous contrast), which most likely represents hematoma, although a metastatic focus or an area of infection cannot be entirely excluded. 3. Diverticulosis without diverticulitis. CXR 2/4/8: 1. Left IJ terminates at the origin of the SVC. 2. Moderate congestive heart failure. Renal Ultrasound 2/5/8: Transplant kidney in the left lower quadrant shows normal echogenicity and vascularity. Size of the left transplant kidney is 10.3 cm, grossly unchanged. There is no hydronephrosis, calculus, or perinephric fluid collection. Doppler and spectral analysis shows normal vascularity and waveform, with resistive indices of 0.7, 0.6 and 0.6, within the range of normal, in the upper, mid, and lower poles. TTE [**2138-3-18**]: The left atrium and right atrium are normal in cavity size. The estimated right atrial pressure is 0-5 mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with akinesis of the basal inferior wall and hypokinesis of the more distal segments. There is mild hypokinesis of the remaining segments (LVEF = 40%). The estimated cardiac index is normal (>=2.5L/min/m2). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets are moderately thickened. There is moderate aortic valve stenosis (area 1.0cm2). Mild to moderate ([**2-12**]+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. There is very mild mitral regurgitation. The estimated pulmonary artery systolic pressure is high normal. There is a very small anterior pericardial effusion. CXR [**2138-3-20**]: Worsening of pulmonary edema and bilateral pleural effusions with overall distention in mediastinal vasculature consistent with volume overload. Brief Hospital Course: 1. Hypotension/Fever Initially received broad spectrum antibiotics, stress dose steriods and aggressive fluid rehydration. Although he required pressors on admission, he was weaned off after less than 24 hours. Given his recent history of C diff and urine cultures positive for pseudomonas, he was treated with vancomycin, zosyn and flagyl empirically. There was no obvious source for infection; blood cultures as well as PICC line cultures were negative. During the course of his hospitalization, he devloped worsening pulmonary edema with anuria, making it difficult to support his blood pressure with IV fluids. 2. Acute on Chronic Renal Failure Unclear etiology for acute worsening, perhaps secondary to volume loss from recent C.diff, possibly secondary to pseudomonal UTI, though per renal there is possibilty of chronic pseudomonal colonization of patient's urine. He developed anuria and was dialyzed by renal. After initiating dialysis, the patient expressed his wish not to be put on dialysis. He and his wife, who is his health care proxy, agreed to change goals of care to make him CMO so that he could go home with hospice. 3. Pulmonary Edema Likely multifactorial causes including aggressive fluid replacement, worsening heart failure, acute renal failure and possible pseudomonal UTI. Echo demonstrated new wall motion abnormality; however, upon review of the Echo with cardiology, the feeling was that the basal wall akinesis was in fact present on prior TTE. Cardiology was consulted and recommended PA catheter placement to ellucidate etiology, catheter was not placed due to comorbidities and change in goals of care. 4. ESRD s/p cadaveric renal transplant Treated with tacrolimus and prednisone. 5. Metastatic prostate cancer. Received Lupron Patient was discharged on [**2138-3-22**] to go home with hospice. He was given ativan and morphine for symptomatic control. Medications on Admission: Tacrolimus 2mg PO BID Prednisone 10mg PO daily Vancomycin 250mg PO QID Lasix 100mg PO BID Humalog insulin SS Ferrous sulfate 300mg PO daily Prevacid 30mg PO Daily Hexavitamin Fluoxetine 30mg PO daily Allopurinol 100mg PO BID Neurontin 100mg PO QHS Epogen MWF Dulcolax, mylanta, tylenol prn Discharge Medications: 1. Lorazepam 2 mg/mL Concentrate Sig: [**2-12**] ml PO Q4H (every 4 hours) as needed. Disp:*50 ml* Refills:*1* 2. Morphine Concentrate 10 mg/0.5 mL Solution Sig: 0.5-1 ml PO every 4-6 hours. Disp:*25 ml* Refills:*1* 3. Acetaminophen 650 mg Suppository Sig: One (1) Rectal every 6-8 hours. Disp:*20 Supp* Refills:*2* 4. home oxygen Discharge Disposition: Home With Service Facility: [**Hospital 269**] Hospice [**Location (un) 270**] East Discharge Diagnosis: End Stage Renal Disease Acute Renal Failure Heart Failure Prostate Cancer-Metastatic Discharge Condition: The patient was discharged hemodynamically stable, afebrile and with appropriate follow up. Discharge Instructions: You were admitted to the hospital with fever and low blood pressure. You were treated for a presumed infection. You were found to have a urinary tract infection which was treated. You also required dialysis because of your end stage renal disease. After discussion with you and your wife, it was decided to pursue comfort measures only and you were discharged with home hospice. Please take all medications as prescribed. Please call your PCP or your nephrologist if you have any questions. Followup Instructions: Call if needed. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2138-3-22**]

038,785,996,584,403,585,599,198,276,008,428,707,995,E878,E849,041,185,424,275,V446

{'Unspecified septicemia,Septic shock,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Intestinal infection due to Clostridium difficile,Acute systolic heart failure,Pressure ulcer, elbow,Severe sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Malignant neoplasm of prostate,Aortic valve disorders,Hypocalcemia,Other artificial opening of urinary tract 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: Hypotension, fever PRESENT ILLNESS: Mr. [**Known lastname 32034**] is a 63 yo M s/p cadaveric renal transplant [**3-15**] polycystic kidney disease on tacrolimus and prednisone, metastatic prostate cancer, and MGUS who presents with fevers from his rehabilitation facility. Of note, he had been recently hospitalized at [**Hospital1 18**] [**Date range (1) 111347**] for shoulder and arm pains. He developed leukocytosis and loose stools during this hospitalization for which he was treated with flagyl empirically for two weeks ending on [**3-8**]. Per his rehab records, PO vancomycin was restarted on [**3-10**]. At rehab, stool had been C diff+ as recently as 1/30 per the records available to us. MEDICAL HISTORY: Polycystic kidney disease s/p cadaveric transplant x2 [**2118**]/[**2131**] Metastatic prostate cancer (mets to spine) on Lupron Chronic LE edema SCC skin HIT MGUS Hx c. difficile RUE cellulitis UGIB [**3-15**] gastritis Gout MEDICATION ON ADMISSION: Tacrolimus 2mg PO BID Prednisone 10mg PO daily Vancomycin 250mg PO QID Lasix 100mg PO BID Humalog insulin SS Ferrous sulfate 300mg PO daily Prevacid 30mg PO Daily Hexavitamin Fluoxetine 30mg PO daily Allopurinol 100mg PO BID Neurontin 100mg PO QHS Epogen MWF Dulcolax, mylanta, tylenol prn ALLERGIES: Heparin Agents PHYSICAL EXAM: General chronically ill appearing, no acute distress HEENT sclera white conjunctiva pink, L eye a little swollen with crusting Neck supple, LIJ in place Pulm lungs clear bilaterally CV regular rate S1 S2 II/VI systolic murmur Abd soft +bowel sounds well healed scar RLQ mild discomfort to palpation RLQ, urostomy with pink stoma no exudate or erythema Extrem 2+ pitting edema bilateral LE with faint erythema of skin bilaterally, patient says this is a chronic issue for him. range of motion of LE bilaterally limited by discomfort. skin bruised, tophi present Neuro alert and oriented x3, moving all extremities FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, admitted from [**Hospital3 **] ### Response: {'Unspecified septicemia,Septic shock,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Intestinal infection due to Clostridium difficile,Acute systolic heart failure,Pressure ulcer, elbow,Severe sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Malignant neoplasm of prostate,Aortic valve disorders,Hypocalcemia,Other artificial opening of urinary tract status'}

CHIEF COMPLAINT: Upper/lower Extremity Weakness, Parasthesias PRESENT ILLNESS: 77 yo Female with hx of HTN, HLD presents with upper/lower extremity weakness, numbness and shortness of breath. . Patient notes that she was in her normal state of health until approx one month ago when she notes migratory joint pain. She notes that it involved the knees, shoulders. The pain wouldn't involve multiple joints at once but would migrate between them. She denies associated swelling. She saw her PCP in [**Name9 (PRE) 108**] who ordered a shoulder film which he thought was concerning for mild dislocation. After several weeks these arthralgias resolved. No associated fevers, chills, or rash. . Approx 2 days ago the patient noted the sudden onset of weakness in the feet, legs and hands. The weakness has been progressive and profound to the point that she cannot even stand. She has difficulty doing things with her hands. Associated with this is some parasthesias. She denies any recent change in thinking, difficulty speaking, trauma, neck or back pain. She has been ambulatory and active up until this occurance two days ago. She denies bug bites. She spends time on Long Boat Key in [**State 108**] during the winter. She did get a flu shot approx 1 month ago however has been otherwise well without viral syndrome. No new medications or change in meds. no heavy metal exposure. . The night prior to presentation while in bed she developed worsening shortness of breath and anxiety. She was unable to sleep. Denies associated chest pain. Shortness of breath led her to come to the hospital. MEDICAL HISTORY: --HTN --HLD --Appendectomy six years ago. --Squamous cell carcinoma of the left leg [**2197**] MEDICATION ON ADMISSION: --Amlodipine/Benzapril 5-20mg --Simvastatin 20mg Daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS - Temp F 97.7, BP 136/80 , HR 93, R 16, O2-sat 96% RA GENERAL - NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear NECK - supple, no thyromegaly, no JVD HEART - PMI non-displaced, RRR, nl S1-S2, 2/6 SEM LUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) FAMILY HISTORY: Father died at 74 years of age due to Parkinson's disease and diabetes. Mother died at 94. Both of her siblings have diabetes. SOCIAL HISTORY: She is a former smoker who has not smoked for more than ten years. She is widowed and works part-time as a hostess at the [**Company 49705**] Long Wharf. Prior History of etoh use, nothing for years

Polyarteritis nodosa,Acute vascular insufficiency of intestine,Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Alkalosis,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Arterial embolism and thrombosis of upper extremity,Urinary tract infection, site not specified,Pulmonary collapse,Peripheral vascular complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Polyneuropathy in collagen vascular disease,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

Polyarteritis nodosa,Ac vasc insuff intestine,Food/vomit pneumonitis,Pleural effusion NOS,Alkalosis,Intestinal adhes w obstr,Upper extremity embolism,Urin tract infection NOS,Pulmonary collapse,Surg comp-peri vasc syst,Atrial fibrillation,Retention urine NOS,Neurpthy in col vasc dis,Abn react-anastom/graft

Admission Date: [**2201-3-1**] Discharge Date: [**2201-3-25**] Date of Birth: [**2123-7-20**] Sex: F Service: NEUROLOGY Allergies: Sulfa (Sulfonamide Antibiotics) Attending:[**First Name3 (LF) 5831**] Chief Complaint: Upper/lower Extremity Weakness, Parasthesias Major Surgical or Invasive Procedure: Lumbar Puncture Exploratory laparotomy, lysis of adhesions, small bowel resection Exploratory laparotomy, small bowel resection x2 with primary anastomosis History of Present Illness: 77 yo Female with hx of HTN, HLD presents with upper/lower extremity weakness, numbness and shortness of breath. . Patient notes that she was in her normal state of health until approx one month ago when she notes migratory joint pain. She notes that it involved the knees, shoulders. The pain wouldn't involve multiple joints at once but would migrate between them. She denies associated swelling. She saw her PCP in [**Name9 (PRE) 108**] who ordered a shoulder film which he thought was concerning for mild dislocation. After several weeks these arthralgias resolved. No associated fevers, chills, or rash. . Approx 2 days ago the patient noted the sudden onset of weakness in the feet, legs and hands. The weakness has been progressive and profound to the point that she cannot even stand. She has difficulty doing things with her hands. Associated with this is some parasthesias. She denies any recent change in thinking, difficulty speaking, trauma, neck or back pain. She has been ambulatory and active up until this occurance two days ago. She denies bug bites. She spends time on Long Boat Key in [**State 108**] during the winter. She did get a flu shot approx 1 month ago however has been otherwise well without viral syndrome. No new medications or change in meds. no heavy metal exposure. . The night prior to presentation while in bed she developed worsening shortness of breath and anxiety. She was unable to sleep. Denies associated chest pain. Shortness of breath led her to come to the hospital. In the ED, initial vitals: 98.5 100 163/115 30 97% 2L. CXR without acute process. D- Dimer checked and elevated so CTA performed which was negative for PE but did reveal mild pulmonary edema. ABG revealed a respiratory alkalosis which fit with the patients increased respiratory rate. UA negative, however 80 ketones noted. BMP with anion gap, hyponatremia. CBC with leukocytosis and left shift. Aspirin level was negative. LFTS with AST/ALT 54/63, mild elevation in alk phos. NIF performed with respiratory -25mmHg. Given 1 liter normal saline. Given Ceftriaxone, Azithromycin, Lorazepam in ED. Vitals prior to transfer: 97.3 22 98 124/78 100%ra. . Currently, patients breathing comfortably. Complains of lower extremity and hand weakness Past Medical History: --HTN --HLD --Appendectomy six years ago. --Squamous cell carcinoma of the left leg [**2197**] Social History: She is a former smoker who has not smoked for more than ten years. She is widowed and works part-time as a hostess at the [**Company 49705**] Long Wharf. Prior History of etoh use, nothing for years Family History: Father died at 74 years of age due to Parkinson's disease and diabetes. Mother died at 94. Both of her siblings have diabetes. Physical Exam: ADMISSION PHYSICAL EXAM: VS - Temp F 97.7, BP 136/80 , HR 93, R 16, O2-sat 96% RA GENERAL - NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear NECK - supple, no thyromegaly, no JVD HEART - PMI non-displaced, RRR, nl S1-S2, 2/6 SEM LUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) SKIN - no rashes or lesions, extremely tan, dry skin in the peripherally NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**4-4**] in deltoids, biceps, triceps, 4/5 strength in interosseous, intrinsic muscle of hand, 4/5 strength with plantar/dorsiflexion, illiopsoas, gait not test, sensation subjectively decreased to light touch in hands, feet in stocking glove distribution, DTRs 2+ on left and 1+ on right, cerebellar exam intact DISCHARGE PHYSICAL EXAM: VS - T 97.9, BP 140-160/80's, HR 70-80's, RR 18, 98% on RA GEN - elderly tanned woman lying in bed in NAD HEENT - OP clear CV - RRR PULM - CTA-B ABD - soft, NT, ND, large midline abdominal scar with staples, well healing, no erythema or exudates EXT: no edema NEURO EXAM: MS - AAOx3 CN - PERRL 4->3mm, EOMI, face symmetrical, tongue midline MOTOR - deltoids, biceps, triceps and wrist extensors [**4-4**] bilaterally, Finger Ext 5-/5 bilaterally, Finger Flex 4+/5 on R and [**3-5**] on L, IP [**4-4**] bilaterally, TA 0/5 bilaterally, gastroc [**12-4**] bilaterally, [**Last Name (un) 938**] 0/5 bilaterally REFLEXES - 0 bilaterally at achilles, 1 at patella bilaterally SENSATION - decreased vibratory and proprioception below ankles bilaterally GAIT - deferred Pertinent Results: ADMISSION LABS: [**2201-3-1**] 07:38AM BLOOD WBC-15.7*# RBC-3.84* Hgb-12.2 Hct-36.7 MCV-96 MCH-31.7 MCHC-33.2 RDW-12.7 Plt Ct-482* [**2201-3-1**] 07:38AM BLOOD Neuts-92.0* Lymphs-4.5* Monos-2.8 Eos-0.5 Baso-0.2 [**2201-3-1**] 07:38AM BLOOD PT-15.1* PTT-26.5 INR(PT)-1.4* [**2201-3-2**] 05:45AM BLOOD Fibrino-613* [**2201-3-1**] 07:10PM BLOOD ESR-120* [**2201-3-1**] 07:38AM BLOOD Glucose-156* UreaN-9 Creat-0.6 Na-132* K-3.5 Cl-96 HCO3-16* AnGap-24* [**2201-3-1**] 07:38AM BLOOD ALT-54* AST-63* LD(LDH)-283* CK(CPK)-1328* AlkPhos-230* TotBili-1.2 [**2201-3-1**] 07:38AM BLOOD proBNP-709* [**2201-3-1**] 07:38AM BLOOD cTropnT-<0.01 [**2201-3-1**] 07:38AM BLOOD Albumin-3.7 Calcium-9.2 Phos-3.2 Mg-1.9 [**2201-3-1**] 07:38AM BLOOD D-Dimer-5605* [**2201-3-1**] 07:38AM BLOOD Osmolal-273* [**2201-3-1**] 07:38AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE IgM HAV-NEGATIVE [**2201-3-1**] 07:10PM BLOOD RheuFac-12 CRP-222.6* [**2201-3-2**] 07:18PM BLOOD IgA-625* [**2201-3-1**] 07:38AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-6* Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2201-3-1**] 07:38AM BLOOD HCV Ab-NEGATIVE [**2201-3-1**] 08:32AM BLOOD Lactate-2.4* [**2201-3-1**] 11:58AM BLOOD Lactate-1.7 DISCHARGE LABS: [**2201-3-25**] 05:39AM BLOOD WBC-9.0 RBC-2.67* Hgb-8.4* Hct-26.4* MCV-99* MCH-31.4 MCHC-31.7 RDW-18.4* Plt Ct-257 [**2201-3-25**] 05:39AM BLOOD Glucose-76 UreaN-14 Creat-0.3* Na-135 K-4.1 Cl-101 HCO3-28 AnGap-10 [**2201-3-25**] 05:39AM BLOOD ALT-88* AST-33 LD(LDH)-245 AlkPhos-142* TotBili-0.5 [**2201-3-25**] 05:39AM BLOOD Albumin-2.6* Calcium-8.1* Phos-1.7* Mg-1.9 REPORTS: CXR [**2201-3-1**]: FINDINGS: Single portable chest radiograph demonstrates unremarkable mediastinal and cardiac contours. Aorta is calcified. There is mild pulmonary vascular congestion. Mild left base atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax evident. CTA CHEST [**2201-3-1**]: IMPRESSION: 1. No evidence of pulmonary embolism. 2. Multiple pulmonary nodules measuring up to 5 mm. Per guidelines, follow up CT may be performed in 6 months in a high risk patient and 12 months in a low-risk patient. EMG [**2201-3-2**]: IMPRESSION: Abnormal study. The electrophysiologic findings are consistent with an acute (<7 days) demyelinating polyradiculoneuropathy, as in [**Month/Day/Year 7816**]-[**Location (un) **] syndrome (GBS) . The absence of slowing of conduction velocity or conduction block, however, prevent a definitive electrodiagnosis of GBS. ECHO [**2201-3-2**]: Conclusions The left atrium is mildly elongated. The estimated right atrial pressure is 0-5 mmHg. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with abnormal contraction of the basal half of the anterior septum. The remaining segments contract normally (LVEF = 55 %). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Physiologic mitral regurgitation is seen (within normal limits). The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Normal left ventricular cavity size with mild regional systolic dysfunction suggetive of CAD (or IVCD if present). LENI [**2201-3-2**]: IMPRESSION: No evidence of DVT. CXR [**2201-3-4**]: FINDINGS: As compared to the previous radiograph, there is a newly occurred right basal opacity that could represent either atelectasis or aspiration. Overall, the lung volumes have decreased. There is no pleural effusion, but mild fluid overload might be present. Moderate cardiomegaly and mild tortuosity of the thoracic aorta. MRI SPINE [**2201-3-4**]: IMPRESSION: 1. No evidence of abnormal signal within the spinal cord to suggest [**First Name9 (NamePattern2) 7816**] [**Location (un) **]. No evidence of abnormal enhancement of the nerve roots. 2. Multilevel degenerative changes of the cervical spine and lumbar spine as described in detail above. 3. 1.1-cm hyperintense lesion in the right thyroid gland. Ultrasound is suggested if clinically warranted. 4. Abnormal signal in the right apex and lower lobes which is limited evaluated by MR. CT/XR is suggested if clinically warranted. CT ABDOMEN AND PELVIS [**2201-3-6**]: IMPRESSION: 1. No evidence of intra-abdominal or pelvic malignancy. 2. Bibasilar atelectasis has worsened since [**2201-3-1**]. Tiny bilateral pleural effusions. 3. Diverticulosis without diverticulitis. 4. Atherosclerotic calcifications throughout the normal-caliber aorta. Stenosis at the origin of the celiac artery with post-stenotic dilation. Calcific densities of the SMA origin with associated stenosis. 5. Dense coronary calcifications noted. MR HEAD [**2201-3-7**]: CONCLUSION: Scattered white matter hyperintensities on FLAIR. These are often attributed to chronic small vessel ischemia, but a demyelinating process could produce a similar appearance. . CT ABD & PELVIS WITH CONTRAST [**2201-3-13**] IMPRESSION: Findings concerning for bowel ischemia of several loops in the pelvis. There is likely an internal hernia in the right lower quadrant with secondary small-bowel obstruction upstream from the hernia. . ART DUP EXT UP UNI OR LMTD [**2201-3-15**] Limited arterial Duplex ultrasound from elbow to wrist. IMPRESSION: Wall thickening of the radial wall and decreased vascular flow. Given the ring-like area of echogenicity a dissection flap is not entirely excluded. Angiography would be helpful to further characterize these findings . Portable TTE [**2201-3-15**] No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). A left ventricular mass/thrombus cannot be excluded. The aortic valve leaflets are mildly thickened (?#). The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. IMPRESSION: Poor quality study. No source of embolism identified. No evidence of endocarditis. If clinically indicated, a TEE would better exclude valvular vegetations. . ART DUP EXT [**2201-3-23**]: IMPRESSION: Occluded right radial artery. Patent proximal inflow. Brief Hospital Course: # Presumed [**First Name9 (NamePattern2) 57635**] [**Location (un) **]: Mrs. [**Known lastname 57636**] initially presented with distal weakness most pronounced in the lower extremities as well as proprioceptive/vibratory sensory loss, and with the prior report of dyspnea, this provoked concern for [**Known lastname 7816**]-[**Location (un) **] syndrome. NIF was initially -25 but was -80 on repeat. A lumbar puncture performed ~5 days after onset of symptoms did not show albuminocytologic dissociation (however this is not seen in [**12-2**] of patients when LP is performed within 7 days of onset). MRI of the cervical and thoracic spine showed no evidence of abnormal signal within the spinal cord to suggest [**First Name9 (NamePattern2) 7816**] [**Location (un) **]. However, EMG was consistent with GBS with dropped F and H waves. A history of migratory arthralgias was thought to be a viral syndrome and a possible trigger for GBS. Stool culture was negative for Campyloabacter. (EBV and CMV serologies were negative for acute infection.) The patient received IVIg x 5 days and did show some improvement, greater in the upper extremities. The patient was found to have urinary retention and a Foley was placed. She was also given ~5 days of erythromycin as a promotility [**Doctor Last Name 360**] given concern for dysautonomia secondary to GBS. The patient did report pain and was started on gabapentin. She was transferred from Medicine to Neurology on HD5. Given that the presentation and lab abnormalities (particularly very high inflammatory markers, e.g., ESR 120, CRP 222) were not entirely consistent with GBS, a sural nerve biopsy was obtained early on HD12. Steroids were considered but deferred in the setting of small bowel infarction (see below). The sural nerve biopsy and bowel pathology did then return positive for ANCA vasculitis and the pt was started on steroids and rituximab as below. . # Polyneuropathy/ANCA vasculitis: The patient was treated for presumed GBS as above. She was also evaluated for vasculitides, hepatitides, Lyme, syphilis, B12 deficiency, heavy metal intoxication, poly/dermatomyositis, monoclonal gammopathy, EBV/CMV as above, sarcoid, and paraneoplastic syndromes. All this workup was negative, with the exception of + [**Doctor First Name **] at 1:80, a weakly positive c-ANCA, and positive SS-A, the significance of which was initially unclear but not thought to be significant enough to explain the clinical presentation. Rheumatology was consulted and provided ongoing input. However, when pt then had an SBO, and the pathology of that surgical specimen as well as the sural nerve biopsy returned positive for ANCA vasculitis, she was then treated with solumedrol 1gram x3 days, then started on steroids, initially prednisone 60mg x1 day, but this was then increased to 80mg QD thereafter. Pt will remain on this dose for the forseeable future, and will need a very very slow taper over many months to complete treatment. In addition, pt was started on rituximab 675mg IV weekly, with first dose given on [**3-23**]. The current plan is to continue this for 4 weeks, but rheumatology will consider a longer treatment after 4 weeks pending clinical improvement, and this follow-up appointment is made. The patient will go to the infusion clinic on a weekly basis for 4 weeks here at [**Hospital1 18**] and will be transported from rehab to this appointment to get her rituximab. . #. Shortness of Breath: At presentation, the patient was worked up for pulmonary embolus given a report of dyspnea and recent air travel. ABG on admission with respiratory alkalosis. CTA was negative for PE. Oxygen saturation remained stable. Echo and lenis were both unrevealing. Per the patient, dyspnea resolved with 0.25 mg IV lorazepam. Oxygen saturation remained normal throughout admission. . # Tachycardia: While on the Medicine service on HD2, the patient had a very brief episode of atrial fibrillation with RVR following a likely aspiration event with correlate on CXR. She was subsequently restarted on metoprolol 37.5 mg QID. She remained normocardic thereafter until she developed small bowel ischemia (below). We stopped the metoprolol once she remained in NSR thereafter. . # Small bowel obstruction with ischemia: On HD11, the patient developed persistent abdominal pain greater on the right side. On HD12, the patient had WBC 32.4 and appeared ill. A CT abdomen/pelvis showed small bowel obstruction in the ileum with ischemia. The ACS team was called to evaluate the patient and was found to have peritoneal signs on exam. She was taken to the OR for exploratory laparotomy and small bowel resection. She was left indiscontinuity until POD 1 when she was returned to the OR for washout and stapled anastamosis of her remaining small bowel. Post operatively the patient did well. She was closely monitored in the ICU where she was kept NPO and administered IVF. An NGT was left in place and her leukocytosis and hyponatremia slowly improved. Zosyn was started empirically and discontinued on POD 3. She was moved to the floor and kept NPO with NGT in place and on mIVF until return of bowel function. Patient started passing flatus and her diet was advanced to regular on POD5 after anastomosis. She has continued to have BM's throughout her admission after the SBO repair. Given that she is now on high dose steroids, surgery decided to leave her staples in for 4 weeks rather than the usual 2 to encourage wound healing. She will have them removed on [**4-9**] at her surgery follow-up appointment. . # Right ring finger cyanosis: On HD15 patient was noticed to have cyanosis of R ring finger and decreased radial pulse. Patient had had a prior radial A-line. An doppler ultrasound showed ring-like area of echogenicity in radial artery thought to represent a focal occlusion of radial artery at site of prior a-line. Ulnar artery was patent and there was a palmar arch signal. She was treated with a heparin gtt and nitropaste over the finger and wrist and serial hand exams followed. HD18 hep gtt and nitropaste was discontinued and there was no residual deficit. HD19 reevaluation showed R hand and finger were warm and well perfused. However, the next day she again had cyanosis of her R hand and nitropaste was used again with good effect. She had a repeat ultrasound of her R radial and ulnar artery. Her radial artery had a thrombus in it, however, she was still getting good flow through her ulnar artery. After discussion with vascular surgery, her general surgery team, rheumatology and her primary neurological team, it was decided to not anticoagulate her at this time given her recent bowel surgery and complicated hospital course. This should be reevaluated at a later date when she is more stable. . # Hyponatremia: The patient's sodium was initially 130 but began to downtrend on HD7. Urine electrolytes were checked on HD9 and found to be consistent with intravascular volume depletion, which was consistent with poor PO intake, and gentle IV fluids were started. However, sodium continued to downtrend on HD11, and rechecked urine lytes were more consistent with SIADH. Sodium continued to downtrend despite strict fluid restriction and two salt tabs on HD12, so on HD13 a PICC was placed and 3% NS started at 20cc/hr x 36 hours. Renal was consulted and agreed with this plan. Etiology of SIADH unclear but could theoretically be related to [**Month (only) 7816**]-[**Location (un) **] syndrome vs. other polyneuropathic process. She improved with 3% NS and then even when taken off of this and allowed as much fluid as she wanted, the SIADH did not recur. . # Urinary tract infection: On HD12, the patient had a rise in WBC and was found on urinalysis to have UTI. Ceftriaxone 1 g IV daily x 3 days was started. . # Anemia: The patient's hematocrit fell slowly from 37 at admission to 24 on HD12, likely due to repeated phlebotomy with IV fluids and poor PO intake. Hemolysis labs were negative. Reticulocytosis was appropriate. No evidence on exam or imaging of retroperitoneal or thigh hematoma. She remained at this HCT without further dropping. She did not receive any pRBCs for her HCT. . # Elevated liver function tests: The patient had mildly elevated ALT, AST, and ALP throughout her admission. Anti-mitochondiral antibodies were negative; anti-smooth muscle Ab was positive at 1:20. Hepatology was consulted re: the signifiance of this result, and IgG/IgM levels were sent. However, it became clear shortly after this that she had an SBO and then when she was diagnosed with vasculitis her elevated transaminases were better explained. These will need to be monitored while at rehab. . # HTN: Antihypertensives were initially held during the hospital course, but the patient was restarted on Metoprolol 37.5 mg PO four times per day as above. This was then stopped when she remained in NSR. She was started on amlodipine 5mg QD for her SBP which kept her normotensive. . # HLD: Simvastatin was held in the setting of muscle weakness. PENDING LABS: ACA IgG, ACA IgM TRANSITIONAL CARE ISSUES: Patient will need her abdominal exam closely monitored given her recent bowel surgery and current need for high dose steroids and rituximab. In addition, she will need her R hand circulation monitored and nitropaste applied as needed. She should have it reevaluated in the future once she is more stable to determine if she will need anticoagulation for her R radial thrombus. Medications on Admission: --Amlodipine/Benzapril 5-20mg --Simvastatin 20mg Daily Discharge Medications: 1. insulin regular human 100 unit/mL Solution Sig: sliding scale units Injection ASDIR (AS DIRECTED). 2. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every four (4) hours as needed for fever or pain. 3. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. heparin (porcine) 5,000 unit/mL Solution Sig: 5,000 units Injection TID (3 times 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. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Calcium 500 500 mg calcium (1,250 mg) Tablet Sig: One (1) Tablet PO twice a day. 10. Vitamin D3 1,000 unit Tablet Sig: One (1) Tablet PO once a day. 11. nitroglycerin 2 % Ointment Sig: One (1) application Transdermal Q6H (every 6 hours) as needed for decreased perfusion of R hand. 12. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours). 13. prednisone 20 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 14. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 15. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily). 16. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush PICC, non-heparin dependent: Flush with 10 mL Normal Saline daily and PRN per lumen. 17. rituximab 10 mg/mL Concentrate Sig: Six [**Age over 90 12887**]y Five (675) mg Intravenous once a week for 3 doses: Patient will receive 675mg IV on [**5-12**] and [**4-13**] at [**Hospital1 18**] infusion clinic. 18. atovaquone 750 mg/5 mL Suspension Sig: 1500 (1500) mg PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: ANCA vasculitis SBO s/p surgical repair x2 Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Ms. [**Known lastname 57636**], You were seen in the hospital for weakness and numbness in your hands and feet. You were initially treated for [**Last Name (un) 4584**]-[**Location (un) **] Syndrome. Your hospital course was complicated by a development of a small bowel obstruction, which was surgically repaired. You had a sural nerve biopsy and with this and your bowel pathology you were able to be diagnosed with ANCA vasculitis. You were then treated with steroids and rituximab. We made the following changes to your medications: 1) We STARTED you on an INSULIN SLIDING SCALE while you are on steroids. 2) We STOPPED your BENAZEPRIL. 3) We STOPPED your SIMVASTATIN. 4) We STARTED you on LISINOPRIL 10mg once a day. 5) We STARTED you on SUBCUTANEOUS HEPARIN 5,000 units three times a day to prevent DVTs while you cannot walk. 6) We STARTED you on DOCUSATE 100mg twice a day. 7) We STARTED you on SENNA 8.6mg twice a day as needed for constipation. 8) We STARTED you on PANTOPRAZOLE 40mg once a day while you are on steroids. 9) We STARTED you on CALCIUM 500mg twice a day while you are on steroids. 10) We STARTED you on VITAMIN D3 1,000mg once a day while you are on steroids. 11) We STARTED you on NITROPASTE every 6 hours as needed for circulation issues in your right hand. 12) We STARTED you on GABAPENTIN 600mg every 8 hours. 13) We STARTED you on PREDNISONE 80mg once a day. Your Rheumatologist will tell you when you can decrease this medication. 14) We STARTED you on BISACODYL 10mg as needed per day for constipation. 15) We STARTED you on POLYETHYLENE GLYCOL 17 grams per day. You can stop this medication if you are having adequate bowel movements. 16) We STARTED you on ATOVAQUONE SUSPENSION 1500mg once a day while you are on steroids to help prevent infections. Please continue to take your other medications as previously prescribed. If you experience any of the below listed Danger Signs, please contact your doctor or go to the nearest Emergency Room. It was a pleausure taking care of you on this hospitalization. Followup Instructions: Department: GENERAL SURGERY/[**Hospital Unit Name 2193**] When: THURSDAY [**2201-4-9**] at 2:45 PM With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: RHEUMATOLOGY When: MONDAY [**2201-4-13**] at 9:30 AM With: [**First Name8 (NamePattern2) 674**] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 2226**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 861**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: NEUROLOGY When: FRIDAY [**2201-4-24**] at 4:00 PM With: DRS. [**Name5 (PTitle) **]/LAGANIERE [**Telephone/Fax (1) 44**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: ADULT MEDICINE When: THURSDAY [**2201-5-7**] at 9:00 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 12175**], MD [**Telephone/Fax (1) 1144**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site

446,557,507,511,276,560,444,599,518,997,427,788,357,E878

{'Polyarteritis nodosa,Acute vascular insufficiency of intestine,Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Alkalosis,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Arterial embolism and thrombosis of upper extremity,Urinary tract infection, site not specified,Pulmonary collapse,Peripheral vascular complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Polyneuropathy in collagen vascular disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Upper/lower Extremity Weakness, Parasthesias PRESENT ILLNESS: 77 yo Female with hx of HTN, HLD presents with upper/lower extremity weakness, numbness and shortness of breath. . Patient notes that she was in her normal state of health until approx one month ago when she notes migratory joint pain. She notes that it involved the knees, shoulders. The pain wouldn't involve multiple joints at once but would migrate between them. She denies associated swelling. She saw her PCP in [**Name9 (PRE) 108**] who ordered a shoulder film which he thought was concerning for mild dislocation. After several weeks these arthralgias resolved. No associated fevers, chills, or rash. . Approx 2 days ago the patient noted the sudden onset of weakness in the feet, legs and hands. The weakness has been progressive and profound to the point that she cannot even stand. She has difficulty doing things with her hands. Associated with this is some parasthesias. She denies any recent change in thinking, difficulty speaking, trauma, neck or back pain. She has been ambulatory and active up until this occurance two days ago. She denies bug bites. She spends time on Long Boat Key in [**State 108**] during the winter. She did get a flu shot approx 1 month ago however has been otherwise well without viral syndrome. No new medications or change in meds. no heavy metal exposure. . The night prior to presentation while in bed she developed worsening shortness of breath and anxiety. She was unable to sleep. Denies associated chest pain. Shortness of breath led her to come to the hospital. MEDICAL HISTORY: --HTN --HLD --Appendectomy six years ago. --Squamous cell carcinoma of the left leg [**2197**] MEDICATION ON ADMISSION: --Amlodipine/Benzapril 5-20mg --Simvastatin 20mg Daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS - Temp F 97.7, BP 136/80 , HR 93, R 16, O2-sat 96% RA GENERAL - NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear NECK - supple, no thyromegaly, no JVD HEART - PMI non-displaced, RRR, nl S1-S2, 2/6 SEM LUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) FAMILY HISTORY: Father died at 74 years of age due to Parkinson's disease and diabetes. Mother died at 94. Both of her siblings have diabetes. SOCIAL HISTORY: She is a former smoker who has not smoked for more than ten years. She is widowed and works part-time as a hostess at the [**Company 49705**] Long Wharf. Prior History of etoh use, nothing for years ### Response: {'Polyarteritis nodosa,Acute vascular insufficiency of intestine,Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Alkalosis,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Arterial embolism and thrombosis of upper extremity,Urinary tract infection, site not specified,Pulmonary collapse,Peripheral vascular complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Polyneuropathy in collagen vascular disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: Respiratory failure PRESENT ILLNESS: 73 yoF w/ h/o HTN, hyperchol, and prior TIAS initially presented to ED [**2182-3-6**] following episode of sudden onset transient slurred speech and paresthesias of lip (sbp at home 190s). In [**Name (NI) **], pt evaluated by neuro, had MRI (-) for acute stroke. [**2182-3-7**] a.m., pt had episode of N/V followed by tachypnea and increased work of breathing. Received lasix 40 mg IV X 1, nitro gtt and was placed on BiPAP for suspected CHF. However, sbp decreased to 60s (no improvement following d/c of nitro gtt). She was intubated, started on levophed and gtt. CTA (-) for PE, showing diffuse ground glass opacities and bibasilar opacities (c/w pulmonary edema and aspiration). Pt then sucessfully extubated. Transferred to the floor [**3-11**] and doing well at this time MEDICAL HISTORY: 1) HTN 2) Hypercholesterolemia 3) h/o pancreatitis 4) lumbar radiculopathy s/p laminectomy 5) s/p bilateral hip replacements 6) h/o aspiration PNA MEDICATION ON ADMISSION: 1. Lipitor 20 mg daily 2. HCTZ 12.5 mg daily 3. Toprol 75 mg daily ALLERGIES: Sulfonamides / Iodine PHYSICAL EXAM: On transfer from MICU to floor. FAMILY HISTORY: NA SOCIAL HISTORY: No tobacco or ETOH use. Mother of 8 children. Very involved family.

Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified transient cerebral ischemia

Acute respiratry failure,Food/vomit pneumonitis,CHF NOS,Hypertension NOS,Pure hypercholesterolem,Dvrtclo colon w/o hmrhg,Trans cereb ischemia NOS

Admission Date: [**2182-3-7**] Discharge Date: [**2182-3-15**] Date of Birth: [**2108-5-19**] Sex: F Service: MEDICINE Allergies: Sulfonamides / Iodine Attending:[**First Name3 (LF) 898**] Chief Complaint: Respiratory failure Major Surgical or Invasive Procedure: Intubation History of Present Illness: 73 yoF w/ h/o HTN, hyperchol, and prior TIAS initially presented to ED [**2182-3-6**] following episode of sudden onset transient slurred speech and paresthesias of lip (sbp at home 190s). In [**Name (NI) **], pt evaluated by neuro, had MRI (-) for acute stroke. [**2182-3-7**] a.m., pt had episode of N/V followed by tachypnea and increased work of breathing. Received lasix 40 mg IV X 1, nitro gtt and was placed on BiPAP for suspected CHF. However, sbp decreased to 60s (no improvement following d/c of nitro gtt). She was intubated, started on levophed and gtt. CTA (-) for PE, showing diffuse ground glass opacities and bibasilar opacities (c/w pulmonary edema and aspiration). Pt then sucessfully extubated. Transferred to the floor [**3-11**] and doing well at this time Past Medical History: 1) HTN 2) Hypercholesterolemia 3) h/o pancreatitis 4) lumbar radiculopathy s/p laminectomy 5) s/p bilateral hip replacements 6) h/o aspiration PNA Social History: No tobacco or ETOH use. Mother of 8 children. Very involved family. Family History: NA Physical Exam: On transfer from MICU to floor. 97.1 135/64 66 15 97% 4L NC Gen- Awake. Pleasant. Alert. NAD. HEENT: PERRL. EOMI. MMM. Cardiac- RRR. S1 S2. No murmers. Pulm- Faint crackles at right base. Abdomen- Soft. NT. ND. Positive bowel sounds. Extremitis- 1+ bilateral LE edema. Pertinent Results: [**2182-3-15**] 04:50AM BLOOD WBC-3.0* RBC-4.02* Hgb-12.7 Hct-36.2 MCV-90 MCH-31.7 MCHC-35.2* RDW-14.1 Plt Ct-110* [**2182-3-11**] 04:15AM BLOOD Neuts-89.1* Bands-0 Lymphs-6.6* Monos-3.8 Eos-0.3 Baso-0.2 [**2182-3-15**] 04:50AM BLOOD Plt Ct-110* [**2182-3-15**] 04:50AM BLOOD Glucose-93 UreaN-8 Creat-0.8 Na-139 K-4.2 Cl-107 HCO3-27 AnGap-9 [**2182-3-15**] 04:50AM BLOOD Calcium-8.5 Phos-2.8 Mg-2.0 [**2182-3-6**] 08:20PM BLOOD %HbA1c-5.6 [**2182-3-6**] 04:30PM BLOOD Triglyc-136 HDL-61 CHOL/HD-4.0 LDLcalc-155* [**2182-3-7**] 09:29PM BLOOD TSH-6.5* [**2182-3-7**] 09:29PM BLOOD Cortsol-34.0* MRA BRAIN W/O CONTRAST ([**2182-3-6**]) FINDINGS: There is no area of restricted diffusion. Again noted are multiple foci and confluent areas of T2 hyperintensity in the periventricular and deep white matter of the cerebral hemispheres which have increased in the interval. There is convex margin of the superior aspect of the pituitary gland and mild glandular enlargement, which is not significantly changed compared to prior examination. There is no mass effect, shift of the normally midline structures, or hydrocephalus. IMPRESSION: 1. No evidence of acute infarct. 2. Progression of patient's known chronic small vessel ischemic infarcts. 3. Unchanged pituitary gland enlargement, compatible with a small tumor. HEAD MRA: 3D time of flight imaging of the anterior and posterior cerebral circulations was obtained. Comparison was made to prior study dated [**2181-7-29**]. FINDINGS: There is no hemodynamically significant stenosis or aneurysmal dilatation of the visualized vasculature. IMPRESSION: Unremarkable head MRA. CHEST (PA & LAT) ([**2182-3-6**]): FINDINGS: The heart is normal in size. The aorta is slightly tortuous and unfolded. The lungs appear clear. There is no pleural effusion. Pulmonary vasculature is within normal limits. There is no pneumothorax. Biapical pleural scarring is unchanged. A clip is seen medially in the superior mediastinum along the left paratracheal margin. The osseous structures demonstrate mild degenerative changes throughout the thoracic spine. IMPRESSION: No radiographic evidence of acute cardiopulmonary process. No CHF. The study and the report were reviewed by the staff radiologist. Echo ([**3-8**]): Findings: LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Normal LV wall thickness. Small LV cavity. Hyperdynamic LVEF. No resting LVOT gradient. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic root diameter. AORTIC VALVE: Three aortic valve leaflets. Mildly thickened aortic valve leaflets. No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. Mild thickening of mitral valve chordae. Calcified tips of papillary muscles. Trivial MR. Prolonged (>250ms) transmitral E-wave decel time. LV inflow pattern c/w impaired relaxation. TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. Mild PA systolic hypertension. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets with physiologic PR. Normal main PA. No Doppler evidence for PDA PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: The patient appears to be in sinus rhythm. Left pleural effusion. Conclusions: The left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity is small. Left ventricular systolic function is hyperdynamic (EF 70-80%). Right ventricular chamber size and free wall motion are normal. There are three aortic valve leaflets. The aortic valve leaflets are mildly thickened. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. CT abdomen and pelvis ([**3-10**]): FINDINGS: Evaluation of the lung bases demonstrates bilateral pleural effusions and atelectasis. This is less severe than on a prior examination although the entire lungs are not evaluated on today's exam. The liver and spleen are unremarkable. A calcified stone and sludge are identified within the gallbladder. There is no evidence of intra or extrahepatic biliary ductal dilatation. The pancreas is slightly fatty replaced, but otherwise unremarkable. No adrenal lesions are present. There is a 4.6 cm exophytic cyst in the left kidney. No other renal masses are identified. The kidneys enhance symmetrically and are without evidence of perinephric stranding or hydronephrosis. There are no dilated loops of small bowel to suggest an obstruction. Contrast is visualized throughout the distal bowel and colon. Scattered left sided and sigmoid diverticula are present without evidence of diverticulitis. No significant lymphadenopathy is present. Note is made of atherosclerotic calcifications and a clacified splenic artery aneurysm. Evaluation of the deep pelvis is slightly limited due to artifact from the indwelling bilateral hip arthroplasties. No discrete fluid collection is identified. The bladder is collapsed with a Foley catheter within it. Evaluation of the bone windows demonstrates no osseous blastic or lytic lesions. Degenerative changes are present throughout the spine. An area of soft tissue density is identified with in the atrophied left paraspinous muscles of L5-S1. This is better evaluated on the prior CT and MRI of the lumbar spine. It is nonspecific and may represent post-surgical changes. IMPRESSION: Bilateral pleural effusions with adjacent atelectasis. No intra-abdominal fluid collections are identified to suggest an abscess. Evaluation of the deep pelvis is slightly limited as described above. Carotid US ([**3-12**]): HISTORY: TIA. There is no appreciable plaque or wall thickening involving either carotid system. The peak systolic velocities bilaterally are normal, as are the ICA to CCA ratios. There is normal antegrade flow in both vertebral arteries. IMPRESSION: Widely patent common and internal carotid arteries bilaterally. Sputum culture ([**3-10**]): GRAM STAIN (Final [**2182-3-10**]): <10 PMNs and <10 epithelial cells/100X field. 1+ (<1 per 1000X FIELD): MULTIPLE ORGANISMS CONSISTENT WITH OROPHARYNGEAL FLORA. RESPIRATORY CULTURE (Final [**2182-3-12**]): SPARSE GROWTH OROPHARYNGEAL FLORA. Brief Hospital Course: A/P: 73 y/o female with PMH significant for HTN, previous TIAs, and hypercholesterolemia admitted through ED on [**3-6**] following an episode of slred speech and lip paresthesias. MRI was negative for acute CVA. On the morning of [**3-7**], the pt had an episode of nausea and vomiting followed by increased work of breathing and decrease in SBP to the 60s. Pt required intubation and was started on levophed. She was transferred to the MICU at that time. CTA was negative for PE but showed bilateral consollidations concerning for aspiration PNA. Pt was treated and successfully extubated. She was transferred to the floor on [**3-11**]. She is currently being treated emperically with levo and flagyl. 1. Respiratory failure- Pt experienced an episode of respiratory failure on [**3-7**]. This occurred following an episode of nausea and vomiting. At that time, the pt developed increased work of breathing and tachypnia. CXR showed florid CHF so the pt was diuresed with lasix 40 mg IV and started on a nitro drip. She was also placed on BiPap. However, her SBP decreased to the 60s at that time and the pt required intubation. She was also started on pressors for her hypotension at that time. A CTA was concerned given a concern for PE but this was negative. Imaging did show bilateral lower lobe infiltrates consistent with probable aspiration PNA. Pt was started on emperic levo, flagyl, and ceftriaxone at that time. Pt was extubated without problem on [**3-11**]. Following transfer to the floor, pt's respiratory status has been stable. At this time, she has an oxygen saturation in the mid 90s on room air. She does not desaturate with ambulation. The ceftriaxone was discontinued on [**3-12**] and the pt will complete a 14 day course of levo and flagyl. Blood cultures have been negative to date and sputum cultures grew only oropharyngeal flora. Of note, pt had bedside swallow eval on [**3-11**] which she passed without difficulty. No further choking epsisodes with eating. 2. [**Name (NI) **] Pt with probable aspiration PNA as above. In addition, pt developed rigoring, transient leukopenia, and hypertension in the MICU on [**3-10**]. At that time, she was experiencing severe back and leg pain. A CT was obtained that diverticulosis and fluid at L4-L5 of the spinal processes. However, there were no findings thought to account for her symtpoms. Blood clutures were sent which are negative to date. A TTE was obtained to evaluate for possible valvular disease/endocarditis. It showed no significant abnormality and no vegitation. As the pt remained afebrile on the floor with negative blood cultures and no new murmer, a TEE was not obtained. The vancomycin was discontinued. She has been stable from an ID standpoint while on the floor. 3. [**Name (NI) **] Pt was hypotensive in the MICU in settion of probable aspiration PNA/concern for SIRS. She was treated with levophed for approximately 2 days. It was weaned off at that time and the pt required one IV fluid bolus but otherwise maintained stable BP. On [**3-10**], in the setting of back and leg pain, the pt devloped hypertesion. She was started back on low doses of her home BP meds and those have slowly been titrated upward since that time. She is now back on her home dose of HCTZ, avapro, and beta blocker. BP is well controlled at the time of discharge. 4. Neuro- On admission, pt had transient dysarthria and facial numbness most probably due to a TIA. Neuro consult was obtained. Head CT and MRI were negative for evidence of acute infarct. Carotid US was obtained [**3-12**] which showed widely patent arteries. TIA may have been in setting of poorly controlled hypertension. As pt had this episode and has had TIAs in the past, an appointment was made for her to follow up with neurology following discharge. 5. [**Name (NI) 14984**] Pt's dose of lipitor was increased to 40 mg during admission. 6. [**Name (NI) 3674**] Pt with slow trend down of Hct over admission but stable over last few days. No obvious source of bleeding. Guiacing all stools which have been negative. She did not require transfusion. 7. FEN- Cardiac diet as tolerated. Electrolytes repleated as needed throughout admission. 8. Proph- SC heparin; PPI; bowel regimen 9. [**Name (NI) 54454**] PT and OT consults were obtained during admission. \ 10. Code- Full 11. [**Name (NI) 2638**] Pt's daughter [**Name (NI) **] [**Name (NI) 4640**] is her health care proxy. [**Name (NI) **] number is [**Telephone/Fax (1) 106085**] and cell number is [**Telephone/Fax (1) 106086**]. Medications on Admission: 1. Lipitor 20 mg daily 2. HCTZ 12.5 mg daily 3. Toprol 75 mg daily Discharge Medications: 1. Aspirin 325 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* 2. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(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. Irbesartan 150 mg Tablet Sig: 1.5 Tablets PO qd (). Disp:*45 Tablet(s)* Refills:*2* 5. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 10 days. Disp:*30 Tablet(s)* Refills:*0* 7. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 10 days. Disp:*10 Tablet(s)* Refills:*0* 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 9. 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* 10. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary diagnosis: Aspiration pneumonia Secondary diagnosis: Respiratory failure Hypotension in setting of PNA Hypertension Hypercholesterolemia TIAs Discharge Condition: Stable. Breathing comfortably on room air. Discharge Instructions: 1. Please keep all follow up appointments. 2. Please take all medications as prescribed. 3. Seek medical attention for chest pain, shortness of breath, abdominal pain, inability to eat, or any other concerning symtpoms. Followup Instructions: 1. Please follow up with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 172**] on Monday [**4-1**] at 1:15. 2. Please follow up in neurology clinic with Dr. [**Last Name (STitle) **] on [**4-2**] at 2:15. His office is on the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical Building. Call [**Telephone/Fax (1) 44**] before your appointment to update your personal information.

518,507,428,401,272,562,435

{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified transient cerebral ischemia'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Respiratory failure PRESENT ILLNESS: 73 yoF w/ h/o HTN, hyperchol, and prior TIAS initially presented to ED [**2182-3-6**] following episode of sudden onset transient slurred speech and paresthesias of lip (sbp at home 190s). In [**Name (NI) **], pt evaluated by neuro, had MRI (-) for acute stroke. [**2182-3-7**] a.m., pt had episode of N/V followed by tachypnea and increased work of breathing. Received lasix 40 mg IV X 1, nitro gtt and was placed on BiPAP for suspected CHF. However, sbp decreased to 60s (no improvement following d/c of nitro gtt). She was intubated, started on levophed and gtt. CTA (-) for PE, showing diffuse ground glass opacities and bibasilar opacities (c/w pulmonary edema and aspiration). Pt then sucessfully extubated. Transferred to the floor [**3-11**] and doing well at this time MEDICAL HISTORY: 1) HTN 2) Hypercholesterolemia 3) h/o pancreatitis 4) lumbar radiculopathy s/p laminectomy 5) s/p bilateral hip replacements 6) h/o aspiration PNA MEDICATION ON ADMISSION: 1. Lipitor 20 mg daily 2. HCTZ 12.5 mg daily 3. Toprol 75 mg daily ALLERGIES: Sulfonamides / Iodine PHYSICAL EXAM: On transfer from MICU to floor. FAMILY HISTORY: NA SOCIAL HISTORY: No tobacco or ETOH use. Mother of 8 children. Very involved family. ### Response: {'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified transient cerebral ischemia'}

CHIEF COMPLAINT: atrial fibrillation with RVR PRESENT ILLNESS: 67 year old man with CAD s/p MI, systolic CHF LVEF 25% with AICD, DM2, ESRD on HD, PVD s/p femoral endarterectomy, afib of warfarin, hypothyroidism, s/p ileostomy for cecal volvulus, who presented to OSH after developing afib with RVR during a hemodialysis session. He received amiodarone followed by synchronized cardioversion but subsequently became hypotensive (SBP 60s) and was transferred to [**Hospital6 17183**] on [**2129-6-8**]. MEDICAL HISTORY: - Cecal volvulus and peritonitis [**5-/2128**], s/p right hemicolectomy, ileostomy, and mucous fistula by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. - CAD s/p MI in [**2111**], medically managed - Systolic CHF (last echo 25% per OSH report) - Pacemaker/AICD placed [**2124**] - PVD s/p multiple arterial surgeries to lower extremities, left great toe amputation and right femoral endarterectomy with resection of right femoral aneurysm by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] [**1-/2129**] MEDICATION ON ADMISSION: amidarone 400mg [**Hospital1 **] aranesp 200mg qweek aspirin 81mg daily cholecalciferol 800mg daily citalopram 20mg daily cyanocobalamin 500mcg daily digoxin 0.125mg daily gabapentin 400mg qAM and 100mg QM/W/F after dialysis levothyroxine 50mcg daily loperamide 2mg [**Hospital1 **] midodrine 2.5mg q M/W/F after dialysis mirtazipine 30mg qHS pantoprazole 40mg [**Hospital1 **] crestor 10mg PO qHS sevelamer 800mg TID bactrim DS [**Hospital1 **] surbex dose unknown coumadin 6mg daily tylenol 650mg q4H PRN dulcolax 10mg daily PRN [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] 30mg q4H PRN hyoscamine 0.125mg [**Hospital1 **] lactulose 20g PO PRN oxycodone IR 10-30mg daily PRN pepto bismol 30ml q6H PRN prochlorperazine 5mg [**Hospital1 **] PRN simethicone 80mg TID PRN trazodone 25mg PO qHS PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: General: Lethargic, awakens to voice, follows commands, too fatigued to tell story HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: decreased breath sounds at bases, intermittent rhonchi anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley draining hematuria Ext: cool feet Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation FAMILY HISTORY: Non contributory SOCIAL HISTORY: Previously lived at home with his wife, but has been living in a skilled nursing facility since [**2128-5-23**]. Has 3 grown children and 3 [**Doctor Last Name **] children. Still smokes (history of 1.5 ppd x many decades, but since moving to [**Hospital1 1501**] only 1 pack per week because it is hard to find time). No alcohol or recreational drugs. Retired engineer.

Unspecified septicemia,Septic shock,End stage renal disease,Unspecified osteomyelitis, ankle and foot,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Other specified types of cystitis,Severe sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified acquired hypothyroidism,Hypocalcemia,Other chronic pain,Epilepsy, unspecified, without mention of intractable epilepsy,Tobacco use disorder,Old myocardial infarction,Renal dialysis status,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Ileostomy status,Do not resuscitate status,Encounter for palliative care

Septicemia NOS,Septic shock,End stage renal disease,Osteomyelitis NOS-ankle,Chr systolic hrt failure,Hyp kid NOS w cr kid V,Prim cardiomyopathy NEC,Hyposmolality,Cystitis NEC,Severe sepsis,Atrial fibrillation,Crnry athrscl natve vssl,Athscl extrm ntv art NOS,Hypothyroidism NOS,Hypocalcemia,Chronic pain NEC,Epilep NOS w/o intr epil,Tobacco use disorder,Old myocardial infarct,Renal dialysis status,Long-term use anticoagul,Status autm crd dfbrltr,Ileostomy status,Do not resusctate status,Encountr palliative care

Admission Date: [**2129-6-11**] Discharge Date: [**2129-6-22**] Date of Birth: [**2061-10-14**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 11040**] Chief Complaint: atrial fibrillation with RVR Major Surgical or Invasive Procedure: Bladder Irrigation Bone Biopsy CVVH History of Present Illness: 67 year old man with CAD s/p MI, systolic CHF LVEF 25% with AICD, DM2, ESRD on HD, PVD s/p femoral endarterectomy, afib of warfarin, hypothyroidism, s/p ileostomy for cecal volvulus, who presented to OSH after developing afib with RVR during a hemodialysis session. He received amiodarone followed by synchronized cardioversion but subsequently became hypotensive (SBP 60s) and was transferred to [**Hospital6 17183**] on [**2129-6-8**]. At [**Hospital3 **] he was in sinus rhythm but persistently hypotensive not responsive to IVF and thus norepinephrine was started. His AICD was interrogated and was functioning appropriately. He developed abdominal distention and vomitting on [**2129-6-9**]. KUB suggested bladder pneumotosis. CT abd/pelvis showed pneumotosis in and around the bladder wall with question of a small bowel to bladder fistula. Foley was placed with return of blood and pus. No UA or culture available. Blood cultures grew GNR, not yet speciated. He was started on Vancomycin and Zosyn. Vancomycin was switched to linezolid given history of VRE urospesis in 2/[**2129**]. Labs notable for WBC 12.8 and INR 7.0 (reversed to 1.5 with vitamin K and FFP), BUN/Cr 39/3.2. He has 2 PIV 20G and an HD tunneled line that did not appear infected per report. Prior to transfer to [**Hospital1 18**] on [**2129-6-10**], he was started on HD and developed afib with RVR. He was given an amiodarone bolus and switched to phenylephrine. He then was cardioverted with return of HR to V-paced rhythm to HR 55. Vitals prior to transfer: Afebrile, rapid afib 160s, BP 114/70 on norepinephrine, 94-95% 2L NC. Exam notable for a stage IV coccyx ulcer. He has 2 PIV 20G. On arrival to the MICU, he is lethargic but arousable to voice and follows commands. He denies pain currently. He is too lethargic to give a ROS. Past Medical History: - Cecal volvulus and peritonitis [**5-/2128**], s/p right hemicolectomy, ileostomy, and mucous fistula by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. - CAD s/p MI in [**2111**], medically managed - Systolic CHF (last echo 25% per OSH report) - Pacemaker/AICD placed [**2124**] - PVD s/p multiple arterial surgeries to lower extremities, left great toe amputation and right femoral endarterectomy with resection of right femoral aneurysm by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] [**1-/2129**] - Type II diabetes mellitus (recent weight loss has led to greatly improved glycemic control) - Hypertension - Atrial fibrillation on warfarin - Status post TURP for urinary retention - Hypothyroidism - Bilateral subdural hematomas with resultant seizure disorder - Urosepsis [**2-/2129**] with VRE - Depression Social History: Previously lived at home with his wife, but has been living in a skilled nursing facility since [**2128-5-23**]. Has 3 grown children and 3 [**Doctor Last Name **] children. Still smokes (history of 1.5 ppd x many decades, but since moving to [**Hospital1 1501**] only 1 pack per week because it is hard to find time). No alcohol or recreational drugs. Retired engineer. Family History: Non contributory Physical Exam: Admission Exam: General: Lethargic, awakens to voice, follows commands, too fatigued to tell story HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: decreased breath sounds at bases, intermittent rhonchi anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley draining hematuria Ext: cool feet Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation Pertinent Results: Admssion Labs: [**2129-6-11**] 03:09AM BLOOD WBC-15.6*# RBC-4.33*# Hgb-10.9*# Hct-35.3*# MCV-82# MCH-25.1*# MCHC-30.8* RDW-17.3* Plt Ct-310 [**2129-6-11**] 03:09AM BLOOD Neuts-91.9* Bands-0 Lymphs-5.5* Monos-2.0 Eos-0.3 Baso-0.3 [**2129-6-11**] 03:09AM BLOOD PT-13.7* PTT-34.3 INR(PT)-1.3* [**2129-6-11**] 03:09AM BLOOD Glucose-69* UreaN-26* Creat-2.4* Na-136 K-3.3 Cl-102 HCO3-19* AnGap-18 [**2129-6-11**] 03:09AM BLOOD ALT-13 AST-32 LD(LDH)-237 AlkPhos-225* TotBili-1.2 [**2129-6-11**] 03:09AM BLOOD Albumin-2.5* Calcium-6.7* Phos-3.3# Mg-1.6 [**2129-6-11**] 10:07AM BLOOD Digoxin-2.0 [**2129-6-11**] 03:45AM BLOOD Type-ART pO2-88 pCO2-37 pH-7.40 calTCO2-24 Base XS-0 Intubat-NOT INTUBA [**2129-6-11**] 03:45AM BLOOD Lactate-1.8 [**2129-6-11**] 07:28AM BLOOD O2 Sat-61 Micro: GRAM STAIN (Final [**2129-6-15**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI IN PAIRS. WOUND CULTURE (Final [**2129-6-19**]): PROTEUS MIRABILIS. SPARSE GROWTH. PRESUMPTIVE IDENTIFICATION. Piperacillin/tazobactam sensitivity testing available on request. ENTEROCOCCUS SP.. SPARSE GROWTH. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PROTEUS MIRABILIS | ENTEROCOCCUS SP. | | AMPICILLIN------------ =>32 R <=2 S AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- 8 R CEFEPIME-------------- <=1 R CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ 8 I MEROPENEM------------- 1 S PENICILLIN G---------- 8 S TOBRAMYCIN------------ 4 S TRIMETHOPRIM/SULFA---- =>16 R VANCOMYCIN------------ 1 S ANAEROBIC CULTURE (Final [**2129-6-17**]): UNABLE TO R/O PATHOGENS DUE TO OVERGROWTH OF SWARMING PROTEUS SPP.. URINE CULTURE (Final [**2129-6-21**]): ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. SECOND STRAIN. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | ENTEROCOCCUS SP. | | AMPICILLIN------------ <=2 S <=2 S LINEZOLID------------- 2 S 1 S NITROFURANTOIN-------- <=16 S <=16 S TETRACYCLINE---------- =>16 R =>16 R VANCOMYCIN------------ =>32 R =>32 R Cdiff NEgative Blood cultures NGTD or negative Imaging: TTE: IMPRESSION: Akinesis of the inferior and inferolateral segments and severe hypokinesis of the septum (EF 15-20%). Dilated and hypokinetic reight ventricle. Moderate to severe, posteriorly directed mitral regurgitation. R Foot Xray [**6-14**]: IMPRESSION: New lytic lesion in posterior calcaneus. If there is no intervening debridement to account for this, then this is consistent with osteomyelitis of the posterior calcaneus. CT Cystogram [**2129-6-17**]: IMPRESSION: 1. Extensive emphysematous cystitis as well as likely clot within the bladder wall but no evidence of fistula connections to the small bowel or bladder rupture. 2. Resolution of the previously extensive bowel wall pneumatosis. 3. Small amount of pelvic and abdominal free fluid. Brief Hospital Course: ID: 67 year old man with CAD s/p MI, systolic CHF LVEF 25% with AICD, DM2, ESRD on HD, PVD s/p femoral endarterectomy, afib of warfarin, hypothyroidism, s/p ileostomy for cecal volvulus, who presented to OSH after developing afib with RVR during a hemodialysis session, found to have septic shock with GNR bacteremia and bladder wall pyocystis with emphysematous cystitis. # Goals of Care: Prior to hospitalization, [**Known firstname **] had been DNR/DNI with expressed interest in maximizing his quality of life in regard to his health. However, while he was at [**Hospital3 **] prior to transfer to [**Hospital1 18**], he reveresed his code status to allow cardioversion of unstable Afib with RVR. After reversing his DNR/DNI status, [**Known firstname **] then articulated desire to pursue aggressive goals of care during his first 10+ days at [**Hospital1 18**]. However, when it becamse unlikely that [**Known firstname **] would be able to return to home or a to a significant quality of life, he decided to focus on comfort with the goal of getting home and spending as much time with his family as possible. His family were in agreement with this plan. As a result, he was discharged on hospice and antibiotics, vassopressors, and dialysis were stopped at time of discharge. The palliative care service saw [**Known firstname **] during his stay and helped with some of these discussions. # Hypotension: Patient was transfered to [**Hospital1 18**] hyotensive on pressors. Thought due to septic shock from urinary source that had seeded the blood. Picture complicated by presence of bad heart failure with EF 25% that was reduced to 15-20% on ECHO during this admission. SVO2s more consistent with septic shock. Patient continued to require pressor support until time of discharge. Was restarted on home midodrine shortly before discharge and this uptitrated to 10mg TID. # Infections - 1) UTI: Imaging evidence of emphasymetous cycstitis and concern was that initial OSH Bcx with proteus and E.coli were bacteremia due to urinary source. Was on numerous Abx initially but ultimately put on Ceftazidime for this. Urology saw and irrigated the bladder and for first few days put in gentamycin dwells. Some concern initially that has fistula between bowel and bladder contributing to problem. Cystogram done did not show this but possible that there was a fistula that has now closed off as had some initial Ucx growing multiple gut flora concerning for fecal contamination. Most recent Urine growing two specieces of enterococcus, which was VRE. ID saw during admission as well as urology to help manage this issue. Initially also seen by general surgery when there was some concern for bowel fistula involvement. 2) R Heel Osteo: Podiatry and saw patient abd were concerned about osteomyelitis. Bone swab grew both proteus and enterococcus which raised question if proteus in blood came initially from that source. Terrible vascular supply to LE and podiatry recommended that might need amputation but very poor surgical candidate. Vancomycin was added to Ceftazidime for the osteo. Bone biopsy done and still pending at time went home. 3) Bacteremia: Grew Proteus and Ecoli out of blood at [**Hospital3 15402**]. Concern that blood was seeed from urine, or possibly osteo. Temained hypotensive requiring pressors, initially thought due to the bacteremia, but persisting even after 10+ days of Abx and clearance of blood cultures. No positive blood cultures at [**Hospital1 18**]. ID followed during hospitalization. # ESRD: Secondary to ATN previously and HD dependent at time of admission. HD was held for first few days due to hypotension requiring pressors, but ultimately had to be started on CVVH as toxins built up. Received CVVH for 4-5 days and then stopped for 3 days. One session of HD was given on pressors the day before discharge. Patient ultimately decided that he would stop HD when he went home on hospice. # Atrial fibrillation with RVR: Had been biggest problem at [**Hospital3 **] requiring cardioversion. When came here was on amiodarone drip but at [**Hospital1 18**] no isses with rate control. Warfarin was held over concern for needing a proceedure and placed on a heparin gtt. Titrated off amio drip and placed on PO amiodarone. This then down-titrated to 200mg daily. Pacer initially set at 60bmp but incredased to set at 80 bpm in ordered to try to agument cardiac output. Digoxin discontinued during admissoin. When patient decided to go home with hospice, both amiodarone and warfarin/heparin stopped. # Pain: Long-standing neuropathic pain in LE on narcotics. Patient with increased pain secondary to bone biopsy after this done. Palliative care service saw to help with pain control and recommended starting methadone for pain control, placed on 2.5mg TID. Also continued on PRN oxycodone. Methadone seemed to help and patient discharged on this. # Chronic congestive heart failure: Worsened EF of 15-20% on ECHO in setting of sepsis. Has bad underlying heart as prior EF only 25%. Due to poor heart used caution with initially IVF in setting of sepsis. Possible throughout hospitalization that hypotension was somewhat complicated by presence of poor systolic function. # Code Status: Changed to DNR/DNI during end of admission and articulated the desire to focus on comfort. Said his primary goal was to spend time with his family. Wanted to stop antibiotics and hemodialysis once he went home but not before, in order to optimize time there with his family. Discharged to hospice on CMO status. Medications on Admission: amidarone 400mg [**Hospital1 **] aranesp 200mg qweek aspirin 81mg daily cholecalciferol 800mg daily citalopram 20mg daily cyanocobalamin 500mcg daily digoxin 0.125mg daily gabapentin 400mg qAM and 100mg QM/W/F after dialysis levothyroxine 50mcg daily loperamide 2mg [**Hospital1 **] midodrine 2.5mg q M/W/F after dialysis mirtazipine 30mg qHS pantoprazole 40mg [**Hospital1 **] crestor 10mg PO qHS sevelamer 800mg TID bactrim DS [**Hospital1 **] surbex dose unknown coumadin 6mg daily tylenol 650mg q4H PRN dulcolax 10mg daily PRN [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] 30mg q4H PRN hyoscamine 0.125mg [**Hospital1 **] lactulose 20g PO PRN oxycodone IR 10-30mg daily PRN pepto bismol 30ml q6H PRN prochlorperazine 5mg [**Hospital1 **] PRN simethicone 80mg TID PRN trazodone 25mg PO qHS PRN Discharge Medications: 1. gabapentin 400 mg Capsule Sig: One (1) Capsule PO QAM (once a day (in the morning)). 2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain or fever. 3. oxycodone 5 mg Tablet Sig: Four (4) Tablet PO Q6H (every 6 hours) as needed for pain. 4. methadone 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 5. midodrine 5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day: For constipation and comfort. Okay to hold if diarrhea. Discharge Disposition: Extended Care Facility: [**Hospital6 31006**] of [**Location (un) **] Discharge Diagnosis: Septic Shock Emphysematous Cystitis Osteomyelitis Heart Failure End-Stage Renal Disease on Dialysis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Tired but arousable. Activity Status: Bedbound. Discharge Instructions: [**Known firstname **], You were admitted to [**Hospital1 18**] due to a serious infection in your bladder and blood. While here we also found an infection in your foot. You required medications to treat the infection and support your blood pressure. You also received dialysis during your stay. You and your family made the decision to pursue measures that would optimize your comfort and time spent with your family. You were discharged to a hospice facility near to your family. We hope this time with your family is rewarding and meaningful. Followup Instructions: The hospice providers will administer further care. Completed by:[**2129-6-22**]

038,785,585,730,428,403,425,276,595,995,427,414,440,244,275,338,345,305,412,V451,V586,V450,V442,V498,V667

{'Unspecified septicemia,Septic shock,End stage renal disease,Unspecified osteomyelitis, ankle and foot,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Other specified types of cystitis,Severe sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified acquired hypothyroidism,Hypocalcemia,Other chronic pain,Epilepsy, unspecified, without mention of intractable epilepsy,Tobacco use disorder,Old myocardial infarction,Renal dialysis status,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Ileostomy status,Do not resuscitate status,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: atrial fibrillation with RVR PRESENT ILLNESS: 67 year old man with CAD s/p MI, systolic CHF LVEF 25% with AICD, DM2, ESRD on HD, PVD s/p femoral endarterectomy, afib of warfarin, hypothyroidism, s/p ileostomy for cecal volvulus, who presented to OSH after developing afib with RVR during a hemodialysis session. He received amiodarone followed by synchronized cardioversion but subsequently became hypotensive (SBP 60s) and was transferred to [**Hospital6 17183**] on [**2129-6-8**]. MEDICAL HISTORY: - Cecal volvulus and peritonitis [**5-/2128**], s/p right hemicolectomy, ileostomy, and mucous fistula by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. - CAD s/p MI in [**2111**], medically managed - Systolic CHF (last echo 25% per OSH report) - Pacemaker/AICD placed [**2124**] - PVD s/p multiple arterial surgeries to lower extremities, left great toe amputation and right femoral endarterectomy with resection of right femoral aneurysm by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] [**1-/2129**] MEDICATION ON ADMISSION: amidarone 400mg [**Hospital1 **] aranesp 200mg qweek aspirin 81mg daily cholecalciferol 800mg daily citalopram 20mg daily cyanocobalamin 500mcg daily digoxin 0.125mg daily gabapentin 400mg qAM and 100mg QM/W/F after dialysis levothyroxine 50mcg daily loperamide 2mg [**Hospital1 **] midodrine 2.5mg q M/W/F after dialysis mirtazipine 30mg qHS pantoprazole 40mg [**Hospital1 **] crestor 10mg PO qHS sevelamer 800mg TID bactrim DS [**Hospital1 **] surbex dose unknown coumadin 6mg daily tylenol 650mg q4H PRN dulcolax 10mg daily PRN [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] 30mg q4H PRN hyoscamine 0.125mg [**Hospital1 **] lactulose 20g PO PRN oxycodone IR 10-30mg daily PRN pepto bismol 30ml q6H PRN prochlorperazine 5mg [**Hospital1 **] PRN simethicone 80mg TID PRN trazodone 25mg PO qHS PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: General: Lethargic, awakens to voice, follows commands, too fatigued to tell story HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: decreased breath sounds at bases, intermittent rhonchi anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley draining hematuria Ext: cool feet Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation FAMILY HISTORY: Non contributory SOCIAL HISTORY: Previously lived at home with his wife, but has been living in a skilled nursing facility since [**2128-5-23**]. Has 3 grown children and 3 [**Doctor Last Name **] children. Still smokes (history of 1.5 ppd x many decades, but since moving to [**Hospital1 1501**] only 1 pack per week because it is hard to find time). No alcohol or recreational drugs. Retired engineer. ### Response: {'Unspecified septicemia,Septic shock,End stage renal disease,Unspecified osteomyelitis, ankle and foot,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Hyposmolality and/or hyponatremia,Other specified types of cystitis,Severe sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified acquired hypothyroidism,Hypocalcemia,Other chronic pain,Epilepsy, unspecified, without mention of intractable epilepsy,Tobacco use disorder,Old myocardial infarction,Renal dialysis status,Long-term (current) use of anticoagulants,Automatic implantable cardiac defibrillator in situ,Ileostomy status,Do not resuscitate status,Encounter for palliative care'}

CHIEF COMPLAINT: Progressive lower extremity edema PRESENT ILLNESS: 76 year old female with a past medical history pertinent for Rheumatic heart disease with mitral valve stenosis and severe pulmonary hypertension, atrial fibrillation-on Coumadin, type II Diabetes Mellitus,Hypertension, hyperlipidemia, COPD, Transient ischemic attack, A-V malformation with recurrent GI bleeds, who was admitted to an outside hospital for exacerabation of hear failure, worsening lower extremity edema, shortness of breath and hyponatremia. MEDICAL HISTORY: anemia secondary to arterio-venous Malformation, bleed 2' Coumadin use, congestive heart failure, Atrial fibrillation, type 2 diabetes mellitus, depression, hypertension, hypothyroidism, peripheral neuropathy, hyponatremia, glaucoma, chronic obstructive pulmonary disease, vascular disease-s/p carotid endarterectomy, obstructive sleep apnea-sleep study x2-does not use recommended CPAP at home, irritable bowel syndrome w/ chronic constipation/diarrhea MEDICATION ON ADMISSION: Coumadin 2.5 mg Fri-Wed/5 mg Thurs Digoxin 0.125mg daily Glucophage 500 mg [**Hospital1 **] Lasix 80 mg daily Omeprazole 20 mg daily Synthroid 150 mcg daily Zocor 20 mg daily Lisinopril 20 mg daily B-12 injections Ambien 5 mg HS ALLERGIES: Penicillins / aspirin / Codeine PHYSICAL EXAM: Pulse:75, Resp: 18, O2 sat: 98% B/P 125/60 Height:148 Weight:63.5" FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives with:her daughter [**Name (NI) 1139**]: intermittent tobacco x 60yr, [**7-17**] cigs/day x last 2 months -pt states last cigarette prior to admission at OSH ETOH:+2 beers/day:pt states last beer ~ 1mo ago

Rheumatic heart failure (congestive),Cellulitis and abscess of trunk,Hematoma complicating a procedure,Hyposmolality and/or hyponatremia,Mitral stenosis,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified hereditary and idiopathic peripheral neuropathy,Alcoholic fatty liver,Alcohol abuse, unspecified

Rheumatic heart failure,Cellulitis of trunk,Hematoma complic proc,Hyposmolality,Mitral stenosis,Chr airway obstruct NEC,Chr pulmon heart dis NEC,Atrial fibrillation,DMII wo cmp nt st uncntr,Long-term use anticoagul,Hypertension NOS,Hypothyroidism NOS,Abn react-cardiac cath,Idio periph neurpthy NOS,Alcoholic fatty liver,Alcohol abuse-unspec

Admission Date: [**2114-7-20**] Discharge Date: [**2114-8-7**] Date of Birth: [**2038-2-16**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / aspirin / Codeine Attending:[**First Name3 (LF) 1505**] Chief Complaint: Progressive lower extremity edema Major Surgical or Invasive Procedure: [**2114-7-30**] Mitral Valve Replacement ([**First Name8 (NamePattern2) 11599**] [**Male First Name (un) 923**] Tissue) History of Present Illness: 76 year old female with a past medical history pertinent for Rheumatic heart disease with mitral valve stenosis and severe pulmonary hypertension, atrial fibrillation-on Coumadin, type II Diabetes Mellitus,Hypertension, hyperlipidemia, COPD, Transient ischemic attack, A-V malformation with recurrent GI bleeds, who was admitted to an outside hospital for exacerabation of hear failure, worsening lower extremity edema, shortness of breath and hyponatremia. Past Medical History: anemia secondary to arterio-venous Malformation, bleed 2' Coumadin use, congestive heart failure, Atrial fibrillation, type 2 diabetes mellitus, depression, hypertension, hypothyroidism, peripheral neuropathy, hyponatremia, glaucoma, chronic obstructive pulmonary disease, vascular disease-s/p carotid endarterectomy, obstructive sleep apnea-sleep study x2-does not use recommended CPAP at home, irritable bowel syndrome w/ chronic constipation/diarrhea Social History: Lives with:her daughter [**Name (NI) 1139**]: intermittent tobacco x 60yr, [**7-17**] cigs/day x last 2 months -pt states last cigarette prior to admission at OSH ETOH:+2 beers/day:pt states last beer ~ 1mo ago Family History: non-contributory Physical Exam: Pulse:75, Resp: 18, O2 sat: 98% B/P 125/60 Height:148 Weight:63.5" General:A&Ox 3, NAD Skin: Dry [x] intact [] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: CTA Heart: RRR [] Irregular [x] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [] Extremities: Warm [x], well-perfused [x] Edema Varicosities:superficial varicosities None [] Neuro: Grossly intact Pulses: Femoral Right: Left: DP Right:1+ Left:1+ PT [**Name (NI) 167**]: Left: Radial Right: Left: Carotid Bruit-none Right: 2+ Left:2+ Pertinent Results: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.4 cm <= 4.0 cm Left Atrium - Four Chamber Length: *5.7 cm <= 5.2 cm Right Atrium - Four Chamber Length: *6.8 cm <= 5.0 cm Left Ventricle - Septal Wall Thickness: 1.0 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: 0.9 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 4.5 cm <= 5.6 cm Left Ventricle - Systolic Dimension: 3.0 cm Left Ventricle - Fractional Shortening: 0.33 >= 0.29 Left Ventricle - Ejection Fraction: 65% >= 55% Left Ventricle - Stroke Volume: 91 ml/beat Left Ventricle - Cardiac Output: 6.01 L/min Aorta - Sinus Level: 3.1 cm <= 3.6 cm Aorta - Ascending: 2.9 cm <= 3.4 cm Aortic Valve - Peak Velocity: 1.7 m/sec <= 2.0 m/sec Aortic Valve - LVOT VTI: 29 Aortic Valve - LVOT diam: 2.0 cm Mitral Valve - Mean Gradient: 7 mm Hg Mitral Valve - E Wave: 2.0 m/sec Mitral Valve - E Wave deceleration time: *300 ms 140-250 ms TR Gradient (+ RA = PASP): *68 mm Hg <= 25 mm Hg Findings LEFT ATRIUM: Moderate LA enlargement. RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA. A catheter or pacing wire is seen in the RA and extending into the RV. LEFT VENTRICLE: Normal LV wall thickness, cavity size and regional/global systolic function (LVEF >55%). No resting LVOT gradient. RIGHT VENTRICLE: RV hypertrophy. Mildly dilated RV cavity. RV function depressed. Abnormal systolic septal motion/position consistent with RV pressure overload. AORTA: Normal aortic diameter at the sinus level. Focal calcifications in aortic root. Normal ascending aorta diameter. Focal calcifications in ascending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. Mild (1+) AR. MITRAL VALVE: Bioprosthetic mitral valve prosthesis (MVR). MVR well seated, with normal leaflet/disc motion and transvalvular gradients. TRICUSPID VALVE: Normal tricuspid valve leaflets. Normal tricuspid valve supporting structures. No TS. Mild to moderate [[**2-11**]+] TR. Severe PA systolic hypertension. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. Normal main PA. No Doppler evidence for PDA PERICARDIUM: No pericardial effusion. Conclusions The left atrium is moderately dilated. The right atrium is moderately dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF 65%). The right ventricular free wall is hypertrophied. The right ventricular cavity is mildly dilated with depressed free wall contractility. There is abnormal systolic septal motion/position consistent with right ventricular pressure overload. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) 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. There is severe pulmonary artery systolic hypertension. There is no pericardial effusion. Brief Hospital Course: Transferred in from outside hospital after presenting with increased edema and shortness of breath for re evaluation for surgical intervention. She was on heparin for atrial fibrillation and underwent preoperative evaluation. Hepatology was consulted, she had abdominal ultrasound that revealed normal liver and spleen, and she was cleared for surgery. Additional preoperative workup included dental, pulmonary function test and echocardiogram. She had discomfort at her catheterization site and had vascular ultrasound that revealed no hematoma or pseudoaneurysm. She was brought to the operating room on [**7-25**] for surgery however due to increased tenderness at the catheterization site her surgery was cancelled and she was started on ancef for potential cellulitis. Vascular surgery was consulted and felt there was no evidence of infection or vascular issues. However her creatinine increased to 1.6, her ace inhibitor and lasix were stopped and the ancef was discontinued. Additionally her digoxin was stopped due to increased creatinine and bradycardia. Over the next few days her creatinine trended down to baseline 1.1-1.3. She developed diarrhea which resolved within twenty four hours with WBC remaining normal. On [**2114-7-30**] she was brought to the operating room and underwent mitral valve replacement. See operative report for further details. She received vancomycin for perioperative antibiotics and was transferred to the intensive care unit for post operative management. That evening, she was weaned from sedation, awoke neurologically intact, and was extubated without complications. However later she was noted to have increasing pulmonary and systolic pressures with no response to milirone, nipride, and nicardipine. Her medications were adjusted and on post operative day one she was started on diuretics, ace inhibitor, and beta blocker. On post operative day two her pulmonary catheter was removed and she remained in the intensive care unit for hemodynamic management. Her epicardial wires and chest tubes were removed per protocol. She continued to have betablockers adjusted for heart rate management and lasix for diuresis. Additionally she was treated for hyponatremia with free water restriction and sodium tablets. She was restarted on coumadin for atrial fibrillation and then on post operative day four was transferred to the floor for the remainder of her care. Physical therapy worked with her on strength and mobility. On post operative day eight she was ready for discharge to rehab - [**Hospital3 **] in [**Hospital1 **] [**Location (un) **]. Medications on Admission: Coumadin 2.5 mg Fri-Wed/5 mg Thurs Digoxin 0.125mg daily Glucophage 500 mg [**Hospital1 **] Lasix 80 mg daily Omeprazole 20 mg daily Synthroid 150 mcg daily Zocor 20 mg daily Lisinopril 20 mg daily B-12 injections Ambien 5 mg HS Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. warfarin 4 mg Tablet Sig: One (1) Tablet PO once a day: received 4 mg on [**8-7**] - to have INR checked [**8-8**] for further dosing - see coumadin referral form for dosing and INR . 4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain/fever. 5. metolazone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): give with lasix daily . 6. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO once a day. 8. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day). 9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 10. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 11. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 13. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 14. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) puffs Inhalation every four (4) hours as needed for shortness of breath or wheezing. 15. Combivent 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs puffs Inhalation every six (6) hours. 16. amlodipine 2.5 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): 7.5 mg daily . 17. Lantus 100 unit/mL Solution Sig: Twelve (12) untis units Subcutaneous at bedtime: 12 units at bedtime . 18. Insulin Sliding scale Insulin SC Sliding Scale Breakfast Lunch Dinner Bedtime Regular Regular Regular Regular Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose 0-70 mg/dL Proceed with hypoglycemia protocol Proceed with hypoglycemia protocol Proceed with hypoglycemia protocol Proceed with hypoglycemia protocol 71-119 mg/dL 0 Units 0 Units 0 Units 0 Units 120-159 mg/dL 2 Units 2 Units 2 Units 2 Units 160-199 mg/dL 4 Units 4 Units 4 Units 4 Units 200-239 mg/dL 6 Units 6 Units 6 Units 6 Units 240-279 mg/dL 8 Units 8 Units 8 Units 8 Units Also note to receive lantus at bedtime 19. potassium chloride 10 mEq Capsule, Extended Release Sig: [**2-11**] Capsule, Extended Releases PO once a day. 20. Outpatient Lab Work Labs: PT/INR for Coumadin ?????? indication: Atrial Fibrillation Goal INR 2.0-2.5 First draw [**2114-8-8**] Please check PT/INR Monday, Wednesday, and Friday for two weeks then decrease as instructed by physician Coumadin to be managed by rehab physician then please arrange for follow up with PCP when discharged from rehab 21. Outpatient Lab Work Please check Chem 7 to evaluate once a week due to lasix/zaroxlyn/lisinopril/potassium Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: Mitral valve stenosis s/p MVR Atrial Fibrillation Diabetes Mellitus type 2 Hyponatremia Rheumatic heart disease Pulmonary hypertension Hypertension Hyperlipidemia Chronic obstructive pulmonary disease Transient ischemic attack A-V malformation with recurrent GI bleeds Depression Hypothyroidism Peripheral neuropathy Hyponatremia Glaucoma Carotid disease Osteoarthritis Discharge Condition: Alert and oriented x3 nonfocal Ambulating with 1 assist Incisional pain managed with tylenol as needed Incisions: Sternal - healing well, no erythema or drainage Edema +1 lower extremity 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. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] on [**8-23**] at 1:30pm Cardiologist: Dr. [**Last Name (STitle) 4783**] [**Telephone/Fax (1) 5424**] on [**9-5**] at 10:45am Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 83705**] in [**5-15**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Labs: PT/INR for Coumadin ?????? indication: Atrial Fibrillation Goal INR 2.0-2.5 First draw [**2114-8-8**] Please check PT/INR Monday, Wednesday, and Friday for two weeks then decrease as instructed by physician Coumadin to be managed by rehab physician then please arrange for follow up with PCP when discharged from rehab Completed by:[**2114-8-7**]

398,682,998,276,394,496,416,427,250,V586,401,244,E879,356,571,305

{'Rheumatic heart failure (congestive),Cellulitis and abscess of trunk,Hematoma complicating a procedure,Hyposmolality and/or hyponatremia,Mitral stenosis,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified hereditary and idiopathic peripheral neuropathy,Alcoholic fatty liver,Alcohol abuse, 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: Progressive lower extremity edema PRESENT ILLNESS: 76 year old female with a past medical history pertinent for Rheumatic heart disease with mitral valve stenosis and severe pulmonary hypertension, atrial fibrillation-on Coumadin, type II Diabetes Mellitus,Hypertension, hyperlipidemia, COPD, Transient ischemic attack, A-V malformation with recurrent GI bleeds, who was admitted to an outside hospital for exacerabation of hear failure, worsening lower extremity edema, shortness of breath and hyponatremia. MEDICAL HISTORY: anemia secondary to arterio-venous Malformation, bleed 2' Coumadin use, congestive heart failure, Atrial fibrillation, type 2 diabetes mellitus, depression, hypertension, hypothyroidism, peripheral neuropathy, hyponatremia, glaucoma, chronic obstructive pulmonary disease, vascular disease-s/p carotid endarterectomy, obstructive sleep apnea-sleep study x2-does not use recommended CPAP at home, irritable bowel syndrome w/ chronic constipation/diarrhea MEDICATION ON ADMISSION: Coumadin 2.5 mg Fri-Wed/5 mg Thurs Digoxin 0.125mg daily Glucophage 500 mg [**Hospital1 **] Lasix 80 mg daily Omeprazole 20 mg daily Synthroid 150 mcg daily Zocor 20 mg daily Lisinopril 20 mg daily B-12 injections Ambien 5 mg HS ALLERGIES: Penicillins / aspirin / Codeine PHYSICAL EXAM: Pulse:75, Resp: 18, O2 sat: 98% B/P 125/60 Height:148 Weight:63.5" FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives with:her daughter [**Name (NI) 1139**]: intermittent tobacco x 60yr, [**7-17**] cigs/day x last 2 months -pt states last cigarette prior to admission at OSH ETOH:+2 beers/day:pt states last beer ~ 1mo ago ### Response: {'Rheumatic heart failure (congestive),Cellulitis and abscess of trunk,Hematoma complicating a procedure,Hyposmolality and/or hyponatremia,Mitral stenosis,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified hereditary and idiopathic peripheral neuropathy,Alcoholic fatty liver,Alcohol abuse, unspecified'}

CHIEF COMPLAINT: dyspnea, hypoxia PRESENT ILLNESS: 87 yo F with h/o Alzheimer's dementia, DM2, HTN, possible history of CHF p/w dyspnea and hypoxia. Patient lives at [**Hospital 100**] Rehab, history obtained from guardian, [**Name (NI) **] [**Name (NI) 112033**], and records from rehab. Per Ms. [**Last Name (Titles) 112033**], patient was at baseline this weekend; conversational but occasionally not making sense, but overall well-looking. Started having symptoms this morning, where she looked as thought she had more difficulty breathing. Mentation not at baseline; patient was unresponsive during this event. CXR done at rehab concerning for PNA showing bibasilar opacities and atelectasis. She spiked fever to 100.7 sounded congested and not responding to nebs. VS at the time were RR in 40s 98/64, HR 114, sat 73% on 15L via NRB. Pt sent to [**Hospital1 18**] for eval, at [**Hospital 100**] Rehab she received lasix IV 40 mg once at 1815, zosyn 2.25 mg and continuous 1/2 NS at 30cc/hr on transfer. She was transferred on CPAP, where her sats improved from 70s to low 80s. MEDICAL HISTORY: Alzeheimer's disease Depression HTN OA s/p knee replacement insomnia DM 2 anemia hypoalbuminemia h/o c-section R cataract removed incontinence L leg swelling (- for DVT) prurigo simplex with recurrent itchy rash MEDICATION ON ADMISSION: amlodipine 5 mg daily lisinopril 30 mg daily hydrocortisone cream apply daily loratadine 10 mg daily miralax 17 gm daily metoprolol tartrate 100 mg [**Hospital1 **] vitamin B12 injection monthly lasix 40 mg daily senna 17.2 mg HS Kcl 10 meq daily ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: General: unresponsive, appears in no distress on CPAP mask HEENT: dry mucous membranes, R pupil irregular and not reactive FAMILY HISTORY: unable to obtain SOCIAL HISTORY: unable to obtain from patient. Lives at [**Hospital 100**] Rehab, has guardian who makes healthcare decisions for her. She has a nephew who lives in [**Country 26231**] who was updated by HCP. Smoking, EtOH and drug history unknown.

Unspecified septicemia,Pneumonia, organism unspecified,Sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Congestive heart failure, unspecified,Do not resuscitate status,Encounter for palliative care

Septicemia NOS,Pneumonia, organism NOS,Sepsis,Alzheimer's disease,Dementia w/o behav dist,DMII wo cmp nt st uncntr,Hypertension NOS,CHF NOS,Do not resusctate status,Encountr palliative care

Admission Date: [**2177-6-22**] Discharge Date: [**2177-6-23**] Service: MEDICINE Allergies: No Allergies/ADRs on File Attending:[**First Name3 (LF) 594**] Chief Complaint: dyspnea, hypoxia Major Surgical or Invasive Procedure: none History of Present Illness: 87 yo F with h/o Alzheimer's dementia, DM2, HTN, possible history of CHF p/w dyspnea and hypoxia. Patient lives at [**Hospital 100**] Rehab, history obtained from guardian, [**Name (NI) **] [**Name (NI) 112033**], and records from rehab. Per Ms. [**Last Name (Titles) 112033**], patient was at baseline this weekend; conversational but occasionally not making sense, but overall well-looking. Started having symptoms this morning, where she looked as thought she had more difficulty breathing. Mentation not at baseline; patient was unresponsive during this event. CXR done at rehab concerning for PNA showing bibasilar opacities and atelectasis. She spiked fever to 100.7 sounded congested and not responding to nebs. VS at the time were RR in 40s 98/64, HR 114, sat 73% on 15L via NRB. Pt sent to [**Hospital1 18**] for eval, at [**Hospital 100**] Rehab she received lasix IV 40 mg once at 1815, zosyn 2.25 mg and continuous 1/2 NS at 30cc/hr on transfer. She was transferred on CPAP, where her sats improved from 70s to low 80s. In the ED initial VS were: HR 122, RR 45, BP 90/71, temp 101.7, 82% on BiPAP. CXR c/w PNA, started on vanc, ceftriaxone and levofloxacin, also received tylenol PR, 1.5 L of IV normal saline. BPs improved to 100s-110s systolic, sat remained in mid 80s on CPAP with 100% O2. Noted to respond to voice and stimulation but not answering questions or following commands. Notably from labs lactate 7 in ED. Guardian was notified from [**Name (NI) **] and confirmed DNR/DNI status and patient was transferred to MICU. On arrival to MICU, patient was unresponsive to voice or sternal rub. She was on CPAP and moving L arm and bilateral lower ext spontaneously but not moving RUE. She was unable to respond to history questions. Guardian, [**Name (NI) **] [**Name (NI) 112033**], was [**Name (NI) 653**] and stated that patient would not want "life-prolonging measures" including intubation, invasive procedures including lines or blood pressure support with vasopressors. She would want "a chance with antibiotics" and wanted to continue CPAP, but if patient's condition deteriorated on antibiotics, CPAP and volume resucitation for low blood pressure she would want to focus on comfort. Guardian unavailable to be [**Name (NI) 653**] until AM with an update. Review of systems: unable to obtain. Past Medical History: Alzeheimer's disease Depression HTN OA s/p knee replacement insomnia DM 2 anemia hypoalbuminemia h/o c-section R cataract removed incontinence L leg swelling (- for DVT) prurigo simplex with recurrent itchy rash Social History: unable to obtain from patient. Lives at [**Hospital 100**] Rehab, has guardian who makes healthcare decisions for her. She has a nephew who lives in [**Country 26231**] who was updated by HCP. Smoking, EtOH and drug history unknown. Family History: unable to obtain Physical Exam: General: unresponsive, appears in no distress on CPAP mask HEENT: dry mucous membranes, R pupil irregular and not reactive CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: ausculated anteriorly with rhonchi throughout, crackles at bases bilaterally Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley in place Ext: moving L arm and bilaterally lower extremities spontaneously and withdraws to pain. RUE not noted to move spontaneously, does not withdraw to pain Pertinent Results: [**2177-6-22**] 11:21PM GLUCOSE-270* UREA N-54* CREAT-2.7* SODIUM-145 POTASSIUM-4.5 CHLORIDE-112* TOTAL CO2-17* ANION GAP-21* [**2177-6-22**] 11:21PM CALCIUM-8.2* PHOSPHATE-3.4 MAGNESIUM-1.9 [**2177-6-22**] 11:21PM WBC-24.5* RBC-3.55* HGB-10.7* HCT-33.3* MCV-94 MCH-30.1 MCHC-32.1 RDW-14.0 [**2177-6-22**] 11:21PM PLT COUNT-235 [**2177-6-22**] 09:45PM URINE COLOR-DkAmb APPEAR-Cloudy SP [**Last Name (un) 155**]-1.019 [**2177-6-22**] 09:45PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-2* PH-5.0 LEUK-LG [**2177-6-22**] 09:45PM URINE RBC-18* WBC->182* BACTERIA-FEW YEAST-NONE EPI-6 TRANS EPI-7 [**2177-6-22**] 09:24PM LACTATE-7.0* [**2177-6-22**] 09:00PM GLUCOSE-86 UREA N-54* CREAT-2.7* SODIUM-144 POTASSIUM-4.7 CHLORIDE-108 TOTAL CO2-16* ANION GAP-25* [**2177-6-22**] 09:00PM cTropnT-0.06* [**2177-6-22**] 09:00PM proBNP-[**Numeric Identifier **]* [**2177-6-22**] 09:00PM WBC-31.6* RBC-4.00* HGB-12.1 HCT-37.2 MCV-93 MCH-30.3 MCHC-32.6 RDW-13.8 [**2177-6-22**] 09:00PM NEUTS-86* BANDS-9* LYMPHS-5* MONOS-0 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2177-6-22**] 09:00PM PLT COUNT-303 [**2177-6-22**] 09:00PM PT-16.5* PTT-36.4 INR(PT)-1.6* Chest Xray [**2177-6-22**] Moderate left-sided pleural effusion. Widespread airspace disease in the right lower lung worrisome for pneumonia. Cholelithiasis. Brief Hospital Course: 87 yo F with h/o Alzheimer's dementia, DM2, HTN, possible history of CHF p/w dyspnea and hypoxia, pneumonia, hypotension likely sepsis in setting of pneumonia # Pneumonia with sepsis: Patient was initially treated with vancomycin, levofloxacin and ceftriaxone. She met SIRS criteria with tachycardia, WBC count elevated, fever. Her BPs in 80s responded initially to IVF resucitation with intermittent 500 mL boluses of NS after arrival to MICU. After conversation with pt's guardian, pt would not want life-prolonging treatment, although guardian wanted to try antibiotics and non-invasive ventilation overnight, however thought the patient would not want lines, vasopressors, intubation, chest compressions, shocks. Non-invasive ventilation and antibiotics were continued overnight, with no clinical improvement and no improvement in labs with worsening blood gas and elevated lactate. Guardian, [**Name (NI) **] [**Name (NI) 112033**], was called for an update and decision was made to focus on comfort measures. Prior to non-invasive mask removal, patient was found to be in asystole. She was pronounced dead at 7:40 AM on [**2177-6-23**], guardian was [**Name (NI) 653**]. [**Name2 (NI) **] family members were available to be [**Name (NI) 653**], autopsy was declined. Medications on Admission: amlodipine 5 mg daily lisinopril 30 mg daily hydrocortisone cream apply daily loratadine 10 mg daily miralax 17 gm daily metoprolol tartrate 100 mg [**Hospital1 **] vitamin B12 injection monthly lasix 40 mg daily senna 17.2 mg HS Kcl 10 meq daily Discharge Medications: N/A, expired Discharge Disposition: Expired Discharge Diagnosis: pneumonia sepsis Discharge Condition: expired Discharge Instructions: N/A, expired Followup Instructions: N/A, expired Completed by:[**2177-6-23**]

038,486,995,331,294,250,401,428,V498,V667

{"Unspecified septicemia,Pneumonia, organism unspecified,Sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Congestive heart failure, unspecified,Do not resuscitate status,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: dyspnea, hypoxia PRESENT ILLNESS: 87 yo F with h/o Alzheimer's dementia, DM2, HTN, possible history of CHF p/w dyspnea and hypoxia. Patient lives at [**Hospital 100**] Rehab, history obtained from guardian, [**Name (NI) **] [**Name (NI) 112033**], and records from rehab. Per Ms. [**Last Name (Titles) 112033**], patient was at baseline this weekend; conversational but occasionally not making sense, but overall well-looking. Started having symptoms this morning, where she looked as thought she had more difficulty breathing. Mentation not at baseline; patient was unresponsive during this event. CXR done at rehab concerning for PNA showing bibasilar opacities and atelectasis. She spiked fever to 100.7 sounded congested and not responding to nebs. VS at the time were RR in 40s 98/64, HR 114, sat 73% on 15L via NRB. Pt sent to [**Hospital1 18**] for eval, at [**Hospital 100**] Rehab she received lasix IV 40 mg once at 1815, zosyn 2.25 mg and continuous 1/2 NS at 30cc/hr on transfer. She was transferred on CPAP, where her sats improved from 70s to low 80s. MEDICAL HISTORY: Alzeheimer's disease Depression HTN OA s/p knee replacement insomnia DM 2 anemia hypoalbuminemia h/o c-section R cataract removed incontinence L leg swelling (- for DVT) prurigo simplex with recurrent itchy rash MEDICATION ON ADMISSION: amlodipine 5 mg daily lisinopril 30 mg daily hydrocortisone cream apply daily loratadine 10 mg daily miralax 17 gm daily metoprolol tartrate 100 mg [**Hospital1 **] vitamin B12 injection monthly lasix 40 mg daily senna 17.2 mg HS Kcl 10 meq daily ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: General: unresponsive, appears in no distress on CPAP mask HEENT: dry mucous membranes, R pupil irregular and not reactive FAMILY HISTORY: unable to obtain SOCIAL HISTORY: unable to obtain from patient. Lives at [**Hospital 100**] Rehab, has guardian who makes healthcare decisions for her. She has a nephew who lives in [**Country 26231**] who was updated by HCP. Smoking, EtOH and drug history unknown. ### Response: {"Unspecified septicemia,Pneumonia, organism unspecified,Sepsis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Congestive heart failure, unspecified,Do not resuscitate status,Encounter for palliative care"}

CHIEF COMPLAINT: CAD, recent urosepsis with ureteral stent placement PRESENT ILLNESS: This 77-year-old patient with recent cardiac symptoms was investigated and was found to have severe triple-vessel disease with diminished ejection fraction of about 35% and was transferred urgently for coronary artery bypass grafting. MEDICAL HISTORY: PMH: CHF, high cholesterol, HTN, NSTEMI, prostate Ca s/p brachytherapy, BPH, nephrolithiasis s/p 12 lithotrpsies, recent urosepsis, uretel stent placement PSH: Lithos, Brachytherapy, cataract surgery MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Atenolol, Lovastatin 40 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 99.0/98.0 76 151/84 20 99RA NAD RRR CTAB Abd soft, NT, ND, no incisions or masses, no flank pain on either side Sternal INC C/D/I palp distal pulses FAMILY HISTORY: NC SOCIAL HISTORY: Recently in rehab after fall, no tob or etoh NC

Subendocardial infarction, initial episode of care,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate

Subendo infarct, initial,Hemorrhage complic proc,Urin tract infection NOS,Crnry athrscl natve vssl,Iatrogenc hypotnsion NEC,Anemia NOS,Hypertension NOS,Pure hypercholesterolem,Hx-prostatic malignancy

Admission Date: [**2152-10-27**] Discharge Date: [**2152-11-4**] Date of Birth: [**2075-10-4**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 165**] Chief Complaint: CAD, recent urosepsis with ureteral stent placement Major Surgical or Invasive Procedure: CABGx6(LIMA-LAD,SVG-D1-D2,SVG-Ramus-OM,SVG-PDA) History of Present Illness: This 77-year-old patient with recent cardiac symptoms was investigated and was found to have severe triple-vessel disease with diminished ejection fraction of about 35% and was transferred urgently for coronary artery bypass grafting. Also pt has the following history of nephrolithiasis s/p multiple shock wave lithotripsies and prostate cancer s/p brachytherapy who presented to [**Hospital **] Hospital on [**10-19**] with chills and fever to 104.4 after having undergone in office cystoscopy in [**Hospital1 1559**] the day before for urinary frequency and new left flank pain. The pt had received 1 periop dose of levaquin. During admission to the MW ED he was found to be uroseptic, hypotensive, have a creatinine of 2.0, WBC of 14, and a tropnin bump to 0.63 (later 29.9) with ST depressions in lateral leads c/w an NSTEMI. In the ED on [**10-19**] a CT was performed which showed an obstructing 1cm left distal ureteral stone with hydro. The pt was treaated with iv abx and transferred to the CCU. After the pt had been reasonably stabilized on [**10-23**], a ureteral stent was placed by Dr. [**First Name (STitle) **] to decompress the left kidney which was obstructed by a 1cm distal left ureteral stone. Per the MW chart, purulent material was drained from the kidney and the pt resopnded well clinically with a return of his creatinine to normal. After further recovery, on [**10-27**], the pt uderwent a cardiac cath which showed severe 3v dz and was transferred to [**Hospital1 18**] for CABG. The pt reports having had many stones in the past, requiring >10 shock wave lithotripsies. He is unsure, but thinks he has not had laser lithotripsies, and may have had a percutaneous nephrolitotomy on the left side in the past. He reports constant urinary frequency and urgency at baseline, urinating every 10 minutes or so. He currently denies fever, chills, nausea, vomitting, hematuria, dysuria, stent pain, flank pain, chest pain, or SOB. Past Medical History: PMH: CHF, high cholesterol, HTN, NSTEMI, prostate Ca s/p brachytherapy, BPH, nephrolithiasis s/p 12 lithotrpsies, recent urosepsis, uretel stent placement PSH: Lithos, Brachytherapy, cataract surgery Social History: Recently in rehab after fall, no tob or etoh NC Family History: NC Physical Exam: VS: 99.0/98.0 76 151/84 20 99RA NAD RRR CTAB Abd soft, NT, ND, no incisions or masses, no flank pain on either side Sternal INC C/D/I palp distal pulses Pertinent Results: [**2152-11-4**] 06:30AM BLOOD WBC-9.7 RBC-3.48* Hgb-10.8* Hct-31.6* MCV-91 MCH-31.1 MCHC-34.3 RDW-15.4 Plt Ct-583* [**2152-11-2**] 04:07AM BLOOD PT-15.7* PTT-33.4 INR(PT)-1.4* [**2152-11-4**] 06:30AM BLOOD Glucose-89 UreaN-12 Creat-1.0 Na-141 K-3.7 Cl-104 HCO3-23 AnGap-18 [**2152-11-2**] 04:07AM BLOOD Calcium-8.4 Phos-2.9 Mg-2.2 [**2152-11-1**] 09:39AM URINE Blood-LG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG URINE RBC->50 WBC-[**4-10**] Bacteri-OCC Yeast-NONE Epi-0 [**2152-11-1**] 9:39 am URINE Source: Catheter. CHEST (PORTABLE AP) [**2152-11-1**] 7:24 AM REASON FOR EXAM: S/P CABG. Followup pleural effusions. Comparison is made to prior study performed a day earlier. A small left pleural effusion and left lower atelectasis is persistent. Small right pleural effusion is unchanged. Left chest tube remains in place as is right IJ vein catheter. Cardiomediastinal silhouette is stable. There is no overt CHF. URINE CULTURE (Final [**2152-11-2**]): NO GROWTH. RADIOLOGY Final Report CT ABDOMEN W/O CONTRAST [**2152-10-28**] 3:42 PM Reason: please check stones / kidney abcess / hydro CT OF THE ABDOMEN WITHOUT IV CONTRAST: Small bibasilar pleural thickening/small effusions are identified. There is a small amount of atelectasis at the lung bases. Trace pericardial effusion is demonstrated. Liver, gallbladder, spleen, pancreas, adrenal glands, and visualized bowel loops are all within normal limits. A nephroureteral stent is identified within the left collecting system extending from the upper pole calix to the bladder. Air is identified within the left collecting system, and there appears to be probable mild hydronephrosis, however, the extent of hydronephrosis cannot be fully evaluated on this non- contrast examination. A left extrarenal pelvis is identified. The proximal and mid portions of the left ureter are dilated and distended with gas, and an apparent caliber change is identified within the distal ureter (series 2, image 60) because of an obstructing 8- mm calculus. There is periureteral stranding demonstrated proximal to this point of obstruction in the ureter. No other renal or ureteral calculi are demonstrated. There is mild bilateral perinephric stranding, left greater than right. No focal fluid collections to suggest an abscess are present. Bilateral simple cysts are also seen within both kidneys. The right kidney does not demonstrate any hydronephrosis. Visualized bowel loops are within normal limits. The abdominal aorta is normal in caliber but demonstrates a somewhat tortuous course. No pathologically enlarged mesenteric or retroperitoneal lymph nodes are seen. There is no free fluid within the abdomen. CT OF THE PELVIS WITHOUT INTRAVENOUS CONTRAST: Multiple fiducial seeds are seen within the prostate. The pelvic loops of bowel appear unremarkable. The bladder contains a small focus of air anteriorly, likely related to the patient's recent instrumentation. The distal right ureter appears unremarkable without evidence of stones. Some calcified phleboliths are seen within the pelvis. No pelvic or inguinal lymphadenopathy is identified. BONE WINDOWS: No suspicious lytic or sclerotic osseous lesions are present. A small bone island is seen within the left proximal femur. Degenerative changes are seen involving the lumbosacral spine. IMPRESSION: 1. 8-mm obstructing calculus within the left distal ureter causing mild- moderate ureteral dilatation and probable mild hydronephrosis. Extent of hydronephrosis cannot be well characterized on this non- contrast study. Air within the left collecting system and ureter is consistent with recent instrumentation. Nephroureteral stent in place. No evidence for renal abscess. 2. Multiple simple bilateral renal cysts. Cardiology Report ECHO Study Date of [**2152-10-30**] MEASUREMENTS: Left Atrium - Long Axis Dimension: 4.0 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: 3.7 cm (nl <= 5.2 cm) Left Ventricle - Inferolateral Thickness: *1.5 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.7 cm (nl <= 5.6 cm) Left Ventricle - Systolic Dimension: 3.5 cm Left Ventricle - Fractional Shortening: *0.26 (nl >= 0.29) Left Ventricle - Ejection Fraction: 40% to 50% (nl >=55%) Left Ventricle - Peak Resting LVOT gradient: 2 mm Hg (nl <= 10 mm Hg) Aorta - Valve Level: 3.4 cm (nl <= 3.6 cm) Aorta - Ascending: 3.4 cm (nl <= 3.4 cm) Aorta - Arch: 2.3 cm (nl <= 3.0 cm) Aorta - Descending Thoracic: 2.4 cm (nl <= 2.5 cm) Aortic Valve - Peak Velocity: *2.1 m/sec (nl <= 2.0 m/sec) Aortic Valve - Peak Gradient: 18 mm Hg Aortic Valve - Mean Gradient: 8 mm Hg Aortic Valve - Valve Area: *1.5 cm2 (nl >= 3.0 cm2) Mitral Valve - Peak Velocity: 0.8 m/sec Mitral Valve - Mean Gradient: 1 mm Hg Mitral Valve - E Wave: 0.8 m/sec Mitral Valve - A Wave: 0.6 m/sec Mitral Valve - E/A Ratio: 1.33 Mitral Valve - E Wave Deceleration Time: 150 msec Pericardium - Effusion Size: 1.2 cm INTERPRETATION: Findings: LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Lipomatous hypertrophy of the interatrial septum. No ASD by 2D or color Doppler. LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Moderate regional LV systolic dysfunction. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Focal calcifications in aortic root. Normal ascending aorta diameter. Focal calcifications in ascending aorta. Normal aortic arch diameter. Complex (>4mm) atheroma in the aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Mildly thickened aortic valve leaflets (3). No AS. Mild AS (AoVA 1.2-1.9cm2). Trace AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS. The MR vena contracta is <0.3cm. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. PERICARDIUM: Small to moderate pericardial effusion. Conclusions: Pre bypas: There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is moderate regional left ventricular systolic dysfunction with moderate mid to apical anterior hypokinesis and mild mid to apical inferior hypokinesis. LVEF 40%. Right ventricular chamber size and free wall motion are normal. There are complex (>4mm) atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. There is partial fusion of the right and left coronary cusps. The aortic valve leaflets (3) are mildly thickened. There is mild aortic valve stenosis (area 1.2-1.9cm2) on multiple analyses, average [**Location (un) 109**] 1.5 cm2. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is a small to moderate sized pericardial effusion. Post bypass: Patient is A paced, on phenylehperine and epinepherine infusions. LV funciton is mildly improved with LVEF 45%. RV function is unchanged. There may be slight improvement in mid anterior wall motion, (possibly due to ionotrope) but remaining wall motion is unchanged. Aortic stenosis is still mild. Aortic contours are intact. Remaining exam is unchanged. All findings discussed with surgeons at the time of the exam. Brief Hospital Course: Admitted [**2152-10-27**], Pt transferd from outide hopital for CABG Pt pre-op'd in the usual fashion. To note pt had recent urosepsis with stent placement in the ureter. Because of this, this prompted a urology and a ID cosult. Pt started on Broad spectrum Antibiotic pre and post surgery. US of kidneys done, CT scan of pelvis done to assess for underlying abcess, ua done, cx of urine sent, blood cx's sent. All negative pt cleared for surgery. [**2152-10-30**] - Pt underewent a Coronary artery bypass graft x6, left internal mammary artery to left anterior descending artery, and saphenous vein graft sequential grafting to obtuse marginal and ramus branches, and saphenous vein graft sequential grafting to diagonal 1 and diagonal 2, and saphenous vein graft to posterior descending artery. POD # 1 Transfered to the CVICU. Required pressure support for hypotension post operative period. POD # 2 Extubated without problems, lopressor and statin started. Transfered to the floor. Chest tubes removed. POD # 3 Pacing wires removed without sequele, pt tachycardic lopressor increased, repeat ua with cx takes. IV antibiotics continued. Pt process begins PT process POD # 4 Foley [**Name (NI) 1788**] pt had some hematuria with voiding trial. Pt urine clear on DC. POD # 5 Urine Cx's X 2 negative. IV Antibiotics stopped. Pt switched to PO Cipro. Pt to continue this untill follow-up with Dr [**First Name (STitle) **] for ureatl stone removal. Lopressor increased for tachycardia. Pt stable for DC Medications on Admission: [**Last Name (un) 1724**]: Atenolol, Lovastatin 40 Discharge Medications: 1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 4 days. 2. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 7 days. 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day): hold for HR less then 60 SBP less then 90. 7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): continue untill kidney stones are removed. 8. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain: PRN for pain. 11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed. 12. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. Discharge Disposition: Extended Care Facility: [**Hospital 1294**] Healthcare Center - [**Location (un) 1294**] Discharge Diagnosis: CAD CHF, high cholesterol, HTN, NSTEMI, BPH recent urosepsis, uretel stent placement prompting an ID and urology consult Discharge Condition: Stable Discharge Instructions: SHOWER DAILY and pat incisions dry no lotions, creams or powders on any incision no driving for one month no lifting greater than 10 pounds for 10 weeks call for fever greater than 100.5, redness, or drainage c/w po cipro untill you folow-up with an urologist and have the stones removed Followup Instructions: You should call your PCP and schedule an appointment for 2 weeks. [**Last Name (un) 46448**],BIPINCHANDRA [**Telephone/Fax (1) 46449**] [**Doctor First Name **] [**Doctor Last Name **] ([**Telephone/Fax (1) 1504**], two weeks this is your cardiologist. Please follow up with Dr [**First Name (STitle) **] the urologist who put your urethral stent in. He can be reached at [**Telephone/Fax (1) 46450**]. He should remove your other stones before you come of the antibiotics ciprofloxacin. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2152-11-4**]

410,998,599,414,458,285,401,272,V104

{'Subendocardial infarction, initial episode of care,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: CAD, recent urosepsis with ureteral stent placement PRESENT ILLNESS: This 77-year-old patient with recent cardiac symptoms was investigated and was found to have severe triple-vessel disease with diminished ejection fraction of about 35% and was transferred urgently for coronary artery bypass grafting. MEDICAL HISTORY: PMH: CHF, high cholesterol, HTN, NSTEMI, prostate Ca s/p brachytherapy, BPH, nephrolithiasis s/p 12 lithotrpsies, recent urosepsis, uretel stent placement PSH: Lithos, Brachytherapy, cataract surgery MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Atenolol, Lovastatin 40 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 99.0/98.0 76 151/84 20 99RA NAD RRR CTAB Abd soft, NT, ND, no incisions or masses, no flank pain on either side Sternal INC C/D/I palp distal pulses FAMILY HISTORY: NC SOCIAL HISTORY: Recently in rehab after fall, no tob or etoh NC ### Response: {'Subendocardial infarction, initial episode of care,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate'}

CHIEF COMPLAINT: Left hip pain. PRESENT ILLNESS: 73 year-old male with history of CAD, HTN, CHB with PPM, PAF on coumadin who suffered a fall forward "onto all fours" per wife in Bahamas on [**Name (NI) 2974**]. He did not have any head trauma. The patient complained of left hip pain. The patient was med flighted to [**Location (un) 71836**], where he was diagnosed with a proximal femur fracture, then transferred to [**Hospital1 18**]. On arrival in the ED, noted to be hemodynamically stable, but hematocrit was 21.9 (unknown baseline). INR was 1.3; he had last taken warfarin the day preceding his fall. . The patient's wife states that at baseline he walks on level surfaces without difficulty, but she has noted he is having increasing SOB. When asked if she thought he could climb two flights of stairs with a bag of groceries, she says that he would have to stop and rest for shortness of breath. . The patient states he has anginal pain when he gets aggrevated, and has been needing to use his nitrostat more frequently of late. . Review of systems otherwise negative in detail. MEDICAL HISTORY: 1. Pacer placed post-MI for complete heart block, replaced x2 most recently [**2-/2188**] 2. Paroxysmal atrial fibrillation, on coumadin 3. Hypertension 4. Early Alzheimer's dementia 5. Depression/anxiety 6. Left femoral fracture 7. ? Hodgkin's Lymphoma 8. ? TIA MEDICATION ON ADMISSION: Diltiazem 360 SR Irbesartan 150 Trazodone 12.5 hs prn Aricept 5 Nameda 10 [**Hospital1 **] Warfarin 3 mg for 5 d/wk, 1.5 mg 2 other days Zocor 40 Q HS Nitrostat prn Toprol XL 100 Protonix 40 Effexor XL 75 ALLERGIES: Percocet / Antipsychotic Drug PHYSICAL EXAM: VS: 98 140/76 101 18 99 2L Pale, anxious, nad. HEENT Face symmetric, MMM, pale-appearing. EOMI, PERRL COR:Tachy, reg, [**4-14**] HSM with radiation to carotids. No R/G PULM:CTA thoughout ABD:Soft, tender bilateral lower quadrants, BS +, no rebound or guarding, no hsn, audible abdominal aortic bruit. EXT:No edema, lle in ace wrap thoughout. NEURO:Alert, anxious, oriented to person, place. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives with wife in [**Name (NI) 3844**]. Rare alcohol use; history of tobacco use, but quit a number of years ago.

Closed fracture of shaft of femur,Acute posthemorrhagic anemia,Subendocardial infarction, initial episode of care,Other postoperative infection,Unspecified septicemia,Severe sepsis,Septic shock,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Unspecified fall,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ

Fx femur shaft-closed,Ac posthemorrhag anemia,Subendo infarct, initial,Other postop infection,Septicemia NOS,Severe sepsis,Septic shock,Surg compl-heart,Parox ventric tachycard,CHF NOS,Pneumonia, organism NOS,Fall NOS,Crnry athrscl natve vssl,Status cardiac pacemaker

Admission Date: [**2189-3-29**] Discharge Date: [**2189-4-18**] Date of Birth: [**2115-8-21**] Sex: M Service: MEDICINE Allergies: Percocet / Antipsychotic Drug Attending:[**First Name3 (LF) 2704**] Chief Complaint: Left hip pain. Major Surgical or Invasive Procedure: Blood transfusion. Left hip ORIF. Cardiac catheterization. History of Present Illness: 73 year-old male with history of CAD, HTN, CHB with PPM, PAF on coumadin who suffered a fall forward "onto all fours" per wife in Bahamas on [**Name (NI) 2974**]. He did not have any head trauma. The patient complained of left hip pain. The patient was med flighted to [**Location (un) 71836**], where he was diagnosed with a proximal femur fracture, then transferred to [**Hospital1 18**]. On arrival in the ED, noted to be hemodynamically stable, but hematocrit was 21.9 (unknown baseline). INR was 1.3; he had last taken warfarin the day preceding his fall. . The patient's wife states that at baseline he walks on level surfaces without difficulty, but she has noted he is having increasing SOB. When asked if she thought he could climb two flights of stairs with a bag of groceries, she says that he would have to stop and rest for shortness of breath. . The patient states he has anginal pain when he gets aggrevated, and has been needing to use his nitrostat more frequently of late. . Review of systems otherwise negative in detail. Past Medical History: 1. Pacer placed post-MI for complete heart block, replaced x2 most recently [**2-/2188**] 2. Paroxysmal atrial fibrillation, on coumadin 3. Hypertension 4. Early Alzheimer's dementia 5. Depression/anxiety 6. Left femoral fracture 7. ? Hodgkin's Lymphoma 8. ? TIA Social History: Lives with wife in [**Name (NI) 3844**]. Rare alcohol use; history of tobacco use, but quit a number of years ago. Family History: Non-contributory. Physical Exam: VS: 98 140/76 101 18 99 2L Pale, anxious, nad. HEENT Face symmetric, MMM, pale-appearing. EOMI, PERRL COR:Tachy, reg, [**4-14**] HSM with radiation to carotids. No R/G PULM:CTA thoughout ABD:Soft, tender bilateral lower quadrants, BS +, no rebound or guarding, no hsn, audible abdominal aortic bruit. EXT:No edema, lle in ace wrap thoughout. NEURO:Alert, anxious, oriented to person, place. Pertinent Results: FEMUR /KNEE/HIP LEFT [**2189-3-29**] IMPRESSION: Oblique fracture of the proximal left femur involving the lesser trochanter and proximal femoral diaphysis. . CT ABDOMEN/PELVIS W/O CONTRAST [**2189-3-29**] IMPRESSION: 1. Tiny bilateral pleural effusions and bibasilar atelectasis. 2. Bilateral renal lesions, the larger are consistent with cysts, several subcentimeter lesions are too small to characterize. There is a 1.6-cm high- density lesion at the upper pole of the left kidney, which is not completely characterized. Further evaluation with ultrasound or MRI is recommended. Differential diagnosis includes hemorrhagic cyst or renal cell carcinoma. 3. Suprarenal abdominal aortic aneurysm. 4. Left femoral fracture extending from the femoral neck down to the proximal femur, this fracture is significantly displaced and there is a large left thigh hematoma involving nearly the entire rectus femoris muscle. There is also a left knee joint effusion. . Transthoracic echocardiogram [**2189-3-31**] Conclusions: Technically suboptimal study. The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. There is mild to moderate regional left ventricular systolic dysfunction with focal akinesis of the basal half of the inferolateral wall and hypokineis of the distal half of the septum and anterior wall and apex. Right ventricular chamber size and free wall motion are normal. The aortic valve is not well seen. No aortic regurgitation is seen. The mitral valve is not well seen. No definite mitral regurgitation is identified. There is no pericardial effusion. IMPRESSION: Regional left ventricular systolic dysfunction c/w multivessel CAD. . Transthoracic echocardiogram [**2189-4-3**] Left Ventricle - Ejection Fraction: 30% to 40% (nl >=55%) The left atrium is elongated. Left ventricle is mildly hypertrophied.. There is moderate regional left ventricular systolic dysfunction. There is Akinesis of the basal and mid posterior wall. There is hypokinesis of the basal inferior wall. There is hypokisis of the distal antieror and septal walls and the apex. Overall, the function and wall motion does not appear appreciably changed from the previous (limited) transthoracic study of [**2189-3-31**]. The right ventricular cavity is moderately dilated. Right ventricular systolic function is borderline normal. There are complex (mobile) 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. There is mild aortic valve stenosis (area 1.2-1.9cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. No mitral regurgitation or stenosis is seen. The tricuspid valve leaflets are mildly thickened. Findings relayed to surgical team at bedside at the time of the exam. . CTA CHEST W&W/O C&RECONS, NON-CORONARY [**2189-4-4**] No pulmonary embolism. Small bilateral pleural effusions with associated dependent bibasilar lung atelectasis. Nonspecific patchy ground glass attenuation throughout both lungs, which is worse in the right upper lobe. Findings may represent early infection or pulmonary edema. Wedge fracture of a single mid thoracic vertebral body. . Tranesophagel echocardiogram [**2189-4-4**] Conclusions: Right ventricular chamber size and free wall motion are normal. Compared with the prior study (images reviewed) of [**2189-3-31**], the right ventricular function is similar. Please see prior echocardiogram for full study. This was a limited examination. . C.CATH Study Date of [**2189-4-15**] *** Not Signed Out *** BRIEF HISTORY: 73 year old male with coronary artery disease status post two remote myocardial infarction who presented with a hip fracture and NSTEMI. Echocardiogram revealed an LVEF of 35% with wall motion abnormalities consistent with rPDA and mid-LAD disease. Catheterization deferred prior to hip surgery but now referred to the cath lab prior to resuming physical rehabilitation. INDICATIONS FOR CATHETERIZATION: Coronary artery disease PROCEDURE: Left Heart Catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 French angled pigtail catheter, advanced to the left ventricle through a 5 French introducing sheath. Coronary Angiography: was performed in multiple projections using a 5 French JL4 and a 5 French JR4 catheter, with manual contrast injections. Conscious Sedation: was provided with appropriate monitoring performed by a member of the nursing staff. HEMODYNAMICS RESULTS BODY SURFACE AREA: m2 HEMOGLOBIN: gms % FICK **PRESSURES LEFT VENTRICLE {s/ed} 158/14 AORTA {s/d/m} 158/72/100 **ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM **RIGHT CORONARY 1) PROXIMAL RCA DISCRETE 100 **ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM **LEFT CORONARY 5) LEFT MAIN DISCRETE 50 6) PROXIMAL LAD DISCRETE 50 6A) SEPTAL-1 NORMAL 7) MID-LAD NORMAL 8) DISTAL LAD NORMAL 9) DIAGONAL-1 DISCRETE 70 10) DIAGONAL-2 DISCRETE 60 12) PROXIMAL CX NORMAL 13) MID CX NORMAL 13A) DISTAL CX NORMAL 14) OBTUSE MARGINAL-1 NORMAL 15) OBTUSE MARGINAL-2 NORMAL TECHNICAL FACTORS: Total time (Lidocaine to test complete) = 19 minutes. Arterial time = 16 minutes. Fluoro time = 4.6 minutes. Contrast injected: Non-ionic low osmolar (isovue, optiray...), vol 55 ml Premedications: ASA 325 mg P.O. Anesthesia: 1% Lidocaine subq. Anticoagulation: Other medication: Fentanyl 50mcg Nahc03 75cc/hr Cardiac Cath Supplies Used: - ALLEGIANCE, CUSTOM STERILE PACK COMMENTS: 1. Selective coronary angiography of this right dominant system revealed two vessel disease. The LMCA had a heavily calcified 50% distal stenosis but with a large caliber lumen. The LAD had a calcified 50% ostial lesion but no significant disease distally. There was a small D1 branch with a 70% stenosis and a 60% focal lesion in D2. The LCx was free of significant stenoses. The RCA was chronically occluded proximally and filled via left to right collaterals. 2. Limited resting hemodynamics revealed mildly elevated left sided filling pressures with an LVEDP of 14mmHg. There was moderate systemic arterial hypertension with an aortic SBP of 158mmHg. 3. Left ventriculography was deferred. FINAL DIAGNOSIS: 1. Two vessel coronary artery disease. 2. Mild diastolic left ventricular dysfunction. . Labwork on admission: [**2189-3-29**] 01:50AM WBC-8.4 RBC-2.44* HGB-7.9* HCT-21.9* MCV-90 MCH-32.3* MCHC-36.0* RDW-13.8 [**2189-3-29**] 01:50AM PLT COUNT-232 [**2189-3-29**] 01:50AM NEUTS-81.1* LYMPHS-11.7* MONOS-6.4 EOS-0.7 BASOS-0.1 [**2189-3-29**] 01:50AM PT-14.8* PTT-29.2 INR(PT)-1.3* [**2189-3-29**] 01:50AM GLUCOSE-96 UREA N-31* CREAT-1.7* SODIUM-137 POTASSIUM-4.7 CHLORIDE-106 TOTAL CO2-21* ANION GAP-15 [**2189-3-29**] 01:50AM CK(CPK)-973* [**2189-3-29**] 01:50AM CK-MB-11* MB INDX-1.1 cTropnT-0.02* [**2189-3-29**] 09:40AM CK(CPK)-836* [**2189-3-29**] 09:40AM CK-MB-10 MB INDX-1.2 cTropnT-0.02* [**2189-3-29**] 01:08PM CK(CPK)-803* [**2189-3-29**] 01:08PM CK-MB-9 cTropnT-0.02* . Labwork on discharge: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2189-4-17**] 05:52AM 11.7* 3.08* 9.6* 28.8* 94 31.4 33.5 16.0* 473* RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2189-4-17**] 05:52AM 83 22* 1.2 139 3.9 102 28 13 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct INR(PT) [**2189-4-18**] 09:20AM 25.0* 38.1* 2.5* Brief Hospital Course: 73 year-old with history of CAD now s/p fall who presented with left femur fracture and chest pain. . The patient presented with an oblique left femur fracture which required surgical correction by orthopedic surgery. However, given elevated troponins, echocardiogram with multiple wall motion abnormalities in the setting of low EF (35%), and patient's complaints of chest pain on admission, the patient's surgery was postponed until cardiac risk assessment was completed. The patient was initially maintained with ASA, Nitro patch, metoprolol, SL NTG, and morphine PCA pump with resolution of chest pain. The risk of peri-operative cardiovascular event was estimated at about 20%. The patient lacked capacity; the patient's wife and son consented to proceed with the high-risk surgery. . The patient's hematocrit was maintained >28 with blood transfusions as needed. The patient's warfarin was initially held given the amount of blood loss and need for surgery. . On [**2189-4-1**], the patient had a pin placed with 15 pounds of traction by orthopedic surgery at the bedside. He was taken to the OR on [**2189-4-3**]. . The patient was noted to be hypotensive post-operatively [**2189-4-3**]. He was maintained on phenylephrine gtt for his hypotension. There was some concern for new elevations in his cardiac enzymes and he was transferred to the CCU team for further care. Once in the CCU, his phenylephrine was discontinued and he was started on peripheral dopamine for blood pressure support. He was noted to be hypoxic and in sinus tachycardia to the 120s. The source of his shock was initially unclear (sepsis vs cardiogenic shock vs secondary to pulmonary embolus), and a Swan-Ganz catheter was placed under fluoroscopic guidance. The Swan numbers showed elevated right-sided pressures and a narrow pulse pressure which was concerning for PE. He was started on a heparin gtt, electively intubated, and underwent a CT angiography which showed no evidence of PE as above. . The etiology of hypotension was not entirely clear but PA catheter numbers were not consistent with cardiogenic shock; the shock was presumed secondary to sepsis from MRSA pneumonia and postoperative hypovolemia. Further CCU course significant for supportive care initially including pressors and IVF. After fluid resuscitation, pressors were weaned several days later. After hemodynamic stability, the patient was extubated without difficulty. The patient completed a 7-day course of Zosyn and a 14-day course of vancomycin started [**2189-4-4**] for MRSA in the sputum and [**2-12**] blood cultures with S. faecium. . Prior to transfer to the floor, the patient had a pulseless polymorphic VT/VF arrest with QT prolongation. The patient received one shock at 300 J and returned to sinus rhythm. The arrest was believed secondary to QT prolongation from haldol. The patient's pacemaker rate was increased to 90 to decrease the QT interval. The patient should not receive any QT prolonging agents in the future. The patient's cardiac enzymes were stable and ischemia was not believed to be responsible for the patient's arrhythmia. The patient was intubated for airway protection during the arrest but extubated easily the day after. The patient does not require ICD placement for this reversible etiology of VT arrest. The patient was evaluated for ICD placement because of his depressed EF, but this was not further pursued because of the patient's decreased mental status. . The day prior to transfer, the patient became hypotensive in the setting of atrial fibrillation with rapid ventricular rate. The patient's pacemaker was adjusted from DDD to DDI with good effect. The patient was started on metoprolol for rate control. . The day of transfer to the floor, the patient received diagnostic/therapeutic cardiac catheterization to evaluate for ischemia given the history of NSTEMI early in his hospital course. The report is as above; there were no intervenable lesions. . The patient is discharged to rehab for further physical therapy post ORIF. The patient is discharged with a cardiac regimen consisting of ASA, plavix, BB, ACEI, and statin. The patient was restarted on coumadin for paroxysmal atrial fibrillation and should receive INR checks regularly at least twice weekly until stable to ensure that INR is at goal [**3-14**]. The patient is taking tylenol and tramadol as needed for left hip pain. . Of note, the patient had a diagnosis of early Alzheimer's dementia prior to admission. The patient was oriented times one to three during admission, in general becoming more disoriented at night. . The patient should follow-up decreasing the pacemaker rate in the future if the QTc is back to normal range and should have pacemaker interrogation per his primary cardiologist. He should have follow-up imaging to reassess the probable renal cysts seen on CT abdomen as above. The patient should have further management of COPD diagnosed on chest X-ray as needed. Medications on Admission: Diltiazem 360 SR Irbesartan 150 Trazodone 12.5 hs prn Aricept 5 Nameda 10 [**Hospital1 **] Warfarin 3 mg for 5 d/wk, 1.5 mg 2 other days Zocor 40 Q HS Nitrostat prn Toprol XL 100 Protonix 40 Effexor XL 75 Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain: [**Month (only) 116**] repeat x2. 7. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) Subcutaneous Q12H (every 12 hours): Until warfarin therapeutic. 8. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 10. Memantine 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 11. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for fever, pain. 13. Tramadol 50 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain. 14. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 15. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 16. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. 17. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical TID (3 times a day) as needed. Discharge Disposition: Extended Care Facility: Apply Velley Discharge Diagnosis: Primary: 1. Left hip fracture status post ORIF 2. Septic shock secondary to hospital-acquired pneumonia 3. Cardiac arrest secondary to ventricular tachycardia with prolonged QT 4. Coronary artery disease status post NSTEMI is peri-operative period 5. Congestive heart failure, EF 30-40% . Secondary: 1. Pacer placed post-MI for complete heart block, replaced x2 most recently [**2-/2188**] 2. Paroxysmal atrial fibrillation, on coumadin 3. Hypertension 4. Early Alzheimer's dementia 5. Depression/anxiety 6. Chronic obstructive pulmonary disease per CXR 7. Left femoral fracture 8. ? Hodgkin's Lymphoma 9. ? TIA Discharge Condition: Afebrile, vital signs stable. INR 2.5. Discharge Instructions: You were hospitalized with a left femur fracture. You underwent surgery to repair this. You are being discharged to a rehab facility for physical therapy. . While hospitalized, you had a cardiac arrest from QT prolongation from haldol. You should discontinue Effexor, as it can increase the QT interval. You should check with your physician before starting any new medications. You should never take any medications that prolong the QT interval. You pacemaker rate was increased to 90 to decrease the QT interval and you should recheck this with your cardiologist. . Please contact a physician if you experience fevers, chills, chest pain, shortness of breath, or any other concerning symptoms. . Please take your medications as prescribed. - For your heart, you should take: -- Aspirin 325 mg once daily -- Plavix 75 mg once daily -- Metoprolol 25 mg twice daily -- Lisinopril 5 mg once daily -- Simvastatin 40 mg once daily -- Warfarin 3 mg once daily -- Please have INR checked every two to three days at rehab with goal INR [**3-14**] until stable values obtained . Please call your cardiologist, Dr. [**First Name4 (NamePattern1) 13740**] [**Last Name (NamePattern1) **], at [**Telephone/Fax (1) 16827**] to schedule a follow-up appointment within two weeks of your discharge from the rehab center. Followup Instructions: Please call your cardiologist, Dr. [**First Name4 (NamePattern1) 13740**] [**Last Name (NamePattern1) **], at [**Telephone/Fax (1) 16827**] to schedule a follow-up appointment within two weeks of your discharge from the rehab center.

821,285,410,998,038,995,785,997,427,428,486,E888,414,V450

{'Closed fracture of shaft of femur,Acute posthemorrhagic anemia,Subendocardial infarction, initial episode of care,Other postoperative infection,Unspecified septicemia,Severe sepsis,Septic shock,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Unspecified fall,Coronary atherosclerosis of native coronary artery,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: Left hip pain. PRESENT ILLNESS: 73 year-old male with history of CAD, HTN, CHB with PPM, PAF on coumadin who suffered a fall forward "onto all fours" per wife in Bahamas on [**Name (NI) 2974**]. He did not have any head trauma. The patient complained of left hip pain. The patient was med flighted to [**Location (un) 71836**], where he was diagnosed with a proximal femur fracture, then transferred to [**Hospital1 18**]. On arrival in the ED, noted to be hemodynamically stable, but hematocrit was 21.9 (unknown baseline). INR was 1.3; he had last taken warfarin the day preceding his fall. . The patient's wife states that at baseline he walks on level surfaces without difficulty, but she has noted he is having increasing SOB. When asked if she thought he could climb two flights of stairs with a bag of groceries, she says that he would have to stop and rest for shortness of breath. . The patient states he has anginal pain when he gets aggrevated, and has been needing to use his nitrostat more frequently of late. . Review of systems otherwise negative in detail. MEDICAL HISTORY: 1. Pacer placed post-MI for complete heart block, replaced x2 most recently [**2-/2188**] 2. Paroxysmal atrial fibrillation, on coumadin 3. Hypertension 4. Early Alzheimer's dementia 5. Depression/anxiety 6. Left femoral fracture 7. ? Hodgkin's Lymphoma 8. ? TIA MEDICATION ON ADMISSION: Diltiazem 360 SR Irbesartan 150 Trazodone 12.5 hs prn Aricept 5 Nameda 10 [**Hospital1 **] Warfarin 3 mg for 5 d/wk, 1.5 mg 2 other days Zocor 40 Q HS Nitrostat prn Toprol XL 100 Protonix 40 Effexor XL 75 ALLERGIES: Percocet / Antipsychotic Drug PHYSICAL EXAM: VS: 98 140/76 101 18 99 2L Pale, anxious, nad. HEENT Face symmetric, MMM, pale-appearing. EOMI, PERRL COR:Tachy, reg, [**4-14**] HSM with radiation to carotids. No R/G PULM:CTA thoughout ABD:Soft, tender bilateral lower quadrants, BS +, no rebound or guarding, no hsn, audible abdominal aortic bruit. EXT:No edema, lle in ace wrap thoughout. NEURO:Alert, anxious, oriented to person, place. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives with wife in [**Name (NI) 3844**]. Rare alcohol use; history of tobacco use, but quit a number of years ago. ### Response: {'Closed fracture of shaft of femur,Acute posthemorrhagic anemia,Subendocardial infarction, initial episode of care,Other postoperative infection,Unspecified septicemia,Severe sepsis,Septic shock,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Unspecified fall,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: s/p failed gallstones removal c/b gallbladder perforation PRESENT ILLNESS: Mr. [**Known lastname 92497**] is a 61 y/o male with h/o HTN, COPD, chronic renal disease on HD, s/p AAA repair and cholecystitis who was admitted to the MICU after a failed attempt to remove stones/biliary dilation and removal of previous catheter fragment that was complicated by gallbladder/cystic duct perforation. The patient presented with acute cholecystitis on [**2169-10-17**] and underwent percutaneous cholecystostomy; at that time as based on his comorbidities he was not felt to be a good surgical candidate. Since then he has undergone ERCP x 2 with sphincterotomy as well as failed laparoscopic cholecystectomy because of adhesions on [**2170-2-8**]. His cholecystostomy tube came out accidentally and a new percutaneous tube was replaced on [**2170-3-9**]. Unfortunately this cholecystostomy tube was severed by VNA, leaving him with a cathetar fragment at his ostomy site. . Of note, all of his prior care has been at [**Hospital1 498**]. He was referred to IR (Dr. [**Last Name (STitle) 4686**] for a cholangiogram via his existing cholecystostomy tube +/- stone extraction, catheter fragment removal and sphincteroplasty. The procedure performed yesterday was unsuccessful in removing the gallbladder stones or the catheter fragment, and was also complicated by gallbaldder/cystic duct perforation. Pt was hemodynamically stable, complaining only of RUQ pain ([**5-8**]). . This morning pt had episodes of hypotension with SBP's to the 70's prior to dialysis. Pt was mentating well, Tmax of 100.1. Pt not currently complaining of abdominal pain. Pt was transferred to the MICU because of concern for sepsis following perforation. MEDICAL HISTORY: -Hypertension -COPD on home oxygen (2L) -Chronic renal disease on HD (T,Th,Sat schedule. Last HD on Saturday [**2170-4-7**]) -Open AAA repair in [**2164**] c/b abdominal wall hernia repaired with mesh. -Thoracic aortic aneurysm, s/p endograft repair -S/p LUE AVF -Cholelithiasis -Sleep apnea -Hypercholesterolemia -CVA -recent (diagnosed via MRI) -Arthritis MEDICATION ON ADMISSION: -Aspirin 81mg daily -Flovent (1puff twice daily) -Furosemide 40mg [**Hospital1 **] -Genasyme -Lisinopril 20mg QD -Metoprolol 100mg [**Hospital1 **] -Gabapentin 100mg tab x 2 tabs TID -Ursodiol 300mg [**Hospital1 **] -Sevelemer 800mg TID -Meclizine 12.5mg [**Hospital1 **] -Darbepoetin injections on Thursday -Oxycodone/Acetaminophen PRN -Simvastatin 40mg dialy -Spiriva daily -Budesonide 2 puffs twice daily -Gemfibrizol 600mg [**Hospital1 **] -Tamsulosin -Sodium bicarbonate 325mg x 2 tabs three times daily ALLERGIES: Penicillins / Arterial Line in RIGHT RADIAL PHYSICAL EXAM: Vitals: T:97.5 BP:90/50 P:79 R:12 O2:99% 2L General: Alert, interactive, oriented, no acute distress HEENT: Sclera anicteric, mucus membranes [**Doctor Last Name **], oropharynx clear, EOMI Neck: Supple CV: Regular rate and rhythm, normal S1 + S2, GII systolic and diastolic murmer at RUSB, GII holosystolic and diastolic murmer at LSB, no rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: Soft, non-tender, mild distension, ostomy site clean with bandage in place and cholecystostomy drain with serosanguinous drainage in bag, +BS Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: - No family history of gallstones - Kidney stones: brothers SOCIAL HISTORY: - Tobacco: 2-3packs/day x 40 years - Alcohol: very heavy drinker x 15 years - Illicits: none

Mechanical complication due to other implant and internal device, not elsewhere classified,Perforation of gallbladder,Obstruction of bile duct,End stage renal disease,Other digestive system complications,Calculus of bile duct with other cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Arthropathy, unspecified, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Tobacco use disorder,Anemia in chronic kidney disease,Other iatrogenic hypotension,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Other sequelae of chronic liver disease,Personal history of noncompliance with medical treatment, presenting hazards to health

Malfunc oth device/graft,Perforation gallbladder,Obstruction of bile duct,End stage renal disease,Oth digestv system comp,Choledochlith/gb NEC-obs,Hyp kid NOS w cr kid V,Acute kidney failure NOS,Enterococcus group d,Abn react-procedure NEC,Renal dialysis status,Chr airway obstruct NEC,Depend-supplement oxygen,Obstructive sleep apnea,Pure hypercholesterolem,Hx TIA/stroke w/o resid,Arthropathy NOS-unspec,DMII wo cmp nt st uncntr,Long-term use of insulin,Tobacco use disorder,Anemia in chr kidney dis,Iatrogenc hypotnsion NEC,Adv eff sympatholytics,Adv eff cardiovasc NEC,Adv eff sedat/hypnot NOS,Oth sequela, chr liv dis,Hx of past noncompliance

Admission Date: [**2170-4-9**] Discharge Date: [**2170-4-15**] Date of Birth: [**2109-1-4**] Sex: M Service: MEDICINE Allergies: Penicillins / Arterial Line in RIGHT RADIAL Attending:[**First Name3 (LF) 10593**] Chief Complaint: s/p failed gallstones removal c/b gallbladder perforation Major Surgical or Invasive Procedure: IR guided attempted removal of gallstones and fragmented cholecystostomy tube (failed attempt), complicated by perforation of the gallbladder. History of Present Illness: Mr. [**Known lastname 92497**] is a 61 y/o male with h/o HTN, COPD, chronic renal disease on HD, s/p AAA repair and cholecystitis who was admitted to the MICU after a failed attempt to remove stones/biliary dilation and removal of previous catheter fragment that was complicated by gallbladder/cystic duct perforation. The patient presented with acute cholecystitis on [**2169-10-17**] and underwent percutaneous cholecystostomy; at that time as based on his comorbidities he was not felt to be a good surgical candidate. Since then he has undergone ERCP x 2 with sphincterotomy as well as failed laparoscopic cholecystectomy because of adhesions on [**2170-2-8**]. His cholecystostomy tube came out accidentally and a new percutaneous tube was replaced on [**2170-3-9**]. Unfortunately this cholecystostomy tube was severed by VNA, leaving him with a cathetar fragment at his ostomy site. . Of note, all of his prior care has been at [**Hospital1 498**]. He was referred to IR (Dr. [**Last Name (STitle) 4686**] for a cholangiogram via his existing cholecystostomy tube +/- stone extraction, catheter fragment removal and sphincteroplasty. The procedure performed yesterday was unsuccessful in removing the gallbladder stones or the catheter fragment, and was also complicated by gallbaldder/cystic duct perforation. Pt was hemodynamically stable, complaining only of RUQ pain ([**5-8**]). . This morning pt had episodes of hypotension with SBP's to the 70's prior to dialysis. Pt was mentating well, Tmax of 100.1. Pt not currently complaining of abdominal pain. Pt was transferred to the MICU because of concern for sepsis following perforation. Past Medical History: -Hypertension -COPD on home oxygen (2L) -Chronic renal disease on HD (T,Th,Sat schedule. Last HD on Saturday [**2170-4-7**]) -Open AAA repair in [**2164**] c/b abdominal wall hernia repaired with mesh. -Thoracic aortic aneurysm, s/p endograft repair -S/p LUE AVF -Cholelithiasis -Sleep apnea -Hypercholesterolemia -CVA -recent (diagnosed via MRI) -Arthritis Social History: - Tobacco: 2-3packs/day x 40 years - Alcohol: very heavy drinker x 15 years - Illicits: none Family History: - No family history of gallstones - Kidney stones: brothers Physical Exam: Vitals: T:97.5 BP:90/50 P:79 R:12 O2:99% 2L General: Alert, interactive, oriented, no acute distress HEENT: Sclera anicteric, mucus membranes [**Doctor Last Name **], oropharynx clear, EOMI Neck: Supple CV: Regular rate and rhythm, normal S1 + S2, GII systolic and diastolic murmer at RUSB, GII holosystolic and diastolic murmer at LSB, no rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: Soft, non-tender, mild distension, ostomy site clean with bandage in place and cholecystostomy drain with serosanguinous drainage in bag, +BS Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema MICU Admission Exam: Vitals: T: 99.5 BP: 83/48 P: 85 R:9 18 O2: 100% on RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, mild tenderness to palpation in the RUQ, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact Pertinent Results: Admission Labs: [**2170-4-9**] 09:40PM BLOOD WBC-11.1* RBC-3.57* Hgb-9.7* Hct-29.4* MCV-82 MCH-27.1 MCHC-32.9 RDW-16.0* Plt Ct-309 [**2170-4-10**] 10:40AM BLOOD Neuts-79* Bands-0 Lymphs-9* Monos-10 Eos-1 Baso-0 Atyps-1* Metas-0 Myelos-0 [**2170-4-10**] 10:40AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-1+ Macrocy-NORMAL Microcy-1+ Polychr-1+ Ovalocy-1+ Schisto-OCCASIONAL Tear Dr[**Last Name (STitle) 833**] [**2170-4-9**] 09:40PM BLOOD Glucose-102* UreaN-29* Creat-4.6* Na-138 K-4.0 Cl-102 HCO3-23 AnGap-17 [**2170-4-10**] 05:35AM BLOOD Calcium-8.2* Phos-6.2* Mg-2.1 [**2170-4-10**] 05:35AM BLOOD ALT-5 AST-10 LD(LDH)-158 AlkPhos-65 TotBili-0.2 [**2170-4-9**] 09:40PM BLOOD PT-12.5 PTT-34.0 INR(PT)-1.2* [**2170-4-11**] 03:24AM BLOOD Cortsol-8.7 [**2170-4-11**] 03:24AM BLOOD Vanco-18.6 Micro: [**4-11**] BCx pending [**4-10**] BCx negative [**4-10**] UCx negative [**2170-4-11**] 9:58 am BILE BILE. **FINAL REPORT [**2170-4-15**]** GRAM STAIN (Final [**2170-4-11**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2170-4-15**]): ENTEROCOCCUS SP.. RARE GROWTH. ENTEROCOCCUS SP.. RARE GROWTH. SECOND MORPHOLOGY. Sensitivity testing performed by Sensititre. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | ENTEROCOCCUS SP. | | AMPICILLIN------------ <=2 S 0.5 S PENICILLIN G---------- 4 S 2 S VANCOMYCIN------------ 1 S <=1 S ANAEROBIC CULTURE (Final [**2170-4-15**]): NO ANAEROBES ISOLATED. Imaging: CT Abd/Pelvis ([**2170-4-10**]): 1. Phlegmonous change within the gallbladder fossa with one intact pigtail catheter in place. There is also a fragment present laterally within No drainable collection identified. Adjacent inflammatory fat stranding and pericholecystic fluid. 2. Moderate duodenal diverticulum. 3. Simple cysts within both kidneys. 4. Multiple stable subcentimeter hepatic hypodensities which are too small to characterize. 4. Intrahepatic ductal dilation with enhancement of the intrahepatic duct suggestive of cholangitis. 5. Stable aneurysmal aorta and right common iliac artery. 6. Sigmoid and ascending colon diverticulosis, without evidence of acute diverticulitis. . TTE ([**2170-4-11**]): The left atrium is mildly dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The number of aortic valve leaflets cannot be determined. There is 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. . RUE Ultrasound ([**2170-4-12**]): No evidence of deep venous thrombosis in the right upper extremity. . CXR ([**2170-4-15**]): Normal size of the cardiac silhouette. No lung parenchymal disease. Brief Hospital Course: 61yoM with h/o HTN, COPD, chronic renal disease on HD, s/p AAA repair and cholecystitis who was admitted after failed attempts by IR to remove stones and previous catheter fragment, complicated by gallbladder/cystic duct perforation and sepsis. . # Hypotension/Perforated Gallbladder/Common Bile Duct: The patient was admitted on [**4-9**] following a failed IR attempt to remove gallstones and a cholecystostomy catheter fragment, which was complicated by gallbladder/cystic duct perforation with contrast seen extravasating from the gallbladder. Post procedure BPs were in the 90s from a baseline of 120-140 systolic, attributed to sedation with slow clearance in the setting of liver failure. He was covered with Ceftriaxone and Flagyl. However, he then became hypotensive with SBP 70's-80's the following morning on [**4-10**] with low grade fever and increasing white count, and he was broadened to Vanc/[**Last Name (un) **] for concern for early peritonitis and sepsis. Blood pressures did not respond to several boluses of IVF and he was transferred to the MICU, where he received 8L NS. His blood pressures stablilized and white count down-trended, fever resolved on Vanc/[**Last Name (un) **]. CT was concerning for cholangitis, but LFTs did not show a cholestatic picture. ERCP was consulted and did not have plans to intervene unless the patient developed a cholestatic hepatitis. Surgery was consulted and is planning to perform an open cholecystectomy when he becomes medically stable. GB was determined to be adequately decompressed with his cholecystostomy tube at this time, and LFTs were WNL. He was discharged with a plan to continue Vancomycin/Meropenem for a 2 week course. Bile culture grew enterococcus sensitive to Vancomycin. The patient was given Acetaminophen and Oxycodone was increased for pain control. Gemfibrozil was discontinued, as this can precipitate gallstone formation. The day of discharge, there was question of whether the patient's insurance would cover his Vancomycin and Meropenem as an outpatient, but the patient refused to remain in-house to wait for confirmation of insurance approval. He will follow-up with his PCP as an outpatient regarding this, as he was refusing to remain in-house for this issue, despite knowing the risks of leaving. The day after discharge, on [**4-16**], the patient was called and he confirmed that the VNA just finished giving him the IV antibiotics and confirmed that his insurance would cover enough antibiotics for 10 days, for a full course. . # Anemia: The patient had hct 29 on initial presentation that slowly down-trended to 24 post-op. Likely dilutional in the setting of missing HD due to hypotension vs slow blood loss from ostomy vs anemia of ESRD without EPO repletion given recent initiation of HD. He was transfused 2 units PRBC in the MICU with subsequent increased and stable HCTs. He will receive EPO with HD per renal. . # R Hand Ischemia: While in the MICU, the patient developed cyanosis of the right hand, which was attributed to A-line insertion in the setting of visualized small caliber vessel. Perfusion returned s/p removal of the line. Surgery/Hand consulted, felt there were no concerning findings. [**Doctor Last Name **]??????s test normal. . # HD dependent ESRD: The patient was initially on a T/Th/Sat hemodialysis schedule but while in the MICU, his schedule was switched to M/W/F. He received an extra dose of HD in-house after being called out to the floor, as he initially missed HD while in the MICU for sepsis. Continued sodium bicarb 650 mg tid, sevelamer 1600 mg tid with meals. Renal was following in-house. . # Hypertension: Patient was recently hypotensive in the setting of sepsis, and his home lisinopril and metoprolol were held until follow-up with his PCP. . # COPD on home oxygen (2L): Patient is currently asymptomatic, with no shortness of breath or wheezing. The patient is on 2L at home chronically but has been non-compliant with his oxygen use at home. He was intermittently on 2L NC in-house. His home regimen of tiotropium and albuterol were continued in-house. . #Hypercholesterolemia: Pt currently on Simvastatin 40mg daily, continued in-house. . #CVA: Recent (diagnosed via MRI). Continued home aspirin 81mg daily. . . # Code: Full code Transitions of Care: - Vancomycin, to be continued until [**2170-4-23**] - needs confirmation that insurance will cover outpatient medication - Meropenem to be continued until [**2170-4-23**] - needs confirmation that insurance will cover outpatient medication - f/u BP; re-start Lisinopril and Metoprolol as BP tolerated - Tamsulosin was STOPPED for hypotension; follow up PCP or nephrologist prior to re-starting this medication - Furosemide was STOPPED for hypotension; follow up with nephrologist prior to re-initiation - Percocet was INCREASED in frequency temporarily for pain control post-procedure - Gemfibrozil was STOPPED, as this can cause gallstones - Genasyme was HELD; follow up with nephrologist or PCP before [**Name9 (PRE) 18290**] Medications on Admission: -Aspirin 81mg daily -Flovent (1puff twice daily) -Furosemide 40mg [**Hospital1 **] -Genasyme -Lisinopril 20mg QD -Metoprolol 100mg [**Hospital1 **] -Gabapentin 100mg tab x 2 tabs TID -Ursodiol 300mg [**Hospital1 **] -Sevelemer 800mg TID -Meclizine 12.5mg [**Hospital1 **] -Darbepoetin injections on Thursday -Oxycodone/Acetaminophen PRN -Simvastatin 40mg dialy -Spiriva daily -Budesonide 2 puffs twice daily -Gemfibrizol 600mg [**Hospital1 **] -Tamsulosin -Sodium bicarbonate 325mg x 2 tabs three times daily Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. fluticasone 110 mcg/actuation Aerosol Sig: One (1) Puff Inhalation [**Hospital1 **] (2 times a day). 3. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO three times a day. 4. ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 6. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. darbepoetin alfa in polysorbat Injection 8. oxycodone-acetaminophen 2.5-325 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain for 7 days: You should not drive or do anything that requires alertness while taking this medication. You should AVOID drinking alcohol while taking this medication. . Disp:*20 Tablet(s)* Refills:*0* 9. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 11. budesonide 90 mcg/actuation Aerosol Powdr Breath Activated Sig: Two (2) puffs Inhalation twice a day. 12. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 13. sodium bicarbonate 325 mg Tablet Sig: Two (2) Tablet PO three times a day. 14. meropenem 500 mg Recon Soln Sig: Five Hundred (500) mg Recon Soln Intravenous Q24H (every 24 hours) for 10 days: Last dose on [**2170-4-24**]. Disp:*5000 mg Recon Soln(s)* Refills:*0* 15. vancomycin in D5W 1 gram/200 mL Piggyback Sig: 1000 (1000) mg Intravenous HD PROTOCOL (HD Protochol) for 10 days: Last dose on [**2170-4-24**]. Disp:*5000 mg* Refills:*0* 16. Normal Saline Flush 0.9 % Syringe Sig: One (1) injection Injection twice a day: 10 cc of normal saline flush- before and after MEROPENEM INFUSION. Disp:*20 INJECTIONS* Refills:*0* Discharge Disposition: Home With Service Facility: Acclaim Discharge Diagnosis: Perforated gallbladder/common bile duct Sepsis Acute on chronic renal failure 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 while you were at [**Hospital1 18**]. You came to the hospital to have Interventional Radiology remove stones and a catheter fragment from your gallbladder. Unfortunately the procedure was very difficult and it was not possible to remove the stones nor the catheter fragment. During the procedure your gallbladder was perforated and you had to be admitted to the hospital for observation. While you were in the hospital, your blood pressure dropped most likely due to your body reacting to a bacteria in the blood. Your antibiotics were switched and you were in the intensive care unit until your blood pressure stabilized. You will be discharged on a course of antibiotics to be taken at home. You will have the VNA who will be doing the antibiotic infusion daily. The infusion company called [**Location (un) 511**] Home therapy will be calling you tomorrow in the morning to set up the delivery time of your antibiotic. However, we were not able to get it approved by your insurance today given it is [**Last Name (LF) 1017**], [**First Name3 (LF) **] we do not know the cost of your copay. We have recommended that you stay inpatient until this is cleared tomorrow morning, but you have refused. IT IS EXTREMELY IMPORTANT THAT YOU GET THE ANTIBIOTIC- MEROPENEM TOMORROW IN THE AFTERNOON. IF YOU HAVE ANY PROBLEMS PLEASE CALL OUR FLOOR AT [**Telephone/Fax (1) 3633**]. While in the hospital, your kidney function was found to be abnormal, likely due to ****dehydration**** and your kidney function improved after receiving intravenous fluids. Please call your dialysis unit on Monday morning at 06:00 AM to make sure if you will need to go on Monday or back to your regular schedule Tues/Thurs/Sat schedule. The following changes were made to your home medications: - Vancomycin was STARTED, to be continued until [**2170-4-23**] - Meropenem was STARTED, to be continued until [**2170-4-23**] - Nephrocaps was STARTED - Sevelamer was INCREASED - Percocet was INCREASED in frequency temporarily - Gemfibrozil was STOPPED, as this can cause gallstones - Tamsulosin was STOPPED; please follow up with your kidney specialist or your primary care physician before [**Name9 (PRE) 18290**] this medication - Furosemide was STOPPED; please follow up with your kidney specialist or your primary care physician before [**Name9 (PRE) 18290**] this medication - Genasyme was HELD; please follow up with your kidney specialist or your primary care physician before [**Name9 (PRE) 18290**] this medication -Lisinopril was STOPPED; please follow up with your kidney specialist or your primary care physician before [**Name9 (PRE) 18290**] this medication -Metoprolol was STOPPED; please follow up with your kidney specialist or your primary care physician before [**Name9 (PRE) 18290**] this medication Followup Instructions: Department: HEMODIALYSIS Please call your dialysis unit on Monday morning at 06:00 AM to make sure if you will need to go on Monday or back to your regular schedule. Please call your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **],[**First Name8 (NamePattern2) 1569**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 92498**], and arrange to follow up with him within 5 days of discharge from the hospital. Please call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in the surgery department at [**Hospital1 18**] at ([**Telephone/Fax (1) 16915**] and arrange to follow up with him within [**3-2**] weeks after discharge to discuss removing your gallbladder.

996,575,576,585,997,574,403,584,041,E879,V451,496,V462,327,272,V125,716,250,V586,305,285,458,E941,E942,E937,572,V158

{'Mechanical complication due to other implant and internal device, not elsewhere classified,Perforation of gallbladder,Obstruction of bile duct,End stage renal disease,Other digestive system complications,Calculus of bile duct with other cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Arthropathy, unspecified, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Tobacco use disorder,Anemia in chronic kidney disease,Other iatrogenic hypotension,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Other sequelae of chronic liver disease,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: s/p failed gallstones removal c/b gallbladder perforation PRESENT ILLNESS: Mr. [**Known lastname 92497**] is a 61 y/o male with h/o HTN, COPD, chronic renal disease on HD, s/p AAA repair and cholecystitis who was admitted to the MICU after a failed attempt to remove stones/biliary dilation and removal of previous catheter fragment that was complicated by gallbladder/cystic duct perforation. The patient presented with acute cholecystitis on [**2169-10-17**] and underwent percutaneous cholecystostomy; at that time as based on his comorbidities he was not felt to be a good surgical candidate. Since then he has undergone ERCP x 2 with sphincterotomy as well as failed laparoscopic cholecystectomy because of adhesions on [**2170-2-8**]. His cholecystostomy tube came out accidentally and a new percutaneous tube was replaced on [**2170-3-9**]. Unfortunately this cholecystostomy tube was severed by VNA, leaving him with a cathetar fragment at his ostomy site. . Of note, all of his prior care has been at [**Hospital1 498**]. He was referred to IR (Dr. [**Last Name (STitle) 4686**] for a cholangiogram via his existing cholecystostomy tube +/- stone extraction, catheter fragment removal and sphincteroplasty. The procedure performed yesterday was unsuccessful in removing the gallbladder stones or the catheter fragment, and was also complicated by gallbaldder/cystic duct perforation. Pt was hemodynamically stable, complaining only of RUQ pain ([**5-8**]). . This morning pt had episodes of hypotension with SBP's to the 70's prior to dialysis. Pt was mentating well, Tmax of 100.1. Pt not currently complaining of abdominal pain. Pt was transferred to the MICU because of concern for sepsis following perforation. MEDICAL HISTORY: -Hypertension -COPD on home oxygen (2L) -Chronic renal disease on HD (T,Th,Sat schedule. Last HD on Saturday [**2170-4-7**]) -Open AAA repair in [**2164**] c/b abdominal wall hernia repaired with mesh. -Thoracic aortic aneurysm, s/p endograft repair -S/p LUE AVF -Cholelithiasis -Sleep apnea -Hypercholesterolemia -CVA -recent (diagnosed via MRI) -Arthritis MEDICATION ON ADMISSION: -Aspirin 81mg daily -Flovent (1puff twice daily) -Furosemide 40mg [**Hospital1 **] -Genasyme -Lisinopril 20mg QD -Metoprolol 100mg [**Hospital1 **] -Gabapentin 100mg tab x 2 tabs TID -Ursodiol 300mg [**Hospital1 **] -Sevelemer 800mg TID -Meclizine 12.5mg [**Hospital1 **] -Darbepoetin injections on Thursday -Oxycodone/Acetaminophen PRN -Simvastatin 40mg dialy -Spiriva daily -Budesonide 2 puffs twice daily -Gemfibrizol 600mg [**Hospital1 **] -Tamsulosin -Sodium bicarbonate 325mg x 2 tabs three times daily ALLERGIES: Penicillins / Arterial Line in RIGHT RADIAL PHYSICAL EXAM: Vitals: T:97.5 BP:90/50 P:79 R:12 O2:99% 2L General: Alert, interactive, oriented, no acute distress HEENT: Sclera anicteric, mucus membranes [**Doctor Last Name **], oropharynx clear, EOMI Neck: Supple CV: Regular rate and rhythm, normal S1 + S2, GII systolic and diastolic murmer at RUSB, GII holosystolic and diastolic murmer at LSB, no rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: Soft, non-tender, mild distension, ostomy site clean with bandage in place and cholecystostomy drain with serosanguinous drainage in bag, +BS Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: - No family history of gallstones - Kidney stones: brothers SOCIAL HISTORY: - Tobacco: 2-3packs/day x 40 years - Alcohol: very heavy drinker x 15 years - Illicits: none ### Response: {'Mechanical complication due to other implant and internal device, not elsewhere classified,Perforation of gallbladder,Obstruction of bile duct,End stage renal disease,Other digestive system complications,Calculus of bile duct with other cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Arthropathy, unspecified, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Tobacco use disorder,Anemia in chronic kidney disease,Other iatrogenic hypotension,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use,Other sequelae of chronic liver disease,Personal history of noncompliance with medical treatment, presenting hazards to health'}

CHIEF COMPLAINT: AMS PRESENT ILLNESS: 42 yo M with an unknown past medical history presents to the ED with presumed drug overdose. Per report, patient was found in a parking lot with altered mental status by EMS and saying that he took a "handful of pills", that were mostly dilantin but unknown if anything else was mixed in. He was exhibiting altered gait at that time (around 10:30 am). He was only oriented x1 at this time. Additional history is not available at this time. Patient did report that he was intentionally trying to hurt himself. . On arrival to the ED, triage VS were 98, 93, 148/105, 18, 97% RA, and patient was lethargic but arousable an answering questions. At arrival, he was about 50 minutes post-ingestion. He did confirm a past medical history of seizures, but no other known medical history was obtained. He was given activated charcoal, and then started to refuse this intervention and became progressively more somnolent. He received narcan with no improvement. He was intbated for poor mental status, but was not reportedly hypoxic or in respiratory distress. Intubation was uncomplicated but was noted to have aspiration of charcoal. ET tube was noted to be high and was advanced 3 cm. QRS was narrom on EKG, dilantin level was 9.7, and tox screen was positive for TCAs. AG was mildly elevated at 14. On transfer, VS were HR 77, 99/63, AC 550 x 17, 50%, PEEP 5 and sat 99%. . A toxicology consult was requested and advised serial dilantin levels Q4H (with administration of extra charcoal dose if greater than 20), EKG q4H, and CT head without contrast. . In the ICU, patient is unarousable. He appears comfortable. MEDICAL HISTORY: Depression Epilepsy Past MVA w/ left shoulder injury MEDICATION ON ADMISSION: Amitriptyline 25mg QHS Effexor SR 150mg [**Hospital1 **] Prozac 20mg QAM Dilantin 100mg [**Hospital1 **] Lorazepam 0.5mg [**Hospital1 **] Remeron 30mg QHS Viagra Vit D ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: T: 97.7 BP: 125/78 P: 99 R: 18 O2: 92% - AC 550 cc x 18 40% FiO2 General: Intubated, Somnolent, Does not arouse to sternal rub HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: negative babinski bilaterally, 2+ patellar and biceps reflex, tone mildly increased, no asterxis and no clonus FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Location 669**] with wife, 4yo daughter and [**Name2 (NI) **], not working on disability. Reports drinking up to 1 bottle of whisky plus beer per day in the past but has not drunk anything for a month. Denies smoking or doing illicit drugs.

Other alteration of consciousness,Poisoning by unspecified drug or medicinal substance,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by unspecified drug or medicinal substance,Depressive disorder, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,Other specified cardiac dysrhythmias

Other alter consciousnes,Poison-medicinal agt NOS,Poison-hydantoin derivat,Poison-drug/medicin NOS,Depressive disorder NEC,Epilep NOS w/o intr epil,Cardiac dysrhythmias NEC

Admission Date: [**2181-3-15**] Discharge Date: [**2181-3-18**] Date of Birth: [**2138-9-9**] Sex: M Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 2181**] Chief Complaint: AMS Major Surgical or Invasive Procedure: none History of Present Illness: 42 yo M with an unknown past medical history presents to the ED with presumed drug overdose. Per report, patient was found in a parking lot with altered mental status by EMS and saying that he took a "handful of pills", that were mostly dilantin but unknown if anything else was mixed in. He was exhibiting altered gait at that time (around 10:30 am). He was only oriented x1 at this time. Additional history is not available at this time. Patient did report that he was intentionally trying to hurt himself. . On arrival to the ED, triage VS were 98, 93, 148/105, 18, 97% RA, and patient was lethargic but arousable an answering questions. At arrival, he was about 50 minutes post-ingestion. He did confirm a past medical history of seizures, but no other known medical history was obtained. He was given activated charcoal, and then started to refuse this intervention and became progressively more somnolent. He received narcan with no improvement. He was intbated for poor mental status, but was not reportedly hypoxic or in respiratory distress. Intubation was uncomplicated but was noted to have aspiration of charcoal. ET tube was noted to be high and was advanced 3 cm. QRS was narrom on EKG, dilantin level was 9.7, and tox screen was positive for TCAs. AG was mildly elevated at 14. On transfer, VS were HR 77, 99/63, AC 550 x 17, 50%, PEEP 5 and sat 99%. . A toxicology consult was requested and advised serial dilantin levels Q4H (with administration of extra charcoal dose if greater than 20), EKG q4H, and CT head without contrast. . In the ICU, patient is unarousable. He appears comfortable. Past Medical History: Depression Epilepsy Past MVA w/ left shoulder injury Social History: Lives in [**Location 669**] with wife, 4yo daughter and [**Name2 (NI) **], not working on disability. Reports drinking up to 1 bottle of whisky plus beer per day in the past but has not drunk anything for a month. Denies smoking or doing illicit drugs. Family History: Non-contributory Physical Exam: Vitals: T: 97.7 BP: 125/78 P: 99 R: 18 O2: 92% - AC 550 cc x 18 40% FiO2 General: Intubated, Somnolent, Does not arouse to sternal rub HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: negative babinski bilaterally, 2+ patellar and biceps reflex, tone mildly increased, no asterxis and no clonus Discharge exam: Vitals: T: 100.0 BP: 144/73 P: 112 R: 16 O2:97% on RA General: Sitting comfortably, nervous and very fixated on past automobile accident, very anxious to [**Doctor Last Name **] approval of doctors medical team. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, otherwise non-focal Pertinent Results: LABS ON ADMISSION: [**2181-3-15**] 12:45PM BLOOD WBC-8.2 RBC-4.95 Hgb-14.7 Hct-44.5 MCV-90 MCH-29.7 MCHC-33.0 RDW-12.9 Plt Ct-264 [**2181-3-15**] 12:45PM BLOOD Neuts-55.7 Lymphs-37.3 Monos-3.8 Eos-2.0 Baso-1.2 [**2181-3-15**] 12:45PM BLOOD Neuts-55.7 Lymphs-37.3 Monos-3.8 Eos-2.0 Baso-1.2 [**2181-3-15**] 12:45PM BLOOD Plt Ct-264 [**2181-3-15**] 07:20PM BLOOD PT-13.9* PTT-29.1 INR(PT)-1.2* [**2181-3-15**] 12:45PM BLOOD Glucose-150* UreaN-12 Creat-0.9 Na-137 K-4.1 Cl-107 HCO3-17* AnGap-17 [**2181-3-15**] 12:45PM BLOOD ALT-30 AST-32 AlkPhos-107 TotBili-0.2 [**2181-3-15**] 07:20PM BLOOD Calcium-8.7 Phos-3.7 Mg-1.8 [**2181-3-15**] 12:45PM BLOOD Phenyto-9.7* [**2181-3-15**] 12:45PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-POS [**2181-3-15**] 01:39PM BLOOD Type-ART pO2-365* pCO2-42 pH-7.35 calTCO2-24 Base XS--2 -ASSIST/CON [**2181-3-15**] 08:57PM BLOOD Type-ART Temp-37.3 FiO2-40 pO2-140* pCO2-37 pH-7.40 calTCO2-24 Base XS-0 -ASSIST/CON Intubat-INTUBATED Admission EKG: Bassline artifact. Sinus rhythm. Inferior T waves cannot be interpreted. Clinical correlation is suggested. No previous tracing available for comparison. [**2181-3-15**] chest AP x-ray: Low lung volumes are noted, with mild crowding of bronchovascular markings. The lungs are clear without consolidation or edema. There are no pleural effusions or pneumothorax. An endotracheal tube is seen with tip below the thoracic inlet, 7 cm from the carina. A nasogastric tube is present in the stomach. [**2181-3-17**] chest AP: FINDINGS: In the interval, the patient has been extubated and the nasogastric tube has been removed. Today's image represents a normal chest radiograph without evidence of pulmonary edema, pulmonary infection or pleural effusions. The size of the cardiac silhouette and the appearance of the mediastinum is unremarkable. [**2181-3-15**] N/C head CT: IMPRESSION: No acute intracranial abnormality. Brief Hospital Course: 42 yo M with unknown past medical history presents with apparent intentional drug overdose, with likely phenytoin and TCAs, now s/p intubation for airwary protection. # Altered mental status: Appears to be related to drug overdose. Dilantin level peaked at 10.7 and then trended down. TCA positive on Serum tox, but no EKG changes so less likely to be toxic from TCA. No clear toxic prodrome fits this clinical picture as patient without tachycardia, hypertension and diaphoresis (sympathomimetics); agitation, tachycardia, flushing (anticholinergics); miosis, lack of response to narcan (opiods); or autonomic instability, clonus, tremors (serotonin syndrome). No dramatic anion gap, so less likely ethylene glycol or methanol toxicity. CT head without acute ICH. The patient was intubated in the ED for somnolence and maintained with mechanical ventilation. He received activated charcoal. Toxicology followed the patient and recommended serial EKGs, which remained unchanged, and serial dilantin levels which were never toxic. The day after admission, the patient's mental status improved and he was extubated without any complications. His neurologic exam was normal and he had no other symptoms.He had one low-grade temperature to 100.5 without any accompanying symptoms. CXR and UA were negative. # Suicideal ideation: Per report patient was attempted to hurt himself by taking a "handful of pills". He describes the decision as impulsive and contact[**Name (NI) **] his psychotherapist afterwards. He was seen by psychiatry who felt that he was suicide risk and required inpatient psychiatric evaluation. He was kept with a section 12 but made no attempts to leave AMA. His home anti-depressants were held per psychiatry recommendation. # Epilepsy: most recent seizure 3 weeks ago per patient report. Dilantin level went down to 7.8, so he was given a 300mg, one-time loading dose and restarting on his home regimen of 100mg [**Hospital1 **]. # Sinus tachycardia: stably tachycardic. Benzo and alcohol tox screen negative on admission, not recently using per patient. Not responsive to fluid boluses. Patient unsure of baseline heart rate. Medications on Admission: Amitriptyline 25mg QHS Effexor SR 150mg [**Hospital1 **] Prozac 20mg QAM Dilantin 100mg [**Hospital1 **] Lorazepam 0.5mg [**Hospital1 **] Remeron 30mg QHS Viagra Vit D Discharge Medications: 1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Discharge Disposition: Extended Care Discharge Diagnosis: Final diagnosis: overdose Secondary diagnoses: depression, epilepsy Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - Independent Discharge Instructions: You were admitted after taking a handfull of your medicines. You were confused and sleepy, so you were intubated and went to the intensive care unit. You are doing better now, but we are worried about your depression and think that you should go to our inpatient psychiatric floor. . We stopped all of your medications except your Dilantin (phenytoin). Your psychiatrists will decide if your other medications should be restarted Followup Instructions: When you are ready to leave the hospital, please call your primary care doctor, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], and make an appointment within the next 1-2 weeks. He should check your Dilantin level to make sure you are protected from having a seizure. Completed by:[**2181-3-18**]

780,977,966,E950,311,345,427

{'Other alteration of consciousness,Poisoning by unspecified drug or medicinal substance,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by unspecified drug or medicinal substance,Depressive disorder, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,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: AMS PRESENT ILLNESS: 42 yo M with an unknown past medical history presents to the ED with presumed drug overdose. Per report, patient was found in a parking lot with altered mental status by EMS and saying that he took a "handful of pills", that were mostly dilantin but unknown if anything else was mixed in. He was exhibiting altered gait at that time (around 10:30 am). He was only oriented x1 at this time. Additional history is not available at this time. Patient did report that he was intentionally trying to hurt himself. . On arrival to the ED, triage VS were 98, 93, 148/105, 18, 97% RA, and patient was lethargic but arousable an answering questions. At arrival, he was about 50 minutes post-ingestion. He did confirm a past medical history of seizures, but no other known medical history was obtained. He was given activated charcoal, and then started to refuse this intervention and became progressively more somnolent. He received narcan with no improvement. He was intbated for poor mental status, but was not reportedly hypoxic or in respiratory distress. Intubation was uncomplicated but was noted to have aspiration of charcoal. ET tube was noted to be high and was advanced 3 cm. QRS was narrom on EKG, dilantin level was 9.7, and tox screen was positive for TCAs. AG was mildly elevated at 14. On transfer, VS were HR 77, 99/63, AC 550 x 17, 50%, PEEP 5 and sat 99%. . A toxicology consult was requested and advised serial dilantin levels Q4H (with administration of extra charcoal dose if greater than 20), EKG q4H, and CT head without contrast. . In the ICU, patient is unarousable. He appears comfortable. MEDICAL HISTORY: Depression Epilepsy Past MVA w/ left shoulder injury MEDICATION ON ADMISSION: Amitriptyline 25mg QHS Effexor SR 150mg [**Hospital1 **] Prozac 20mg QAM Dilantin 100mg [**Hospital1 **] Lorazepam 0.5mg [**Hospital1 **] Remeron 30mg QHS Viagra Vit D ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: T: 97.7 BP: 125/78 P: 99 R: 18 O2: 92% - AC 550 cc x 18 40% FiO2 General: Intubated, Somnolent, Does not arouse to sternal rub HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: negative babinski bilaterally, 2+ patellar and biceps reflex, tone mildly increased, no asterxis and no clonus FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Location 669**] with wife, 4yo daughter and [**Name2 (NI) **], not working on disability. Reports drinking up to 1 bottle of whisky plus beer per day in the past but has not drunk anything for a month. Denies smoking or doing illicit drugs. ### Response: {'Other alteration of consciousness,Poisoning by unspecified drug or medicinal substance,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by unspecified drug or medicinal substance,Depressive disorder, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,Other specified cardiac dysrhythmias'}

CHIEF COMPLAINT: Syncope, chest pain, abdominal pain PRESENT ILLNESS: 48 yo F h/o cocaine abuse, MVP, p/w multiple complaints, including syncope, chest and abdominal pain. Pt states that she noticed substernal chest pain that worsened in the few weeks prior to admission and was elicited by climbing the stairs to her apartment. CP was relieved with rest. She also noted that could no longer sleep with one pillow and would also awaken with SOB. In the week prior to admission, the patient developed epigastric pain, worse with meals. She had one episode of nausea/NBNB vomiting the day PTA. Also on the day prior to admission, she reports having used cocaine. On the day of admission, she had difficulty driving, she pulled over and passed out. She was found unconscious in car by fire dept. Pt pulled from car and became conscious, though agitated. EMS called. . In [**Hospital1 18**] ED, initial vitals 99.2, hr 115, bp 112/80, rr 20, 98% 2L NC. Initially alert, complaining of [**2-22**] days of CP/SOB, epigastric pain with some nausea, no vomiting. Denied HA. Admitted to recent cocaine use. EKG: ST @ 106 bpm, nml axis, nml int, TWI in III, V1. Pt subsequently had acute episode of nonresponsiveness in setting of SBPs to 70s, hr 100s. Given naloxone 4mg, dexamethasone 10 mg IVX1. Pt intubated for airway protection. Central line (L SC)was placed, started on levophed. Spiked temp to 101. Started on ctx, vanc. Given 8L NS. Labs in ED significant for initial lactate 4.5 (down to 2.7), tpn 0.39. Utox sig for +cocaine. u/a trace leuks/large blood/tr ket/0 wbcs/occ bact. CTA negative for PE. On CT: B/L lower lobe opacities concerning for pna, ground-glass opacities within the upper and lower lung lobes. CT abdomen with: heterogeneous perfusion of the liver, and a large amount of intra-abdominal ascites, peripancreatic inflammatory fat stranding and intra- abdominal free fluid consistent with mild pancreatitis. Echo in ED with EF 20%, global hypokinesis, 3+ MR. CT head negative. Patient transfered to MICU for further management. MEDICAL HISTORY: 1. Mitral valve prolapse (per pt, no TTE available) 2. H/o heart murmur since childhood 3. H/o substance abuse: cocaine abuse since the age of 26 (nasal and inhaled cocaine) 4. Stress urinary incontinence 5. H/o "tilted" uterus with (per pt report) 6. Frequent fungal skin infx under breasts 7. History of DOE, no Echo previously MEDICATION ON ADMISSION: Medications on Admission: None . Medications on Transfer to Floor: ASA 325mg qD Atorvastatin 80mg PO qD Captopril 6.25mg PO TID Carvedilol 6.25mg PO BID Furosemide 10mg PO qD Levofloxacin 500mg PO qD NGL SL 0.3mg PRN Pantoprazole 40mg PO qD ALLERGIES: Morphine PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION TO MICU: VS T 98.3 BP 122/70 HR 87 RR 13 O2Sat 100 vent AC 600X14 FiO2 100% PEEP 5 Gen: intubated, sedated HEENT: NC/AT, PERRL, mmd NECK: no LAD, no JVD COR: S1S2, regular rhythm, no murmurs appreciated PULM: coarse breath sounds on anterior exam ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 2+ DP, no edema Neuro: moving all extremities . PHYSICAL EXAM ON TRANSFER TO FLOOR VS T afebrile BP 124/65 HR 76 RR 18 O2Sat 98%RA Gen: tachypnic, NAD HEENT: NC/AT, PERRL, MMM, no OP lesions NECK: no LAD, no JVD COR: RRR, nl S1S2, no murmurs appreciated PULM: +labored breathing, tachypneic, CTA BL, no egophany ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 1+ peripheral pulses, trace pitting edema B/L LE Neuro: non-focal, moving all extremities FAMILY HISTORY: M(alive): CHF, DM2, ESRD (denies CAD); F (alive): gout, substance abuse, pA breast cancer, pA "bone cancer and brain cancer"; brother d. AIDS; sister [**Name (NI) 98177**] significant FH for ETOH and drug abuse SOCIAL HISTORY: She is a widow with 5 children who are in good health. Husband killed in DR ~10years ago. She used to smoke 5 cig/ day but quit several years ago. No alcohol use. Intermittent cocaine use(inhaled and snorted). Currently not sexually active. Previous HIV test negative. Denies IVDU.

Unspecified septicemia,Other primary cardiomyopathies,Systolic heart failure, unspecified,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute pancreatitis,Other and unspecified coagulation defects,Urinary tract infection, site not specified,Cocaine abuse, continuous,Mitral valve disorders,Severe sepsis,Anemia, unspecified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria

Septicemia NOS,Prim cardiomyopathy NEC,Systolic hrt failure NOS,Acute respiratry failure,Septic shock,Food/vomit pneumonitis,Acute pancreatitis,Coagulat defect NEC/NOS,Urin tract infection NOS,Cocaine abuse-continuous,Mitral valve disorder,Severe sepsis,Anemia NOS,Oth specf bacteria

Admission Date: [**2143-10-13**] Discharge Date: [**2143-10-21**] Date of Birth: [**2095-2-13**] Sex: F Service: MEDICINE Allergies: Morphine Attending:[**First Name3 (LF) 2932**] Chief Complaint: Syncope, chest pain, abdominal pain Major Surgical or Invasive Procedure: Endotracheal intubation. History of Present Illness: 48 yo F h/o cocaine abuse, MVP, p/w multiple complaints, including syncope, chest and abdominal pain. Pt states that she noticed substernal chest pain that worsened in the few weeks prior to admission and was elicited by climbing the stairs to her apartment. CP was relieved with rest. She also noted that could no longer sleep with one pillow and would also awaken with SOB. In the week prior to admission, the patient developed epigastric pain, worse with meals. She had one episode of nausea/NBNB vomiting the day PTA. Also on the day prior to admission, she reports having used cocaine. On the day of admission, she had difficulty driving, she pulled over and passed out. She was found unconscious in car by fire dept. Pt pulled from car and became conscious, though agitated. EMS called. . In [**Hospital1 18**] ED, initial vitals 99.2, hr 115, bp 112/80, rr 20, 98% 2L NC. Initially alert, complaining of [**2-22**] days of CP/SOB, epigastric pain with some nausea, no vomiting. Denied HA. Admitted to recent cocaine use. EKG: ST @ 106 bpm, nml axis, nml int, TWI in III, V1. Pt subsequently had acute episode of nonresponsiveness in setting of SBPs to 70s, hr 100s. Given naloxone 4mg, dexamethasone 10 mg IVX1. Pt intubated for airway protection. Central line (L SC)was placed, started on levophed. Spiked temp to 101. Started on ctx, vanc. Given 8L NS. Labs in ED significant for initial lactate 4.5 (down to 2.7), tpn 0.39. Utox sig for +cocaine. u/a trace leuks/large blood/tr ket/0 wbcs/occ bact. CTA negative for PE. On CT: B/L lower lobe opacities concerning for pna, ground-glass opacities within the upper and lower lung lobes. CT abdomen with: heterogeneous perfusion of the liver, and a large amount of intra-abdominal ascites, peripancreatic inflammatory fat stranding and intra- abdominal free fluid consistent with mild pancreatitis. Echo in ED with EF 20%, global hypokinesis, 3+ MR. CT head negative. Patient transfered to MICU for further management. Past Medical History: 1. Mitral valve prolapse (per pt, no TTE available) 2. H/o heart murmur since childhood 3. H/o substance abuse: cocaine abuse since the age of 26 (nasal and inhaled cocaine) 4. Stress urinary incontinence 5. H/o "tilted" uterus with (per pt report) 6. Frequent fungal skin infx under breasts 7. History of DOE, no Echo previously Social History: She is a widow with 5 children who are in good health. Husband killed in DR ~10years ago. She used to smoke 5 cig/ day but quit several years ago. No alcohol use. Intermittent cocaine use(inhaled and snorted). Currently not sexually active. Previous HIV test negative. Denies IVDU. Family History: M(alive): CHF, DM2, ESRD (denies CAD); F (alive): gout, substance abuse, pA breast cancer, pA "bone cancer and brain cancer"; brother d. AIDS; sister [**Name (NI) 98177**] significant FH for ETOH and drug abuse Physical Exam: PHYSICAL EXAM ON ADMISSION TO MICU: VS T 98.3 BP 122/70 HR 87 RR 13 O2Sat 100 vent AC 600X14 FiO2 100% PEEP 5 Gen: intubated, sedated HEENT: NC/AT, PERRL, mmd NECK: no LAD, no JVD COR: S1S2, regular rhythm, no murmurs appreciated PULM: coarse breath sounds on anterior exam ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 2+ DP, no edema Neuro: moving all extremities . PHYSICAL EXAM ON TRANSFER TO FLOOR VS T afebrile BP 124/65 HR 76 RR 18 O2Sat 98%RA Gen: tachypnic, NAD HEENT: NC/AT, PERRL, MMM, no OP lesions NECK: no LAD, no JVD COR: RRR, nl S1S2, no murmurs appreciated PULM: +labored breathing, tachypneic, CTA BL, no egophany ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 1+ peripheral pulses, trace pitting edema B/L LE Neuro: non-focal, moving all extremities Pertinent Results: EKG:ST @ 106 bpm, nml axis, nml int, TWI in III, V1 . CXR: Pulmonary effusions bilaterally, ht. globular, increased vascular markings. . CT head: negative for acute intracranial process [**2143-10-13**] CTA Abd/Chest/pelvis: Pancreatic edema and intra- abdominal free fluid consistent with mild pancreatitis. Please note that the amount of intra-abdominal free fluid cannot be explained by this mild degree of pancreatitis. Multiple findings consistent with congestive heart failure/volume overload including bilateral ground-glass opacities within the upper and lower lung, interlobular septal thickening, heterogeneous perfusion of the liver, and a large amount of intra-abdominal ascites. Bilateral lower lung lobe consolidations which could represent bilateral aspiration. Small amount of subsegmental atelectasis at the lung bases bilaterally. Right mainstem bronchus intubation. Two cystic masses within the left ovary may represent simple cysts, however definitive characterization is difficult with a large amount of intrapelvic ascites. A pelvic ultrasound is recommended when this patient's clinical status improves. [**2143-10-13**] transthoracic [**Month/Day/Year 461**]: The left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated with severe global hypokinesis. Systolic function of apical segments is relatively preserved (suggesting a non-ischemic cardiomyopathy). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size is normal with severe global free wall hypokinesis. The aortic valve leaflets appear structurally normal with good leaflet excursion. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. At least moderate to severe (3+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. The pulmonary artery systolic pressure could not be estimated. Significant pulmonic regurgitation is seen. There is no pericardial effusion. [**2143-10-15**] Abd CT: Small amount of fluid surrounding the head of the pancreas may related to mild pancreatitis, per given history. No peripancreatic fluid collections and homogeneous pancreatic parenchymal enhancement. Right lower lobe consolidation, likely pneumonia. Small associated pleural effusions and atelectasis. Trace ascites and periportal edema. Simple left renal cyst. Brief Hospital Course: Ms. [**Known lastname 5749**] is a 48 year-old female with a history significant for cocaine use who presented with two to three weeks of increasing dyspnea on exertion and angina particularly when climbing stairs. She reported abdominal pain, cocaine use and subsequent syncopal episode within 24 hours of being seen in the Emergency Department. She was febrile to 101 in the ED, with an initial lactate of 4.7 and evidence of pneumonia on CT. She became hemodynamically unstable in the Emergency Department which required endotracheal intubation for airway protection, aggressive fluid resuscitation and pressors. EKG demonstrated T-wave inversions in leads III and V1. The patient was found to have elevated cardiac markers and severely decreased ejection fraction (20%). She was admitted to the MICU for further management. Her troponin and MB-index peaked at 0.39 and 4.7, respectively. Given these findings, it was felt that cardiac ischemia in the setting of cocaine use caused a new cardiomyopathy (or worsening of an underlying cardiomyopathy) and resulted in cardiogenic shock. She was started on aspirin and a statin, but a beta-blocker was avoided initially due to recent cocaine use. A heparin drip was not initiated during this hospitalization because her picture was not consistent with ACS. Alternatively, septic shock was considered as a possible cause of a new cardiomyopathy. She was started on broad spectrum antibiotics and pan-cultured, but all cultures were negative. When she became hemodynamically stable, after-load reduction was achieved with diuresis and she was extubated without complication. She was then transferred to the floor and repeat ECHO demonstrated an EF of 35%. A complete work-up for new cardiomyopathy was pursued, with the exception of an HIV test. The patient preferred to discuss HIV testing at her new patient appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. . At discharge, she was given prescriptions for aspirin, lisinopril, carvedilol, furosemide and nitroglycerin and asked to follow up with Cardiology in 6 weeks and to have an ECHO repeated prior to that visit. She was also sent home with the remainder of a 14-day course of levofloxacin to cover for community acquired pneumonia. The risks of continued cocaine use were explained. Medications on Admission: Medications on Admission: None . Medications on Transfer to Floor: ASA 325mg qD Atorvastatin 80mg PO qD Captopril 6.25mg PO TID Carvedilol 6.25mg PO BID Furosemide 10mg PO qD Levofloxacin 500mg PO qD NGL SL 0.3mg PRN Pantoprazole 40mg PO qD Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: [**1-21**] Tablet, Sublinguals Sublingual PRN (as needed) as needed for chest pain. Disp:*30 Tablet, Sublingual(s)* Refills:*2* 3. Omeprazole 20 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* 4. Carvedilol 12.5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 6. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Cardiomyopathy Discharge Condition: Stable. Pt afebrile, ambulating w/o assistance. Discharge Instructions: Please return to the ER or call your doctor if you experience and chest pain, shortness of breath, numbness or tingling, lightheadedness or any other concerning symptoms. . Please take all medications as prescribed. . Please follow-up with all appointments as scheduled. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2143-10-25**] 3:00 Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 128**] Date/Time:[**2143-11-12**] 11:00; [**Hospital Ward Name 23**] Bldg, [**Location (un) **] Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2143-11-20**] 11:20; [**Hospital Ward Name 23**] [**Location (un) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**]

038,425,428,518,785,507,577,286,599,305,424,995,285,041

{'Unspecified septicemia,Other primary cardiomyopathies,Systolic heart failure, unspecified,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute pancreatitis,Other and unspecified coagulation defects,Urinary tract infection, site not specified,Cocaine abuse, continuous,Mitral valve disorders,Severe sepsis,Anemia, unspecified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria'}

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, chest pain, abdominal pain PRESENT ILLNESS: 48 yo F h/o cocaine abuse, MVP, p/w multiple complaints, including syncope, chest and abdominal pain. Pt states that she noticed substernal chest pain that worsened in the few weeks prior to admission and was elicited by climbing the stairs to her apartment. CP was relieved with rest. She also noted that could no longer sleep with one pillow and would also awaken with SOB. In the week prior to admission, the patient developed epigastric pain, worse with meals. She had one episode of nausea/NBNB vomiting the day PTA. Also on the day prior to admission, she reports having used cocaine. On the day of admission, she had difficulty driving, she pulled over and passed out. She was found unconscious in car by fire dept. Pt pulled from car and became conscious, though agitated. EMS called. . In [**Hospital1 18**] ED, initial vitals 99.2, hr 115, bp 112/80, rr 20, 98% 2L NC. Initially alert, complaining of [**2-22**] days of CP/SOB, epigastric pain with some nausea, no vomiting. Denied HA. Admitted to recent cocaine use. EKG: ST @ 106 bpm, nml axis, nml int, TWI in III, V1. Pt subsequently had acute episode of nonresponsiveness in setting of SBPs to 70s, hr 100s. Given naloxone 4mg, dexamethasone 10 mg IVX1. Pt intubated for airway protection. Central line (L SC)was placed, started on levophed. Spiked temp to 101. Started on ctx, vanc. Given 8L NS. Labs in ED significant for initial lactate 4.5 (down to 2.7), tpn 0.39. Utox sig for +cocaine. u/a trace leuks/large blood/tr ket/0 wbcs/occ bact. CTA negative for PE. On CT: B/L lower lobe opacities concerning for pna, ground-glass opacities within the upper and lower lung lobes. CT abdomen with: heterogeneous perfusion of the liver, and a large amount of intra-abdominal ascites, peripancreatic inflammatory fat stranding and intra- abdominal free fluid consistent with mild pancreatitis. Echo in ED with EF 20%, global hypokinesis, 3+ MR. CT head negative. Patient transfered to MICU for further management. MEDICAL HISTORY: 1. Mitral valve prolapse (per pt, no TTE available) 2. H/o heart murmur since childhood 3. H/o substance abuse: cocaine abuse since the age of 26 (nasal and inhaled cocaine) 4. Stress urinary incontinence 5. H/o "tilted" uterus with (per pt report) 6. Frequent fungal skin infx under breasts 7. History of DOE, no Echo previously MEDICATION ON ADMISSION: Medications on Admission: None . Medications on Transfer to Floor: ASA 325mg qD Atorvastatin 80mg PO qD Captopril 6.25mg PO TID Carvedilol 6.25mg PO BID Furosemide 10mg PO qD Levofloxacin 500mg PO qD NGL SL 0.3mg PRN Pantoprazole 40mg PO qD ALLERGIES: Morphine PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION TO MICU: VS T 98.3 BP 122/70 HR 87 RR 13 O2Sat 100 vent AC 600X14 FiO2 100% PEEP 5 Gen: intubated, sedated HEENT: NC/AT, PERRL, mmd NECK: no LAD, no JVD COR: S1S2, regular rhythm, no murmurs appreciated PULM: coarse breath sounds on anterior exam ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 2+ DP, no edema Neuro: moving all extremities . PHYSICAL EXAM ON TRANSFER TO FLOOR VS T afebrile BP 124/65 HR 76 RR 18 O2Sat 98%RA Gen: tachypnic, NAD HEENT: NC/AT, PERRL, MMM, no OP lesions NECK: no LAD, no JVD COR: RRR, nl S1S2, no murmurs appreciated PULM: +labored breathing, tachypneic, CTA BL, no egophany ABD: + bowel sounds, soft, nd, nt Skin: no rash EXT: 1+ peripheral pulses, trace pitting edema B/L LE Neuro: non-focal, moving all extremities FAMILY HISTORY: M(alive): CHF, DM2, ESRD (denies CAD); F (alive): gout, substance abuse, pA breast cancer, pA "bone cancer and brain cancer"; brother d. AIDS; sister [**Name (NI) 98177**] significant FH for ETOH and drug abuse SOCIAL HISTORY: She is a widow with 5 children who are in good health. Husband killed in DR ~10years ago. She used to smoke 5 cig/ day but quit several years ago. No alcohol use. Intermittent cocaine use(inhaled and snorted). Currently not sexually active. Previous HIV test negative. Denies IVDU. ### Response: {'Unspecified septicemia,Other primary cardiomyopathies,Systolic heart failure, unspecified,Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute pancreatitis,Other and unspecified coagulation defects,Urinary tract infection, site not specified,Cocaine abuse, continuous,Mitral valve disorders,Severe sepsis,Anemia, unspecified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria'}

CHIEF COMPLAINT: Decompensated cirrhosis PRESENT ILLNESS: Mr. [**Known lastname 99200**] is a pleasant 55 yo man with recently-diagnosed presumed alcoholic cirrhosis who presents from clinic today with gross volume overload. MEDICAL HISTORY: Cirrhosis Alcoholism BPH MEDICATION ON ADMISSION: lactulose Tamsulosin Finasteride Prednisone 20 [**Hospital1 **] Pantoprazole . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 96.5 BP: 109/80 P: 115 R: 18 SaO2: 98% General: Awake, alert, NAD, pleasant, appropriate, cooperative HEENT: NCAT, PERRL, EOMI, mild scleral icterus, MMM, no lesions noted in OP Neck: supple, no significant JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally, bibasilar rales, no wheezes or ronchi Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated Abdomen: Distended, nontender, + shifting dullness, normoactive bowel sounds, no masses or organomegaly noted Extremities: Deep pitting edema to midcalf, with edema evident to thighs bilaterally Lymphatics: No cervical, supraclavicular lymphadenopathy noted Skin: no spider angiomata, no gynecomastia Neurologic: Alert, oriented x 3. Able to relate history without difficulty. Cranial nerves II-XII intact. Normal bulk, strength and tone throughout. No abnormal movements noted. No deficits to light touch throughout. No nystagmus, dysarthria, intention or action tremor. 2+ biceps, triceps, brachioradialis, patellar reflexes and 2+ ankle jerks bilaterally. Plantar response was flexor bilaterally. FAMILY HISTORY: No h/o liver disease SOCIAL HISTORY: Drank 1.5L of wine per day for 10-15 years; has been abstinent for about one month now; denies tobacoo or drug use; no h/o transfusions; no tattoos; no h/o incarceration or homelessness; no IVDU

Alcoholic cirrhosis of liver,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Dehydration,Candidiasis of other urogenital sites,Hepatorenal syndrome,Defibrination syndrome,Other and unspecified alcohol dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified pruritic disorder,Anemia, unspecified

Alcohol cirrhosis liver,Septicemia NOS,Severe sepsis,Acute respiratry failure,Septic shock,Acute kidney failure NOS,Chronic kidney dis NOS,Dehydration,Candidias urogenital NEC,Hepatorenal syndrome,Defibrination syndrome,Alcoh dep NEC/NOS-contin,DMII wo cmp nt st uncntr,BPH w urinary obs/LUTS,Pruritic disorder NOS,Anemia NOS

Admission Date: [**2118-2-24**] Discharge Date: [**2118-3-8**] Date of Birth: [**2062-3-4**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: Decompensated cirrhosis Major Surgical or Invasive Procedure: Multiple paracenteses EGD History of Present Illness: Mr. [**Known lastname 99200**] is a pleasant 55 yo man with recently-diagnosed presumed alcoholic cirrhosis who presents from clinic today with gross volume overload. He had not seen a doctor for 10-15 years until about 1 month prior toadmission, at which time he found a primary care physician for generalized malaise and fatigue. He was apparently sent from her office to an OSH for evaluation. During that admission, he was diagnosed with cirrhosis and what appears to be acute alcoholic hepatitis, as he was discharged on prednisone. He returned to the OSH with abdominal pain and chills. He was found to be in renal failure, which was thought to be secondary to a combination of obstruction and contrast-induced nephropathy, and he was discharged with a Foley catheter after being started on tamsulosin and finasteride. He has had loose stools for about 6 months, and he was apparently started on an empiric course of vancomycin PO for C. difficile, although D/C summaries from the second hospitalization showed no evidence of C. diff in his stool. In addition, he has been on a course of amoxicillin-clavulanic acid for an unknown indication. He has also been taking levofloxacin qweek for his chronic Foley catheter. He presented to liver clinic today, and was admitted for management of decompensated liver failure. He reports increasing lower extremity swelling and abdominal girth since being discharge [**2-11**]. Over the past few days, he also reports lower back pain that is both positional and worse with movement. He has been having trouble ambulating because of the swelling in his legs and his increasing weight. He has not weighed himself since his last discharge. He denies fevers, chills, night sweats, cough, nausea, vomiting, hematemesis, coffee-ground emesis, melena, abdominal pain. He does report mild abdominal distension. He does report blood-streaked light-brown stool but he does have a h/o hemorrhoids. ROS was otherwise essentially negative. Past Medical History: Cirrhosis Alcoholism BPH Social History: Drank 1.5L of wine per day for 10-15 years; has been abstinent for about one month now; denies tobacoo or drug use; no h/o transfusions; no tattoos; no h/o incarceration or homelessness; no IVDU Family History: No h/o liver disease Physical Exam: Vitals: T: 96.5 BP: 109/80 P: 115 R: 18 SaO2: 98% General: Awake, alert, NAD, pleasant, appropriate, cooperative HEENT: NCAT, PERRL, EOMI, mild scleral icterus, MMM, no lesions noted in OP Neck: supple, no significant JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally, bibasilar rales, no wheezes or ronchi Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated Abdomen: Distended, nontender, + shifting dullness, normoactive bowel sounds, no masses or organomegaly noted Extremities: Deep pitting edema to midcalf, with edema evident to thighs bilaterally Lymphatics: No cervical, supraclavicular lymphadenopathy noted Skin: no spider angiomata, no gynecomastia Neurologic: Alert, oriented x 3. Able to relate history without difficulty. Cranial nerves II-XII intact. Normal bulk, strength and tone throughout. No abnormal movements noted. No deficits to light touch throughout. No nystagmus, dysarthria, intention or action tremor. 2+ biceps, triceps, brachioradialis, patellar reflexes and 2+ ankle jerks bilaterally. Plantar response was flexor bilaterally. Pertinent Results: [**2118-2-24**] 12:40PM URINE RBC-398* WBC-2 BACTERIA-NONE YEAST-MANY EPI-0 [**2118-2-24**] 12:40PM URINE BLOOD-LGE NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-TR [**2118-2-24**] 12:40PM URINE COLOR-LtAmb APPEAR-SlCloudy SP [**Last Name (un) 155**]-1.018 [**2118-2-24**] 12:40PM PT-17.7* PTT-34.2 INR(PT)-1.7* [**2118-2-24**] 12:40PM PLT COUNT-107* [**2118-2-24**] 12:40PM NEUTS-88.8* LYMPHS-6.0* MONOS-5.1 EOS-0.1 BASOS-0.1 [**2118-2-24**] 12:40PM WBC-20.8* RBC-3.90* HGB-13.5* HCT-42.2 MCV-108* MCH-34.4* MCHC-31.9 RDW-14.6 [**2118-2-24**] 12:40PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG marijuana-NEG [**2118-2-24**] 12:40PM URINE HOURS-RANDOM [**2118-2-24**] 12:40PM HCV Ab-NEGATIVE [**2118-2-24**] 12:40PM ETHANOL-NEG [**2118-2-24**] 12:40PM HBsAg-NEGATIVE HBs Ab-NEGATIVE HBc Ab-NEGATIVE HAV Ab-NEGATIVE [**2118-2-24**] 12:40PM TSH-2.1 [**2118-2-24**] 12:40PM TOT PROT-5.9* ALBUMIN-3.2* GLOBULIN-2.7 CALCIUM-8.9 PHOSPHATE-3.8 MAGNESIUM-2.4 [**2118-2-24**] 12:40PM LIPASE-76* [**2118-2-24**] 12:40PM ALT(SGPT)-441* AST(SGOT)-293* ALK PHOS-267* AMYLASE-66 TOT BILI-6.2* DIR BILI-3.6* INDIR BIL-2.6 [**2118-2-24**] 12:40PM LIPASE-76* [**2118-2-24**] 12:40PM ALT(SGPT)-441* AST(SGOT)-293* ALK PHOS-267* AMYLASE-66 TOT BILI-6.2* DIR BILI-3.6* INDIR BIL-2.6 [**2118-2-24**] 12:40PM estGFR-Using this [**2118-2-24**] 12:40PM UREA N-45* CREAT-1.8* SODIUM-133 POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-19* ANION GAP-17 [**2118-2-24**] 12:40PM GLUCOSE-146* [**2118-2-24**] 05:51PM ASCITES WBC-51* RBC-51* POLYS-18* LYMPHS-16* MONOS-46* MESOTHELI-2* MACROPHAG-18* [**2118-2-24**] 05:51PM ASCITES TOT PROT-0.4 GLUCOSE-181 LD(LDH)-39 ALBUMIN-<1.0 [**2118-2-24**] 06:01PM URINE HOURS-RANDOM UREA N-806 CREAT-66 SODIUM-18 Brief Hospital Course: 55 yo man with newly-diagnosed cirrhosis and BPH who presented with decompensated cirrhosis and renal failure and subsequent shock. . On presentation, patient was found to be in shock with MRSA bacteremia. He was started on Vancomycin and his blood pressure was supported with pressors and steroids. He eventually became hemodynamically stable and pressors were being weaned off. However, his overall prognosis was poor with decompensated cirrhosis and resultant renal failure and pulmonary edema/ARDS. Patient was also very sedated and even off sedating medications, had a depressed mental status, likely from hepatic encephalopathy. Discussions with the family about goals of care eventually caused the patient to become CMO. All unnecessary medications were discontinued. The patient passed away on [**2118-3-8**] with his family at the bedside. Medications on Admission: lactulose Tamsulosin Finasteride Prednisone 20 [**Hospital1 **] Pantoprazole . Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Cirrhosis Discharge Condition: Expired Discharge Instructions: N/A Followup Instructions: N/A

571,038,995,518,785,584,585,276,112,572,286,303,250,600,698,285

{'Alcoholic cirrhosis of liver,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Dehydration,Candidiasis of other urogenital sites,Hepatorenal syndrome,Defibrination syndrome,Other and unspecified alcohol dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified pruritic disorder,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: Decompensated cirrhosis PRESENT ILLNESS: Mr. [**Known lastname 99200**] is a pleasant 55 yo man with recently-diagnosed presumed alcoholic cirrhosis who presents from clinic today with gross volume overload. MEDICAL HISTORY: Cirrhosis Alcoholism BPH MEDICATION ON ADMISSION: lactulose Tamsulosin Finasteride Prednisone 20 [**Hospital1 **] Pantoprazole . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 96.5 BP: 109/80 P: 115 R: 18 SaO2: 98% General: Awake, alert, NAD, pleasant, appropriate, cooperative HEENT: NCAT, PERRL, EOMI, mild scleral icterus, MMM, no lesions noted in OP Neck: supple, no significant JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally, bibasilar rales, no wheezes or ronchi Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated Abdomen: Distended, nontender, + shifting dullness, normoactive bowel sounds, no masses or organomegaly noted Extremities: Deep pitting edema to midcalf, with edema evident to thighs bilaterally Lymphatics: No cervical, supraclavicular lymphadenopathy noted Skin: no spider angiomata, no gynecomastia Neurologic: Alert, oriented x 3. Able to relate history without difficulty. Cranial nerves II-XII intact. Normal bulk, strength and tone throughout. No abnormal movements noted. No deficits to light touch throughout. No nystagmus, dysarthria, intention or action tremor. 2+ biceps, triceps, brachioradialis, patellar reflexes and 2+ ankle jerks bilaterally. Plantar response was flexor bilaterally. FAMILY HISTORY: No h/o liver disease SOCIAL HISTORY: Drank 1.5L of wine per day for 10-15 years; has been abstinent for about one month now; denies tobacoo or drug use; no h/o transfusions; no tattoos; no h/o incarceration or homelessness; no IVDU ### Response: {'Alcoholic cirrhosis of liver,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Dehydration,Candidiasis of other urogenital sites,Hepatorenal syndrome,Defibrination syndrome,Other and unspecified alcohol dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified pruritic disorder,Anemia, unspecified'}

CHIEF COMPLAINT: Wound drainage PRESENT ILLNESS: 65 year old female with ongoing issues with nonhealing and infection issues with sternal wound. Presented at Dr [**First Name (STitle) **] office for wound evaluation and was found to have increased drainage. Was referred for admission and plan for sternal debridement. MEDICAL HISTORY: -[**4-5**] Coronary Artery Bypass Graft x 2 (Left internal mammary artery to left anterior descending artery, Saphenous vein graft to posterior descending artery), Mitral valve repair -Severe Mitral regurgitation -Coronary artery disease s/p prior RCA stenting c/b ISR x 2, most recently with Cypher stenting in [**2107-4-24**] for NSTEMI -Hypertension -Dyslipidemia -'[**05**]: post cath large retroperitoneal hematoma extending from the right groin superiorly to the level of the lower pole of the right kidney-->required 7 units PRBCs -Non sustained polymorphic VT s/p ICD [**2-24**] -Depression -History of panic attacks/anxiety, prior psychiatric admission within the past several years -Gastroesophageal reflux disease -Osteopenia -History of pulmonary nodules, followed by serial imaging -Glucose intolerance -History of H. pylori MEDICATION ON ADMISSION: Medications at rehab: Aspirin 81 mg' Metoprolol Tartrate 50 mg [**Hospital1 **] Oxycodone-Acetaminophen 5-325 mg 1 Tablet PO Q4H PRN Lamotrigine 25 mg PO twice daily Citalopram 30 mg PO DAILY Famotidine 20 mg PO Q12H Lorazepam 1 mg PO Q8H PRN Ipratropium Bromide 1 Inh q 6 hrs Albuterol MDI 1 Inh q 6 hrs PRN Lisinopril 5 mg PO DAILY Warfarin 2 mg PO Once Daily Dexamethasone 1mg PO twice daily acyclovir 800mg PO three times daily LD [**8-9**] Lidoderm 5% patch to thoracic spine 6am-6pm daily floranex tabs PO twice daily flovent 110 mcg 2 puffs daily Iron sulfate 325 mg PO daily vitamin D2 50,000units 2times/week abilify 5mg PO every morning ALLERGIES: Influenza Virus Vaccine / Shellfish Derived / Egg / Adhesive Bandage PHYSICAL EXAM: Pulse:84 Resp: 18 O2 sat: 96 B/P Right: 155/74 Left: Height: Weight: FAMILY HISTORY: Father died at age 50 of an MI and "enlarged heart." Brother with drug abuse. Mother had depression and panic attacks SOCIAL HISTORY: Retired, worked as hairdresser. Husband died in [**12-2**] from MI. Lives alone smoked cigarettes x many years, Denies ETOH abuse.

Other postoperative infection,Cellulitis and abscess of trunk,Acute posthemorrhagic anemia,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,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,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Benign neoplasm of cerebral meninges,Anticoagulants causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Mitral valve disorders,Automatic implantable cardiac defibrillator in situ,Benign neoplasm of bronchus and lung,Esophageal reflux,Disorder of bone and cartilage, unspecified,Dysthymic disorder,Diarrhea

Other postop infection,Cellulitis of trunk,Ac posthemorrhag anemia,Pseudomonas infect NOS,Delirium d/t other cond,Abn react-anastom/graft,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hx-ven thrombosis/embols,Long-term use anticoagul,Ben neo cerebr meninges,Adv eff anticoagulants,DMII wo cmp nt st uncntr,Hypertension NOS,Mitral valve disorder,Status autm crd dfbrltr,Benign neo bronchus/lung,Esophageal reflux,Bone & cartilage dis NOS,Dysthymic disorder,Diarrhea

Admission Date: [**2113-8-8**] Discharge Date: [**2113-8-16**] Date of Birth: [**2047-6-23**] Sex: F Service: PLASTIC Allergies: Influenza Virus Vaccine / Shellfish Derived / Egg / Adhesive Bandage Attending:[**First Name3 (LF) 1430**] Chief Complaint: Wound drainage Major Surgical or Invasive Procedure: Debridement and placement of a VAC History of Present Illness: 65 year old female with ongoing issues with nonhealing and infection issues with sternal wound. Presented at Dr [**First Name (STitle) **] office for wound evaluation and was found to have increased drainage. Was referred for admission and plan for sternal debridement. Past Medical History: -[**4-5**] Coronary Artery Bypass Graft x 2 (Left internal mammary artery to left anterior descending artery, Saphenous vein graft to posterior descending artery), Mitral valve repair -Severe Mitral regurgitation -Coronary artery disease s/p prior RCA stenting c/b ISR x 2, most recently with Cypher stenting in [**2107-4-24**] for NSTEMI -Hypertension -Dyslipidemia -'[**05**]: post cath large retroperitoneal hematoma extending from the right groin superiorly to the level of the lower pole of the right kidney-->required 7 units PRBCs -Non sustained polymorphic VT s/p ICD [**2-24**] -Depression -History of panic attacks/anxiety, prior psychiatric admission within the past several years -Gastroesophageal reflux disease -Osteopenia -History of pulmonary nodules, followed by serial imaging -Glucose intolerance -History of H. pylori Social History: Retired, worked as hairdresser. Husband died in [**12-2**] from MI. Lives alone smoked cigarettes x many years, Denies ETOH abuse. Family History: Father died at age 50 of an MI and "enlarged heart." Brother with drug abuse. Mother had depression and panic attacks Physical Exam: Pulse:84 Resp: 18 O2 sat: 96 B/P Right: 155/74 Left: Height: Weight: General: HEENT:mouth w/crusted/scabbed lesions thruout Skin: Dry [x] intact [] Neck: Supple [x] Full ROM [] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities:cool distally, toes w/some motteling Edema 2+pitting, L ant lower leg w/long area of ecchyosis Neuro: awake, moves all extremities, follows commands Pulses: DP Right:[**11-25**]+ Left:Tr-1+ PT [**Name (NI) 167**]:1+ Left:Tr-1+ Radial Right:2+ Left:2+ Sternal incision: 2 open areas on distal incision about 2-3 cm round, very superficial w/surrounding erythema, draining yellow green purulent material. Pertinent Results: [**2113-8-15**] 09:02AM [**Month/Day/Year 3143**] WBC-16.5* RBC-3.85*# Hgb-11.3*# Hct-34.5* MCV-89 MCH-29.4 MCHC-32.8 RDW-18.1* Plt Ct-198 [**2113-8-8**] 10:10AM [**Month/Day/Year 3143**] WBC-19.1*# RBC-4.02* Hgb-11.6* Hct-38.1 MCV-95 MCH-28.9 MCHC-30.5* RDW-17.9* Plt Ct-336 [**2113-8-10**] 02:09AM [**Month/Day/Year 3143**] Neuts-92.7* Lymphs-5.3* Monos-1.8* Eos-0.1 Baso-0.1 [**2113-8-15**] 09:02AM [**Month/Day/Year 3143**] Plt Ct-198 [**2113-8-15**] 09:02AM [**Month/Day/Year 3143**] PT-12.0 PTT-21.7* INR(PT)-1.0 [**2113-8-8**] 10:10AM [**Month/Day/Year 3143**] Plt Ct-336 [**2113-8-8**] 09:50PM [**Month/Day/Year 3143**] PT-30.2* PTT-30.8 INR(PT)-3.0* [**2113-8-14**] 10:24PM [**Month/Day/Year 3143**] ESR-3 [**2113-8-15**] 09:02AM [**Month/Day/Year 3143**] Glucose-140* UreaN-26* Creat-0.5 Na-137 K-3.9 Cl-102 HCO3-28 AnGap-11 [**2113-8-8**] 10:10AM [**Month/Day/Year 3143**] UreaN-21* Creat-0.6 Na-148* K-4.1 Cl-111* HCO3-25 AnGap-16 [**2113-8-9**] 07:00AM [**Month/Day/Year 3143**] ALT-34 AST-81* LD(LDH)-442* AlkPhos-299* Amylase-31 TotBili-0.6 [**2113-8-15**] 09:02AM [**Month/Day/Year 3143**] Calcium-8.3* Phos-2.9 Mg-1.9 [**2113-8-8**] 10:10AM [**Month/Day/Year 3143**] TotProt-5.5* Albumin-3.3* Globuln-2.2 [**2113-8-14**] 10:24PM [**Month/Day/Year 3143**] CRP-2.3 [**2113-8-14**] 11:21 am STOOL CONSISTENCY: SOFT Source: Stool. **FINAL REPORT [**2113-8-14**]** CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2113-8-14**]): REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @ 11:37P [**2113-8-14**]. CLOSTRIDIUM DIFFICILE. FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. (Reference Range-Negative). [**2113-8-9**] 5:39 pm TISSUE DEEP WOUND. **FINAL REPORT [**2113-8-14**]** GRAM STAIN (Final [**2113-8-10**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). REPORTED BY PHONE TO [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] AT 0015 ON [**2113-8-10**]. TISSUE (Final [**2113-8-14**]): Due to mixed bacterial types (>=3) an abbreviated workup is performed; P.aeruginosa, S.aureus and beta strep. are reported if present. Susceptibility will be performed on P.aeruginosa and S.aureus if sparse growth or greater.. WORK UP PER DR [**Last Name (STitle) 3143**] [**2113-8-11**]. PSEUDOMONAS AERUGINOSA. MODERATE GROWTH. ESCHERICHIA COLI. RARE GROWTH. CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). QUANTITATION NOT AVAILABLE. ENTEROCOCCUS SP.. QUANTITATION NOT AVAILABLE. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PSEUDOMONAS AERUGINOSA | ESCHERICHIA COLI | | ENTEROCOCCUS SP. | | | AMIKACIN-------------- 16 S AMPICILLIN------------ <=2 S <=2 S AMPICILLIN/SULBACTAM-- <=2 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- 16 I <=1 S CEFTAZIDIME----------- 16 I <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S CIPROFLOXACIN--------- =>4 R 0.5 S GENTAMICIN------------ =>16 R <=1 S LINEZOLID------------- 1 S MEROPENEM------------- 4 S <=0.25 S PENICILLIN G---------- 4 S PIPERACILLIN---------- R <=4 S PIPERACILLIN/TAZO----- =>128 R <=4 S TOBRAMYCIN------------ =>16 R <=1 S TRIMETHOPRIM/SULFA---- <=1 S VANCOMYCIN------------ =>32 R ANAEROBIC CULTURE (Final [**2113-8-13**]): NO ANAEROBES ISOLATED. Brief Hospital Course: Admitted and underwent preoperative workup, and was brought to the operating [**2113-8-9**] for debridement and VAC placement with Dr [**First Name (STitle) **], see operative report. She was started on vancomycin and meropenum for antibiotic coverage and infectious disease was consulted. She was resumed on heparin and coumadin for treatment of pulmonary embolism but then per plastics changed to Lovenox due to potential future debridements. However she had increased bleeding from VAC and decrease in hematocrit requiring transfusion. Lovenox was stopped, hematology was consulted for appropriate management and since past the first six weeks and no current evidence of DVT or PE she was placed on lovenox for DVT prevention. Planned for continued antibiotics - meropenum for enterococcus, E coli, pseudomonas and vancomycin for corynebacterium and flagyl for Cdiff, all to continue until further instructions from infections disease. Plan for follow up with plastic surgery and infectious disease as outpatient. Medications on Admission: Medications at rehab: Aspirin 81 mg' Metoprolol Tartrate 50 mg [**Hospital1 **] Oxycodone-Acetaminophen 5-325 mg 1 Tablet PO Q4H PRN Lamotrigine 25 mg PO twice daily Citalopram 30 mg PO DAILY Famotidine 20 mg PO Q12H Lorazepam 1 mg PO Q8H PRN Ipratropium Bromide 1 Inh q 6 hrs Albuterol MDI 1 Inh q 6 hrs PRN Lisinopril 5 mg PO DAILY Warfarin 2 mg PO Once Daily Dexamethasone 1mg PO twice daily acyclovir 800mg PO three times daily LD [**8-9**] Lidoderm 5% patch to thoracic spine 6am-6pm daily floranex tabs PO twice daily flovent 110 mcg 2 puffs daily Iron sulfate 325 mg PO daily vitamin D2 50,000units 2times/week abilify 5mg PO every morning Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 1121**] - [**Location (un) 1456**] Discharge Diagnosis: superficial sternal wound infection Clostridium Difficle Coronary Artery Disease s/p CABG Mitral regurgitation s/p MV repair Hypertension Pulmonary Embolism Dyslipidemia Non sustained polymorphic VT s/p ICD [**2-24**] Depression History of panic attacks/anxiety Gastroesophageal reflux disease Osteopenia History of pulmonary nodules, followed by serial imaging Diabetes Mellitus H. pylori Discharge Condition: Fair Discharge Instructions: Report any fever or purulent drainage from sternal wound VAC changes qmonday per plastic surgery Any bleeding issues from VAC or with dressing changes please contact plastic surgery, if significant bleeding please transport to emergency department at [**Hospital1 18**] for plastic surgery evaluation Lovenox for DVT prophalaxis - hold day of VAC change until VAC dressing change complete, no further coumadin Followup Instructions: Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**2113-8-29**] at 9:30 am ([**Telephone/Fax (1) 1416**]) Provider CAT SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2113-8-22**] 8:45 Provider [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13896**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2113-8-22**] 9:30 Completed by:[**2113-8-16**]

998,682,285,041,293,E878,414,V458,V125,V586,225,E934,250,401,424,V450,212,530,733,300,787

{'Other postoperative infection,Cellulitis and abscess of trunk,Acute posthemorrhagic anemia,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,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,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Benign neoplasm of cerebral meninges,Anticoagulants causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Mitral valve disorders,Automatic implantable cardiac defibrillator in situ,Benign neoplasm of bronchus and lung,Esophageal reflux,Disorder of bone and cartilage, unspecified,Dysthymic disorder,Diarrhea'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Wound drainage PRESENT ILLNESS: 65 year old female with ongoing issues with nonhealing and infection issues with sternal wound. Presented at Dr [**First Name (STitle) **] office for wound evaluation and was found to have increased drainage. Was referred for admission and plan for sternal debridement. MEDICAL HISTORY: -[**4-5**] Coronary Artery Bypass Graft x 2 (Left internal mammary artery to left anterior descending artery, Saphenous vein graft to posterior descending artery), Mitral valve repair -Severe Mitral regurgitation -Coronary artery disease s/p prior RCA stenting c/b ISR x 2, most recently with Cypher stenting in [**2107-4-24**] for NSTEMI -Hypertension -Dyslipidemia -'[**05**]: post cath large retroperitoneal hematoma extending from the right groin superiorly to the level of the lower pole of the right kidney-->required 7 units PRBCs -Non sustained polymorphic VT s/p ICD [**2-24**] -Depression -History of panic attacks/anxiety, prior psychiatric admission within the past several years -Gastroesophageal reflux disease -Osteopenia -History of pulmonary nodules, followed by serial imaging -Glucose intolerance -History of H. pylori MEDICATION ON ADMISSION: Medications at rehab: Aspirin 81 mg' Metoprolol Tartrate 50 mg [**Hospital1 **] Oxycodone-Acetaminophen 5-325 mg 1 Tablet PO Q4H PRN Lamotrigine 25 mg PO twice daily Citalopram 30 mg PO DAILY Famotidine 20 mg PO Q12H Lorazepam 1 mg PO Q8H PRN Ipratropium Bromide 1 Inh q 6 hrs Albuterol MDI 1 Inh q 6 hrs PRN Lisinopril 5 mg PO DAILY Warfarin 2 mg PO Once Daily Dexamethasone 1mg PO twice daily acyclovir 800mg PO three times daily LD [**8-9**] Lidoderm 5% patch to thoracic spine 6am-6pm daily floranex tabs PO twice daily flovent 110 mcg 2 puffs daily Iron sulfate 325 mg PO daily vitamin D2 50,000units 2times/week abilify 5mg PO every morning ALLERGIES: Influenza Virus Vaccine / Shellfish Derived / Egg / Adhesive Bandage PHYSICAL EXAM: Pulse:84 Resp: 18 O2 sat: 96 B/P Right: 155/74 Left: Height: Weight: FAMILY HISTORY: Father died at age 50 of an MI and "enlarged heart." Brother with drug abuse. Mother had depression and panic attacks SOCIAL HISTORY: Retired, worked as hairdresser. Husband died in [**12-2**] from MI. Lives alone smoked cigarettes x many years, Denies ETOH abuse. ### Response: {'Other postoperative infection,Cellulitis and abscess of trunk,Acute posthemorrhagic anemia,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,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,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Benign neoplasm of cerebral meninges,Anticoagulants causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Mitral valve disorders,Automatic implantable cardiac defibrillator in situ,Benign neoplasm of bronchus and lung,Esophageal reflux,Disorder of bone and cartilage, unspecified,Dysthymic disorder,Diarrhea'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 78 year old male with a known history of valvular disease, mitral regurgitation with a recent admission at [**Hospital3 3583**] for chest pain and positive stress test. Catheterization after he was transferred to [**Hospital1 69**] revealed a 50% left main lesion and three vessel coronary artery disease with a normal ejection fraction and 2+ mitral regurgitation. MEDICAL HISTORY: His past medical history was significant for dyspnea on exertion, fatigue times six months, glaucoma, benign prostatic hypertrophy, bladder polyp resection, hernia repair, bilateral carpal tunnel syndrome repair, transurethral resection of prostate and a remote head injury. MEDICATIONS ON ADMISSION: 1. Aspirin one tablet each day. 2. Lisinopril 2.5 mg a day. 3. Nitroglycerin 0.4 mcg once daily. 4. Flomax 0.4 mg q.h.s. 5. Protonix 40 mg p.o. once daily. 6. Zoloft 50 mg p.o. once daily. 7. Eye drops, name unknown. MEDICATION ON ADMISSION: 1. Aspirin one tablet each day. 2. Lisinopril 2.5 mg a day. 3. Nitroglycerin 0.4 mcg once daily. 4. Flomax 0.4 mg q.h.s. 5. Protonix 40 mg p.o. once daily. 6. Zoloft 50 mg p.o. once daily. 7. Eye drops, name unknown. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Negative. SOCIAL HISTORY: The patient is married, a retired mechanic. No history of smoking.

Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified pleural effusion,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft

Crnry athrscl natve vssl,Mitral valve disorder,Pleural effusion NOS,Atrial fibrillation,Meth sus pneum d/t Staph,Food/vomit pneumonitis,CHF NOS,React-oth vasc dev/graft

Admission Date: [**2108-1-3**] Discharge Date: [**2108-1-19**] Service: CARDIAC SURGERY HISTORY OF PRESENT ILLNESS: The patient is a 78 year old male with a known history of valvular disease, mitral regurgitation with a recent admission at [**Hospital3 3583**] for chest pain and positive stress test. Catheterization after he was transferred to [**Hospital1 69**] revealed a 50% left main lesion and three vessel coronary artery disease with a normal ejection fraction and 2+ mitral regurgitation. PAST MEDICAL HISTORY: His past medical history was significant for dyspnea on exertion, fatigue times six months, glaucoma, benign prostatic hypertrophy, bladder polyp resection, hernia repair, bilateral carpal tunnel syndrome repair, transurethral resection of prostate and a remote head injury. MEDICATIONS ON ADMISSION: 1. Aspirin one tablet each day. 2. Lisinopril 2.5 mg a day. 3. Nitroglycerin 0.4 mcg once daily. 4. Flomax 0.4 mg q.h.s. 5. Protonix 40 mg p.o. once daily. 6. Zoloft 50 mg p.o. once daily. 7. Eye drops, name unknown. LABORATORY DATA: His laboratories on admission were white blood cell count 7.0, hematocrit 37.0, and platelet count 120,000. Chem7 revealed sodium 139, potassium 4.1, chloride 102, bicarbonate 25, blood urea nitrogen 13 and creatinine 0.9. Normal coagulation studies. HOSPITAL COURSE: The patient was taken to the operating room on [**2108-1-4**], for a coronary artery bypass graft times two, left internal mammary artery to left anterior descending, saphenous vein graft to OM with a mitral valve repair. The patient did well with the procedure and an EVH was performed on the right thigh. Postoperatively, the patient was transferred to the CSRU, weaned off drips and was extubated. On postoperative day number one, he was doing well, requiring only a small amount of tone with Neo-Synephrine and insulin drip. Plan was made to discontinue Swan on day one and discontinue his chest tube. His hematocrit had drifted down to 23.0 on postoperative day one for which he got two units of red blood cells which brought his hematocrit back up to 28.0 appropriately. His blood urea nitrogen and creatinine on postoperative day two were 15 and 0.8 and he was in no distress whatsoever and was doing well. The Foley was discontinued on day two as well as central line and he was transferred to the floor. Cartia Intensive Care Unit. On [**2108-1-7**], it was noted that the patient had thick sputum and vomiting. Heart rate was in the 120s, pale color, blood pressure as high as 200/90. The patient was in respiratory distress and was transferred back to the CSRU. On that night, he was intubated and A line and central line were placed to help monitor him. Chest tube was inserted to help drain an effusion on the left side. He had some atrial fibrillation and an Amiodarone drip was started. Tube feeds were begun. He spiked and cultures were performed which revealed negative growth. On postoperative day number five, at this point we had started the patient on broad spectrum antibiotics, given chest x-ray showing a likely picture of possible aspiration, some Vancomycin, Levofloxacin and Flagyl. He was aggressively cultured. He was back on Neo-Synephrine, Amiodarone and Propofol and was tolerating tube feeds. No major changes were made. The patient remained in CSRU without any acute issues. Postoperative day six, antibiotics were continued. We weaned off the Neo-Synephrine. Cultures were still negative and decision was made to keep him intubated, p.r.n. pain control, stable with Amiodarone and pulmonary we tried to wean him. He was on Aspirin and deep vein thrombosis prophylaxis. Postoperative day Vancomycin, Levofloxacin and Flagyl day six. His atrial fibrillation, the Amiodarone was rebolused. A new central line was placed. Hematocrit was 28.0, blood urea nitrogen and creatinine normal. Cultures from when he was transferred back to the Intensive Care Unit came back negative blood, negative sputum, negative stool. He had Amiodarone continuing and continuous Lopressor p.o. and he was weaned, pressors weaned and tube feeds were a go. On postoperative day ten, the patient remained in a lot of atrial fibrillation and was weaned off Neo-Synephrine and Heparin drip was started. The patient was doing well. Insulin was started for high sugars. On postoperative day eleven, Vancomycin, Levofloxacin and Flagyl day number nine. The Amiodarone was changed back to intravenous from p.o. which had been performed after his atrial fibrillation. He had some abdominal distention, tenderness, and general surgery was consulted and ultrasound revealed no evidence of cholecystitis or gallstone disease. Liver function tests correlated this as well as ultrasound and CAT scan. White blood cell count at this point was 14.7, hematocrit 26.7, platelet count 255,000 and blood urea nitrogen was 33 and creatinine 0.6. The patient was doing well. On postoperative day twelve, the patient continued on Heparin drip. No acute moves were made. Physical therapy was consulted. The patient was doing well. On [**2108-1-17**], the patient was extubated and was doing well. He received aggressive chest physical therapy and tolerated it well. His saturation still remained 70 pO2 and his saturations were 95 to 100%. He showed no evidence of respiratory distress. His arterial blood gases were drawn in follow-up as well as physical therapy being called who agreed with the plan disposition for rehabilitation. On [**2108-1-18**], the patient was doing well and it was noted that he had some left upper extremity swelling. Ultrasound was done to rule out deep vein thrombosis which it did. The patient on [**2108-1-19**], has a bed at rehabilitation and is going to be scheduled to go there. MEDICATIONS ON DISCHARGE: 1. Potassium Chloride 20 meq p.o. twice a day given so long as potassium is greater than 4.5. 2. Colace 100 mg p.o. twice a day. 3. Milk of Magnesia p.r.n. as needed. 4. Bisacodyl 10 mg suppository PR p.r.n. 5. Flomax 0.4 mg q.h.s. 6. Zoloft 50 mg p.o. once daily. 7. Prednisolone Acetate Ophthalmic drops four times a day. 8. Ocular one drop O.S. four times a day. 9. ******* one drop O.D. once daily. 10. Levofloxacin 500 mg p.o. q24hours for a total of fourteen day antibiotic course. 11. Vancomycin one gram q12hours for a total of two week course. 12. Reglan 10 mg intravenous q4hours. 13. Flagyl 500 mg p.o. three times a day for a total fourteen day course. 14. Tylenol 650 mg to 1000 mg q6-8hours p.r.n. 15. ******** 25 mg p.o. once daily. 16. Percocet Elixir 5 to 10 cc q4-6hours p.r.n. 17. Ipratropium Bromide nebulizer one to two nebulizers every four hours around the clock until 14th and then p.r.n. 18. Albuterol nebulizers one to two nebulizers every four hours around the clock until 14th and then p.r.n. 19. Metoprolol 25 mg p.o. twice a day. 20. Furosemide 20 mg intravenously twice a day times seven days and then reevaluate for body fluid status and make decision to continue or not. 21. Amiodarone 400 mg p.o. once daily. 22. Insulin sliding scale starting at 150 to get 2 units, greater than 200 to get 4 units, greater than 250, to get 6 units, greater than 300 to get 8 units and house officer on call should be notified. All these antibiotics should include hospital days when counting the two week course. Neurologically, the patient is intact at this point. He was sedated while he was intubated and postoperatively he was moving all four extremities without evidence of any ischemia in the brain or any neurologic damage. Cardiac - The patient had bouts of atrial fibrillation while in the hospital. He was started on Amiodarone and blockaded with Lopressor which he tolerated well and he was transferred to the floor out of the Intensive Care Unit with that. Respiratory - The patient's chest tubes have been discontinued and the chest tubes were then replaced during the second admission to the Intensive Care Unit. Otherwise, at baseline he does not have a very good respiratory status and around the clock inhalers of both Albuterol and Ipratropium are being used on him in order to maximize his respiratory status as well as aggressive chest physical therapy. Gastrointestinal - The patient is not tolerating diet and requiring tube feeds for the last ten days. Infectious disease - The patient had increased white count during hospital stay as well as fever to 103 on [**2108-1-8**], and pancultures revealed nothing. The patient was started on Vancomycin, Levofloxacin, Flagyl empirically and none of the cultures showed anything after discussion with the cardiac team. The patient is to go on a total of two weeks of antibiotics as noted on page one. Renal - The patient had no renal issues and did well. Hematology - The patient was transfused two units of blood during his hospital stay. Otherwise, he had a stable hematocrit. No evidence of oozing or bleeding. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Name8 (MD) 16758**] MEDQUIST36 D: [**2108-1-18**] 16:51 T: [**2108-1-18**] 18:39 JOB#: [**Job Number 47260**] Admission Date: [**2108-1-2**] Discharge Date: [**2108-2-23**] Service: MICU ADDENDUM: Please see the cardiothoracic discharge summary for initial event. Briefly, the patient was referred to [**Hospital1 18**] for a cardiac catheterization which was then recommended for the patient to undergo CABG. The patient underwent two vessel CABG with MVR and tolerated the surgery well. On postoperative day number one, the patient was extubated and transferred to the floor. On postoperative day number two, the patient went in and out of atrial fibrillation requiring Amiodarone drip. On postoperative day number five, the patient was reintubated for hypoxic failure, developed fevers, and was presumed to be suffering from an aspiration pneumonia. He received vancomycin, levofloxacin, Flagyl, and Imipenem. He received a 14 day course of these antibiotics. On postoperative day number six, the patient was extubated. On postoperative day number 19, the patient had to be reintubated for hypoxia. At this time, the patient was also cardioverted times two for atrial fibrillation. On postoperative day number 20, the patient had increasing temperature, decreasing blood pressure, and increasing white count and had another episode of aspiration pneumonia versus pneumonitis. On postoperative day number 24, the patient was referred for a tracheostomy and PEG tube placement. On postoperative day number 29, the patient was eventually transferred to the MICU for management of presumed ARDS. PAST MEDICAL HISTORY: 1. Valvular heart disease, aortic and mitral valve replacement. 2. BPH. 3. Glaucoma. ADMISSION MEDICATIONS: 1. Aspirin 81 mg p.o. q.d. 2. Lisinopril 2.5 mg p.o. q.d. 3. Flomax 0.4 mg p.o. q.d. 4. Protonix 40 mg p.o. q.d. 5. Zoloft 50 mg p.o. q.d. 6. Ocuflox eyedrops. 7. Pred-Forte eyedrops to the left eye. 8. Acular eyedrops to the left eye. 9. Betimol eyedrops to right eye. MEDICATIONS ON TRANSFER: 1. Captopril 12.5 mg p.o. t.i.d. 2. Lasix drip. 3. Fentanyl drip. 4. Lopressor 25 b.i.d. 5. Versed drip. 6. Insulin drip. 7. Nystatin swish and swallow q.i.d. 8. Sucralfate 1 gram p.o. q.i.d. 9. Albuterol nebulizers q. four. 10. Atrovent nebulizers q. four. 11. Aspirin. 12. Colace. 13. Prednisone eyedrops to the left eye. 14. Cipro eyedrops to the left eye. SOCIAL HISTORY: The patient is married, a retired mechanic. No history of smoking. FAMILY HISTORY: Negative. PHYSICAL EXAMINATION ON TRANSFER: Vital signs: 97.0, 103, 140/70. General: The patient was intubated, sedated, and paralyzed. HEENT: JVP 8 cm. Coronary: Regular rate and rhythm. No murmurs, rubs, or gallops. Lungs: Coarse breath sounds, decreased breath sounds at the bases. Abdomen: Soft, nontender, nondistended, positive bowel sounds. No hepatosplenomegaly. Extremities: 1+ pulses bilaterally. No lower extremity edema, but 2+ upper extremity edema, pitting. Right subclavian line, right A line. LABORATORY DATA: WBC 11.3, hematocrit 28.3, platelets 230,000. ABGs 7.24, 74, 79 on assist control tidal volume 390, respiratory rate 26, PEEP 12.5, FI02 0.5. The patient had sputum on [**2108-1-28**] with 10-25 polys but no organisms. Urine culture with yeast. Chest x-ray with persistent bilateral pulmonary opacities consistent with ARDS. HOSPITAL COURSE: The patient was started on pressure control ventilation to control his ARDS. He was attempted to be weaned off the pressures and suffered an episode of hypercapnia on [**2108-2-1**] likely secondary to a mucus plug in the main stem bronchus. On [**2108-2-2**], the patient was noted to have bleeding from his tracheostomy site, bleeding mucus plugs. He remained tachycardiac. He was able to be weaned of Neo. He also had problems with his residuals and tube feeds. The patient underwent bronchoscopy on [**2108-2-1**] which revealed trauma to the tracheostomy tip, a small amount of clot, and minimal secretions. Prior to this procedure, the patient had to have his heparin discontinued. The patient required blood transfusion for a slowly decreasing hematocrit. The patient's PEEP was also decreased with hopes of weaning the patient off the ventilator. On [**2108-2-3**], the patient underwent repeat bronchoscopy which revealed purulent sputum in the left lower lobe, status post BAL. The Gram's stain revealed gram-positive cocci in pairs and clusters. The patient was started on vancomycin 1 gram b.i.d. for concern over MRSA. The patient remained total volume overloaded and was slowly diuresed with Lasix. On [**2108-2-4**], the patient had an A line placed in the right radial artery as well as underwent another bronchoscopy to remove the thick secretions. The patient was noted to be in atrial fibrillation with rapid ventricular rate starting at a systolic blood pressure of 120s. The patient was started on an Amiodarone drip with no improvement. The patient remained in atrial fibrillation for a couple of days and then converted on the Amiodarone and Lopressor. The patient had also been started on a heparin drip again for his atrial fibrillation. The patient was noted to have increasing residuals on his tube feeds which required them to be held. On [**2108-2-7**], the patient was noted to have a cuff leak that was able to be stopped with a stop cock. The patient also started to experience bloody secretions, likely secondary to his anticoagulation and his heparin drip was again discontinued. The patient remained on a pressure control mode of ventilation. During this period, the patient also remained hypertensive and had his Toprol increased. On [**2108-2-8**], the patient had an episode of hypotension down to the 70s and remained tachycardiac. The patient's cultures also returned to be positive for MRSA. The patient will complete a course of antibiotics with vancomycin. On [**2108-2-9**], the patient underwent central line and Swan insertion to further characterize the patient's volume status. On [**2108-2-10**], the patient again underwent an episode of hypotension and had to be started on phenylephrine drip. This was transient. The patient was able to come off it slowly. A cardiac echocardiogram did not demonstrate any new changes or signs of ischemic changes following the procedure. He was also placed on sucralfate which was changed from Protonix given his risk of recurrent aspiration pneumonia. The patient was also switched over to assist control for improving cardiopulmonary status. The patient had another episode of hypotension. These episodes of hypotension were thought to be due to tenuous cardiac status and hypotension given diuresis from his CHF. On [**2108-2-14**], the patient underwent a head CT for his continued sedation which was negative. Also, his blood cultures growing positive which were likely secondary to an infected line. He again underwent bronchoscopy on [**2108-2-15**] for increased mucus secretions. No new findings were found on bronchoscopy. He remained on assist control secondary to his sedation. He was unable to have his sedation decreased as the patient became very agitated. On [**2108-2-18**], the patient's blood pressure improved and he was able to come off all of his drips. He was changed to pressure support with hopes of weaning. On [**2108-2-19**], the patient's blood pressure continued to be elevated despite a dose of antihypertensives. He was started on beta blockers and had an ACE inhibitor added. He remained on Amiodarone for his atrial fibrillation which had remained in good control and in normal sinus rhythm. The patient remained on vancomycin for his MRSA pneumonia and line sepsis. On [**2108-2-20**], the patient continues to do well and had his pressure support weaned. On [**2108-2-21**], the patient was noted to have increasing swelling of his left upper extremity on the same line as his left IJ. The patient was referred for left upper extremity ultrasound which demonstrated a clot in the brachial vein. The patient was started on IV heparin which was then switched to Lovenox. The patient continued to have his hypertensive medications increased without much effect. He apparently was maxed out on Lopressor, Captopril. Norvasc 5 was started. The patient was also noted to be slightly more tachypneic with more fluid on his lungs. The patient was diuresed with Lasix 40 IV times two and underwent an episode of hypotension with a systolic blood pressure in the 70s which responded well to fluid resuscitation. The patient is very pre-load dependent. On [**2108-2-23**], the patient was noted to have some small ulceration around the PEG site which appears to not be infected. Cultures have been sent and will be evaluated by Surgery. This is pending at the time of this dictation. The patient's symptoms continue to improve and he remained with good blood pressure control also on NPH insulin for the glucose control. The patient's ventilator has improved overall and will continue to need to be adjusted. The patient was last started on a pressure support of 5 and PEEP of zero which he did not tolerate. These had to be increased again to 10 and 5. Mental status at discharge remained somewhat slow but he was able to follow commands. He will remain on antibiotics until [**2108-2-24**]. He will also require a six week course of anticoagulation with Lovenox/Coumadin given his clot on [**2108-2-22**]. He is improving. He was able to tolerate full nutrition. DISCHARGE STATUS: The patient will be discharged to rehabilitation where his ventilator will be able to be weaned. He will continue one day of antibiotics for his MRSA pneumonia. He will continue his anticoagulation for his upper extremity clot. Long-term anticoagulation for his atrial fibrillation will need to be decided with his PCP given his multiple episodes of bleeding on anticoagulation. The patient will require ophthalmology follow-up for his glaucoma. DISCHARGE DIAGNOSIS: 1. Status post cardiac catheterization. 2. Status post coronary artery bypass graft for two vessel disease and mitral valve replacement. 3. Adult Respiratory Distress Syndrome. 4. Methicillin-resistant Staphylococcus aureus pneumonia. 5. Methicillin-resistant Staphylococcus aureus line infection with sepsis requiring pressors. 6. Left upper extremity brachial vein deep venous thrombosis. 7. Status post tracheostomy and G tube placement. 8. Diabetes mellitus. 9. Atrial fibrillation with rapid ventricular response. DISCHARGE MEDICATIONS: 1. Insulin NPH 44 units b.i.d. 2. Regular insulin sliding scale. 3. Metoclopramide 10 mg p.o. q.i.d. 4. Cipro eyedrops one to two drops O.S. q.i.d. 5. Aspirin 325 mg p.o. q.d. 6. Colace 100 mg p.o. b.i.d. 7. Atrovent two puffs inhaler q. four hours. 8. Albuterol two puffs inhaler q. four hours. 9. Senna two tablets p.o. q.h.s. 10. Amiodarone 200 mg p.o. q.d. 11. Sucralfate 1 gram p.o. q.i.d. 12. Vancomycin 1,000 mg IV q. 24 hours to be completed on [**2108-2-24**]. 13. Metoprolol 100 mg p.o. t.i.d. 14. Timolol 0.5% one drop O.D. q.h.s. 15. Captopril 150 mg p.o. t.i.d. 16. Sertraline 25 mg p.o. q.d. 17. Lovenox 70 mg subcutaneously q. 12 hours. 18. Coumadin 5 mg p.o. q.d. to complete six week course of anticoagulation from [**2108-2-22**]. 19. Amlodipine 5 mg p.o. q.d. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-761 Dictated By:[**Name8 (MD) 17420**] MEDQUIST36 D: [**2108-2-23**] 01:51 T: [**2108-2-23**] 14:00 JOB#: [**Job Number 47261**]

414,424,511,427,482,507,428,996

{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified pleural effusion,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 78 year old male with a known history of valvular disease, mitral regurgitation with a recent admission at [**Hospital3 3583**] for chest pain and positive stress test. Catheterization after he was transferred to [**Hospital1 69**] revealed a 50% left main lesion and three vessel coronary artery disease with a normal ejection fraction and 2+ mitral regurgitation. MEDICAL HISTORY: His past medical history was significant for dyspnea on exertion, fatigue times six months, glaucoma, benign prostatic hypertrophy, bladder polyp resection, hernia repair, bilateral carpal tunnel syndrome repair, transurethral resection of prostate and a remote head injury. MEDICATIONS ON ADMISSION: 1. Aspirin one tablet each day. 2. Lisinopril 2.5 mg a day. 3. Nitroglycerin 0.4 mcg once daily. 4. Flomax 0.4 mg q.h.s. 5. Protonix 40 mg p.o. once daily. 6. Zoloft 50 mg p.o. once daily. 7. Eye drops, name unknown. MEDICATION ON ADMISSION: 1. Aspirin one tablet each day. 2. Lisinopril 2.5 mg a day. 3. Nitroglycerin 0.4 mcg once daily. 4. Flomax 0.4 mg q.h.s. 5. Protonix 40 mg p.o. once daily. 6. Zoloft 50 mg p.o. once daily. 7. Eye drops, name unknown. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Negative. SOCIAL HISTORY: The patient is married, a retired mechanic. No history of smoking. ### Response: {'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified pleural effusion,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft'}

CHIEF COMPLAINT: Dyspnea PRESENT ILLNESS: 45 year old male w ESRD on M/W/F HD, CHF, COPD on home O2 and OSA on nocturnal biPAP and right sided pleural effusion presenting [**Location (un) 54358**]with shortness of breath and hypoxia. The patient is a poor historian but reports recently being in the hospital and being transferred [**Location (un) 54359**]to live approximately 2-3 days ago. Although he has requires daytime oxygen at baseline, he reports not being given O2 while [**Location (un) 54360**]. He felt short of breath earlier on the day of admission so he called EMS. Per report, when EMS arrived, his sat was in the 60s so he was placed on supplemental O2 and transferred to the [**Hospital1 18**] ED. . In the ED, initial vs were: 99.1 74 152/92 20 98% 4L NC --> 80s on 6L NC. Exam was notable for an uncomfortable male, expiratory wheezing with bilateral decrease in basilar breath sounds. Labs revealed Hct 29.5, K 4.9, creatinine 11.3, lactate 1.2, ABG 7.32/57/74 on 8L NC CoOx 6%. Blood cultures were drawn. Patient was given vanc, cefepime, levofloxacin, methylpred 125mg IV and nebs *3. CXR showed right pleural effusion. VS prior to transfer were: 71 144/69 14 95% on 8L. . Upon arrival to the ICU, the patient is very agitated and combative. He is not interested in providing further history. He reports wanting to die. MEDICAL HISTORY: CHF (further history unknown) COPD on home O2 ESRD on HD M/W/F OSA on nocturnal biPap Paranoid psychotic disorder Substance abuse MEDICATION ON ADMISSION: (per recent DC summary) - Aspirin 81 mg PO daily - Calcium acetate 1334 mg PO TID w meals - Hydroxyzine 25 mg PO Q6H - Divalproex 375 mg PO BID - Acetaminophen 650 mg PO Q6H - Metoprolol succinate 100 mg PO daily - Amlodipine 10 mg PO daily - Lisinopril 40 mg PO daily ALLERGIES: Gabapentin / Lipitor / Zyprexa / Seroquel PHYSICAL EXAM: Vitals: 98.1 156/67 19 94% on 40% high flow General: Alert, oriented, agitated, yelling; poor hygeine HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated Lungs: diminished BS throughout, scattered crackles CV: Regular rate and rhythm Abdomen: obese GU: no foley (reportedly anuric) Ext: warm, no edema FAMILY HISTORY: Mother - cancer, type unknown. Father was on dialysis. SOCIAL HISTORY: - Tobacco: Ongoing - etOH: Admits to drinking, unclear how much or how recently - [**Name (NI) 3264**]: Endorses active use - Lives at [**Location **] House [**Telephone/Fax (1) 54361**]

Obstructive chronic bronchitis with (acute) exacerbation,End stage renal disease,Acute and chronic respiratory failure,Chronic combined systolic and diastolic heart failure,Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Paranoid type schizophrenia, unspecified,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Hypoxemia,Tobacco use disorder,Other chronic pulmonary heart diseases,Anemia, unspecified,Unemployment,Other and unspecified alcohol dependence, in remission

Obs chr bronc w(ac) exac,End stage renal disease,Acute & chronc resp fail,Chr syst/diastl hrt fail,Pleural effusion NOS,Hyp kid NOS w cr kid V,Paranoid schizo-unspec,Suicidal ideation,Obstructive sleep apnea,Hypoxemia,Tobacco use disorder,Chr pulmon heart dis NEC,Anemia NOS,Unemployment,Alcoh dep NEC/NOS-remiss

Admission Date: [**2148-3-9**] Discharge Date: [**2148-3-12**] Date of Birth: [**2102-10-18**] Sex: M Service: MEDICINE Allergies: Gabapentin / Lipitor / Zyprexa / Seroquel Attending:[**First Name3 (LF) 1115**] Chief Complaint: Dyspnea Major Surgical or Invasive Procedure: None History of Present Illness: 45 year old male w ESRD on M/W/F HD, CHF, COPD on home O2 and OSA on nocturnal biPAP and right sided pleural effusion presenting [**Location (un) 54358**]with shortness of breath and hypoxia. The patient is a poor historian but reports recently being in the hospital and being transferred [**Location (un) 54359**]to live approximately 2-3 days ago. Although he has requires daytime oxygen at baseline, he reports not being given O2 while [**Location (un) 54360**]. He felt short of breath earlier on the day of admission so he called EMS. Per report, when EMS arrived, his sat was in the 60s so he was placed on supplemental O2 and transferred to the [**Hospital1 18**] ED. . In the ED, initial vs were: 99.1 74 152/92 20 98% 4L NC --> 80s on 6L NC. Exam was notable for an uncomfortable male, expiratory wheezing with bilateral decrease in basilar breath sounds. Labs revealed Hct 29.5, K 4.9, creatinine 11.3, lactate 1.2, ABG 7.32/57/74 on 8L NC CoOx 6%. Blood cultures were drawn. Patient was given vanc, cefepime, levofloxacin, methylpred 125mg IV and nebs *3. CXR showed right pleural effusion. VS prior to transfer were: 71 144/69 14 95% on 8L. . Upon arrival to the ICU, the patient is very agitated and combative. He is not interested in providing further history. He reports wanting to die. Past Medical History: CHF (further history unknown) COPD on home O2 ESRD on HD M/W/F OSA on nocturnal biPap Paranoid psychotic disorder Substance abuse Social History: - Tobacco: Ongoing - etOH: Admits to drinking, unclear how much or how recently - [**Name (NI) 3264**]: Endorses active use - Lives at [**Location **] House [**Telephone/Fax (1) 54361**] Family History: Mother - cancer, type unknown. Father was on dialysis. Physical Exam: Vitals: 98.1 156/67 19 94% on 40% high flow General: Alert, oriented, agitated, yelling; poor hygeine HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated Lungs: diminished BS throughout, scattered crackles CV: Regular rate and rhythm Abdomen: obese GU: no foley (reportedly anuric) Ext: warm, no edema Pertinent Results: Admission Labs: [**2148-3-9**] 10:40AM BLOOD WBC-4.6 RBC-3.03* Hgb-10.0* Hct-29.5* MCV-97 MCH-32.9* MCHC-33.8 RDW-20.3* Plt Ct-154 [**2148-3-9**] 10:40AM BLOOD Neuts-69.4 Lymphs-20.5 Monos-8.5 Eos-1.2 Baso-0.3 [**2148-3-9**] 10:40AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-OCCASIONAL Macrocy-1+ Microcy-OCCASIONAL Polychr-OCCASIONAL Ovalocy-OCCASIONAL Stipple-OCCASIONAL [**2148-3-9**] 10:40AM BLOOD PT-13.7* PTT-26.0 INR(PT)-1.2* [**2148-3-9**] 10:40AM BLOOD Glucose-78 UreaN-64* Creat-11.3* Na-144 K-4.9 Cl-101 HCO3-28 AnGap-20 [**2148-3-9**] 10:40AM BLOOD ALT-19 AST-28 LD(LDH)-254* CK(CPK)-59 AlkPhos-268* TotBili-0.3 [**2148-3-9**] 10:40AM BLOOD Lipase-44 [**2148-3-9**] 10:40AM BLOOD proBNP-[**Numeric Identifier 54362**]* [**2148-3-9**] 10:40AM BLOOD cTropnT-0.06* [**2148-3-10**] 12:40AM BLOOD CK-MB-3 cTropnT-0.04* [**2148-3-10**] 05:43AM BLOOD CK-MB-3 cTropnT-0.03* proBNP-[**Numeric Identifier **]* [**2148-3-9**] 10:40AM BLOOD Calcium-8.8 Phos-4.4# Mg-2.4 [**2148-3-9**] 10:40AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2148-3-9**] 11:52AM BLOOD pO2-74* pCO2-57* pH-7.32* calTCO2-31* Base XS-0 [**2148-3-10**] 11:23AM BLOOD Type-ART Temp-36.1 pO2-62* pCO2-64* pH-7.26* calTCO2-30 Base XS-0 Intubat-NOT INTUBA [**2148-3-9**] 11:06AM BLOOD Lactate-1.2 . PCXR: 1. Opacification of the right lower lung presumably combination of moderate right pleural effusion and RLL atelectasis; however, cannot exclude pneumonia. 2. Improved aeration of the left lung base with residual atelectasis. 3. Persistent prominent hila, as seen on CT could be reactive lymphadenopathy. 4. Mild edema.. . ECHO: Conclusions: The left atrium is mildly dilated. The estimated right atrial pressure is 0-5 mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular free wall is hypertrophied. The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. 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. There is no mitral valve prolapse. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . IMPRESSION: Right ventricular hypertrophy with mild cavity enlargement with free wall hypokinesis. Moderate pulmonary artery systolic hypertension. Mild symmetric left ventricular hypertrophy with preserved global and regional left ventricular systolic function. This constellation of findings is suggestive of a chronic or acute on chronic primary pulmonary process (e.g., primary pulmonary hypertension, pulmlonary embolism, bronchospasm, sleep apnea, etc.). . Brief Hospital Course: 45M with what appears to be paranoid schizophrenia, ESRD on HD, COPD on 3L NC O2 at home, OSA on CPAP, and substance abuse who was admitted to the ICU for hypoxic respiratory distress from volume overload and due to lack of access to his home oxygen per the patient. . In the MICU, empiric antibiotics and steroids were started. However, his hypoxia was much improved after a single session of HD. His behavioral issues were an impediment to optimal medical care, and due to threatening behavior and suicidal expressions he was placed on a 1:1 security sitter and made Section 12. . # Hypoxia: Given rapidity of response to HD, it seem likely that he was volume overloaded. Given this, antibiotics and steroids were stopped. Continued HD Q MWF for volume control. Received standing Albuterol 0.083% Neb Soln 1 NEB IH Q6H and Ipratropium Bromide Neb 1 NEB IH Q6H. His oxygen requirement decreased back to baseline over the course of his hospitalization to his baseline requirement of 3L NC O2. The patient has a pleural effusion that is of unclear etiology. Pulmonary recommended repeat thoracentesis and/or consideration of a thoracotomy was suggested for further work up but the patient adamently refused. One barrier for the patient is that he reports that he was not allowed to use his portable oxygen outside of his room at his group home. We explained to the patient that there was a danger to have oxygen around when he was smoking and he understands the risks of combustion. However, he does need to wear his oxygen at all other times. He reported having a functional CPAP machine at home to use for his OSA. -outpatient pulmonary or interventional pulmonary follow up for further evaluation of his pleural effusion is suggested if the patient is agreeable in the future patient is agreeable . # Psychotic disorder: After being aggitated in the MICU, the patient remained non-aggressive on the floor (though he had paranoia, did raise his voice and did try to leave the floor to smoke on multiple occasions). We believe his increased aggression was likelely due to hypoxia and hypercarbia. Has paranoid features, which were felt consistent with schizophrenic v schizoaffective v bipolar disorder. Psych and SW consulted on the patient this admission. After talking to outpatient providers, and doing an evaluation, psychiatry felt the patient was at his baseline and section 12 was removed. He was continued Divalproex (DELayed Release) 375 mg PO BID for mood stablization. . # COPD: Active smoker. Baseline oxygen requirement is 3L NC O2. Received standing nebs as above and supplemental oxygen. Encouraged smoking cessation. -Started Albuterol Inhaler - [**Month (only) 116**] benefit from a long acting anticholinergic such as tiotropium and an inhaled steroid such as fluticasone given his smoking history and hypoxia. Outpatient pulmonary follow up recommended as above. . # OSA: Patient required CPAP at night with settings 20/10. At first patient [**Month (only) 15797**] that he had a CPAP machine at home, however his group home confirmed that he did and the patient later agreed that he did. It is very important that the patient continued to wear CPAP at night or while taking naps. . # ESRD on HD: HD Q MWF. Continued home Calcium Acetate 1334 mg PO/NG TID W/MEALS. . # Pulmonary Hypertension: Patient had an ECHO suggestive of pulmonary hypertension most likely [**1-10**] to COPD and OSA with normal EF of 55%. Patient was continued on his home Aspirin 81 mg PO/NG DAILY, home ACEi and Bblocker. Consider starting a statin as an outpatient. Pulm follow up recommended as above. . # HTN: Patient was continued on home Amlodipine 10 mg PO/NG DAILY, Lisinopril 40 mg PO/NG, DAILY and was treated with Metoprolol Tartrate 37.5 mg PO/NG TID. On discharge his Metoprolol was switched back to home Toprol XL 100mg po daily. Medications on Admission: (per recent DC summary) - Aspirin 81 mg PO daily - Calcium acetate 1334 mg PO TID w meals - Hydroxyzine 25 mg PO Q6H - Divalproex 375 mg PO BID - Acetaminophen 650 mg PO Q6H - Metoprolol succinate 100 mg PO daily - Amlodipine 10 mg PO daily - Lisinopril 40 mg PO daily Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. calcium acetate 667 mg Capsule Sig: Two (2) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 3. divalproex 125 mg Tablet, Delayed Release (E.C.) Sig: Three (3) Tablet, Delayed Release (E.C.) PO BID (2 times a day). 4. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 7. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: One (1) puff Inhalation every 4-6 hours as needed for shortness of breath or wheezing. Disp:*1 unit* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary: - COPD - ESRD - Psychosis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the hospital with dangerously low oxygen levels. This was due to a combination of lung disease from smoking, missing your oxygen, and fluid retention. Smoking is extremely unhealthy. If you do not use your oxygen you will also have inadequate oxygen levels. . We offered you a further work up for the fluid in your lung but you refused further management. We counselled you about stopping smoking, but you refused nicotine patches and lozenges. . Please continue to take your medications as directed. You require oxygen 3L continuous flow to maintain your oxygenation. However, it is VERY dangerous for you to smoke and have the oxygen tank near you as it could explode. . Please follow up with your primary care doctor. They will call you with an appointment. . We made the following changes to your medications: STARTED Albuterol inhaler. You can use this up to every 4 hours as needed for shortness of breath or wheezing. Followup Instructions: We are working on a follow up appointment with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Name (STitle) 45392**] within 1-3 days. The office will contact you at home with an appointment. If you havent heard please call the office at [**Telephone/Fax (1) 54363**].

491,585,518,428,511,403,295,V628,327,799,305,416,285,V620,303

{'Obstructive chronic bronchitis with (acute) exacerbation,End stage renal disease,Acute and chronic respiratory failure,Chronic combined systolic and diastolic heart failure,Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Paranoid type schizophrenia, unspecified,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Hypoxemia,Tobacco use disorder,Other chronic pulmonary heart diseases,Anemia, unspecified,Unemployment,Other and unspecified alcohol dependence, in remission'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Dyspnea PRESENT ILLNESS: 45 year old male w ESRD on M/W/F HD, CHF, COPD on home O2 and OSA on nocturnal biPAP and right sided pleural effusion presenting [**Location (un) 54358**]with shortness of breath and hypoxia. The patient is a poor historian but reports recently being in the hospital and being transferred [**Location (un) 54359**]to live approximately 2-3 days ago. Although he has requires daytime oxygen at baseline, he reports not being given O2 while [**Location (un) 54360**]. He felt short of breath earlier on the day of admission so he called EMS. Per report, when EMS arrived, his sat was in the 60s so he was placed on supplemental O2 and transferred to the [**Hospital1 18**] ED. . In the ED, initial vs were: 99.1 74 152/92 20 98% 4L NC --> 80s on 6L NC. Exam was notable for an uncomfortable male, expiratory wheezing with bilateral decrease in basilar breath sounds. Labs revealed Hct 29.5, K 4.9, creatinine 11.3, lactate 1.2, ABG 7.32/57/74 on 8L NC CoOx 6%. Blood cultures were drawn. Patient was given vanc, cefepime, levofloxacin, methylpred 125mg IV and nebs *3. CXR showed right pleural effusion. VS prior to transfer were: 71 144/69 14 95% on 8L. . Upon arrival to the ICU, the patient is very agitated and combative. He is not interested in providing further history. He reports wanting to die. MEDICAL HISTORY: CHF (further history unknown) COPD on home O2 ESRD on HD M/W/F OSA on nocturnal biPap Paranoid psychotic disorder Substance abuse MEDICATION ON ADMISSION: (per recent DC summary) - Aspirin 81 mg PO daily - Calcium acetate 1334 mg PO TID w meals - Hydroxyzine 25 mg PO Q6H - Divalproex 375 mg PO BID - Acetaminophen 650 mg PO Q6H - Metoprolol succinate 100 mg PO daily - Amlodipine 10 mg PO daily - Lisinopril 40 mg PO daily ALLERGIES: Gabapentin / Lipitor / Zyprexa / Seroquel PHYSICAL EXAM: Vitals: 98.1 156/67 19 94% on 40% high flow General: Alert, oriented, agitated, yelling; poor hygeine HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated Lungs: diminished BS throughout, scattered crackles CV: Regular rate and rhythm Abdomen: obese GU: no foley (reportedly anuric) Ext: warm, no edema FAMILY HISTORY: Mother - cancer, type unknown. Father was on dialysis. SOCIAL HISTORY: - Tobacco: Ongoing - etOH: Admits to drinking, unclear how much or how recently - [**Name (NI) 3264**]: Endorses active use - Lives at [**Location **] House [**Telephone/Fax (1) 54361**] ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,End stage renal disease,Acute and chronic respiratory failure,Chronic combined systolic and diastolic heart failure,Unspecified pleural effusion,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Paranoid type schizophrenia, unspecified,Suicidal ideation,Obstructive sleep apnea (adult)(pediatric),Hypoxemia,Tobacco use disorder,Other chronic pulmonary heart diseases,Anemia, unspecified,Unemployment,Other and unspecified alcohol dependence, in remission'}

CHIEF COMPLAINT: s/p cardiac arrest PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 yo male found down on side of road with abrasions to the face. Per wife, they had just bought a bicycle and the patient was riding it home with the wife driving ahead in a car. She said he was not traveling at a particularly fast pace, but she got ahead of him and proceeded home. The next she heard he had been found down on the wrong side of the road. Per wife, pt was an avid biker prior to his MI in [**2182**] and would not have ridden on the wrong side of the road, so something must have happened to cause him to swerve that way. The patient was found down, apneic and without a pulse. He was defibrillated x3, received CPR, epi/vaso, and intubated in the field. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Diabetes, + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: - PERCUTANEOUS CORONARY INTERVENTIONS: - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] to proximal LAD [**2182**] ([**Hospital1 2025**]) - hospitalized for atypical chest pain [**12/2183**] ([**Hospital1 2025**]) 3. OTHER PAST MEDICAL HISTORY: - spontaneous pneumothorax while biking (date unknown) - [**12-11**] toe amputation for non-healing ulcer [**1-11**] diabetes - diabetes mellitus type 2 on insulin, dx age 42, c/b peripheral neuropathy and proteinuria (baseline creatinine 0.9 in [**2183**]) - HTN - HLD - h/o depression - erectile dysfuntion - fatty liver - tubular adenoma on [**2180**] colonoscopy MEDICATION ON ADMISSION: - metoprolol succinate 12.5mg po daily - lisinopril 20mg daily - simvastatin 40mg po qHS - plavix 75mg po daily - insulin humalog SS + long acting insulin qHS (in [**2183**] he took lantus 25 units qHS) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission: GENERAL: intubated, sedated, wearing cooling device. HEENT: intubated. NECK: in neck brace. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. LUNGS: CTAB anteriorly, but could not assess posterior or inferior lung sounds due to cooling device ABDOMEN: in cooling device, could not assess. EXTREMITIES: no edema, 2+ pulses UE and LE bilat. SKIN: cool to touch. occ abrasions with denuded skin over LE and UE bilat. NEURO: sedated, unresponsive PULSES: 2+ DP and radial FAMILY HISTORY: Father - MI in mid-50s and CABG, died at age 69 from MI. SOCIAL HISTORY: married, one daughter, two sons. former competitive rower and rowed for [**University/College **] as undergrad. - Tobacco history: nonsmoker - ETOH: once a month

Ventricular fibrillation,Cardiogenic shock,Acute and subacute necrosis of liver,Flail chest,Other pneumothorax,Ventilator associated pneumonia,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Acidosis,Precipitous drop in hematocrit,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Accidents occurring in residential institution,Old myocardial infarction,Impotence of organic origin,Other alteration of consciousness

Ventricular fibrillation,Cardiogenic shock,Acute necrosis of liver,Flail chest,Other pneumothorax,Ventltr assoc pneumonia,Acute kidney failure NOS,Lung contusion-closed,Acidosis,Drop, hematocrit, precip,Crnry athrscl natve vssl,Status-post ptca,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Long-term use of insulin,Abn react-procedure NEC,Pseudomonas infect NOS,Accid in resident instit,Old myocardial infarct,Impotence, organic orign,Other alter consciousnes

Admission Date: [**2187-5-5**] Discharge Date: [**2187-5-26**] Date of Birth: [**2129-11-7**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 425**] Chief Complaint: s/p cardiac arrest Major Surgical or Invasive Procedure: [**2187-5-5**] endotracheal intubation [**2187-5-5**] cardiac catheterization with placement of drug eluding stent to mid-LAD [**2187-5-8**] placement right pigtail catheter in pleural space [**2187-5-8**] placement right PICC line [**2187-5-9**] placement right chest tube [**2187-5-25**] ICD placement History of Present Illness: Mr. [**Known lastname **] is a 57 yo male found down on side of road with abrasions to the face. Per wife, they had just bought a bicycle and the patient was riding it home with the wife driving ahead in a car. She said he was not traveling at a particularly fast pace, but she got ahead of him and proceeded home. The next she heard he had been found down on the wrong side of the road. Per wife, pt was an avid biker prior to his MI in [**2182**] and would not have ridden on the wrong side of the road, so something must have happened to cause him to swerve that way. The patient was found down, apneic and without a pulse. He was defibrillated x3, received CPR, epi/vaso, and intubated in the field. In the ED, he was evaluated by trauma surgery, pan-CT, rib fractures and pulmonary contusions but no obvious active hemorrhage. The patient was noted to have a flail chest, presumably from ?CPR vs. trauma. The patient was noted to have ST depressions inferiorly. The patient was initiated on a cooling regimen, getting cisatracurium, versed, fentanyl. In the ED, BPs 130s/80s, HR-70s-80s. Unable to obtain review fo symptoms as pt was intubated and unresponsive. Per wife, pt had not had any anginal symptoms prior to this event. No chest pain or shortness of breath recently, and she reports that this is something he would report to her if it occurred. He had only just begun biking again. He has a history of stent placement to the LAD in [**2182**] at [**Hospital1 2025**]. At that time, he presented with restrosternal chest pain with exertion x 2, the second episode persistent, leading to ED presentation. Found to have NSTEMI with positive biomarkers. She said that he is very organized with medications and always takes them as directed, and has not missed doses. Past Medical History: 1. CARDIAC RISK FACTORS: + Diabetes, + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: - PERCUTANEOUS CORONARY INTERVENTIONS: - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] to proximal LAD [**2182**] ([**Hospital1 2025**]) - hospitalized for atypical chest pain [**12/2183**] ([**Hospital1 2025**]) 3. OTHER PAST MEDICAL HISTORY: - spontaneous pneumothorax while biking (date unknown) - [**12-11**] toe amputation for non-healing ulcer [**1-11**] diabetes - diabetes mellitus type 2 on insulin, dx age 42, c/b peripheral neuropathy and proteinuria (baseline creatinine 0.9 in [**2183**]) - HTN - HLD - h/o depression - erectile dysfuntion - fatty liver - tubular adenoma on [**2180**] colonoscopy Social History: married, one daughter, two sons. former competitive rower and rowed for [**University/College **] as undergrad. - Tobacco history: nonsmoker - ETOH: once a month Family History: Father - MI in mid-50s and CABG, died at age 69 from MI. Physical Exam: Physical Exam on Admission: GENERAL: intubated, sedated, wearing cooling device. HEENT: intubated. NECK: in neck brace. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. LUNGS: CTAB anteriorly, but could not assess posterior or inferior lung sounds due to cooling device ABDOMEN: in cooling device, could not assess. EXTREMITIES: no edema, 2+ pulses UE and LE bilat. SKIN: cool to touch. occ abrasions with denuded skin over LE and UE bilat. NEURO: sedated, unresponsive PULSES: 2+ DP and radial Physical Exam on Discharge: afebrile, BP 110-130s/70-80s, HR 80s, saturations >94% on RA awake, alert, interactive and appropriate. Voice is shaky and quiet but no dysarthria. Oriented x3 but waxes and wanes RRR, no m/r/g decreased breath sounds in the right base but no crackles or wheezes abdomen is soft, nontender, nondistended no edema, 2+ pulses bilateral DP and radial neuro exam: oriented x 3, CN 2-12 intact, strength right deltoids [**3-15**], left [**2-12**], bilateral forearms [**4-14**], bilateral hip flexers [**2-12**], bilateral plantarflexion [**3-15**]. sensation intact to light touch in dermatomes C5-T1 an L4-S1. gait only with assistance Pertinent Results: ADMISSION LABS: [**2187-5-5**] 03:10PM WBC-13.0* RBC-4.79 HGB-15.3 HCT-45.2 MCV-94 MCH-32.0 MCHC-34.0 RDW-12.2 [**2187-5-5**] 03:10PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2187-5-5**] 03:10PM ALBUMIN-4.2 CALCIUM-9.0 PHOSPHATE-8.8* MAGNESIUM-2.6 [**2187-5-5**] 03:10PM cTropnT-<0.01 [**2187-5-5**] 03:10PM LIPASE-64* [**2187-5-5**] 03:10PM ALT(SGPT)-1684* AST(SGOT)-1113* ALK PHOS-85 TOT BILI-2.0* [**2187-5-5**] 03:10PM UREA N-26* CREAT-1.4* [**2187-5-5**] 03:15PM freeCa-1.12 [**2187-5-5**] 03:15PM GLUCOSE-259* LACTATE-13.6* NA+-143 K+-3.7 CL--109* TCO2-13* [**2187-5-5**] 05:25PM TYPE-ART RATES-[**9-29**] TIDAL VOL-600 PEEP-5 O2-100 PO2-208* PCO2-40 PH-7.30* TOTAL CO2-20* BASE XS--5 AADO2-475 REQ O2-80 INTUBATED-INTUBATED [**2187-5-5**] 10:17PM CK-MB-34* MB INDX-4.1 cTropnT-0.97* [**2187-5-5**] 10:17PM GLUCOSE-294* UREA N-25* CREAT-1.2 SODIUM-138 POTASSIUM-6.4* CHLORIDE-105 TOTAL CO2-14* ANION GAP-25* . Imaging: CT Head non-contrast ([**5-5**]): There is no evidence of acute intracranial hemorrhage, mass effect, or shift of normally midline structures. There is no cerebral edema or loss of [**Doctor Last Name 352**]-white matter differentiation to suggest an acute ischemic event. The sulci and ventricles are slightly prominent, likely age related involutional changes. There is no hydrocephalus. The basal cisterns are patent. Imaged paranasal sinuses and mastoid air cells appear well aerated. No acute fracture is seen. IMPRESSION: No evidence of acute intracranial process. . CT C-spine ([**5-5**]): There is no evidence of acute cervical spine fracture or malalignment. A non-displaced fracture of the right first rib is noted. No significant degenerative changes are seen including no evidence of critical central canal stenosis. Evaluation of the prevertebral soft tissues is limited due to endotracheal and orogastric tube placement. Ground-glass opacities in the imaged lung apices are better assessed on CT torso of the same date. IMPRESSION: No evidence of acute cervical spine fracture or malalignment. Non-displaced fracture of the right first rib. . CT Torso ([**5-5**]): 1. Right upper and middle lobe ground-glass opacities, most likely representing areas of contusion and aspiration. Bilateral lower lobe consolidations, which may reflect atelectasis or aspiration. 2. Multiple bilateral rib fractures, including displaced right anterior rib fractures, likely related to recent CPR. No pneumothorax. 3. Severe coronary artery calcifications. 4. Decreased liver attenuation, possibly suggestive of fatty deposition. . CXR ([**5-7**]): There is an endotracheal tube and a feeding tube whose distal tip is not well seen. There is unchanged stable cardiomegaly. There are multiple right-sided rib fractures. There are areas of increased density within the right lung, possibly due to contusion related to the rib fractures. No pneumothoraces are seen. . [**Hospital1 2025**] Records: C. CATH [**2183-6-3**]: FINDINGS: - LM patent. LAD 95% proximal stenosis with 40-50% stenoses in mid-, distal-, and diags. Lcx 40% prox stenosis, RCA 40% mid vessel dz. INTERVENTION: - PTA and DES to proximal LAD. . ROUTINE FOLLOW UP EXERCISE STRESS TEST s/p MI [**6-/2183**]: 1-1.5mm horizontal ST segment depressions in leads V5-V6 at peak exercise which became rapidly upsloping by one minute following cessation of exercise. Quickly resolved. Asymptomatic. Walked 12 minutes; excellent exercise tolerance. Obtained nuclear stress [**1-11**] above EKG findings --> no ischemia but multiple PVCs, PVC couplets, and PVC triplets causing termination of test. Arrythmia resolved with rest. . DIAGNOSTIC C. CATH (right heart) [**2183-7-22**] (done [**1-11**] NSVT on [**6-17**] stress test): Left dominant heart. Left main normal. LAD with widely patent stent. 40-50% stenoses at mid and distal LAD. LCx normal. RCA normal. . EXERCISE STRESS TEST/MR SPECT [**2183-12-28**] for atypical CP: Excellent exercise capacity (15 mets). Exercise time 13 minutes. HR 60 --> 146 (88% of predicted). BP 118/68 --> 160/80. No chest pain. End point: dypsnea, fatigue. Occasional APCs and VPCs on EKG but neg for ischemia. NSVT. Myocardial perfusion images normal without evidence of ischemia or infarction. LVEF 62% with normal contractile function. . Peripheral arterial testing [**2184-10-1**]: no PAD in right or left leg. . ECHO [**2187-5-5**]: RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Severe regional LV systolic dysfunction. Severely depressed LVEF. No LV mass/thrombus. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. AORTIC VALVE: Normal aortic valve leaflets (3). No AR. MITRAL VALVE: Mild to moderate ([**12-11**]+) MR. TRICUSPID VALVE: Mild [1+] TR. Borderline PA systolic hypertension. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Suboptimal image quality - poor subcostal views. Suboptimal image quality - ventilator. Conclusions There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe regional left ventricular systolic dysfunction with akinesis of the anterior wall, septum and distal inferior wall. The apex is dyskinetic. The remaining segments contract normally (LVEF = 25-30%). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. No aortic regurgitation is seen. Mild to moderate ([**12-11**]+) mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Severe regional left ventricular systolic dysfunction, c/w extensive LAD-territory infarction. Dyskinetic LV apex without current evidence of thrombus. Mild to moderate mitral regurgitation. . CARDIAC CATH [**2187-5-5**]: Findings ESTIMATED blood loss: <30 cc Hemodynamics (see above): Coronary angiography: left dominant LMCA: No angiographically apparent CAD LAD: Proximal calcification. Mid vessel diffuse 80-90% stenosis LCX: Mild luminal irregularities RCA: Nondominant. Mild luminal irregularities Interventional details Change for 6 French XBLAD3.5. Crossed with Prowater wire and predilated with a 2.5 mm balloon. Could not cross with a stent. Further predilation and then able to deliver a 3.0 x 30 mm Resolute stent. Postdilated with a 3.5 mm balloon. Final angiography revealed normal flow, no dissection and 0% residual stenosis. . CTA CHEST [**2187-5-9**]: TECHNIQUE: MDCT-acquired axial images were obtained from the thoracic inlet to the pubic symphysis prior to and following the uneventful administration of 120 cc Omnipaque intravenous contrast. Coronally and sagittally reformatted images were generated and reviewed. CT CHEST WITH CONTRAST: The pulmonary arterial tree is well opacified with intravenous contrast to the subsegmental levels without filling defects to suggest pulmonary embolism. The pulmonary arterial trunk is normal in caliber. The thoracic aorta is also normal in caliber without evidence of acute aortic syndrome. There is a left-sided central venous catheter in place with the tip terminating in the SVC. There is a normal three-vessel takeoff from the aortic arch. The great vessels are otherwise unremarkable. The heart is normal in size without pericardial effusion. There are dense calcifications of the coronary arteries. No pathologically enlarged axillary, mediastinal, or hilar lymph nodes are detected. The tracheobronchial tree is patent to the subsegmental levels. An endotracheal tube appears appropriately positioned. An orogastric tube is also seen coursing through the esophagus and terminating in the stomach. The thyroid gland is unremarkable. There is a moderate-sized right pneumothorax which is new from [**2187-5-5**]. A right-sided chest tube is in place with the tip terminating posterior to be lung which is inadequately positioned. Within the pulmonary parenchyma, there are diffuse nodular and tree-in-[**Male First Name (un) 239**] opacities predominantly in the right lung with more confluent regions of consolidation in the right lung base and left lung base. No pleural effusions are present. . CT OF THE ABDOMEN WITH CONTRAST: The liver enhances homogeneously without evidence of hepatic laceration. No focal liver lesion is identified. No intrahepatic or extrahepatic biliary ductal dilation is seen. The gallbladder contains dense material layering in the dependent portions consistent with vicarious excretion of contrast from prior CT. No calcified gallstones are seen and there is no gallbladder wall edema or pericholecystic fluid to suggest acute inflammation. The spleen is unremarkable. Two splenules are incidentally noted at the splenic hilum. The pancreas, bilateral adrenal glands, and kidneys are unremarkable. The intra-abdominal loops of small and large bowel are unremarkable without evidence of wall thickening or obstruction. There is no free air or ascites. No pathologically enlarged lymph nodes are identified in the retroperitoneal or mesenteric regions. The intra-abdominal aorta and its branches are normal in caliber and patent. CT OF THE PELVIS WITH CONTRAST: The urinary bladder is relatively decompressed by a Foley catheter in place. Loculated gas is again seen in the dome of the bladder likely related to Foley placement. The rectum, prostate, seminal vesicles and sigmoid colon are unremarkable. There is no free pelvic fluid/inguinal or pelvic lymphadenopathy. A small fat-containing left inguinal hernia is incidentally noted. OSSEOUS STRUCTURES: There are multiple displaced fractures involving the right anterior second, third, fourth, fifth and a minimally displaced fracture involving the right anterolateral sixth rib. There are fractures at the right costochondral cartilage at the levels of the right second, third, fourth, and fifth ribs. Nondisplaced fractures are seen involving the right posterior fifth, sixth and seventh ribs. The spine appears intact. Subcutaneous air is seen in the right thorax and overlying the sternum. IMPRESSION: 1. Moderate-sized right pneumothorax is new from [**2187-5-5**] with a posteriorly positioned right chest tube which is not adequately draining the pneumothorax. 2. Bibasilar pulmonary consolidations and nodular and confluent opacities in the right lung most likely represent areas of aspiration/atelectasis and contusion, respectively. 3. Multiple rib fractures and fractures of the right costochondral cartilage. 4. Severe coronary artery calcifications. No evidence of acute aortic injury or acute intra-abdominal pathology. . CT CHEST [**2187-5-10**]: FINDINGS: A previously large pneumothorax, barely visible on chest radiograph, is tiny. Minimal residual air is seen in the right lung base (401B:14) adjacent to the right atrium (401B:21). Multifocal consolidations in the right middle lobe have coalesced to a larger consolidation with air bronchograms (2:40). The right lower lobe remains completely collapsed. The left lower lobe is completely collapsed, whereas previously the superior segment of the left lower lobe remained aerated. Ground-glass opacity in the posterior right upper lobe (2:36) has coalesced into a small consolidation. Small amount of pneumomediastinum is similar. Coronary artery calcifications in the LAD and proximal circumflex are similar. The heart is mildly enlarged. The great vessels are normal caliber. The aortic arch is free of calcifications. A left-sided PICC line tip terminates in the low SVC. An enteric catheter courses into the stomach. This study was not designed to evaluate sub-diaphragmatic contents. The hypodense liver is consistent with diffuse steatosis. A 2 cm CC x 4.3 cm TV hyperdense lesion at the left liver capsular edge (401B:25) was hypodense on the portal venous phase of prior imaging studies. A smaller 3.2 cm TV x 1.2 cm CC similarly hyperattenuating lesion is located along the superior liver edge in segment II (401B:25). Displaced overriding rib fractures of the anterior right 2nd through fifth ribs are unchanged. There are no lytic or sclerotic bone lesions concering for malignancy. IMPRESSION: 1. Tiny residual right pnuemothorax has improved 2. Progressive bilateral lower lobe collapse 3. Worsening right middle and left upper lobe pneumonia 4. Fatty liver with two large hyperdense lesions in the left lobe which are more conspicuous on the present study. These lesions are non-specific and could represent benign or malignent entities. An abdominal MRI is required for further characterization when the patient's acute issues have stabalized. . CT HEAD [**2187-5-10**]: FINDINGS: There is no hemorrhage, edema, mass effect, or territorial infarction. The ventricles and sulci are normal in size and configuration. The basal cisterns remain patent and there is no evidence of central herniation. The [**Doctor Last Name 352**]-white matter differentiation is unchanged. There is mild mucosal thickening and there is an air-fluid level in the right maxillary and sphenoid sinuses, likely related to intubation. The mastoid air cells and middle ear cavities are clear. IMPRESSION: No acute intracranial process. MRI is more sensitive for evidence of anoxic brain injury. . RUQ ULTRASOUND [**2187-5-13**]: FINDINGS: The liver is normal in shape and contour. There is no increased echogenicity. In the left lobe of the liver, there is a small 1.5 x 1.5 cm hypoechoic lesion which does not have a corresponding lesion seen in the prior CTs. There is no increased vascularity. The portal vein is patent. The gallbladder is unremarkable without evidence of cholelithiasis. Mild echogenicity within the gallbladder likely represents artifact, or less likely a small amount of sludge. There is no gallbladder wall edema or pericholecystic fluid. The common bile duct measures 4 mm. There is no intra- or extra-hepatic biliary duct dilation. There is no ascites. IMPRESSION: 1. No evidence of cholelithiasis or cholecystitis. Hazy echogenicity within the gallbladder is likely artifact, although a small amount of sludge may be present. 2. Indeterminate lesion in the left lobe of the liver. Recommend nonemergent followup with MRI for further evaluation. . [**5-16**] CT CHEST/ABDOMEN/PELVIS: CT CHEST: The thyroid gland contains an 8-mm hypodense lesion in the inferior left lobe (2:13). No axillary or supraclavicular lymphadenopathy is seen. Shotty lymph nodes in the mediastinum do not meet CT size criteria for lymphadenopathy. An endotracheal tube is in place with the tip terminating at the level of the clavicles. An orogastric tube is in place. A left-sided PICC line is seen with the tip terminating in the low SVC. The pulmonary arterial trunk is normal in caliber as is the thoracic aorta. There is a normal three-vessel takeoff from the aortic arch. The heart is normal in size without pericardial effusion. Calcification of the coronary arteries is noted with a possible stent in the left anterior descending artery. The central tracheobronchial tree is patent to the subsegmental levels. There are no pleural effusions. There is a recurrent small right pneumothorax with air seen in the cardiophrenic recess and the base of the right lung (2:43, 48) with slight leftward shift of the mediastinal structures. Multifocal consolidations have coalesced to predominantly bibasilar consolidations with air bronchograms (2:43). There is residual ground-glass opacification in the right upper lobe (2:30). A right-sided chest tube is unchanged in position, extending through the fissure with the tip terminating in the right lung apex. There is extensive subcutaneous emphysema extending through the soft tissues of the right thorax and also the right posterior neck. CT ABDOMEN: Evaluation of solid organs is limited without intravenous contrast. Within these limitations, the liver is diffusely hypoattenuating consistent with hepatic steatosis. No gross liver abnormality is detected. No intra- or extra-hepatic biliary ductal dilatation is seen. The gallbladder contains diffuse hyperdensity consistent with biliary sludge. A solitary coarse calcification is noted in the head of the pancreas which is otherwise unremarkable. The spleen, bilateral adrenal glands and kidneys are unremarkable. Two splenules measuring 1.9 cm and 2.9 cm are incidentally noted in the splenic hilum. An enteric feeding tube is in place within the stomach. The stomach and intra-abdominal loops of small and large bowel are unremarkable without evidence of wall thickening or obstruction. No free air or ascites is present. There is no appreciable mesenteric or retroperitoneal lymphadenopathy. The abdominal aorta is normal in caliber with minimal atherosclerosis. CT PELVIS: The prostate and seminal vesicles are unremarkable. The urinary bladder is decompressed by a Foley catheter with a locule of air in the nondependent portion of the bladder dome consistent with Foley placement. The rectum and sigmoid colon are mildly distended with stool but otherwise unremarkable. There is no free pelvic fluid or inguinal/pelvic lymphadenopathy. OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesions are detected. Minimal degenerative changes are noted in the lumbar spine, most pronounced at the L2-3 level with loss of intervertebral disc space, endplate sclerosis and osteophytosis. Displaced overriding rib fractures of the anterior right 2nd-5th ribs are unchanged. IMPRESSION: 1. Recurrent small right pneumothorax with slight leftward deviation of mediastinal structures from [**2187-5-10**]. 2. Improved multifocal pneumonia with persistent bibasilar consolidation likely due to lower lobe collapse. 3. Persisting ground-glass opacity in the right upper lobe. 4. Hepatic steatosis. 5. Hyperdense gallbladder consistent with biliary sludge. 6. No evidence of colitis or intra-abdominal abscess. . [**5-16**]/ MRI HEAD: FINDINGS: There is no acute intracranial hemorrhage, infarction, mass effect, or edema seen. Ventricles and sulci appear age appropriate. Major intracranial flow voids are preserved. There is fluid signal in the sphenoid sinuses, nasopharynx and mastoid air cells bilaterally, which might be related to intubation. Visualized orbits appear unremarkable. IMPRESSION: No acute intracranial abnormality. . [**5-16**] MRI CSPINE FINDINGS: Limited examination due to patient motion. Cervical vertebrae are normal in height, marrow signal intensity and alignment. Craniocervical junction is normal. Cervical spinal cord shows normal morphology and signal intensity. At C2-C3, uncovertebral and facet joint osteophytes result in moderate right neural foraminal narrowing. There is no significant spinal canal or left neural foraminal narrowing. At C3-C4, there is disc bulge effacing the anterior thecal sac remodeling the cord, but no cord signal abnormality is seen. There is no significant neural foraminal narrowing. At C4-C5 and C5-C6, there are disc bulges without significant canal or neural foraminal narrowing. At C6-C7, there is a disc bulge with central disc protrusion indenting the anterior thecal sac but no significant canal or neural foraminal narrowing is seen. At C7-T1, there is no significant spinal canal or neural foraminal narrowing. Pre- and para-vertebral soft tissues appear unremarkable. IMPRESSION: Study limited by patient motion. Mild degenerative changes in the cervical spine without significant spinal canal or neural foraminal narrowing. . [**5-17**] EMG: Complex, abnormal study. There is electrophysiologic evidence for a generalized, sensorimotor polyneuropathy characterized by axonal loss, which is at least moderately severe. However, the complete absence of identifiable motor unit activity in upper and lower extremities with relatively normal motor nerve conduction studies is consistent with a primary upper motor neuron etiology for the patient's weakness. The associated finding of normal cranial EMG supports a localization within the cervical spinal cord. There is no evidence for a presynaptic neuromuscular transmission disorder. . [**5-19**] MRI HEAD AND CSPINE: CONCLUSION: Hyperintense lesions in the medulla and upper cervical cord, not detectable on diffusion images. Small right frontal white matter hyperintensity. These findings may all be a consequence of ischemia, but they do not appear acute by MR criteria. . [**5-22**] TTE: LEFT ATRIUM: Normal LA size. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Mild regional LV systolic dysfunction. No resting LVOT gradient. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Mild PA systolic hypertension. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. Conclusions The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with mid- and distal septal hypokinesis (mid-LAD territory). The remaining segments contract normally (LVEF = 40-45%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. Mild pulmonary hypertension. . [**5-24**] VIDEO SWALLOW STUDY FINDINGS: Video swallow fluoroscopy was performed in conjunction with speech and swallow division. Multiple consistencies of barium were administered. Barium passed freely through the esophagus without evidence of obstruction. There was aspiration with thin and nectar consistencies, which improved on chin tuck. There was mild pharyngeal residue with pureed consistencies but no aspiration or penetration. IMPRESSION: Mild aspiration of thin and nectar consistencies which improved with chin tuck. Pharyngeal residue with pureed consistency. Please see speech and swallow note in OMR for further details. Brief Hospital Course: Mr. [**Known lastname **] is a 57 year old male with coronary artery disease (CAD) status post stent to proximal LAD in [**2182**], hypertension, hyperlipidemia, and diabetes mellitus type 2 who was found down on side of road in ventricular fibrillation and cardiac arrest s/p resuscitation and intubation. He underwent cardiac cath with placement of DES to mid-LAD, and post-cath arctic sun cooling protocol. He had an ICD placed before discharge for a primary vfib arrest. His course was complicated by rib fractures and resultant right pneumothorax requiring chest tube and ventilator-associated psuedomonas pneumonia. ACTIVE ISSUES: # Primary Vfib arrest: Although he had a history of CAD and is s/p drug eluding stent (DES) to proximal left anterior descending (LAD) in [**2182**], he had been doing well prior to this incident. He was found down after riding a bike home, requiring multiple shocks for ventricular fibrillation (VF) arrest in the field and endotracheal intubation for respiratory failure. Arctic Sun Cooling protocol was initiated in the ED on arrival. He was taken for cardiac cath and recieved DES to mid-LAD on [**2187-5-5**]. Transferred to the CCU post-cath where he has been hemodynamically stable and cooled to 33'C. He was placed on neuromuscular blockade (cisatracurium) as well as fentanyl and versed. Monitored on EEG for seizure activity while on NM block, no seizures seen. After 24 hours cooling was stopped and warming protocol initiated. NM block discontinued after patient reached 35'C per protocol. After rewarming, he remained became mildly hypertensive so he was restarted on home antihypertensives, which included metoprolol and lisinopril (takes captopril at home). He began to trend towards fevers (see below) so he was continued on artic sun device which kept him maintained at 37'C with cooling for an additional 48 hours. He was not extubatable after warming so tube feeds were initiated and he was transitioned to fentanyl/propofol. He was treated for MI with plavix 75mg daily, aspirin 325mg daily, atorvastatin 80 mg daily, metoprolol tartrate 25 mg [**Hospital1 **]. Patient remained ventilator-dependent for 14 days. Sedation was changed to precedex nearing extubatation. After additional management of his pneumothorax and pneumonia (see below) he was successfully extubated on [**5-18**] without complication. There were many discussions about whether his vifb was secondary to acute MI or not, and ultimately it was felt that there was not evidence to confirm either way. Since he may have had a primary vfib arrest (due to previous MI in [**2182**] and structural heart disease), he was a candidate for ICD placement during this admission. He had an ICD placed on [**2187-5-25**] and tolerated the procedure well. CXR the following day confirmed lead placement and interrogation by the EP team showed that it was functioning well. He should keep dressing on for three days, take keflex 500 mg 4x/d for 3 days, and follow-up in [**Hospital **] clinic. # Pneumothorax: Patient developed crepitus on exam the morning of hospital day 4 while still intubated. CXR revealed right apical pneumothorax and trauma surgery placed a pigtail catheter on [**2187-5-8**]. Initially, this tube drained air and serosanguinous fluid and repeat CXR showed improvement in the pneumothorax. However, the following day his ventilator oxygenation requirements did not improve. He was requiring very high PEEP and FiO2 90-100% to maintain saturations in the low to mid 90s. His blood pressures were also noted be decreased during this time. Because the differential included pulmonary embolus and he was not clinically improving, a CTA chest was performed on [**2187-5-9**]. This showed a large persistent right pneumothorax which was layered anteriorly and thus not visible on portable CXRs and the apical pigtail catheter was inadequately placed to drain. He also had basal pneumonia. Trauma surgery returned and placed a right chest tube on [**2187-5-9**] with repeat CT chest the following day showing resolution of pneumothorax. He ventilator dependence and mild hypotension improved following chest tube placement. It was successfully removed on [**5-20**] wihtouth recurrence of PTX. # Ventilator associated pneumonia (VAP): Upon rewarming from the arctic sun protocol, the patient was noted to be persistently febrile. When he became hypoxic with increasing vent requirements, he was started on empiric coverage for VAP in addition to treatment of pneumothorax as above. He remained febrile and sputum culture grew pseudomonas so ciprofloxacin was added to the regimen while awaiting sensitivities. Pseudomonas was pan-sensitive so he was narrowed to ciprofloxacin only. However, he remained febrile so vanc and cefepime were added back on. Flagyl was added to his regimen on [**5-15**] for anaerobic coverage given fevers and concern for aspiration. Vancomycin and ciprofloxacin were subsequently weaned off and he completed a 8 day course of cefepime and metronidazole from [**5-16**], which was the last day of positive sputum cultures. # Mental status: Initially we were unable to assess while pt was being cooled and sedated. Though he was resuscitated, amount of time he was pulseless was unknown. Patient had EEG performed early in his stay which showed mild/moderate diffuse background slowing and slow alpha rhythm, however was notable for background frequencies with the appearance of an anterior-posterior gradient of frequencies, clear reactivity, and improvement in the alpha rhythm frequency which was thought to be associated with good neurologic outcome. During daily attempts to wean off propofol, he was often noted to be agitated and somewhat delirious appearing. He was transitioned to precedex with apparent improvement in mental status and was extubated shortly thereafter. His mental status upon extubation was encouraging, with patient conversant and able to follow commands. He was noted to sundown intermittently with disorientation during his stay in the ICU but was easily redirectable. To improve his sleep/wake cycle in the setting of sundowning, he was started on seroquel 25mg po qhs prn for insomnia and delirium. This was not continued to rehab but can be restarted if needed. # Trauma: Patient was admitted s/p fall from bike which may have resulted from or caused cardiac arrest. CT imaging showed no acute intracranial process but did show multiple rib fractures from CPR. His course was complicated by flail chest. He was followed by the trauma surgery team but they did not think he had any indications for surgery to fix the flail chest. Chest tube placed on hospital day 4 as above for new onset pneumothorax. His C-spine was cleared with CT neck on admission and C-collar was removed per trauma surgery recommendations. # Diabetes mellitus type 2: On insulin at home, complicated by peripheral neuropathy and proteinuria (baseline creatinine 0.9 in [**2183**]). He required insulin drip while being cooled due to delayed absorption. Transitioned to long-acting insulin plus SSI once pt was warmed. Sugars again became difficult to control in the setting of continous tube feedings and infection. He again necessitated insulin drip before weaning to lantus with HISS. Regimen on discharge included glargine 23 units at bedtime and a sliding scale insulin. This should be titrated based on QID fingersticks. # Weakness: With weaning of sedation, it was noted patient was not moving extremities. Head CT showed no acute process, and there was concern for critical illness neuropathy vs. myopathy. EMG/NCS was ordered which was concerning for upper motor nerve lesion in the cervical spine. Repeat MRI's showed poorly defined subacute to chronic lesion in C1 to C2. Regardless, patient's strength slowly returned and he was moving all extremities to command by day of extubation on [**5-18**]. With continued PT he continued to improve and was able to move with assitance. He should continue with PT. # swallow discoordination: Also, he had significant weakness of his pharyngeal muscles which cause quiet voice and swallowing difficulties. He had a video swallow and speech/swallow team evaluation which cleared him for a diet of pureed solids and honey-thick liquids. This can be advanced with time. # Bladder atony: Similarly, he had bladder atony after the foley was removed (in place 18-20 days) but eventually recovered his ability to urinate. If he cannot urinate, he may need a few straight caths while his bladder gets strength back. # Hypertension (HTN)/ hypotension: Initially normotensive on admission to ED and CCU s/p cardiac arrest and resuscitation. Held antihypertensives initially. His pressures decreased with SBP's in th 90's in the setting of new pneumothorax. Antihypertensives including metoprolol and lisinopril were restarted when patients pressured had stabilized following treatment of ptx. On discharge his regimen consisted of lisinopril 10 mg daily, metoprolol succinate 100 mg daily. # Hyperlipidemia (HLD): He was taking simvastatin at home but was transitioned to high dose atorvastatin given his acute MI. Discharged on atorvastatin 80 mg daily. His initial CK was very high 800s in the setting of being found down and trauma, AST/ALT also very high (see below). Both of these should be rechecked as an outpatient once he is stable to ensure that he is not having toxicity of high dose atorvastatin. # Transaminitis: Admission LFTs very elevated with AST/ALT 1100/1600, Tbili 2.0, and normal alkaline phosphatase. It was felt that this pattern and history fit well with shock liver in the setting of cardiac arrest. [**Month (only) 116**] also have LFT elevation at baseline due to fatty liver disease. LFT's trended down during admission and at the time of discharge were in the 80s. He should have these rechecked in a month or so and also should have a f/u MRI of his liver for nondescript findings on CT. # H/o depression: not currently being treated for this, but has taken meds in the past. # Erectile dysfunction (ED): on discharge, instruct pt to avoid ED meds. TRANSITIONAL ISSUES: - For his ICD: He should keep dressing on for three days and then leave his steri strips on until they fall off by themselves, take keflex 500 mg 4x/d for 3 days, and follow-up in [**Hospital **] clinic in one week. -Follow-up needed for Liver lesion seen on Ultrasound- recommended a nonemergent MRI to further characterize - recheck CK and AST/ALT after stabilized as an outpatient to ensure no toxicity from high dose atorvastatin - To improve his sleep/wake cycle in the setting of sundowning, he was started on seroquel 25mg po qhs prn for insomnia and delirium. This was not continued to rehab but can be restarted if needed. Medications on Admission: - metoprolol succinate 12.5mg po daily - lisinopril 20mg daily - simvastatin 40mg po qHS - plavix 75mg po daily - insulin humalog SS + long acting insulin qHS (in [**2183**] he took lantus 25 units qHS) Discharge Medications: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Clopidogrel 75 mg PO DAILY 4. Codeine Sulfate 15-30 mg PO HS:PRN cough 5. Lisinopril 10 mg PO DAILY Hold for SBP<100 6. Metoprolol Succinate XL 100 mg PO DAILY hold for sbp<90 or hr<55 7. Heparin 5000 UNIT SC TID Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: PRIMARY DIAGNOSES ventricular fibrillation coronary artery disease pneumothorax ventilator-associated pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted to the hospital because you were found unresponsive, without a pulse and not breathing outside the hospital. The EMS team performed CPR and they were able to get your heart pumping again. Your lab work and EKG showed that you had a large heart attack. You underwent a cardiac cath with placement of a stent in your heart to open the artery and restore blood flow. You underwent cooling of your body in the ICU to perserve your brain function while your heart had stopped pumping blood to the brain. You also were not breathing when the EMS team found you alongside the road. You had a tube inserted in your lungs and you were ventilated by a machine in the ICU. You had several rib fractures from the CPR and developed a pneumothorax. This is when free air enters the chest and pushes the lungs out of the way, collapsing the lungs. You had a tube inserted through your chest wall to let this air out so that the lungs could re-expand. While you were on the ventilator, you aspirated some of your saliva and vomit, resulting in a pneumonia. You recieved antibiotics for this and your respiratory status has improved. Ultimately, you were in the ICU under sedation for a very long time while your lungs were recovering. You are ready for discharge from the hospital now but you will still feel weak and tired for some time. You were paralyzed during part of this recovery and your body is using many of its resources to heal. This results in significant weakness and fatigue which can last for several months but which will get better as your work with physical therapy. The following changes were made to your medications: - CHANGE TO metoprolol succinate 100 mg daily for your heart - STOP taking simvastatin, this has been replaced with another med - START taking atorvastatin (lipitor) 80 mg daily for your cholesterol - START taking aspirin 81 mg daily for your heart - YOU SHOULD CONTINUE TAKING PLAVIX 75 MG DAILY, THIS IS TO KEEP THE STENT IN YOUR HEART OPEN - DECREASE lisinopril to 10 mg daily - INCREASE INSULIN as directed by the sliding scale You should keep all of the follow-up appointments listed below so that we can ensure that you continue to improve. You should bring your medications to each appointment so your doctors [**Name5 (PTitle) **] update their records and adjust the doses as needed. It was a pleasure taking care of you in the hospital! Follow up needed for: You will need to have an MRI of your liver to assess an area that they noticed on an ultrasound that would need to be further defined. Followup Instructions: While you are at [**Hospital3 **], the doctor there will adjust your medications as needed. When you leave, they will arrange for an appointment with your primary care doctor: Name: [**Last Name (LF) **],[**First Name3 (LF) 247**] M. Location: PRIMARY CARE OF [**University/College **] Address: [**Hospital1 80695**], WELLESLLEY,[**Numeric Identifier 42001**] Phone: [**Telephone/Fax (1) 111936**] Fax: [**Telephone/Fax (1) 111937**] Name: [**Last Name (LF) **],[**First Name3 (LF) 251**] S. MD Location: [**Hospital1 **] CARDIOLOGISTS Address: [**2183**]/STE. 562, [**Location (un) **],[**Numeric Identifier 8934**] Phone: [**Telephone/Fax (1) 18278**] Appointment: Thursday [**2187-6-28**] 1:00pm Department: CARDIAC SERVICES When: MONDAY [**2187-6-4**] at 9:00 AM 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 ** You will also have the cardiologists calling you to set up an appointment with Dr. [**Last Name (STitle) **].

427,785,570,807,512,997,584,861,276,790,414,V458,401,272,250,357,V586,E879,041,E849,412,607,780

{'Ventricular fibrillation,Cardiogenic shock,Acute and subacute necrosis of liver,Flail chest,Other pneumothorax,Ventilator associated pneumonia,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Acidosis,Precipitous drop in hematocrit,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Accidents occurring in residential institution,Old myocardial infarction,Impotence of organic origin,Other alteration of consciousness'}

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 cardiac arrest PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 yo male found down on side of road with abrasions to the face. Per wife, they had just bought a bicycle and the patient was riding it home with the wife driving ahead in a car. She said he was not traveling at a particularly fast pace, but she got ahead of him and proceeded home. The next she heard he had been found down on the wrong side of the road. Per wife, pt was an avid biker prior to his MI in [**2182**] and would not have ridden on the wrong side of the road, so something must have happened to cause him to swerve that way. The patient was found down, apneic and without a pulse. He was defibrillated x3, received CPR, epi/vaso, and intubated in the field. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Diabetes, + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: - PERCUTANEOUS CORONARY INTERVENTIONS: - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] to proximal LAD [**2182**] ([**Hospital1 2025**]) - hospitalized for atypical chest pain [**12/2183**] ([**Hospital1 2025**]) 3. OTHER PAST MEDICAL HISTORY: - spontaneous pneumothorax while biking (date unknown) - [**12-11**] toe amputation for non-healing ulcer [**1-11**] diabetes - diabetes mellitus type 2 on insulin, dx age 42, c/b peripheral neuropathy and proteinuria (baseline creatinine 0.9 in [**2183**]) - HTN - HLD - h/o depression - erectile dysfuntion - fatty liver - tubular adenoma on [**2180**] colonoscopy MEDICATION ON ADMISSION: - metoprolol succinate 12.5mg po daily - lisinopril 20mg daily - simvastatin 40mg po qHS - plavix 75mg po daily - insulin humalog SS + long acting insulin qHS (in [**2183**] he took lantus 25 units qHS) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission: GENERAL: intubated, sedated, wearing cooling device. HEENT: intubated. NECK: in neck brace. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. LUNGS: CTAB anteriorly, but could not assess posterior or inferior lung sounds due to cooling device ABDOMEN: in cooling device, could not assess. EXTREMITIES: no edema, 2+ pulses UE and LE bilat. SKIN: cool to touch. occ abrasions with denuded skin over LE and UE bilat. NEURO: sedated, unresponsive PULSES: 2+ DP and radial FAMILY HISTORY: Father - MI in mid-50s and CABG, died at age 69 from MI. SOCIAL HISTORY: married, one daughter, two sons. former competitive rower and rowed for [**University/College **] as undergrad. - Tobacco history: nonsmoker - ETOH: once a month ### Response: {'Ventricular fibrillation,Cardiogenic shock,Acute and subacute necrosis of liver,Flail chest,Other pneumothorax,Ventilator associated pneumonia,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Acidosis,Precipitous drop in hematocrit,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Accidents occurring in residential institution,Old myocardial infarction,Impotence of organic origin,Other alteration of consciousness'}

CHIEF COMPLAINT: "My VNA found me at 65%" PRESENT ILLNESS: Mr. [**Known lastname **] is a 63 yo male with severe COPD on home oxygen, s/p recent PEA arrest, referred to the ED by his VNA. Per his report, his visiting nurse found him satting 65% on his supplemental O2. He states that his sat rose to 81% with "some exercises." He states that he felt extremely short of breath at the time but is unable to identify any precipitating event. He states that he felt sluggish that morning and had returned to bed, but was up out of bed by the time his VNA arrived. He denies any fever or chills or rigors. He has had a productive cough for several months, which he distinguishes from his baseline "smokers cough." He reports that it is occasionally productive of deep green sputum. He states that his coughing has been limited by chest wall pain since he underwent CPR 2 weeks ago. He was recently seen by the NP[**Company 2316**] on [**4-13**] and was prescribed a steroid taper for a COPD flare at that visit; he states that he did not take this taper as prescribed. He continues to smoke [**4-18**] cigarettes per day. In the ED, he received combivent nebs x3, azithromycin 500 mg PO, ceftriaxone 1 g IV, ASA 325 mg, and prednisone 60 mg PO. MEDICAL HISTORY: 1. COPD- on home O2 (3L), FEV1 22% predicted, FEV1/FVC ratio 43% predicted, last intubated 3 years ago. followed by Pulm 2. Tobacco Abuse 3. DM II 4. Diverticulosis 5. h/o SBO 6. C6-C7 HERNITATION 7. B12 Deficiency- on monthly injections 8. Obesity MEDICATION ON ADMISSION: Prednisone 10 mg QOD Albuterol MDI 2 puffs 4x/day Aledronate 70 mg PO qMonday Norvasc 5 mg daily ASA 325 mg daily Calcium + Vit D [**Hospital1 **] Colace 100 mg [**Hospital1 **] Senna 2 tabs qHS Combivent QID Flonase 50 mcg 2 sprays daily Metformin 100 mg [**Hospital1 **] Glyburide 2.5 mg QOD Lasix 40 mg daily Prilosec 20 mg [**Hospital1 **] Ranitidine 300 mg qHS Ferrous sulfate 325 mg daily Advair 250/50 [**Hospital1 **] Ibuprofen 600 mg TID:PRN Lisinopril 20 mg daily Lumigan OU daily Vitamin B12 1000 mcg qmonth ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Mother and Father died of lung cancer in their 60s, sister just recently died at age 50s from lung CA, daughter with cystic fibrosis SOCIAL HISTORY: Pt is married and lives with wife and 2 of his children. He is currently umemployed- former restaurant manager Tob: smokes [**6-20**] cigs/day, used to smoke 5PPD for 50 years, cut down 3 years ago EtOH: last drink over [**Holiday 944**], used to drink heavily Drugs: no IV drug use, no other illicits

Methicillin susceptible pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Chronic diastolic heart failure,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins,Other dependence on machines, supplemental oxygen,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Diverticulosis of colon (without mention of hemorrhage),Other B-complex deficiencies,Obesity, unspecified,Hypoxemia,Benign essential hypertension

Meth sus pneum d/t Staph,Obs chr bronc w(ac) exac,Chr diastolic hrt fail,Bacteria dis carrier NEC,Inf mcrg rstn pncllins,Depend-supplement oxygen,Tobacco use disorder,DMII wo cmp uncntrld,Dvrtclo colon w/o hmrhg,B-complex defic NEC,Obesity NOS,Hypoxemia,Benign hypertension

Admission Date: [**2119-4-18**] Discharge Date: [**2119-4-24**] Date of Birth: [**2056-4-16**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1674**] Chief Complaint: "My VNA found me at 65%" Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname **] is a 63 yo male with severe COPD on home oxygen, s/p recent PEA arrest, referred to the ED by his VNA. Per his report, his visiting nurse found him satting 65% on his supplemental O2. He states that his sat rose to 81% with "some exercises." He states that he felt extremely short of breath at the time but is unable to identify any precipitating event. He states that he felt sluggish that morning and had returned to bed, but was up out of bed by the time his VNA arrived. He denies any fever or chills or rigors. He has had a productive cough for several months, which he distinguishes from his baseline "smokers cough." He reports that it is occasionally productive of deep green sputum. He states that his coughing has been limited by chest wall pain since he underwent CPR 2 weeks ago. He was recently seen by the NP[**Company 2316**] on [**4-13**] and was prescribed a steroid taper for a COPD flare at that visit; he states that he did not take this taper as prescribed. He continues to smoke [**4-18**] cigarettes per day. In the ED, he received combivent nebs x3, azithromycin 500 mg PO, ceftriaxone 1 g IV, ASA 325 mg, and prednisone 60 mg PO. Past Medical History: 1. COPD- on home O2 (3L), FEV1 22% predicted, FEV1/FVC ratio 43% predicted, last intubated 3 years ago. followed by Pulm 2. Tobacco Abuse 3. DM II 4. Diverticulosis 5. h/o SBO 6. C6-C7 HERNITATION 7. B12 Deficiency- on monthly injections 8. Obesity Social History: Pt is married and lives with wife and 2 of his children. He is currently umemployed- former restaurant manager Tob: smokes [**6-20**] cigs/day, used to smoke 5PPD for 50 years, cut down 3 years ago EtOH: last drink over [**Holiday 944**], used to drink heavily Drugs: no IV drug use, no other illicits Family History: Mother and Father died of lung cancer in their 60s, sister just recently died at age 50s from lung CA, daughter with cystic fibrosis Pertinent Results: [**2119-4-18**] 11:00AM WBC-9.3 RBC-4.59* HGB-13.4* HCT-42.3 MCV-92 MCH-29.2 MCHC-31.7 RDW-14.1 [**2119-4-18**] 11:00AM NEUTS-75.4* LYMPHS-15.1* MONOS-6.7 EOS-2.5 BASOS-0.3 [**2119-4-18**] 11:00AM CK-MB-NotDone [**2119-4-18**] 11:00AM cTropnT-0.02* [**2119-4-18**] 11:00AM CK(CPK)-53 [**2119-4-18**] 11:00AM GLUCOSE-128* UREA N-22* CREAT-0.8 SODIUM-148* POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-37* ANION GAP-10 [**2119-4-18**] 11:00AM PLT COUNT-199 [**2119-4-18**] 11:00AM PT-11.9 PTT-22.1 INR(PT)-1.0 Brief Hospital Course: A/P: Mr. [**Known lastname **] is a 63 yo male with severe COPD who presents with hypoxia . 1) COPD flare: No clear infectious trigger identified with a clear CXR, normal WBC, negative ROS. Treated with steroids, IV then to prednisone with slow taper. Plan to see NP[**Company 2316**] in week and determine whether can taper to off. 2) Diastolic heart failure: Continue lasix 40 mg daily 3) Hypertension: Continue Norvasc, Lisinopril 4) Chest wall pain, s/p chest compressions: Ibuprofen PRN 5) DM2: Glyburide, Glucophage at home. Required insulin while on higher doses of steroids, but fsbg better controlled as glucophsge restarted and prednisone tapered down. Pt told to check fsbg at home and report to his primary nurse practitioner. 6)Pneumonia: CXR c/w pneumonia, sputum with MRSA. Double coverage with Bactrim and Levofloxacin. Medications on Admission: Prednisone 10 mg QOD Albuterol MDI 2 puffs 4x/day Aledronate 70 mg PO qMonday Norvasc 5 mg daily ASA 325 mg daily Calcium + Vit D [**Hospital1 **] Colace 100 mg [**Hospital1 **] Senna 2 tabs qHS Combivent QID Flonase 50 mcg 2 sprays daily Metformin 100 mg [**Hospital1 **] Glyburide 2.5 mg QOD Lasix 40 mg daily Prilosec 20 mg [**Hospital1 **] Ranitidine 300 mg qHS Ferrous sulfate 325 mg daily Advair 250/50 [**Hospital1 **] Ibuprofen 600 mg TID:PRN Lisinopril 20 mg daily Lumigan OU daily Vitamin B12 1000 mcg qmonth Discharge Medications: 1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Simvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 7. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QMON (every Monday). 8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID W/ MEALS (). 9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain. 14. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 15. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 3 days. Disp:*6 Tablet(s)* Refills:*0* 16. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 18. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO twice a day. 19. Prednisone 10 mg Tablet Sig: 1-3 Tablets PO once a day: Take 30 mg [**4-25**], then Prednisone 20 mg per day until you see your nurse [**5-2**]. Disp:*30 Tablet(s)* Refills:*0* 20. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 3 days. Disp:*3 Tablet(s)* Refills:*0* 21. Albuterol 90 mcg/Actuation Aerosol Sig: One (1) inhalation Inhalation every 4-6 hours as needed for shortness of breath or wheezing. Disp:*1 inhaler* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: COPD flare pneumonia Discharge Condition: stable Discharge Instructions: Please continue your steroids (prednisone) until you see your nurse at [**Hospital6 733**]. She will let you know how much longer you need to take the prednisone. Please continue the antibiotics until completed. Call your PCP with increased shortness of breath. Followup Instructions: Provider: [**First Name8 (NamePattern2) 1238**] [**Last Name (NamePattern1) 1239**] [**Name8 (MD) **], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 250**] Date/Time:[**2119-5-2**] 10:00 Provider: [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Date/Time:[**2119-5-29**] 2:00 [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**] Completed by:[**2119-4-28**] Name: [**Known lastname **],[**Known firstname 77**] Unit No: [**Numeric Identifier 17962**] Admission Date: [**2119-4-18**] Discharge Date: [**2119-4-24**] Date of Birth: [**2056-4-16**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 12246**] Addendum: MRSA pneumonia: Pt treated for MRSA pneumonia based on clinical evidence of pneumonia and sputum with MRSA on cx. Treated with Bactrim. Discharge Disposition: Home With Service Facility: [**Hospital 136**] Homecare [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 12247**] Completed by:[**2119-5-6**]

482,491,428,V025,V090,V462,305,250,562,266,278,799,401

{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Chronic diastolic heart failure,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins,Other dependence on machines, supplemental oxygen,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Diverticulosis of colon (without mention of hemorrhage),Other B-complex deficiencies,Obesity, unspecified,Hypoxemia,Benign 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: "My VNA found me at 65%" PRESENT ILLNESS: Mr. [**Known lastname **] is a 63 yo male with severe COPD on home oxygen, s/p recent PEA arrest, referred to the ED by his VNA. Per his report, his visiting nurse found him satting 65% on his supplemental O2. He states that his sat rose to 81% with "some exercises." He states that he felt extremely short of breath at the time but is unable to identify any precipitating event. He states that he felt sluggish that morning and had returned to bed, but was up out of bed by the time his VNA arrived. He denies any fever or chills or rigors. He has had a productive cough for several months, which he distinguishes from his baseline "smokers cough." He reports that it is occasionally productive of deep green sputum. He states that his coughing has been limited by chest wall pain since he underwent CPR 2 weeks ago. He was recently seen by the NP[**Company 2316**] on [**4-13**] and was prescribed a steroid taper for a COPD flare at that visit; he states that he did not take this taper as prescribed. He continues to smoke [**4-18**] cigarettes per day. In the ED, he received combivent nebs x3, azithromycin 500 mg PO, ceftriaxone 1 g IV, ASA 325 mg, and prednisone 60 mg PO. MEDICAL HISTORY: 1. COPD- on home O2 (3L), FEV1 22% predicted, FEV1/FVC ratio 43% predicted, last intubated 3 years ago. followed by Pulm 2. Tobacco Abuse 3. DM II 4. Diverticulosis 5. h/o SBO 6. C6-C7 HERNITATION 7. B12 Deficiency- on monthly injections 8. Obesity MEDICATION ON ADMISSION: Prednisone 10 mg QOD Albuterol MDI 2 puffs 4x/day Aledronate 70 mg PO qMonday Norvasc 5 mg daily ASA 325 mg daily Calcium + Vit D [**Hospital1 **] Colace 100 mg [**Hospital1 **] Senna 2 tabs qHS Combivent QID Flonase 50 mcg 2 sprays daily Metformin 100 mg [**Hospital1 **] Glyburide 2.5 mg QOD Lasix 40 mg daily Prilosec 20 mg [**Hospital1 **] Ranitidine 300 mg qHS Ferrous sulfate 325 mg daily Advair 250/50 [**Hospital1 **] Ibuprofen 600 mg TID:PRN Lisinopril 20 mg daily Lumigan OU daily Vitamin B12 1000 mcg qmonth ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Mother and Father died of lung cancer in their 60s, sister just recently died at age 50s from lung CA, daughter with cystic fibrosis SOCIAL HISTORY: Pt is married and lives with wife and 2 of his children. He is currently umemployed- former restaurant manager Tob: smokes [**6-20**] cigs/day, used to smoke 5PPD for 50 years, cut down 3 years ago EtOH: last drink over [**Holiday 944**], used to drink heavily Drugs: no IV drug use, no other illicits ### Response: {'Methicillin susceptible pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Chronic diastolic heart failure,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms resistant to penicillins,Other dependence on machines, supplemental oxygen,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Diverticulosis of colon (without mention of hemorrhage),Other B-complex deficiencies,Obesity, unspecified,Hypoxemia,Benign essential hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname **] is a 43-year-old male with a past medical history of chronic hepatitis B and metastatic hepatocellular carcinoma who presented to the [**Location (un) 5871**] Emergency Room on [**11-11**] after four episodes of hematemesis. He described the vomitus as bright red blood with some clots, possibly also with some coffee ground. He state through a translator that he had had one episode of hematemesis one year ago, was admitted briefly to an outside hospital, and then was discharged on some unknown medicines. He has never had an upper endoscopy. He denied any chest pain or pressure. He had some shortness of breath associated with the vomiting. He also had some lightheadedness. He denied bright red blood per rectum or melena. MEDICAL HISTORY: Chronic hepatitis B, poorly differentiated hepatoma by liver biopsy with metastases to the right adrenal gland, extensive metastases to the lung, and direct invasion of the superior vena cava. Thrombocytopenia. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Strong family history of hepatoma (both parents and two brothers deceased of hepatoma). SOCIAL HISTORY: The patient lives with his wife and 10-year-old son. [**Name (NI) **] is originally from [**Country 5142**].

Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia

Portal hypertension,Bleed esoph var oth dis,Mal neo liver, primary,Secondary malig neo lung,Second malig neo adrenal,Hpt B chrn wo cm wo dlta,Thrombocytopenia NOS,Hyposmolality

Admission Date: [**2187-11-11**] Discharge Date: [**2187-11-19**] Date of Birth: [**2144-6-10**] Sex: M Service: Medicine HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname **] is a 43-year-old male with a past medical history of chronic hepatitis B and metastatic hepatocellular carcinoma who presented to the [**Location (un) 5871**] Emergency Room on [**11-11**] after four episodes of hematemesis. He described the vomitus as bright red blood with some clots, possibly also with some coffee ground. He state through a translator that he had had one episode of hematemesis one year ago, was admitted briefly to an outside hospital, and then was discharged on some unknown medicines. He has never had an upper endoscopy. He denied any chest pain or pressure. He had some shortness of breath associated with the vomiting. He also had some lightheadedness. He denied bright red blood per rectum or melena. PAST MEDICAL HISTORY: Chronic hepatitis B, poorly differentiated hepatoma by liver biopsy with metastases to the right adrenal gland, extensive metastases to the lung, and direct invasion of the superior vena cava. Thrombocytopenia. MEDICATIONS: On admission, Vicodin 1-2 tablets q 4-6 hours prn pain and Chinese herbal medicine. ALLERGIES: No known drug allergies. FAMILY HISTORY: Strong family history of hepatoma (both parents and two brothers deceased of hepatoma). SOCIAL HISTORY: The patient lives with his wife and 10-year-old son. [**Name (NI) **] is originally from [**Country 5142**]. PHYSICAL EXAMINATION: A fatigued appearing male. Vital signs afebrile. Blood pressure 110/60, pulse 110 to 120, sat 97-99% on room air. HEENT: Pupils are equal, round, and reactive to light, mild scleral icterus. Oropharynx with dry blood in the oropharynx. Cardiac, sinus tachycardia, grade 2/6 systolic murmur at the left sternal border, no increase in JVP. Lungs clear to auscultation with decreased breath sounds at the bases bilaterally. Abdomen, distended with bowel sounds present, nontender. Extremities, 2+ pulses, dorsalis pedis bilaterally without edema. Neurologic, alert and oriented times three, moving all extremities spontaneously. LABORATORY DATA: On admission, white blood cell count 6.8, hematocrit 31.3, platelet count 92,000, PT 14.1, PTT 31.6, INR 1.4, sodium 137, potassium 5.6 (hemolyzed), chloride 106, CO2 26, BUN 12, creatinine 0.6, glucose 117. Labs from [**11-9**], LDH 734, alkaline phosphatase 282, total bilirubin 1.7, alpha fetoprotein 67.2 (29.3 on [**2187-9-28**]). MRI of the abdomen from [**2187-9-10**], 11 by 9 by 8 cm lesion in the liver, non occlusive thrombus in the right portal vein, tumor throughout right adrenal gland with invasion to the inferior vena cava, multiple pulmonary nodules. Pathology, biopsy [**2187-9-4**] of liver mass showed poorly differentiated malignant tumor with marked fibrosis and focal nodules suggesting likely cirrhosis. EGD from [**2187-8-19**], grade 2 varices in the mid and distal esophagus. HOSPITAL COURSE: 1. GI: The patient was admitted to the Intensive Care Unit at [**Hospital1 69**] on [**2187-11-11**] and underwent urgent upper endoscopy which showed varices of the upper, middle and lower thirds of the esophagus as well as blood in the stomach. Six bands were successfully placed during the procedure. The patient was then started on Protonix 40 mg po bid and Octreotide drip over the next several days per the GI service. He had no further episodes of hematemesis and his hematocrit remained stable. On [**11-15**] the patient underwent a repeat upper endoscopy which showed no active bleeding from the esophageal varices. The patient was transferred from the Intensive Care Unit to the floor on [**2187-11-12**]. In terms of the patient's hepatocellular carcinoma, the oncology staff unfortunately was not able to offer any further chemotherapeutic options for Mr. [**Known lastname **] cancer as it was widely metastatic. ......... [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D. [**MD Number(1) 3475**] Dictated By:[**Last Name (NamePattern1) 737**] MEDQUIST36 D: [**2187-11-17**] 13:21 T: [**2187-11-19**] 21:46 JOB#: [**Job Number 27851**] Name: [**Known lastname **], [**Known firstname **] [**Doctor Last Name 909**] Unit No: [**Numeric Identifier 4828**] Admission Date: [**2187-11-11**] Discharge Date: [**2187-11-19**] Date of Birth: [**2144-6-10**] Sex: M Service: HOSPITAL COURSE: Gastrointestinal: The patient was admitted to the Intensive Care Unit to the [**Hospital1 536**] on [**11-11**] with a diagnosis of upper gastrointestinal bleeding. He underwent urgent upper endoscopy which showed variceal varices were banded with six bands. He was transfused with two units of packed red blood cells. He was also started on Protonix IV and octreotide drip for 72 hours. Following the procedure, his hematocrit remained stable throughout the admission (range 29-30). A repeat upper endoscopy on [**11-15**] showed no active bleeding. At the banding in [**1-6**] weeks time with either Dr. [**Last Name (STitle) 3575**] or Dr. [**Last Name (STitle) 4829**]. The patient is to call [**Telephone/Fax (1) 906**] to schedule the procedure. Propanolol was added to the medical regimen to decrease the risk of re-bleeding from the varices. In terms of the patient's hepatocellular carcinoma which was known to be metastatic, the patient was evaluated by his oncologist, Dr. [**First Name (STitle) **], and unfortunately, no further therapy was recommended. The patient's family inquired about the use of thalidomide, however, according to Dr. [**First Name (STitle) **], thalidomide was not considered appropriate in Mr. [**Known lastname 4830**] situation. As such, the hepatocellular carcinoma was managed symptomatically with emphasis given to controlling Mr. [**Known lastname 4830**] pain and lower extremity edema. This was accomplished with pain medications including a Fentanyl patch 50 mcg/hour with Dilaudid for breakthrough pain. The lower extremity edema was modestly controlled with diuretics including Lasix and aldactone as well as compression stockings and lower extremity elevation. The medical team was concerned during admission that attempts to reduce the lower extremity edema might be limited if the edema resulted from a thrombus or tumor thrombus of the portal vein or inferior vena cava. It was also considered that the edema may have been due to ascites and worsening hepatic failure. In terms of the patient's hepatitis B, no therapy was initiated during this admission. Pulmonary: The patient remained stable from a pulmonary standpoint. He had no subjective shortness of breath, had good room air oxygen saturations and did not require oxygen. Because of the patient's decreased breath sounds on examination, he received a chest x-ray on [**11-13**], which showed diffuse pulmonary metastases, bilateral pleural effusions right greater than left, and right middle lobe, and right lower lobe consolidation versus collapse. Cardiovascular: The patient remained cardiovascularly stable during the admission. Pulse ranged from the 80s to high 90s. Blood pressure systolic ranged 90s-100s, and diastolic ranged from 50-70s. Nutrition: Patient was allowed to eat as tolerated and mainly had a diet consisting of broth, noodles, and rice. Nutrition service was also consulted to make recommendations for nutritional supplements. DISPOSITION: A meeting with the patient, his family, and the medical team was held on [**11-14**] to discuss a care plan. The patient was informed of his poor prognosis and the available medical interventions. After discussion with his family, he decided to become comfort care/DNR/DNI, but indicated his preference to return to the hospital should he experience additional esophageal-variceal bleeding. Return to the hospital for treatment of esophageal-variceal bleeding should it recur. He indicated his preference to go home with home services. Hospice was addressed with him but gien the potential need for intervention for GI BLeed while he is still fairly functional, this was deferred till later and he remains DNR/DNI only. As his cancer progresses and his disease worsens this will be broached with him again. Arrangements at the time of this dictation have been made. Mr. [**Known lastname 4830**] care at home will be coordinated by Dr. [**First Name (STitle) 4831**] [**Name (STitle) **] at [**Telephone/Fax (1) 4832**]. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSES: 1. Metastatic hepatocellular carcinoma. 2. Hepatitis B. 3. Grade III esophageal varices. DISCHARGE STATUS: To home with home hospice services. DIET: As tolerated with nutritional supplements. ACTIVITY: As tolerated; continue lower extremity elevation, compression stockings, ambulation. DISCHARGE MEDICATIONS: 1. Protonix 40 mg po bid. 2. Lasix 120 mg po q day. 3. Propanolol 20 mg po bid. 4. Aldactone 50 mg po q day. 5. Colace 100 mg po bid. 6. Lactulose 15-30 cc po q six hours as needed for constipation. 7. Simethicone 80 mg po qid. 8. Fentanyl 50 mcg per hour topical patch, change q 72 hours, hold for respiratory rate less than 10. 9. Dilaudid 2-4 mg po q six hours prn breakthrough pain. 10. Ativan 1-2 mg po q 6-8 hours prn anxiety, nausea. 11. Compazine 10 mg po q 4-6 hours prn nausea. FOLLOWUP: The patient is to followup with Dr. [**First Name (STitle) 4831**] [**Name (STitle) **] again at [**Telephone/Fax (1) 4832**], and Dr. [**Last Name (STitle) **] will coordinate the [**Hospital 1325**] hospice care and make changes to his medication regimen as needed. [**Name6 (MD) **] [**Last Name (NamePattern4) 424**], M.D. [**MD Number(1) 425**] Dictated By:[**Last Name (NamePattern1) 30**] MEDQUIST36 D: [**2187-11-20**] 11:12 T: [**2187-11-20**] 11:44 JOB#: [**Job Number 4833**]

572,456,155,197,198,070,287,276

{'Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia'}

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: Mr. [**Known lastname **] is a 43-year-old male with a past medical history of chronic hepatitis B and metastatic hepatocellular carcinoma who presented to the [**Location (un) 5871**] Emergency Room on [**11-11**] after four episodes of hematemesis. He described the vomitus as bright red blood with some clots, possibly also with some coffee ground. He state through a translator that he had had one episode of hematemesis one year ago, was admitted briefly to an outside hospital, and then was discharged on some unknown medicines. He has never had an upper endoscopy. He denied any chest pain or pressure. He had some shortness of breath associated with the vomiting. He also had some lightheadedness. He denied bright red blood per rectum or melena. MEDICAL HISTORY: Chronic hepatitis B, poorly differentiated hepatoma by liver biopsy with metastases to the right adrenal gland, extensive metastases to the lung, and direct invasion of the superior vena cava. Thrombocytopenia. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Strong family history of hepatoma (both parents and two brothers deceased of hepatoma). SOCIAL HISTORY: The patient lives with his wife and 10-year-old son. [**Name (NI) **] is originally from [**Country 5142**]. ### Response: {'Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia'}

CHIEF COMPLAINT: confusion PRESENT ILLNESS: 54 year old man with DM1 complicated by gastroparesis/neuropathy, ESRD s/p renal transplant in [**2119**] now on PD, CAD s/p IMI with stent, CHF with EF 45% who presents with dehydration, L foot infection, and confusion. The patient was admitted for sepsis in [**Month (only) 359**] and d/c'd on Keflex. He had sudden onset of weakness and chills. He denied fevers cp sob or abd pain. He did have some nausea, that is normal for him following PD. He had been off plavix for 2-3 days for recent nose bleeds. In the [**Name (NI) **], pt's initial vitals were T98.6, P93, BP80/51, RR 23, O2 sat 97%. His blood sugars remained in the 70s/40s with BS 40. His blood pressures did not respond to 2x1L IVF boluses and he was started on levophed. He was cultured and then started on Ceftriaxone 1gm IV x 1, Vancoymcin 1gm IV x 1. He was later given Zosyn for pseudomonas coverage. Given his Hct drop to 21, he was type and crossed for 4 units. FAST ultrasound showed no pericardial effusion, some abdominal fluid. He had a Pt was also intubated for airway protection/unresponsiveness. During intubation, wife reported new right-sided tooth fracture. He was ventilated on 550x14, PEEP 5 with fent/midaz for sedation. A sepsis line was placed in the right IJ vein. He had elevated cardiac enzymes and lateral wall ST depressions and was given ASA 325mg PO x 1. He was given 10 mg decadron for h/o adrenal insufficiency. On exam, he had bilateral pitting edema that had been resolving, but his left 3rd toe was dusky. It had no signal on doppler or pleth and vascular was consulted. They will see him in the ICU. Prior to transfer, VS 98 132/75 (on levo) 86 14 100% (intubated). Of note, the patient had been DNI, but his wife [**Name (NI) 19490**] this in the [**Name (NI) **]. He is now full code. . In the ICU, he was intubated and sedated. . Review of systems: Unable to obtain MEDICAL HISTORY: # Insulin dependent diabetes type I - complications of neuropathy, retinopathy, gastroparesis (somewhat responsive to erthromycin) # Renal transplant, [**2119**], now on PD since [**5-27**] - followed by Dr [**First Name (STitle) 805**] # CAD - 3VD, DES to OM [**3-26**], following MI (deferred placing multiple stents d/t excessive dye load in setting of renal insufficiency). # Systolic CHF: ECHO from [**1-25**]--EF 45-50%, akinesis of basal inferior wall and hypokinese of the mid and basal inferolateral wall. # Polycythemia [**Doctor First Name **] # PVD # HTN # h/o Osteomyelitis of R 5th metatarsal in [**2128**] # Eosinophilic gastritis # Stoke in [**2123**] with right hand weakness, resolved on its own MEDICATION ON ADMISSION: Sevelamer HCl 800 mg TID W/ [**Known lastname **] Clopidogrel 75 mg Daily Prednisone 5 mg Daily Cyclosporine 25 mg daily Metoprolol Succinate 25 mg SR daiyl Aspirin 81 mg Daily Simvastatin 80 mg Daily Calcitriol 0.5 mcg Daily Lantus 20u qAM ISS ALLERGIES: Reglan / Protonix PHYSICAL EXAM: Exam on admission. Vitals: afebrile, 56, 91/42, 16, 100% Gen: Sedated, intubated Eyes: No conjunctival pallor. No icterus. ENT: MM. OP clear. CV: JVP not assessable. Normal carotid upstroke without bruits. PMI in 5th intercostal space, mid clavicular line. RR. Distant S1, S2. No appreciable murmurs, rubs, clicks, or gallops. LUNGS: Mechanical breath sounds anteriorly, no obvious wheeze, rhonchi or rales ABD: NABS. Soft, ND. No HSM. Abdominal aorta was not enlarged by palpation. No abdominal bruits. Heme/Lymph/Immune: No CCE, no cervical lymphadenopathy. SKIN: R heel ulcer, L 2nd toe ulcer NEURO: Sedated, intubated FAMILY HISTORY: One sister has a congenital [**Last Name 4006**] problem. Mother and another sister with bipolar disorder on lithium. SOCIAL HISTORY: Patient lives with his wife. [**Name (NI) **] is a retired auto mechanic. Per wife, no smoking, alcohol, and any illicit drug use.

Methicillin susceptible Staphylococcus aureus septicemia,End stage renal disease,Acute respiratory failure,Cardiogenic shock,Acidosis,Chronic systolic heart failure,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Intestinal infection due to Clostridium difficile,Glucocorticoid deficiency,Severe sepsis,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Polycythemia vera,Eosinophilic gastritis, without mention of hemorrhage,Other hammer toe (acquired),Obesity, unspecified,Long-term (current) use of insulin,Renal dialysis status,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Meth susc Staph aur sept,End stage renal disease,Acute respiratry failure,Cardiogenic shock,Acidosis,Chr systolic hrt failure,Ulcer other part of foot,Ac osteomyelitis-ankle,Hyp kid NOS w cr kid V,Kidney transplant status,Int inf clstrdium dfcile,Glucocorticoid deficient,Severe sepsis,DMI circ nt st uncntrld,Gastroparesis,Neuropathy in diabetes,Diabetic retinopathy NOS,Crnry athrscl natve vssl,Old myocardial infarct,Periph vascular dis NOS,Polycythemia vera,Eosinophil gastrt wo hem,Other hammer toe,Obesity NOS,Long-term use of insulin,Renal dialysis status,Status-post ptca,Hx TIA/stroke w/o resid

Admission Date: [**2135-1-29**] Discharge Date: [**2135-2-4**] Date of Birth: [**2080-11-23**] Sex: M Service: MEDICINE Allergies: Reglan / Protonix Attending:[**First Name3 (LF) 6195**] Chief Complaint: confusion Major Surgical or Invasive Procedure: left second toe amputation. History of Present Illness: 54 year old man with DM1 complicated by gastroparesis/neuropathy, ESRD s/p renal transplant in [**2119**] now on PD, CAD s/p IMI with stent, CHF with EF 45% who presents with dehydration, L foot infection, and confusion. The patient was admitted for sepsis in [**Month (only) 359**] and d/c'd on Keflex. He had sudden onset of weakness and chills. He denied fevers cp sob or abd pain. He did have some nausea, that is normal for him following PD. He had been off plavix for 2-3 days for recent nose bleeds. In the [**Name (NI) **], pt's initial vitals were T98.6, P93, BP80/51, RR 23, O2 sat 97%. His blood sugars remained in the 70s/40s with BS 40. His blood pressures did not respond to 2x1L IVF boluses and he was started on levophed. He was cultured and then started on Ceftriaxone 1gm IV x 1, Vancoymcin 1gm IV x 1. He was later given Zosyn for pseudomonas coverage. Given his Hct drop to 21, he was type and crossed for 4 units. FAST ultrasound showed no pericardial effusion, some abdominal fluid. He had a Pt was also intubated for airway protection/unresponsiveness. During intubation, wife reported new right-sided tooth fracture. He was ventilated on 550x14, PEEP 5 with fent/midaz for sedation. A sepsis line was placed in the right IJ vein. He had elevated cardiac enzymes and lateral wall ST depressions and was given ASA 325mg PO x 1. He was given 10 mg decadron for h/o adrenal insufficiency. On exam, he had bilateral pitting edema that had been resolving, but his left 3rd toe was dusky. It had no signal on doppler or pleth and vascular was consulted. They will see him in the ICU. Prior to transfer, VS 98 132/75 (on levo) 86 14 100% (intubated). Of note, the patient had been DNI, but his wife [**Name (NI) 19490**] this in the [**Name (NI) **]. He is now full code. . In the ICU, he was intubated and sedated. . Review of systems: Unable to obtain Past Medical History: # Insulin dependent diabetes type I - complications of neuropathy, retinopathy, gastroparesis (somewhat responsive to erthromycin) # Renal transplant, [**2119**], now on PD since [**5-27**] - followed by Dr [**First Name (STitle) 805**] # CAD - 3VD, DES to OM [**3-26**], following MI (deferred placing multiple stents d/t excessive dye load in setting of renal insufficiency). # Systolic CHF: ECHO from [**1-25**]--EF 45-50%, akinesis of basal inferior wall and hypokinese of the mid and basal inferolateral wall. # Polycythemia [**Doctor First Name **] # PVD # HTN # h/o Osteomyelitis of R 5th metatarsal in [**2128**] # Eosinophilic gastritis # Stoke in [**2123**] with right hand weakness, resolved on its own Social History: Patient lives with his wife. [**Name (NI) **] is a retired auto mechanic. Per wife, no smoking, alcohol, and any illicit drug use. Family History: One sister has a congenital [**Last Name 4006**] problem. Mother and another sister with bipolar disorder on lithium. Physical Exam: Exam on admission. Vitals: afebrile, 56, 91/42, 16, 100% Gen: Sedated, intubated Eyes: No conjunctival pallor. No icterus. ENT: MM. OP clear. CV: JVP not assessable. Normal carotid upstroke without bruits. PMI in 5th intercostal space, mid clavicular line. RR. Distant S1, S2. No appreciable murmurs, rubs, clicks, or gallops. LUNGS: Mechanical breath sounds anteriorly, no obvious wheeze, rhonchi or rales ABD: NABS. Soft, ND. No HSM. Abdominal aorta was not enlarged by palpation. No abdominal bruits. Heme/Lymph/Immune: No CCE, no cervical lymphadenopathy. SKIN: R heel ulcer, L 2nd toe ulcer NEURO: Sedated, intubated Exam on discharge: VS - T 128/77 HR 73 RR 13 O2-sat % RA GENERAL - pleasant man in NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, dry MM, OP clear NECK - supple, no thyromegaly, no JVD, no carotid bruits LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - PMI non-displaced, RRR, no MRG, nl S1-S2, S3 ABDOMEN - NABS, soft/NT, distended, PD catheter in place C/D/I, no rebound/guarding EXTREMITIES - warm, no c/c/e, s/p 2nd toe amputation with wound vac in place; 3rd nail bed necrotic SKIN - no rashes or lesions LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**6-22**] throughout, Did not test dorsiflexion/plantar flexion, able to wiggle toes, decreased sensation in L4 distribution on Left, normal sensation to light touch and proprioception otherwise, did not ambulate patient, dressing to left foot C.D.I. Pertinent Results: [**2135-1-29**] 09:34PM TYPE-[**Last Name (un) **] TEMP-36.7 RATES-/14 TIDAL VOL-500 PEEP-5 O2-40 PO2-43* PCO2-37 PH-7.32* TOTAL CO2-20* BASE XS--6 INTUBATED-INTUBATED VENT-CONTROLLED [**2135-1-29**] 09:34PM LACTATE-1.5 [**2135-1-29**] 09:34PM O2 SAT-70 [**2135-1-29**] 09:22PM CK(CPK)-380* [**2135-1-29**] 09:22PM CK-MB-12* MB INDX-3.2 cTropnT-0.95* [**2135-1-29**] 09:22PM WBC-7.3 RBC-2.28* HGB-6.6* HCT-20.0* MCV-88 MCH-28.9 MCHC-32.9 RDW-17.7* [**2135-1-29**] 09:22PM PLT COUNT-208 [**2135-1-29**] 09:00PM ASCITES WBC-30* RBC-35* POLYS-11* LYMPHS-37* MONOS-50* MESOTHELI-2* [**2135-1-29**] 06:18PM TYPE-MIX PO2-128* PCO2-29* PH-7.32* TOTAL CO2-16* BASE XS--9 COMMENTS-GREEN TOP [**2135-1-29**] 06:18PM GLUCOSE-100 LACTATE-2.7* [**2135-1-29**] 06:18PM O2 SAT-97 [**2135-1-29**] 05:43PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.017 [**2135-1-29**] 05:43PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-500 GLUCOSE-100 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2135-1-29**] 05:43PM URINE RBC-[**4-22**]* WBC-[**7-28**]* BACTERIA-MOD YEAST-NONE EPI-0-2 TRANS EPI-0-2 [**2135-1-29**] 05:43PM URINE HYALINE-0-2 [**2135-1-29**] 04:15PM GLUCOSE-47* UREA N-64* CREAT-6.6* SODIUM-137 POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-19* ANION GAP-22 [**2135-1-29**] 04:15PM ALT(SGPT)-14 AST(SGOT)-34 CK(CPK)-194* ALK PHOS-87 TOT BILI-0.2 [**2135-1-29**] 04:15PM cTropnT-1.0* [**2135-1-29**] 04:15PM CK-MB-5 [**2135-1-29**] 04:15PM ALBUMIN-2.8* CALCIUM-7.8* PHOSPHATE-5.0* MAGNESIUM-2.0 [**2135-1-29**] 04:15PM CORTISOL-2.5 [**2135-1-29**] 04:15PM WBC-6.2 RBC-2.45*# HGB-7.0* HCT-21.7*# MCV-89 MCH-28.8 MCHC-32.5 RDW-17.6* [**2135-1-29**] 04:15PM NEUTS-61.7 LYMPHS-31.4 MONOS-3.9 EOS-1.9 BASOS-1.1 [**2135-1-29**] 04:15PM PLT COUNT-192 [**2135-1-29**] 04:15PM PT-14.3* PTT-28.4 INR(PT)-1.2* [**2135-2-4**] 06:10AM BLOOD WBC-5.7 RBC-3.27* Hgb-9.6* Hct-29.2* MCV-89 MCH-29.4 MCHC-33.0 RDW-17.0* Plt Ct-189 [**2135-2-4**] 06:10AM BLOOD Plt Ct-189 [**2135-2-4**] 06:10AM BLOOD Glucose-141* UreaN-41* Creat-5.0* Na-138 K-3.8 Cl-104 HCO3-24 AnGap-14 [**2135-2-4**] 06:10AM BLOOD Calcium-7.4* Phos-5.4* Mg-1.9 . Pathology. SPECIMEN SUBMITTED: LEFT SECOND TOE MPJ Procedure date Tissue received Report Date Diagnosed by [**2135-1-31**] [**2135-1-31**] [**2135-2-3**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/ttl Previous biopsies: [**-4/2867**] GI BX'S. [**-4/2864**] BONE DISTAL PHALANX & RIGHT ULCER. [**-4/2841**] GI BX'S. [**-4/2816**] RIGHT 5TH BONE. (and more) DIAGNOSIS: Left second toe, MPJ: - Acute osteomyelitis. - Skin with ulceration. - Bony and soft tissue margins are viable. . Foot 1. Cortical irregularity and periosteal reaction in the shaft of the proximal phalanx of the great toe, is concerning for osteomyelitis. 2. Suspected minimally impacted fracture at the base of the middle phalanx of the left second toe. 3. Continued healing of the proximal left metatarsal shaft fracture with callus formation and obscuration of the fracture line. If clinically indicated, a lateral view targeted to the second toe (the current lateral view is of the entire foot) or alternatively a CT or MRI may help to better depcit the findings in the second digit. Brief Hospital Course: Mr. [**Known lastname 10936**] was admitted with hypotension and intubated in the ED for altered mental status, though there was some report that he had throat swelling after an injection of dexamethasone. He was admitted to the MICU intubated on a small dose of norepinephrine. His norepinephrine was weaned off and his lactate/central venous O2 were noted to worsen to 3.2 and 44% so the norepinephrine was restarted. Cardiology was consulted for rising cardiac enzyems his CK peaked at 647 and troponin 1.59. Cardiology thought that this was most likely secondary to demand and given his 3vd he would not benefit from catheterization, they recommended calling cardiac surgery to redisscuss a CABG as he had been turned down for unclear reasons in the past. He had an infected toe which grew MSSA and was amputated by vascular surgery with placement of a wound vac. He was switched from vancomycin to unasyn. His mental status improved and he was extubated 2 days after admission. He was transitioned to the regular floor where he continued to do well. The wound vac was removed and the wound was sutured closed. He received wound care, with a recommendation for dry dressings and his antibioitics were switched to augmentin for a total antibiotic course of 10 days. He was seen by physical therapy, with a plan for weight bearing while wearing a post operative shoe, and continued outpatient physical therapy. He was found to be c.difficile positive in the intensive care unit. He was not having increased stool output, and it was unclear whether this was asymptomatic carriage. Given the host context, he was treated with p.o vancomycin for this. He continued to receive peritoneal dialysis. He has follow up planned with vascular surgery as well as his primary care doctor. For his Coronary Artery disease, his simvastatin was increased to 80mg daily from 20 mg daily for cardioprotective purposes while revascularization surgery continues to be considered. He was a full code during this hospitalization. Medications on Admission: Sevelamer HCl 800 mg TID W/ [**Known lastname **] Clopidogrel 75 mg Daily Prednisone 5 mg Daily Cyclosporine 25 mg daily Metoprolol Succinate 25 mg SR daiyl Aspirin 81 mg Daily Simvastatin 80 mg Daily Calcitriol 0.5 mcg Daily Lantus 20u qAM ISS Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Cyclosporine 25 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed for fungal rash. 6. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 7. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. Vancomycin 125 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 9 days. Disp:*45 Capsule(s)* Refills:*0* 9. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) injection Injection QMOWEFR (Monday -Wednesday-Friday). Disp:*30 injection* Refills:*0* 10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain : please do not drink alcohol, or perform activities that require a fast reaction time while taking this medication.[**Month (only) 116**] cause sedation. Disp:*84 Tablet(s)* Refills:*0* 11. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Sevelamer Carbonate 800 mg Tablet Sig: One (1) Tablet PO three times a day: with [**Month (only) 16429**]. 13. Lantus 100 unit/mL Cartridge Sig: Ten (10) units Subcutaneous qam. 14. insulin sliding scale Sig: dose depends on blood glucose level as needed. 15. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 4 days. Disp:*8 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 932**] Area VNA Discharge Diagnosis: Primary Toe osteomyelitis complicated by sepsis . Secondary Diabetes complicated by gastroparesis/neuropathy End Stage Renal Disease on Peritoneal Dialysis Discharge Condition: stable, good, baseline mental status, full weight bearing in post operative shoe. Discharge Instructions: You were admitted to the hospital because you had sepsis from a toe infection. The toe was amputated, and you were treated with antibiotics for the foot infection with improvement. . The following changes were made to your medications. 1. Augmentin 500mg every 12 hours for 4 days 2. Vancomycin 125mg four times a day for 9 days. 3. Simvastatin 80mg daily . Followup Instructions: Dr[**Name (NI) 11574**] office will call you to set up an appointment for the week of [**2135-2-7**]. Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2135-2-7**] 8:15 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2135-3-17**] 8:40 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 2625**] Date/Time:[**2136-1-30**] 1:00 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6198**] MD, [**MD Number(3) 6199**]

038,585,518,785,276,428,707,730,403,V420,008,255,995,250,536,357,362,414,412,443,238,535,735,278,V586,V451,V458,V125

{'Methicillin susceptible Staphylococcus aureus septicemia,End stage renal disease,Acute respiratory failure,Cardiogenic shock,Acidosis,Chronic systolic heart failure,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Intestinal infection due to Clostridium difficile,Glucocorticoid deficiency,Severe sepsis,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Polycythemia vera,Eosinophilic gastritis, without mention of hemorrhage,Other hammer toe (acquired),Obesity, unspecified,Long-term (current) use of insulin,Renal dialysis status,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: confusion PRESENT ILLNESS: 54 year old man with DM1 complicated by gastroparesis/neuropathy, ESRD s/p renal transplant in [**2119**] now on PD, CAD s/p IMI with stent, CHF with EF 45% who presents with dehydration, L foot infection, and confusion. The patient was admitted for sepsis in [**Month (only) 359**] and d/c'd on Keflex. He had sudden onset of weakness and chills. He denied fevers cp sob or abd pain. He did have some nausea, that is normal for him following PD. He had been off plavix for 2-3 days for recent nose bleeds. In the [**Name (NI) **], pt's initial vitals were T98.6, P93, BP80/51, RR 23, O2 sat 97%. His blood sugars remained in the 70s/40s with BS 40. His blood pressures did not respond to 2x1L IVF boluses and he was started on levophed. He was cultured and then started on Ceftriaxone 1gm IV x 1, Vancoymcin 1gm IV x 1. He was later given Zosyn for pseudomonas coverage. Given his Hct drop to 21, he was type and crossed for 4 units. FAST ultrasound showed no pericardial effusion, some abdominal fluid. He had a Pt was also intubated for airway protection/unresponsiveness. During intubation, wife reported new right-sided tooth fracture. He was ventilated on 550x14, PEEP 5 with fent/midaz for sedation. A sepsis line was placed in the right IJ vein. He had elevated cardiac enzymes and lateral wall ST depressions and was given ASA 325mg PO x 1. He was given 10 mg decadron for h/o adrenal insufficiency. On exam, he had bilateral pitting edema that had been resolving, but his left 3rd toe was dusky. It had no signal on doppler or pleth and vascular was consulted. They will see him in the ICU. Prior to transfer, VS 98 132/75 (on levo) 86 14 100% (intubated). Of note, the patient had been DNI, but his wife [**Name (NI) 19490**] this in the [**Name (NI) **]. He is now full code. . In the ICU, he was intubated and sedated. . Review of systems: Unable to obtain MEDICAL HISTORY: # Insulin dependent diabetes type I - complications of neuropathy, retinopathy, gastroparesis (somewhat responsive to erthromycin) # Renal transplant, [**2119**], now on PD since [**5-27**] - followed by Dr [**First Name (STitle) 805**] # CAD - 3VD, DES to OM [**3-26**], following MI (deferred placing multiple stents d/t excessive dye load in setting of renal insufficiency). # Systolic CHF: ECHO from [**1-25**]--EF 45-50%, akinesis of basal inferior wall and hypokinese of the mid and basal inferolateral wall. # Polycythemia [**Doctor First Name **] # PVD # HTN # h/o Osteomyelitis of R 5th metatarsal in [**2128**] # Eosinophilic gastritis # Stoke in [**2123**] with right hand weakness, resolved on its own MEDICATION ON ADMISSION: Sevelamer HCl 800 mg TID W/ [**Known lastname **] Clopidogrel 75 mg Daily Prednisone 5 mg Daily Cyclosporine 25 mg daily Metoprolol Succinate 25 mg SR daiyl Aspirin 81 mg Daily Simvastatin 80 mg Daily Calcitriol 0.5 mcg Daily Lantus 20u qAM ISS ALLERGIES: Reglan / Protonix PHYSICAL EXAM: Exam on admission. Vitals: afebrile, 56, 91/42, 16, 100% Gen: Sedated, intubated Eyes: No conjunctival pallor. No icterus. ENT: MM. OP clear. CV: JVP not assessable. Normal carotid upstroke without bruits. PMI in 5th intercostal space, mid clavicular line. RR. Distant S1, S2. No appreciable murmurs, rubs, clicks, or gallops. LUNGS: Mechanical breath sounds anteriorly, no obvious wheeze, rhonchi or rales ABD: NABS. Soft, ND. No HSM. Abdominal aorta was not enlarged by palpation. No abdominal bruits. Heme/Lymph/Immune: No CCE, no cervical lymphadenopathy. SKIN: R heel ulcer, L 2nd toe ulcer NEURO: Sedated, intubated FAMILY HISTORY: One sister has a congenital [**Last Name 4006**] problem. Mother and another sister with bipolar disorder on lithium. SOCIAL HISTORY: Patient lives with his wife. [**Name (NI) **] is a retired auto mechanic. Per wife, no smoking, alcohol, and any illicit drug use. ### Response: {'Methicillin susceptible Staphylococcus aureus septicemia,End stage renal disease,Acute respiratory failure,Cardiogenic shock,Acidosis,Chronic systolic heart failure,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Intestinal infection due to Clostridium difficile,Glucocorticoid deficiency,Severe sepsis,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Peripheral vascular disease, unspecified,Polycythemia vera,Eosinophilic gastritis, without mention of hemorrhage,Other hammer toe (acquired),Obesity, unspecified,Long-term (current) use of insulin,Renal dialysis status,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}

CHIEF COMPLAINT: OSH Transfer PRESENT ILLNESS: (per [**Hospital6 33**] Records and pt) 83F with history of NSTEMI ([**6-22**]) and CHF who originally presented to [**Hospital1 34**] on [**9-4**] with hypertensive urgency and florid CHF. She had been feeling slightly "under the weather" all day, and then while taking her evening medications developed sudden onset SOB and diaphoresis with out any CP or chest pressure. She states that this episode was identical to her NSTEMI in [**6-22**]. She pushed her Lifeline; EMS gave her Lasix 80 mg IV and SL ntg x3. . In the OSH ED she was hypertensive to 187/102, HR 98. CXR was consistent with decompensated heart failure. EKG revealed Lateral ST depressions (old) and TWI in V2-V4 (new) (per report; ekg not available fore review on admission). . OSH course: She ruled in for MI, with peak CK of 206, MB 24, Troponin 0.6. pro BNP was elevated at 1605. Her hospital course was complicated by 2 episodes of symptomatic bradycardia to the 40s with 3 second pauses associated with presyncope ([**9-7**] and [**9-8**]). Carvedilol was discontinued. . She was transferred to [**Hospital1 18**] for consideration of cath. . On admission to [**Hospital1 18**], she feels well and has no complaints. She notes that her chronic LLE edema has resolved since being on bedsrest in the hospital. No CP/SOB/fevers/chills/urinary sx/cough/DOE/PND/ orthopnea. MEDICAL HISTORY: NSTEMI [**6-22**], declined cath, medical management Systolic CHF with LVEF 40%, apical akiniesis, septal HK Mild MR, Mild TR Moderate AS Hypertension Hyperlipidemia ?CRI (b/l Cr 1.6 per OSH- though Cr =1 [**6-22**]) Open angle glaucoma Cataracts Anxiety Hearing loss MEDICATION ON ADMISSION: MEDICATIONS AT HOME: Dorzolamide-Timolol 2-0.5 % 1 Drop [**Hospital1 **] Aspirin 325 mg Tablet EC Atorvastatin 40 mg daily Carvedilol 12.5 mg [**Hospital1 **] Isosorbide Mononitrate SR 30 mg qday Lisinopril 7.5 mg DAILY Furosemide 20 mg qday Latanoprost 0.005 % Drops 1 Drop HS . MEDICATIONS ON TRANSFER: -Heparin gtt -Plavix 75 mg qday -Aspirin -Premedication for dye allergy: Prednisone 30 mg q6H, Benadryl 25 mg q6h, Zantac 150 mg q6h -Lisinopril 10 mg qday -Lipitor 40 mg qday -Imdur 30 mg qday -PRN Lasix -Cosopt 2 drops [**Hospital1 **] -Xalatan 0.005% 1 drop [**Hospital1 **] ALLERGIES: Shellfish / Heparin Agents PHYSICAL EXAM: VS: T 98.6 BP 166/80 HR 85 RR 18 O2 96% RA Gen: WDWN eldery female 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. FAMILY HISTORY: both parents had CAD SOCIAL HISTORY: The patient is widowed, and lives alone in [**Location (un) **], MA. Her daughter lives nearby in [**Name (NI) 38640**] and she has a son who lives in Main. She is a past smoker who quit many years ago, she used to smoke 1 pack per day of tobbacco. She denies any history of alcohol or introvenous drug use.

Acute myocardial infarction of other anterior wall, initial episode of care,Acute on chronic systolic heart failure,Hematoma complicating a procedure,Cardiogenic shock,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anticoagulants causing adverse effects in therapeutic use

AMI anterior wall, init,Ac on chr syst hrt fail,Hematoma complic proc,Cardiogenic shock,Acute kidney failure NOS,Surg compl-heart,Urin tract infection NOS,Crnry athrscl natve vssl,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Adv eff anticoagulants

Admission Date: [**2143-9-8**] Discharge Date: [**2143-9-30**] Service: CARDIOTHORACIC Allergies: Shellfish / Heparin Agents Attending:[**First Name3 (LF) 1505**] Chief Complaint: OSH Transfer Major Surgical or Invasive Procedure: Intra-aortic balloon pump. Femoral artery repair-- rt side cardiac catherization. CABG x 3 (LIMA -> LAD, SVG -> OM, SVG -> PDA) History of Present Illness: (per [**Hospital6 33**] Records and pt) 83F with history of NSTEMI ([**6-22**]) and CHF who originally presented to [**Hospital1 34**] on [**9-4**] with hypertensive urgency and florid CHF. She had been feeling slightly "under the weather" all day, and then while taking her evening medications developed sudden onset SOB and diaphoresis with out any CP or chest pressure. She states that this episode was identical to her NSTEMI in [**6-22**]. She pushed her Lifeline; EMS gave her Lasix 80 mg IV and SL ntg x3. . In the OSH ED she was hypertensive to 187/102, HR 98. CXR was consistent with decompensated heart failure. EKG revealed Lateral ST depressions (old) and TWI in V2-V4 (new) (per report; ekg not available fore review on admission). . OSH course: She ruled in for MI, with peak CK of 206, MB 24, Troponin 0.6. pro BNP was elevated at 1605. Her hospital course was complicated by 2 episodes of symptomatic bradycardia to the 40s with 3 second pauses associated with presyncope ([**9-7**] and [**9-8**]). Carvedilol was discontinued. . She was transferred to [**Hospital1 18**] for consideration of cath. . On admission to [**Hospital1 18**], she feels well and has no complaints. She notes that her chronic LLE edema has resolved since being on bedsrest in the hospital. No CP/SOB/fevers/chills/urinary sx/cough/DOE/PND/ orthopnea. Past Medical History: NSTEMI [**6-22**], declined cath, medical management Systolic CHF with LVEF 40%, apical akiniesis, septal HK Mild MR, Mild TR Moderate AS Hypertension Hyperlipidemia ?CRI (b/l Cr 1.6 per OSH- though Cr =1 [**6-22**]) Open angle glaucoma Cataracts Anxiety Hearing loss Social History: The patient is widowed, and lives alone in [**Location (un) **], MA. Her daughter lives nearby in [**Name (NI) 38640**] and she has a son who lives in Main. She is a past smoker who quit many years ago, she used to smoke 1 pack per day of tobbacco. She denies any history of alcohol or introvenous drug use. Family History: both parents had CAD Physical Exam: VS: T 98.6 BP 166/80 HR 85 RR 18 O2 96% RA Gen: WDWN eldery female 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. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. [**1-22**] SM at RUSB. No thrills, lifts. No S3 or S4. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: trace edema b/l. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: [**2143-9-28**] 04:55AM BLOOD WBC-9.4 RBC-3.63* Hgb-11.2* Hct-32.6* MCV-90 MCH-30.9 MCHC-34.4 RDW-15.6* Plt Ct-288 [**2143-9-28**] 04:55AM BLOOD Plt Ct-288 [**2143-9-27**] 04:40AM BLOOD PT-13.9* PTT-27.6 INR(PT)-1.2* [**2143-9-28**] 04:55AM BLOOD Glucose-112* UreaN-20 Creat-0.8 Na-138 K-4.2 Cl-102 HCO3-25 AnGap-15 Brief Hospital Course: ASSESSMENT AND PLAN: Pt is a 83F with CAD s/p NSTEMI [**6-22**] transferred from OSH with NSTEMI and CHF for consideration of cath, found to have three vessel disease, scheduled for cath, but found to have retroperitoneal bleed and Hct drop, suspected to have HIT, found negative, had CABG. . CAD: NSTEMI in [**6-22**] and again [**2143-9-4**]. Cardiac catherization showed 3 vessel diease. she was continued on ASA, plavix, statin , ace. She was scheduled for CABG, but as she was taken to the OR, was found to have mass in abdomen and Hct of 23. She was sent to a stat CT scan and found to have retroperitoneal bleed as well as very large renal cyst. She was hemodynamically unstable. In light of findings, CABG was not done and balloon pump and swan were placed and she was intubated. Patient was fluid overloaded and diuresed. Platlets started trending low, with a minimum of 64. Unclear at the time whether this was HIT, or thromocytopenia secondary to balloon pump. Balloon pump was dc/ed in the OR for concern with low platlets. She is on BBlocker, Ace, CCB, statin, ASA. After SRA negative, She was taken to the operating room on 10.9 where she underwent CABG x 3. She was transferred to the ICU in critical but stable condition. Her milrinone and epinephrine were weaned to off by POD #2. She had atrial fibrillation for which she was started on amiodarone and lopressor and she converted to NSR. She was extubated on POD #1. Bedside swallow evaluation recommended soft solids and thin liquids. She as transferred to the floor on POD #2. She did well postoperatively and was ready for discharge to rehab on POD #6. . retroperitneal bleed/Anemia: patient found to have retroperitoneal bleed on CT scan, and a dropping HCT. She was transfused a total of 2 units on [**9-12**]. The rt femoral artery was repaired in the OR when the balloon pump was dc/ed on [**9-11**]. She subsequently maintained a stable Hct. She continues with wet to dry dressings to her right groin. HIT: Patient with dropping platelets after cath. HIT vs ballon pump related thrombocytopenia. Patient admitted with platlets of 230's, nadir of 64. all heparin products were discontinued. Balloon pump was dced. HIT antibodies sent, came back positive x2. Patient started on argatroban for HIT. Confirmatory test Serotonin release antibody sent out and came back negative. UTI: patient with proteus on Urine culture. treated with 3 days of levofloxacin. Medications on Admission: MEDICATIONS AT HOME: Dorzolamide-Timolol 2-0.5 % 1 Drop [**Hospital1 **] Aspirin 325 mg Tablet EC Atorvastatin 40 mg daily Carvedilol 12.5 mg [**Hospital1 **] Isosorbide Mononitrate SR 30 mg qday Lisinopril 7.5 mg DAILY Furosemide 20 mg qday Latanoprost 0.005 % Drops 1 Drop HS . MEDICATIONS ON TRANSFER: -Heparin gtt -Plavix 75 mg qday -Aspirin -Premedication for dye allergy: Prednisone 30 mg q6H, Benadryl 25 mg q6h, Zantac 150 mg q6h -Lisinopril 10 mg qday -Lipitor 40 mg qday -Imdur 30 mg qday -PRN Lasix -Cosopt 2 drops [**Hospital1 **] -Xalatan 0.005% 1 drop [**Hospital1 **] Discharge Medications: 1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 4. Albuterol 90 mcg/Actuation Aerosol Sig: 2-4 Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 5. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours). 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 10. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 11. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed. 13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 14. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 15. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 16. Insulin Regular Human 100 unit/mL Solution Sig: as directed Injection QACHS: 0-60 mg/dL 4 oz. Juice 4 oz. Juice 4 oz. Juice 4 oz. Juice 61-120 mg/dL 0 Units 0 Units 0 Units 0 Units 121-160 mg/dL 2 Units 2 Units 2 Units 0 Units 161-200 mg/dL 4 Units 4 Units 4 Units 2 Units 201-240 mg/dL 6 Units 6 Units 6 Units 4 Units 241-280 mg/dL 8 Units 8 Units 8 Units 6 Units 281-320 mg/dL 10 Units 10 Units 10 Units 8 Units 321-360 mg/dL 12 Units 12 Units 12 Units 10 Units . 17. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: CAD s/p NSTEMI [**8-23**], [**6-22**], HTN, acute on chronic systolic CHF, anxiety, s/p IABP, s/p femoral artery repair [**9-12**], cataracts, glaucoma, ^chol., mod. AS Discharge Condition: Good. Discharge Instructions: Shower daily, no bathing or swimming for 1 month No creams, lotions, or powders to any incisions No driving for 1 month No lifting > 10 lbs. for 10 weeks Wet to dry dressings to right groin [**Hospital1 **]. Followup Instructions: F/U with Dr. [**Last Name (STitle) **] (Cardiac Surgeon) in 4 wks F/U with Dr. [**Last Name (STitle) 39510**] (cardiologist) in [**1-19**] wks F/U with Dr. [**Last Name (STitle) 35663**] (PCP) in [**1-19**] wks Completed by:[**2143-9-30**]

410,428,998,785,584,997,599,414,427,403,585,E934

{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute on chronic systolic heart failure,Hematoma complicating a procedure,Cardiogenic shock,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anticoagulants 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: OSH Transfer PRESENT ILLNESS: (per [**Hospital6 33**] Records and pt) 83F with history of NSTEMI ([**6-22**]) and CHF who originally presented to [**Hospital1 34**] on [**9-4**] with hypertensive urgency and florid CHF. She had been feeling slightly "under the weather" all day, and then while taking her evening medications developed sudden onset SOB and diaphoresis with out any CP or chest pressure. She states that this episode was identical to her NSTEMI in [**6-22**]. She pushed her Lifeline; EMS gave her Lasix 80 mg IV and SL ntg x3. . In the OSH ED she was hypertensive to 187/102, HR 98. CXR was consistent with decompensated heart failure. EKG revealed Lateral ST depressions (old) and TWI in V2-V4 (new) (per report; ekg not available fore review on admission). . OSH course: She ruled in for MI, with peak CK of 206, MB 24, Troponin 0.6. pro BNP was elevated at 1605. Her hospital course was complicated by 2 episodes of symptomatic bradycardia to the 40s with 3 second pauses associated with presyncope ([**9-7**] and [**9-8**]). Carvedilol was discontinued. . She was transferred to [**Hospital1 18**] for consideration of cath. . On admission to [**Hospital1 18**], she feels well and has no complaints. She notes that her chronic LLE edema has resolved since being on bedsrest in the hospital. No CP/SOB/fevers/chills/urinary sx/cough/DOE/PND/ orthopnea. MEDICAL HISTORY: NSTEMI [**6-22**], declined cath, medical management Systolic CHF with LVEF 40%, apical akiniesis, septal HK Mild MR, Mild TR Moderate AS Hypertension Hyperlipidemia ?CRI (b/l Cr 1.6 per OSH- though Cr =1 [**6-22**]) Open angle glaucoma Cataracts Anxiety Hearing loss MEDICATION ON ADMISSION: MEDICATIONS AT HOME: Dorzolamide-Timolol 2-0.5 % 1 Drop [**Hospital1 **] Aspirin 325 mg Tablet EC Atorvastatin 40 mg daily Carvedilol 12.5 mg [**Hospital1 **] Isosorbide Mononitrate SR 30 mg qday Lisinopril 7.5 mg DAILY Furosemide 20 mg qday Latanoprost 0.005 % Drops 1 Drop HS . MEDICATIONS ON TRANSFER: -Heparin gtt -Plavix 75 mg qday -Aspirin -Premedication for dye allergy: Prednisone 30 mg q6H, Benadryl 25 mg q6h, Zantac 150 mg q6h -Lisinopril 10 mg qday -Lipitor 40 mg qday -Imdur 30 mg qday -PRN Lasix -Cosopt 2 drops [**Hospital1 **] -Xalatan 0.005% 1 drop [**Hospital1 **] ALLERGIES: Shellfish / Heparin Agents PHYSICAL EXAM: VS: T 98.6 BP 166/80 HR 85 RR 18 O2 96% RA Gen: WDWN eldery female 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. FAMILY HISTORY: both parents had CAD SOCIAL HISTORY: The patient is widowed, and lives alone in [**Location (un) **], MA. Her daughter lives nearby in [**Name (NI) 38640**] and she has a son who lives in Main. She is a past smoker who quit many years ago, she used to smoke 1 pack per day of tobbacco. She denies any history of alcohol or introvenous drug use. ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Acute on chronic systolic heart failure,Hematoma complicating a procedure,Cardiogenic shock,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anticoagulants causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Weakness PRESENT ILLNESS: 26 yF h/o DM1 who presents to the ED today with 2 days of fatigue, abdominal pain, dysuria, and malaise. She states that symptoms started on Sunday when she felt tired and could not get out of bed. Subsequently on Sunday night the patient was unable to fall asleep and experience malaise all night. On Monday she stayed around the house and felt progressively more fatigued and weak. She otherwise also complained of abdominalp ain primarily in the mid lower abdomen consistent with her previous diabetic gastroparesis. She says that she took extra doses of her insulin however continued to feel worse to the point where her boyfriend finally made her come to the emergency department to be evaluted. Last A1c was 7.5 3/15 per patient report, (15.9, 9 months ago). . In the ED, initial vs were: T 97.8 HR 110 BP 108/68 RR 16 SatO2 100%. Patient was given 10 units IV insulin and 2L NS with an improvement in her fingersticks to the 500's so she was subsequently started on an insulin gtt at 8 units/hr. She was given dilaudid 1mg x 2 for abdominal pain and admitted to the ICU for further management. VS on transfer were: 98.3, 107, 132/67, 18, 98% on RA. . On the floor, initial VS were: 98.3, 107, 132/67, 18, 98% on RA. She is currently complaining of feeling unwell and tired. Otherwise she says she feels weak with midline lower abdominal pain. The patient was able to fall asleep however upon arousal would become tearful. She was also very anxious since she is not from [**Location (un) 86**] and is currently missing her family. . MEDICAL HISTORY: DM1 GERD gastroparesis depression/anxiety MEDICATION ON ADMISSION: zoloft 100 mg po daily prilosec 20mg PO daily vistaril 50mg PO q4h PRN clonidine 0.1 mg PO q4h prn lorazepam 1mg PO q6h prn trazodone 50mg PO qhs prn insomnia lantus 36 units @ noon HISS ALLERGIES: Penicillins / morphine / Codeine PHYSICAL EXAM: Admission labs: Vitals: 98.3, 107, 132/67, 18, 98% on RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower midline, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . on discharge Vitals: 98 126/82 60 18 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower quadrants, more in the LLQ, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . FAMILY HISTORY: father side- [**Name2 (NI) 499**] ca mother side- breast ca father murdered by step mom mother [**Name2 (NI) 88916**] from heroin SOCIAL HISTORY: Lives in [**Location (un) 5503**]. Visiting boyfriend in [**Name (NI) 86**]. - Tobacco: denies - Alcohol: denies - Illicits: marijuana (1-2x/week)

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Gastroparesis,Esophageal reflux,Dysthymic disorder,Anemia, unspecified

DMI ketoacd uncontrold,Long-term use of insulin,Gastroparesis,Esophageal reflux,Dysthymic disorder,Anemia NOS

Admission Date: [**2169-5-23**] Discharge Date: [**2169-5-26**] Date of Birth: [**2143-4-5**] Sex: F Service: MEDICINE Allergies: Penicillins / morphine / Codeine Attending:[**First Name3 (LF) 5810**] Chief Complaint: Weakness Major Surgical or Invasive Procedure: PICC line placement History of Present Illness: 26 yF h/o DM1 who presents to the ED today with 2 days of fatigue, abdominal pain, dysuria, and malaise. She states that symptoms started on Sunday when she felt tired and could not get out of bed. Subsequently on Sunday night the patient was unable to fall asleep and experience malaise all night. On Monday she stayed around the house and felt progressively more fatigued and weak. She otherwise also complained of abdominalp ain primarily in the mid lower abdomen consistent with her previous diabetic gastroparesis. She says that she took extra doses of her insulin however continued to feel worse to the point where her boyfriend finally made her come to the emergency department to be evaluted. Last A1c was 7.5 3/15 per patient report, (15.9, 9 months ago). . In the ED, initial vs were: T 97.8 HR 110 BP 108/68 RR 16 SatO2 100%. Patient was given 10 units IV insulin and 2L NS with an improvement in her fingersticks to the 500's so she was subsequently started on an insulin gtt at 8 units/hr. She was given dilaudid 1mg x 2 for abdominal pain and admitted to the ICU for further management. VS on transfer were: 98.3, 107, 132/67, 18, 98% on RA. . On the floor, initial VS were: 98.3, 107, 132/67, 18, 98% on RA. She is currently complaining of feeling unwell and tired. Otherwise she says she feels weak with midline lower abdominal pain. The patient was able to fall asleep however upon arousal would become tearful. She was also very anxious since she is not from [**Location (un) 86**] and is currently missing her family. . Past Medical History: DM1 GERD gastroparesis depression/anxiety Social History: Lives in [**Location (un) 5503**]. Visiting boyfriend in [**Name (NI) 86**]. - Tobacco: denies - Alcohol: denies - Illicits: marijuana (1-2x/week) Family History: father side- [**Name2 (NI) 499**] ca mother side- breast ca father murdered by step mom mother [**Name2 (NI) 88916**] from heroin Physical Exam: Admission labs: Vitals: 98.3, 107, 132/67, 18, 98% on RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower midline, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . on discharge Vitals: 98 126/82 60 18 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower quadrants, more in the LLQ, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . Pertinent Results: Admission labs: =============== [**2169-5-22**] 09:00PM BLOOD WBC-11.1* RBC-4.49 Hgb-12.9 Hct-38.6 MCV-86 MCH-28.8 MCHC-33.5 RDW-15.1 Plt Ct-349 [**2169-5-22**] 09:00PM BLOOD Neuts-80.6* Lymphs-15.8* Monos-1.7* Eos-1.0 Baso-0.9 [**2169-5-22**] 09:00PM BLOOD Plt Ct-349 [**2169-5-22**] 09:00PM BLOOD Glucose-748* UreaN-12 Creat-1.1 Na-130* K-5.4* Cl-92* HCO3-10* AnGap-33* [**2169-5-23**] 12:10AM BLOOD Glucose-586* Na-136 K-4.1 Cl-98 HCO3-7* AnGap-35* [**2169-5-23**] 09:25AM BLOOD Glucose-268* UreaN-8 Creat-0.9 Na-134 K-5.1 Cl-104 HCO3-11* AnGap-24* [**2169-5-24**] 02:49AM BLOOD Glucose-930* UreaN-2* Creat-0.7 Na-141 K-GREATER TH Cl-127* HCO3-18* [**2169-5-24**] 04:00AM BLOOD Glucose-131* UreaN-2* Creat-0.6 Na-137 K-4.2 Cl-108 HCO3-20* AnGap-13 [**2169-5-22**] 09:00PM BLOOD Calcium-9.1 Phos-3.5 Mg-1.7 [**2169-5-23**] 09:25AM BLOOD %HbA1c-8.4* eAG-194* . Discharge labs: =============== [**2169-5-26**] 05:18AM BLOOD WBC-6.2 RBC-4.00* Hgb-11.2* Hct-32.2* MCV-81* MCH-28.1 MCHC-34.8 RDW-15.5 Plt Ct-274 [**2169-5-26**] 05:18AM BLOOD Glucose-178* UreaN-6 Creat-0.6 Na-139 K-4.1 Cl-103 HCO3-29 AnGap-11 [**2169-5-26**] 05:18AM BLOOD Calcium-8.6 Phos-2.8 Mg-1.9 [**2169-5-23**] 09:25AM BLOOD %HbA1c-8.4* eAG-194* Imaging: ======== CXR post-PICC: AP single view of the chest has been obtained with patient in sitting semi-upright position. A left-sided PICC line is identified seen to terminate overlying the right-sided mediastinal structures at the level close to the expected entrance into the right atrium. In order to avoid any contact with right atrial structures withdrawal of the line by 3 cm is recommended. No pneumothorax or any other placement-related complication can be identified. On this portable chest examination there is a crowded appearance of the pulmonary vasculature on the bases, indicative of poor inspirational effort, but conclusive evidence for acute pulmonary abnormalities is absent. No prior chest examination exists in our records. . CT ab/pelvis: 1. No evidence for acute appendicitis. 2. Prominent right ovary in the adnexa. Correlation with pelvic ultrasound may be helpful if pain located in this region. . ECG: Sinus tachycardia. Rightward axis. Tracing may be normal for age. No previous tracing available for comparison. Brief Hospital Course: 26 yF h/o DM1 p/w increasing fatigue, nausea and abdominal pain found to have a sugar of >700, w/ ketones in urine and anion gap metabolic acidosis, all consistent with DKA. . # DKA: Patient presented with an anion gap metabolic acidosis with high glucose (600) and ketones in her urine, anion gap was 31. Precipitating event is unclear though likely in setting of poor adherence on Lantus. She was started on an insulin drip, IVF with potassium, and q1hr checks of glucose and electrolytes. Patient declined CXR as part of infectious work-up on admission given concern for radiation exposure from multiple recent hospitalizations, even after radiatin risk was discussed with her. She had no localizing signs or symptoms of infection. The day after admission, anion gap closed and patient was started on SC insulin regimen [**First Name8 (NamePattern2) **] [**Last Name (un) **] recommendations. Her diet was advanced but she reported abdominal pain and requested IV dilaudid for pain control. She had a benign abdominal exam, but continued to report RLQ pain and CT abdomen was ordered though suspicion for intra-abdominal pathology was low. Given improved control of glucose, pain was thought not to be related to hyperglycemia, gastroparesis is possible. A1c was 8.4%. PICC line was placed for access as pt has difficult peripheral access. Of note, she does have a history of PICC and port placements in the past which were complicated by infection. . Patient follows with an endocrinologist (Dr. [**Last Name (STitle) 88917**] - [**Telephone/Fax (1) 9674**]) but has missed several appointments since [**Month (only) **]. Also of note, her uncle stated that pt has a history of spiking her sugars in order to present with complains of abdominal pain and receive dilaudid. Her last confirmed insulin dose was 30units/24units of lantus in AM and PM, as well as humalog sliding scale. She reports interest in starting an insulin pump. . On subcutaneous insulin, anion gap remained closed. [**Last Name (un) **] assisted in creating home long acting (Lantus 28u) and sliding scale regimen and will follow-up with pt as an outpatient. . # Abdominal pain - Patient has chronic abdominal pain likely secondary to her diabetes and gastroparesis. She states that this pain is similar to her DKA abdominal pain which resolves once DKA is resolve. With improvement in her fingersticks, however, she continued to report RLQ pain out of proportion to her benign physical exam (no rebound/guarding, non-tender to palpation and non-distended). Patient was given oxycodone which did not relieve the pain, and requested IV dilaudid. She had no leukocytosis or fever, and very low suspicion for infection but given patient's self report of [**10-16**] pain in RLQ, a CT abdomen was ordered to evaluate for appendix/ovarian or other intra-abdominal pathology. CT was reassuring. Pt was discharged with 30 tablets of oxycodone to help control her pain as it resolved with tapering assisted by the ppl at her sober house. . # Psychiatric issues - The patient has a history of depression and anxiety for which she is on home clonazepam. She was extremely tearful and labile throughout admission. On admission, she reported that her home medications included Zoloft 200mg daily and clonazepam. Her pharmacy was [**Date Range 653**] and had no record of dispensing these medications. PCP was [**Name (NI) 653**] and noted that her medication list as of [**2169-2-28**] included: paxil 40mg daily, clonidine 0.5mg [**Hospital1 **] (not clonazepam), and xanax 1mg [**Hospital1 **] though none of these medications were prescribed or refilled by the PCP. [**Name10 (NameIs) 20282**] reported she is seen by a therapist at Child & Family Services, phone [**Telephone/Fax (1) 88918**], though nobody there could be reached to confirm her meds. Additionally pt had recent hospitalization at [**Hospital 1680**] Hospital in [**Location (un) 20291**] ([**Telephone/Fax (1) 88919**]). During the hospitalization, pt was given lorazepam 1mg PO QID prn anxiety. As pt had significant anxiety, was tremulous and diaphoretic, she was restarted on clonazepam 2mg TID (the dose she claimed to be on) out of concern for withdrawal. She was discharged with 6 days of clonazepam to be further titrated as an outpt. She was also restarted on zoloft, vistaril, and trazodone (as per [**Hospital1 1680**] records). The pt was told to follow-up with her psychiatrist and stated she would make the appt herself. . # GERD- Restarted prilosec. . # Anemia: normocytic, nl RDW. Was stable throughout admission. . # Communication: Patient, Uncle [**Name (NI) 4648**](HCP) [**Telephone/Fax (1) 88920**] . # Dispo: return to sober house Medications on Admission: zoloft 100 mg po daily prilosec 20mg PO daily vistaril 50mg PO q4h PRN clonidine 0.1 mg PO q4h prn lorazepam 1mg PO q6h prn trazodone 50mg PO qhs prn insomnia lantus 36 units @ noon HISS Discharge Medications: 1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 3. sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for anxiety. 5. trazodone 50 mg Tablet Sig: 1-2 Tablets PO HS (at bedtime) as needed for insomnia: If 50mg doesn't work after 1h may repeat dose . 6. clonazepam 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*18 Tablet(s)* Refills:*0* 7. insulin glargine 100 unit/mL Solution Sig: Twenty Eight (28) units Subcutaneous qAM. Disp:*1 month supply* Refills:*2* 8. Humalog 100 unit/mL Solution Sig: as per sliding scale Subcutaneous qACHS: check with FSG with each meal and at nighttime, adjust humalong based on sliding scale . Disp:*1 month supply* Refills:*2* 9. insulin syringes (disposable) 1 mL Syringe Sig: One (1) syringe Miscellaneous qachs. Disp:*120 syringes* Refills:*2* 10. lancets Misc Sig: One (1) lancet Miscellaneous qachs. Disp:*120 lancets* Refills:*2* 11. FreeStyle Test Strip Sig: One (1) strip Miscellaneous qachs. Disp:*120 test strips* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: DKA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms. [**Known lastname 9625**], It was a pleasure participating in your care. You were admitted for Diabetic Ketoacidosis (DKA) due to high blood sugars. You were in the medical intensive care unit where you were on an insulin drip and your blood sugars were stabilized, and then were switched to subcutaneous insulin. Specialists from the [**Last Name (un) **] Diabetes Center consulted and helped manage your insulin. You will follow up with them as an outpatient to continue to manage your chronic Diabetes. During this admission you also suffered from abdominal pain. Several studies were done that ruled out acute infection or other abdominal problem. This pain may be related to your DKA or to your chronic abdominal pain, and should improve over the next few days. You will be discharged with a prescription for oxycodone for the next few days until this pain becomes more tolerable. Please call or return to the hospital if you develop increased blood sugars that you cannot control, fevers, chills, or any [**Last Name **] problem that concern you. ----------- You are being prescribed 30 tablets of oxycodone to help control your pain as it resolves. The people at the sober house should help you taper this medication. . As recommended by [**Last Name (un) **], you are being prescribed Lantus 28u to take every morning, and a humalog sliding scale to take with each meal and at night based on your blood sugar. You will have an appointment with [**Last Name (un) **] (as listed below) to further manage your Diabetes. . As you requested, you were connected with a new PCP through the [**Hospital1 18**] system. For your initial post-hospital appointment you will meet with a physician who works in our system to ensure that you are improving from your hospital stay. In [**Month (only) 596**] you will have an appointment with your new PCP to fully establish primary care. . During this admission there was some confusion regarding whether you should be on lorazepam or clonazepam. You are being discharged with 5 days worth of clonazepam however subsequent to that your benzodiazepines should be prescribed by your psychiatrist. Followup Instructions: You should make an appointment to follow up with your psychiatrist within the next week. . Department: [**Hospital3 249**] With: [**First Name4 (NamePattern1) 2184**] [**Last Name (NamePattern1) 2185**], MD When: WEDNESDAY [**2169-5-31**] at 8:40 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 physician as part of your transition from the hospital back to your new primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 18835**]. After this visit, you will see Dr. [**Last Name (STitle) 18835**] in follow up as listed below for [**7-5**]. Name: [**First Name8 (NamePattern2) 32440**] [**Name8 (MD) **], MD Specialty: Endocrinology When: Wednesday [**6-7**] at 1pm Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 16420**] You will register at 1pm. At 1:30pm you will have imaging done on your eyes. You will see Dr. [**Last Name (STitle) **] at 2pm. Please call the [**Hospital **] Clinic at [**Telephone/Fax (1) 88921**] to update your demographics and insurance information as soon as possible. Department: [**Hospital3 249**] When: WEDNESDAY [**2169-7-5**] at 3:50 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Dr. [**Last Name (STitle) 18835**] is your new physician in [**Name9 (PRE) 191**] and Dr. [**Last Name (STitle) 18835**] works closely with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] so both will be involved in your care. For insurance purposes, please indicate Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] as your primary care physician.

250,V586,536,530,300,285

{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Gastroparesis,Esophageal reflux,Dysthymic disorder,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: Weakness PRESENT ILLNESS: 26 yF h/o DM1 who presents to the ED today with 2 days of fatigue, abdominal pain, dysuria, and malaise. She states that symptoms started on Sunday when she felt tired and could not get out of bed. Subsequently on Sunday night the patient was unable to fall asleep and experience malaise all night. On Monday she stayed around the house and felt progressively more fatigued and weak. She otherwise also complained of abdominalp ain primarily in the mid lower abdomen consistent with her previous diabetic gastroparesis. She says that she took extra doses of her insulin however continued to feel worse to the point where her boyfriend finally made her come to the emergency department to be evaluted. Last A1c was 7.5 3/15 per patient report, (15.9, 9 months ago). . In the ED, initial vs were: T 97.8 HR 110 BP 108/68 RR 16 SatO2 100%. Patient was given 10 units IV insulin and 2L NS with an improvement in her fingersticks to the 500's so she was subsequently started on an insulin gtt at 8 units/hr. She was given dilaudid 1mg x 2 for abdominal pain and admitted to the ICU for further management. VS on transfer were: 98.3, 107, 132/67, 18, 98% on RA. . On the floor, initial VS were: 98.3, 107, 132/67, 18, 98% on RA. She is currently complaining of feeling unwell and tired. Otherwise she says she feels weak with midline lower abdominal pain. The patient was able to fall asleep however upon arousal would become tearful. She was also very anxious since she is not from [**Location (un) 86**] and is currently missing her family. . MEDICAL HISTORY: DM1 GERD gastroparesis depression/anxiety MEDICATION ON ADMISSION: zoloft 100 mg po daily prilosec 20mg PO daily vistaril 50mg PO q4h PRN clonidine 0.1 mg PO q4h prn lorazepam 1mg PO q6h prn trazodone 50mg PO qhs prn insomnia lantus 36 units @ noon HISS ALLERGIES: Penicillins / morphine / Codeine PHYSICAL EXAM: Admission labs: Vitals: 98.3, 107, 132/67, 18, 98% on RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower midline, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . on discharge Vitals: 98 126/82 60 18 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, tender in the lower quadrants, more in the LLQ, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . FAMILY HISTORY: father side- [**Name2 (NI) 499**] ca mother side- breast ca father murdered by step mom mother [**Name2 (NI) 88916**] from heroin SOCIAL HISTORY: Lives in [**Location (un) 5503**]. Visiting boyfriend in [**Name (NI) 86**]. - Tobacco: denies - Alcohol: denies - Illicits: marijuana (1-2x/week) ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Gastroparesis,Esophageal reflux,Dysthymic disorder,Anemia, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 76 year-old female with coronary artery disease status post coronary artery bypass graft in [**2153**] and multiple percutaneous interventions who was brought to the Emergency Department after a witnessed cardiac arrest. The patient was in the mall and had a witness cardiac arrest. There was bystander CPR at two minutes and after eight minutes an AED arrived and the patient was shocked. CPR continued for five to six minutes and then EMS arrived. Initial rhythm was complete heart block and the patient was treated with epinephrine. This led to ventricular tachycardia and the patient was shocked leading to a rhythm of ventricular fibrillation, which converted to sinus rhythm after two further shocks. Electrocardiogram showed inferior ST elevations and lateral ST depressions. The patient was intubated and brought to the Emergency Department. In the Emergency Department she was treated with heparin and Integrilin, but this was discontinued due to coffee ground emesis. A chest x-ray showed a right pneumothorax and a chest tube was placed. The patient became hypotensive and Dobutamine and Levophed were started for blood pressure support. The patient was transferred to the Coronary Care Unit and the pressors were weaned off with fluid boluses. MEDICAL HISTORY: 1. Hypertension. 2. Hyperlipidemia. 3. Coronary artery disease status post coronary artery bypass graft in [**2153**], multiple PCIs and a redo coronary artery bypass graft in [**2163**]. 4. Bladder prolapse. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Ventricular fibrillation,Acute respiratory failure,Anoxic brain damage,Iatrogenic pneumothorax,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Traumatic subcutaneous emphysema,Urinary tract infection, site not specified,Hematemesis

Ventricular fibrillation,Acute respiratry failure,Anoxic brain damage,Iatrogenic pneumothorax,Food/vomit pneumonitis,CHF NOS,Traum subcutan emphysema,Urin tract infection NOS,Hematemesis

Admission Date: [**2168-11-28**] Discharge Date: [**2168-12-2**] Date of Birth: [**2092-3-27**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: This is a 76 year-old female with coronary artery disease status post coronary artery bypass graft in [**2153**] and multiple percutaneous interventions who was brought to the Emergency Department after a witnessed cardiac arrest. The patient was in the mall and had a witness cardiac arrest. There was bystander CPR at two minutes and after eight minutes an AED arrived and the patient was shocked. CPR continued for five to six minutes and then EMS arrived. Initial rhythm was complete heart block and the patient was treated with epinephrine. This led to ventricular tachycardia and the patient was shocked leading to a rhythm of ventricular fibrillation, which converted to sinus rhythm after two further shocks. Electrocardiogram showed inferior ST elevations and lateral ST depressions. The patient was intubated and brought to the Emergency Department. In the Emergency Department she was treated with heparin and Integrilin, but this was discontinued due to coffee ground emesis. A chest x-ray showed a right pneumothorax and a chest tube was placed. The patient became hypotensive and Dobutamine and Levophed were started for blood pressure support. The patient was transferred to the Coronary Care Unit and the pressors were weaned off with fluid boluses. PAST MEDICAL HISTORY: 1. Hypertension. 2. Hyperlipidemia. 3. Coronary artery disease status post coronary artery bypass graft in [**2153**], multiple PCIs and a redo coronary artery bypass graft in [**2163**]. 4. Bladder prolapse. PHYSICAL EXAMINATION ON ADMISSION: Pulse 100 to 120. Blood pressure 60 to 80/40 to 60. Oxygen saturation 86 to 90% on the ventilator. Her heart was regular with no murmurs. There were rhonchorous breath sounds bilaterally. The abdomen was benign and there was no edema. HOSPITAL COURSE: The patient was admitted to the Coronary Care Unit status post cardiac arrest and resuscitation. The main concern of the family from the time of admission was the patient's wishes regarding end of life care and previous discussions suggesting that she wished not to be intubated or resuscitated. After extensive discussions with the family it was determined to give the patient 48 hours to determine, which direction her neurologic status would go. The neurology consult team followed throughout the hospitalization and while she initially showed some positive signs by [**12-1**] it appeared that the patient was not going to make a rapid recovery back to her baseline functional status as she would have wished. Additionally the patient's respiratory status was compromised both by right pneumothorax secondary to rib fracture sustained during CPR as well as probable aspiration pneumonia. On [**12-2**] another meeting with the patient's two sons and daughter was held. They believed firmly that it would be their mother's wishes to withdraw care as she never wished to have her life sustained with heroic measures. Therefore in the afternoon of [**12-2**] the patient's mechanical ventilation was discontinued and she quickly had a respiratory arrest. The patient was pronounced dead at 2:40 p.m. The family declines postmortem examination. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**MD Number(1) 1009**] Dictated By:[**Last Name (NamePattern1) 15468**] MEDQUIST36 D: [**2168-12-2**] 03:09 T: [**2168-12-7**] 07:08 JOB#: [**Job Number 95435**]

427,518,348,512,507,428,958,599,578

{'Ventricular fibrillation,Acute respiratory failure,Anoxic brain damage,Iatrogenic pneumothorax,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Traumatic subcutaneous emphysema,Urinary tract infection, site not specified,Hematemesis'}

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 female with coronary artery disease status post coronary artery bypass graft in [**2153**] and multiple percutaneous interventions who was brought to the Emergency Department after a witnessed cardiac arrest. The patient was in the mall and had a witness cardiac arrest. There was bystander CPR at two minutes and after eight minutes an AED arrived and the patient was shocked. CPR continued for five to six minutes and then EMS arrived. Initial rhythm was complete heart block and the patient was treated with epinephrine. This led to ventricular tachycardia and the patient was shocked leading to a rhythm of ventricular fibrillation, which converted to sinus rhythm after two further shocks. Electrocardiogram showed inferior ST elevations and lateral ST depressions. The patient was intubated and brought to the Emergency Department. In the Emergency Department she was treated with heparin and Integrilin, but this was discontinued due to coffee ground emesis. A chest x-ray showed a right pneumothorax and a chest tube was placed. The patient became hypotensive and Dobutamine and Levophed were started for blood pressure support. The patient was transferred to the Coronary Care Unit and the pressors were weaned off with fluid boluses. MEDICAL HISTORY: 1. Hypertension. 2. Hyperlipidemia. 3. Coronary artery disease status post coronary artery bypass graft in [**2153**], multiple PCIs and a redo coronary artery bypass graft in [**2163**]. 4. Bladder prolapse. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Ventricular fibrillation,Acute respiratory failure,Anoxic brain damage,Iatrogenic pneumothorax,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Traumatic subcutaneous emphysema,Urinary tract infection, site not specified,Hematemesis'}

CHIEF COMPLAINT: PRESENT ILLNESS: 60-year-old female with a history of insulin dependent diabetes mellitus now with end stage renal disease on peritoneal dialysis for five years. The patient presents in normal state of health for a cadaveric renal transplant. The patient denies nausea, vomiting, chest pain, shortness of breath, fevers, chills. MEDICAL HISTORY: Insulin dependent diabetes mellitus. Peritoneal dialysis. End stage renal disease. Hypertension. Glaucoma. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: No alcohol, no cigarettes.

Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Reflux esophagitis,Unspecified essential hypertension

DMI renl nt st uncntrld,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Reflux esophagitis,Hypertension NOS

Admission Date: [**2102-1-16**] Discharge Date: [**2102-1-28**] Date of Birth: [**2041-2-21**] Sex: F Service: Transplant Surgery HISTORY OF PRESENT ILLNESS: 60-year-old female with a history of insulin dependent diabetes mellitus now with end stage renal disease on peritoneal dialysis for five years. The patient presents in normal state of health for a cadaveric renal transplant. The patient denies nausea, vomiting, chest pain, shortness of breath, fevers, chills. PAST MEDICAL HISTORY: Insulin dependent diabetes mellitus. Peritoneal dialysis. End stage renal disease. Hypertension. Glaucoma. PAST SURGICAL HISTORY: Tenckhoff catheter placement five years ago, cesarean section times three, umbilical hernia repair. SOCIAL HISTORY: No alcohol, no cigarettes. MEDICATIONS: Cardizem 300 mg q day, Lipitor 10 mg q day, Zestril 20 mg q day, Insulin 42 units NPH q a.m., Lasix 40 mg po qid, TUMS 2 tabs tid, RenaGel 800 mg [**Hospital1 **], Cosopt eyedrops, Xalatan eyedrops, Zantac, Nephrocaps one tab po q day. ALLERGIES: No known drug allergies. HOSPITAL COURSE: The patient was brought to the operating room on [**1-16**] for cadaveric renal transplant. The patient received intraoperative doses of thymoglobulin, Solu-Medrol, Kefzol. Ischemic time during the surgery was 19 hours. Intraoperatively the kidney was initially pink, then developed areas of blue. Biopsies were negative for rejection in the intraoperative period. It was determined that the flow to the kidneys was dependent upon blood pressure intraoperatively. Post-operatively the patient was transferred to the surgical Intensive Care Unit on a Dobutamine drip. There she was rapidly extubated. A Heparin drip was also started at 400 units per hour. Postoperative day #1 the patient was started on CellCept and Reglan. She was receiving 1 cc per cc fluid replacement. Postoperative day #2 a renal ultrasound was obtained which showed good flow to both kidneys. Ganciclovir was started for CMV positive status. On postoperative day #3 Bactrim was started as was Aspirin and Heparin drip was discontinued. Postoperative day #4 an MRA of her kidneys were obtained. The MRA revealed no anastomotic stricture with the renal anastomosis. Also a good flow was noted to the kidneys. Creatinine on postoperative day #4 was 6.9. By postoperative day #5 the patient's urine output began to significantly improve. Her po intake was good. She was dialyzed using peritoneal dialysis one time on postoperative day #5 as well. The patient was on the floor by postoperative day #3. On postoperative day #6 the patient's JP output was noted to be approximately 300 cc per day. A creatinine was sent on the JP fluid which revealed it to be consistent with a lymphocele. JP creatinine value was 6. Prograf was started on [**1-23**]. Up to this point the patient was receiving ?????? doses of thymoglobulin. Rapamune was also started on this day. The creatinine began to decrease. On [**1-24**] the creatinine was 4.8. Prograf levels were increased to 4 mg [**Hospital1 **] based upon a low Prograf level. The patient became to experience persistent nausea and emesis. A KUB was obtained which revealed no signs of destruction. It appeared that the patient was experiencing this emesis in relation to taking her medications. Various anti-emetics were used to insure the patient received her medications. Creatinine on [**1-26**] was 3.5. An EGD was obtained by the gastrointestinal service on [**1-27**]. This showed esophagitis of the lower third of the esophagus and pyloric spasms. The patient was started on Protonix 40 mg [**Hospital1 **], as well as continuing with the Reglan. Also patient was put Erythromycin 250 mg tid. CONDITION ON DISCHARGE: Stable. DISCHARGE MEDICATIONS: Prograf 4 mg [**Hospital1 **], Rapamune 5 mg q d, Prednisone 20 mg q d, Ganciclovir 500 mg [**Hospital1 **], Insulin NPH 42 units subcu q a.m., Xalatan eyedrops, Cosopt eyedrops, Dulcolax 10 mg pr q h.s. prn, Bactrim single strength one tablet po q day, Erythromycin 250 mg po tid, Colace 100 mg [**Hospital1 **], Protonix 40 mg [**Hospital1 **], Aspirin 325 mg q d, Reglan 10 mg qid, Cardizem 300 mg q d. DISCHARGE STATUS: Rehabilitation facility. The patient has extensive follow-up set up with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **]. She also has multiple blood draws set up at appropriate intervals. DISCHARGE DIAGNOSIS: 1. Status post cadaveric renal transplant. 2. IDDM. 3. Hypertension. 4. Glaucoma. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3598**], MD [**MD Number(1) 3599**] Dictated By:[**Name8 (MD) 1308**] MEDQUIST36 D: [**2102-1-27**] 15:33 T: [**2102-1-27**] 15:12 JOB#: [**Job Number 29574**]

250,583,362,530,401

{'Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Reflux esophagitis,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: PRESENT ILLNESS: 60-year-old female with a history of insulin dependent diabetes mellitus now with end stage renal disease on peritoneal dialysis for five years. The patient presents in normal state of health for a cadaveric renal transplant. The patient denies nausea, vomiting, chest pain, shortness of breath, fevers, chills. MEDICAL HISTORY: Insulin dependent diabetes mellitus. Peritoneal dialysis. End stage renal disease. Hypertension. Glaucoma. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: No alcohol, no cigarettes. ### Response: {'Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Reflux esophagitis,Unspecified essential hypertension'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname 105012**] is a 71 year old male with h/o CAD s/p overlapping DES to the LAD [**6-26**] then [**8-28**], recent admit for CP ([**11-23**]) had MIBI with no reversible defects, ESRD on HD, hyperlipidemia, HTN, DM2 who presents with chest pain since Thursday. Mr. [**Known lastname 105012**] had a DES placed in the mid LAD in [**6-/2143**] and DES placed to the proximal LAD in [**Month (only) **] of this year. He was admitted on [**11-23**] for chest pain. He had three sets of enzymes - negative CK and trop stable at 0.20. He had an exercise MIBI that showed fixed moderate sized defect of the inferior and anterior wall and apex, no reversible defects were appreciated, exercise induced LV dilitation. He was discharged on [**11-24**]. He returns with 2 days of substernal squeezing chest pain which he feels is similar to prior. He has occasional sharp chest pains on the left side. He also has some back pain which he is attributing to lying on the stretcher for hrs. He has not slept in two days due to the chest pressure. He says that Friday evening the chest pain was at its worst, but still persists today. He has associated shortness of breath and nausea, no lightheadedness or diaphoresis. He has been taking NTG at home with some brief relief of chest pain. He is on HD for ESRD. Had HD yesterday without event. . In the ED, vital signs were BP 132/66, HR 72, RR 20, O2sat 100% on RA. He was given morphine 2mg with no relief of CP. SL NTG x1 with pain improved from [**2-1**] to [**1-1**]. He was given lopressor 50mg x1 and second SL NTG and became pain free. At 6PM CP returned, this time [**4-30**] pain and started on nitro gtt. Reportedly became CP free. Case discussed with cardiology in the ED and decision to start heparin gtt w/o bolus. Positive troponin (CK 415, MB 31, Trop 0.58). Other notable labs: WBC 13.7, Hct stable 37.9, creatinine 5.0. . Review of symptoms is positive for nausea, shortness of breath and fatigue. Negative for nausea, dizziness, palpitations, abdominal pain or syncope. He has not had any BRBPR or melena. . On arrival to the floor patient continues to have [**3-31**] substernal chest squeezing. He also says that his shortness of breath is increased from prior. He is on nitro gtt and heparin gtt. He is complaining of back pain. MEDICAL HISTORY: CAD, s/p stent to the LAD on [**2142**] then overlapping DES to the LAD on [**2144-8-26**] Hypertension CHF- EF 55%, 1+ MR, mild LVH by echo [**6-/2141**] (EF 49% by stress MIBI [**2144-8-21**]) Diabetes Hyperlipidemia Heart block s/p pacemaker [**2-/2142**] Chronic renal failure on HD q MON, and Friday (plan for a transplant in the future) S/P right arm AV fistula [**3-/2143**] Cellulitis [**6-/2141**] Bilateral adrenal adenomas Diverticulosis Antral polyps Cholelithiasis by CT on [**2143-7-16**] S/P right CFA pseudoaneurysm repair [**2143-7-16**] for wound cellulitis MEDICATION ON ADMISSION: Nifedipine 60mg [**Hospital1 **] Aspirin 325mg daily Imdur 30mg HS Plavix 75mg daily Lipitor 20mg daily Calcium acetate 667 TID Lasix 80mg [**Hospital1 **] Valsartan 160mg [**Hospital1 **] Toprol 100mg qPM, 50mg qAM Amytriptyline 10mg HS ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS 98.3, BP 148/89, HR 76, RR 20, O2sat 95% RA Gen: WDWN middle aged 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. FAMILY HISTORY: Negative for coronary artery disease. Mother: died of multiple myeloma at age 84. Father: Died at age 30 as a casualty of war SOCIAL HISTORY: Restauranteur Denies etoh intake, tobacco use or illicit drug use 40 pk-yr history, quit 24 yr ago.

Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of adrenal gland,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Percutaneous transluminal coronary angioplasty status,Personal history of other diseases of digestive system,Leukocytosis, unspecified

Subendo infarct, initial,Ac systolic hrt failure,Hyp kid NOS w cr kid V,End stage renal disease,Crnry athrscl natve vssl,Status cardiac pacemaker,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Dvrtclo colon w/o hmrhg,Benign neoplasm adrenal,Cholelithiasis NOS,Status-post ptca,Prsnl hst ot spf dgst ds,Leukocytosis NOS

Admission Date: [**2144-11-28**] Discharge Date: [**2144-12-3**] Date of Birth: [**2073-6-24**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 7881**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: Cardiac catheterization with intervention (drug eluting stent to LAD) Hemodialysis History of Present Illness: Mr. [**Known lastname 105012**] is a 71 year old male with h/o CAD s/p overlapping DES to the LAD [**6-26**] then [**8-28**], recent admit for CP ([**11-23**]) had MIBI with no reversible defects, ESRD on HD, hyperlipidemia, HTN, DM2 who presents with chest pain since Thursday. Mr. [**Known lastname 105012**] had a DES placed in the mid LAD in [**6-/2143**] and DES placed to the proximal LAD in [**Month (only) **] of this year. He was admitted on [**11-23**] for chest pain. He had three sets of enzymes - negative CK and trop stable at 0.20. He had an exercise MIBI that showed fixed moderate sized defect of the inferior and anterior wall and apex, no reversible defects were appreciated, exercise induced LV dilitation. He was discharged on [**11-24**]. He returns with 2 days of substernal squeezing chest pain which he feels is similar to prior. He has occasional sharp chest pains on the left side. He also has some back pain which he is attributing to lying on the stretcher for hrs. He has not slept in two days due to the chest pressure. He says that Friday evening the chest pain was at its worst, but still persists today. He has associated shortness of breath and nausea, no lightheadedness or diaphoresis. He has been taking NTG at home with some brief relief of chest pain. He is on HD for ESRD. Had HD yesterday without event. . In the ED, vital signs were BP 132/66, HR 72, RR 20, O2sat 100% on RA. He was given morphine 2mg with no relief of CP. SL NTG x1 with pain improved from [**2-1**] to [**1-1**]. He was given lopressor 50mg x1 and second SL NTG and became pain free. At 6PM CP returned, this time [**4-30**] pain and started on nitro gtt. Reportedly became CP free. Case discussed with cardiology in the ED and decision to start heparin gtt w/o bolus. Positive troponin (CK 415, MB 31, Trop 0.58). Other notable labs: WBC 13.7, Hct stable 37.9, creatinine 5.0. . Review of symptoms is positive for nausea, shortness of breath and fatigue. Negative for nausea, dizziness, palpitations, abdominal pain or syncope. He has not had any BRBPR or melena. . On arrival to the floor patient continues to have [**3-31**] substernal chest squeezing. He also says that his shortness of breath is increased from prior. He is on nitro gtt and heparin gtt. He is complaining of back pain. Past Medical History: CAD, s/p stent to the LAD on [**2142**] then overlapping DES to the LAD on [**2144-8-26**] Hypertension CHF- EF 55%, 1+ MR, mild LVH by echo [**6-/2141**] (EF 49% by stress MIBI [**2144-8-21**]) Diabetes Hyperlipidemia Heart block s/p pacemaker [**2-/2142**] Chronic renal failure on HD q MON, and Friday (plan for a transplant in the future) S/P right arm AV fistula [**3-/2143**] Cellulitis [**6-/2141**] Bilateral adrenal adenomas Diverticulosis Antral polyps Cholelithiasis by CT on [**2143-7-16**] S/P right CFA pseudoaneurysm repair [**2143-7-16**] for wound cellulitis post catheterization Social History: Restauranteur Denies etoh intake, tobacco use or illicit drug use 40 pk-yr history, quit 24 yr ago. Family History: Negative for coronary artery disease. Mother: died of multiple myeloma at age 84. Father: Died at age 30 as a casualty of war Physical Exam: VS 98.3, BP 148/89, HR 76, RR 20, O2sat 95% RA Gen: WDWN middle aged 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 however difficult to assess [**1-24**] habitus, no carotid bruits CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. [**1-28**] holosystolic murmur at the apex. No thrills, lifts. No S3 or S4. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. Clear bilaterally, no wheezes or rhonchi. Abd: Obese, soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Back: No tenderness to palpation over vertebrae and no paraspinal tenderness Ext: Trace edema bilaterally. No femoral bruits. Pertinent Results: [**2144-11-28**] 07:50PM CK(CPK)-362* [**2144-11-28**] 07:50PM CK-MB-25* MB INDX-6.9* cTropnT-0.72* [**2144-11-28**] 12:30PM GLUCOSE-241* UREA N-32* CREAT-5.0* SODIUM-138 POTASSIUM-4.6 CHLORIDE-96 TOTAL CO2-31 ANION GAP-16 [**2144-11-28**] 12:30PM CK(CPK)-415* [**2144-11-28**] 12:30PM cTropnT-0.58* [**2144-11-28**] 12:30PM CK-MB-31* MB INDX-7.5* [**2144-11-28**] 12:30PM WBC-13.7* RBC-4.10* HGB-12.7* HCT-37.9* MCV-92 MCH-30.9 MCHC-33.5 RDW-16.1* [**2144-11-28**] 12:30PM NEUTS-82.9* LYMPHS-10.7* MONOS-4.1 EOS-2.2 BASOS-0.2 [**2144-11-28**] 12:30PM PLT COUNT-293 Cardiology Report C.CATH Study Date of [**2144-11-30**] *** Not Signed Out *** BRIEF HISTORY: 71 year old man with CAD (Cypher to mLAD [**6-26**]; last catheterization on [**8-28**] with 2.5 x 18 and 3 x 13 Cypher DES to proximal and mid LAD); DM, ESRD on HD twice a week; hypertension, complete heart block s/p PM placement, surgically repaired R femoral pseudoaneurism, gastic ulcer/LGIB 2 months ago, who presented with an NSTEMI and was referred for a cardiac catheterization. INDICATIONS FOR CATHETERIZATION: NSTEMI; CAD; multiple prior PCIs PROCEDURE: Left Heart Catheterization: was performed by percutaneous entry of the left femoral artery, using a 5 French left [**Last Name (un) 2699**] catheter, advanced to the ascending aorta through a 6 French introducing sheath. Coronary Angiography: was performed in multiple projections using a 5 French JL4 and a 5 French JR4 catheter, with manual contrast injections. Percutaneous coronary revascularization was performed using placement of drug-eluting stent(s). Conscious Sedation: was provided with appropriate monitoring performed by a member of the nursing staff. **ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM **RIGHT CORONARY 1) PROXIMAL RCA DIFFUSELY DISEASED 2) MID RCA NORMAL 2A) ACUTE MARGINAL DIFFUSELY DISEASED 3) DISTAL RCA DIFFUSELY DISEASED **ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM **LEFT CORONARY 5) LEFT MAIN NORMAL 6) PROXIMAL LAD DISCRETE 99 6A) SEPTAL-1 NORMAL 7) MID-LAD NORMAL 8) DISTAL LAD DIFFUSELY DISEASED 9) DIAGONAL-1 NORMAL 12) PROXIMAL CX NORMAL 13) MID CX NORMAL 13A) DISTAL CX DIFFUSELY DISEASED 14) OBTUSE MARGINAL-1 NORMAL 15) OBTUSE MARGINAL-2 DIFFUSELY DISEASED 17) LEFT PDA DIFFUSELY DISEASED 17A) POSTERIOR LV DIFFUSELY DISEASED **PTCA RESULTS LAD PTCA COMMENTS: Initial angiography revealed a 99% in-stent restenosis in the previously placed cypher stent in the proximal LAD. We planned to treat this lesion wiht ptca and stenting. Bivalirdudin was started prophyalctically for the procedure. A 6 frenech xblad3.5 guiding catheter provided adequate support for the procedure. A prowater wire crossed the lesion with minimal difficulty. The lesion was dilated with a 2.5x12mm voyager balloon at 10 atm. A 3.0x16mm taxus stent was then deployed at 16 atm. The stent was post dilated with a 3.5x15mm nc [**Male First Name (un) **] balloon at 14 atm. Final angiography revealed 0% residual stenosis, no angiographically apparent dissection and TIMI 3 flow. The patient left the lab free of angina and in stable condition. TECHNICAL FACTORS: Total time (Lidocaine to test complete) = 0 hour55 minutes. Arterial time = 0 hour51 minutes. Fluoro time = 14 minutes. Contrast injected: Non-ionic low osmolar (isovue, optiray...), vol 180 ml, Indications - Hemodynamic Premedications: Versed 0.5 mg IV Fentanyl 50 mcg IV Bivalirudin 82.5 mg IV Bivalirudin 27.5 mg/hr gtt Ntg 300 mcg IC Anesthesia: 1% Lidocaine subq. Cardiac Cath Supplies Used: .014 [**Doctor Last Name **], PROWATER 300CM 2.5 [**Doctor Last Name **], VOYAGER 12MM 3.5MM [**Doctor Last Name **], NC [**Male First Name (un) **] 15MM 6 CORDIS, XBLAD 3.5 - ALLEGIANCE, CUSTOM STERILE PACK - GUIDANT, PRIORITY PACK 20/30 3.0MM [**Company **], TAXUS 16MM COMMENTS: 1. Selective coronary angiography of this left dominant system demonstrated a diffuse CAD with a severe single vessel CAD. The LMCA was patent. The LAD had 99% ISR of a previously placed proximal Cypher DES; the distal LAD was a small and diffusely diseased vessel. The LCx had a severe diffuse disease of the OM2 branch and diffuse disease in the distal LCx. The RCA was a small non-dominant vessel with a diffuse disease. 2. Limited resting hemodynamics revealed systemic aortic normotension with an SBP of 126 mmHg. 3. Left ventriculography was deferred given elevated LVEDP and renal dysfunction. 4. Successful ptca and stenting of the proximal in-stent restenotic LAD lesion with a 3.0x16mm taxus stent which was post-dilated to 3.5mm. Final angiography revealed 0% residual stenosis, no angiographically apparent dissection and timi 3 flow (see ptca comments). FINAL DIAGNOSIS: 1. Diffuse CAD with a severe ISR of the proxiaml LAD Cypher DES. ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. CARDIOLOGY FELLOW: [**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **],[**First Name3 (LF) **] A. ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] P. ([**Numeric Identifier 105015**]) Brief Hospital Course: Patient is a 71 year old diabetic male with h/o CAD s/p DES x2 to mid/proximal LAD, HTN, hyperlipidemia who presents with 2 days of chest pain, positive enzymes. Heparin drip was started and patients chest pain was controlled with Nitro drip as well as morphine. Patient underwent cardiac catheterization and a drug eluting stent was placed in his LAD (full report attached). Post MI echo was significant for depressed left ventricular systolic function (LVEF= 40%) with apical akinesis, without obvious thrombosis. Given patients history of severe GI bleeding the decision was made to start patient NOT on Coumadin as patient already hypocoagulable due to aspirin, Plavix and hemodialysis. During the hospital course, after cardiac catheterization, patient developed mild respiratory distress with O2 saturation as low as 85% however without subjective feelings of shortness of breath or changes in mental status. Nevertheless patient was transferred to the ICU for close observation and was hemodialysed the following day, with significant improvement. His usual medical regiment of beta blocker, [**Last Name (un) **] and Lasix were continued over the hospital course and his volume status was at baseline upon discharge. . Patient appeared sleepy and somnolent on several occasions throughout the day. As reported by his daughter this seems to be "normal" for him. We suggest further workup as out patient with sleep studies to rule out obstructive sleep apnea. Medications on Admission: Nifedipine 60mg [**Hospital1 **] Aspirin 325mg daily Imdur 30mg HS Plavix 75mg daily Lipitor 20mg daily Calcium acetate 667 TID Lasix 80mg [**Hospital1 **] Valsartan 160mg [**Hospital1 **] Toprol 100mg qPM, 50mg qAM Amytriptyline 10mg HS Discharge Medications: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 3. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: 1.5 Tablet Sustained Release 24 hrs PO once a day. Disp:*45 Tablet Sustained Release 24 hr(s)* Refills:*2* 4. Amitriptyline 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 10. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Furosemide 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Home With Service Facility: [**Hospital1 **] Family & [**Hospital1 1926**] Services Discharge Diagnosis: Primary: Non-ST elevation myocardial infarction Acute systolic congestive heart failure End stage renal disease on hemodialysis . Secondary: Hypertension Diabetes mellitus, type 2 Hyperlipidemia Complete heart block status post pacemaker Bilateral adrenal adenomas Diverticulosis Antral polyps Cholelithiasis Status post right CFA pseudoaneurysm repair Discharge Condition: Afebrile. Stable vitals. O2sat on room air mid-90s. Ambulatory. Discharge Instructions: You were admitted for chest pain and found to have a mild heart attack. You underwent cardiac catheterization and were found to have narrowing in your coronary artery (LAD) at the place where you had a prior stent; a new stent was placed in this location. . After the procedure you developed trouble breathing related to fluid overload and required an overnight stay in the intensive care unit for dialysis. Your dialysis schedule will be increased to 3 times per week according to your renal doctors. . You were also noted to have poor contraction of a portion of your heart likely due to the heart attack. The location of this heart dysfunction increases your risk of stroke and therefore starting a medication to thin your blood (coumadin) was discussed with you. It was decided that ... . Please take all medications as prescribed 2gm sodium diet; fluid restriction 1500ml Measure weights daily, call your doctor if increase > 3 pounds New medications: Changed medications: Discontinued medications: . You absolutely must take both asprin and plavix every day without exception as missing any dose may lead to a repeat heart attack and death. . Call your doctor or return to the ED immediately if you experience worsening chest pain, shortness of breath, nausea, vomiting, abdominal pain, sweating, fevers, chills, bleeding, or other concerning symptoms. Followup Instructions: You are scheduled for the following appointments. Please contact the [**Name2 (NI) 11686**] provider with any questions or if you need to reschedule. . Call your PCP to schedule [**Name Initial (PRE) **] followup appointment in 2 weeks. . You will go for hemodialysis tomorrow (Friday [**2144-12-4**]) at your regular outpatient dialysis center. . Cardiology follow-up ...

410,428,403,585,414,V450,250,272,562,227,574,V458,V127,288

{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of adrenal gland,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Percutaneous transluminal coronary angioplasty status,Personal history of other diseases of digestive system,Leukocytosis, unspecified'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname 105012**] is a 71 year old male with h/o CAD s/p overlapping DES to the LAD [**6-26**] then [**8-28**], recent admit for CP ([**11-23**]) had MIBI with no reversible defects, ESRD on HD, hyperlipidemia, HTN, DM2 who presents with chest pain since Thursday. Mr. [**Known lastname 105012**] had a DES placed in the mid LAD in [**6-/2143**] and DES placed to the proximal LAD in [**Month (only) **] of this year. He was admitted on [**11-23**] for chest pain. He had three sets of enzymes - negative CK and trop stable at 0.20. He had an exercise MIBI that showed fixed moderate sized defect of the inferior and anterior wall and apex, no reversible defects were appreciated, exercise induced LV dilitation. He was discharged on [**11-24**]. He returns with 2 days of substernal squeezing chest pain which he feels is similar to prior. He has occasional sharp chest pains on the left side. He also has some back pain which he is attributing to lying on the stretcher for hrs. He has not slept in two days due to the chest pressure. He says that Friday evening the chest pain was at its worst, but still persists today. He has associated shortness of breath and nausea, no lightheadedness or diaphoresis. He has been taking NTG at home with some brief relief of chest pain. He is on HD for ESRD. Had HD yesterday without event. . In the ED, vital signs were BP 132/66, HR 72, RR 20, O2sat 100% on RA. He was given morphine 2mg with no relief of CP. SL NTG x1 with pain improved from [**2-1**] to [**1-1**]. He was given lopressor 50mg x1 and second SL NTG and became pain free. At 6PM CP returned, this time [**4-30**] pain and started on nitro gtt. Reportedly became CP free. Case discussed with cardiology in the ED and decision to start heparin gtt w/o bolus. Positive troponin (CK 415, MB 31, Trop 0.58). Other notable labs: WBC 13.7, Hct stable 37.9, creatinine 5.0. . Review of symptoms is positive for nausea, shortness of breath and fatigue. Negative for nausea, dizziness, palpitations, abdominal pain or syncope. He has not had any BRBPR or melena. . On arrival to the floor patient continues to have [**3-31**] substernal chest squeezing. He also says that his shortness of breath is increased from prior. He is on nitro gtt and heparin gtt. He is complaining of back pain. MEDICAL HISTORY: CAD, s/p stent to the LAD on [**2142**] then overlapping DES to the LAD on [**2144-8-26**] Hypertension CHF- EF 55%, 1+ MR, mild LVH by echo [**6-/2141**] (EF 49% by stress MIBI [**2144-8-21**]) Diabetes Hyperlipidemia Heart block s/p pacemaker [**2-/2142**] Chronic renal failure on HD q MON, and Friday (plan for a transplant in the future) S/P right arm AV fistula [**3-/2143**] Cellulitis [**6-/2141**] Bilateral adrenal adenomas Diverticulosis Antral polyps Cholelithiasis by CT on [**2143-7-16**] S/P right CFA pseudoaneurysm repair [**2143-7-16**] for wound cellulitis MEDICATION ON ADMISSION: Nifedipine 60mg [**Hospital1 **] Aspirin 325mg daily Imdur 30mg HS Plavix 75mg daily Lipitor 20mg daily Calcium acetate 667 TID Lasix 80mg [**Hospital1 **] Valsartan 160mg [**Hospital1 **] Toprol 100mg qPM, 50mg qAM Amytriptyline 10mg HS ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS 98.3, BP 148/89, HR 76, RR 20, O2sat 95% RA Gen: WDWN middle aged 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. FAMILY HISTORY: Negative for coronary artery disease. Mother: died of multiple myeloma at age 84. Father: Died at age 30 as a casualty of war SOCIAL HISTORY: Restauranteur Denies etoh intake, tobacco use or illicit drug use 40 pk-yr history, quit 24 yr ago. ### Response: {'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Benign neoplasm of adrenal gland,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Percutaneous transluminal coronary angioplasty status,Personal history of other diseases of digestive system,Leukocytosis, unspecified'}

CHIEF COMPLAINT: Retroperitoneal Bleed PRESENT ILLNESS: 51 year old female who is transferred from OSH with retroperitoneal bleed. She presented to the OSH with her multiple episodes of vomiting and epigastric pain. She gets these episodes every 4 to 5 years. Always treated symptomatically. She had this episode on Friday and was sent home after a cardiac rule out. The pain is episodic and is like a spasm. It comes and goes. Emesis is always bilious, nonbloody. Episodes in the past have been attributed to intestinal or biliary spasm. She says that on Monday she had the epigastric pain with some flank pain which is different from her previous episodes. She also had a temp of 101.6 in the ED at the OSH. She denies diarrhea, melena or bright red blood. Denies trauma. Denies NSAID use. No bowel movement in ten days. Positive flatus. No appetite. Minimal food intact. Denies dysuria or history of kidney stones. History of duodenal ulcer 10-15 years ago at [**Hospital1 1774**]. She had an EGD Tuesday which showed esophageal ulcer, small hiatal hernia and gastritis and they took a biopsy of the stomach and second portion of the duodenum. She then had a hematocrit drop from 43->39->23.7 last Hematocrit at 0800. Repeat EGD with no active bleeding to the 3rd portion of the duodenum so then they obtained a CT scan. The CT scan showed retroperitoneal bleed around the duodenum second portion and caudal. HIDA scan from OSH was negative. She got one unit of PRBCs at 2100 and then she was transferred to [**Hospital1 18**]. MEDICAL HISTORY: PMHx: Depression, peptic ulcer disease, gastroesophageal reflux. . PSHx: Carpal tunnel release x 2, uterine ablation [**2143**] for menorrhagia. MEDICATION ON ADMISSION: 1. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QAM (in the morning) and 1 capsule PO QPM (at bedtime). ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: Vital Signs: T 98.5 HR 106-> 95 BP 117/67 RR 18 O2 Sat 98% RA General: No acute Distress Lungs: Clear to Auscultation bilaterally Cardiac: Regular rate and rhythm, S1/S2 Abdomen: Soft, nondistended, tender in the epigastrium and right upper abdomen. No guarding. No rebound. No CVA tenderness. Rectal: Normal tone, no gross blood, guaiac negative, no stool only mucous. FAMILY HISTORY: Coronary Artery disease in her mother and father. SOCIAL HISTORY: Lives with her significant other. [**Name (NI) 1403**] as hospice nurse. Two grown daughters. Denies tobacco. Denies illicit drug use. ETOH socially

Hemoperitoneum (nontraumatic),Acute pancreatitis,Other obstruction of duodenum,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Constipation, unspecified,Unspecified essential hypertension

Hemoperitoneum,Acute pancreatitis,Duodenal obstruction NEC,Drop, hematocrit, precip,Abn react-procedure NEC,Depressive disorder NEC,Esophageal reflux,Peptic ulcer NOS,Constipation NOS,Hypertension NOS

Admission Date: [**2146-2-25**] Discharge Date: [**2146-3-4**] Date of Birth: [**2094-10-6**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6346**] Chief Complaint: Retroperitoneal Bleed Major Surgical or Invasive Procedure: None History of Present Illness: 51 year old female who is transferred from OSH with retroperitoneal bleed. She presented to the OSH with her multiple episodes of vomiting and epigastric pain. She gets these episodes every 4 to 5 years. Always treated symptomatically. She had this episode on Friday and was sent home after a cardiac rule out. The pain is episodic and is like a spasm. It comes and goes. Emesis is always bilious, nonbloody. Episodes in the past have been attributed to intestinal or biliary spasm. She says that on Monday she had the epigastric pain with some flank pain which is different from her previous episodes. She also had a temp of 101.6 in the ED at the OSH. She denies diarrhea, melena or bright red blood. Denies trauma. Denies NSAID use. No bowel movement in ten days. Positive flatus. No appetite. Minimal food intact. Denies dysuria or history of kidney stones. History of duodenal ulcer 10-15 years ago at [**Hospital1 1774**]. She had an EGD Tuesday which showed esophageal ulcer, small hiatal hernia and gastritis and they took a biopsy of the stomach and second portion of the duodenum. She then had a hematocrit drop from 43->39->23.7 last Hematocrit at 0800. Repeat EGD with no active bleeding to the 3rd portion of the duodenum so then they obtained a CT scan. The CT scan showed retroperitoneal bleed around the duodenum second portion and caudal. HIDA scan from OSH was negative. She got one unit of PRBCs at 2100 and then she was transferred to [**Hospital1 18**]. Past Medical History: PMHx: Depression, peptic ulcer disease, gastroesophageal reflux. . PSHx: Carpal tunnel release x 2, uterine ablation [**2143**] for menorrhagia. Social History: Lives with her significant other. [**Name (NI) 1403**] as hospice nurse. Two grown daughters. Denies tobacco. Denies illicit drug use. ETOH socially Family History: Coronary Artery disease in her mother and father. Physical Exam: On Admission: Vital Signs: T 98.5 HR 106-> 95 BP 117/67 RR 18 O2 Sat 98% RA General: No acute Distress Lungs: Clear to Auscultation bilaterally Cardiac: Regular rate and rhythm, S1/S2 Abdomen: Soft, nondistended, tender in the epigastrium and right upper abdomen. No guarding. No rebound. No CVA tenderness. Rectal: Normal tone, no gross blood, guaiac negative, no stool only mucous. Pertinent Results: On Admission: [**2146-2-25**] 02:51PM HCT-32.7* [**2146-2-25**] 08:45AM HCT-27.4* [**2146-2-25**] 04:30AM GLUCOSE-88 UREA N-9 CREAT-0.6 SODIUM-143 POTASSIUM-3.3 CHLORIDE-104 TOTAL CO2-24 ANION GAP-18 [**2146-2-25**] 04:30AM CALCIUM-8.3* PHOSPHATE-3.9 MAGNESIUM-1.9 [**2146-2-25**] 04:30AM WBC-7.6 HCT-24.5* [**2146-2-25**] 04:30AM PLT COUNT-171 [**2146-2-25**] 12:52AM HGB-9.6* calcHCT-29 [**2146-2-25**] 12:45AM GLUCOSE-92 UREA N-9 CREAT-0.6 SODIUM-137 POTASSIUM-3.6 CHLORIDE-104 TOTAL CO2-24 ANION GAP-13 [**2146-2-25**] 12:45AM ALT(SGPT)-23 AST(SGOT)-20 ALK PHOS-74 TOT BILI-0.9 [**2146-2-25**] 12:45AM LIPASE-26 [**2146-2-25**] 12:45AM WBC-10.2 RBC-2.92* HGB-8.8* HCT-25.6* MCV-88 MCH-30.3 MCHC-34.5 RDW-13.0 [**2146-2-25**] 12:45AM NEUTS-51.3 LYMPHS-43.3* MONOS-3.6 EOS-1.4 BASOS-0.4 [**2146-2-25**] 12:45AM PLT COUNT-203 [**2146-2-25**] 12:45AM PT-13.0 PTT-20.3* INR(PT)-1.1 . IMAGING: [**2146-2-26**] ABD/PELVIC CT W/CONTRAST: 1. Improved appearance to right retroperitoneal hematoma. 2. No bowel obstruction or pneumoperitoneum is present. 3. Scattered diverticula with no signs of acute diverticulitis. . [**2146-3-2**] KUB/upright: No evidence of volvulus or small-bowel obstruction. . [**2146-3-3**] PELVIC/TRANSVAGINAL U/S: 1. Fibroid uterus. 2. Normal ovarian size and vascular waveforms without evidence to suggest torsion. . MICROBIOLOGY: SEROLOGY/BLOOD HELICOBACTER PYLORI ANTIBODY TEST-FINAL: NEGATIVE. [**2146-2-25**] MRSA SCREEN MRSA SCREEN-FINAL: NEGATIVE. Brief Hospital Course: The patient was admitted to the General Surgical Service on [**2146-2-25**] for evaluation and treatment of a retroperitoneal bleed. The patient was admitted to the TICU, made NPO, started on IV fluids and an IV Pantoprazole infusion, and given both IV Zofran and Compazine for nausea. Serial hematocrits were monitored. The patient was hemodynamically stable. . Neuro: The patient received anti-emetics and a Dilaudid PCA for nausea and pain, respectively, with good effect. When tolerating oral intake, the patient was transitioned to oral pain medications with continued good effect. . CV: The patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. . Pulmonary: The patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. Good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. . GI/GU/FEN: Upon admission, the patient was made NPO with IV fluids started, and an NG tube was placed. Diet was advanced to clears on [**2-27**] after the NG tube was discontined, but she expereinced persisent nausea and vomiting. Given persistent GI symptoms, a PICC line was placed on [**2-28**], and TPN started. A foley catheter was placed upon admission to the TICU, then discontinued on [**2-26**]. The patient subsequently voided without problem. [**Name (NI) 15110**] to contuinued abdominal pain and nausea, the patient underwent pelvic and transvaginal ultra-sound on [**2146-3-3**], which was unremarkable. An abdominal ultra-sound and HIDA scan performed at the Outside Hospital were also unremarkable, demonstrating no gallbladder pathology or other acute findings. When her GI symptoms resolved, diet was progressively returned to regular with good tolerability. TPN was discontinued. Patient's intake and output were closely monitored, and IV fluid was adjusted when necessary. Electrolytes were routinely followed, and repleted when necessary. She was discharged home on a PPI. . ID: The patient's white blood count and fever curves were closely watched for signs of infection. Admission MRSA screen was negative. . Endocrine: While on TPN, the patient's blood sugar was monitored throughout her stay; sliding scale insulin was administered when indicated. She did not require exogenous insulin at discharge. . Hematology: After receiving 1 unit of PRBCs at the Outside Hospital (OSH), the patient's hematocrit rebounded from a low 23.7, and remained stable between 30-33. Serial hematocrits were monitored. No further transfusions were required. . Prophylaxis: Venodyne boots were used during this stay; she was encouraged to get up and ambulate as early and frequently as possible. Subcutaneous heparin was contra-indicated due to bleeding diagnosis. . Psychosocial: Visiting family members expressed their concern that the patient's boyfriend/fiancee is allegedly verbally abusive and controlling. Social Work was consulted. The patient reported to Nursing and Social Work that she and her boyfriend were in couple's counseling, and that he had never been physically abusive or sexually coersive. She endorsed that she felt safe in his presence, and did not believe he would harm her. She declined referral to the Center for Violence Prevention and Recovery. She did change her Health Care Proxy to her sister. Domestic violence resource information was given prior to discharge. She felt that she would be safe upon discharge, and declined any special precautions or services. . At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. She was discharged home without services. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Medications on Admission: 1. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QAM (in the morning) and 1 capsule PO QPM (at bedtime). Discharge Medications: 1. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QAM (in the morning) and 1 capsule PO QPM (at bedtime). 2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. Disp:*60 Capsule(s)* Refills:*0* 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day: If NON-FORMULARY, change to Omeprazole 20mg 1 cap PO daily (#30; 2RF). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 4. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*14 Capsule(s)* Refills:*0* 5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain, fever. 6. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*25 Tablet(s)* Refills:*0* 7. Polyethylene Glycol 3350 17 gram/dose Powder Sig: Seventeen (17) grams dissolved in 8oz water or juice PO once a day as needed for constipation. Disp:*255 grams* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: 1. Retroperitoneal bleed around the second portion of the duodenum status post endoscopy. 2. Depression. 3. GERD 4. PUD Discharge Condition: Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - Independent Discharge Instructions: Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than [**5-16**] lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Followup Instructions: Please call ([**Telephone/Fax (1) 84852**] to arrange a follow-up appointment with Dr. [**Last Name (STitle) 85763**] (PCP) in [**1-8**] weeks. . Please call ([**Telephone/Fax (1) 8105**] to schedule a follow-up appointment with Dr. [**First Name (STitle) 2819**] (Surgery) in [**2-9**] weeks. Completed by:[**2146-3-4**] Admission Date: [**2146-3-4**] Discharge Date: [**2146-3-16**] Date of Birth: [**2094-10-6**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6346**] Chief Complaint: nausea, emesis, and abdominal pain Major Surgical or Invasive Procedure: none History of Present Illness: 51 year old female recently discharged from [**Hospital1 18**] after hospitalization for a right-sided retroperitoneal hematoma, nausea, emesis, and obstructive symptoms and re-admitted for continued nausea, emesis, and abdominal pain. During her initial admission pt was transferred from OSH with retroperitoneal bleed. She presented to the OSH with multiple episodes of vomiting and epigastric pain. She reported experiencing these episodes every 4 to 5 years. Always treated symptomatically. She had this episode on Friday and was sent home after a cardiac rule out. The pain is episodic, intermittent, and is spasm-like. Emesis is always bilious and nonbloody. Episodes in the past have been attributed to intestinal or biliary spasm. Patient states that on Monday she had epigastric pain with some flank pain which is different from her previous episodes and also noted to have a temp of 101.6 in the ED at the OSH. She denies diarrhea, melena or bright red blood. Denies trauma. Denies NSAID use. No bowel movement in ten days. Positive flatus. No appetite. Minimal food intact. Past Medical History: PMHx: Depression, peptic ulcer disease, gastroesophageal reflux. . PSHx: Carpal tunnel release x 2, uterine ablation [**2143**] for menorrhagia. Social History: Lives with her sister, significant other no longer allowed near her. Works as hospice nurse. Two grown daughters. Denies tobacco. Denies illicit drug use. ETOH socially. Family History: Coronary Artery disease in her mother and father. Physical Exam: On admission Tc 98.0, HR 122, BP 164/104, RR 18, O2sat 100% Genl: NAD CV: tachycardic Resp: CTA-B Abd: soft, diffusely tender, non-distended; no rebound, no guarding Extr: no c/c/e At discharge Gen: AOX3, NAD CV: RRR Lung: CTAB Abd: soft non tender, non-distended, no rebound, no guarding Extra: non c/c/e Pertinent Results: [**2146-3-4**] 10:30PM GLUCOSE-150* UREA N-17 CREAT-0.7 SODIUM-138 POTASSIUM-3.4 CHLORIDE-100 TOTAL CO2-20* ANION GAP-21* [**2146-3-4**] 10:30PM ALT(SGPT)-190* AST(SGOT)-120* ALK PHOS-172* TOT BILI-1.1 [**2146-3-4**] 10:30PM LIPASE-103* [**2146-3-4**] 10:30PM ALBUMIN-4.8 CALCIUM-10.5* PHOSPHATE-1.1*# MAGNESIUM-1.8 [**2146-3-4**] 10:30PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2146-3-4**] 10:30PM WBC-8.7# RBC-3.91* HGB-11.6*# HCT-33.4* MCV-85 MCH-29.6 MCHC-34.6 RDW-13.4 [**2146-3-4**] 10:30PM NEUTS-72.0* LYMPHS-23.7 MONOS-3.5 EOS-0.5 BASOS-0.3 [**2146-3-4**] 05:14AM GLUCOSE-88 UREA N-18 CREAT-0.6 SODIUM-138 POTASSIUM-4.5 CHLORIDE-104 TOTAL CO2-24 ANION GAP-15 [**2146-3-4**] 05:14AM GLUCOSE-88 UREA N-18 CREAT-0.6 SODIUM-138 POTASSIUM-4.5 CHLORIDE-104 TOTAL CO2-24 ANION GAP-15 [**2146-3-4**] 05:14AM estGFR-Using this [**2146-3-4**] 05:14AM CALCIUM-9.0 PHOSPHATE-5.0* MAGNESIUM-2.0 [**2146-3-3**] 04:41AM GLUCOSE-115* UREA N-16 CREAT-0.5 SODIUM-136 POTASSIUM-4.5 CHLORIDE-104 TOTAL CO2-25 ANION GAP-12 [**2146-3-3**] 04:41AM CALCIUM-8.7 PHOSPHATE-4.2 MAGNESIUM-2.0 Brief Hospital Course: The patient was initially admitted to the General Surgical Service on [**2146-2-25**] for evaluation and treatment of a retroperitoneal bleed and readmitted on [**2146-3-4**] shortly after discharge for recurrence of symptoms. The patient was admitted, made NPO, started on IV fluids, and given both IV zofran and compazine for nausea. Serial hematocrits were monitored. The patient was hemodynamically stable. . Neuro: The patient received anti-emetics and a dilaudid PCA for nausea and pain, respectively, with adequate effect. When tolerating oral intake, the patient was transitioned to oral pain medications with continued good effect. . CV: The patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. . Pulmonary: The patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. Good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. . GI/GU/FEN: Upon admission, the patient was made NPO with IV fluids started, an NG tube was placed, and supportive care for her symptoms was provided. Urine metanephrines were ordered and endocrine consult obtained with determination of no current suspicion of pheochromocytoma. A MR performed on [**2146-3-10**] revealed: 1. previous retroperitoneal hematoma inseparable and enveloping the antero-inferior aspect of 3rd portion of the duodenum is smaller, more organized and more liquified as compared to prior study. 2. No definite enhancing mass, adrenal glands and pancreas are normal. Patient experienced significant improvement in her symptoms during the course of this admission and when GI symptoms resolved, diet was advanced to regular with good tolerance and TPN was discontinued and [**2146-3-15**]. Patient's intake and output were closely monitored, and IV fluid was adjusted when necessary. Electrolytes were routinely followed, and repleted when necessary. She was discharged home on a PPI as instructed from her previous discharge on [**2146-3-4**]. . ID: The patient's white blood count and fever curves were closely watched for signs of infection. . Endocrine: While on TPN, the patient's blood sugar was monitored throughout her stay; sliding scale insulin was administered when indicated. She did not require exogenous insulin at discharge. As above, an endocrine consult was obtained for evaluation of elevated metanephrines with determination of low suspicion of pheochromocytoma and instructions to follow-up as outpatient after discontinuation of prochlorperazine for 2-3 weeks. . Hematology: Patient was hemodynamically stable during this admission and required no blood transfusions. Prophylaxis: Venodyne boots and twice daily subcutaneous heparin were used during this admission; she was encouraged to get up and ambulate as early and frequently as possible. . Psychosocial: Patient seen by social work during this admission. Privacy alert was initiated for this admission. Please refer to social work note for additional details. . At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. She was discharged home without services. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Medications on Admission: . Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QAM (in the morning) and 1 capsule PO QPM (at bedtime). . Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. . Pantoprazole 40mg DAILY . Fluoxetine 10 mg PO DAILY . Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H as needed for pain. Discharge Medications: 1. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QPM (once a day (in the evening)). 2. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Four (4) Capsule, Sust. Release 24 hr PO QAM (once a day (in the morning)). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Discharge Disposition: Home Discharge Diagnosis: Severe nausea, vomiting, abdominal pain, elevated liver enzymes Discharge Condition: stable Discharge Instructions: You are recovering from a serious illness. You will need some time before you feel completely well again, take time to rest and recover. Please call you doctor or come back to the hospital if you have any new symptoms including: fevers chills, shortness of breath, chest pain, vomitting, inability to hydrate, dizziness. Your liver enzymes were elevated. Please avoid using products with acetaminophen (tylenol). Keep consumption of alcohol to a minimum. Followup Instructions: Follow up with the endocrinologist Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 1803**] in approximately 3 months. Please refrain from taking prochlorperazine 1 month prior to your appointment. Follow up with Dr. [**First Name (STitle) 2819**] in 2 weeks, call [**Telephone/Fax (1) 2998**] to make an appointment. Completed by:[**2146-3-16**]

568,577,537,790,E879,311,530,533,564,401

{'Hemoperitoneum (nontraumatic),Acute pancreatitis,Other obstruction of duodenum,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Constipation, unspecified,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: Retroperitoneal Bleed PRESENT ILLNESS: 51 year old female who is transferred from OSH with retroperitoneal bleed. She presented to the OSH with her multiple episodes of vomiting and epigastric pain. She gets these episodes every 4 to 5 years. Always treated symptomatically. She had this episode on Friday and was sent home after a cardiac rule out. The pain is episodic and is like a spasm. It comes and goes. Emesis is always bilious, nonbloody. Episodes in the past have been attributed to intestinal or biliary spasm. She says that on Monday she had the epigastric pain with some flank pain which is different from her previous episodes. She also had a temp of 101.6 in the ED at the OSH. She denies diarrhea, melena or bright red blood. Denies trauma. Denies NSAID use. No bowel movement in ten days. Positive flatus. No appetite. Minimal food intact. Denies dysuria or history of kidney stones. History of duodenal ulcer 10-15 years ago at [**Hospital1 1774**]. She had an EGD Tuesday which showed esophageal ulcer, small hiatal hernia and gastritis and they took a biopsy of the stomach and second portion of the duodenum. She then had a hematocrit drop from 43->39->23.7 last Hematocrit at 0800. Repeat EGD with no active bleeding to the 3rd portion of the duodenum so then they obtained a CT scan. The CT scan showed retroperitoneal bleed around the duodenum second portion and caudal. HIDA scan from OSH was negative. She got one unit of PRBCs at 2100 and then she was transferred to [**Hospital1 18**]. MEDICAL HISTORY: PMHx: Depression, peptic ulcer disease, gastroesophageal reflux. . PSHx: Carpal tunnel release x 2, uterine ablation [**2143**] for menorrhagia. MEDICATION ON ADMISSION: 1. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: Two (2) Capsule, Sust. Release 24 hr PO QAM (in the morning) and 1 capsule PO QPM (at bedtime). ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: Vital Signs: T 98.5 HR 106-> 95 BP 117/67 RR 18 O2 Sat 98% RA General: No acute Distress Lungs: Clear to Auscultation bilaterally Cardiac: Regular rate and rhythm, S1/S2 Abdomen: Soft, nondistended, tender in the epigastrium and right upper abdomen. No guarding. No rebound. No CVA tenderness. Rectal: Normal tone, no gross blood, guaiac negative, no stool only mucous. FAMILY HISTORY: Coronary Artery disease in her mother and father. SOCIAL HISTORY: Lives with her significant other. [**Name (NI) 1403**] as hospice nurse. Two grown daughters. Denies tobacco. Denies illicit drug use. ETOH socially ### Response: {'Hemoperitoneum (nontraumatic),Acute pancreatitis,Other obstruction of duodenum,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Constipation, unspecified,Unspecified essential hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient was admitted after three days complaining of headache increasing in intensity and frequency. He initially presented to the Emergency Room awake, alert, and oriented times three. He had some slight slurring of his speech which resolved spontaneously. He was spontaneously. Otherwise he was neurologically intact with full range of motion, full strength, and full sensation. No pronator drift was noted. Vitals signs were stable. Visual fields were intact. Labs were within normal limits except for a PT of 2.7, but he is on Coumadin. MEDICAL HISTORY: Hypertension. Gallbladder disease. Mitral valve prolapse. Atrial fibrillation. Congenital abnormality of his right thumb. MEDICATION ON ADMISSION: Lopressor, Coumadin. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Subarachnoid hemorrhage,Cardiogenic shock,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension

Subarachnoid hemorrhage,Cardiogenic shock,Pneumonia, organism NOS,Atrial fibrillation,CHF NOS,Hypertension NOS

Admission Date: [**2137-10-14**] Discharge Date: [**2137-11-12**] Date of Birth: [**2080-10-24**] Sex: M Service: NEUROSURGERY HISTORY OF PRESENT ILLNESS: The patient was admitted after three days complaining of headache increasing in intensity and frequency. He initially presented to the Emergency Room awake, alert, and oriented times three. He had some slight slurring of his speech which resolved spontaneously. He was spontaneously. Otherwise he was neurologically intact with full range of motion, full strength, and full sensation. No pronator drift was noted. Vitals signs were stable. Visual fields were intact. Labs were within normal limits except for a PT of 2.7, but he is on Coumadin. CAT scan revealed a subarachnoid hemorrhage with blood in Otherwise PE was unremarkable. PAST MEDICAL HISTORY: Hypertension. Gallbladder disease. Mitral valve prolapse. Atrial fibrillation. Congenital abnormality of his right thumb. PAST SURGICAL HISTORY: Mitral valve repair in [**2137-5-4**] along with an AFB repair. He also has had pilonidal cyst excision and digit removal. MEDICATIONS ON ADMISSION: Lopressor, Coumadin. HOSPITAL COURSE: On [**10-15**], he underwent a cerebral angiogram which revealed a dissecting fusiform aneurysm of the superior cerebellar artery and underwent GDC aneurysm coiling to achieve parent vessel occlusion (PVO) in the Angiography Suite. He was transferred to the Intensive Care Unit. Triple therapy was started with Cardiology input. He was in rapid atrial fibrillation in the 140s which was difficult to control with Labetalol and Amiodarone. He self-extubated on the 15th and was subsequently reintubated on [**10-20**] for increased work of breathing. He remained in rapid atrial fibrillation, and he was treated with Diltiazem with some affect. On the 17th, a PA line was inserted due to hemodynamic instability. Cardiac index was found to be 17. On the next morning on 18th, a balloon pump was placed for hemodynamic support. Low-dose Heparin was also started for anticoagulation. He spiked a temperature to 103-104??????. He did have some gram-negative rods in his sputum which was treated with a [**6-12**] day course of antibiotics. He also had a catheter tip culture which was positive, but blood cultures were negative, so that was not treated. On the 19th, he had some increasing LFTs. He had a right upper quadrant ultrasound which was negative. His LFTs came down on its own without treatment. On the 20th, hemodynamics slowly improved since the balloon pump was put in, and that was subsequently removed with a last index of 30. On the 23rd, he had some bibasilar vasospasms and was started on Heparin. On the 27th, he was extubated and has done well since. On [**11-5**], he discontinued his vent drain himself, and he was later transferred to the floor. On the 4th, he had a swallow study done, and he passed. Physical Therapy and Occupational Therapy evaluated him, and he will require acute rehabilitation. DISCHARGE MEDICATIONS: Heparin IV 1550 U/hr, Protonix 40 mg p.o. q.d., Reglan 10 mg p.o. q.i.d., Diltiazem 60 mg p.o. q.i.d., Tylenol 1000 p.o. q.6 hours p.r.n., sliding scale Insulin, Docusate 100 mg p.o. b.i.d. FOLLOW-UP: The patient will need to follow-up with [**Doctor Last Name 1132**] in two weeks after discharge. CONDITION ON DISCHARGE: The patient was stable at the time of discharge. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2137-11-6**] 12:05 T: [**2137-11-6**] 14:03 JOB#: [**Job Number 95493**] 1 1 1 DR Name: [**Last Name (LF) 15136**],[**Known firstname **] Unit No: [**Numeric Identifier 15134**] Admission Date: [**2137-10-14**] Discharge Date: [**2137-11-12**] Date of Birth: [**2080-10-24**] Sex: M Service: ADDENDUM: The patient's discharge was delayed secondary to lack of a rehabilitation bed. The patient was discharged to [**Hospital6 8525**] on [**2137-11-12**] in stable condition. He will follow up with Dr. [**Last Name (STitle) 365**] in one to two weeks. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 5862**] Dictated By:[**Last Name (NamePattern1) 366**] MEDQUIST36 D: [**2138-1-9**] 09:51 T: [**2138-1-9**] 10:03 JOB#: [**Job Number 15137**]

430,785,486,427,428,401

{'Subarachnoid hemorrhage,Cardiogenic shock,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: The patient was admitted after three days complaining of headache increasing in intensity and frequency. He initially presented to the Emergency Room awake, alert, and oriented times three. He had some slight slurring of his speech which resolved spontaneously. He was spontaneously. Otherwise he was neurologically intact with full range of motion, full strength, and full sensation. No pronator drift was noted. Vitals signs were stable. Visual fields were intact. Labs were within normal limits except for a PT of 2.7, but he is on Coumadin. MEDICAL HISTORY: Hypertension. Gallbladder disease. Mitral valve prolapse. Atrial fibrillation. Congenital abnormality of his right thumb. MEDICATION ON ADMISSION: Lopressor, Coumadin. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Subarachnoid hemorrhage,Cardiogenic shock,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified essential hypertension'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: This is a 59 year old female with recent diagnosis of mitral regurgitation. Over the last several months, she has experienced worsening shortness of breath and cough. Also admits to orthopnea and dyspnea on exertion. She has no history of myocardial infarction. Echocardiogram in [**2183-3-27**] revealed severe mitral regurgitation with flail posterior leaflet, and normal LV function. In preperation for cardiac surgery, she underwent cardiac catheterization which showed normal coronary arteries. It confirmed 4+ mitral regurgitation and normal left ventricular function. She had moderate pulmonary hypertension with PAP 50/19 with a mean of 30 mmHg. She was admitted for mitral valve surgery. MEDICAL HISTORY: Mitral regurgitation Gastroesophogeal Reflux Disease History of Hemoptysis History of postive PPD - s/p treatment MEDICATION ON ADMISSION: Omeprazole 20 qd, Lisinopril 5 qd, Hydroxyzine 25 qd, Singulair 10 qd, Albuterol MDI, Bromfenex ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: BP 132/86, HR 77, RR 18 General: well developed female in no acute distress HEENT: oropharynx benign, Neck: supple, no JVD, Heart: regular rate, normal s1s2, 4/6 systolic murmur Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds Ext: cool, no edema, no varicosities Pulses: 2+ distally Neuro: nonfocal FAMILY HISTORY: Father died at age 30 - unknown cause SOCIAL HISTORY: Denies tobacco and ETOH. Married, works in a grocery store. Lives with husband.

Mitral valve disorders,Atrial fibrillation,Intermediate coronary syndrome,Esophageal reflux,Chronic pulmonary heart disease, unspecified,Hypopotassemia

Mitral valve disorder,Atrial fibrillation,Intermed coronary synd,Esophageal reflux,Chr pulmon heart dis NOS,Hypopotassemia

Admission Date: [**2183-5-26**] Discharge Date: [**2183-5-30**] Date of Birth: [**2123-12-14**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1283**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: [**2183-5-26**] Mitral Valve Repair utilizing a 28mm [**Doctor Last Name 405**] Band History of Present Illness: This is a 59 year old female with recent diagnosis of mitral regurgitation. Over the last several months, she has experienced worsening shortness of breath and cough. Also admits to orthopnea and dyspnea on exertion. She has no history of myocardial infarction. Echocardiogram in [**2183-3-27**] revealed severe mitral regurgitation with flail posterior leaflet, and normal LV function. In preperation for cardiac surgery, she underwent cardiac catheterization which showed normal coronary arteries. It confirmed 4+ mitral regurgitation and normal left ventricular function. She had moderate pulmonary hypertension with PAP 50/19 with a mean of 30 mmHg. She was admitted for mitral valve surgery. Past Medical History: Mitral regurgitation Gastroesophogeal Reflux Disease History of Hemoptysis History of postive PPD - s/p treatment Social History: Denies tobacco and ETOH. Married, works in a grocery store. Lives with husband. Family History: Father died at age 30 - unknown cause Physical Exam: Vitals: BP 132/86, HR 77, RR 18 General: well developed female in no acute distress HEENT: oropharynx benign, Neck: supple, no JVD, Heart: regular rate, normal s1s2, 4/6 systolic murmur Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds Ext: cool, no edema, no varicosities Pulses: 2+ distally Neuro: nonfocal Pertinent Results: [**2183-5-30**] 06:20AM BLOOD WBC-13.8* RBC-3.21* Hgb-9.6* Hct-28.5* MCV-89 MCH-30.0 MCHC-33.8 RDW-14.5 Plt Ct-292# [**2183-5-29**] 06:05AM BLOOD WBC-13.3* RBC-2.89* Hgb-8.6* Hct-25.4* MCV-88 MCH-29.7 MCHC-33.8 RDW-14.3 Plt Ct-179 [**2183-5-28**] 06:35AM BLOOD WBC-16.7* RBC-3.02* Hgb-9.0* Hct-26.1* MCV-87 MCH-29.7 MCHC-34.3 RDW-14.5 Plt Ct-148* [**2183-5-26**] 11:57PM BLOOD WBC-20.9*# RBC-3.55* Hgb-10.7* Hct-31.0* MCV-87 MCH-30.1 MCHC-34.5 RDW-14.5 Plt Ct-179 [**2183-5-26**] 03:06PM BLOOD WBC-13.9*# RBC-3.60* Hgb-10.8*# Hct-31.3* MCV-87 MCH-30.0 MCHC-34.5 RDW-14.1 Plt Ct-182 [**2183-5-30**] 06:20AM BLOOD Glucose-102 UreaN-11 Creat-0.8 Na-137 K-4.6 Cl-98 HCO3-28 AnGap-16 [**2183-5-29**] 06:05AM BLOOD Glucose-157* UreaN-14 Creat-0.7 Na-134 K-3.3 Cl-97 HCO3-31 AnGap-9 [**2183-5-28**] 06:35AM BLOOD Glucose-124* UreaN-16 Creat-0.6 Na-137 K-3.8 Cl-97 HCO3-35* AnGap-9 [**2183-5-26**] 11:57PM BLOOD Glucose-119* UreaN-14 Creat-0.6 Na-140 K-4.2 Cl-108 HCO3-26 AnGap-10 [**2183-5-30**] 06:20AM BLOOD Mg-3.1* [**2183-5-28**] 06:35AM BLOOD Calcium-8.0* Phos-2.7 Mg-2.3 [**2183-5-29**]: The central venous line was removed in the meantime interval. The heart size is normal. The bibasilar atelectasis are again demonstrated, the worse on the right with no significant change on the left. The bilateral pleural effusion is small. There is no pneumothorax. Brief Hospital Course: Mrs. [**Known lastname 13260**] was admitted and underwent mitral valve repair by Dr. [**Last Name (STitle) 1290**]. For surgical details, please see seperate dictated operative note. Following the operation, she was brought to the CSRU for invasive monitoring. Within 24 hours, she awoke neurologically intact and was extubated. Her CSRU course was uneventful and she transferred to the SDU on postoperative day one. Chest tubes and wires were removed without complication. She tolerated low dose beta blockade and continued to improve with diuresis. Given persistent systolic blood pressures in the 90 - 100mmHg range, her preoperative ACE inhibitor was not resumed. Several self limiting bursts of paroxysmal were noted but she remained mostly in a normal sinus rhythm. She continued to make steady progress and was cleared for discharge to home on postoperative day four. At discharge, her oxygen saturations were 96% on room air and her chest x-rays showed only small bilateral pleural effusions. Her sternum was stable and all surgical incisions were clean, dry and intact. Medications on Admission: Omeprazole 20 qd, Lisinopril 5 qd, Hydroxyzine 25 qd, Singulair 10 qd, Albuterol MDI, Bromfenex 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. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Omeprazole 20 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* 8. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**5-2**] hours as needed. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Mitral regurgitation - s/p MV Repair Postop Anemia GERD History of positive PPD 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: Dr. [**Last Name (STitle) 1290**] in [**5-1**] weeks, call for appt Dr. [**Last Name (STitle) **] in [**3-1**] weeks, call for appt Completed by:[**2183-5-30**]

424,427,411,530,416,276

{'Mitral valve disorders,Atrial fibrillation,Intermediate coronary syndrome,Esophageal reflux,Chronic pulmonary heart disease, unspecified,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: Shortness of breath PRESENT ILLNESS: This is a 59 year old female with recent diagnosis of mitral regurgitation. Over the last several months, she has experienced worsening shortness of breath and cough. Also admits to orthopnea and dyspnea on exertion. She has no history of myocardial infarction. Echocardiogram in [**2183-3-27**] revealed severe mitral regurgitation with flail posterior leaflet, and normal LV function. In preperation for cardiac surgery, she underwent cardiac catheterization which showed normal coronary arteries. It confirmed 4+ mitral regurgitation and normal left ventricular function. She had moderate pulmonary hypertension with PAP 50/19 with a mean of 30 mmHg. She was admitted for mitral valve surgery. MEDICAL HISTORY: Mitral regurgitation Gastroesophogeal Reflux Disease History of Hemoptysis History of postive PPD - s/p treatment MEDICATION ON ADMISSION: Omeprazole 20 qd, Lisinopril 5 qd, Hydroxyzine 25 qd, Singulair 10 qd, Albuterol MDI, Bromfenex ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: BP 132/86, HR 77, RR 18 General: well developed female in no acute distress HEENT: oropharynx benign, Neck: supple, no JVD, Heart: regular rate, normal s1s2, 4/6 systolic murmur Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds Ext: cool, no edema, no varicosities Pulses: 2+ distally Neuro: nonfocal FAMILY HISTORY: Father died at age 30 - unknown cause SOCIAL HISTORY: Denies tobacco and ETOH. Married, works in a grocery store. Lives with husband. ### Response: {'Mitral valve disorders,Atrial fibrillation,Intermediate coronary syndrome,Esophageal reflux,Chronic pulmonary heart disease, unspecified,Hypopotassemia'}

CHIEF COMPLAINT: Fevers PRESENT ILLNESS: Ms. [**Known lastname 69147**] is a 49 year old female who presented to [**Hospital1 18**]-ED on [**3-30**] with complaints of fevers and increased output from midline wound, she recently completed a 2 week course of antibiotics. She was hypotensive with a systolic blood pressure in the 80's and febrile to 103 in the ED, she was admitted to the surgical ICU for treatment and close monitoring. MEDICAL HISTORY: Past Medical History: --Colocutaneous Fistula --h/o MRSA aspiration pneumonia --Diverticulitis --Anxiety --Depression --Afib, paroxysmal --Abdominal abscess with percuteous drain: +MRSA, E.Coli, Klebsiella --h/o UE DVT (?treated with coumadin 1 month) --[**2118-7-21**]- Exploratory laparotomy with total colectomy --[**2118-7-23**]- Takedown ileorectal anastomosis, [**Doctor Last Name **] pouch, ileostomy --[**2115**]- Sigmoid Colectomy --[**2109**]- Cholecystectomy MEDICATION ON ADMISSION: Trazadone Mirtazapine Clonazepam MS [**First Name (Titles) **] [**Last Name (Titles) 69156**] Dilaudid ALLERGIES: Zantac 75 / Lipitor PHYSICAL EXAM: Upon admission: FAMILY HISTORY: Mother died lung CA age 57. Father had malignant HEENT tumor nect in 70's. Also had diverticulitis s/p colectomy. Fraternal twin sister has bipolar dz. Father/mother have depression+anxiety. SOCIAL HISTORY: lives w/ husband -- homemaker. former nurse. -- married w/ 4 children (7-19yo) -- eldest daughter recently had son -- 16 pack year smoking hx -- now no EtOH, used to enjoy "kahlua" -- no illicit drug use -- feels safe at home. no exposures reported

Septicemia due to pseudomonas,Abscess of intestine,Atrial fibrillation,Diverticulitis of colon (without mention of hemorrhage),Depressive disorder, not elsewhere classified,Sepsis

Pseudomonas septicemia,Intestinal abscess,Atrial fibrillation,Dvrtcli colon w/o hmrhg,Depressive disorder NEC,Sepsis

Admission Date: [**2119-3-30**] Discharge Date: [**2119-4-4**] Date of Birth: [**2069-10-26**] Sex: F Service: SURGERY Allergies: Zantac 75 / Lipitor Attending:[**First Name3 (LF) 371**] Chief Complaint: Fevers Major Surgical or Invasive Procedure: [**3-30**] CT guided drainage and placement of pigtail catheter History of Present Illness: Ms. [**Known lastname 69147**] is a 49 year old female who presented to [**Hospital1 18**]-ED on [**3-30**] with complaints of fevers and increased output from midline wound, she recently completed a 2 week course of antibiotics. She was hypotensive with a systolic blood pressure in the 80's and febrile to 103 in the ED, she was admitted to the surgical ICU for treatment and close monitoring. Past Medical History: Past Medical History: --Colocutaneous Fistula --h/o MRSA aspiration pneumonia --Diverticulitis --Anxiety --Depression --Afib, paroxysmal --Abdominal abscess with percuteous drain: +MRSA, E.Coli, Klebsiella --h/o UE DVT (?treated with coumadin 1 month) --[**2118-7-21**]- Exploratory laparotomy with total colectomy --[**2118-7-23**]- Takedown ileorectal anastomosis, [**Doctor Last Name **] pouch, ileostomy --[**2115**]- Sigmoid Colectomy --[**2109**]- Cholecystectomy Social History: lives w/ husband -- homemaker. former nurse. -- married w/ 4 children (7-19yo) -- eldest daughter recently had son -- 16 pack year smoking hx -- now no EtOH, used to enjoy "kahlua" -- no illicit drug use -- feels safe at home. no exposures reported Family History: Mother died lung CA age 57. Father had malignant HEENT tumor nect in 70's. Also had diverticulitis s/p colectomy. Fraternal twin sister has bipolar dz. Father/mother have depression+anxiety. Physical Exam: Upon admission: 96.7 85 94/53 14 Gen: No active distress but mucus membranes dry, pale Chest: Decreased breath sounds bilaterally at bases CV: Regular Abd: Soft, moderate tenderness along left side, midline incision without tympany, mild fibrinous exudative drainage with pus, no erythema Pertinent Results: CT guided drainage [**3-30**]: IMPRESSION: Status post successful drainage of abscess with catheter left in situ in right iliac fossa with fluid sent for culture and sensitivity. CT [**3-30**]: IMPRESSION: 1. Large rim-enhancing fluid collection within the right iliac fossa, in the same location, yet slightly smaller, than that seen on previous CT from [**2118-11-29**]. No oral contrast is identified entering into the collection, and there is no identifiable communication with adjacent bowel or other source. 2. No other fluid collection is identified and no free air is present within the abdomen or pelvis. 3. Status post total colectomy with Hartmann pouch and functional right lower quadrant diverting ileostomy, with no evidence of obstruction. Status post cholecystectomy. COMMENT: Findings were discussed with the General Surgery team, and arrangements were made for CT-guided drainage of this fluid collection by Interventional Radiology. Fistulagram [**4-3**]: IMPRESSION: No evidence of enteric fistula. Admission labs: [**2119-3-30**] 11:35AM BLOOD WBC-11.3*# RBC-5.10# Hgb-15.0# Hct-42.9# MCV-84 MCH-29.4 MCHC-35.0 RDW-13.9 Plt Ct-475*# [**2119-3-30**] 11:35AM BLOOD Neuts-91.7* Bands-0 Lymphs-4.7* Monos-3.3 Eos-0.2 Baso-0.1 [**2119-3-30**] 11:35AM BLOOD PT-12.3 PTT-20.2* INR(PT)-1.1 [**2119-3-30**] 11:35AM BLOOD Glucose-159* UreaN-23* Creat-1.3* Na-133 K-5.1 Cl-90* HCO3-20* AnGap-28* [**2119-3-30**] 11:35AM BLOOD ALT-7 AST-21 CK(CPK)-34 AlkPhos-246* Amylase-52 TotBili-0.5 [**2119-3-30**] 11:35AM BLOOD Albumin-4.5 Calcium-10.3* Mg-2.5 Discharge labs: [**2119-4-2**] 05:05AM BLOOD WBC-3.5* Hct-28.7* Plt Ct-321 [**2119-4-2**] 05:05AM BLOOD Plt Ct-321 [**2119-4-2**] 05:05AM BLOOD Glucose-93 UreaN-3* Creat-0.6 Na-139 K-3.3 Cl-105 HCO3-27 AnGap-10 [**2119-3-30**] 8:30 pm ABSCESS GRAM STAIN (Final [**2119-3-31**]): 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 4+ (>10 per 1000X FIELD): GRAM NEGATIVE ROD(S). 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 3+ (5-10 per 1000X FIELD): GRAM POSITIVE ROD(S). SMEAR REVIEWED; RESULTS CONFIRMED. WOUND CULTURE (Final [**2119-4-3**]): Due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for Pseudomonas aeruginosa, Staphylococcus aureus and beta streptococcus). BETA STREPTOCOCCUS GROUP B. MODERATE GROWTH. GRAM NEGATIVE ROD(S). MODERATE GROWTH. GRAM NEGATIVE ROD #2. SPARSE GROWTH. ANAEROBIC CULTURE (Preliminary): NO ANAEROBES ISOLATED. Brief Hospital Course: Ms. [**Known lastname 69147**] was admitted to the SICU, a central line was placed, she was made NPO with intravenous hydration and broad spectrum antibiotics, she was successfully resuscitated with intravenous fluid; a CT scan revealed a large fluid collection within the right iliac fossa, she [**Known lastname 1834**] a CT guided drainage and placement of a pigtail catheter. HD 2, she was transferred to an in-patient nursing unit, was tolerating a regular diet, had good pain control with oral Dilaudid, remained afebrile, and normotensive. HD 5, final cultures were reported (see pertinent results), she was placed on oral Ciprofloxacin for two weeks; a fistulagram through the abscess drain was negative for communication with the bowel. She was discharged home in good condition on [**4-4**] with visiting nurse services for assistance with her drain. She was to follow-up with Dr. [**Last Name (STitle) **] on [**4-10**]. She was provided prescriptions for: Dilaudid, Ciprofloxacin, and Protonix. Medications on Admission: Trazadone Mirtazapine Clonazepam MS [**First Name (Titles) **] [**Last Name (Titles) 69156**] Dilaudid Discharge Medications: 1. 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* 2. Trazodone 100 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed. 3. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 4. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). 5. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). 6. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 2 weeks: Take with food. Disp:*28 Tablet(s)* Refills:*0* 7. Alprazolam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. 8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3 to 4 Hours) as needed for pain: Take with food. Disp:*40 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 2255**] [**Name (NI) 2256**] Discharge Diagnosis: Sepsis Abdominal abscess Anxiety Depression Discharge Condition: Good Discharge Instructions: Notify MD or return the emergency department if you experience: *Increased or persistent pain not relieved by pain medication *Fever > 101.5 *Nausea, vomiting, abdominal distention, or increased or decreased outputs from ostomy that last longer than 24 hours *If drain pulls out, or if exit site develops redness or leakage *Any other symptoms concerning to you Please take the antibiotics as directed, do not skip any doses No driving or alcohol use with pain medication You may also take Tylenol or Motrin every 6 hours as needed for pain You may continue your home medications of: Mirtazipine, Klonnapin, [**Name (NI) 69156**], MS Contin, Protonix Please maintain dry dressing over exit site of drain at all times Be sure to eat small frequent meals and drink fluids throughout the day Be sure to slowly increase your daily activities, including walking during the day Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] on [**4-10**] at 2:30pm, call [**Telephone/Fax (1) 1864**] for questions or concerns. Completed by:[**2119-4-4**]

038,569,427,562,311,995

{'Septicemia due to pseudomonas,Abscess of intestine,Atrial fibrillation,Diverticulitis of colon (without mention of hemorrhage),Depressive disorder, not elsewhere classified,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: Fevers PRESENT ILLNESS: Ms. [**Known lastname 69147**] is a 49 year old female who presented to [**Hospital1 18**]-ED on [**3-30**] with complaints of fevers and increased output from midline wound, she recently completed a 2 week course of antibiotics. She was hypotensive with a systolic blood pressure in the 80's and febrile to 103 in the ED, she was admitted to the surgical ICU for treatment and close monitoring. MEDICAL HISTORY: Past Medical History: --Colocutaneous Fistula --h/o MRSA aspiration pneumonia --Diverticulitis --Anxiety --Depression --Afib, paroxysmal --Abdominal abscess with percuteous drain: +MRSA, E.Coli, Klebsiella --h/o UE DVT (?treated with coumadin 1 month) --[**2118-7-21**]- Exploratory laparotomy with total colectomy --[**2118-7-23**]- Takedown ileorectal anastomosis, [**Doctor Last Name **] pouch, ileostomy --[**2115**]- Sigmoid Colectomy --[**2109**]- Cholecystectomy MEDICATION ON ADMISSION: Trazadone Mirtazapine Clonazepam MS [**First Name (Titles) **] [**Last Name (Titles) 69156**] Dilaudid ALLERGIES: Zantac 75 / Lipitor PHYSICAL EXAM: Upon admission: FAMILY HISTORY: Mother died lung CA age 57. Father had malignant HEENT tumor nect in 70's. Also had diverticulitis s/p colectomy. Fraternal twin sister has bipolar dz. Father/mother have depression+anxiety. SOCIAL HISTORY: lives w/ husband -- homemaker. former nurse. -- married w/ 4 children (7-19yo) -- eldest daughter recently had son -- 16 pack year smoking hx -- now no EtOH, used to enjoy "kahlua" -- no illicit drug use -- feels safe at home. no exposures reported ### Response: {'Septicemia due to pseudomonas,Abscess of intestine,Atrial fibrillation,Diverticulitis of colon (without mention of hemorrhage),Depressive disorder, not elsewhere classified,Sepsis'}

CHIEF COMPLAINT: Seizure PRESENT ILLNESS: Mr [**Known lastname 98789**] is 42 a year-old male with a PMH of alcohol abuse, seizure disorder, traumatic brain injuries requiring multiple craniotomies in [**2145**] with apparent memory deficit who was found with a generalized seizure. The length of the seizure is unknown but 25min after EMS was called and the pt stopped seizing spontaneously. Per report of his group home, the patient may not have been takin his meds. He was febrile to 102F, desated to 80s and was intubated in the field with concern for an aspiration. He was brought to [**Hospital1 18**] and admitted to the ICU. MEDICAL HISTORY: -EtOH abuse -Seizure disorder -h/o traumatic brain injury requiring multiple craiectomies in [**2145**] - with memory deficit -Subdural hematoma - [**2145**] -asthma -hepatis C -anxiety -bipolar MEDICATION ON ADMISSION: 1 mvi qday colace 100 [**Hospital1 **] nicoderm patch keppra 1000 [**Hospital1 **] b complex 100 1 tab daily folic acid 1 mg daily trazadone 175 mg HS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: At Admission General: intubated HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, no masses or organomegaly noted. Extremities:warm and well perfused Skin: Scars on abdomen, erythematous on the back . Neurologic examination: -Mental Status: off sedation patient opens eyes to noxious and then immediately closes them. Did not follow commands. However had purposeful movements on the left. -Cranial Nerves: I: Olfaction not tested. II: PERRL 5 to 3mm and brisk. III, IV, VI: roving eye movements; slow random predominantly horizontal conjugate eye movements No V: Facial sensation intact to light touch. VII: No facial droop, facial musculature symmetric. FAMILY HISTORY: He has a sister who lives in western [**Name (NI) **] who is well. Otherwise, no family history obtainable from the patient due to memory deficits. SOCIAL HISTORY: Mr. [**Known lastname 98789**] lives [**Street Address(1) 29735**] Inn, has visiting nurse to help him with his medications. He has had a significant history of EtOH use, reports AA has been helpful to him in the past and plans to go back. He reports he has not smoked in 3 weeks (somewhat concurrent with his hospitalization), previously was about [**12-17**] pack per day of cigarettes and per report has stopped using other drugs such as cocaine. He has a sister who knows him well, but who is not able to see him often.

Alcohol withdrawal,Pneumonia, organism unspecified,Grand mal status,Acute and subacute necrosis of liver,Acute respiratory failure,Hepatic encephalopathy,Toxic encephalopathy,Acute kidney failure, unspecified,Rhabdomyolysis,Acidosis,Other and unspecified coagulation defects,Other and unspecified alcohol dependence, unspecified,Other specified paralytic syndrome,Acute alcoholic hepatitis,Disorders of phosphorus metabolism,Bipolar disorder, unspecified,Anxiety state, unspecified,Asthma, unspecified type, unspecified,Tobacco use disorder,Chronic hepatitis C without mention of hepatic coma,Other secondary thrombocytopenia,Anemia, unspecified,Personal history of traumatic brain injury,Lack of housing,Personal history of noncompliance with medical treatment, presenting hazards to health

Alcohol withdrawal,Pneumonia, organism NOS,Grand mal status,Acute necrosis of liver,Acute respiratry failure,Hepatic encephalopathy,Toxic encephalopathy,Acute kidney failure NOS,Rhabdomyolysis,Acidosis,Coagulat defect NEC/NOS,Alcoh dep NEC/NOS-unspec,Oth spcf paralytic synd,Ac alcoholic hepatitis,Dis phosphorus metabol,Bipolar disorder NOS,Anxiety state NOS,Asthma NOS,Tobacco use disorder,Chrnc hpt C wo hpat coma,Sec thrombocytpenia NEC,Anemia NOS,Hx traumatc brain injury,Lack of housing,Hx of past noncompliance

Admission Date: [**2149-7-29**] Discharge Date: [**2149-8-6**] Date of Birth: [**2107-7-27**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1185**] Chief Complaint: Seizure Major Surgical or Invasive Procedure: intubation for airway protection History of Present Illness: Mr [**Known lastname 98789**] is 42 a year-old male with a PMH of alcohol abuse, seizure disorder, traumatic brain injuries requiring multiple craniotomies in [**2145**] with apparent memory deficit who was found with a generalized seizure. The length of the seizure is unknown but 25min after EMS was called and the pt stopped seizing spontaneously. Per report of his group home, the patient may not have been takin his meds. He was febrile to 102F, desated to 80s and was intubated in the field with concern for an aspiration. He was brought to [**Hospital1 18**] and admitted to the ICU. Past Medical History: -EtOH abuse -Seizure disorder -h/o traumatic brain injury requiring multiple craiectomies in [**2145**] - with memory deficit -Subdural hematoma - [**2145**] -asthma -hepatis C -anxiety -bipolar Social History: Mr. [**Known lastname 98789**] lives [**Street Address(1) 29735**] Inn, has visiting nurse to help him with his medications. He has had a significant history of EtOH use, reports AA has been helpful to him in the past and plans to go back. He reports he has not smoked in 3 weeks (somewhat concurrent with his hospitalization), previously was about [**12-17**] pack per day of cigarettes and per report has stopped using other drugs such as cocaine. He has a sister who knows him well, but who is not able to see him often. Family History: He has a sister who lives in western [**Name (NI) **] who is well. Otherwise, no family history obtainable from the patient due to memory deficits. Physical Exam: At Admission General: intubated HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, no masses or organomegaly noted. Extremities:warm and well perfused Skin: Scars on abdomen, erythematous on the back . Neurologic examination: -Mental Status: off sedation patient opens eyes to noxious and then immediately closes them. Did not follow commands. However had purposeful movements on the left. -Cranial Nerves: I: Olfaction not tested. II: PERRL 5 to 3mm and brisk. III, IV, VI: roving eye movements; slow random predominantly horizontal conjugate eye movements No V: Facial sensation intact to light touch. VII: No facial droop, facial musculature symmetric. . -Motor: spontaneous movement on the left upper extremity and right lower extremity. -Sensory: withdraws to noxious on the left (upper and lower). minimal withdraw on the right lower. flicker of withdraw on the right upper . -DTRs: [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach L 2 2 2 2 1 R 2 2 2 2 1 Plantar response was mute bilaterally (likely secondary to heavily calused feet ________________________________________________________________ At Discharge: GENERAL - NAD, alert sitting up in bed HEENT - NC/AT, EOMI, sclerae mildly icteric, dry MM, OP clear NECK - supple, no JVD LUNGS - CTAB, mild crackles at bases bilaterally HEART - RRR, no MRG, nl S1-S2 ABDOMEN - NABS, soft/NT/ND, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses SKIN - numerous ecchymoses, jaundiced NEURO - A&Ox3, though slow responses, unable to remember home street address, strength 5/5 Pertinent Results: Admission Labs: . [**2149-7-29**] 08:30AM BLOOD WBC-8.4 RBC-4.33* Hgb-14.4 Hct-41.7 MCV-96 MCH-33.4* MCHC-34.6 RDW-13.3 Plt Ct-112* [**2149-7-29**] 08:30AM BLOOD Neuts-77.0* Lymphs-18.5 Monos-3.3 Eos-0.9 Baso-0.3 [**2149-7-29**] 08:30AM BLOOD PT-11.8 PTT-23.4 INR(PT)-1.0 [**2149-7-29**] 08:30AM BLOOD Glucose-161* UreaN-12 Creat-1.4* Na-140 K-4.7 Cl-97 HCO3-15* AnGap-33* [**2149-7-29**] 08:30AM BLOOD ALT-191* AST-175* LD(LDH)-309* CK(CPK)-544* AlkPhos-70 TotBili-0.9 [**2149-7-29**] 08:30AM BLOOD Lipase-112* [**2149-7-29**] 08:30AM BLOOD Calcium-8.8 Phos-5.9*# Mg-1.9 . [**2149-7-29**] 08:55AM BLOOD Lactate-12.6* [**2149-7-29**] 04:25PM BLOOD Lactate-1.4 Na-135 . CEREBROSPINAL FLUID (CSF) WBC-1 RBC-0 POLYS-0 LYMPHS-33 MONOS-67 PROTEIN-67* GLUCOSE-101 GRAM STAIN (Final [**2149-7-29**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2149-8-1**]): NO GROWTH. VIRAL CULTURE: R/O HERPES SIMPLEX VIRUS (Final [**2149-8-5**]): No Herpes simplex (HSV) virus isolated. [**7-29**] Blood cx negative [**8-3**] Blood cx no growth (final result on [**8-9**]) [**8-3**] Urine cx negative [**8-5**] C.diff negative . Liver testing: . [**2149-7-30**] 04:08PM BLOOD ALT-4091* AST-8031* LD(LDH)-2780* CK(CPK)-[**Numeric Identifier 98790**]* AlkPhos-68 TotBili-4.4* DirBili-3.4* IndBili-1.0 [**2149-7-30**] 09:43AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE HAV Ab-NEGATIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE [**2149-7-30**] 04:08PM BLOOD AMA-NEGATIVE [**2149-8-5**] 05:50AM BLOOD HIV Ab-NEGATIVE . Drug/tox screen: . [**2149-7-29**] 08:30AM BLOOD Phenoba-LESS THAN Phenyto-<0.6* Lithium-LESS THAN Valproa-LESS THAN [**2149-7-29**] 08:30AM BLOOD ASA-NEG Ethanol-NEG Carbamz-LESS THAN Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG . Discharge labs: [**2149-8-6**] 06:25AM BLOOD WBC-5.6 RBC-3.92* Hgb-13.1* Hct-38.4* MCV-98 MCH-33.3* MCHC-34.0 RDW-14.6 Plt Ct-245 [**2149-8-6**] 06:25AM BLOOD PT-12.5 INR(PT)-1.1 [**2149-8-6**] 06:25AM BLOOD Glucose-102* UreaN-10 Creat-0.6 Na-133 K-4.0 Cl-98 HCO3-24 AnGap-15 [**2149-8-6**] 06:25AM BLOOD Calcium-9.3 Phos-3.6 Mg-1.8 [**2149-8-6**] 06:25AM BLOOD ALT-454* AST-118* CK(CPK)-212 AlkPhos-93 TotBili-6.3* [**2149-7-31**] 02:03AM BLOOD Lipase-41 . Imaging: . [**2149-7-29**] Head CT w/o contrast IMPRESSION: 1. No evidence of acute intracranial process. 2. Stable post-surgical changes as described above. 3. Stable left frontal lobe and left temporal lobe encephalomalacia with corresponding ex vacuo dilatation of the frontal [**Doctor Last Name 534**] of the left lateral ventricle, likely sequela of prior trauma. [**2149-7-30**] Abd U/S IMPRESSION: 1. Significant asymmetric gallbladder wall edema without associated gallbladder wall distention, stones or pericholecystic fluid. Given degree of gallbladder wall edema and lack of distention, these findings are suggestive of acute hepatitis. 2. Doppler assessment of the hepatic vasculature shows patency, appropriate waveforms and directionality of flow. [**2149-7-30**] CXR FINDINGS: Low lung volumes accentuate the cardiac silhouette and bronchovascular structures, limiting assessment of the cardiovascular status of the patient. A questionable area of confluent opacity has developed in the left retrocardiac region, and could be confirmed or excluded by repeat a radiograph with improved inspiratory level. Lungs are otherwise grossly clear, and there is no pleural effusion or pneumothorax. [**2149-8-5**] CXR FINDINGS: Upright PA and lateral views of the chest show slight decrease in a small right pleural effusion. Cardiomediastinal and pulmonary structures are unremarkable. Again seen are multiple rib fractures. No pneumothorax. IMPRESSION: Slight decrease in small right pleural effusion Brief Hospital Course: Mr [**Known lastname 98789**] is 42 a year-old male with a PMH of alcohol abuse, seizure disorder, traumatic brain injuries requiring multiple craniotomies in [**2145**] with apparent memory deficit who was found with a generalized seizure believed secondary to alcohol withdrawal. . He received a loading dose of keppra in the ED. An LP was performed in the ED found to be negative for infection, tox screen was negative and antiseizure med levels were undetectable. He was found to have a lactate of 12.6 which improved with IVF, and he was started on folate, thiamine and a multivitamin. He awoke with [**Initials (NamePattern4) **] [**Doctor Last Name 555**] paralysis and was extubated the evening of admission. Head imaging showed no cause of seizure, so seizure was believed to be secondary to alcohol withdrawal and the patient was started on CIWA scale, restarted on home keppra and encouraged to abstain from alcohol use. He had no further seizures in the hospital. . He was started on Vanc and cefepime for a HCAP for continuing fevers to 101 and a retrocardiac opacity noted on CXR. Blood cx and urine cx were negative. He was switched to ceftriaxone and azithromycin for CAP, and finished a 5 day course on [**8-4**], no respiratory symptoms or O2 requirement during course. On repeat CXR he was found to have a small resolving right pleural effusion upon finishing abx, no evidence of loculations. It was thought likely this effusion was secondary to inflammation associated with acute hepatic injury and regeneration. The first day of admission he was noted to have greatly elevated LFTs, CK, INR and Tbili. (ALT/AST in the [**2137**], INR 1.7s, bili to 9). His LFTs, INR and Tbili trended down through his hospital course, with a negative abd U/S for cholestasis. He was found to have Hep C, but negative for Hep B, Hep A, AMA and HIV. Hepatology was consulted and suggested that the damage was secondary to ischemic injury superimposed on chronic liver disease from alcohol and hep C. His CK also trended down with IVF, and Cr returned to baseline. . He was somnolent secondary to benzo use per CIWA scale in the context of liver injury. By discharge he was at baseline mental status (some confusion, AOX3) per report of sister. . TO DO: Repeat LFTs, INR, bilirubin for continuing downward trend. Chest X-ray should be repeated in 1 month to follow up right pleural effusion, with diagnostic tap if persistent. Medications on Admission: 1 mvi qday colace 100 [**Hospital1 **] nicoderm patch keppra 1000 [**Hospital1 **] b complex 100 1 tab daily folic acid 1 mg daily trazadone 175 mg HS Discharge Medications: 1. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. B complex vitamins Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*60 tab* Refills:*2* 4. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 5. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 6. Nicoderm CQ 21 mg/24 hr Patch 24 hr Sig: One (1) patch Transdermal once a day. Disp:*30 patch* Refills:*2* Discharge Disposition: Home With Service Facility: Nizhoni VNA Discharge Diagnosis: Primary Diagnoses Seizure secondary to alcohol withdrawal Acute liver injury Acute Kidney Injury secondary to rhabdomyolysis Secondary Diagnoses Seizure disorder Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 98789**], It was a pleasure taking care of you. You were admitted to the hospital after having a seizure after you stopped drinking alcohol. While you were here, you were found to have some damage to your liver which we believe was due to longterm damage from an infection (hepatitis C), alcohol use, as well as in the short term a lack of oxygen to your liver. You improved during your hospitalization but it is very important that you continue to not drink and take your anti-seizure medications regularly. There were no medication changes during this hospitalization. Followup Instructions: Name: Dr. [**First Name4 (NamePattern1) 698**] [**Last Name (NamePattern1) 98791**] Location: [**Hospital1 2177**] INTERNAL MEDICINE Address: [**Location (un) **], 5TH FL, Suite B, [**Location (un) **],[**Numeric Identifier 5138**] Phone: [**Telephone/Fax (1) 11463**] Appointment: Wednesday [**2149-8-13**] 9:00am *This is a follow up appointment of your hospitalization. You will be reconnected with your primary care physician after this visit. Department: LIVER CENTER When: THURSDAY [**2149-8-21**] at 10:30 AM With: [**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD [**Telephone/Fax (1) 2422**] Building: LM [**Hospital Unit Name **] [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage [**Name6 (MD) **] [**Name8 (MD) **] MD [**Doctor Last Name 1189**] Completed by:[**2149-8-8**]

291,486,345,570,518,572,349,584,728,276,286,303,344,571,275,296,300,493,305,070,287,285,V155,V600,V158

{'Alcohol withdrawal,Pneumonia, organism unspecified,Grand mal status,Acute and subacute necrosis of liver,Acute respiratory failure,Hepatic encephalopathy,Toxic encephalopathy,Acute kidney failure, unspecified,Rhabdomyolysis,Acidosis,Other and unspecified coagulation defects,Other and unspecified alcohol dependence, unspecified,Other specified paralytic syndrome,Acute alcoholic hepatitis,Disorders of phosphorus metabolism,Bipolar disorder, unspecified,Anxiety state, unspecified,Asthma, unspecified type, unspecified,Tobacco use disorder,Chronic hepatitis C without mention of hepatic coma,Other secondary thrombocytopenia,Anemia, unspecified,Personal history of traumatic brain injury,Lack of housing,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: Seizure PRESENT ILLNESS: Mr [**Known lastname 98789**] is 42 a year-old male with a PMH of alcohol abuse, seizure disorder, traumatic brain injuries requiring multiple craniotomies in [**2145**] with apparent memory deficit who was found with a generalized seizure. The length of the seizure is unknown but 25min after EMS was called and the pt stopped seizing spontaneously. Per report of his group home, the patient may not have been takin his meds. He was febrile to 102F, desated to 80s and was intubated in the field with concern for an aspiration. He was brought to [**Hospital1 18**] and admitted to the ICU. MEDICAL HISTORY: -EtOH abuse -Seizure disorder -h/o traumatic brain injury requiring multiple craiectomies in [**2145**] - with memory deficit -Subdural hematoma - [**2145**] -asthma -hepatis C -anxiety -bipolar MEDICATION ON ADMISSION: 1 mvi qday colace 100 [**Hospital1 **] nicoderm patch keppra 1000 [**Hospital1 **] b complex 100 1 tab daily folic acid 1 mg daily trazadone 175 mg HS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: At Admission General: intubated HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, no masses or organomegaly noted. Extremities:warm and well perfused Skin: Scars on abdomen, erythematous on the back . Neurologic examination: -Mental Status: off sedation patient opens eyes to noxious and then immediately closes them. Did not follow commands. However had purposeful movements on the left. -Cranial Nerves: I: Olfaction not tested. II: PERRL 5 to 3mm and brisk. III, IV, VI: roving eye movements; slow random predominantly horizontal conjugate eye movements No V: Facial sensation intact to light touch. VII: No facial droop, facial musculature symmetric. FAMILY HISTORY: He has a sister who lives in western [**Name (NI) **] who is well. Otherwise, no family history obtainable from the patient due to memory deficits. SOCIAL HISTORY: Mr. [**Known lastname 98789**] lives [**Street Address(1) 29735**] Inn, has visiting nurse to help him with his medications. He has had a significant history of EtOH use, reports AA has been helpful to him in the past and plans to go back. He reports he has not smoked in 3 weeks (somewhat concurrent with his hospitalization), previously was about [**12-17**] pack per day of cigarettes and per report has stopped using other drugs such as cocaine. He has a sister who knows him well, but who is not able to see him often. ### Response: {'Alcohol withdrawal,Pneumonia, organism unspecified,Grand mal status,Acute and subacute necrosis of liver,Acute respiratory failure,Hepatic encephalopathy,Toxic encephalopathy,Acute kidney failure, unspecified,Rhabdomyolysis,Acidosis,Other and unspecified coagulation defects,Other and unspecified alcohol dependence, unspecified,Other specified paralytic syndrome,Acute alcoholic hepatitis,Disorders of phosphorus metabolism,Bipolar disorder, unspecified,Anxiety state, unspecified,Asthma, unspecified type, unspecified,Tobacco use disorder,Chronic hepatitis C without mention of hepatic coma,Other secondary thrombocytopenia,Anemia, unspecified,Personal history of traumatic brain injury,Lack of housing,Personal history of noncompliance with medical treatment, presenting hazards to health'}

CHIEF COMPLAINT: Esophageal Cancer PRESENT ILLNESS: Patient is a 59 year old gentleman who was found to have severe dysphagia and weight loss and was noted to have a near obstructing distal esophageal cancer. This was treated with an esophageal stent placement and then chemotherapy and radiation. His restaging head CT appeared to show stable if not improved disease and he presents for minimally invasive esophagectomy. MEDICAL HISTORY: ONCOLOGIC HISTORY (taken from OMR - [**Doctor Last Name **] [**11-12**]): This 59-year-old gentleman initially presented in [**11/2142**] due to dysphagia and weight loss. At that time, he had a barium swallow, which showed a pinpoint narrowing of his distal esophagus. He had endoscopy and underwent dilatation of this stricture. He did not have much improvement with the dilatation and in [**Month (only) 116**] of this year underwent a second dilatation once again with no improvement. He had motility tests, which were most consistent with achalasia. In [**Month (only) **], he underwent a Botox injection to the narrowing in order to help to release it. He had a CT scan after this which showed a 1.5 cm gastrohepatic lymph node. On [**2143-8-28**] he underwent an upper endoscopy on which they saw distal esophageal narrowing. They also performed multiple biopsies of the area of narrowing. Of note, they saw some ulceration in the GE junction and a thick abnormal fold concerning for esophageal or gastric cardia cancer. The biopsy showed moderate to poorly differentiated adenocarcinoma. After this he underwent endoscopic ultrasound, however, they were unable to pass the ultrasound probe beyond the stricture. He has had a port, g-tube, and esophageal stent placed. He started treatement with 5-FU and Cisplatin on [**2143-10-10**] with concurrent radiation therapy. . PMH: 1. Sinusitis status post 2 surgeries. 2. Hypertension. MEDICATION ON ADMISSION: Ativan 0.5 PRN, compazine 10 PRN, Zofran 4 PRN, Protonix 40' ALLERGIES: Penicillins PHYSICAL EXAM: T: 98.1 HR: 91 BP: 104/58 RR: 20 O2sat: 99% (FM 0.4) Gen: NAD, normal respiratory effort without stridor or stertor. Symmetric facial movement. Lungs: CTA b Heart: RRR Abd: Soft, NT, J tube in place Ext: No CCE FAMILY HISTORY: He has a father with pancreatic cancer who died at the age of 70. SOCIAL HISTORY: He originally moved from [**Country 6171**] 17 years ago. Married, 2 children. Teaches french and spanish. He used to smoke a pack a day, but quit 15 years ago. He used to drink a couple of glasses of wine with dinner each night, but not since diagnosis.

Malignant neoplasm of cardia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Iatrogenic pneumothorax,Unspecified essential hypertension,Other chronic sinusitis,Unilateral paralysis of vocal cords or larynx, partial,Anxiety state, unspecified

Mal neo stomach cardia,Mal neo lymph intra-abd,Iatrogenic pneumothorax,Hypertension NOS,Chronic sinusitis NEC,Vocal paral unilat part,Anxiety state NOS

Admission Date: [**2144-1-20**] Discharge Date: [**2144-1-31**] Date of Birth: [**2084-3-2**] Sex: M Service: SURGERY Allergies: Penicillins Attending:[**First Name3 (LF) 1481**] Chief Complaint: Esophageal Cancer Major Surgical or Invasive Procedure: Minimally invasive esophagectomy, mediastinal lymph node dissection. History of Present Illness: Patient is a 59 year old gentleman who was found to have severe dysphagia and weight loss and was noted to have a near obstructing distal esophageal cancer. This was treated with an esophageal stent placement and then chemotherapy and radiation. His restaging head CT appeared to show stable if not improved disease and he presents for minimally invasive esophagectomy. Past Medical History: ONCOLOGIC HISTORY (taken from OMR - [**Doctor Last Name **] [**11-12**]): This 59-year-old gentleman initially presented in [**11/2142**] due to dysphagia and weight loss. At that time, he had a barium swallow, which showed a pinpoint narrowing of his distal esophagus. He had endoscopy and underwent dilatation of this stricture. He did not have much improvement with the dilatation and in [**Month (only) 116**] of this year underwent a second dilatation once again with no improvement. He had motility tests, which were most consistent with achalasia. In [**Month (only) **], he underwent a Botox injection to the narrowing in order to help to release it. He had a CT scan after this which showed a 1.5 cm gastrohepatic lymph node. On [**2143-8-28**] he underwent an upper endoscopy on which they saw distal esophageal narrowing. They also performed multiple biopsies of the area of narrowing. Of note, they saw some ulceration in the GE junction and a thick abnormal fold concerning for esophageal or gastric cardia cancer. The biopsy showed moderate to poorly differentiated adenocarcinoma. After this he underwent endoscopic ultrasound, however, they were unable to pass the ultrasound probe beyond the stricture. He has had a port, g-tube, and esophageal stent placed. He started treatement with 5-FU and Cisplatin on [**2143-10-10**] with concurrent radiation therapy. . PMH: 1. Sinusitis status post 2 surgeries. 2. Hypertension. Social History: He originally moved from [**Country 6171**] 17 years ago. Married, 2 children. Teaches french and spanish. He used to smoke a pack a day, but quit 15 years ago. He used to drink a couple of glasses of wine with dinner each night, but not since diagnosis. Family History: He has a father with pancreatic cancer who died at the age of 70. Physical Exam: T: 98.1 HR: 91 BP: 104/58 RR: 20 O2sat: 99% (FM 0.4) Gen: NAD, normal respiratory effort without stridor or stertor. Symmetric facial movement. Lungs: CTA b Heart: RRR Abd: Soft, NT, J tube in place Ext: No CCE Pertinent Results: [**2144-1-20**] 09:41AM freeCa-1.07* [**2144-1-20**] 09:41AM HGB-10.7* calcHCT-32 [**2144-1-20**] 09:41AM GLUCOSE-123* LACTATE-1.1 NA+-137 K+-3.4* CL--103 [**2144-1-20**] 09:41AM TYPE-ART PO2-253* PCO2-41 PH-7.43 TOTAL CO2-28 BASE XS-3 [**2144-1-20**] 02:41PM freeCa-1.04* [**2144-1-20**] 02:41PM HGB-11.9* calcHCT-36 . DIAGNOSIS: I. Left peri-esophageal lymph node (A): 1. Anthracosis and hyperplasia. 2. No tumor. II. Peri-esophageal tissue (B): Fibroadipose tissue with one small lymph node: No tumor. III. Esophagogastrectomy (C-AF): 1. Regional lymph nodes and adjacent tissue: a. Metastatic adenocarcinoma in 4 of 6 perigastric lymph nodes and separate foci of tumor in the adjacent adipose tissue. b. No tumor in 10 peri-esophageal lymph nodes. 2. Extensive ulceration and fibrosis of the distal esophagus with transmural tear, status-post chemoradiation. 3. There is no residual carcinoma in the esophagus. 4. The proximal squamous-lined esophagus and gastric fundic portion are unremarkable. Clinical: Esophageal cancer, post-chemoradiation. . RADIOLOGY Final Report UGI SGL CONTRAST W/ KUB [**2144-1-24**] 10:11 AM Reason: Assess anatomy for leak at anastamosis site. Please use Thi IMPRESSION: No evidence of leak at the cervical esophagectomy anastomosis. Surgical staples, drain, subclavian line and NG tube in appropriate position. . RADIOLOGY Final Report CHEST (PORTABLE AP) [**2144-1-29**] 5:35 AM Reason: reasses pneumothoraces [**Hospital 93**] MEDICAL CONDITION: 59 year old man s/p esophagogastrectomy, s/p R chest tube removal, stable R PTx on last CXR, now with slight increase SOB REASON FOR THIS EXAMINATION: reasses pneumothoraces REASON FOR EXAMINATION: Followup of a patient after esophagogastrectomy. IMPRESSION: Overall stable appearance of post-surgical chest. Decrease in free intraperitoneal air. Brief Hospital Course: Mr. [**Known lastname 73080**] operative course was prolonged as expected, but uncomplicated. He was routinely observed in the PACU, and transferred to the ICU for closer monitoring due to the complexity/acuity of the surgery. . ICU [**Date range (1) 68315**]:He tolerated extubation. Both Left & Right CT's were placed to 20cm of suction. [**1-22**]: hoarseness was noted with speaking. ENT service was consulted, and patient noted to have left vocal cord paralysis. Currently, no need for inpatient intervention as pt stable; should follow-up with Dr. [**Last Name (STitle) **] as outpt. . On [**1-23**], he was transferred to [**Hospital Ward Name 2978**] for routine post-op care. He continued NPO with NGT to suction, and IV hydration. The left cervical JP drain to bulb suction was intact with scant serous output. Left and Right Chest tubes to 20cm of suction with no evidence of leak; draining serosanguinous fluid. JTUBE was patent draining green, bilious fluid to gravity bag. Foley catheter was patent, and draining clear urine. His pain was managed with IV Dilaudid. He reported adequate pain management, [**6-13**]. He was assisted to chair. . On [**1-24**], Tube feeds were started at 10cc/h. Nutrition Team was consulted for adequate caloric intake. Tube feed formula and rate was modified per Nutrition recommendations throughout admission. He underwent a Barium swallow which revealed NO LEAK. His NGT was removed. He remained NPO. Social Work was consulted for support, and Physical Therapy was consulted due to expected prolonged hospitalization and recovery. He will likely require REHAB. . On [**1-25**], his foley catheter was removed. He was able to urinate independently. He was advanced to sips of clear liquids, and tolerated well. He continued with tube feedings via JTUBE. Medications were transitioned to PO/PJTUBE as tolerated, including PO oxycodone which relieved pain adequately. CXR revealed increased bilateral pneumothoraces. Chest tubes were put back to 20cm of suction. Treated with IV Lasix. . On [**1-26**], CXR revealed resolving pneumothoraces. Bilateral chest tubes were place to water seal. Treated with IV Lasix. He was advanced to clear liquids, and tolerated well. He continued with tube feedings via JTUBE. Blood sugars remain controlled, treated with regular insulin sliding scale. Pain continued to be well managed. . On [**1-27**], Chest xray improved, and Righ Chest Tube was removed. Treated with IV Lasix. Respiratory status remained stable. His diet was advanced to regular, dysphagia diet. . on [**1-29**], Chest xray stable, and Left Chest Tube removed. Respiratory status remained stable. He was able to tolerate adequate PO intake with regular food. Tube feedings were discontinued. His weight has remained stable. . On [**1-30**],he has remained stable, awaiting Rehab placement. His physical & surgical status has improved daily. He was re-evaluated per physical therapy, and cleared for discharge home with VNA & PT. He & his wife agreed with this plan. His last bowel movement was Tuesday [**2144-1-30**]. He will be discharged with oxycodone, colace, ativan, and albuterol. He will follow-up with Dr. [**Last Name (STitle) **] in [**2-5**] weeks, JTUBE will be removed in office at that time as indicated. Medications on Admission: Ativan 0.5 PRN, compazine 10 PRN, Zofran 4 PRN, Protonix 40' Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain for 2 weeks. Disp:*35 Tablet(s)* Refills:*0* 3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for sleep anxiety. Disp:*30 Tablet(s)* Refills:*0* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 1 months. Disp:*60 Capsule(s)* Refills:*1* 5. Pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Albuterol 90 mcg/Actuation Aerosol Sig: [**2-5**] Inhalation every 4-6 hours as needed for shortness of breath or wheezing: Use with spacer chamber. Disp:*1 * Refills:*1* 7. Spacer Aerochamber spacer-to be used with albuterol inhaler as directed. Size: Large/Adult Disp:1 Refill:1 Discharge Disposition: Home With Service Facility: VNA of [**Location (un) 270**]-East & Visiting Nurse Hospice Discharge Diagnosis: Primary: Esophageal cancer . Secondary: sinusitis/sinus polyps, HTN, anxiety Discharge Condition: Stable Tolerating Regular Consistency: Soft (dysphagia); Thin liquids diet Adequate pain control with oral medications Discharge Instructions: Incision Care: -Your steri-strips will fall off on their own. Please remove any remaining strips 7-10 days after surgery. -You may shower, and wash surgical incisions. -Avoid swimming and baths until your follow-up appointment. -Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomitting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. *Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your skin, or the whites of your eyes become yellow. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *Do not drive or operative heavy machinery while taking pain medication. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. * Continue to amubulate several times per day. . JTUBE care: *Keep tube securely fastened to skin to avoid pulling. *If tube falls out, apply dressing & pressure, and head to closest Emergency Room. Followup Instructions: 1. Follow up with Dr. [**Last Name (STitle) **] in [**2-5**] weeks. Please call his office for an appointment ([**Telephone/Fax (1) 1483**]. 2. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD Phone:[**0-0-**] Date/Time:[**2144-2-20**] 11:30 3. Provider: [**Name10 (NameIs) 8111**] [**Name11 (NameIs) 8112**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2144-2-20**] 12:30 4. Please follow-up with your primary care provider, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 36206**] [**Telephone/Fax (1) 73081**], in 1 week or as needed. Completed by:[**2144-1-30**]

151,196,512,401,473,478,300

{'Malignant neoplasm of cardia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Iatrogenic pneumothorax,Unspecified essential hypertension,Other chronic sinusitis,Unilateral paralysis of vocal cords or larynx, partial,Anxiety state, 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: Esophageal Cancer PRESENT ILLNESS: Patient is a 59 year old gentleman who was found to have severe dysphagia and weight loss and was noted to have a near obstructing distal esophageal cancer. This was treated with an esophageal stent placement and then chemotherapy and radiation. His restaging head CT appeared to show stable if not improved disease and he presents for minimally invasive esophagectomy. MEDICAL HISTORY: ONCOLOGIC HISTORY (taken from OMR - [**Doctor Last Name **] [**11-12**]): This 59-year-old gentleman initially presented in [**11/2142**] due to dysphagia and weight loss. At that time, he had a barium swallow, which showed a pinpoint narrowing of his distal esophagus. He had endoscopy and underwent dilatation of this stricture. He did not have much improvement with the dilatation and in [**Month (only) 116**] of this year underwent a second dilatation once again with no improvement. He had motility tests, which were most consistent with achalasia. In [**Month (only) **], he underwent a Botox injection to the narrowing in order to help to release it. He had a CT scan after this which showed a 1.5 cm gastrohepatic lymph node. On [**2143-8-28**] he underwent an upper endoscopy on which they saw distal esophageal narrowing. They also performed multiple biopsies of the area of narrowing. Of note, they saw some ulceration in the GE junction and a thick abnormal fold concerning for esophageal or gastric cardia cancer. The biopsy showed moderate to poorly differentiated adenocarcinoma. After this he underwent endoscopic ultrasound, however, they were unable to pass the ultrasound probe beyond the stricture. He has had a port, g-tube, and esophageal stent placed. He started treatement with 5-FU and Cisplatin on [**2143-10-10**] with concurrent radiation therapy. . PMH: 1. Sinusitis status post 2 surgeries. 2. Hypertension. MEDICATION ON ADMISSION: Ativan 0.5 PRN, compazine 10 PRN, Zofran 4 PRN, Protonix 40' ALLERGIES: Penicillins PHYSICAL EXAM: T: 98.1 HR: 91 BP: 104/58 RR: 20 O2sat: 99% (FM 0.4) Gen: NAD, normal respiratory effort without stridor or stertor. Symmetric facial movement. Lungs: CTA b Heart: RRR Abd: Soft, NT, J tube in place Ext: No CCE FAMILY HISTORY: He has a father with pancreatic cancer who died at the age of 70. SOCIAL HISTORY: He originally moved from [**Country 6171**] 17 years ago. Married, 2 children. Teaches french and spanish. He used to smoke a pack a day, but quit 15 years ago. He used to drink a couple of glasses of wine with dinner each night, but not since diagnosis. ### Response: {'Malignant neoplasm of cardia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Iatrogenic pneumothorax,Unspecified essential hypertension,Other chronic sinusitis,Unilateral paralysis of vocal cords or larynx, partial,Anxiety state, unspecified'}

CHIEF COMPLAINT: Large Left Temporal hemorrhage PRESENT ILLNESS: 53M apparently found down (?in bed) and intoxicated, brought to OSH apparently moving all 4 extremities, combative. Intubated, head CT showed large left temporal hemorrhage, pt transported to [**Hospital1 18**] Ed for further evaluation/treatment. MEDICAL HISTORY: +ETOH, otherwise unknown MEDICATION ON ADMISSION: Unknown: per mother prescribed many but takes sporadically and incorrectly ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: VS: BP: 112/83 HR:101 R 12 O2Sats100 Gen: WD/WN, intubated, dried blood on face,multiple bruises/abrasions on body HEENT: Pupils: 3->2 EOMs unable to assess FAMILY HISTORY: non-contributory SOCIAL HISTORY: unknown

Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Subarachnoid hemorrhage,Chronic airway obstruction, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,Dysphagia, unspecified,Unspecified fall,Benign essential hypertension

Intracerebral hemorrhage,Cerebral edema,Acute respiratry failure,Protein-cal malnutr NOS,Alcohol withdrawal,Ac DVT/emb prox low ext,Hyposmolality,Subarachnoid hemorrhage,Chr airway obstruct NEC,Epilep NOS w/o intr epil,Dysphagia NOS,Fall NOS,Benign hypertension

Admission Date: [**2140-4-28**] Discharge Date: [**2140-5-16**] Date of Birth: [**2087-1-27**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1835**] Chief Complaint: Large Left Temporal hemorrhage Major Surgical or Invasive Procedure: [**5-2**]: Left craniotomy for evacuation of intraparenchymal blood 3/24: Bedside tracheostomy placement [**5-10**]: PICC line placement by interventional radiology History of Present Illness: 53M apparently found down (?in bed) and intoxicated, brought to OSH apparently moving all 4 extremities, combative. Intubated, head CT showed large left temporal hemorrhage, pt transported to [**Hospital1 18**] Ed for further evaluation/treatment. Past Medical History: +ETOH, otherwise unknown Social History: unknown Family History: non-contributory Physical Exam: On Admission: VS: BP: 112/83 HR:101 R 12 O2Sats100 Gen: WD/WN, intubated, dried blood on face,multiple bruises/abrasions on body HEENT: Pupils: 3->2 EOMs unable to assess Extrem: Warm and well-perfused. Neuro:intubated sedated, PERRLA, +corneal reflexes, +gag, min movement all 4 to noxious Toes mute bilaterally Pertinent Results: Labs on Admission: [**2140-4-28**] 01:18PM BLOOD WBC-4.5 RBC-3.71* Hgb-12.6* Hct-35.0* MCV-94 MCH-34.1* MCHC-36.1* RDW-13.7 Plt Ct-40* [**2140-4-28**] 01:18PM BLOOD PT-12.3 PTT-30.0 INR(PT)-1.0 [**2140-4-28**] 01:18PM BLOOD Fibrino-170 [**2140-4-28**] 05:27PM BLOOD Glucose-94 UreaN-15 Creat-0.6 Na-139 K-3.5 Cl-98 HCO3-31 AnGap-14 [**2140-4-28**] 05:27PM BLOOD ALT-134* AST-179* LD(LDH)-329* CK(CPK)-247* AlkPhos-52 TotBili-1.0 [**2140-4-28**] 05:27PM BLOOD Albumin-3.6 Calcium-7.8* Phos-3.1 Mg-1.6 [**2140-4-28**] 01:18PM BLOOD ASA-NEG Ethanol-71* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG Imaging: CT Head [**4-28**]: FINDINGS: There is a large mixed density intraparenchymal blood collection in the left parietotemporal lobe measuring 7.6 x 3.3 cm in axial dimensions and consistent with acute hemorrhage. This lesion demonstrates surrounding edema. There is a 5-mm rightward shift of normally midline structures and subfalcine herniation. There is diffuse effacement of the sulci in the left cerebral hemisphere and the left lateral ventricle. There is no entrapment of the right lateral ventricle or uncal herniation. There is a second focus of acute hemorrhage in the right inferior frontal lobe measuring 1.1 x 1.5 cm. In addition, there are scattered foci of subarachnoid hemorrhage in the right temporal and left frontal and parietal lobes. There is no major vascular territory infarction. Mucosal thickening in the left maxillary and ethmoidal sinuses is noted. There is a mucous retention cyst in the right maxillary sinus. No osseous abnormality is detected. IMPRESSION: 1. Large left parietotemporal intraparenchymal hemorrhage with associated mass effect including 5 mm rightward shift of the normally midline structures and subfalcine herniation. 2. Focus of intraparenchymal hemorrhage in the right inferior frontal lobe. 3. Scattered areas of subarachnoid hemorrhage bilaterally. 4. Maxillary and ethmoidal sinus disease. CT Chest/Abd/Pelvis [**4-28**]: IMPRESSION: 1. No evidence of acute intrathoracic, intra-abdominal, or pelvic injury. 2. 2-mm nodule in the left lower lobe. According to the [**Last Name (un) 8773**] Society criteria, if the patient is at low risk for malignancy, no further followup is needed. If the patient is at high risk for malignancy, CT followup in 12 months is recommended, and if unchanged at that time, no additional followup is recommended. 3. Probable remote bilateral clavicular fractures and right and left rib fractures. 4. Fatty infiltration of the liver. 5. 4-mm hypodensity in the left renal cortex which is too small to characterize, but likely a simple cyst. Head CTA [**4-28**]: IMPRESSION: 1. No evidence of aneurysm or other vascular malformation. 2. Complete right ICA occlusion, likely at the origin. MRI C-Spine [**4-29**]: IMPRESSION: 1. No evidence of ligamentous injury in the cervical spine. 2. Multilevel degenerative change as detailed above, most severe at C5/6. No sign of cord signal abnormality. CT L-Spine [**4-29**]: IMPRESSION: 1. No fracture or lumbar spine malalignment. 2. Multilevel degenerative change as detailed above. CT T-Spine [**4-29**]: IMPRESSION: 1. No fracture or thoracic spine malalignment. 2. Fatty liver. EKG [**4-28**]: Sinus tachycardia. Low limb lead voltage. No previous tracing available for comparison. Intervals Axes Rate PR QRS QT/QTc P QRS T 114 100 84 334/428 78 62 69 CXR [**4-28**]: SINGLE SUPINE AP VIEW OF THE CHEST: The endotracheal tube terminates approximately 7.5 cm from the carina. The lungs are clear without focal consolidation, pneumothorax or pleural effusion. The heart size is normal. There is tortuosity of the thoracic aorta. There is bilateral clavicular deformity which may be related to prior trauma. An NG tube is noted projecting out of the field of view in the left upper abdomen. IMPRESSION: Endotracheal tube 7.5 cm from the carina. Consider repositioning. CXR [**4-30**]: FINDINGS: Comparison is made to the prior study from [**2140-4-28**]. Endotracheal tube terminates 4.2 cm above the carina. Cardiomediastinum otherwise normal. Nasogastric tube terminates in the stomach. There is mild atelectasis at both lung bases. Remainder of the lungs are clear. No frank infiltrate to suggest aspiration at this time. There is an old right clavicular deformity. Non-Invasive Ultrasound Studies: [**5-7**]:IMPRESSION: No DVT of the right upper extremity. [**5-8**]: DVT in the right superficial femoral vein which is occlusive. Head CT [**5-7**]: FINDINGS: There is evolution of hemorrhage in the left frontal craniotomy bed with decreasing air in the post-surgical bed. Large vasogenic edema adjacent to the hemorrhage with moderate mass effect on the ipsilateral left frontal [**Doctor Last Name 534**] is similar to [**2140-5-6**]. Right inferior frontal lobe hemorrhage is similar to [**2140-5-6**]. There is stable minimal right frontal subarachnoid hemorrhage. 7mm rightward shift of normally midline structures, left subfalcine and uncal herniation are similar to [**2140-5-6**]. Bilateral pneumocephalus has slightly decreased since [**2140-5-6**]. Opacification of the left frontal sinus, the sphenoid sinus, bilateral ethmoids and left maxillary sinuses are similar to [**2140-5-6**]. The mastoid air cells are clear. IMPRESSION: 1. Evolution of left parietoemporal parenchymal hemorrhage with large edema and subfalcine as well as uncal herniation that is similar to [**2140-5-6**]. 2. Evolution of R inferior frontal lobe hemorrhage unchanged since [**2140-5-6**]. 3. Diffuse paranasal sinus opacification is unchanged since [**2140-5-6**]. IVC Filter placement [**5-9**]: PFI: Placement of G2 retrievable infrarenal IVC filter. The filter can be retrieved at any time as needed. Brief Hospital Course: The patient was admitted to the ICU after having been intubated and sedated. He was not opening his eyes and was not following commands upon admission. He was however, able to move all 4 extremities to noxious stimuli. On [**4-28**] he had a CTA showing no aneurysm or AVM. There was complete right ICA occulsion but there was collateral flow. On [**5-2**] there was a question of a self-resolving focal seizure in the LUE so keppra was started. He underwent craniotomy for evacuation of hematoma on [**2140-5-2**]. The patient was able to move his extremities spontaneously and started to follow commands with the LUE post-operatively. He was also able to open his eyes. The patient was able to tolerate some time on trach mask but still required the ventilator at night. On [**5-5**] the patient had been on the trach mask for over 24 hours. He was tracking with his eyes and moving his LUE and lowers spontaneously and the RUE had slight withdrawal. On [**5-7**] the patient had a stat head CT due to a period of unresponsiveness. The scan was unchanged and the patient's exam improved subsequently. He had blood and urine cultures drawn for continued fevers. On [**5-8**], he was found to have lower extremity DVT and IVC filter was placed by interventional radiology on [**5-9**]. Subsequent to that, he was started on a heparin infusion without bolus, with goal PTT of 50-70. Also on [**5-10**], he was taken to interventional radiology again to have PICC line placed for continued access. During his hospitalization, he had hyponatremia, which was treated with salt tablets and a fluid restriction. On [**5-11**] the patient had a fall on the floor. He had a stat head CT which was unchanged. He was also scanned for any traumatic injuries. All of the imaging was unremarkable. He was seen and evaluated by physical and occupational therapy who determined he would be a candidate for rehab. The patient was more awake and attentive to examiner on the day of discharge although it was still difficult to have him follow commands. His pupils were equal and reactive to light. He was moving spontaneously with the right upper and both lowers. The left upper moved slightly. He was evaluated by the speech therapist and he was unable to tolerate a passimuir valve. Therefore his will go to rehab with a trach mask. He was discharged to an appropriate facility on [**2140-5-16**]. Medications on Admission: Unknown: per mother prescribed many but takes sporadically and incorrectly Discharge Medications: 1. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 2. Multivitamin,Tx-Minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 5. Erythromycin 5 mg/g Ointment Sig: One (1) Ophthalmic QID (4 times a day). 6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). 7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed. 10. Ibuprofen 100 mg/5 mL Suspension Sig: One (1) PO Q8H (every 8 hours). 11. Warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 12. Sodium Chloride 1 gram Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for hyponatremia. 13. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed. 14. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. 15. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 16. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML Intravenous PRN (as needed) as needed for line flush. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Left large subacute IPH with Ry frontal contracoup IPH Respiratory Failure s/p trach placement Fever Lower Extremity DVT Dysphagia, s/p PEG placement Hyponatremia Discharge Condition: Neurologically Stable Discharge Instructions: General Instructions ?????? Have a friend/family member check your incision daily for signs of infection. ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ?????? You haven been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? 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, unless you have been instructed not to. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? Fever greater than or equal to 101?????? F. Followup Instructions: Follow-Up Appointment Instructions ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**Last Name (STitle) **], to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast. Completed by:[**2140-5-16**]

431,348,518,263,291,453,276,430,496,345,787,E888,401

{'Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Subarachnoid hemorrhage,Chronic airway obstruction, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,Dysphagia, unspecified,Unspecified fall,Benign 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: Large Left Temporal hemorrhage PRESENT ILLNESS: 53M apparently found down (?in bed) and intoxicated, brought to OSH apparently moving all 4 extremities, combative. Intubated, head CT showed large left temporal hemorrhage, pt transported to [**Hospital1 18**] Ed for further evaluation/treatment. MEDICAL HISTORY: +ETOH, otherwise unknown MEDICATION ON ADMISSION: Unknown: per mother prescribed many but takes sporadically and incorrectly ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: VS: BP: 112/83 HR:101 R 12 O2Sats100 Gen: WD/WN, intubated, dried blood on face,multiple bruises/abrasions on body HEENT: Pupils: 3->2 EOMs unable to assess FAMILY HISTORY: non-contributory SOCIAL HISTORY: unknown ### Response: {'Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Subarachnoid hemorrhage,Chronic airway obstruction, not elsewhere classified,Epilepsy, unspecified, without mention of intractable epilepsy,Dysphagia, unspecified,Unspecified fall,Benign essential hypertension'}

CHIEF COMPLAINT: Shortness of Breath PRESENT ILLNESS: [**Age over 90 **] yo female with history of TB sp treatment, bronchiectasis, untreated MAC (diagnosed [**6-/2149**]), atrial fibrillation who presents with worsening shortness of breath. Patient was hospitalized in [**6-/2149**] with hemoptysis and shortness of breath. At that time she was diagnosed with pneumonia/bronchiectasis and treated with ceftriaxone/azithromycin with improvment in symptoms. After discharge sputum samples revealed MAC. She underwent no treatment of MAC given her frail state and the feeling that she would not live through treatment. Since the last DC she has been on home 02. . Patient states the last several weeks her breathing has become progressively worse. She saw her PCP the day prior to admission and declined hospital admission at that time. Today she felt her breathing was worse with ambulation and agreed to evaluation at the hospital. Denies fever, chills, chest pain, productive cough. Denies lower extremity edema, orthopnea, PND. . Initial VS in the ED: 97.9 99 152/89 18 95%. Labs revealed a normocytic anemia with hematocrit of 28.1 which is down from 32 in [**6-/2149**], INR 3.5, Lactate of 1.4, UA with 31 WBC and few bacteria, nitrite negative. CXR with bilateral lower lobe effusion with possible peripneumonic effusions. Patient was given Vancomycin and Levofloxacin. EKG with A. Fib. VS prior to transfer: 98.9 87 AF 150/74 25 99% 3L. . On the floor, feels fine, comfortable. MEDICAL HISTORY: - Paroxysmal atrial fibrillation - History of pulmonary tuberculosis --->treated with pneumothoraces and subsequently with PAS/INH 50 years ago --->PFTs [**2144**]: FEV1 0.86, FEV1/FVC 128% predicted. DLSO not performed --->prior CT revealing for calcified granulomas in the right lower lobe and left lower lobe, calcified pleural scar on the right, and fibrotic changes in the right lower lobe leading to a mediastinal shift to the right - MGUS - Osteoporosis - Cervical Osteoarthritis - s/p cataract extraction MEDICATION ON ADMISSION: - Calcium Carbonate 200mg PO three times a day - Omeprazole 20mg PO daily - conjugated estrogens 0.3 mg Daily - multivitamin one tab daily - donepezil 5 mg Tablet QHS - mirtazapine 45 mg daily - fluticasone-salmeterol 250-50 mcg/dose one inhalation daily - B complex vitamins one daily - cholecalciferol (vitamin D3) 1,000 unit daily - atorvastatin 10 mg Tablet Sig: 0.5 tablet daily - metoprolol tartrate 25 mg Tablet [**Hospital1 **] - warfarin 3mg Daily ALLERGIES: Ibuprofen PHYSICAL EXAM: Admission Physical Exam: Vitals: T: 97.9 BP: 133/63 P: 63 R: 18 O2: 97 3L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear FAMILY HISTORY: Mother: Died age 80 [**2-12**] MI Father: Died in 80s [**2-12**] MI No family history of lung cancer or other lung disease. SOCIAL HISTORY: The patient is currently a resident at [**Location (un) 5481**] independent living. She has two children, who do not live in the area. She was previously employed as a dental hygienist. She is independent in her ADL's. She denies tobacco or EtOH use.

Disseminated due to other mycobacteria,Acute on chronic diastolic heart failure,Other dependence on machines, supplemental oxygen,Atrial fibrillation,Personal history of tuberculosis,Bronchiectasis without acute exacerbation,Osteoporosis, unspecified,Do not resuscitate status,Cervical spondylosis without myelopathy,Encounter for palliative care,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Dysthymic disorder,Hypoxemia

DMAC bacteremia,Ac on chr diast hrt fail,Depend-supplement oxygen,Atrial fibrillation,Prsnl hst tuberculosis,Bronchiectas w/o ac exac,Osteoporosis NOS,Do not resusctate status,Cervical spondylosis,Encountr palliative care,Diaphragmatic hernia,Esophageal reflux,Dysthymic disorder,Hypoxemia

Admission Date: [**2149-9-26**] Discharge Date: [**2149-9-29**] Service: MEDICINE Allergies: Ibuprofen Attending:[**First Name3 (LF) 2610**] Chief Complaint: Shortness of Breath Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **] yo female with history of TB sp treatment, bronchiectasis, untreated MAC (diagnosed [**6-/2149**]), atrial fibrillation who presents with worsening shortness of breath. Patient was hospitalized in [**6-/2149**] with hemoptysis and shortness of breath. At that time she was diagnosed with pneumonia/bronchiectasis and treated with ceftriaxone/azithromycin with improvment in symptoms. After discharge sputum samples revealed MAC. She underwent no treatment of MAC given her frail state and the feeling that she would not live through treatment. Since the last DC she has been on home 02. . Patient states the last several weeks her breathing has become progressively worse. She saw her PCP the day prior to admission and declined hospital admission at that time. Today she felt her breathing was worse with ambulation and agreed to evaluation at the hospital. Denies fever, chills, chest pain, productive cough. Denies lower extremity edema, orthopnea, PND. . Initial VS in the ED: 97.9 99 152/89 18 95%. Labs revealed a normocytic anemia with hematocrit of 28.1 which is down from 32 in [**6-/2149**], INR 3.5, Lactate of 1.4, UA with 31 WBC and few bacteria, nitrite negative. CXR with bilateral lower lobe effusion with possible peripneumonic effusions. Patient was given Vancomycin and Levofloxacin. EKG with A. Fib. VS prior to transfer: 98.9 87 AF 150/74 25 99% 3L. . On the floor, feels fine, comfortable. Past Medical History: - Paroxysmal atrial fibrillation - History of pulmonary tuberculosis --->treated with pneumothoraces and subsequently with PAS/INH 50 years ago --->PFTs [**2144**]: FEV1 0.86, FEV1/FVC 128% predicted. DLSO not performed --->prior CT revealing for calcified granulomas in the right lower lobe and left lower lobe, calcified pleural scar on the right, and fibrotic changes in the right lower lobe leading to a mediastinal shift to the right - MGUS - Osteoporosis - Cervical Osteoarthritis - s/p cataract extraction Social History: The patient is currently a resident at [**Location (un) 5481**] independent living. She has two children, who do not live in the area. She was previously employed as a dental hygienist. She is independent in her ADL's. She denies tobacco or EtOH use. Family History: Mother: Died age 80 [**2-12**] MI Father: Died in 80s [**2-12**] MI No family history of lung cancer or other lung disease. Physical Exam: Admission Physical Exam: Vitals: T: 97.9 BP: 133/63 P: 63 R: 18 O2: 97 3L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: decrease BS bilateral bases, with fine rales, occasional wheeze right lower lung fields, no egophony, minimal dullness to percussion along the lower lung fields, no accessory muscle use CV: Irregular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis, left lower extremity with trace edema (patient notes this to be chronic. Discharge Physical Exam: Pertinent Results: Admission Labs: [**2149-9-26**] 11:55AM BLOOD WBC-6.5 RBC-3.24* Hgb-9.0* Hct-28.1* MCV-87# MCH-27.9 MCHC-32.1 RDW-15.8* Plt Ct-317 [**2149-9-26**] 11:55AM BLOOD PT-35.0* PTT-27.1 INR(PT)-3.5* [**2149-9-26**] 11:55AM BLOOD Glucose-104* UreaN-19 Creat-0.6 Na-143 K-3.8 Cl-102 HCO3-34* AnGap-11 [**2149-9-26**] 12:04PM BLOOD Lactate-1.4 Discharge Labs: Studies: CXR ([**2149-9-26**]): IMPRESSION: 1. Moderate pulmonary edema. 2. Increased size of moderate right and small left pleural effusions. 3. Bibasilar airspace opacities which could reflect atelectasis though infection or aspiration cannot be excluded. 4. Large hiatal hernia. Brief Hospital Course: [**Age over 90 **] yo female with history of TB s/p treatment, bronchiectasis, untreated MAC (diagnosed [**6-/2149**]), atrial fibrillation who presented with worsening shortness of breath, CXR concerning for bilateral lower lobe opacification with possible peripneumonic effusion. . Active issues: . #SOB/Cough: Upon admission, the patient described an increasing oxygen requirement for the past few days without fever, and with no evidence of leukocytosis. At that time, she demonstrated no signs of volume overload and her CXR was thought to be due to untreated MAC infection. However, overnight, she desaturated down to the low 80%, required 10L on a non-rebreather to maintain her oxygen saturation, and was thought to be volume overloaded with evidence of pulmonary edema on her subsequent CXR. She was subsequently transferred to the MICU for BIPAP given her worsening oxygen requirement. In the ICU the family decided to make the patient CMO wo continuation of lasix, abx, or other non-comfort medications (inhalers, bowel regimen, and beta blocker continued). Her geriatrician from the NH arranged for dispo back to the NH with hospice services under new code status on [**2149-9-29**]. . # Pyuria: No symptoms. Lots of epis on UA. No antibiotics given current goals of care. . # Atrial Fibrillation: Rate Controlled. Continued metoprolol for comfort. . # Normocytic Anemia: HCT down from 32 to 28. No evidence of acute bleed. Labs discontinued. . #. Depression: Continue Mirtazapine for sleep assistance. . Pt will be discharged to hospice services. Palliative care consult initiated at [**Hospital1 18**] w/ follow-up to be managed by hospice at outpatient facility. Medications on Admission: - Calcium Carbonate 200mg PO three times a day - Omeprazole 20mg PO daily - conjugated estrogens 0.3 mg Daily - multivitamin one tab daily - donepezil 5 mg Tablet QHS - mirtazapine 45 mg daily - fluticasone-salmeterol 250-50 mcg/dose one inhalation daily - B complex vitamins one daily - cholecalciferol (vitamin D3) 1,000 unit daily - atorvastatin 10 mg Tablet Sig: 0.5 tablet daily - metoprolol tartrate 25 mg Tablet [**Hospital1 **] - warfarin 3mg Daily Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Capsule(s) 2. senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for fever, pain. 4. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. mirtazapine 30 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime). 6. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: Three (3) ml Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 7. ipratropium bromide 0.02 % Solution Sig: One (1) ml Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 8. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 9. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 11. morphine 15 mg Tablet Sig: One (1) Tablet PO every 4-6 hours as needed for pain. Disp:*25 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Location (un) 5481**] TCU Discharge Diagnosis: Pulmonary edema Atrial fibrillation MAC - untreated Discharge Condition: Mental Status: Confused - sometimes. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Dear Ms. [**Known lastname **], It was a pleasure taking care of you at [**Hospital1 **]. You were admitted with shortness of breath related to fluid in your lung and your heart arrhythmia (atrial fibrillation). A meeting was held with you and your family to determine the most appropriate management for you given your recently declining health and wish to prioritize quality of life. Plans were made to transition you to hospice at your current nursing home with an emphasis on comfort care. The following changes were made to your medications: STOPPED all non-comfort medications Continued: inhalers, betablocker, bowel regimen, sleep aids STARTED morphine orally as needed for dyspnea and pain You have several follow-up appointments with [**Hospital1 18**] physicians. These appointments have been detailed in the follow-up section below. Should you desire medical evaluation in the future, please call your primary care physician to make an appointment, or if you need more immediate attention seek care at the emergency department. Followup Instructions: Department: PULMONARY FUNCTION LAB When: WEDNESDAY [**2149-10-1**] at 12:40 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: MEDICAL SPECIALTIES When: WEDNESDAY [**2149-10-1**] at 1 PM With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 612**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: PFT When: WEDNESDAY [**2149-10-1**] at 1 PM Completed by:[**2149-10-2**] Name: [**Known lastname 2406**],[**Known firstname 1683**] Unit No: [**Numeric Identifier 2407**] Admission Date: [**2149-9-26**] Discharge Date: [**2149-9-29**] Date of Birth: [**2058-1-6**] Sex: F Service: MEDICINE Allergies: Ibuprofen Attending:[**First Name3 (LF) 2408**] Addendum: To clarify several points from this [**Hospital 1325**] hospital course: . #SOB/Cough: Upon admission, the patient described an increasing oxygen requirement for the past few days without fever, and with no evidence of leukocytosis. At that time, she demonstrated no signs of volume overload and her CXR was thought to be due to untreated MAC infection. However, overnight, she desaturated down to the low 80%, required 10L on a non-rebreather to maintain her oxygen saturation, and this was thought to be volume overloaded with evidence of pulmonary edema on her subsequent CXR. The pulmonary edema was acute in nature, cardiac in etiology. On discharge pneumonia had been ruled out, and therefore not associated with MAC, which is her underlying pulmonary disease. Brief Hospital Course: Discharge Disposition: Extended Care Facility: [**Location (un) 1267**] TCU [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2409**] MD [**MD Number(2) 2410**] Completed by:[**2149-11-11**]

031,428,V462,427,V120,494,733,V498,721,V667,553,530,300,799

{'Disseminated due to other mycobacteria,Acute on chronic diastolic heart failure,Other dependence on machines, supplemental oxygen,Atrial fibrillation,Personal history of tuberculosis,Bronchiectasis without acute exacerbation,Osteoporosis, unspecified,Do not resuscitate status,Cervical spondylosis without myelopathy,Encounter for palliative care,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Dysthymic disorder,Hypoxemia'}

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: [**Age over 90 **] yo female with history of TB sp treatment, bronchiectasis, untreated MAC (diagnosed [**6-/2149**]), atrial fibrillation who presents with worsening shortness of breath. Patient was hospitalized in [**6-/2149**] with hemoptysis and shortness of breath. At that time she was diagnosed with pneumonia/bronchiectasis and treated with ceftriaxone/azithromycin with improvment in symptoms. After discharge sputum samples revealed MAC. She underwent no treatment of MAC given her frail state and the feeling that she would not live through treatment. Since the last DC she has been on home 02. . Patient states the last several weeks her breathing has become progressively worse. She saw her PCP the day prior to admission and declined hospital admission at that time. Today she felt her breathing was worse with ambulation and agreed to evaluation at the hospital. Denies fever, chills, chest pain, productive cough. Denies lower extremity edema, orthopnea, PND. . Initial VS in the ED: 97.9 99 152/89 18 95%. Labs revealed a normocytic anemia with hematocrit of 28.1 which is down from 32 in [**6-/2149**], INR 3.5, Lactate of 1.4, UA with 31 WBC and few bacteria, nitrite negative. CXR with bilateral lower lobe effusion with possible peripneumonic effusions. Patient was given Vancomycin and Levofloxacin. EKG with A. Fib. VS prior to transfer: 98.9 87 AF 150/74 25 99% 3L. . On the floor, feels fine, comfortable. MEDICAL HISTORY: - Paroxysmal atrial fibrillation - History of pulmonary tuberculosis --->treated with pneumothoraces and subsequently with PAS/INH 50 years ago --->PFTs [**2144**]: FEV1 0.86, FEV1/FVC 128% predicted. DLSO not performed --->prior CT revealing for calcified granulomas in the right lower lobe and left lower lobe, calcified pleural scar on the right, and fibrotic changes in the right lower lobe leading to a mediastinal shift to the right - MGUS - Osteoporosis - Cervical Osteoarthritis - s/p cataract extraction MEDICATION ON ADMISSION: - Calcium Carbonate 200mg PO three times a day - Omeprazole 20mg PO daily - conjugated estrogens 0.3 mg Daily - multivitamin one tab daily - donepezil 5 mg Tablet QHS - mirtazapine 45 mg daily - fluticasone-salmeterol 250-50 mcg/dose one inhalation daily - B complex vitamins one daily - cholecalciferol (vitamin D3) 1,000 unit daily - atorvastatin 10 mg Tablet Sig: 0.5 tablet daily - metoprolol tartrate 25 mg Tablet [**Hospital1 **] - warfarin 3mg Daily ALLERGIES: Ibuprofen PHYSICAL EXAM: Admission Physical Exam: Vitals: T: 97.9 BP: 133/63 P: 63 R: 18 O2: 97 3L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear FAMILY HISTORY: Mother: Died age 80 [**2-12**] MI Father: Died in 80s [**2-12**] MI No family history of lung cancer or other lung disease. SOCIAL HISTORY: The patient is currently a resident at [**Location (un) 5481**] independent living. She has two children, who do not live in the area. She was previously employed as a dental hygienist. She is independent in her ADL's. She denies tobacco or EtOH use. ### Response: {'Disseminated due to other mycobacteria,Acute on chronic diastolic heart failure,Other dependence on machines, supplemental oxygen,Atrial fibrillation,Personal history of tuberculosis,Bronchiectasis without acute exacerbation,Osteoporosis, unspecified,Do not resuscitate status,Cervical spondylosis without myelopathy,Encounter for palliative care,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Dysthymic disorder,Hypoxemia'}

CHIEF COMPLAINT: L-sided weakness, falling, dysarthria PRESENT ILLNESS: Mr [**Known lastname **] is a 71 yo M with h/o metastatic inoperable NSCLC s/p chemo and radiation who presented to the [**Hospital1 18**] ED after developing L-sided weakness and falling when attempting to rise from a chair around 10:30pm on [**2109-8-12**]. His wife states that he had developed difficulty speaking, a left-sided forehead sparing facial droop prior to falling. Mr [**Known lastname **] was diagnosed with NSCLC approximately 1 year ago and two metastatic brain lesions were found in [**Month (only) 216**] (one R thalamic lesion and one R temporal lesion). Upon falling, Mr [**Known lastname **] was taken to [**Hospital6 50929**], where he was found to have bleeding of the R thalamic metastatic brain lesion with significant intraventricular extension. MEDICAL HISTORY: -NSCLC s/p chemo and radiation (see HPI) -DM -Glaucoma -s/p b/l cataract surgery -Lupus -Peripheral artery disease MEDICATION ON ADMISSION: Decadron 4 [**Hospital1 **] and Keppra 500 [**Hospital1 **] started 2 days ago for Cyberknife prep, xanax prn, ibuprofen, metformin, plavix, xalatan, nitroquick, humolog, prednisone ALLERGIES: Fentanyl / Sporanox PHYSICAL EXAM: Vitals 98.0 BP 113/61 HR 86 RR 20 SpO2 98% on NC FAMILY HISTORY: No known family history of malignancy. SOCIAL HISTORY: The pt lives with his wife in [**Name (NI) **]. He worked for most of his life as a bricklayer, and retired approximately 10 years ago. He spent much of his childhood boxing, from the ages of 11 to 29.

Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Hemiplegia, unspecified, affecting nondominant side,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Systemic lupus erythematosus,Unspecified glaucoma,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Chronic airway obstruction, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use

Sec mal neo brain/spine,Intracerebral hemorrhage,Cerebral edema,Mal neo bronch/lung NOS,Unsp hmiplga nondmnt sde,DMII wo cmp nt st uncntr,Syst lupus erythematosus,Glaucoma NOS,Hypertension NOS,Periph vascular dis NOS,Chr airway obstruct NEC,Hx antineoplastic chemo,Hx of irradiation,History of tobacco use

Admission Date: [**2109-8-13**] Discharge Date: [**2109-8-17**] Date of Birth: [**2038-3-11**] Sex: M Service: NEUROLOGY Allergies: Fentanyl / Sporanox Attending:[**First Name3 (LF) 6075**] Chief Complaint: L-sided weakness, falling, dysarthria Major Surgical or Invasive Procedure: none History of Present Illness: Mr [**Known lastname **] is a 71 yo M with h/o metastatic inoperable NSCLC s/p chemo and radiation who presented to the [**Hospital1 18**] ED after developing L-sided weakness and falling when attempting to rise from a chair around 10:30pm on [**2109-8-12**]. His wife states that he had developed difficulty speaking, a left-sided forehead sparing facial droop prior to falling. Mr [**Known lastname **] was diagnosed with NSCLC approximately 1 year ago and two metastatic brain lesions were found in [**Month (only) 216**] (one R thalamic lesion and one R temporal lesion). Upon falling, Mr [**Known lastname **] was taken to [**Hospital6 50929**], where he was found to have bleeding of the R thalamic metastatic brain lesion with significant intraventricular extension. Mr [**Known lastname **] notes that he has experienced intermittent vertigo for the past several months, often experienced when standing, but denies lightheadedness. He also notes veering to the left when he walks for the past several months. The pt states that he has fallen several times over the past 1-2 years -- so many times that he has lost count. He also states that he has hit his head on multiple occasions when he has fallen. Prior to these falls, the pt had a h/o head trauma with multiple concussions (w/o loss of consciousness) as a boxer from ages 11 to 29. The pt also has a 90 pack year smoking history. The pt denies any diplopia, blurring of vision, or other changes in his vision. He endorses mild retro-orbital HA, but denies fevers, chills, nausea, vomiting , and diarrhea. He denies any pain, numbness, or tingling, but acknowledges weakness of his L side. Past Medical History: -NSCLC s/p chemo and radiation (see HPI) -DM -Glaucoma -s/p b/l cataract surgery -Lupus -Peripheral artery disease Social History: The pt lives with his wife in [**Name (NI) **]. He worked for most of his life as a bricklayer, and retired approximately 10 years ago. He spent much of his childhood boxing, from the ages of 11 to 29. He states that he drank heavily for approximately 20-25 years, about a quart of whiskey a day. Pt smoked about 1.5 PPD for 59 years. He quit one year ago when he was diagnosed with NSCLC. Family History: No known family history of malignancy. Physical Exam: Vitals 98.0 BP 113/61 HR 86 RR 20 SpO2 98% on NC Physical Exam: Gen: Man with several tattoos lying in bed only partially draped appearing his stated age of 71 HEENT: No scleral icterus. No conjunctival injection. MMM. Poor dentition. Neck: Supple, no LAD in cervical chains. Lungs: Crackles in bases bilaterally, decreased breath sounds throughout. Increased respiratory effort. CV: RRR, no m/r/g Abdomen: soft, NT, ND, NABS Extremities: warm and well perfused, no cyanosis, clubbing, edema in LE. RUE with fluid infiltrate in forearm. Skin: No rashes or ulcers. Neurologic examination: Mental status: Awake, alert, cooperative, affect appropriate ORIENTATION: Oriented to person and place, was able to state that it was toward the end of [**2109-7-24**] ATTENTION: + DOW forward and backward, not able to perform MOYB SPEECH/LANGUAGE: Speech fluent but dysarthric with intact comprehension, repetition, naming. Can follow simple commands. Poor lingual pronunciation, labial and gutteral pronunciation intact. No paraphasic errors. MEMORY: Registered [**1-23**] after drilling, recalled [**12-26**] words at 5 minutes CALCULATION: $1.75 = 7 quarters, $2.25 = 9 quarters PRAXIS/NEGLECT: No evidence of apraxia with RUE (LUE immobile). Able to simulate hammering a nail with right hand. Pt is unaware of his inability to move his L side. When asked to simulate hammering a nail with his left hand, believes he is hammering the nail, when he is actually not moving his LUE. Cranial Nerves: I - not tested; II, III - Pupils equal, round, not reactive to light (s/p cataract surgery b/l). Visual fields full to confrontation bilaterally III, IV, VI - EOMI, no nystagmus bilaterally, normal saccades V - Sensation intact V1-V3 VII - Forehead sparing facial droop on L side. Smile asymmetric. Pt unable to close L eye tightly. VIII - Hearing intact to finger rub bilaterally, L > R IX, X - Voice normal, palate elevates symmetrically [**Doctor First Name 81**] - Sternocleidomastoid, trapezius grossly intact. XII - Tongue protrudes midline, movements intact Motor: Normal bulk, tone throughout. Mild pronator drift on right, no asterixis. Postural tremor seen on right. Spontaneous movement of all extremities. Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Sensation: Intact to light touch and proprioception except for L arm. L arm shows diminished sensitivity to light touch and extinction to DSS. L arm also shows diminished sensitivity to pinprick. Reflexes: Br [**Hospital1 **] Tri [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] L 2 2 2 3 1 R 2 2 2 2 2 No clonus. Downgoing toe on right, but upgoing on left. Coordination: Mild dysmetria on FNF. Mirror test normal. RAMs slow. Gait: Not tested Pertinent Results: [**2109-8-13**] 04:40PM GLUCOSE-168* UREA N-23* CREAT-0.6 SODIUM-142 POTASSIUM-4.1 CHLORIDE-108 TOTAL CO2-22 ANION GAP-16 [**2109-8-13**] 04:40PM CALCIUM-9.5 PHOSPHATE-2.9 MAGNESIUM-1.7 [**2109-8-13**] 04:40PM WBC-9.8 RBC-3.89* HGB-13.3* HCT-37.2* MCV-96 MCH-34.1* MCHC-35.6* RDW-15.6* [**2109-8-13**] 04:40PM PLT COUNT-168 [**2109-8-13**] 04:40PM PT-12.4 PTT-19.5* INR(PT)-1.0 [**2109-8-13**] 03:10AM URINE GR HOLD-HOLD [**2109-8-13**] 03:10AM WBC-10.4 RBC-3.87* HGB-13.0* HCT-35.9* MCV-93 MCH-33.7* MCHC-36.4* RDW-15.8* [**2109-8-13**] 03:10AM NEUTS-93.2* LYMPHS-5.2* MONOS-1.2* EOS-0.2 BASOS-0.1 [**2109-8-13**] 03:10AM PLT COUNT-158 [**2109-8-13**] 03:10AM PT-11.9 PTT-19.1* INR(PT)-1.0 [**2109-8-13**] 03:10AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015 [**2109-8-13**] 03:10AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-500 KETONE-TR BILIRUBIN-NEG UROBILNGN-0.2 PH-7.0 LEUK-NEG HEAD CT [**8-13**] 1. Stable right intraparenchymal hemorrhage. Stable intraventricular extension of hemorrhage. 2. Stable vasogenic edema within the right temporoparietal lobe. HEAD CT [**8-14**] 1. Unchanged right hemispheric parenchymal hemorrhages at the site of known masses, with stable degree of intraventricular extension of the hemorrhage. 3. Stable asymmetric dilatation of the temporal [**Doctor Last Name 534**] of the right lateral ventricle at the level of the ventricular atrium. Brief Hospital Course: Mr [**Known lastname **] is a 71 yo M with h/o metastatic inoperable NSCLC s/p chemo and radiation who presented to the [**Hospital1 18**] ED after developing L-sided weakness and falling when attempting to rise from a chair around 10:30pm on [**2109-8-12**]. He was found to have intraparenchymal hemorrhage into a right thalamic metastases. Another CT scan on [**8-14**] was performed to view if there was any change in his hemorrhage which showed unchanged right hemispheric parenchymal hemorrhages at the site of known masses, with stable degree of intraventricular extension of the hemorrhage. There was stable asymmetric dilatation of the temporal [**Doctor Last Name 534**] of the right lateral ventricle at the level of the ventricular atrium. He was seen by speech and swallow as there were concerns about his ability to swallow. There evaluation showed aspiration with thin liquids and prolonged mastication with mild-moderate residue with regular solid. They recommended him for PO diet of nectar-thick liquids and soft solids and that medications should be take whole with nectar-thick liquids or puree. Patient was seen by palliative care who discussed with the patient and his family the two options for radiotherapy which include whole brain radiation therapy, which is standard of care,especially for lung cancer with brain metastases. The logistics and side effects and expected outcomes of the treatment were discussed in detail with the patient. The advantage of the whole brain therapy to treat both visible and undetectable disease was outlined to the patient. The patient and his wife ultimately will likely decide against this, and pursue only palliative directed therapies. Medications on Admission: Decadron 4 [**Hospital1 **] and Keppra 500 [**Hospital1 **] started 2 days ago for Cyberknife prep, xanax prn, ibuprofen, metformin, plavix, xalatan, nitroquick, humolog, prednisone Discharge Medications: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2* 4. Dexamethasone 2 mg Tablet Sig: Three (3) Tablet PO Q12H (every 12 hours). Disp:*180 Tablet(s)* Refills:*2* 5. Alprazolam 0.25 mg Tablet Sig: 1-2 Tablets PO TID (3 times a day) as needed for anxiety. Disp:*30 Tablet(s)* Refills:*0* 6. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED): Insulin sliding scale 150-180 give 2 units, 180-220 give 4 units, 220-250 give 6 units, 250-300 give 8 units, 300-350 10 units. Disp:*1 1* Refills:*2* Discharge Disposition: Extended Care Facility: [**Location (un) 582**] at [**Location (un) **] Discharge Diagnosis: Right sided thalamic hemorrhagic stroke Non small cell lung cancer with two metastasis to the brain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted to the hospital for acute onset of left sided weakness, left sided facial droop, and difficulty speaking. You were found to have a R sided brain bleed. Followup Instructions: Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2109-9-9**] 10:35 Provider: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD Phone:[**Telephone/Fax (1) 1844**] Date/Time:[**2109-9-9**] 11:30

198,431,348,162,342,250,710,365,401,443,496,V874,V153,V158

{'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Hemiplegia, unspecified, affecting nondominant side,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Systemic lupus erythematosus,Unspecified glaucoma,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Chronic airway obstruction, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,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: L-sided weakness, falling, dysarthria PRESENT ILLNESS: Mr [**Known lastname **] is a 71 yo M with h/o metastatic inoperable NSCLC s/p chemo and radiation who presented to the [**Hospital1 18**] ED after developing L-sided weakness and falling when attempting to rise from a chair around 10:30pm on [**2109-8-12**]. His wife states that he had developed difficulty speaking, a left-sided forehead sparing facial droop prior to falling. Mr [**Known lastname **] was diagnosed with NSCLC approximately 1 year ago and two metastatic brain lesions were found in [**Month (only) 216**] (one R thalamic lesion and one R temporal lesion). Upon falling, Mr [**Known lastname **] was taken to [**Hospital6 50929**], where he was found to have bleeding of the R thalamic metastatic brain lesion with significant intraventricular extension. MEDICAL HISTORY: -NSCLC s/p chemo and radiation (see HPI) -DM -Glaucoma -s/p b/l cataract surgery -Lupus -Peripheral artery disease MEDICATION ON ADMISSION: Decadron 4 [**Hospital1 **] and Keppra 500 [**Hospital1 **] started 2 days ago for Cyberknife prep, xanax prn, ibuprofen, metformin, plavix, xalatan, nitroquick, humolog, prednisone ALLERGIES: Fentanyl / Sporanox PHYSICAL EXAM: Vitals 98.0 BP 113/61 HR 86 RR 20 SpO2 98% on NC FAMILY HISTORY: No known family history of malignancy. SOCIAL HISTORY: The pt lives with his wife in [**Name (NI) **]. He worked for most of his life as a bricklayer, and retired approximately 10 years ago. He spent much of his childhood boxing, from the ages of 11 to 29. ### Response: {'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Hemiplegia, unspecified, affecting nondominant side,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Systemic lupus erythematosus,Unspecified glaucoma,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Chronic airway obstruction, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use'}