CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 80-year-old white
male with a history of hypertension and stroke who presented
to the [**Hospital **] Hospital with complaints of back pain for
three days.  The workup would include an ultrasound of the
abdomen revealing a 10 cm abdominal aortic aneurysm.  The
patient was also noted to be orthostatic and was subsequently
transferred to the [**Hospital1 **] Hospital for further
care for the possibility of a leaking abdominal aortic
aneurysm.

MEDICAL HISTORY: 1. Hypertension.
2. Cerebrovascular accident.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Abdominal aneurysm, ruptured,Subendocardial infarction, initial episode of care,Hemoperitoneum (nontraumatic),Atrial fibrillation,Systolic heart failure, unspecified,Perforation of intestine,Septicemia due to gram-negative organism, unspecified,Acute kidney failure, unspecified
Rupt abd aortic aneurysm,Subendo infarct, initial,Hemoperitoneum,Atrial fibrillation,Systolic hrt failure NOS,Perforation of intestine,Gram-neg septicemia NOS,Acute kidney failure NOS
Admission Date:  [**2113-11-19**]      Discharge Date:  [**2113-12-2**]

Date of Birth:                  Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This is an 80-year-old white
male with a history of hypertension and stroke who presented
to the [**Hospital **] Hospital with complaints of back pain for
three days.  The workup would include an ultrasound of the
abdomen revealing a 10 cm abdominal aortic aneurysm.  The
patient was also noted to be orthostatic and was subsequently
transferred to the [**Hospital1 **] Hospital for further
care for the possibility of a leaking abdominal aortic
aneurysm.

Just prior to transfer, the patient's blood pressure
increased to 180s to 200s, and was treated on nitrodrip and
nitroprusside drip, and Lopressor all of which were quickly
discontinued with his systolic blood pressure decreased
rapidly to the 80s.

On arrival to the [**Hospital3 **] Emergency Room, a systolic was
in the 60s to 70s.  A trauma line was quickly placed left
subclavian and 4 units of packed cells O negative was given
from a level 1 transfuser, 2 liters of crystalloid as well
were instilled in this patient, and his systolic blood
pressure improved to the 130s, but only for a few minutes,
and then his blood pressure again dropped to the 50s and was
rushed to the operating room.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Cerebrovascular accident.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Unknown what his medications were.

PHYSICAL EXAMINATION:  He was mildly distended in his
abdomen, but firm with a pulsatile mass.  His extremities
were cool and clammy.

He was brought to the operating room on [**2113-11-19**] with
the likely diagnosis of ruptured abdominal aortic aneurysm.
In the operating room, they found a ruptured abdominal aortic
aneurysm which was repaired with an aortic bifemoral bypass
graft.  The attending surgeon was Dr. [**Last Name (STitle) 1391**].
Intraoperatively, he was given 7 units of packed cells, 3
units of fresh-frozen plasma, and 2 of platelets.  He had 2.5
units of cell [**Doctor Last Name 10105**] and 9 liters of crystalloid.  He had a 4
liter estimated blood loss and 175 of urine output was
produced.

He was started on antibiotics.  He was on Neo-Synephrine drip
as well as propofol.  He had full vent support and Levophed
was started as well to maintain his systolic blood pressure.
P.A. catheter was placed postoperatively to help with fluid
management.  He was transferred to the Surgical Intensive
Care Unit immediately postoperatively, and he had a
complicated and long Intensive Care Unit course including a
myocardial infarction, atrial fibrillation, acalculous
cholecystitis, status post cholecystostomy drainage tube,
acute renal failure with aneuria, hemodynamic instability,
anemia, electrolyte abnormalities, hypotension, and
hyperalimentation for malnutrition, unable to eat, ventilator
dependence, volume overload requiring Lasix.

Cardiology was following him as well secondary to the atrial
fibrillation in which he had amiodarone drip performed and
transitioned to po.

Patient was extubated on [**Month (only) 359**] of 26th, but reintubated one
hour later because he became in respiratory distress.  He
again failed the weaning trial and had ventilatory dependence
on [**11-27**], but on [**11-29**], he was extubated.
Continuing on his TPN with sips of water and with moderate
thick bilious output from his gallbladder drain to relieve
the gallbladder inflammation.

He also auto anticoagulated himself, an INR rising above 5.
In addition to the anemia, he also had leukopenia as well as
leukocytosis.  Tachycardia went along with his atrial
fibrillation.  On [**Month (only) **] the 1st, he was also noted to be
febrile.  The worsening clinical course including an
increasing distended abdomen, hypotension down to the 70
systolic range, metabolic acidemia, decreasing white count
which was worrisome for sepsis and the origin was thought to
be in his abdomen.

So in discussion with the family, Intensive Care Unit team,
general surgery took this patient to the operating room with
the diagnosis of probably a necrotic left colon.  The
procedure was exploratory laparotomy, left colectomy,
transverse colostomy, drainage of multiple intra-abdominal
abscesses as well as assessing the cholecystostomy tube for
the gallbladder.

At surgery, it was confirmed that he had an open perforation
with stool in his peritoneal cavity.  The gallbladder
appeared viable.  Multiple units of fresh-frozen plasma was
given for his coagulopathy and all the abscesses were
drained.  At the end of the case, he had become anuric, again
intubated, requiring hemodynamic instability on IV
antibiotics requiring pressure support.

Renal consult was obtained suggested a continued TPN and to
continue with volume resuscitation, who felt the oliguria was
secondary to septic shock.  Continued to have respiratory
distress and ventilatory dependence as well as dependence on
total parenteral nutrition on pressors without any signs of
improvement.  Continuing to be coagulopathic and family
discussions with the Surgical Intensive Care Unit and the
Surgical staff took place, and ended up deciding to change
the patient's status to comfort measures only.  The pressors
were weaned off.  Ventilatory support was continued, and he
expired shortly thereafter in the Surgical Intensive Care
Unit.

DISCHARGE DIAGNOSES:
1. Hypertension.
2. Cerebrovascular accident.
3. Atherosclerosis.
4. Ruptured abdominal aortic aneurysm.
5. Status post repair of abdominal aortic aneurysm.
6. Atrial fibrillation.
7. Hypotension.
8. Ventilatory dependence.
9. Anemia.
10. Hypercoagulable state.
11. Leukocytosis followed by leukopenia.
12. Metabolic acidosis.
13. Congestive heart failure.
14. ARDS.
15. Perforated left colon.
16. Cecal peritonitis.
17. Sepsis.
18. Acalculous cholecystitis.
19. Status post percutaneously drained gallbladder with a
cholecystostomy tube.
20. Acute renal failure.
21. Repair of perforated left colon.
22. Incision and drainage of multiple intra-abdominal
abscesses.
23. Left colectomy and transverse colostomy.
24. Hemodynamic instability requiring pressors.
25. Hypoxemia.
26. Tachycardia associated with arrhythmia requiring
amiodarone and intravenous antiarrhythmic.
27. Electrolyte abnormalities.
28. Malnutrition status post total parenteral nutrition.
29. Electrolyte abnormalities that includes hypernatremia.

DISCHARGE STATUS:  Expired.

This gentleman came in under Dr.[**Name (NI) 1392**] service, but was
transferred to Dr.[**Name (NI) 18535**] service under his care on the
General Surgery Service.



                                   [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.

Dictated By:[**Last Name (NamePattern1) 8344**]

MEDQUIST36

D:  [**2114-6-14**]  16:02
T:  [**2114-6-19**]  07:30
JOB#:  [**Job Number 45447**]
{'Abdominal aneurysm, ruptured,Subendocardial infarction, initial episode of care,Hemoperitoneum (nontraumatic),Atrial fibrillation,Systolic heart failure, unspecified,Perforation of intestine,Septicemia due to gram-negative organism, unspecified,Acute kidney failure, 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: This is an 80-year-old white
male with a history of hypertension and stroke who presented
to the [**Hospital **] Hospital with complaints of back pain for
three days.  The workup would include an ultrasound of the
abdomen revealing a 10 cm abdominal aortic aneurysm.  The
patient was also noted to be orthostatic and was subsequently
transferred to the [**Hospital1 **] Hospital for further
care for the possibility of a leaking abdominal aortic
aneurysm.

MEDICAL HISTORY: 1. Hypertension.
2. Cerebrovascular accident.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Abdominal aneurysm, ruptured,Subendocardial infarction, initial episode of care,Hemoperitoneum (nontraumatic),Atrial fibrillation,Systolic heart failure, unspecified,Perforation of intestine,Septicemia due to gram-negative organism, unspecified,Acute kidney failure, unspecified'}
