CHIEF COMPLAINT: saddle pulmonary embolism

PRESENT ILLNESS: 49 yo male transferred from OSH after being found to have a
saddle PE. He reports that for the last 2 days, he has felt more
dyspneic, even with minimal exertion. He denies any chest pain
or chest tightness. This morning, with minimal exertion, he felt
like he was going to "black out". He denied any syncopal
episodes. He otherwise denied any other symptoms. He presented
to an OSH where a CTA Chest was performed which showed saddle
PE, and he was transferred here for further management.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals - T: 97.7, BP: 107/74, HR: 81, RR: 20, 02 sat: 97% 1 L NC

FAMILY HISTORY: Mother with [**Name2 (NI) **] aneurysm. Father with Hypertension.
Otherwise denies any family history of PE or DVT or other
clotting disorders

SOCIAL HISTORY: Worked previously for [**Company **], now retired. He is
married without any children. He denies tobacco. Very rare ETOH
use. He denies any drug use or h/o IVDU.
Other pulmonary embolism and infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Pulm embol/infarct NEC,DMII wo cmp nt st uncntr
Admission Date:  [**2178-7-26**]              Discharge Date:   [**2178-7-30**]

Date of Birth:  [**2128-8-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4365**]
Chief Complaint:
saddle pulmonary embolism

Major Surgical or Invasive Procedure:
None


History of Present Illness:
49 yo male transferred from OSH after being found to have a
saddle PE. He reports that for the last 2 days, he has felt more
dyspneic, even with minimal exertion. He denies any chest pain
or chest tightness. This morning, with minimal exertion, he felt
like he was going to "black out". He denied any syncopal
episodes. He otherwise denied any other symptoms. He presented
to an OSH where a CTA Chest was performed which showed saddle
PE, and he was transferred here for further management.

In the ED, vitals were normal. He was on a heparin gtt that was
started at the OSH, but PTT was >150 so heparin was decreased to
1750 units. Re-read of his OSH CT confirmed saddle PE. There was
no evidence of hemodynamic compromise while in the ED. His
vitals prior to transfer were 67 113/84 24 97%3L.

Currently, he denies any pain, chest tightness. His dyspnea is
improved currently. Denies nausea, vomiting. He denies any leg
swelling or recent surgery. He had a flight to [**State 33977**] in
[**Month (only) 547**], but otherwise no other recent travel. He reports that at
baseline, he is quite active and has not been immobile for any
reason. He reports that in the past, after air travel, he
usually develops respiratory symptoms similar to a cold or
bronchitis. He is treated with antibiotics.

ROS: Denies fever, chills, night sweats, headache, vision
changes, rhinorrhea, congestion, sore throat, cough, chest pain,
abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR,
melena, hematochezia, dysuria, hematuria.


Past Medical History:
None

Social History:
Worked previously for [**Company **], now retired. He is
married without any children. He denies tobacco. Very rare ETOH
use. He denies any drug use or h/o IVDU.

Family History:
Mother with [**Name2 (NI) **] aneurysm. Father with Hypertension.
Otherwise denies any family history of PE or DVT or other
clotting disorders

Physical Exam:
ADMISSION PHYSICAL EXAM:
Vitals - T: 97.7, BP: 107/74, HR: 81, RR: 20, 02 sat: 97% 1 L NC

GENERAL: WDWN obese male, NAD
HEENT: PERRL, MMM. oropharynx clear. + acanthosis nigricans
CARDIAC: RRR, no M/R/G
LUNG: CTA bilaterally
ABDOMEN: Soft, NT, obese. Normal bowel sounds. Guaiac negative
in ER
EXT: no edema. 2+ DP pulses
NEURO: A/O x 3; moving all extremities without any difficulty.


Pertinent Results:
[**2178-7-26**] 07:10PM BLOOD WBC-13.0* RBC-4.75 Hgb-15.6 Hct-44.6
MCV-94 MCH-32.8* MCHC-34.9 RDW-12.3 Plt Ct-210

[**2178-7-26**] 07:10PM BLOOD Glucose-110* UreaN-12 Creat-1.0 Na-138
K-4.2 Cl-105 HCO3-22 AnGap-15

[**2178-7-30**] 06:35AM BLOOD PT-32.1* PTT-32.2 INR(PT)-3.2*

HgbA1C=5.6

EKG: NSR, rate approx 90. TWI in II, III, aVF and V1-V5. Also
notable for S1,Q3,T3.

CHEST CT OSH: re-read here with saddle PE, no other acute
process. films not available for review in PACS yet.

Brief Hospital Course:
Saddle pulmonary embolus: The patient was transferred to the ICU
and monitored on telemetry. He did not have any hemodynamic
compromise and stayed stable from a respiratory standpoint on
nasal cannula. The patient was immediately started on a heparin
drip. Oral therapy with Coumadin was initiated. Since the
patient remained stable, he was transferred to the general
medicine floors. On the general medicine floors, the patient
remained stable. His heparin was discontinued after his INR was
in the therapeutic range of 2.0-3.0. The day prior to discharge,
the patient had an INR=2.8 and on the day of discharge his
INR=3.2. The patient was educated about Coumadin and advised not
to take a dose on the night of discharge. He will get his INR
checked on the day after discharge.

Acanthosis nigricans: Patient noted to have acanthosis
nigricans. His fasting blood glucose~110 daily. HgbA1c=5.6.

Outpatient follow-up:
1. Workup for coagulopathy
2. INR appointments
3. Regular health maintenance visits

Medications on Admission:
None

Discharge Medications:
1. Coumadin 1 mg Tablet Sig: Four (4) Tablet PO once a day:
Start taking this medication on [**2178-7-31**]. Your dose will be
adjusted by your primary care physician.
[**Name Initial (NameIs) **]:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
1. Pulmonary embolus


Discharge Condition:
Hemodynamically stable. O2 saturation > 97% on room air.
Ambulatory without assistance.


Discharge Instructions:
You came into the hospital because you felt short of breath. You
were found to have a large pulmonary embolus, a blood clot, in
your lungs. You were started on anti-clotting "blood thinners"
therapy with heparin and transitioned to coumadin.
.
You will continue to take coumadin, a blood thinner, when you
leave the hospital. Since coumadin is a blood thinner and has
potential side effects of bleeding, you need to get your blood
monitored on a regular basis. Specifically, doctors need to
[**Name5 (PTitle) 4169**] your INR to reassess your coumadin dose.
.
You should come back to the hospital if you feel short of
breath, have any bleeding, have chest pain, or for any other
symptoms which are concerning to you.

Followup Instructions:
Please go to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 36688**] Hospital in [**Location (un) 5028**] tomorrow morning
- [**2178-7-31**]. You should have bloodwork done and sent to Dr. [**Name (NI) 83350**] office - information is below.

You also have an appointment to Dr. [**Last Name (STitle) **], your primary care
physician, [**Last Name (NamePattern4) **] [**2178-8-3**] at 2:15pm.
Practice name: [**Location (un) 5028**] Family Practice
Address: [**Street Address(2) 83351**], [**Location (un) 5028**], NH
Phone number: [**Telephone/Fax (1) 83352**]

You will need to see your primary care physician every [**Name9 (PRE) 766**],
Wednesday, and Friday to check your coumadin levels.
{'Other pulmonary embolism and infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: saddle pulmonary embolism

PRESENT ILLNESS: 49 yo male transferred from OSH after being found to have a
saddle PE. He reports that for the last 2 days, he has felt more
dyspneic, even with minimal exertion. He denies any chest pain
or chest tightness. This morning, with minimal exertion, he felt
like he was going to "black out". He denied any syncopal
episodes. He otherwise denied any other symptoms. He presented
to an OSH where a CTA Chest was performed which showed saddle
PE, and he was transferred here for further management.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals - T: 97.7, BP: 107/74, HR: 81, RR: 20, 02 sat: 97% 1 L NC

FAMILY HISTORY: Mother with [**Name2 (NI) **] aneurysm. Father with Hypertension.
Otherwise denies any family history of PE or DVT or other
clotting disorders

SOCIAL HISTORY: Worked previously for [**Company **], now retired. He is
married without any children. He denies tobacco. Very rare ETOH
use. He denies any drug use or h/o IVDU. 

### Response:
{'Other pulmonary embolism and infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
