CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old white male
who was initially evaluated by the trauma service on the [**8-25**] after a fall on the commode.  At that time, he was
noted to have multiple rib fractures and a small splenic lac.
He had stable hematocrits in the hospital and was discharged
to rehab on [**8-29**].  He was readmitted on [**9-6**],
brought in via the [**Last Name (un) 4068**] ER, for lethargy and hypotension
into the 80s/50s.  The outside hospital hematocrit was listed
at 15 prior to the 3 units transfused.  He was found to have
a posttransfusion hematocrit of 26, which was down from his
previous of 35.  He was scanned and then transferred here
after being given 3 units of PRBCs and being intubated.

MEDICAL HISTORY: 1. Hypothyroidism.
2. Parkinson's disease.
3. Lower leg elephantiasis.
4. COPD.

MEDICATION ON ADMISSION: 

ALLERGIES: NKDA.

PHYSICAL EXAM: Vital signs - temperature 94.3, blood
pressure initially 121/30, remeasured at 145/57, heart rate
80, sat 100.  The gentleman was intubated and sedated.  He
had a regular rate and clear lungs bilaterally.  He had a
distended and tense abdomen.  He had bilateral right greater
than left lower extremity edema.  This was consistent with
his previous history of especially right-sided elephantiasis.

FAMILY HISTORY: 

SOCIAL HISTORY: No use of tobacco or alcohol.  Nursing home
report indicates alert and oriented at baseline.
Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Paralytic ileus,Accidental fall from commode,Unspecified acquired hypothyroidism,Paralysis agitans,Other lymphedema
Spleen disruption-clos,Chr airway obstruct NEC,Urin tract infection NOS,Paralytic ileus,Fall from commode,Hypothyroidism NOS,Paralysis agitans,Other lymphedema
Admission Date:  [**2107-9-6**]       Discharge Date:  [**2107-9-19**]


Service:  TRAUMA SURGERY

HISTORY OF PRESENT ILLNESS:  This is a [**Age over 90 **]-year-old white male
who was initially evaluated by the trauma service on the [**8-25**] after a fall on the commode.  At that time, he was
noted to have multiple rib fractures and a small splenic lac.
He had stable hematocrits in the hospital and was discharged
to rehab on [**8-29**].  He was readmitted on [**9-6**],
brought in via the [**Last Name (un) 4068**] ER, for lethargy and hypotension
into the 80s/50s.  The outside hospital hematocrit was listed
at 15 prior to the 3 units transfused.  He was found to have
a posttransfusion hematocrit of 26, which was down from his
previous of 35.  He was scanned and then transferred here
after being given 3 units of PRBCs and being intubated.

PAST MEDICAL HISTORY:
1. Hypothyroidism.
2. Parkinson's disease.
3. Lower leg elephantiasis.
4. COPD.

PAST SURGICAL HISTORY:  Left total knee replacement.

HOME MEDICATIONS:
1. Serevent.
2. Advair.
3. Levoxyl.
4. Vicodin.

ALLERGIES:  NKDA.

SOCIAL HISTORY:  No use of tobacco or alcohol.  Nursing home
report indicates alert and oriented at baseline.

INITIAL PHYSICAL EXAM:  Vital signs - temperature 94.3, blood
pressure initially 121/30, remeasured at 145/57, heart rate
80, sat 100.  The gentleman was intubated and sedated.  He
had a regular rate and clear lungs bilaterally.  He had a
distended and tense abdomen.  He had bilateral right greater
than left lower extremity edema.  This was consistent with
his previous history of especially right-sided elephantiasis.

The CT from outside hospital indicated a large amount of
intraperitoneal fluid.  He had a trauma line placed in his
left groin in the trauma bay, and he was taken urgently to
the OR for suspected delayed onset of splenic bleed.

HOSPITAL COURSE:  The gentleman was taken to the operating
room on the [**9-7**] and had an exploratory laparotomy,
during which was noted a large splenic bleed.  He had a
splenectomy at that time.  He had no other internal injuries
noted.  The patient was sent to the Trauma SICU after the
operation.  He had a left subclavian and Swan-Ganz catheter
placed secondary to decreasing urine output and rising
creatinine preoperatively.  Opening pressures were within
normal limits with a wedge of 17-23, CVP 10-16, CCO [**4-30**] with
a CI greater than 3, SVO2 77-83%.  His initial postoperative
crit was 26.1, and he was transfused with an additional 2
units of PRBCs with repeat hematocrit of 34.  He required
calcium repletion, but his other lytes were within normal
limits.

The patient was initially hypothermic on presentation and was
warmed gradually with a bear-hugger.  The patient was
extubated by evening on [**9-7**].  The Swan-Ganz catheter
was removed by [**9-8**], secondary to hemodynamic
stabilization.  He remained afebrile on cefazolin and
Levaquin.  His NG tube was DC'd on [**9-9**], and he was
taking small amounts of clear liquids without nausea or
vomiting in the unit.  He was transferred over to the floor
on [**9-10**].

On the floor, Mr. [**Known lastname **] was noted to have a moderate
amount of abdominal distention with tympany.  He had no
abdominal pain and no nausea.  His incision from the surgery
remained intact with midline staples.  There was also some
serous drainage noted from the site of the left groin Cordis
that had been pulled, but this resolved over the next several
days.  He resolved chest PT q 4 h, as well as physical
therapy to attempt to improve the deconditioning that had
occurred while he was in the hospital.  In addition, his
abdominal exam was closely followed while he was on the
floor.

The patient continued to tolerate POs well; however, he
remained distended.  He reported that he was passing flatus,
but had had no bowel movement in many days.  Dulcolax PR
seemed to have no effect.  A KUB was checked on [**9-12**]
which just showed nonspecific bowel gas pattern with no
evidence of obstruction or perforation.  His amylase was 51,
indicating no sign of pancreatic injury or inflammation.  TSH
was checked to see if inadequate treatment of his
hypothyroidism might be contributing to his ileus, and it
turned out to be 13.  So, his dose of levothyroxine was upped
from 50 mcg po to 75 IV with a plan to recheck a T4 in a
couple of days.  He had a small bowel movement on that day,
the [**9-12**], but still remained quite distended.  His
abdominal exam was closely followed.

His distention did not resolve by the following day, so a PO
and IV contrast abdominal CT was obtained in order to
determine if there was sign of obstruction or abscess.  The
CT from the 21 showed no focally drainable collections, no
findings to suggest bowel obstruction, a small amount of
abdominopelvic ascites consistent with ex-lap, and mild
distention of the gallbladder without any discrete fluid
around it, and with some calculi.  Since there was no
indication or obstruction or abscess, and the patient was
still tolerating POs, it was assumed that this distention and
lack of bowel movements was probably due to ileus.  We
continued a bowel regimen with PO Dulcolax, as well as tid
ambulation to encourage return of bowel function.  A free T4
was checked on the 23 which showed 0.9 at the lower end of
normal, so his levothyroxine was increased to 100 qd.  He was
placed on [**Hospital1 **] lactulose which caused him to have several
large quantity bowel movements, and so the lactulose was
discontinued.

The patient required occasional albuterol nebs in order to
treat some mild expiratory wheezes.  The patient also
required a few doses of lasix 20 mg IV for fluid overload.
Lower extremity and scrotal edema improved with lasix.  His K
was repleted along with diuresis.  The patient was noted to
be very weak and continued to require PT and assist with
ambulation.  Prior to discharge to rehabilitation, he was
given the pneumococcal, meningococcal and H. flu vaccines.

LABS ON ADMISSION:  CBC showed a white count of 17,
hematocrit 26, platelet count 185.  Coags were PT 12.5, PTT
27.9, INR 1.0.  Chem-7 - sodium 136, potassium 4.2, chloride
105, CO2 22, BUN 55, creatinine 2.2, and glucose 126.  His UA
was positive which was why he was placed on Levaquin for 3
days for the urinary tract infection

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To rehabilitation unit.

DIAGNOSIS:  Status post fall with delayed bleed from splenic
laceration, status post exploratory laparotomy with
splenectomy.

DISCHARGE MEDICATIONS:
1. Levothyroxine sodium 100 mcg po qd.
2. Bisacodyl 10 mg po qd prn.
3. Nystatin ointment applied up to qid prn.
4. Famotidine 20 mg po qd.
5. PRN Tylenol
6. Metoprolol 12.5 po bid.
7. Docusate 100 mg po bid.
8. Albuterol nebulizers q 6 h prn.
9. Heparin 5,000 U subcu q 12 h.

FOLLOW-UP in 2 weeks with Trauma Clinic.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 11889**]

Dictated By:[**MD Number(1) 107103**]
MEDQUIST36

D:  [**2107-9-19**]  09:27
T:  [**2107-9-19**]  09:33
JOB#:  [**Job Number 107104**]
{'Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Paralytic ileus,Accidental fall from commode,Unspecified acquired hypothyroidism,Paralysis agitans,Other lymphedema'}


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 [**Age over 90 **]-year-old white male
who was initially evaluated by the trauma service on the [**8-25**] after a fall on the commode.  At that time, he was
noted to have multiple rib fractures and a small splenic lac.
He had stable hematocrits in the hospital and was discharged
to rehab on [**8-29**].  He was readmitted on [**9-6**],
brought in via the [**Last Name (un) 4068**] ER, for lethargy and hypotension
into the 80s/50s.  The outside hospital hematocrit was listed
at 15 prior to the 3 units transfused.  He was found to have
a posttransfusion hematocrit of 26, which was down from his
previous of 35.  He was scanned and then transferred here
after being given 3 units of PRBCs and being intubated.

MEDICAL HISTORY: 1. Hypothyroidism.
2. Parkinson's disease.
3. Lower leg elephantiasis.
4. COPD.

MEDICATION ON ADMISSION: 

ALLERGIES: NKDA.

PHYSICAL EXAM: Vital signs - temperature 94.3, blood
pressure initially 121/30, remeasured at 145/57, heart rate
80, sat 100.  The gentleman was intubated and sedated.  He
had a regular rate and clear lungs bilaterally.  He had a
distended and tense abdomen.  He had bilateral right greater
than left lower extremity edema.  This was consistent with
his previous history of especially right-sided elephantiasis.

FAMILY HISTORY: 

SOCIAL HISTORY: No use of tobacco or alcohol.  Nursing home
report indicates alert and oriented at baseline. 

### Response:
{'Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Paralytic ileus,Accidental fall from commode,Unspecified acquired hypothyroidism,Paralysis agitans,Other lymphedema'}
