CHIEF COMPLAINT: Right humeral fracture

PRESENT ILLNESS: [**Age over 90 **] year old female with a history of CAD, CHF EF 45%, and
gastric ca who is s/p fall 2 weeks ago that is post-op from ORIF
of R shoulder for a displaced 2 part proximal humerus fracture.
Pt fell 2 weeks ago sustaining both a right intertrochanteric
hip fracture which was fixed at [**Hospital 1474**] Hospital and a Right
shoulder fracture. She was discharged to rehab and was noted
while in rehab to have further displacement of her proximal
humerus fracture. Dr. [**First Name (STitle) **] saw her [**2124-4-19**] for evaluation
deonstrating new displacement, she was scheduled for ORIF of the
humerus on [**2124-4-24**]. Pt transferred to the [**Hospital Unit Name 153**] secondary to
hypertension to 210/... early in the operation treated with 80mg
of propofol, 20mg labetolol, and titration of the sevoflurane.
BPs improved to 120/..... In the [**Hospital Ward Name 332**] ICU, the patient was
intubated and ventilated on SIMV and remained hemodynamically
stable with SBP ranged between 90s to 160s on propofol.
Extubated without difficulty at 9am. Post extubation her SBPs
ranged in the 150 to 170s. Currently she denies headache,
shortness of breath, pain with breathing, chest pains, vomiting,
abdominal pains. She does note mild nausea at this time.

MEDICAL HISTORY: 1. CAD-3 vessel disease- status post CABG in [**2116**], SVG to LAD,
SVG to OM, SVG to RCA. Catheterization in [**2118**] revealed patent
SVG to LAD
but occluded SVG to RCA and SVG to OM. EF was 45% at that
time. The ejection fraction in [**Month (only) 404**] of this year was 50%.
[**2-/2123**]- Stenting of Left Main into Lcx.
2. Pacemaker.
3. Congestive heart failure- EF 45% ([**2-18**]).
4. Osteoarthritis.
5. Upper GI bleed secondary to esophageal erosions in [**2115**].
6. Left eye cataract.
7. Status post lumbar disk surgery.
8. Status post hysterectomy.
9. Status post appendectomy.
10. Diverticulosis.
11. Status post gastric surgery for cancer in [**2119**].
12. COPD- ? on chronic prednisone.

MEDICATION ON ADMISSION: 1. Atenolol 50 mg q.d.
2. Lipitor 10 mg q.h.s.
3. Colace 100 mg b.i.d.
4. Atrovent MDI two puffs inhaler q.i.d.
5. Prednisone 5 mg q.d.
6. Folic acid 1 mg q.d.
7. Guaifenesin p.r.n. cough and secretions.
8. Imdur 30 mg QD
9. MVI
10. Nicotine Patch
11. Norvasc 5 mg QD
12. Protonix 40 mg QD
13. CaCO3
14. Vicodin PRN for pain
15. Coumadin 3 mg QD

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Afebrile, 63 120/38 100% Intubated SIMV
NAD, on the ventillator, appears comfortable, cachectic
Right arm is in sling
MMM, OP- ETT in place, no appreciable JVP
RR
Coarse BS anteriorly
soft, NT/ND +BS
No LE edema, Right arm with echymosis in sling, Right
radial/ulnar 1+

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has smoked a pack per day for
her entire life and still continues to smoke. She does not
drink alcohol or use other drugs. She is currently living
Closed fracture of surgical neck of humerus,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Unspecified fall,Personal history of malignant neoplasm of stomach,Long-term (current) use of steroids,Cardiac pacemaker in situ,Aortocoronary bypass status,Coronary atherosclerosis of native coronary artery,Aftercare for healing traumatic fracture of hip
Fx surg nck humerus-clos,CHF NOS,Chr airway obstruct NEC,Acidosis,Acute kidney failure NOS,Fall NOS,Hx of gastric malignancy,Long-term use steroids,Status cardiac pacemaker,Aortocoronary bypass,Crnry athrscl natve vssl,Aftrcre traumatic fx hip
Admission Date:  [**2124-4-24**]              Discharge Date:   [**2124-4-26**]


Service: MEDICINE

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
Right humeral fracture

Major Surgical or Invasive Procedure:
Right ORIF [**2124-4-24**]

History of Present Illness:
[**Age over 90 **] year old female with a history of CAD, CHF EF 45%, and
gastric ca who is s/p fall 2 weeks ago that is post-op from ORIF
of R shoulder for a displaced 2 part proximal humerus fracture.
Pt fell 2 weeks ago sustaining both a right intertrochanteric
hip fracture which was fixed at [**Hospital 1474**] Hospital and a Right
shoulder fracture. She was discharged to rehab and was noted
while in rehab to have further displacement of her proximal
humerus fracture. Dr. [**First Name (STitle) **] saw her [**2124-4-19**] for evaluation
deonstrating new displacement, she was scheduled for ORIF of the
humerus on [**2124-4-24**]. Pt transferred to the [**Hospital Unit Name 153**] secondary to
hypertension to 210/... early in the operation treated with 80mg
of propofol, 20mg labetolol, and titration of the sevoflurane.
BPs improved to 120/..... In the [**Hospital Ward Name 332**] ICU, the patient was
intubated and ventilated on SIMV and remained hemodynamically
stable with SBP ranged between 90s to 160s on propofol.
Extubated without difficulty at 9am. Post extubation her SBPs
ranged in the 150 to 170s. Currently she denies headache,
shortness of breath, pain with breathing, chest pains, vomiting,
abdominal pains. She does note mild nausea at this time.

Past Medical History:
1. CAD-3 vessel disease- status post CABG in [**2116**], SVG to LAD,
SVG to OM, SVG to RCA. Catheterization in [**2118**] revealed patent
SVG to LAD
but occluded SVG to RCA and SVG to OM. EF was 45% at that
time. The ejection fraction in [**Month (only) 404**] of this year was 50%.
[**2-/2123**]- Stenting of Left Main into Lcx.
2. Pacemaker.
3. Congestive heart failure- EF 45% ([**2-18**]).
4. Osteoarthritis.
5. Upper GI bleed secondary to esophageal erosions in [**2115**].
6. Left eye cataract.
7. Status post lumbar disk surgery.
8. Status post hysterectomy.
9. Status post appendectomy.
10. Diverticulosis.
11. Status post gastric surgery for cancer in [**2119**].
12. COPD- ? on chronic prednisone.


Social History:
 The patient has smoked a pack per day for
her entire life and still continues to smoke. She does not
drink alcohol or use other drugs. She is currently living


Physical Exam:
Afebrile, 63 120/38 100% Intubated SIMV
NAD, on the ventillator, appears comfortable, cachectic
Right arm is in sling
MMM, OP- ETT in place, no appreciable JVP
RR
Coarse BS anteriorly
soft, NT/ND +BS
No LE edema, Right arm with echymosis in sling, Right
radial/ulnar 1+


Pertinent Results:
SHOULDER (AP, NEUTRAL & AXILLARY) SOFT TISSUE RIGHT PORT
[**2124-4-25**] 9:44 AM
IMPRESSION: Status post ORIF right humeral neck fracture.
Alignment impossible to assess given the one view.

PORTABLE ABDOMEN  [**2124-4-25**] 2:10 PM

IMPRESSION: No evidence of free air on this supine radiograph.
If clinically indicated, further evaluation can be obtained with
a decubitus film.

[**2124-4-25**] 12:04AM BLOOD WBC-18.3*# RBC-3.28*# Hgb-9.2*# Hct-29.4*
MCV-90 MCH-28.0 MCHC-31.3 RDW-19.4* Plt Ct-265
[**2124-4-25**] 12:04AM BLOOD PT-13.7* PTT-23.2 INR(PT)-1.2
[**2124-4-25**] 12:04AM BLOOD Glucose-116* UreaN-25* Creat-0.8 Na-136
K-4.8 Cl-107 HCO3-20* AnGap-14
[**2124-4-26**] 05:30AM BLOOD ALT-<4 AST-19 LD(LDH)-180 AlkPhos-133*
Amylase-559* TotBili-0.4
[**2124-4-25**] 04:20AM BLOOD Calcium-7.9* Phos-5.4* Mg-1.7
[**2124-4-24**] 04:41PM BLOOD Type-ART pO2-180* pCO2-38 pH-7.38
calHCO3-23 Base XS--1
[**2124-4-24**] 04:41PM BLOOD Glucose-138* Lactate-1.1 Na-137 K-4.4
Cl-108
[**2124-4-24**] 04:41PM BLOOD Hgb-10.8* calcHCT-32
[**2124-4-24**] 06:59PM BLOOD Hgb-9.9* calcHCT-30
[**2124-4-24**] 06:59PM BLOOD freeCa-1.17

HUMERUS (AP & LAT) RIGHT  [**2124-4-26**] 8:26 AM

Single bedside frontal radiograph of the right humerus and
shoulder show large plate and across the proximal humerus with
multiple associated screws and overlying skin staples. No
discrete fracture lines are identified but assessment is
suboptimal on this portable exam. One of the screws projects [**12-19**]
mm beyond the subchondral bone of the humeral head. Generalized
demineralization. Pacing device overlies a partially visualized
right upper thorax. Soft tissue gas is present in the operative
site. No dislocation. No position change from similarly
positioned single radiograph done one day ago (10 in [**4-20**]).


Brief Hospital Course:
A/P: [**Age over 90 **] YO female with MMP admitted s/p ORIF of Right shoulder
intubated from the OR. She was admitted to the ortho service and
remained intubated post-op so she was transferred to the MICU.
She was extubated uneventfully on [**4-25**]. Post operatively, she
was noted to have a purplish right arm, with minimal radial
pulse but palpable antevubital pulse, which ortho did not feel
was unusual. Her medications were continued post-operatively
including aspirin and plavix. She was kept on lovenox post
operatively. Her hematocrit slowly decreased to 25 post
operatively and she was transfused 1 unit pRBC on [**4-26**]. She was
given ultram for pain, and developed decreased urine output post
operatively and received numberous fluid boluses with urine
output around 15 cc per hour, which was deemed to be acceptable
for her very low body mass. She developed some nausea and
vomiting after extubation, but a KUB showed no free air or
evidence of obstruction. She was transferred to the medical
floor on [**4-26**].

That evening, she was alert and tolerating minimal PO intake
with some persistent nausea. She did not receive any further
fluid boluses. She lost IV access and the IV team reevaluated
her at around 8 pm, and was unable after multiple attempts to
secure access. She was not receiving IV medications so a PICC
line was ordered for the morning for access. Around 9:35 pm, a
coworker went into her room and found her to be unresponsive. As
she was DNR/DNI, a code was not called but the medical team
immediately evaluated her and found her apneic, pulseless, and
without reflexes. She was pronounced dead at 9:40 pm. The
immediate cause of death was likley due to cardiac arrest, as
she was not short of breath or in any distress prior to being
found.



Medications on Admission:
1. Atenolol 50 mg q.d.
2. Lipitor 10 mg q.h.s.
3. Colace 100 mg b.i.d.
4. Atrovent MDI two puffs inhaler q.i.d.
5. Prednisone 5 mg q.d.
6. Folic acid 1 mg q.d.
7. Guaifenesin p.r.n. cough and secretions.
8. Imdur 30 mg QD
9. MVI
10. Nicotine Patch
11. Norvasc 5 mg QD
12. Protonix 40 mg QD
13. CaCO3
14. Vicodin PRN for pain
15. Coumadin 3 mg QD


Discharge Disposition:
Expired

Discharge Diagnosis:
cardiac arrest

Discharge Condition:
dead

                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Closed fracture of surgical neck of humerus,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Unspecified fall,Personal history of malignant neoplasm of stomach,Long-term (current) use of steroids,Cardiac pacemaker in situ,Aortocoronary bypass status,Coronary atherosclerosis of native coronary artery,Aftercare for healing traumatic fracture of hip'}


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: Right humeral fracture

PRESENT ILLNESS: [**Age over 90 **] year old female with a history of CAD, CHF EF 45%, and
gastric ca who is s/p fall 2 weeks ago that is post-op from ORIF
of R shoulder for a displaced 2 part proximal humerus fracture.
Pt fell 2 weeks ago sustaining both a right intertrochanteric
hip fracture which was fixed at [**Hospital 1474**] Hospital and a Right
shoulder fracture. She was discharged to rehab and was noted
while in rehab to have further displacement of her proximal
humerus fracture. Dr. [**First Name (STitle) **] saw her [**2124-4-19**] for evaluation
deonstrating new displacement, she was scheduled for ORIF of the
humerus on [**2124-4-24**]. Pt transferred to the [**Hospital Unit Name 153**] secondary to
hypertension to 210/... early in the operation treated with 80mg
of propofol, 20mg labetolol, and titration of the sevoflurane.
BPs improved to 120/..... In the [**Hospital Ward Name 332**] ICU, the patient was
intubated and ventilated on SIMV and remained hemodynamically
stable with SBP ranged between 90s to 160s on propofol.
Extubated without difficulty at 9am. Post extubation her SBPs
ranged in the 150 to 170s. Currently she denies headache,
shortness of breath, pain with breathing, chest pains, vomiting,
abdominal pains. She does note mild nausea at this time.

MEDICAL HISTORY: 1. CAD-3 vessel disease- status post CABG in [**2116**], SVG to LAD,
SVG to OM, SVG to RCA. Catheterization in [**2118**] revealed patent
SVG to LAD
but occluded SVG to RCA and SVG to OM. EF was 45% at that
time. The ejection fraction in [**Month (only) 404**] of this year was 50%.
[**2-/2123**]- Stenting of Left Main into Lcx.
2. Pacemaker.
3. Congestive heart failure- EF 45% ([**2-18**]).
4. Osteoarthritis.
5. Upper GI bleed secondary to esophageal erosions in [**2115**].
6. Left eye cataract.
7. Status post lumbar disk surgery.
8. Status post hysterectomy.
9. Status post appendectomy.
10. Diverticulosis.
11. Status post gastric surgery for cancer in [**2119**].
12. COPD- ? on chronic prednisone.

MEDICATION ON ADMISSION: 1. Atenolol 50 mg q.d.
2. Lipitor 10 mg q.h.s.
3. Colace 100 mg b.i.d.
4. Atrovent MDI two puffs inhaler q.i.d.
5. Prednisone 5 mg q.d.
6. Folic acid 1 mg q.d.
7. Guaifenesin p.r.n. cough and secretions.
8. Imdur 30 mg QD
9. MVI
10. Nicotine Patch
11. Norvasc 5 mg QD
12. Protonix 40 mg QD
13. CaCO3
14. Vicodin PRN for pain
15. Coumadin 3 mg QD

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Afebrile, 63 120/38 100% Intubated SIMV
NAD, on the ventillator, appears comfortable, cachectic
Right arm is in sling
MMM, OP- ETT in place, no appreciable JVP
RR
Coarse BS anteriorly
soft, NT/ND +BS
No LE edema, Right arm with echymosis in sling, Right
radial/ulnar 1+

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has smoked a pack per day for
her entire life and still continues to smoke. She does not
drink alcohol or use other drugs. She is currently living 

### Response:
{'Closed fracture of surgical neck of humerus,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Unspecified fall,Personal history of malignant neoplasm of stomach,Long-term (current) use of steroids,Cardiac pacemaker in situ,Aortocoronary bypass status,Coronary atherosclerosis of native coronary artery,Aftercare for healing traumatic fracture of hip'}
