CHIEF COMPLAINT: Necrotizing fasciitis

PRESENT ILLNESS: Mr. [**Known lastname 71818**] is a 27-year-old gentleman who 12
days ago incurred an injury to the right lower leg while
moving a refrigerator. He subsequently developed swelling,
induration and erythema. Over the course of this last 2-3
days the pain and swelling had increased. Over the course of
this day, the erythema had spread dramatically. On
examination the patient had boggy edema circumferentially.
There were numerous bullae with tense clear fluid. The patient
was unable to dorsiflex his foot and he was in a tremendous
amount of pain.8 days after inciting event was taken to OR for
nec fascitis.

MEDICAL HISTORY: alcoholism by report

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant etoh use.
Necrotizing fasciitis,Struck accidentally by falling object,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group A
Necrotizing fasciitis,Struck by falling object,Streptococcus group a
Admission Date:  [**2176-3-29**]              Discharge Date:   [**2176-4-12**]

Date of Birth:  [**2148-10-31**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5883**]
Chief Complaint:
Necrotizing fasciitis

Major Surgical or Invasive Procedure:
1.  Debridement and irrigation of right lower portion of leg
    (circumferential). Application of wound VAC dressing.
2.  Skin graft


History of Present Illness:
Mr. [**Known lastname 71818**] is a 27-year-old gentleman who 12
days ago incurred an injury to the right lower leg while
moving a refrigerator. He subsequently developed swelling,
induration and erythema. Over the course of this last 2-3
days the pain and swelling had increased. Over the course of
this day, the erythema had spread dramatically. On
examination the patient had boggy edema circumferentially.
There were numerous bullae with tense clear fluid. The patient
was unable to dorsiflex his foot and he was in a tremendous
amount of pain.8 days after inciting event was taken to OR for
nec fascitis.


Past Medical History:
alcoholism by report

Social History:
Significant etoh use.

Pertinent Results:
[**2176-3-29**] 03:51PM   COMMENTS-GREEN TOP
[**2176-3-29**] 03:51PM   LACTATE-1.4
[**2176-3-29**] 03:35PM   GLUCOSE-103 UREA N-10 CREAT-0.9 SODIUM-130*
POTASSIUM-3.0* CHLORIDE-87* TOTAL CO2-29 ANION GAP-17
[**2176-3-29**] 03:35PM   estGFR-Using this
[**2176-3-29**] 03:35PM   WBC-23.0* RBC-5.20 HGB-15.2 HCT-42.5 MCV-82
MCH-29.1 MCHC-35.7* RDW-13.7
[**2176-3-29**] 03:35PM   NEUTS-93.2* BANDS-0 LYMPHS-3.8* MONOS-2.6
EOS-0.4 BASOS-0.1
[**2176-3-29**] 03:35PM   HYPOCHROM-NORMAL ANISOCYT-1+
POIKILOCY-OCCASIONAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-OCCASIONAL
[**2176-3-29**] 03:35PM   PLT SMR-NORMAL PLT COUNT-208

Brief Hospital Course:
The patient was admitted [**3-29**] and was debrided in the OR the
same day by General Surgery. The patient was placed on IV
antibiotics. Plastic Surgery was consulted for skin grafting.
The patient was taken again to the OR by General Surgery [**4-1**]
for debridement and a vac dressing was placed.  On [**4-4**], the
Plastic Surgery team took the patient to the OR for skin graft.
He had a VAC dressing in place for 5 days.  Upon removal of the
VAC dressing, the graft was noted to have excellent take.

The patient's hosptal course has been complicated by the
following:
1.  Increased creatinine.  Baseline 0.6.  Up to 1.5.  On
discharge, creatinine was 1.1
2.  Low hematocrit noted on [**4-6**] - 18.8.  The patient was
transfused 2 units PRBCs.
3.  Personality changes.  Pscyhiatric consult was obtained.  The
patient was started on remeron qhs instead of ambien and the
following labs were sent per their recommendations: vitamin B12,
folate, RPR, TSH.


Medications on Admission:
none

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Amoxicillin 500 mg Capsule Sig: One (1) Capsule PO three
times a day for 2 weeks.
Disp:*42 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Necrotizing faciitis of the right lower leg


Discharge Condition:
Stable


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:

* Temperature greater than 101.5 F
* Sloughing of the skin grafted to your lower leg
* Pain not controlled by your pain medications
* Increasing redness, pain, or drainage from your right lower
leg


Followup Instructions:
Follow up with Dr. [**First Name (STitle) **] in clinic next week.  Please call ([**Telephone/Fax (1) 71819**] to schedule your appointment.
{'Necrotizing fasciitis,Struck accidentally by falling object,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group A'}


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: Necrotizing fasciitis

PRESENT ILLNESS: Mr. [**Known lastname 71818**] is a 27-year-old gentleman who 12
days ago incurred an injury to the right lower leg while
moving a refrigerator. He subsequently developed swelling,
induration and erythema. Over the course of this last 2-3
days the pain and swelling had increased. Over the course of
this day, the erythema had spread dramatically. On
examination the patient had boggy edema circumferentially.
There were numerous bullae with tense clear fluid. The patient
was unable to dorsiflex his foot and he was in a tremendous
amount of pain.8 days after inciting event was taken to OR for
nec fascitis.

MEDICAL HISTORY: alcoholism by report

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant etoh use. 

### Response:
{'Necrotizing fasciitis,Struck accidentally by falling object,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group A'}
