CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 61 female with h/o HATN, CAD, DM and recently now C6 [**Female First Name (un) **] B
[**Female First Name (un) 39850**] developed s/p C6 discectomy and C7-T1 anterior
cervical discectomy and fusion (ACDF)ACDF. She had a complicated
hospital course and was discharged to [**Hospital1 **] on [**5-29**] and was
there for less than 8 hours. She complained of chest  pain
[**11-16**]. Her trach gauze had also required changing four times
with increased clear secretions.

MEDICAL HISTORY: C5 [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 39850**]
Chronic respiratory failure with trach
s/p C6 corpectomy and ACDF C7T1 c allograft and plate c/b CSF
leak
stage II pressure ulcers
MRSA/Hflu VAP
LUE DVT
Neurogenic bowel
Neurogenic bladder
h/o HTN
h/o MI in 03 s/p BMS to LCcx
DM (diet controlled)
hypercholesterolemia
s/p TAH-BSO [**2146**]
hypotension, on florinef/MICU and glycopyrrelate

MEDICATION ON ADMISSION: 1. senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
Gen: sleepy, NAD
HEENT: tach in place on trach mask
PULM: rhonchi bilaterally
CV: RR, SM LSB
ABD: s/nt/nd nabs
EXT: no c/c/e
Neuro: alert but drowsy appearing. B UE weakness R>L but able to
move left extremity. BLE paralysis
.
On discharge:
Gen: alert and oriented x 3, NAD
HEENT: PERRL, trach in place
CV: RRR, no m/r/g
Pulm: CTA bilaterally
Abd: soft, NTND
Extrem: no edema

FAMILY HISTORY: HTN

SOCIAL HISTORY: Occupation:
Drugs:
Tobacco: prior (30-40 years) 1+ pack/day smoker
Alcohol:
Other: used to work as [**Hospital1 112**] clerk
.
She smokes approximately a third of a pack per day.
Other chest pain,Quadriplegia, unspecified,Chronic respiratory failure,Neurogenic bowel,Acidosis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Pure hypercholesterolemia,Tobacco use disorder,Arthrodesis status,Tracheostomy status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Chest pain NEC,Quadriplegia, unspecifd,Chronic respiratory fail,Neurogenic bowel,Acidosis,Hypertension NOS,DMII wo cmp nt st uncntr,Neurogenic bladder NOS,Fever NOS,Crnry athrscl natve vssl,Anemia NOS,Pure hypercholesterolem,Tobacco use disorder,Arthrodesis status,Tracheostomy status,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2167-5-30**]              Discharge Date:   [**2167-6-2**]

Date of Birth:  [**2105-6-17**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 8404**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
61 female with h/o HATN, CAD, DM and recently now C6 [**Female First Name (un) **] B
[**Female First Name (un) 39850**] developed s/p C6 discectomy and C7-T1 anterior
cervical discectomy and fusion (ACDF)ACDF. She had a complicated
hospital course and was discharged to [**Hospital1 **] on [**5-29**] and was
there for less than 8 hours. She complained of chest  pain
[**11-16**]. Her trach gauze had also required changing four times
with increased clear secretions.

The summary of her hospital course is detailed in the discharge
summary from [**5-29**]. Briefly:
?????? Admitted electively for C6 corpectomy and C7-T1 ACDF after
being seen in referral for difficulty buttoning blouse and found
to have compression of C5-C6 and C6-C7.
?????? Post noted to have motor defecits
?????? MRI showed new signal abnormality in cord
?????? Respiratory falure [**5-4**] ?????? intubation and bronch
?????? Persistant fevers
?????? Started on vanc/cefepime cipro for VAP
?????? Cefepime changed to ceftriaxone for better coverage of H flu
in sputum [**5-8**]
?????? Pseudomeningocele on MRI
?????? DVT LUE
?????? Still febrile ?????? abx ceftriaxone and linezolid
?????? [**5-12**] attempted trach?????? aborted due to encountering CSF
?????? JP drain at CSF
?????? [**5-14**] JP removed and lumbar drain placed
?????? [**5-15**] trach + peg
?????? [**5-17**] lumbar drain not working
?????? [**5-18**] 2 lumbar drains placed
?????? [**5-19**] abx for VAP d/c??????d, ancef for drain ppx
?????? [**5-24**] lumbar drain removed
?????? Transistioned to Coumadin
.
On arrival to ED, initial vitals were 101.2 90 144/60 18 100%.
She was given Vancomycin, Zosyn, 2 g ceftriaxone and Tylenol for
fever.  CTA with no PE, + bibasilar consolidation.  NS
consulted, wound site looks good; drain sites in place look
well.  No further imaging necessary per Dr. [**Last Name (STitle) 548**]. No new
neurosurgical issues so did not feel admission to Neurosurgery
was indicated. She was hemodynamically stable but admitted to
the due to concern for increased nursing care.
.
Currently she denies pain.

Past Medical History:
C5 [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 39850**]
Chronic respiratory failure with trach
s/p C6 corpectomy and ACDF C7T1 c allograft and plate c/b CSF
leak
stage II pressure ulcers
MRSA/Hflu VAP
LUE DVT
Neurogenic bowel
Neurogenic bladder
h/o HTN
h/o MI in 03 s/p BMS to LCcx
DM (diet controlled)
hypercholesterolemia
s/p TAH-BSO [**2146**]
hypotension, on florinef/MICU and glycopyrrelate

Social History:
Occupation:
Drugs:
Tobacco: prior (30-40 years) 1+ pack/day smoker
Alcohol:
Other: used to work as [**Hospital1 112**] clerk
.
She smokes approximately a third of a pack per day.

Family History:
HTN

Physical Exam:
On Admission:
Gen: sleepy, NAD
HEENT: tach in place on trach mask
PULM: rhonchi bilaterally
CV: RR, SM LSB
ABD: s/nt/nd nabs
EXT: no c/c/e
Neuro: alert but drowsy appearing. B UE weakness R>L but able to
move left extremity. BLE paralysis
.
On discharge:
Gen: alert and oriented x 3, NAD
HEENT: PERRL, trach in place
CV: RRR, no m/r/g
Pulm: CTA bilaterally
Abd: soft, NTND
Extrem: no edema

Pertinent Results:
On Admission:
[**2167-5-29**] 02:40AM BLOOD WBC-4.9 RBC-2.63* Hgb-8.2* Hct-26.1*
MCV-99* MCH-31.2 MCHC-31.5 RDW-16.7* Plt Ct-116*
[**2167-5-29**] 02:40AM BLOOD PT-26.3* PTT-37.7* INR(PT)-2.5*
[**2167-5-29**] 02:40AM BLOOD Glucose-93 UreaN-15 Creat-0.3* Na-142
K-4.1 Cl-106 HCO3-28 AnGap-12
[**2167-5-29**] 02:40AM BLOOD Calcium-8.4 Phos-3.1 Mg-2.2
.
On Discharge:
[**2167-5-31**] 03:15AM BLOOD WBC-4.8 RBC-2.50* Hgb-7.8* Hct-24.8*
MCV-99* MCH-31.0 MCHC-31.2 RDW-16.8* Plt Ct-163
[**2167-5-31**] 03:15AM BLOOD Neuts-61.8 Lymphs-27.1 Monos-6.8 Eos-3.9
Baso-0.5
[**2167-5-31**] 03:15AM BLOOD PT-23.7* PTT-81.4* INR(PT)-2.2*
[**2167-5-31**] 03:15AM BLOOD Glucose-94 UreaN-12 Creat-0.5 Na-144
K-4.1 Cl-110* HCO3-25 AnGap-13
[**2167-5-31**] 03:15AM BLOOD Calcium-8.7 Phos-3.1 Mg-2.3
[**2167-5-31**] 03:12AM BLOOD Lactate-0.8
.
Troponin trend:
[**2167-5-31**] 03:15AM BLOOD cTropnT-<0.01
[**2167-5-30**] 12:14PM BLOOD cTropnT-<0.01
[**2167-5-30**] 02:15AM BLOOD cTropnT-<0.01
.
Microbiology:
[**2167-5-30**] 02:35AM URINE Blood-MOD Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG
[**2167-5-30**] 02:35AM URINE RBC-42* WBC-2 Bacteri-FEW Yeast-NONE
Epi-0
URINE CULTURE (Pending): ngtd
Blood Culture, Routine (Pending): ngtd
.
Imaging:
CTA on admission:
1. No evidence of PE or acute abdominal process.
2. Bibasilar atelectasis, with small pleural effusions.

Brief Hospital Course:
61 y/o F recent [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] s/p C6 corpectomy with C7-T1
ACDF and complicated post-op course admitted after <24h in rehab
with fevers and a report of chest pain.
.
# Chest Pain: Chest pain free on admission. No EKG changes on
admission. Patient does have history of inferior MI [**2159**]. Had an
ECHO [**Month (only) 547**] with normal EF. Patient ruled out for ACS with
Troponin x 3 negative. CTA negative for PE. Patient was
restarted on her cardiac medications including. ASA 81,
Simvastatin and Lisinopril.  We did not restart her Beta-blocker
as she has recent bradycardia from autonomic dysfunction.
-ACE and statin should be up-titrated as needed.
-ASA use discussed with neurosurgery team, and no
contraindications to proceed
-If patient recovers her autonomic dysfunction and is felt
unlikely to be at risk for bradycardia, she can restart low dose
metoprolol and uptitrate as indicated.
.
# Fever: No leukocytosis. Tmax during admission 100.1. No
localized source. No diarrhea to suggest C. Diff. No altered
mental status to suggest CSF etiology. CTA no evidence of
pneumonia. Ua negative. However, due to the report of increasing
secretions, the patient was started on broad coverage
Vanc/Cefepime.  Once the patient's blood cultures negative for
48 hours and she had no further fever, leukocytosis or other
sign of infection, these antbiotics were stopped.
- Will f/u blood cultures and call [**Hospital1 **] if negative
tomorrow - our contact number is [**Telephone/Fax (1) 105208**] if you do not hear
from us.
.
# Recent LUE DVT: CTA negative for PE on admission. She was
therapeutic on coumadin and INR was 2.1 on the day of discharge.
Coumadin dose is 5mg daily.
-recheck INR on Wednesday [**2167-6-4**] and if stable will need
weekly INR checks
-patient's coumadin should continue for 3-6 months.  After that
she will require DVT prophylaxis with SQ heparin or lovenox
ongoing given her [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] state.
.
# Anemia: Stable
.
# Lactic acidosis: Lactate elevated on admission resolved with
IVF.
.
# H/O respiratory failure s/p trach: Stable on trach mask. No
notable increase during admission. CTA demonstrates no
infiltrate or evidence of pneumonia. Patient admitted to the ICU
but required no vent support.  Patient continued on prn
albuterol and standing ipratropium.  Acetylcysteine nebs were
not needed or continued.
.
# stage II pressure ulcers: Continued wound care. No evidence of
infection.
.
# C5 [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with Neurogenic bowel/bladder, hypotension: This
appears unchanged from recent discharge.  Patient was continued
on her bowel regimen, foley was kept in place.  Patient was
hypertensive so her midodrine was decreased to [**Hospital1 **] and florinef
was continued.
- Midodrine can be further weaned for SBP >140
.
# DM: Sliding scale while in house but did not require any
insulin. Can be considered diet controlled.
.
# hypercholesterolemia: restarted on statin as above.
.
# Recent hospital stay: Patient with recent complicated stay
(see HPI) - please refer to recent d/c summary. Printed out
extra copy and sent with patient.
.
# Trach care: Inner cannula was changed on [**2167-6-1**]. Discussed
with Dr. [**Last Name (STitle) **] [**Name (STitle) **] who placed trach and confirmed trach
is ok to proceed with down-sizing as the fibrous track of the
tracheotomy will be well sealed off from the neck tissues in
general. In addition CSF collection in the neck dried up after
placement of the lumbar drains and the dural injury has no doubt
long since sealed. Secretions are not CSF they are sputum.

Medications on Admission:
1. senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a

day) as needed for constipation.
2. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
6-8 Puffs Inhalation Q4H (every 4 hours) as needed for wheezing.

3. fludrocortisone 0.1 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. glycopyrrolate 1 mg Tablet Sig: Two (2) Tablet PO QID (4
times a day).
5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
6. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler Sig:

Six (6) Puff Inhalation Q4H (every 4 hours) as needed for
wheezing.
7. docusate sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
8. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
9. oxycodone 5 mg/5 mL Solution Sig: Five (5) mg PO Q4H (every 4

hours) as needed for pain.
10. midodrine 2.5 mg Tablet Sig: 1.5 Tablets PO Q6H (every 6
hours).
11. warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
goal INR 2.5 - 3.0.
12. acetaminophen 650 mg/20.3 mL Solution Sig: Six [**Age over 90 1230**]y

(650) mg PO Q6H (every 6 hours) as needed for pain/fever.
13. acetylcysteine 20 % (200 mg/mL) Solution Sig: 1-10 MLs
Miscellaneous Q6H (every 6 hours) as needed for thick
secretions.


Discharge Medications:
1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation every four (4) hours as
needed for shortness of breath or wheezing.
3. fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. glycopyrrolate 1 mg Tablet Sig: Two (2) Tablet PO QID (4
times a day).
5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily).
6. ipratropium bromide 0.02 % Solution Sig: One (1) neb
Inhalation every four (4) hours.
7. docusate sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
8. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
9. oxycodone-acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q6H (every 6 hours) as needed for pain.
10. alendronate 70 mg Tablet Sig: One (1) Tablet PO QTUES (every
Tuesday).
11. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
12. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for thrush.
15. warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
16. midodrine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
17. psyllium     Packet Sig: One (1) Packet PO DAILY (Daily) as
needed for constipation.
18. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig:
Thirty (30) ML PO QID (4 times a day) as needed for dyspepsia.
19. acetaminophen 650 mg/20.3 mL Solution Sig: Six [**Age over 90 1230**]y
(650) mh PO Q6H (every 6 hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Atypical cardiac pain
Fever

Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.

Discharge Instructions:
You were admitted for chest pain. You did not have a heart
attack. You were also ruled out for a blood clot in your lung.
.
You were covered with antibiotics until your blood cultures
returned negative.
.
Please follow your medications as listed.

Followup Instructions:
Please follow recommended follow-up according to last discharge:
YOUR SUTURES ARE UNDER THE SKIN YOU WILL NOT NEED TO BE SEEN
UNTIL THE FOLLOW UP APPOINTMENT
PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) **] TO BE SEEN IN 6 WEEKS.
YOU WILL NEED AP AND LATERAL C SPINE XRAYS PRIOR TO YOUR
APPOINTMENT


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 8405**]
{'Other chest pain,Quadriplegia, unspecified,Chronic respiratory failure,Neurogenic bowel,Acidosis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Pure hypercholesterolemia,Tobacco use disorder,Arthrodesis status,Tracheostomy status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: Chest Pain

PRESENT ILLNESS: 61 female with h/o HATN, CAD, DM and recently now C6 [**Female First Name (un) **] B
[**Female First Name (un) 39850**] developed s/p C6 discectomy and C7-T1 anterior
cervical discectomy and fusion (ACDF)ACDF. She had a complicated
hospital course and was discharged to [**Hospital1 **] on [**5-29**] and was
there for less than 8 hours. She complained of chest  pain
[**11-16**]. Her trach gauze had also required changing four times
with increased clear secretions.

MEDICAL HISTORY: C5 [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 39850**]
Chronic respiratory failure with trach
s/p C6 corpectomy and ACDF C7T1 c allograft and plate c/b CSF
leak
stage II pressure ulcers
MRSA/Hflu VAP
LUE DVT
Neurogenic bowel
Neurogenic bladder
h/o HTN
h/o MI in 03 s/p BMS to LCcx
DM (diet controlled)
hypercholesterolemia
s/p TAH-BSO [**2146**]
hypotension, on florinef/MICU and glycopyrrelate

MEDICATION ON ADMISSION: 1. senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
Gen: sleepy, NAD
HEENT: tach in place on trach mask
PULM: rhonchi bilaterally
CV: RR, SM LSB
ABD: s/nt/nd nabs
EXT: no c/c/e
Neuro: alert but drowsy appearing. B UE weakness R>L but able to
move left extremity. BLE paralysis
.
On discharge:
Gen: alert and oriented x 3, NAD
HEENT: PERRL, trach in place
CV: RRR, no m/r/g
Pulm: CTA bilaterally
Abd: soft, NTND
Extrem: no edema

FAMILY HISTORY: HTN

SOCIAL HISTORY: Occupation:
Drugs:
Tobacco: prior (30-40 years) 1+ pack/day smoker
Alcohol:
Other: used to work as [**Hospital1 112**] clerk
.
She smokes approximately a third of a pack per day. 

### Response:
{'Other chest pain,Quadriplegia, unspecified,Chronic respiratory failure,Neurogenic bowel,Acidosis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Fever, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Pure hypercholesterolemia,Tobacco use disorder,Arthrodesis status,Tracheostomy status,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
