CHIEF COMPLAINT: hypotension

PRESENT ILLNESS: 58 yo F s/p TAAA stent for type B dissection in [**2150-10-26**]. She
had a long post op course and underwent tracheostomy for
respiratory failure. Is on 4 weeks course of vanco and aztreonam
for staph in blood and proteus in urine. She was dc'd to rehab
on [**11-11**] and had an asystolic arrest there. She was transferred
to Good [**Hospital 57794**] Hospital, she has been off the vent and doind
well but had a HCT drop of 6 points (31-25) and underwent CT
scan which showed question of endoleak and was transferred for
further eval.

MEDICAL HISTORY: cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

MEDICATION ON ADMISSION: Combivent, Aztreonam, Vanco, Solucortef, Zypreza, Lopressor,
Nedium, Heparin gtt

ALLERGIES: Codeine / Talwin / Nafcillin

PHYSICAL EXAM: HR 76 RR 21 BP 108/94
Lungs CTAB
Heart RRR
Abdomen benign
No CCE
A&O, MAE to command
Left radial pulse absent

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown.
Other mechanical complication of cardiac device, implant, and graft,Anoxic brain damage,Chronic airway obstruction, not elsewhere classified,Cushing's syndrome,Precipitous drop in hematocrit,Esophageal reflux,Other dysphagia,Hypotension, unspecified,Tracheostomy status,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,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Foreign body in trachea,Foreign body accidentally entering other orifice
Malfunc card dev/grf NEC,Anoxic brain damage,Chr airway obstruct NEC,Cushing's syndrome,Drop, hematocrit, precip,Esophageal reflux,Dysphagia NEC,Hypotension NOS,Tracheostomy status,Abn react-anastom/graft,Long-term use anticoagul,Heart valve replac NEC,Foreign body in trachea,FB entering oth orifice
Admission Date:  [**2150-11-20**]              Discharge Date:   [**2150-12-3**]

Date of Birth:  [**2092-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Talwin / Nafcillin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
hypotension

Major Surgical or Invasive Procedure:
Angiogram

History of Present Illness:
58 yo F s/p TAAA stent for type B dissection in [**2150-10-26**]. She
had a long post op course and underwent tracheostomy for
respiratory failure. Is on 4 weeks course of vanco and aztreonam
for staph in blood and proteus in urine. She was dc'd to rehab
on [**11-11**] and had an asystolic arrest there. She was transferred
to Good [**Hospital 57794**] Hospital, she has been off the vent and doind
well but had a HCT drop of 6 points (31-25) and underwent CT
scan which showed question of endoleak and was transferred for
further eval.

Past Medical History:
cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

Social History:
unknown.


Family History:
NC

Physical Exam:
HR 76 RR 21 BP 108/94
Lungs CTAB
Heart RRR
Abdomen benign
No CCE
A&O, MAE to command
Left radial pulse absent


Pertinent Results:
[**2150-12-3**] 05:22AM BLOOD WBC-9.3 RBC-3.38* Hgb-10.1* Hct-30.9*
MCV-91 MCH-30.0 MCHC-32.8 RDW-16.9* Plt Ct-788*
[**2150-12-3**] 05:22AM BLOOD Plt Ct-788*
[**2150-12-3**] 05:22AM BLOOD PT-14.4* PTT-51.4* INR(PT)-1.3*
[**2150-12-3**] 05:22AM BLOOD Glucose-122* UreaN-10 Creat-0.7 Na-140
K-3.6 Cl-104 HCO3-27 AnGap-13

CTA CHEST W&W/O C&RECONS, NON-CORONARY  [**2150-11-21**] 1:55 AM

CTA CHEST W&W/O C&RECONS, NON-; CTA ABD W&W/O C & RECONS

Reason: s/p thorocoabd stent, r/o endo leak
Field of view: 39 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
58 year old woman endovascular stent
REASON FOR THIS EXAMINATION:
s/p thorocoabd stent, r/o endo leak
CONTRAINDICATIONS for IV CONTRAST: None.

STUDY: CT OF THE CHEST, ABDOMEN AND PELVIS.

INDICATION: 58-year-old female status post thoracoabdominal
aortic stent. Assess for a leak.

COMPARISONS: [**2150-11-9**].

TECHNIQUE: Non-contrast MDCT axial images of the chest, abdomen,
and pelvis were acquired. Following the administration of 60 mL
of Optiray intravenous contrast, MDCT axial images were acquired
from the thoracic inlet to the pubic symphysis. Coronal and
sagittal reconstructed images were then obtained.

CT OF THE CHEST WITHOUT AND WITH IV CONTRAST: The patient is
status post endotracheal intubation. The patient is status post
endovascular stenting of the thoracic aorta beginning at the
level of the aortic arch and extending inferiorly to the level
of T12 approximately. A focal area of contrast extravasation is
noted anteriorly along the graft at the junction of the two
overlapping grafts and measures 3.1 x 0.8 cm (series 401B:image
39). Comparison to the previous CT examination demonstrates
increased of the size in this focal leak. Once again,
surrounding hematoma is noted concentrically around the graft
and not appreciably changed in size compared to the previous
evaluation. There is moderate-to-severe cardiomegaly. No
pericardial effusion is present. The pulmonary artery is
enlarged, measuring 3.5 cm. There is bibasilar dependent
atelectasis. The lungs are otherwise grossly clear. The patient
is status post median sternotomy. Few mediastinal lymph nodes
are noted, none of which meet criteria for pathology by CT.

CT OF THE ABDOMEN WITH IV CONTRAST: Once again, note is made of
multiple hyperattenuating nodules throughout the liver. Several
low-attenuation foci are consistent in appearance with simple
cysts. The liver is grossly unchanged compared to the previous
evaluation. A moderate-sized left pleural effusion is noted. The
kidneys, adrenal glands, spleen, pancreas, gallbladder and
abdominal portions of the large and small bowel appear grossly
unremarkable and unchanged compared to the previous examination.
There is no free fluid within the abdomen.

CT OF THE PELVIS WITH IV CONTRAST: A Foley balloon is present
within the collapsed bladder. The rectum, sigmoid colon, uterus
and adnexa appear unremarkable. There are no pathologically
enlarged inguinal or pelvic lymph nodes. No free fluid is
present within the pelvis.

OSSEOUS STRUCTURES: There is severe S-shaped scoliosis of the
thoracolumbar spine. T12 and L2 compression fractures are
unchanged.

IMPRESSION:

1. Findings consistent with an endoleak at the level of the
graft- to-graft anastomosis in the mid thoracic cavity
anteriorly. This focal area of contrast extravasation has
increased compared to the CT of [**2150-11-9**]. Relatively stable
appearance of peri-aortic hematoma.

2. Left moderate subpulmonic effusion.

These findings were discussed over the telephone with [**First Name8 (NamePattern2) 402**]
[**Last Name (NamePattern1) **] by Dr

Brief Hospital Course:
She was seen by vascular surgery and underwent repeat CT scan
which showed findings consistent with endoleak at the lower pole
of the graft to graft anastomosis with increased area of
extravasation as compared to previous CT. She was hypertensive
and her medications were adjusted. A dobhoff tube was placed and
tubefeedings were restarted. She received a nutrition consult
for increased risk of malnutrition. She awaited normalization of
INR prior to undergoing angiogram on [**11-24**] which showed no
endoleak. She was transferred to the floor on [**11-24**]. Coumadin and
heparin were restarted for mechanical AVR. She underwent speech
and swallow evaluation and aspirated. Thoracic surgery was
consulted for PEG tube which was placed on [**11-30**].  Her coumadin
and tube feeds was restarted. She was ready for discharge to
rehab on heparin on [**12-2**].

Medications on Admission:
Combivent, Aztreonam, Vanco, Solucortef, Zypreza, Lopressor,
Nedium, Heparin gtt

Discharge Medications:
1. Heparin (Porcine) in D5W 100 unit/mL Parenteral Solution [**Month/Year (2) **]:
1350 (1350) units/hr Intravenous ASDIR (AS DIRECTED): until INR
is therapeutic.
2. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol [**Month/Year (2) **]: Six
(6) Puff Inhalation Q4H (every 4 hours).
3. Nystatin 100,000 unit/g Cream [**Month/Year (2) **]: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
4. Prednisone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

5. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
6. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: Two (2)  PO BID (2
times a day).
7. Aspirin 325 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).
8. Olanzapine 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a
day).
9. Atorvastatin 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
10. Lisinopril 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
11. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID
(3 times a day).
12. Aztreonam 1 gram Recon Soln [**Last Name (STitle) **]: One (1) Recon Soln
Injection Q8H (every 8 hours) for 1 weeks: to finish 4 week
course.
13. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Last Name (STitle) **]: One (1)
g Intravenous Q 24H (Every 24 Hours) for 1 weeks: to finish 4
week course.
14. Warfarin 2 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO at bedtime:
Adjust dosing for goal INR between 2.0 - 3.0.


Discharge Disposition:
Extended Care

Facility:
sinae

Discharge Diagnosis:
Type II endoleak - s/p thoracoabdominal stent graft for ruptured
thoracic aneurysm/dissection [**10-26**], coiling of L subclavian [**10-27**],
s/p tracheal stent [**10-30**]; chronic respiratory failure - s/p Trach
[**11-4**], s/p PEG [**11-30**], severe malnutrition - started on tube
feeds, aspiration, s/p AVR(mech), COPD, GERD, h/o splenic lac
c/b cardiac arrest and anoxic brain injury, [**Location (un) 3484**], s/p
asystolic arrest [**11-14**], +MRSA bacteremia and Proteus urinary
tract infection - being treated with Vanco and Aztreonam

Discharge Condition:
Stable.


Discharge Instructions:
1)Continue IV Heparin until INR above 2.0. Monitor PT/INR
closely and adjust Warfarin for goal INR between 2.5 - 3.0.
Please arrange outpatient Warfarin followup with Dr. [**Last Name (STitle) **]
prior to discharge from rehab. 2)Tracheostomy #7 Portex -
continue trach mask with PMV as tolerated 3)Aspiration
precautions - Continue NPO and tube feedings as directed -
please reconsult speech and swallow when indicated 4)Continue
antibiotics as directed 5)Routine PICC care 6)Pulmonary Toilet

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **] MD [**2150-3-2**] 1PM - Phone [**Telephone/Fax (1) 170**]
Provider: [**First Name8 (NamePattern2) 4021**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:
[**2150-12-24**] 11:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:
[**2151-3-3**] 1:00
Provider: [**Name10 (NameIs) **] SCAN(CTA with MMS)Phone:[**Telephone/Fax (1) 327**] Date/Time:
[**2151-3-3**] 11:45



Completed by:[**2150-12-3**]

Name:  [**Known lastname 11167**],[**Known firstname **] F          Unit No:   [**Numeric Identifier 11168**]

Admission Date:  [**2150-11-20**]              Discharge Date:   [**2150-12-3**]

Date of Birth:  [**2092-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Talwin / Nafcillin

Attending:[**First Name3 (LF) 1543**]
Addendum:
Correction to previous discharge summary.  Ms. [**Known lastname **] had
MSSA not MRSA bacteremia.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2150-12-28**]

Name:  [**Known lastname 11167**],[**Known firstname **] F          Unit No:   [**Numeric Identifier 11168**]

Admission Date:  [**2150-11-20**]              Discharge Date:   [**2150-12-3**]

Date of Birth:  [**2092-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Talwin / Nafcillin

Attending:[**First Name3 (LF) 1543**]
Addendum:
She inadvertently pulled out her PICC oine by approximately 4 cm
prior to discharge, CXR showed continued placement in SVC.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2150-12-3**]
{"Other mechanical complication of cardiac device, implant, and graft,Anoxic brain damage,Chronic airway obstruction, not elsewhere classified,Cushing's syndrome,Precipitous drop in hematocrit,Esophageal reflux,Other dysphagia,Hypotension, unspecified,Tracheostomy status,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,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Foreign body in trachea,Foreign body accidentally entering other orifice"}


You are an AI assistant analyzing clinical admission notes from the MIMIC III 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: 58 yo F s/p TAAA stent for type B dissection in [**2150-10-26**]. She
had a long post op course and underwent tracheostomy for
respiratory failure. Is on 4 weeks course of vanco and aztreonam
for staph in blood and proteus in urine. She was dc'd to rehab
on [**11-11**] and had an asystolic arrest there. She was transferred
to Good [**Hospital 57794**] Hospital, she has been off the vent and doind
well but had a HCT drop of 6 points (31-25) and underwent CT
scan which showed question of endoleak and was transferred for
further eval.

MEDICAL HISTORY: cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

MEDICATION ON ADMISSION: Combivent, Aztreonam, Vanco, Solucortef, Zypreza, Lopressor,
Nedium, Heparin gtt

ALLERGIES: Codeine / Talwin / Nafcillin

PHYSICAL EXAM: HR 76 RR 21 BP 108/94
Lungs CTAB
Heart RRR
Abdomen benign
No CCE
A&O, MAE to command
Left radial pulse absent

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown. 

### Response:
{"Other mechanical complication of cardiac device, implant, and graft,Anoxic brain damage,Chronic airway obstruction, not elsewhere classified,Cushing's syndrome,Precipitous drop in hematocrit,Esophageal reflux,Other dysphagia,Hypotension, unspecified,Tracheostomy status,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,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Foreign body in trachea,Foreign body accidentally entering other orifice"}
