CHIEF COMPLAINT: fevers

PRESENT ILLNESS: 63 year-old Chinese-speaking man with a history of rheumatic
heart disease status post prosthetic MVR & [**First Name3 (LF) 1291**], afib/flutter s/p
MAZE on coumadin, who presents with fevers x 2days.
Interpretation provided by family member.  Mr. [**Known lastname **] had been in
his USOH until two days prior to admission, when he devloped
chills & subjective fevers.  These persisted and his wife noted
some confusion on the day of presentation, noting that he would
not answer her questions appropriately.  He was brought to the
ED for further evaluation.
.
In the ED, vitals were rectal Temp 105, BP 99/58, then dropped
in to 80s systolic, HR 90s O2sat 93%RA.  Bld cx were sent. UA
showed possible UTI ([**5-29**] WBC & Mod bacteria).  Crt was elevated
at 1.4.  K was 2.9. CXR showed no infiltrates. He received 4L
IVF, vanc & zosyn as well as tylenol and potassium.  He is being
admitted
.
ROS: Positive for for fevers, chills. Pt reports feeling
generally weak.  He denies cough, SOB, CP, although he does have
chronic R shoulder/upper back pain.  No abdominal pain, nausea,
vomiting, diarrhea, melena, hematochezia, hematemesis, dysuria.
No HA/dizziness/paresthesias or weakness.

MEDICAL HISTORY: -Rheumatic heart diseaseStatus post [**First Name8 (NamePattern2) 1495**] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**] & MVR, and
MAZE [**2150-3-12**], on Coumadin
-Atrial fibrillation (previously on amiodarone [**2149**]-[**2150**])
-Pericardial effusion, status post pericardial window.
-Peri-op pleural effusion.
-[**2150-3-10**] Cath: LMCA, LAD, RCX, and RCA showed mild
irregularities
w/o flow limiting stenoses. 2+ MR. 2+ AR. Mild global
hypokinesis. EF 43%

MEDICATION ON ADMISSION: metoprolol 12.5 mg b.i.d.,
Coumadin 2-3.5mg daily
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 100.5, 88, 82/51 RR 19, 96% RA
GEN: slightly tired appearing, NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate or hemorrhagic lesions
NECK: Supple, no LAD, no appreciable JVD
CV: RRR, metallic S1S2, [**1-24**] syst murm at LUSB and apex-->axilla,
no rubs or gallops
PULM: CTAB, though slightly decreased at b/l bases, good air
movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly, no
abdominal bruit appreciated
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema
Skin: Osler's Node on L big toe; ? few petechiae on RLE & L
foremarm
NEURO: alert and orient to self, [**Hospital1 **], [**2153-8-20**], says he's here
b/c he's sick, CN 2-12 intact; moving all limbs; sensation
grossly intact to light touch

FAMILY HISTORY: NC

SOCIAL HISTORY: immigrated to the US in [**2147**]; family live in area
Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Septic shock,Infection and inflammatory reaction due to cardiac device, implant, and graft,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Severe sepsis,Thrombocytopenia, unspecified,Atrial fibrillation,Long-term (current) use of anticoagulants
Meth susc Staph aur sept,Acute respiratry failure,Septic shock,React-cardiac dev/graft,Urin tract infection NOS,Subarachnoid hemorrhage,Severe sepsis,Thrombocytopenia NOS,Atrial fibrillation,Long-term use anticoagul
Admission Date:  [**2153-8-20**]              Discharge Date:   [**2153-8-22**]

Date of Birth:  [**2089-9-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
fevers

Major Surgical or Invasive Procedure:
Intubation
Resuscitation for cardiac asystole

History of Present Illness:
63 year-old Chinese-speaking man with a history of rheumatic
heart disease status post prosthetic MVR & [**First Name3 (LF) 1291**], afib/flutter s/p
MAZE on coumadin, who presents with fevers x 2days.
Interpretation provided by family member.  Mr. [**Known lastname **] had been in
his USOH until two days prior to admission, when he devloped
chills & subjective fevers.  These persisted and his wife noted
some confusion on the day of presentation, noting that he would
not answer her questions appropriately.  He was brought to the
ED for further evaluation.
.
In the ED, vitals were rectal Temp 105, BP 99/58, then dropped
in to 80s systolic, HR 90s O2sat 93%RA.  Bld cx were sent. UA
showed possible UTI ([**5-29**] WBC & Mod bacteria).  Crt was elevated
at 1.4.  K was 2.9. CXR showed no infiltrates. He received 4L
IVF, vanc & zosyn as well as tylenol and potassium.  He is being
admitted
.
ROS: Positive for for fevers, chills. Pt reports feeling
generally weak.  He denies cough, SOB, CP, although he does have
chronic R shoulder/upper back pain.  No abdominal pain, nausea,
vomiting, diarrhea, melena, hematochezia, hematemesis, dysuria.
No HA/dizziness/paresthesias or weakness.


Past Medical History:
-Rheumatic heart diseaseStatus post [**First Name8 (NamePattern2) 1495**] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**] & MVR, and
MAZE [**2150-3-12**], on Coumadin
-Atrial fibrillation (previously on amiodarone [**2149**]-[**2150**])
-Pericardial effusion, status post pericardial window.
-Peri-op pleural effusion.
-[**2150-3-10**] Cath: LMCA, LAD, RCX, and RCA showed mild
irregularities
w/o flow limiting stenoses. 2+ MR. 2+ AR. Mild global
hypokinesis. EF 43%

Social History:
immigrated to the US in [**2147**]; family live in area


Family History:
NC

Physical Exam:
VS: T 100.5, 88, 82/51 RR 19, 96% RA
GEN: slightly tired appearing, NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate or hemorrhagic lesions
NECK: Supple, no LAD, no appreciable JVD
CV: RRR, metallic S1S2, [**1-24**] syst murm at LUSB and apex-->axilla,
no rubs or gallops
PULM: CTAB, though slightly decreased at b/l bases, good air
movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly, no
abdominal bruit appreciated
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema
Skin: Osler's Node on L big toe; ? few petechiae on RLE & L
foremarm
NEURO: alert and orient to self, [**Hospital1 **], [**2153-8-20**], says he's here
b/c he's sick, CN 2-12 intact; moving all limbs; sensation
grossly intact to light touch


Pertinent Results:
CT head [**2153-8-21**]

Extensive bilateral subarachnoid hemorrhage without significant
mass effect, edema, or shift of normally midline structures on
the current study. There is also no definite evidence of
intraventricular blood at this time.



Brief Hospital Course:
63 year-old man w/ a history of rheumatic heart disease s/p St.
[**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**] & MVR in [**2149**] with MAZE for afib, who presented with
fever (as high as 105 rectal) and found  have staph bacteremia.
Patient with sepsis with fever, elevated WBC (11.1), and
hypotension.  Treated for endocarditis as source of sepsis
although TEE showed no vegetations with vanco, cefepime, and
gentamycin. Physical examination revealed osler's node on L big
toe.  He has [**1-24**] syst murmur both at LUSB & apex-->axilla
(?new).  Pt also does not have e/o other infections.  CXR
overall clear.  Urine only has [**5-29**] WBC so less likely that this
is source.  Lactate improving w/ IVF.  Pt mentating clearly &
making urine until [**2153-8-21**] when he had acute event at
approximately 6:30pm when he became acutely unresponsive, had
flaccid paralyis, was noted to have vomited and have been
incontinent of stool, left blown pupil, b/l not constricting to
light. Emergently intubated and head scanned, showed large
subarachnoid hemorrhage.  On arrival back to the floor was
tachycardic.  Rapidly became hypotensive became asystolic,
coded, perfusing rhythm re-established. Heparin and INR
reversed.  Cardiac [**Doctor First Name **] called, agreed with full reversal in
this situation. Neurosurgery consulted.  Recommended mannitol,
no current indication for acute surgery.  Pt maxed out on 5
pressors, received 13+ L IVF, given bicarb for profound
acidemia, also given FFP, factors, vitamin K and protamine.
Family meeting was held, family informed of gravity of pt's
prognosis and expectation that he may not survive the night.
Decision was made to continue aggressive care but to make pt
DNR.  PEEP increased as pt persistently difficult to oxygenate.
On [**2153-8-22**], as patient did not regain any neurologic function and
continued to be hypotensive despite maximal pressor support, and
with O2 sat in 70s despite intubation, family meeting was called
to discuss goals of care and patient was made comfort measures
only. Pressure support was withdrawn, patient extubated, and he
had a quick decline but was comfortable at time of death at
4:45pm [**2153-8-22**] with family at bedside.


Medications on Admission:
metoprolol 12.5 mg b.i.d.,
Coumadin 2-3.5mg daily
MVI


Discharge Medications:
Patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient expired

Discharge Condition:
Patient expired

Discharge Instructions:
Patient expired

Followup Instructions:
Patient expired
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Septic shock,Infection and inflammatory reaction due to cardiac device, implant, and graft,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Severe sepsis,Thrombocytopenia, unspecified,Atrial fibrillation,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: fevers

PRESENT ILLNESS: 63 year-old Chinese-speaking man with a history of rheumatic
heart disease status post prosthetic MVR & [**First Name3 (LF) 1291**], afib/flutter s/p
MAZE on coumadin, who presents with fevers x 2days.
Interpretation provided by family member.  Mr. [**Known lastname **] had been in
his USOH until two days prior to admission, when he devloped
chills & subjective fevers.  These persisted and his wife noted
some confusion on the day of presentation, noting that he would
not answer her questions appropriately.  He was brought to the
ED for further evaluation.
.
In the ED, vitals were rectal Temp 105, BP 99/58, then dropped
in to 80s systolic, HR 90s O2sat 93%RA.  Bld cx were sent. UA
showed possible UTI ([**5-29**] WBC & Mod bacteria).  Crt was elevated
at 1.4.  K was 2.9. CXR showed no infiltrates. He received 4L
IVF, vanc & zosyn as well as tylenol and potassium.  He is being
admitted
.
ROS: Positive for for fevers, chills. Pt reports feeling
generally weak.  He denies cough, SOB, CP, although he does have
chronic R shoulder/upper back pain.  No abdominal pain, nausea,
vomiting, diarrhea, melena, hematochezia, hematemesis, dysuria.
No HA/dizziness/paresthesias or weakness.

MEDICAL HISTORY: -Rheumatic heart diseaseStatus post [**First Name8 (NamePattern2) 1495**] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 1291**] & MVR, and
MAZE [**2150-3-12**], on Coumadin
-Atrial fibrillation (previously on amiodarone [**2149**]-[**2150**])
-Pericardial effusion, status post pericardial window.
-Peri-op pleural effusion.
-[**2150-3-10**] Cath: LMCA, LAD, RCX, and RCA showed mild
irregularities
w/o flow limiting stenoses. 2+ MR. 2+ AR. Mild global
hypokinesis. EF 43%

MEDICATION ON ADMISSION: metoprolol 12.5 mg b.i.d.,
Coumadin 2-3.5mg daily
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 100.5, 88, 82/51 RR 19, 96% RA
GEN: slightly tired appearing, NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate or hemorrhagic lesions
NECK: Supple, no LAD, no appreciable JVD
CV: RRR, metallic S1S2, [**1-24**] syst murm at LUSB and apex-->axilla,
no rubs or gallops
PULM: CTAB, though slightly decreased at b/l bases, good air
movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly, no
abdominal bruit appreciated
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema
Skin: Osler's Node on L big toe; ? few petechiae on RLE & L
foremarm
NEURO: alert and orient to self, [**Hospital1 **], [**2153-8-20**], says he's here
b/c he's sick, CN 2-12 intact; moving all limbs; sensation
grossly intact to light touch

FAMILY HISTORY: NC

SOCIAL HISTORY: immigrated to the US in [**2147**]; family live in area 

### Response:
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Septic shock,Infection and inflammatory reaction due to cardiac device, implant, and graft,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Severe sepsis,Thrombocytopenia, unspecified,Atrial fibrillation,Long-term (current) use of anticoagulants'}
