CHIEF COMPLAINT: coffee ground emesis

PRESENT ILLNESS: 68M w/ h/o paroxysmal afib s/p cardioversion [**12-17**], discharged
with INR 4.1 off coumadin, who presented to OSH on [**12-19**] w/ 5h
increasing right flank pain and nausea. His flank pain began
suddenly while driving home from Foxwoods casino. The patient
denied trauma.
.
Of note, INR at time of cardioversion was 4.1, pt was discharged
home with instructions not to take coumadin for 1 day, then
start with half dose. He denied hematuria, CP/SOB. CT abdomen at
OSH revealed right perinephric hematoma with contrast
extravasation. He was transferred to [**Hospital1 18**] on [**12-19**]. Overnight,
his Hct fell 35.9 -> 26 over 12 hours. INR on admission was 2.4.
Cr was 1.3 (baseline 1.2). He received vitamin K, 1U PRBC, 2
bags FFP. He remained hemodynamically stable throughout. On the
morning of [**12-19**], he was found to have 250cc coffee ground
emesis. Per report, NG lavage did not clear. The pt was taken to
angiography to assess perinephric bleeding, which was
unremarkable. Repeat NG lavage afterwards, upon arrival to the
[**Hospital Unit Name 153**], was negative.

MEDICAL HISTORY: Atrial Fibrillation: s/p DC cardioversion [**2118**], found to be back
in asymptomatic afib on routine visit [**2121-10-2**], s/p cardioversion
[**2121-10-17**], found to be in afib again, now s/p repeat cardioversion
([**2121-12-17**])
CAD singel vessel s/p circumflex stenting [**2114**]
CHF/cardiomyopathy (global hypokinesis, EF 40-50%)
HTN
Prostate cancer, s/p radical prostatectomy [**2114**]
MVA with scapular and rib fractures [**2103**]
? left side kidney stones (asymptomatic, discovered on USN at
time of prostate resection).
GERD
basal cell ca (nose) s/p resection
.

MEDICATION ON ADMISSION: Medications (HOME):
sotalol 80 mg b.i.d
Lasix 20 mg daily,
lisinopril 5 mg daily,
aspirin 81 mg daily
Coumadin 2.5 mg po qdaily.
MVI
vit c
.
.
Medications (TRANSFER):
Hydromorphone 6-10 mg PO Q2H:PRN pain
Ipratropium Bromide Neb 1 NEB IH Q6H
Lisinopril 5 mg PO DAILY
Pantoprazole 40 mg PO Q24H
Acetaminophen 650 mg PO Q4-6H:PRN T>101.4
Senna 1 TAB PO BID:PRN constipation
Amiodarone HCl 400 mg PO BID first dose at 8PM on [**12-26**]
Simethicone 40-80 mg PO QID:PRN gas
Ceftriaxone 1 gm IV Q24H pneumonia
Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea
Docusate Sodium 100 mg PO BID
Furosemide 20 mg PO DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.2, 144/72, 73, 22, 97% RA
GEN: NAD
HEENT: PERRLA, EOMI, sclera anicteric, OP clear, MMM, no LAD, no
carotid bruits. No JVD.
CV: RRR, soft 2/6 SEM loudest at LSB.
PULM: decreased breath sounds RLL, otherwise CTAB, no r/r/w.
ABD: soft, NT, ND, + BS, no HSM.
EXT: warm, 2+ dp/radial pulses BL.
NEURO: alert & oriented x 3
.

FAMILY HISTORY: NC

SOCIAL HISTORY: 35pack years, quit ten years ago tobbacco. married. retired.
Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Atrial fibrillation,Hematemesis,Bacterial pneumonia, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin
Benign neoplasm kidney,Hemoperitoneum,Atrial fibrillation,Hematemesis,Bacterial pneumonia NOS,CHF NOS,Ac posthemorrhag anemia,Chronic kidney dis NOS,Long-term use anticoagul,Status-post ptca,Hypertension NOS,Esophageal reflux,Hx-prostatic malignancy,Hx-skin malignancy NEC
Admission Date:  [**2121-12-19**]              Discharge Date:   [**2121-12-29**]

Date of Birth:  [**2053-8-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 458**]
Chief Complaint:
coffee ground emesis

Major Surgical or Invasive Procedure:
DC cardioversion x 3


History of Present Illness:
68M w/ h/o paroxysmal afib s/p cardioversion [**12-17**], discharged
with INR 4.1 off coumadin, who presented to OSH on [**12-19**] w/ 5h
increasing right flank pain and nausea. His flank pain began
suddenly while driving home from Foxwoods casino. The patient
denied trauma.
.
Of note, INR at time of cardioversion was 4.1, pt was discharged
home with instructions not to take coumadin for 1 day, then
start with half dose. He denied hematuria, CP/SOB. CT abdomen at
OSH revealed right perinephric hematoma with contrast
extravasation. He was transferred to [**Hospital1 18**] on [**12-19**]. Overnight,
his Hct fell 35.9 -> 26 over 12 hours. INR on admission was 2.4.
Cr was 1.3 (baseline 1.2). He received vitamin K, 1U PRBC, 2
bags FFP. He remained hemodynamically stable throughout. On the
morning of [**12-19**], he was found to have 250cc coffee ground
emesis. Per report, NG lavage did not clear. The pt was taken to
angiography to assess perinephric bleeding, which was
unremarkable. Repeat NG lavage afterwards, upon arrival to the
[**Hospital Unit Name 153**], was negative.

Past Medical History:
Atrial Fibrillation: s/p DC cardioversion [**2118**], found to be back
in asymptomatic afib on routine visit [**2121-10-2**], s/p cardioversion
[**2121-10-17**], found to be in afib again, now s/p repeat cardioversion
([**2121-12-17**])
CAD singel vessel s/p circumflex stenting [**2114**]
CHF/cardiomyopathy (global hypokinesis, EF 40-50%)
HTN
Prostate cancer, s/p radical prostatectomy [**2114**]
MVA with scapular and rib fractures [**2103**]
? left side kidney stones (asymptomatic, discovered on USN at
time of prostate resection).
GERD
basal cell ca (nose) s/p resection
.


Social History:
35pack years, quit ten years ago tobbacco. married. retired.


Family History:
NC

Physical Exam:
VS: 99.2, 144/72, 73, 22, 97% RA
GEN: NAD
HEENT: PERRLA, EOMI, sclera anicteric, OP clear, MMM, no LAD, no
carotid bruits. No JVD.
CV: RRR, soft 2/6 SEM loudest at LSB.
PULM: decreased breath sounds RLL, otherwise CTAB, no r/r/w.
ABD: soft, NT, ND, + BS, no HSM.
EXT: warm, 2+ dp/radial pulses BL.
NEURO: alert & oriented x 3
.

Pertinent Results:
[**2121-12-18**] 10:50PM   GLUCOSE-189* UREA N-29* CREAT-1.2 SODIUM-140
POTASSIUM-4.8 CHLORIDE-107 TOTAL CO2-25 ANION GAP-13
[**2121-12-18**] 10:50PM   WBC-12.9* RBC-4.19* HGB-12.3* HCT-35.9*
MCV-86 MCH-29.4 MCHC-34.3 RDW-14.5
[**2121-12-18**] 10:50PM   NEUTS-89.6* LYMPHS-7.2* MONOS-2.5 EOS-0.5
BASOS-0.2
[**2121-12-18**] 10:50PM   PLT COUNT-240#
[**2121-12-18**] 10:50PM   PT-26.8* PTT-32.7 INR(PT)-2.7*

MRI abdomen [**12-22**]:
IMPRESSIONS:
1.  Right perinephric collection with signal characteristics
consistent with hemorrhage. The suggested etiology is, when also
corrlelated with CT is a right upper pole angiomyolipoma (AML).
A short-term followup examination is recommended to assess
resolution of the perinephric fluid collection.
2.  Cholelithiasis.
3.  Hepatic lesions, which are likely cysts.


Brief Hospital Course:
## perinehpric hematoma
CT abdomen at OSH revealed right perinephric hematoma with
contrast extravasation. Pt was transfered to [**Hospital1 18**] on [**12-19**] and
next morning pt was found to have 250cc cofeee ground emesis. NG
lavage did not clear. pt was taken to angiography to assess
perinephric bleeding, which was unremarkable. repeat NG lavage
afterwards, upon arrival to [**Hospital Unit Name 153**], was negative (few clots, no
bleeding). His hct had dropped from baseline 36 to 28 on
admission.  He received a total of 3 units of PRBC's since
admission, and then his hct subsequently stabilized.  MRI of the
abdomen suggested cause of perinephric bleed to be due to an
angiomyolipoma. Urology recommended follow up CT in [**3-14**] weeks.
.
# GIB
He initially presented with coffee ground emesis which cleared
with NG lavage and was hemodynamically stable. He was maintained
on a PPI. He was H. pylori negative. GI recommended that he be
followed as an outpatient with colonoscopy and endoscopy.
.
## atrial fibrillation
On first transfer to the [**Hospital Unit Name 153**], he was initially in afib with
RVR.  He was refractory to 2 electrical cardioversions. He was
continued on sotalol, but his dose was increased. Upper
endoscopy was deferred at that time due to pt's increasing O2
requirement (due to RLL pneumonia) as well as Afib. A third
cardioversion had been planned when the patient spontaneously
converted to NSR. He was then transferred to the floor. Then, on
[**2121-12-24**], patient again developed afib with RVR, rate unable to
be controlled, and he was transferred back to ICU for diltiazem
drip for rate control.
.
He was then electrically cardioverted successfully, was started
on amiodarone, and has remained in NSR.  He did not require TEE
prior to the electrical cardioversions because episodes of Afib
lasted less than 48 hours.  His pnuemonia is being treated with
Ceftriaxone.  His hct has remained stable, with the GI service
recommending endoscopy and colonoscopy as an outpatinet.  His
coumadin and aspirin have been held during this admission.  He
was then transferred to the cardiology service for further
monitoring. The following morning ([**12-27**]) he converted again to
afib with heart rates in the 110s-120s. It did not respond to
lopressor 5 IVx2 or diltiazem 10mg IV x1. PO diltiazem was
started [**2121-12-28**] and increased to 90mg po qid. Amiodarone was
continued. The morning of [**12-29**], he converted back to NSR
spontaneously after 5mg IV lopressor with HR in the 60s. His QT
interval in NSR was ~430. TFTs and LFTs were normal in-house,
and he will need outpatient PFTs.  Pt will require twice annual
lfts and tfts, as well as baseline and annual cxr, pfts, and eye
exam which will be deferred to Dr. [**Last Name (STitle) 11649**].
.
## hypoxia
The patient was noted to develop an oxygen requirement while in
afib. His hypoxia was felt to likely be from afib, although a
contribution from pneumonia was also considered. He was started
on ceftriaxone on [**12-24**] for focal opacity seen on CXR.
Aithromycin was added on [**12-27**] for atypical coverage but d/c'ed
due to potential to prolong the QT interval. He was discharged
on cefpodoxime and doxycycline with improved oxygenation to
complete a 10-day course of antibiotics.
- d/c on cefpodoxime, doxy
.
#HTN
Lisinopril and lasix were continued on home doses. He remained
hemodynamically stable throughout his hospital course.


Medications on Admission:
Medications (HOME):
sotalol 80 mg b.i.d
Lasix 20 mg daily,
lisinopril 5 mg daily,
aspirin 81 mg daily
Coumadin 2.5 mg po qdaily.
MVI
vit c
.
.
Medications (TRANSFER):
Hydromorphone 6-10 mg PO Q2H:PRN pain
Ipratropium Bromide Neb 1 NEB IH Q6H
Lisinopril 5 mg PO DAILY
Pantoprazole 40 mg PO Q24H
Acetaminophen 650 mg PO Q4-6H:PRN T>101.4
Senna 1 TAB PO BID:PRN constipation
Amiodarone HCl 400 mg PO BID first dose at 8PM on [**12-26**]
Simethicone 40-80 mg PO QID:PRN gas
Ceftriaxone 1 gm IV Q24H pneumonia
Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea
Docusate Sodium 100 mg PO BID
Furosemide 20 mg PO DAILY


Discharge Medications:
1. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 4 days.
[**Month/Year (2) **]:*8 Tablet(s)* Refills:*0*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 2 tablets twice a day for 4 days, then 2 tablets
once a day for 7 days, then 1 tablet once a day until directed
otherwise by your doctor.
[**Last Name (Titles) **]:*60 Tablet(s)* Refills:*2*
6. Diltiazem HCl 360 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO DAILY (Daily).
[**Last Name (Titles) **]:*30 Capsule, Sust. Release 24HR(s)* Refills:*2*
7. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO
twice a day for 4 days.
[**Last Name (Titles) **]:*8 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: right perinephric hematoma, atrial fibrillation
Secondary: coronary artery disease, congestive heart failure,
hypertension, GERD


Discharge Condition:
good, stable, ambulating independently, O2 sat mid-90s on room
air


Discharge Instructions:
You were admitted for evaluation of bleeding around your right
kidney and also treated for atrial fibrillation.

If you have chest pain, palpitations, lightheadedness, shortness
of breath, or episodes of loss of consciousness, call your
doctor or seek medical attention immediately.

Do NOT take coumadin until directed to do so by your doctor. Do
NOT take sotalol anymore. Take your medications as directed.
Follow up with your doctors [**First Name (Titles) 3**] [**Last Name (Titles) 1988**].

Wear the [**Doctor Last Name **] of Hearts monitor and use as directed.

Followup Instructions:
You should follow up with your primary care physician [**Name Initial (PRE) 176**] [**2-10**]
weeks. You may call Dr. [**First Name8 (NamePattern2) 951**] [**Last Name (NamePattern1) 24684**] office at [**Telephone/Fax (1) 6163**]
to make an appointment.

You have an appointment with your cardiologist, Dr.
[**Last Name (STitle) 1911**], on [**2122-1-8**] at 3pm. You may call his office at
[**Telephone/Fax (1) 902**] with any questions.

Follow up with your urologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 986**], for your
hematoma. You may call his office at [**Telephone/Fax (1) 24685**] for an
appointment.

You should have a colonoscopy, endoscopy, and pulmonary function
tests done as an outpatient. Your PCP can arrange this for you.

The urology service has recommended a CT/MRI in a couple of
weeks to assess for resolution of the hematoma. This can be
arranged for you by your PCP or your urologist.
{'Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Atrial fibrillation,Hematemesis,Bacterial pneumonia, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin'}


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: coffee ground emesis

PRESENT ILLNESS: 68M w/ h/o paroxysmal afib s/p cardioversion [**12-17**], discharged
with INR 4.1 off coumadin, who presented to OSH on [**12-19**] w/ 5h
increasing right flank pain and nausea. His flank pain began
suddenly while driving home from Foxwoods casino. The patient
denied trauma.
.
Of note, INR at time of cardioversion was 4.1, pt was discharged
home with instructions not to take coumadin for 1 day, then
start with half dose. He denied hematuria, CP/SOB. CT abdomen at
OSH revealed right perinephric hematoma with contrast
extravasation. He was transferred to [**Hospital1 18**] on [**12-19**]. Overnight,
his Hct fell 35.9 -> 26 over 12 hours. INR on admission was 2.4.
Cr was 1.3 (baseline 1.2). He received vitamin K, 1U PRBC, 2
bags FFP. He remained hemodynamically stable throughout. On the
morning of [**12-19**], he was found to have 250cc coffee ground
emesis. Per report, NG lavage did not clear. The pt was taken to
angiography to assess perinephric bleeding, which was
unremarkable. Repeat NG lavage afterwards, upon arrival to the
[**Hospital Unit Name 153**], was negative.

MEDICAL HISTORY: Atrial Fibrillation: s/p DC cardioversion [**2118**], found to be back
in asymptomatic afib on routine visit [**2121-10-2**], s/p cardioversion
[**2121-10-17**], found to be in afib again, now s/p repeat cardioversion
([**2121-12-17**])
CAD singel vessel s/p circumflex stenting [**2114**]
CHF/cardiomyopathy (global hypokinesis, EF 40-50%)
HTN
Prostate cancer, s/p radical prostatectomy [**2114**]
MVA with scapular and rib fractures [**2103**]
? left side kidney stones (asymptomatic, discovered on USN at
time of prostate resection).
GERD
basal cell ca (nose) s/p resection
.

MEDICATION ON ADMISSION: Medications (HOME):
sotalol 80 mg b.i.d
Lasix 20 mg daily,
lisinopril 5 mg daily,
aspirin 81 mg daily
Coumadin 2.5 mg po qdaily.
MVI
vit c
.
.
Medications (TRANSFER):
Hydromorphone 6-10 mg PO Q2H:PRN pain
Ipratropium Bromide Neb 1 NEB IH Q6H
Lisinopril 5 mg PO DAILY
Pantoprazole 40 mg PO Q24H
Acetaminophen 650 mg PO Q4-6H:PRN T>101.4
Senna 1 TAB PO BID:PRN constipation
Amiodarone HCl 400 mg PO BID first dose at 8PM on [**12-26**]
Simethicone 40-80 mg PO QID:PRN gas
Ceftriaxone 1 gm IV Q24H pneumonia
Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea
Docusate Sodium 100 mg PO BID
Furosemide 20 mg PO DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.2, 144/72, 73, 22, 97% RA
GEN: NAD
HEENT: PERRLA, EOMI, sclera anicteric, OP clear, MMM, no LAD, no
carotid bruits. No JVD.
CV: RRR, soft 2/6 SEM loudest at LSB.
PULM: decreased breath sounds RLL, otherwise CTAB, no r/r/w.
ABD: soft, NT, ND, + BS, no HSM.
EXT: warm, 2+ dp/radial pulses BL.
NEURO: alert & oriented x 3
.

FAMILY HISTORY: NC

SOCIAL HISTORY: 35pack years, quit ten years ago tobbacco. married. retired. 

### Response:
{'Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Atrial fibrillation,Hematemesis,Bacterial pneumonia, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin'}
