CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: Mr. [**Known lastname 97372**] is a 72 y.o. M with CAD s/p CABG in [**2144**], CHF (EF
20% in [**2157**]), and complete heart back, pacer dependent, who
presents to ED for RLE wound evaluation.  The patient was
recently admitted to the Vascular Surgery service from [**6-5**] for RLE pain x 1 day and difficulty ambulating.  He
was diagnosed with compartment syndrome and on [**6-6**] had a R leg
3-compartment fasciotumy.  Post-operatively, he was extubated
and transferred to the CVICU.  On [**6-8**], he had a wound vac
placement. His CKs trended from [**Numeric Identifier 35553**] to 2291.  His RLE
improved.  His hospitalization was complicated by significant
hematuria for which urology was consulted. He was discharged
with CBI with plans to remove at rehab if UOP clears.
Additionally, he had an episode of acute on chronic systolic
dysfunction and responded to lasix IV.  He was transferred to
VICU for further monitoring, and then to the medical floor where
he progressed with mobility.  He was discharged to a
rehabilitation facility.

MEDICAL HISTORY: -coronary artery disease
-EF 20%
-complete heart block, pacer dependent
-diabetes mellitus type 2
-obstructive sleep apnea on CPAP
-history of syncope
-hypertension
-benign prostatic hypertrophy
-peripheral vascular disease
-hiatal hernia
-Meniere's disease
-psoriasis
-cervical and lumbar spinal stenosis
-GERD
-right eye blindness

MEDICATION ON ADMISSION: Pioglitazone 15 mg po daily
Fluticasone-Salmeterol 250-50 mcg 2 puffs INH [**Hospital1 **] prn SOB/wheeze
ASA 325 mg po daily
Carvedilol 12.5 mg po BID
CPAP 13 50 cc EERS, 2 L Oxygen
Valsartan 40 mg po daily
Atorvastatin 40 mg po daily
Albuterol Sulfate 90 mcg 2 puffs inhaled prn SOB or wheezing
Gemfibrozil 600 mg po BID
Glyburide 10 mg po BID
Nasonex 50 mcg 1 inhaled intranasal [**Hospital1 **]
Tamsulosin SR 0.4 mg po qhs
Ranitidine 150 mg po daily
Colace 100 mg po BID (liquid)
Senna 8.6 mg po BID prn constipation
Percocet 300-30 1-2 tablets po q4 hours prn pain
Oxybutynin Chloride 5 mg po TID
Lovenox
Metformin 500 mg po QID (8 AM, Noon, 4 PM, [**2152**])
Lasix 20 mg po daily

ALLERGIES: Procardia / Benadryl

PHYSICAL EXAM: VITAL SIGNS: T 96.9  BP 109/66  HR 76  RR 12  98% on 2 L NC -->
92% on RA
GEN: pleasant obese male lying in bed in NAD
HEENT: anicteric, EOMI, PERRL, OP - MMM, no exudate, no
erythema; no cervical LAD
CHEST:
CV: RRR, nl S1, S2, no m/r/g
ABD: obese, soft,
EXT: no c/c/e, RLE with scattered red macules/[**Last Name (un) 97373**], 1+ DP
bilaterally, able to move feet and wiggle toes.
NEURO: A&O x 3, CN II-XII grossly intact, [**5-5**] grip strength
bilaterally
DERM: two fasciotomy openings on RLE on either side of calf with
dressing completely saturated with blood.  Exterior fascioutomy
wound with bleeding from bottom of wound.

FAMILY HISTORY: No family history of cardiac disease

SOCIAL HISTORY: Lives alone-presents from rehabilitation, widowed, Tobacco -
quit cigars 30 yrs ago, No eTOH, no illicits
Hypotension, unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute on chronic systolic heart failure,Hematuria, unspecified,Injury to bladder and urethra, without mention of open wound into cavity,Atrioventricular block, complete,Automatic implantable cardiac defibrillator in situ,Hyposmolality and/or hyponatremia,Obstructive sleep apnea (adult)(pediatric),Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Hypotension NOS,Hemorrhage complic proc,Ac posthemorrhag anemia,Ac on chr syst hrt fail,Hematuria NOS,Bladder/urethra inj-clos,Atriovent block complete,Status autm crd dfbrltr,Hyposmolality,Obstructive sleep apnea,Athscl extrm ntv art NOS,Hypertension NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2161-6-13**]              Discharge Date:   [**2161-6-16**]

Date of Birth:  [**2088-11-10**]             Sex:   M

Service: MEDICINE

Allergies:
Procardia / Benadryl

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Hypotension

Major Surgical or Invasive Procedure:
Right lower extremity wound vac change [**2161-6-16**].


History of Present Illness:
Mr. [**Known lastname 97372**] is a 72 y.o. M with CAD s/p CABG in [**2144**], CHF (EF
20% in [**2157**]), and complete heart back, pacer dependent, who
presents to ED for RLE wound evaluation.  The patient was
recently admitted to the Vascular Surgery service from [**6-5**] for RLE pain x 1 day and difficulty ambulating.  He
was diagnosed with compartment syndrome and on [**6-6**] had a R leg
3-compartment fasciotumy.  Post-operatively, he was extubated
and transferred to the CVICU.  On [**6-8**], he had a wound vac
placement. His CKs trended from [**Numeric Identifier 35553**] to 2291.  His RLE
improved.  His hospitalization was complicated by significant
hematuria for which urology was consulted. He was discharged
with CBI with plans to remove at rehab if UOP clears.
Additionally, he had an episode of acute on chronic systolic
dysfunction and responded to lasix IV.  He was transferred to
VICU for further monitoring, and then to the medical floor where
he progressed with mobility.  He was discharged to a
rehabilitation facility.

The patient was sent from [**Hospital 100**] Rehab after medical staff noted
[**Hospital 100**] Rehab. This started overnight prior to admission.  [**Name8 (MD) **]
MD, he needed more frequent dressing changes (2 ABD pads)
overnight due to blood.  Usually, SBP 110-150 but with transfer
to chair, his SBP declined to 70-80s once during [**Hospital 100**] Rehab
stay.  On admission to [**Hospital 100**] Rehab, T 100.4 and cultures
continue to be NGTD with UCx negative.  Plan for hematuria was
to do hand irrigation or CBI once clear UOP.

In the ED, initial VS: T 98.8  HR 88  BP 114/74  RR 16  O2 95%
RA.
Labs and active T&S were drawn, significant for hyponatremia of
129 and stable Hct from discharge of 27.1.  Leukocytosis
trending down from recent hospitalization.  Lactate 1.6.  Blood
cultures x 2 were obtained.  EKG and CXR were obtained.
Vascular surgery was consulted, and they changed the dressing
and removed the vac.  VSurg placed a wet-to-dry dressing and did
not note any oozing from the wound.  The patient was given ASA
325 mg po daily x 1, Vancomycin 1 g IV x 1, Acetaminophen 1 gm
po x 1, and Zosyn 4.5 gm IV x 1.

In the ED, the patient was noted to drop his SBP to 68/45 mostly
while sleeping (per ED), but SBP 97-145s when awake. Rectal
temperature 100.4. 1 L IVFs were given with 2nd liter hanging.
RIJ was placed and confirmed.  Per ED signout, patient with dry
MM. PE without any localizing symptoms.  Pt still with CBI from
rehab.

Currently, the patient does not complain of pain.  He asks for
pain medication if his Foley is to be changed. He did note
feeling lightheaded at [**Hospital 100**] Rehab when he first started
working with PT. He also noted increased bleeding from his RLE
wound overnight.

REVIEW OF SYSTEMS:
(+) subjective fever last night. 2 month cough nonproductive
(-) Denies chills, night sweats, recent weight loss or gain.
Denies shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation.
Denies BRBPR and melena, hematochezia.


Past Medical History:
-coronary artery disease
-EF 20%
-complete heart block, pacer dependent
-diabetes mellitus type 2
-obstructive sleep apnea on CPAP
-history of syncope
-hypertension
-benign prostatic hypertrophy
-peripheral vascular disease
-hiatal hernia
-Meniere's disease
-psoriasis
-cervical and lumbar spinal stenosis
-GERD
-right eye blindness

Surgical History
-CABGx3 '[**44**] (LGSV)
-pacemaker and ICD '[**54**]
-laminectomy of the cervical and lumbar spine


Social History:
Lives alone-presents from rehabilitation, widowed, Tobacco -
quit cigars 30 yrs ago, No eTOH, no illicits


Family History:
No family history of cardiac disease

Physical Exam:
VITAL SIGNS: T 96.9  BP 109/66  HR 76  RR 12  98% on 2 L NC -->
92% on RA
GEN: pleasant obese male lying in bed in NAD
HEENT: anicteric, EOMI, PERRL, OP - MMM, no exudate, no
erythema; no cervical LAD
CHEST:
CV: RRR, nl S1, S2, no m/r/g
ABD: obese, soft,
EXT: no c/c/e, RLE with scattered red macules/[**Last Name (un) 97373**], 1+ DP
bilaterally, able to move feet and wiggle toes.
NEURO: A&O x 3, CN II-XII grossly intact, [**5-5**] grip strength
bilaterally
DERM: two fasciotomy openings on RLE on either side of calf with
dressing completely saturated with blood.  Exterior fascioutomy
wound with bleeding from bottom of wound.


Pertinent Results:
ADMISSION LABS:
.
[**2161-6-13**] 11:20AM   WBC-11.1* RBC-3.13* HGB-9.6* HCT-27.1* MCV-87
MCH-30.7 MCHC-35.4* RDW-13.5
[**2161-6-13**] 11:20AM   NEUTS-79.1* LYMPHS-13.3* MONOS-5.2 EOS-2.0
BASOS-0.4
[**2161-6-13**] 11:20AM   PLT COUNT-618*#
[**2161-6-13**] 11:20AM   PT-17.8* PTT-34.9 INR(PT)-1.6*
[**2161-6-13**] 11:27AM   LACTATE-1.6
[**2161-6-13**] 11:20AM   GLUCOSE-148* UREA N-30* CREAT-0.9 SODIUM-129*
POTASSIUM-4.1 CHLORIDE-96 TOTAL CO2-22 ANION GAP-15
[**2161-6-13**] 01:50PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG
KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
[**2161-6-13**] 01:50PM URINE  RBC-21-50* WBC-0-2 BACTERIA-OCC
YEAST-NONE EPI-0
.
.
PERTINENT LABS/STUDIES:
Hct: 27.1 -> 24.9 -> 23.7 -> 22.8 -> (transfused 2 Units) 26.8
-> 29.1
WBC: 11.1 -> 8.9 -> 9.1 -> 11.9
Reticulocyte Ct: 3.3%
Na: 129 -> 131 -> 132 -> 136 -> 139
Blood cultures: Negative
Urine Culture: Negative
.
CT Abdomen/Pelvis: No soft tissue hematoma seen. There is mild
dilatation of bilateral renal collecting systems, possibly due
to marked distention of the bladder, which is from instillation
of saline or clamping of the Foley which was requested prior to
CT scan. The non-enhanced bladder otherwise appears
unremarkable. There may be urethral diverticulum. There is
marked prostatic enlargement.  There is flattening of the IVC
when compared to the study of [**2161-6-5**], which can be seen in
hypovolemic states. Clinical correlation is recommended.
Cholelithiasis. Coronary artery disease.

pCXR: There has been interval removal of the right IJ central
line. The AICD/biventricular pacing device is unchanged. Mild
cardiomegaly is unchanged. The enlarged mediastinal and hilar
contours are unchanged. There are low lung volumes bilaterally.
New small left pleural effusion is noted. Old right lateral rib
fractures are again noted.

Right leg ultrasound of fluid collection: 5 cm distal right
lower extremity subcutaneous fluid collection. Diagnostic
considerations include infected fluid collection versus evolving
hematoma. Correlate clinically

Echo ([**6-16**]): The left atrium and right atrium are normal in
cavity size. Left ventricular wall thicknesses and cavity size
are normal. There is mild global left ventricular hypokinesis
(LVEF = 45 %). The right ventricular cavity is mildly dilated
with mild global free wall hypokinesis. The aortic root is
mildly dilated at the sinus level. 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. Trivial
mitral regurgitation is seen. There is mild pulmonary artery
systolic hypertension. Significant pulmonic regurgitation is
seen. There is an anterior space which most likely represents a
fat pad.  Compared with the report of the prior study (images
unavailable for review) of [**2157-9-21**], the left ventricular
cavity is smaller and global systolic function has improved.
Aortic regurgitation is no longer seen and the severity of
mitral regurgitation is reduced.
.
.
DISCHARGE LABS
.
[**2161-6-16**] 12:50PM BLOOD WBC-11.9* RBC-3.32* Hgb-9.9* Hct-29.1*
MCV-88 MCH-29.8 MCHC-34.0 RDW-14.8 Plt Ct-530*
[**2161-6-16**] 12:50PM BLOOD Plt Ct-530*
[**2161-6-16**] 12:50PM BLOOD Glucose-278* UreaN-11 Creat-0.8 Na-135
K-4.3 Cl-101 HCO3-26 AnGap-12

Brief Hospital Course:
1. Hypotension: The patient presented with hypotension to 68/45.
 He was initially treated with vancomycin and Zosyn, but sepsis
no source of infection was found, so the antibiotics were
discontinued.  His MAPs were occasionally low, usually during
sleep--which is likely related to his significantly decreased
systolic function.  It was thought that his hypotension was
secondary to acute blood loss in the setting of lower extremity
wound and hematuria.  He was given 2 Units of PRBCs, and his
hematocrit rose appropriately.  His antihypertensives were held
on this admission, and Lasix was restarted on the day of
discharge.  He was continued on Lovenox as per vascular surgery
(see below).  He had low BP on [**6-14**] which was related to a brisk
post-obstructive diuresis.  He responded to fluid and had no
need for intervention for >24 hours at time of transfer.  Please
restart patient's Valsartan and Carvedilol as his blood pressure
tolerates.

# Hematuria: The patient arrived to the ED on CBI, as he had
been discharged on CBI from the Vascular surgery service.  The
foley was changed at admission for an unclear reason and the
balloon was inflated in his distal urethra. Hematuria resulted
and CBI was continued through this catheter. The patient
complained of lower abdominal pain and CT scan demonstrated the
enlarged bladder. The foley was advanced to the proper position
and CBI was restarted until the hematuria resolved.  The patient
then developed significant post obstructive diuresis (~6L) and
required fluid resuscitation for resulting hypotension.  The
foley catheter is currently in the correct location, and the
patient continues to have good urine output.  Per urology, if
the patient's urine is clear on [**2161-6-17**] (1 day after discharge)
his foley catheter can be removed. If hematuria persists, please
leave in and make an appointment with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] urology ([**Telephone/Fax (1) 14702**].

# RLE wound s/p fasciotomy:  The patient was seen by vascular
surgery team on this admission.  The Vac dressing was replaced
on [**6-16**] and was connected to low suction.  He is to remain on
Lovenox at treatment doses for popliteal aneurysms.  The
patient's Lovenox dose was decreased to 80 [**Hospital1 **], which he will
need to continue until his popliteal surgery on [**6-26**].

# RLE fluid collection: The patient was found to have a fluid
collection distal to his popliteal aneurysm.  The the vascular
surgery team, the fluid collection is consistent with a
hematoma.  The site was outlined, and the lesion did not change
in appearance during this admission.

# Hyponatremia: The patient was found to have hyponatremia on
admission.   This improved with hydration, and it is thought
that this was secondary to hypovolemic hyponatremia.

# Systolic CHF:  The patient has a history of systolic CHF, with
EF 20% in [**2157**].  He had a repeat TTE on this admission, which
demonstrated an increase in his EF to 40%.  The patient was
restarted on his home dose of Lasix on [**6-16**].  Please restart his
home dose of Carvedilol and Valsartan as his blood pressure
tolerates.

# BPH: The patient has a history of BPH, for which he takes
Oxybutynin and Tamsulosin.  He was continued on these
medications, and his hospital course was complicated by foley
trauma, as described above.
.
# CAD: The patient has a history of CAD, for which he takes ASA,
Carvedilol, Gemfibrozil and Atorvastatin.  His ASA was initially
held on this admission, in the setting of his acute bleed.
However, this was restarted prior to discharge as the patient's
hematocrit remained stable.  Please restart home dose of
Carvedilol and Valsartan as blood pressure tolerates.
.
# Hypertension:  As above, the patient was restarted on his home
dose of Lasix.  His Carvedilol and Valsartan were held in the
setting of hypotension.  Please restart these medications as
tolerated.
.
# Type 2 Diabetes:  The patient was continued on a Humalog
insulin sliding scale on this admission.  He was restarted on
his home oral hypoglycemics on discharge.  Please continue to
check the patient's blood sugar daily.

# Obstructive Sleep Apnea:  The patient has a history of OSA,
for which he uses CPAP 13 50 cc EERS, 2 L Oxygen. He did not
tolerate this in the ICU.  Please continue to use, as tolerated,
at rehab.

CODE STATUS: FULL (confirmed with patient)

Medications on Admission:
Pioglitazone 15 mg po daily
Fluticasone-Salmeterol 250-50 mcg 2 puffs INH [**Hospital1 **] prn SOB/wheeze
ASA 325 mg po daily
Carvedilol 12.5 mg po BID
CPAP 13 50 cc EERS, 2 L Oxygen
Valsartan 40 mg po daily
Atorvastatin 40 mg po daily
Albuterol Sulfate 90 mcg 2 puffs inhaled prn SOB or wheezing
Gemfibrozil 600 mg po BID
Glyburide 10 mg po BID
Nasonex 50 mcg 1 inhaled intranasal [**Hospital1 **]
Tamsulosin SR 0.4 mg po qhs
Ranitidine 150 mg po daily
Colace 100 mg po BID (liquid)
Senna 8.6 mg po BID prn constipation
Percocet 300-30 1-2 tablets po q4 hours prn pain
Oxybutynin Chloride 5 mg po TID
Lovenox
Metformin 500 mg po QID (8 AM, Noon, 4 PM, [**2152**])
Lasix 20 mg po daily

Discharge Medications:
1. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO once a day.

2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation every six (6) hours as needed for
shortness of breath or wheezing.
6. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
7. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO twice a day.
8. Nasonex 50 mcg/Actuation Spray, Non-Aerosol Sig: One (1)
spray Nasal twice a day.
9. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2
times a day).
12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every four (4) hours as needed for pain.
14. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
15. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours).
16. Metformin 500 mg Tablet Sig: One (1) Tablet PO four times a
day: Please administer at 0800, 1200, 1600, [**2152**].
17. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
18. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Primary:
Hypotension
Hematuria

Secondary:
Systolic Congestive Heart Failure
Right lower extremity wound s/p fasciotomy


Discharge Condition:
Good.  The patient's VS are stable, and he is no longer
hypotensive.


Discharge Instructions:
You were admitted to the hospital because your blood pressure
was very low.  While you were here, we initially treated you
with antibiotics, because we believed you had a blood infection.
 However, we did not find a source for your infection and thus
believe that your low blood pressure was caused by bleeding from
your lower extremity.  We gave you two units of blood, and your
blood pressure increased back to normal levels.  While you were
here, we also did a repeat ultrasound of your heart, which
showed that your heart is functioning better than it was in
[**2157**].  You were seen by vascular surgery during this
hospitalization, and they changed the bandage on your wound this
morning.  You also had some blood in your urine which resolved
on adjustment of your foley catheter. Your urine has cleared and
if your urine continues to be clear tomorrow (1 day after
discharge, [**2161-6-17**]), your foley catheter can be removed.

While you were here, we made the following changes to your
medications:
1.  We CHANGED your Advair dose to one puff twice daily
2.  We HELD your Carvedilol and Valsartan, given your low blood
pressure.  Please restart these medications as your blood
pressure tolerates.
3.  We DECREASED your Lovenox dose to 80 mg [**Hospital1 **].

Please take all medications as prescribed.

Please keep all previously scheduled appointments.

Please return to the ED or your healthcare provider if you
experience increased bleeding from your lower extremity surgical
site, dizziness, syncope, confusion, shortness of breath, chest
pain, fevers, chills, or any other concerning symptoms.  Please
weigh yourself every morning, and call your doctor if you weight
increases by more than 3 lbs.  Please adhere to a low sodium (<
2g/day) diet.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2161-7-2**] 2:00

Provider: [**Name10 (NameIs) 1571**] FUNCTION LAB Phone:[**Telephone/Fax (1) 609**]
Date/Time:[**2161-7-15**] 10:10

Provider: [**Name10 (NameIs) 1570**],INTERPRET W/LAB NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION
BILLING Date/Time:[**2161-7-15**] 10:30

Provider: [**Name10 (NameIs) 1111**], [**Name11 (NameIs) 1112**].  Date/Time: [**2161-6-26**]. Phone: ([**Telephone/Fax (1) 16580**].  This appointment is for endovascular repair of
popliteal aneurysms.

If hematuria persists or for any urologic problems as needed,
please make an appointment with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] urology ([**Telephone/Fax (1) 14702**]



Completed by:[**2161-6-16**]
{'Hypotension, unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute on chronic systolic heart failure,Hematuria, unspecified,Injury to bladder and urethra, without mention of open wound into cavity,Atrioventricular block, complete,Automatic implantable cardiac defibrillator in situ,Hyposmolality and/or hyponatremia,Obstructive sleep apnea (adult)(pediatric),Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: Mr. [**Known lastname 97372**] is a 72 y.o. M with CAD s/p CABG in [**2144**], CHF (EF
20% in [**2157**]), and complete heart back, pacer dependent, who
presents to ED for RLE wound evaluation.  The patient was
recently admitted to the Vascular Surgery service from [**6-5**] for RLE pain x 1 day and difficulty ambulating.  He
was diagnosed with compartment syndrome and on [**6-6**] had a R leg
3-compartment fasciotumy.  Post-operatively, he was extubated
and transferred to the CVICU.  On [**6-8**], he had a wound vac
placement. His CKs trended from [**Numeric Identifier 35553**] to 2291.  His RLE
improved.  His hospitalization was complicated by significant
hematuria for which urology was consulted. He was discharged
with CBI with plans to remove at rehab if UOP clears.
Additionally, he had an episode of acute on chronic systolic
dysfunction and responded to lasix IV.  He was transferred to
VICU for further monitoring, and then to the medical floor where
he progressed with mobility.  He was discharged to a
rehabilitation facility.

MEDICAL HISTORY: -coronary artery disease
-EF 20%
-complete heart block, pacer dependent
-diabetes mellitus type 2
-obstructive sleep apnea on CPAP
-history of syncope
-hypertension
-benign prostatic hypertrophy
-peripheral vascular disease
-hiatal hernia
-Meniere's disease
-psoriasis
-cervical and lumbar spinal stenosis
-GERD
-right eye blindness

MEDICATION ON ADMISSION: Pioglitazone 15 mg po daily
Fluticasone-Salmeterol 250-50 mcg 2 puffs INH [**Hospital1 **] prn SOB/wheeze
ASA 325 mg po daily
Carvedilol 12.5 mg po BID
CPAP 13 50 cc EERS, 2 L Oxygen
Valsartan 40 mg po daily
Atorvastatin 40 mg po daily
Albuterol Sulfate 90 mcg 2 puffs inhaled prn SOB or wheezing
Gemfibrozil 600 mg po BID
Glyburide 10 mg po BID
Nasonex 50 mcg 1 inhaled intranasal [**Hospital1 **]
Tamsulosin SR 0.4 mg po qhs
Ranitidine 150 mg po daily
Colace 100 mg po BID (liquid)
Senna 8.6 mg po BID prn constipation
Percocet 300-30 1-2 tablets po q4 hours prn pain
Oxybutynin Chloride 5 mg po TID
Lovenox
Metformin 500 mg po QID (8 AM, Noon, 4 PM, [**2152**])
Lasix 20 mg po daily

ALLERGIES: Procardia / Benadryl

PHYSICAL EXAM: VITAL SIGNS: T 96.9  BP 109/66  HR 76  RR 12  98% on 2 L NC -->
92% on RA
GEN: pleasant obese male lying in bed in NAD
HEENT: anicteric, EOMI, PERRL, OP - MMM, no exudate, no
erythema; no cervical LAD
CHEST:
CV: RRR, nl S1, S2, no m/r/g
ABD: obese, soft,
EXT: no c/c/e, RLE with scattered red macules/[**Last Name (un) 97373**], 1+ DP
bilaterally, able to move feet and wiggle toes.
NEURO: A&O x 3, CN II-XII grossly intact, [**5-5**] grip strength
bilaterally
DERM: two fasciotomy openings on RLE on either side of calf with
dressing completely saturated with blood.  Exterior fascioutomy
wound with bleeding from bottom of wound.

FAMILY HISTORY: No family history of cardiac disease

SOCIAL HISTORY: Lives alone-presents from rehabilitation, widowed, Tobacco -
quit cigars 30 yrs ago, No eTOH, no illicits 

### Response:
{'Hypotension, unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute on chronic systolic heart failure,Hematuria, unspecified,Injury to bladder and urethra, without mention of open wound into cavity,Atrioventricular block, complete,Automatic implantable cardiac defibrillator in situ,Hyposmolality and/or hyponatremia,Obstructive sleep apnea (adult)(pediatric),Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
