CHIEF COMPLAINT: Mds/AML s/p  driver MVC

PRESENT ILLNESS: Mr. [**Known lastname 1313**] is a 64-year-old gentleman with a history of
myelodysplastic syndrome presenting in [**2149-5-3**] with
pancytopenia, initially managed with danazol and Aranesp and
supportive care with transfusions.  An attempt was made to find
a
bone marrow donor but was unsuccessful, and he was treated with
5-azacitidine in [**2149-9-3**]. He initially responded to
treatment with a stable platelet count and HCt.  He had
progression despite
this and transformed to acute leukemia over the summer of [**2150**].

MEDICAL HISTORY: 1. MDS as described above.
2. Gout.
3. Rotator cuff injury.
4. Hypertension.
5. Essential tremor.
6. Depression.

MEDICATION ON ADMISSION: Primidone, Protonix, Levaquin, prednisone, Celexa,
acyclovir, allopurinol, Valtrex, and Epogen in clinic.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.2, 133/77, 104, 24, 96% on 3L NC
Gen: Fatigued white male lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, petechiae on the hard palate
Lungs: Inspiratory crackles at the bases R>L, tender back at ~
t6 L>R
CV: Tachycardic, -M/R/G
Abd: mildly distended, tender w/ light percussion greatest in
the LUQ, - rebound
Ext: -C/C, 2+ peripheral edema in both LE
Neuro:  CN 2-12 intact grossly, strength 5/5 bilaterally

FAMILY HISTORY: Mother had MI at age 40.
Father died at age 89 with "slow growing leg cancer."

SOCIAL HISTORY: He works for the railroad as a conductor.  He lives alone and
denies alcohol or tobacco use.
Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute myeloid leukemia, without mention of having achieved remission,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acquired coagulation factor deficiency,Paralytic ileus,Acute pericarditis, unspecified,Contusion of abdominal wall,Unspecified essential hypertension
Peritoneum injury-closed,Fx lumbar vertebra-close,Ac myl leuk wo achv rmsn,Mv collision NOS-driver,Acute respiratry failure,Ac kidny fail, tubr necr,Ac posthemorrhag anemia,Pleural effusion NOS,Acq coagul factor defic,Paralytic ileus,Acute pericarditis NOS,Contusion abdominal wall,Hypertension NOS
Admission Date:  [**2150-11-5**]              Discharge Date:   [**2150-11-19**]

Date of Birth:  [**2086-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6169**]
Chief Complaint:
Mds/AML s/p  driver MVC

Major Surgical or Invasive Procedure:
1.  PRBC multiple units
2.  Fresh frozen plasma x multiple units
3. Platelet transfusion x multiple units

History of Present Illness:
Mr. [**Known lastname 1313**] is a 64-year-old gentleman with a history of
myelodysplastic syndrome presenting in [**2149-5-3**] with
pancytopenia, initially managed with danazol and Aranesp and
supportive care with transfusions.  An attempt was made to find
a
bone marrow donor but was unsuccessful, and he was treated with
5-azacitidine in [**2149-9-3**]. He initially responded to
treatment with a stable platelet count and HCt.  He had
progression despite
this and transformed to acute leukemia over the summer of [**2150**].


His recent course has been complicated by multiple admissions
for
febrile neutropenia with the development of pulmonary
infiltrates.  He was recently discharged from the hospital on
[**2150-9-16**], on a course of voriconazole.  He was
readmitted on [**2150-10-9**], for febrile neutropenia with
bilateral pulmonary infiltrates.  He was treated with multiple
antibiotics including AmBisome, voriconazole, Levaquin, and
meropenem.  Over the course of the extended admission, a lung
biopsy was performed and was negative for fungal or viral
etiologies.  He ultimately defervesced and was discharged on a
10-day course of voriconazole and 10-day course of Levaquin.  He
had a recurrent fever on [**2150-10-28**], and was started on
ceftriaxone.  His cultures have remained without growth to date,
and his chest x-ray at the time was unremarkable.
.
On his way into clinic on [**11-5**], he had a motor vehicle accident
without deployment of his airbags.  He was evaluated by the
trauma service and was now being admitted to their service for
further management of L3 vertebral fracture and a venous
retroperitoneal bleed.  He was managed conservatively w/
transfusions prn for his cytopenia, pain control, and monitoring
of his retroperitoneal bleed.


Past Medical History:
1. MDS as described above.
2. Gout.
3. Rotator cuff injury.
4. Hypertension.
5. Essential tremor.
6. Depression.


Social History:
He works for the railroad as a conductor.  He lives alone and
denies alcohol or tobacco use.


Family History:
Mother had MI at age 40.
Father died at age 89 with "slow growing leg cancer."

Physical Exam:
99.2, 133/77, 104, 24, 96% on 3L NC
Gen: Fatigued white male lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, petechiae on the hard palate
Lungs: Inspiratory crackles at the bases R>L, tender back at ~
t6 L>R
CV: Tachycardic, -M/R/G
Abd: mildly distended, tender w/ light percussion greatest in
the LUQ, - rebound
Ext: -C/C, 2+ peripheral edema in both LE
Neuro:  CN 2-12 intact grossly, strength 5/5 bilaterally

Pertinent Results:
[**2150-11-9**] 05:24AM BLOOD WBC-1.6* RBC-3.66* Hgb-11.4* Hct-31.4*
MCV-86 MCH-31.1 MCHC-36.3* RDW-14.0 Plt Ct-32*
[**2150-11-8**] 02:53AM BLOOD WBC-1.4* RBC-3.40* Hgb-10.4* Hct-29.7*
MCV-87 MCH-30.6 MCHC-35.1* RDW-13.9 Plt Ct-55*
[**2150-11-7**] 08:09AM BLOOD WBC-1.6* RBC-3.46* Hgb-10.7* Hct-29.9*
MCV-86 MCH-31.0 MCHC-36.0* RDW-13.9 Plt Ct-48*
[**2150-11-6**] 01:55PM BLOOD WBC-2.0* RBC-3.41* Hgb-10.6* Hct-29.1*
MCV-85 MCH-31.0 MCHC-36.3* RDW-14.1 Plt Ct-75*#
[**2150-11-4**] 02:00PM BLOOD WBC-1.6* RBC-3.28* Hgb-9.7* Hct-28.3*
MCV-86 MCH-29.7 MCHC-34.4 RDW-15.9* Plt Ct-22*
[**2150-11-5**] 01:00PM BLOOD Neuts-12* Bands-0 Lymphs-40 Monos-8 Eos-0
Baso-0 Atyps-1* Metas-0 Myelos-0 Blasts-39*
[**2150-11-4**] 02:00PM BLOOD Neuts-16* Bands-4 Lymphs-28 Monos-0 Eos-0
Baso-0 Atyps-4* Metas-4* Myelos-0 Blasts-44*
[**2150-11-9**] 05:24AM BLOOD Plt Ct-32*
[**2150-11-9**] 05:24AM BLOOD PT-15.3* PTT-27.6 INR(PT)-1.6
[**2150-11-8**] 02:39PM BLOOD Plt Ct-44*
[**2150-11-8**] 02:39PM BLOOD PT-16.3* PTT-26.0 INR(PT)-1.8
[**2150-11-8**] 02:53AM BLOOD Plt Ct-55*
[**2150-11-7**] 08:38PM BLOOD Plt Ct-61*
[**2150-11-6**] 01:55PM BLOOD PT-14.8* PTT-27.5 INR(PT)-1.5
[**2150-11-6**] 10:48AM BLOOD PT-14.9* PTT-28.0 INR(PT)-1.5
[**2150-11-6**] 05:49AM BLOOD Plt Ct-56*
[**2150-11-6**] 01:43AM BLOOD Plt Ct-62*
[**2150-11-6**] 01:39AM BLOOD PT-15.3* PTT-25.2 INR(PT)-1.6
[**2150-11-4**] 02:00PM BLOOD Plt Ct-22*
[**2150-11-6**] 10:48AM BLOOD Fibrino-227
[**2150-11-9**] 05:24AM BLOOD Glucose-116* UreaN-23* Creat-1.0 Na-136
K-3.9 Cl-98 HCO3-25 AnGap-17
[**2150-11-5**] 01:00PM BLOOD Glucose-210* UreaN-23* Creat-1.1 Na-135
K-4.1 Cl-100 HCO3-24 AnGap-15
[**2150-11-9**] 05:24AM BLOOD Calcium-9.5 Phos-2.9 Mg-1.8

Brief Hospital Course:
A/P: A 64-year-old gentleman with MDS which recently transformed
to acute leukemia who presented after a motor vehicle accident.
He was cared for on the surgical service where he received
transfusions prn and his pain was controlled.  No surgical
intervention was attempted for his L3 fracture.  He was
transfered to the [**Month/Day/Year 3242**] service after concerns that his MDS was
his primary process.  On the floor, his MDS was treated w/
transfusions prn.  He continued to be neutropenic and was kept
on voriconazole/cefepime/levo for his lung process.  His was
cultured but none of his cultures ever revealed a source of
infection.  He was severely edematous when transfered from the
surgical service, developed renal failure, presumably secondary
to the MVA, and this exacerbated his edema.  He developed mild
respiratory distress and became oxygen dependent.  His mental
status deteriorated and this was initially thought to be
secondary to narcotics as he responded briefly to narcan.
However, the mental status depression became more profound and
he became less conversant with family and responsive to
commands.  At this time, although the patient was already
DNR/DNI, code status was readdressed with the family.  The son
and daughter together indicated that he would not have wanted to
be made comfortable and the patient's status was changed to CMO.
 He was provided with a morphine drip and administered prn
ativan, amicar, and anzemet.  He expired shortly thereafter.

Medications on Admission:
Primidone, Protonix, Levaquin, prednisone, Celexa,
acyclovir, allopurinol, Valtrex, and Epogen in clinic.


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
1. L3 vertebral body fracture
2. Bilateral pleural effusion
3. Retroperitoneal hematoma
4. Neutropenia
5. Thrombocytopenia
6. Anemia

Discharge Condition:
stable

Discharge Instructions:
none

Followup Instructions:
none


Completed by:[**2150-11-26**]
{'Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute myeloid leukemia, without mention of having achieved remission,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acquired coagulation factor deficiency,Paralytic ileus,Acute pericarditis, unspecified,Contusion of abdominal wall,Unspecified essential hypertension'}


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: Mds/AML s/p  driver MVC

PRESENT ILLNESS: Mr. [**Known lastname 1313**] is a 64-year-old gentleman with a history of
myelodysplastic syndrome presenting in [**2149-5-3**] with
pancytopenia, initially managed with danazol and Aranesp and
supportive care with transfusions.  An attempt was made to find
a
bone marrow donor but was unsuccessful, and he was treated with
5-azacitidine in [**2149-9-3**]. He initially responded to
treatment with a stable platelet count and HCt.  He had
progression despite
this and transformed to acute leukemia over the summer of [**2150**].

MEDICAL HISTORY: 1. MDS as described above.
2. Gout.
3. Rotator cuff injury.
4. Hypertension.
5. Essential tremor.
6. Depression.

MEDICATION ON ADMISSION: Primidone, Protonix, Levaquin, prednisone, Celexa,
acyclovir, allopurinol, Valtrex, and Epogen in clinic.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.2, 133/77, 104, 24, 96% on 3L NC
Gen: Fatigued white male lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, petechiae on the hard palate
Lungs: Inspiratory crackles at the bases R>L, tender back at ~
t6 L>R
CV: Tachycardic, -M/R/G
Abd: mildly distended, tender w/ light percussion greatest in
the LUQ, - rebound
Ext: -C/C, 2+ peripheral edema in both LE
Neuro:  CN 2-12 intact grossly, strength 5/5 bilaterally

FAMILY HISTORY: Mother had MI at age 40.
Father died at age 89 with "slow growing leg cancer."

SOCIAL HISTORY: He works for the railroad as a conductor.  He lives alone and
denies alcohol or tobacco use. 

### Response:
{'Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute myeloid leukemia, without mention of having achieved remission,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acquired coagulation factor deficiency,Paralytic ileus,Acute pericarditis, unspecified,Contusion of abdominal wall,Unspecified essential hypertension'}
