CHIEF COMPLAINT: Bilateral foot ulcers

PRESENT ILLNESS: 86y/o male with histroy of PVD s/p rt. fem-DP bypass graft with
composite SVG
for rt. foot ulcer [**10-6**]
 Returned for right calf wound infection s/p primary closure d/c
[**11-5**]
 returns now  with persistant right foot wound and new left #2
toe tip wound which probes to bone.Denies any constutional
symptoms.Now admitted for evaluatiion and treatment.

MEDICAL HISTORY: seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH

MEDICATION ON ADMISSION: detrol 2mgm [**Hospital1 **]
amidarone 200mgm qd
cozaar 50mgm qd
lasix 40mgm qd
glipazide 10mgm qd
lipitor 10mgm qd
protonix 40mgm qd
KCl 50meq qd
avandia 8mgm qd
colace 100mgm [**Hospital1 **]
lopressor 75mgm [**Hospital1 **]
atrovent MDI puff 2 qid
Emycin 500mgm [**Hospital1 **] x 10 days ([**Date range (1) 17553**])
percocet tab q4h prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 97.5-56-20 138/68
HEENT:rt. carotid bruit. carotid pulses palpable 1+ no JVD
Lungs: L > chest A/P diameter with expiratory wheezes
LT.>Rt.Ronchros rt. air way sounds
Heart: distant ? irregular. no mumur or gallop
ABD: protrubrent, soft, nontender active bowel sounds. no
abdominal bruits.
PV: right foot: lateral foot wouond 2x3cm with clean base with
tendon exposed . no excudates. Left #2 toe tip wound probes
tobone. no erythema,excudate, excudaates
pulses: right femoral 2+ palpable,absent popliteal pulses
bilaterally,rt. DP absent. Rt. Pt  dopperable. Left pedal pulses
dopperable. graft pulse palpable.
Neuro: orient x3. grossly intact

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired single. Lives in a trailer home. Has not been home since
[**10-6**]
habits former [**Month/Year (2) 1818**] d/c x 19 yrs
ETOH; d/c'd x 19 years
Atherosclerosis of native arteries of the extremities with ulceration,Arterial embolism and thrombosis of lower extremity,Atrial flutter,Other convulsions,Chronic obstructive asthma, unspecified,Ulcer of other part of foot,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Other bone involvement in diseases classified elsewhere,Chronic osteomyelitis, ankle and foot,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of peptic ulcer disease
Ath ext ntv art ulcrtion,Lower extremity embolism,Atrial flutter,Convulsions NEC,Chronic obst asthma NOS,Ulcer other part of foot,DMII oth nt st uncntrld,Bone involv in oth dis,Chr osteomyelit-ankle,Mth sus Stph aur els/NOS,Hypertension NOS,Crnry athrscl natve vssl,Prsnl hst peptic ulcr ds
Admission Date:  [**2154-1-8**]              Discharge Date:   [**2154-1-19**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4748**]
Chief Complaint:
Bilateral foot ulcers

Major Surgical or Invasive Procedure:
right below knee amputation [**2154-1-11**]
left5 SFA to PT bypassgraft with issvg, left SFA endartectomy,
angioscopy [**2154-1-14**]
angio with bilateral lower extremity runoff [**2154-1-9**]
PICC line rt. [**2154-1-17**]


History of Present Illness:
86y/o male with histroy of PVD s/p rt. fem-DP bypass graft with
composite SVG
for rt. foot ulcer [**10-6**]
 Returned for right calf wound infection s/p primary closure d/c
[**11-5**]
 returns now  with persistant right foot wound and new left #2
toe tip wound which probes to bone.Denies any constutional
symptoms.Now admitted for evaluatiion and treatment.

Past Medical History:
seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH


Social History:
retired single. Lives in a trailer home. Has not been home since
[**10-6**]
habits former [**Month/Year (2) 1818**] d/c x 19 yrs
ETOH; d/c'd x 19 years

Family History:
unknown

Physical Exam:
Vital signs: 97.5-56-20 138/68
HEENT:rt. carotid bruit. carotid pulses palpable 1+ no JVD
Lungs: L > chest A/P diameter with expiratory wheezes
LT.>Rt.Ronchros rt. air way sounds
Heart: distant ? irregular. no mumur or gallop
ABD: protrubrent, soft, nontender active bowel sounds. no
abdominal bruits.
PV: right foot: lateral foot wouond 2x3cm with clean base with
tendon exposed . no excudates. Left #2 toe tip wound probes
tobone. no erythema,excudate, excudaates
pulses: right femoral 2+ palpable,absent popliteal pulses
bilaterally,rt. DP absent. Rt. Pt  dopperable. Left pedal pulses
dopperable. graft pulse palpable.
Neuro: orient x3. grossly intact


Pertinent Results:
[**2154-1-8**] 11:51PM   WBC-5.1 RBC-2.69* HGB-7.8* HCT-24.6* MCV-92
MCH-29.2 MCHC-31.9 RDW-15.8*
[**2154-1-8**] 11:51PM   PLT COUNT-231
[**2154-1-8**] 11:51PM   PT-13.3 PTT-28.6 INR(PT)-1.1
[**2154-1-8**] 11:51PM   GLUCOSE-212* UREA N-34* CREAT-1.5* SODIUM-138
POTASSIUM-4.6 CHLORIDE-102 TOTAL CO2-26 ANION GAP-15
[**2154-1-8**] 11:51PM   CALCIUM-8.6 PHOSPHATE-3.2 MAGNESIUM-2.2

Brief Hospital Course:
[**2154-1-8**] admitted to vascular service. Wound cultures obtained.
Started on Vanco,levo, and flagyl. Placed on bedrest. wound care
began.
[**2154-1-9**] u/s of carotids rt. ICA 40-50%, left ICA 60-69%. Graft
duplex : occluded graft. Rt. sfa and tibial disease with severe
forefoot decreased flow.Angiogram: severe bilateral femoral
-tibial disease.
[**2154-1-11**] Rt. BKA
[**2154-1-14**] POD# 5/DOS left sfa-pt bpg with issvg and lefeet SFA
endarectomy, angioscopy. Patient tolerated the procedure and
tranasfered to PACU extubated.Urinary output borderline. Fluid
bolus prn.Transfused for HCT. 28.2
[**2154-1-15**] POD# [**7-3**] no overnight events.afebrile. dieta advanced.
IV fluids heplocked.
[**2154-1-17**] POD# [**8-3**] afebril wounds clean dry and intact. graft
pulse palpabale with palpable pedal pulses. PT  evaluated
patient. recommend rehabilitation. PICCline placed for continued
antibiotics for  two weeks.Social service consult for emotional
support.[**2154-1-18**] POD# [**9-4**] Patient is doing well and ready for
rehab.  He is full weight bearing.

Medications on Admission:
detrol 2mgm [**Hospital1 **]
amidarone 200mgm qd
cozaar 50mgm qd
lasix 40mgm qd
glipazide 10mgm qd
lipitor 10mgm qd
protonix 40mgm qd
KCl 50meq qd
avandia 8mgm qd
colace 100mgm [**Hospital1 **]
lopressor 75mgm [**Hospital1 **]
atrovent MDI puff 2 qid
Emycin 500mgm [**Hospital1 **] x 10 days ([**Date range (1) 17553**])
percocet tab q4h prn

Discharge Medications:
1. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Losartan Potassium 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Glipizide 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

6. Rosiglitazone Maleate 8 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. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
9. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
11. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 2 weeks.
12. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 2 weeks.
13. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
14. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
16. Vancomycin HCl 1,000 mg Recon Soln Sig: One (1) gm
Intravenous  twice a day for 2 weeks.
17. Heparin Flush CVL  (100 units/ml) 1 ml IV DAILY:PRN
10ml NS followed by 1ml of 100 units/ml heparin (100 units
heparin) each lumen QD and PRN.  Inspect site every shift
18. Insulin Reg (Human) Buffered 100 unit/mL Solution Sig: as
directed  Injection four times a day: AC:
glucoses <150/no insulin
glucoses 151-200/2u
glucoses 201-250/4u
glucoses 251-300/6u
glucoses 301-350/8u
glucoses 351-400/10u
glucoses > 400 / 12u.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Health of [**Hospital3 **] - [**Location (un) 32944**]

Discharge Diagnosis:
bilateral foot infection
history of seizure disorder
hypertension
asthma/COPD
left hip avascular necrosis s/p hip arthroplasty [**2128**],revision
[**2144**]
history peptic ulcer disease, asymptomatic
diabetes type 2 with nocturnal hypoglycemia
coronary artery diseased
gout
history of PVD s/p rt, fem-dp with composite vein [**10-6**]



Discharge Condition:
stable

Discharge Instructions:
moniter CBC, Bun, Cr weekly while on Vancomycin

Followup Instructions:
2 weeks Dr. [**Last Name (STitle) 1391**]. call for appoointment [**Telephone/Fax (1) 1393**]



Completed by:[**2154-1-18**]

Name:  [**Known lastname 7186**],[**Known firstname 7187**]                  Unit No:   [**Numeric Identifier 7188**]

Admission Date:  [**2154-1-8**]              Discharge Date:   [**2154-1-19**]

Date of Birth:  [**2067-6-7**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 231**]
Addendum:
[**1-18**] Podiatry performed an osteotomy on Left second toe.  There
were no complications.  Patient still ready for rehab.

swab from [**1-17**] still reporting: gram + cocci to ID or
sensitivities

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 6463**] Health of [**Hospital3 7189**] - [**Location (un) 7190**]

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern1) 237**] MD [**MD Number(1) 238**]

Completed by:[**2154-1-19**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Arterial embolism and thrombosis of lower extremity,Atrial flutter,Other convulsions,Chronic obstructive asthma, unspecified,Ulcer of other part of foot,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Other bone involvement in diseases classified elsewhere,Chronic osteomyelitis, ankle and foot,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of peptic ulcer 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: Bilateral foot ulcers

PRESENT ILLNESS: 86y/o male with histroy of PVD s/p rt. fem-DP bypass graft with
composite SVG
for rt. foot ulcer [**10-6**]
 Returned for right calf wound infection s/p primary closure d/c
[**11-5**]
 returns now  with persistant right foot wound and new left #2
toe tip wound which probes to bone.Denies any constutional
symptoms.Now admitted for evaluatiion and treatment.

MEDICAL HISTORY: seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH

MEDICATION ON ADMISSION: detrol 2mgm [**Hospital1 **]
amidarone 200mgm qd
cozaar 50mgm qd
lasix 40mgm qd
glipazide 10mgm qd
lipitor 10mgm qd
protonix 40mgm qd
KCl 50meq qd
avandia 8mgm qd
colace 100mgm [**Hospital1 **]
lopressor 75mgm [**Hospital1 **]
atrovent MDI puff 2 qid
Emycin 500mgm [**Hospital1 **] x 10 days ([**Date range (1) 17553**])
percocet tab q4h prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 97.5-56-20 138/68
HEENT:rt. carotid bruit. carotid pulses palpable 1+ no JVD
Lungs: L > chest A/P diameter with expiratory wheezes
LT.>Rt.Ronchros rt. air way sounds
Heart: distant ? irregular. no mumur or gallop
ABD: protrubrent, soft, nontender active bowel sounds. no
abdominal bruits.
PV: right foot: lateral foot wouond 2x3cm with clean base with
tendon exposed . no excudates. Left #2 toe tip wound probes
tobone. no erythema,excudate, excudaates
pulses: right femoral 2+ palpable,absent popliteal pulses
bilaterally,rt. DP absent. Rt. Pt  dopperable. Left pedal pulses
dopperable. graft pulse palpable.
Neuro: orient x3. grossly intact

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired single. Lives in a trailer home. Has not been home since
[**10-6**]
habits former [**Month/Year (2) 1818**] d/c x 19 yrs
ETOH; d/c'd x 19 years 

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Arterial embolism and thrombosis of lower extremity,Atrial flutter,Other convulsions,Chronic obstructive asthma, unspecified,Ulcer of other part of foot,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Other bone involvement in diseases classified elsewhere,Chronic osteomyelitis, ankle and foot,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of peptic ulcer disease'}
