CHIEF COMPLAINT: Bilateral Pulmonary Emboli

PRESENT ILLNESS: History of Present Illness: 19 yo female with no past medical
history transferred from [**Hospital 1474**] hospital for bilateral PEs.
She was at the gym this morning, began to feel faint and
lightheaded, and on the way to the bathroom, she lost
consciousness. She thinks she may have been unconscious for
about a minute or so, and subsequently EMS was called and she
was transferred to [**Hospital1 1474**]. She denies any dyspnea or chest
pain prior to or after the syncopal event. She denies symptoms
of lower or upper extremity swelling. At [**Hospital1 1474**], she had a
positive d-dimer, then had a CTA chest which showed large right
sided PE obstructing the distal main right pulmonary artery, as
well as other segmental right arteries, and segmental left
arteries as well. She was bolused with heparin there, and
started on a heparin gtt at 1050 units/hr and was transferred to
[**Hospital1 18**] for further management.
.
In the ED, initial vs were: 99.5, 143/107, 18, 97%2L. Her
initial labs showed a normal chemistry and CBC, but a trop of
0.09. She had a re-read of the CT which showed the same findings
as above. Her vitals prior to transfer were 98.1, 85, 134/84,
24, 97%2L. She was given 850 cc of IVFs while she was in the ED.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: [**Female First Name (un) **] (drospirenone and ethinyl estradiol) x 6 months

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, PERRL, EOMI
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic with regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: a/ox3, CNs [**3-15**] intact, strength and sensation intact
throughout

FAMILY HISTORY: Mother with PE 1.5 yrs ago as well as RUE DVT after
thrombophlebitis secondary to IV post partum. Paternal
Grandmother with PE, paternal great uncle #1 with DVT, paternal
great uncle #2 with PE, Maternal Grandfather with CVA

SOCIAL HISTORY: Is a student studying phlebotomy and radiology. She denies
tobacco or drug use. She denies ETOH use. Not sexually active at
this time.
Other pulmonary embolism and infarction,Closed fracture of middle or proximal phalanx or phalanges of hand,Long-term (current) use of anticoagulants,Other fall
Pulm embol/infarct NEC,Fx mid/prx phal, hand-cl,Long-term use anticoagul,Fall NEC
Admission Date:  [**2108-8-11**]              Discharge Date:   [**2108-8-16**]

Date of Birth:  [**2088-10-11**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Bilateral Pulmonary Emboli

Major Surgical or Invasive Procedure:
None

History of Present Illness:
History of Present Illness: 19 yo female with no past medical
history transferred from [**Hospital 1474**] hospital for bilateral PEs.
She was at the gym this morning, began to feel faint and
lightheaded, and on the way to the bathroom, she lost
consciousness. She thinks she may have been unconscious for
about a minute or so, and subsequently EMS was called and she
was transferred to [**Hospital1 1474**]. She denies any dyspnea or chest
pain prior to or after the syncopal event. She denies symptoms
of lower or upper extremity swelling. At [**Hospital1 1474**], she had a
positive d-dimer, then had a CTA chest which showed large right
sided PE obstructing the distal main right pulmonary artery, as
well as other segmental right arteries, and segmental left
arteries as well. She was bolused with heparin there, and
started on a heparin gtt at 1050 units/hr and was transferred to
[**Hospital1 18**] for further management.
.
In the ED, initial vs were: 99.5, 143/107, 18, 97%2L. Her
initial labs showed a normal chemistry and CBC, but a trop of
0.09. She had a re-read of the CT which showed the same findings
as above. Her vitals prior to transfer were 98.1, 85, 134/84,
24, 97%2L. She was given 850 cc of IVFs while she was in the ED.

.
Pt denies chest pain, shortness of breath, pleuritic pain. She
denies any other symptoms. She denies lightheadedness or
dizziness at this time. She reports using OCPs, but denies
smoking history. Her mother was diagnosed with a RUE DVT 1.5 yrs
ago with subsequent PE and was treated with anticoagulation.
Patient has been on OCPs for about 6 months. Of note, she just
started period today. She denies any recent trauma, no MVAs, no
recent surgeries, no melena, no seizure history.


Past Medical History:
None

Social History:
 Is a student studying phlebotomy and radiology. She denies
tobacco or drug use. She denies ETOH use. Not sexually active at
this time.

Family History:
Mother with PE 1.5 yrs ago as well as RUE DVT after
thrombophlebitis secondary to IV post partum. Paternal
Grandmother with PE, paternal great uncle #1 with DVT, paternal
great uncle #2 with PE, Maternal Grandfather with CVA

Physical Exam:
Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, PERRL, EOMI
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic with regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: a/ox3, CNs [**3-15**] intact, strength and sensation intact
throughout


Pertinent Results:
[**2108-8-11**] 08:33PM URINE  UCG-NEGATIVE
[**2108-8-11**] 08:33PM   WBC-11.9* RBC-4.60 HGB-13.0 HCT-37.8 MCV-82
MCH-28.3 MCHC-34.4 RDW-12.5
[**2108-8-11**] 08:33PM   PLT COUNT-174
[**2108-8-11**] 07:57PM   GLUCOSE-87 UREA N-8 CREAT-0.6 SODIUM-140
POTASSIUM-3.6 CHLORIDE-104 TOTAL CO2-22 ANION GAP-18
[**2108-8-11**] 07:57PM   CK(CPK)-65
[**2108-8-11**] 07:57PM   CK-MB-NotDone cTropnT-0.08*
[**2108-8-11**] 07:57PM   CALCIUM-8.7 PHOSPHATE-3.7 MAGNESIUM-1.9
[**2108-8-11**] 07:57PM   PT-13.3 PTT-83.0* INR(PT)-1.1
[**2108-8-11**] 02:10PM   CK-MB-NotDone proBNP-194*
UCx negative

BILAT LOWER EXT VEINS Study Date of [**2108-8-11**] 4:46 PM
IMPRESSION:  No evidence of DVT.

CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2108-8-11**]
IMPRESSION: Extensive bilateral pulmonary emboli involving the
left and right main pulmonary arteries and branches as
characterized above with evidence of right heart strain. These
findings should be correlated
with echocardiography.

Echo:
IMPRESSION: Dilated and hypokinetic right ventricle with
evidence of pressure/volume overload. Mild pulmonary artery
hypertension (may be underestimated). Normal left ventricular
function. No significant valvular abnormality seen.

Right 3rd finger xray: FINDINGS: There is a fracture involving
the volar base of the middle phalanx
of the long finger. This is at the expected attachment of the
flexor
digitorum superficialis tendon.


Brief Hospital Course:
Assessment and Plan: This is a 19 year old with no PMH transfer
from [**Hospital1 1474**] with bilateral PE's.
.
# Massive Pulmonary Embolism: patient was noted to have syncopal
episode while at the gym yesterday, and was taken to [**Hospital 1474**]
hospital where she was found to have b/l PEs. She was
transferred to [**Hospital1 18**] and initially was admitted to the MICU. Pt
did have evidence of right heart strain on both transthoracic
echocardiogram and by EKG. Pt remained hemodynamically stable
and the decision was made against lysis with TPA. Pt was
therefore transferred to the floor several hours later.
Bilateral lower extremity ultrasounds did not show evidence of
DVT. Pt was anticoagulated with heparin gtt throughout her stay
and was bridged to coumadin with 48 hours of overlap (when both
her INR and PTT were therapeutic). She was discharged on
coumadin.
.
Pt's only risk factors for PE are FH of clotting and oral
contraceptives. Pt did not take her contraceptives while in the
hospital and was advised to not take oral contraceptives in the
future. She was also advised to discuss all future contraceptive
decisions (aside from condoms) with her hematologist as other
hormonal contraceptives can also carry an increased risk of
clotting. Pt will follow up with  with her primary care doctor
(who will follow her INR) and hematologist.
.
#S/P FALL: Pt had syncopal episode at gym without hitting her
head. She did have swelling and pain in her right third finger
which was found to have a non-displaced avulsion fracture.
Plastic surgery saw her and gave her a brace for the finger. She
will follow-up in hand clinic.
.


Medications on Admission:
[**Female First Name (un) **] (drospirenone and ethinyl estradiol) x 6 months

Discharge Medications:
1. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO at bedtime.
Disp:*60 Tablet(s)* Refills:*2*
2. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain: Let the doctor who is monitoring your
warfarin (coumadin) know how much acetaminophen (tylenol) you
are taking. Do not take more than 4 g in a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: Pulmonary Emboli, R middle finger fracture
Secondary Diagnoses: none


Discharge Condition:
good; ambulating, breathing without difficulty; requiring low
activity level to avoid tachycardia


Discharge Instructions:
You were admitted to [**Hospital1 **] Hospital because of
several clots in the arteries that go to your lungs (pulmonary
arteries). We looked at your heart with ultrasound (called an
echocardiogram) and monitored your heart rate while you were
here; both the echocardiogram and your heart rate made us think
that your heart is having to work harder than usual to pump
blood through your lung arteries. This means that when you go
home you need to be very calm, walk slowly, not exercise or lift
heavy things, and not go to work until either your primary care
doctor or your hematologist says that you are well enough to do
those things.

You were started on several medicines (heparin and coumadin)
which help to prevent the clots from growing. At this point, the
coumadin levels are high enough to prevent further clotting
without the heparin (which you can only get in the hospital), so
we are sending you home on the coumadin alone.

You should take 4mg of coumadin every day in the evening until
you see your doctor [**First Name (Titles) **] [**Last Name (Titles) 2974**]. He will check your coumadin level
(called an INR) and then he may increase or decrease your dose
based on the blood test. Make sure you discuss your INR and your
coumadin dose before you leave his office on [**Last Name (Titles) 2974**]. If your INR
is not back by the time you leave his office, please make sure
you know what time to call the office to find out what your
coumadin dose should be. They should also be able to tell you
when your next blood test will be (probably sometime next week).


Please return to the hospital for fainting or shortness of
breath. Please call your doctor or return to the hospital for
chest pain or lightheadedness or any other symptoms which are
concerning to you.

Followup Instructions:
You have already made appointments with your primary care doctor
for [**2108-8-17**].

Go to the hand clinic to follow up for your finger fracture; you
have an appointment for [**2108-8-21**] at 9 am, [**Location (un) **] of the
[**Hospital Ward Name 23**] Clinical Center; call [**Telephone/Fax (1) 3009**] if you need to change
this appointment or if you need more information.

You also have the following appointment in the hematology dept
at [**Hospital3 **] Deaconness:
Provider: [**First Name11 (Name Pattern1) 1730**] [**Last Name (NamePattern4) 5056**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2108-9-21**] 9:30



Completed by:[**2108-8-19**]
{'Other pulmonary embolism and infarction,Closed fracture of middle or proximal phalanx or phalanges of hand,Long-term (current) use of anticoagulants,Other fall'}


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: Bilateral Pulmonary Emboli

PRESENT ILLNESS: History of Present Illness: 19 yo female with no past medical
history transferred from [**Hospital 1474**] hospital for bilateral PEs.
She was at the gym this morning, began to feel faint and
lightheaded, and on the way to the bathroom, she lost
consciousness. She thinks she may have been unconscious for
about a minute or so, and subsequently EMS was called and she
was transferred to [**Hospital1 1474**]. She denies any dyspnea or chest
pain prior to or after the syncopal event. She denies symptoms
of lower or upper extremity swelling. At [**Hospital1 1474**], she had a
positive d-dimer, then had a CTA chest which showed large right
sided PE obstructing the distal main right pulmonary artery, as
well as other segmental right arteries, and segmental left
arteries as well. She was bolused with heparin there, and
started on a heparin gtt at 1050 units/hr and was transferred to
[**Hospital1 18**] for further management.
.
In the ED, initial vs were: 99.5, 143/107, 18, 97%2L. Her
initial labs showed a normal chemistry and CBC, but a trop of
0.09. She had a re-read of the CT which showed the same findings
as above. Her vitals prior to transfer were 98.1, 85, 134/84,
24, 97%2L. She was given 850 cc of IVFs while she was in the ED.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: [**Female First Name (un) **] (drospirenone and ethinyl estradiol) x 6 months

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, PERRL, EOMI
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic with regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: a/ox3, CNs [**3-15**] intact, strength and sensation intact
throughout

FAMILY HISTORY: Mother with PE 1.5 yrs ago as well as RUE DVT after
thrombophlebitis secondary to IV post partum. Paternal
Grandmother with PE, paternal great uncle #1 with DVT, paternal
great uncle #2 with PE, Maternal Grandfather with CVA

SOCIAL HISTORY: Is a student studying phlebotomy and radiology. She denies
tobacco or drug use. She denies ETOH use. Not sexually active at
this time. 

### Response:
{'Other pulmonary embolism and infarction,Closed fracture of middle or proximal phalanx or phalanges of hand,Long-term (current) use of anticoagulants,Other fall'}
