CHIEF COMPLAINT: Left foot pain

PRESENT ILLNESS: 71 y/o male with DM 2, CAD severe 3v-d, Paroxysmal AFib, PVD,
ESRD on PD, admitted on [**8-28**] with a L plantar abscess. No signs
of osteo, was managed medically with abx until [**9-5**], pt went for
L SFA/popliteal atherectomy, went to OR for L plantar abscess
debridement. The pt developed post-op rapid A-fib, was treated
with dilt gtt and metoprolol 100 [**Hospital1 **], became hypotensive and
developed trop leak to 1.6, thought [**1-26**] demand ischemia with
hypotension related to the negative intropes. Rate remained
poorly controlled on dilt/metoprolol, amio started orally
without IV load, the pt was transferred to CCU for further
management. Enzymes are trending down.

MEDICAL HISTORY: 1)CAD s/p CABG [**2102**]
2)PVD: s/p fem-[**Doctor Last Name **] bypass in [**12-29**] for cluadication, non-healing
ulcer on [**2-26**] s/p atherectomy of L SFA popliteal tbioperoneal
trunk with angioplasty x 2.  Pt had recent right first toe
amputation and left TMA on [**2107-3-24**].
3)Paroxysmal atrial fibrillation
4)Type II DM: followed by [**Last Name (un) **]
5)Hyperlipidemia
6)Chronic bronchiectasis
7)EF 54%
8)BPH
9)Anemia of chronic illness
10)CRI on daily peritoneal dialysis

MEDICATION ON ADMISSION: Discharge Worksheet-Discharge Medicatons-Last Updated by:
[**Doctor Last Name 30609**],[**Name8 (MD) 30610**], MD on [**9-2**] @ 0953
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Dicloxacillin Sodium 250 mg Capsule Sig: One (1) Capsule PO
Q6H (every 6 hours) for 14 total days.
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
6. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
11. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
12. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).

ALLERGIES: Sulfonamides / Amlodipine / Percocet

PHYSICAL EXAM: O: Vitals: 95.1 110/56 78 22 91%RA increased to 96%2LNC
FS: 135
Gen: NAD, lying in bed, somnolent
Neck: JVD@7cm
Cardio: RRR, S1S2,no m/r/g appreciated
Resp: CTAB.
Abd: soft, nt, nd, +BS. diffuse ecchymoses.
Ext: both LE bandaged and in protective boots
Neuro: PERRL. AAOx2

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He has been an active pharmacist until the surgery in [**Month (only) 958**]. He
Infection (chronic) of amputation stump,Cellulitis and abscess of leg, except foot,Atherosclerosis of native arteries of the extremities with gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,End stage renal disease,Anemia, unspecified
Infection amputat stump,Cellulitis of leg,Ath ext ntv art gngrene,DMII wo cmp uncntrld,Subendo infarct, initial,Atrial fibrillation,CHF NOS,Chr airway obstruct NEC,Pneumonia, organism NOS,Urin tract infection NOS,End stage renal disease,Anemia NOS
Admission Date:  [**2107-8-28**]              Discharge Date:   [**2107-9-24**]

Date of Birth:  [**2036-8-7**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfonamides / Amlodipine / Percocet

Attending:[**First Name3 (LF) 759**]
Chief Complaint:
Left foot pain

Major Surgical or Invasive Procedure:
L foot debridement 9/14
L femoral artery, popliteal artery atherectomy [**9-5**]

History of Present Illness:
71 y/o male with DM 2, CAD severe 3v-d, Paroxysmal AFib, PVD,
ESRD on PD, admitted on [**8-28**] with a L plantar abscess. No signs
of osteo, was managed medically with abx until [**9-5**], pt went for
L SFA/popliteal atherectomy, went to OR for L plantar abscess
debridement. The pt developed post-op rapid A-fib, was treated
with dilt gtt and metoprolol 100 [**Hospital1 **], became hypotensive and
developed trop leak to 1.6, thought [**1-26**] demand ischemia with
hypotension related to the negative intropes. Rate remained
poorly controlled on dilt/metoprolol, amio started orally
without IV load, the pt was transferred to CCU for further
management. Enzymes are trending down.

Past Medical History:
1)CAD s/p CABG [**2102**]
2)PVD: s/p fem-[**Doctor Last Name **] bypass in [**12-29**] for cluadication, non-healing
ulcer on [**2-26**] s/p atherectomy of L SFA popliteal tbioperoneal
trunk with angioplasty x 2.  Pt had recent right first toe
amputation and left TMA on [**2107-3-24**].
3)Paroxysmal atrial fibrillation
4)Type II DM: followed by [**Last Name (un) **]
5)Hyperlipidemia
6)Chronic bronchiectasis
7)EF 54%
8)BPH
9)Anemia of chronic illness
10)CRI on daily peritoneal dialysis

PAST SURGICAL HISTORY: Includes angioplasties of the left
common femoral, superficial femoral, tibioperoneal trunk in
[**2106-11-24**], left CEA in [**2102**] at [**Hospital1 2025**], coronary artery
bypasses, LIMA to the LAD and saphenous [**Hospital1 5703**] graft to the
obtuse marginal 1 and the ramus intermedius in [**2103-11-24**], cholecystectomy with exploratory lap with repair of
liver lacerations in [**2105-11-23**], PD catheter placement in
[**2106-9-24**], right eye cataract with intraocular lens, right
eye vitrectomy, right common femoral artery to posterior
tibial bypass graft with in situ saphenous [**Year (4 digits) 5703**] in [**2107-9-24**].


Social History:
He has been an active pharmacist until the surgery in [**Month (only) 958**]. He

is married and lives with his spouse. [**Name (NI) **] used to ambulate with
a cane but now requiring more assistance. He is a former smoker

of 1.5 pack per day x25 years and has not smoked for 20 years.
He denies alcohol use.


Family History:
Noncontributory


Physical Exam:
O: Vitals: 95.1 110/56 78 22 91%RA increased to 96%2LNC
FS: 135
Gen: NAD, lying in bed, somnolent
Neck: JVD@7cm
Cardio: RRR, S1S2,no m/r/g appreciated
Resp: CTAB.
Abd: soft, nt, nd, +BS. diffuse ecchymoses.
Ext: both LE bandaged and in protective boots
Neuro: PERRL. AAOx2

Pertinent Results:
REPORTS:
ATHERECTOMY:
1. Access: 7F antegrade in the left common femoral artery.
2. Left lower extremity: The SFA had severe diffuse disease. The
popliteal artery had severe diffuse disease. The PT was patent
to the
foot. The distal PT had mild disease at the level of the
previous PTA
site.
3. Successful atherectomy of the LSFA and popliteal artery with
the SX
and LSF SilverHawk device with excellent results (see PTCA
comments).

[**9-16**] EKG:
Sinus rhythm. Biatrial abnormality. Low limb lead voltage. Q
waves in the
anterior leads with ST segment elevation consistent with acute
infarction or
aneurysm formation. Diffuse non-specific ST-T wave changes.
Compared to the
previous tracing no significant change

[**8-28**] CXR:
IMPRESSION: Interstitial pulmonary edema and congestive heart
failure

[**9-16**] CXR:
FINDINGS: The left-sided central venous dialysis catheter ends
at the right atrium. The patient is status post median
sternotomy with normal alignment of the sutures. The
cardiomediastinal silhouette is stable. There is slight
improvement in the pulmonary edema.

[**9-21**] CXR:
Mild interstitial edema has improved substantially since
[**9-15**], less so since [**9-16**]. Small areas of
residual consolidation are present in the perihilar portions of
both lungs. A region of peribronchial infiltration in the right
lung apex may represent a new or recurrent pneumonia. Follow up
is advised.

MICRO:
 WOUND CULTURE L FOOT (Final [**2107-8-31**]):
      Due to mixed bacterial types ( >= 3 colony types) an
abbreviated
      workup is performed appropriate to the isolates recovered
from the
      site (including a screen for Pseudomonas aeruginosa,
Staphylococcus
      aureus and beta streptococcus).
      STAPH AUREUS COAG +.    MODERATE GROWTH.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.
      GRAM NEGATIVE ROD(S).    SPARSE GROWTH OF TWO COLONIAL
MORPHOLOGIES.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    SPARSE GROWTH.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------<=0.25 S
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------  0.25 S
OXACILLIN-------------     1 S
PENICILLIN------------ =>0.5 R

LABS:

[**2107-9-17**] 08:20AM BLOOD WBC-10.8 RBC-3.86* Hgb-12.0* Hct-37.0*
MCV-96 MCH-31.2 MCHC-32.6 RDW-16.2* Plt Ct-437
[**2107-9-8**] 05:00AM BLOOD WBC-16.3* RBC-2.59* Hgb-8.3* Hct-26.3*
MCV-102* MCH-32.1* MCHC-31.6 RDW-16.7* Plt Ct-350
[**2107-8-28**] 11:50AM BLOOD WBC-15.2*# RBC-3.55* Hgb-11.5* Hct-35.8*
MCV-101* MCH-32.5* MCHC-32.2 RDW-16.5* Plt Ct-340
[**2107-8-28**] 11:50AM BLOOD Neuts-77.9* Lymphs-17.4* Monos-3.8
Eos-0.7 Baso-0.2
[**2107-8-28**] 11:50AM BLOOD Hypochr-2+ Anisocy-1+ Poiklo-1+
Macrocy-3+
[**2107-8-30**] 09:55AM BLOOD Hgb A-97.8 Hgb S-0 Hgb C-0 Hgb A2-2.2*
[**2107-9-17**] 08:20AM BLOOD Plt Ct-437
[**2107-9-16**] 04:16AM BLOOD PT-17.9* PTT-29.8 [**Month/Day/Year 263**](PT)-2.2
[**2107-9-15**] 06:02AM BLOOD PT-21.1* PTT-36.4* [**Month/Day/Year 263**](PT)-3.2
[**2107-9-14**] 06:36AM BLOOD PT-24.0* PTT-43.3* [**Month/Day/Year 263**](PT)-4.2
[**2107-9-13**] 05:48AM BLOOD PT-23.8* PTT-44.8* [**Month/Day/Year 263**](PT)-4.1
[**2107-9-6**] 06:18AM BLOOD PT-15.9* PTT-37.5* [**Month/Day/Year 263**](PT)-1.7
[**2107-9-4**] 10:30AM BLOOD PT-34.2* [**Month/Day/Year 263**](PT)-8.9
[**2107-9-4**] 05:10AM BLOOD PT-31.6* [**Month/Day/Year 263**](PT)-7.5
[**2107-8-28**] 11:50AM BLOOD PT-16.7* PTT-29.7 [**Month/Day/Year 263**](PT)-1.8
[**2107-9-17**] 08:20AM BLOOD Glucose-135* Creat-4.3* Na-134 K-3.9
Cl-97 HCO3-23 AnGap-18
[**2107-9-16**] 04:16AM BLOOD Glucose-106* UreaN-33* Creat-3.4* Na-140
K-4.0 Cl-101 HCO3-27 AnGap-16
[**2107-9-15**] 06:02AM BLOOD Glucose-131* UreaN-31* Creat-3.3* Na-136
K-4.2 Cl-98 HCO3-25 AnGap-17
[**2107-9-4**] 05:10AM BLOOD Glucose-102 UreaN-36* Creat-3.3* Na-136
K-4.8
[**2107-8-28**] 11:50AM BLOOD Glucose-229* UreaN-42* Creat-3.3* Na-136
K-5.5* Cl-96 HCO3-27 AnGap-19
[**2107-8-30**] 08:10AM BLOOD Glucose-207* UreaN-54* Creat-3.7* Na-138
K-4.3 Cl-98 HCO3-24 AnGap-20
[**2107-9-11**] 06:06AM BLOOD ALT-21 AST-15 LD(LDH)-315* AlkPhos-120*
TotBili-0.4
[**2107-9-10**] 03:34PM BLOOD CK(CPK)-69
[**2107-9-6**] 05:50PM BLOOD CK(CPK)-269*
[**2107-8-30**] 09:55AM BLOOD ALT-44* AST-36 AlkPhos-240* Amylase-107*
TotBili-0.4
[**2107-8-30**] 09:55AM BLOOD Lipase-12
[**2107-9-10**] 03:34PM BLOOD CK-MB-NotDone cTropnT-2.51*
[**2107-9-8**] 05:00AM BLOOD CK-MB-9
[**2107-9-7**] 09:20PM BLOOD CK-MB-10 MB Indx-8.1* cTropnT-1.41*
[**2107-9-7**] 01:05PM BLOOD CK-MB-13* MB Indx-9.4* cTropnT-1.59*
[**2107-9-6**] 05:50PM BLOOD CK-MB-30* MB Indx-11.2* cTropnT-1.28*
[**2107-9-6**] 11:42AM BLOOD CK-MB-42* MB Indx-11.8* cTropnT-1.05*
[**2107-9-6**] 05:50AM BLOOD CK-MB-30* MB Indx-9.8* cTropnT-0.62*
[**2107-9-17**] 08:20AM BLOOD Albumin-2.6* Calcium-8.5 Phos-2.1* Mg-2.1
[**2107-9-16**] 04:16AM BLOOD Calcium-9.1 Phos-1.7*# Mg-2.1
[**2107-9-15**] 06:02AM BLOOD Mg-1.9
[**2107-9-3**] 09:30AM BLOOD Albumin-2.6* Calcium-8.4 Phos-5.4* Mg-1.7
[**2107-8-30**] 08:10AM BLOOD Calcium-8.4 Phos-5.8*# Mg-1.7
[**2107-8-30**] 01:45PM BLOOD %HbA1c-5.8 [Hgb]-DONE [A1c]-DONE
[**2107-9-8**] 05:00AM BLOOD VitB12-278 Folate-GREATER TH
[**2107-8-30**] 01:45PM BLOOD Triglyc-89 HDL-36 CHOL/HD-2.3 LDLcalc-28
[**2107-8-30**] 09:55AM BLOOD Triglyc-95 HDL-37 CHOL/HD-3.6 LDLcalc-77
[**2107-9-8**] 05:00AM BLOOD TSH-14*
[**2107-9-8**] 05:00AM BLOOD Free T4-0.9*
[**2107-8-30**] 01:45PM BLOOD Free T4-1.2
[**2107-9-9**] 01:30PM BLOOD Vanco-13.6*
[**2107-9-3**] 09:30AM BLOOD Vanco-3.7*
[**2107-9-14**] 06:36AM BLOOD Digoxin-1.2
[**2107-9-11**] 06:06AM BLOOD Digoxin-1.0
[**2107-9-13**] 08:12AM BLOOD Type-ART Temp-37.8 pO2-70* pCO2-52*
pH-7.36 calHCO3-31* Base XS-2
[**2107-9-10**] 11:21AM BLOOD Type-ART pO2-68* pCO2-37 pH-7.44
calHCO3-26 Base XS-0
[**2107-9-8**] 09:52PM BLOOD Type-ART pO2-92 pCO2-34* pH-7.47*
calHCO3-25 Base XS-1 Intubat-NOT INTUBA
[**2107-9-6**] 06:09AM BLOOD Type-ART pO2-153* pCO2-34* pH-7.42
calHCO3-23 Base XS--1
[**2107-9-8**] 09:52PM BLOOD Lactate-2.9*
[**2107-9-6**] 06:09AM BLOOD Lactate-1.7
[**2107-8-28**] 11:57AM BLOOD Glucose-214* Lactate-2.8* K-5.0
[**2107-9-13**] 08:12AM BLOOD freeCa-1.18
[**2107-9-8**] 09:52PM BLOOD freeCa-1.14
[**2107-9-6**] 06:09AM BLOOD freeCa-1.13

Brief Hospital Course:
71 y/o male with severe PVD s/p multiple interventions,
paroxysmal AFib, CAD s/p CABG, CHF EF 30%, ESRD on HD, DM2. Pt
initially managed in the CCU, improved with fluid management
with hemodialysis and control of [**Hospital 30608**] transferred to floor.
.
1. Respiratory distress/CHF - pt initially develop post-op
decompensation [**1-26**] AFib with rapid ventricular resopnse as well
as fluid overload.  Pt continued on hemodialysis while inpatient
with plans to eventually transfer back to peritoneal dialysis
only.  After initiation of amiodarone, and lopressor pt remained
in NSR.  In addition, started on captopril for CHF.  CXR to
follow CHF and ? PNA showed improvement of CHF but still some
question of pneumonia.  Pt was on Zosyn inpatient, with plans to
switch to clindamycin for his cellulitis and to cover any
possibly pulmonary infection.  Pt will need 2 wks of antibiotics
after discharge until [**10-7**].
.
2. Mental status changes: initially developed in the setting of
infection, multiple pain meds, and ?ICU delirium.
-cont holding all sedating meds, gabapentin, amitrytiline
-lowest necessary dose of dilaudid.
-stopped haldol, use zyprexa as needed
-depression may also be contributing, and pt was started on
celexa 10mg daily on [**9-19**].
Mental status improved and patient was fully alert and oriented
at discharge with appropriate affect.
.
3. Pain syndrome:
-patient with multiple sensitivities previously.  Managed with
Dilaudid po 2mg q4hrs prn, in addition started MSContin 15mg PO
BID 2 d prior to discharge, which he tolerated well.
.
4. Paroxysmal Afib: currently in sinus rhythm. Hemodynamically
stable when in a-fib.
-cont amiodarone 200mg daily (may interact with warfarin)
-continue metoprolol 50 tid.
-cont coumadin at 2mg po [**Name (NI) **], pt will need [**Name (NI) 263**] check (goal [**1-27**])
and may need adjustment of doses
.
5. CAD: No active coronary ischemia. Trops trended down from
demand ischemia with hypotension. trop peak 1.6 on [**9-7**], trended
down.
-cont aspirin, plavix, BB, statin, ACE
-monitor HCT, keep > 30, no obvious bleeding.
.
6. PVD: s/p L SFA/[**Doctor Last Name **] atherectomy [**9-7**]. debridement of L foot
abscess. OSSA from foot.
-continue asa, plavix, statin, bb
-on zosyn for 2 wks while inpatient, ok to switch to po per
vascular surgery, will continue additional two weeks of
clindamycin 450 mg po q6hrs.
.
7. ESRD: On HD, with plans to swithc back to peritoneal
dialysis.
-Renal following, HD initiated as peritoneal dialysis was not
sufficient to control fluid status. Presently much better
controlled, may possibly return to peritoneal dialysis only
eventually.  Pt received dialysis during the day of discharge in
AM, he has hx of some mild hypotension to SBP of 90s following
dialysis, but has not been symptomatic from this.
.
8. F/E/N: taking PO with Nepro supplements.  Nutrition
following, monitoring calorie count.
.
9. DM2- RISS with NPH 22 Units qAM and 6 Units qPM. Cont to
follow and titrate as needed.
.
10. Proph: Anticoagulated on warfarin. Bowel regimen. PPI
.
11. dispo: to inpatient rehab, follow-up with vascular surgery
and PCP.


Medications on Admission:
Discharge Worksheet-Discharge Medicatons-Last Updated by:
[**Doctor Last Name 30609**],[**Name8 (MD) 30610**], MD on [**9-2**] @ 0953
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Dicloxacillin Sodium 250 mg Capsule Sig: One (1) Capsule PO
Q6H (every 6 hours) for 14 total days.
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
6. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
11. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
12. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
3. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Ascorbic Acid 500 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Albuterol Sulfate 0.083 % Solution Sig: One (1) nebulizer
Inhalation Q6H (every 6 hours) as needed.
8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
10. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
11. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every
4 hours) as needed.
12. Warfarin 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
15. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).
16. Gentamicin 0.1 % Cream Sig: One (1) appl Topical  qd ():
with PD changes.
17. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
18. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for nausea.
19. Clindamycin HCl 300 mg Capsule Sig: Four [**Age over 90 1230**]y (450)
mg PO four times a day for 14 days.
Disp:*86 capsules* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 30611**]

Discharge Diagnosis:
Left leg cellulitis


Discharge Condition:
stable


Discharge Instructions:
Please continue prescribed antibiotics (clindamycin).  Continue
hemodialysis at outpatient dialysis center. Return to emergency
room if signs of infection occurs such as temperatures greater
than 101.4, increasing pain, redness in left lower extremity or
any discharge from previous incision.  Call if there any other
questions or concerns.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 1391**] in two weeks. Please call ([**Telephone/Fax (1) 29063**]

Call pt's PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 3109**], [**First Name3 (LF) **] [**Telephone/Fax (1) 3110**] to schedule f/u
appointment in the next 2 weeks.



Completed by:[**2107-9-24**]
{'Infection (chronic) of amputation stump,Cellulitis and abscess of leg, except foot,Atherosclerosis of native arteries of the extremities with gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,End stage renal disease,Anemia, unspecified'}


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: Left foot pain

PRESENT ILLNESS: 71 y/o male with DM 2, CAD severe 3v-d, Paroxysmal AFib, PVD,
ESRD on PD, admitted on [**8-28**] with a L plantar abscess. No signs
of osteo, was managed medically with abx until [**9-5**], pt went for
L SFA/popliteal atherectomy, went to OR for L plantar abscess
debridement. The pt developed post-op rapid A-fib, was treated
with dilt gtt and metoprolol 100 [**Hospital1 **], became hypotensive and
developed trop leak to 1.6, thought [**1-26**] demand ischemia with
hypotension related to the negative intropes. Rate remained
poorly controlled on dilt/metoprolol, amio started orally
without IV load, the pt was transferred to CCU for further
management. Enzymes are trending down.

MEDICAL HISTORY: 1)CAD s/p CABG [**2102**]
2)PVD: s/p fem-[**Doctor Last Name **] bypass in [**12-29**] for cluadication, non-healing
ulcer on [**2-26**] s/p atherectomy of L SFA popliteal tbioperoneal
trunk with angioplasty x 2.  Pt had recent right first toe
amputation and left TMA on [**2107-3-24**].
3)Paroxysmal atrial fibrillation
4)Type II DM: followed by [**Last Name (un) **]
5)Hyperlipidemia
6)Chronic bronchiectasis
7)EF 54%
8)BPH
9)Anemia of chronic illness
10)CRI on daily peritoneal dialysis

MEDICATION ON ADMISSION: Discharge Worksheet-Discharge Medicatons-Last Updated by:
[**Doctor Last Name 30609**],[**Name8 (MD) 30610**], MD on [**9-2**] @ 0953
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Dicloxacillin Sodium 250 mg Capsule Sig: One (1) Capsule PO
Q6H (every 6 hours) for 14 total days.
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
6. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
11. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
12. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).

ALLERGIES: Sulfonamides / Amlodipine / Percocet

PHYSICAL EXAM: O: Vitals: 95.1 110/56 78 22 91%RA increased to 96%2LNC
FS: 135
Gen: NAD, lying in bed, somnolent
Neck: JVD@7cm
Cardio: RRR, S1S2,no m/r/g appreciated
Resp: CTAB.
Abd: soft, nt, nd, +BS. diffuse ecchymoses.
Ext: both LE bandaged and in protective boots
Neuro: PERRL. AAOx2

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He has been an active pharmacist until the surgery in [**Month (only) 958**]. He 

### Response:
{'Infection (chronic) of amputation stump,Cellulitis and abscess of leg, except foot,Atherosclerosis of native arteries of the extremities with gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,End stage renal disease,Anemia, unspecified'}
