CHIEF COMPLAINT: The patient is an 83 year old female status
post atrial ablation, status post gastric ulcer perforation
repair, status post pneumothorax after internal jugular
placement, Methicillin-resistant Staphylococcus aureus,
sepsis, Clostridium difficile.

PRESENT ILLNESS: This is a complicated patient
who essentially was admitted to [**Hospital6 2018**] for EP ablation.  The patient had been admitted to
[**Hospital1 **]-Gluver on [**2-10**] through [**2-24**].  The
patient complained of left heart palpitations with weakness,
dry cough, no nausea, fever, chills or vomiting.  The patient
did have a little bit of yellow mucous when social history
awoke on [**2-10**] with palpitations, notified her primary
care physician who noted [**Name Initial (PRE) **] heartrate of 180 and sent her to
the Emergency Room.  The patient did have a history of atrial
tachycardia but it had been quiescent.  The patient had a
long ventriculoperitoneal tachycardiac narrow complex at 139,
a Dopamine drip was terminated but recurred.  Sotalol and
Metoprolol was added.  Cardizem eventually was made p.o.
Blood pressure had been limiting.  On [**2-12**] ? the
patient had had surgery for repair of gastric ulcer
perforation.  Records are not available at this time
regarding that procedure.  The patient had near total gastric
outlet obstruction, silk suture closed and placement of
jejunostomy tube and gastrostomy tube.  Right internal
jugular line was placed at the same time.  It was hard to
control the patient's arrhythmias and was originally
transferred to Dr.[**Name (NI) 1565**] service for EP ablation.
However, the procedure was cancelled secondary to the patient
developing a fever.  On transfer to the Medicine Intensive
Care Unit the patient denies shortness of breath, chest pain,
dizziness and was evaluated in the Medicine Intensive Care
Unit.

MEDICAL HISTORY: Significant for hypothyroidism,
hypertension, paroxysmal atrial fibrillation treated with
Verapamil and Digoxin with no recent episodes, status post
appendectomy, depression status post total abdominal
hysterectomy, status post motor vehicle accident.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with sister, no children.  She has
five siblings.
Paroxysmal supraventricular tachycardia,Iatrogenic pneumothorax,Infection of colostomy or enterostomy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Unspecified acquired hypothyroidism
Parox atrial tachycardia,Iatrogenic pneumothorax,Colosty/enterost infectn,Urin tract infection NOS,Int inf clstrdium dfcile,Mth sus Stph aur els/NOS,Drug dermatitis NOS,Adv eff quinoline,Hypothyroidism NOS
Admission Date:  [**2152-2-25**]       Discharge Date:  [**2152-3-4**]


Service:

CHIEF COMPLAINT:  The patient is an 83 year old female status
post atrial ablation, status post gastric ulcer perforation
repair, status post pneumothorax after internal jugular
placement, Methicillin-resistant Staphylococcus aureus,
sepsis, Clostridium difficile.

HISTORY OF PRESENT ILLNESS:  This is a complicated patient
who essentially was admitted to [**Hospital6 2018**] for EP ablation.  The patient had been admitted to
[**Hospital1 **]-Gluver on [**2-10**] through [**2-24**].  The
patient complained of left heart palpitations with weakness,
dry cough, no nausea, fever, chills or vomiting.  The patient
did have a little bit of yellow mucous when social history
awoke on [**2-10**] with palpitations, notified her primary
care physician who noted [**Name Initial (PRE) **] heartrate of 180 and sent her to
the Emergency Room.  The patient did have a history of atrial
tachycardia but it had been quiescent.  The patient had a
long ventriculoperitoneal tachycardiac narrow complex at 139,
a Dopamine drip was terminated but recurred.  Sotalol and
Metoprolol was added.  Cardizem eventually was made p.o.
Blood pressure had been limiting.  On [**2-12**] ? the
patient had had surgery for repair of gastric ulcer
perforation.  Records are not available at this time
regarding that procedure.  The patient had near total gastric
outlet obstruction, silk suture closed and placement of
jejunostomy tube and gastrostomy tube.  Right internal
jugular line was placed at the same time.  It was hard to
control the patient's arrhythmias and was originally
transferred to Dr.[**Name (NI) 1565**] service for EP ablation.
However, the procedure was cancelled secondary to the patient
developing a fever.  On transfer to the Medicine Intensive
Care Unit the patient denies shortness of breath, chest pain,
dizziness and was evaluated in the Medicine Intensive Care
Unit.

PAST MEDICAL HISTORY:  Significant for hypothyroidism,
hypertension, paroxysmal atrial fibrillation treated with
Verapamil and Digoxin with no recent episodes, status post
appendectomy, depression status post total abdominal
hysterectomy, status post motor vehicle accident.

SOCIAL HISTORY:  Lives with sister, no children.  She has
five siblings.

MEDICATIONS ON ARRIVAL:
Verapamil 120 b.i.d.
Aspirin q.d.
Synthroid 100 mcg q.d.
[**Doctor First Name **] 60 mg p.o. b.i.d. prn
Digoxin .125 mg times one year

On transfer the patient was on:
Subcutaneous Heparin
Sotalol 80 mg b.i.d., held
Risperdal 5 mg p.o. q. h.s.
Cardizem 60 mg p.o. q.i.d., held
Synthroid 100 mcg q.d.
Protonix 40 mg q.d.
Metoprolol 50 mg q. 6 hours, held

ALLERGIES:  No known drug allergies

HOSPITAL COURSE:  On arrival at the Medicine Intensive Care
Unit the patient had a temperature of 98.2.  Pulse was in the
160s.  Blood pressure was 112/60.  Respirations 20.  Room
saturations, oxygen 95 to 98%.  The patient weighed 54.7.
General:  The patient is an elderly female in no apparent
distress, lying in bed.  Head, eyes, ears, nose and throat
examination:  Extraocular movements intact.  Oropharynx
clear.  Dry tongue.  Left pupil, round and reactive to light.
Heart examination:  Tachycardiac, 160 to 180, S1 and S2
within normal limits, clear.  Lung examination, clear to
auscultation bilaterally.  Extremities, no cyanosis, clubbing
or edema.  Abdominal examination, tender suprapubic, midline
vertical scar incision, positive bowel sounds, erythema and
pus coming from the gastrostomy tube site.

LABORATORY DATA:  Studies at an outside hospital,
computerized tomography scan noted right greater than left
pleural effusion, ascites free air.  Bilateral renal cysts.
Electrocardiogram on [**2-25**] noted supraventricular
tachycardia, 160s, left axis deviation, scalloped 1, 2,
flatter ST waves in V2 through V6.  White count on admission
was 16, hemoglobin 13.3, hematocrit 41.3, platelet count 230,
neutrophils 85, lymphocytes 10, monocytes 2.7, eosinophils
1.1, basophils .5.  PT 12.9, PTT 25, INR 1.2.  Glucose 246,
BUN 26, creatinine .9, sodium 140, potassium 4.4, chloride
104, bicarbonate 25.  Clostridium difficile positive for
stool on [**2152-2-26**].  Methicillin-resistant
Staphylococcus aureus positive at gastrostomy tube site on
[**2152-2-26**].  Methicillin-resistant Staphylococcus
aureus positive for urine on [**2152-2-25**].

HOSPITAL COURSE:  On [**2-11**] at the outside hospital she
was in normal sinus rhythm, within normal limits.  On
[**2-17**], narrow tachycardia, supraventricular tachycardia
120s to 130 with rare related ST changes.  The patient was
placed on Telemetry.  Rate was in the 180s after examination.
Repeat blood pressure noted the patient to be in 80s/40s. The
patient was then sent to the medical floor for fever workup.
Diltiazem drip was started for tachycardia.  The patient
became hypotensive.  The patient was transferred to the
Coronary Care Unit for treatment of hypotension and
concomitant atrial tachycardia as well as fever workup.  On
[**2152-2-27**], the patient was noted to have a right
pneumothorax, status post right internal jugular line
placement.  Chest tube was placed.  The patient was also
noted to have Methicillin-resistant Staphylococcus aureus in
the urine and gastrotomy tube.  Esmolol drip and
Neosynephrine drip were started for her hypotension.  On
[**2-29**], the patient underwent the ablation procedure.
Esmolol and Amiodarone were discontinued.  The patient was
weaned off of Neosynephrine.  On [**3-1**], the patient was
taken off of pressors and was placed on maintenance fluid.
The patient was also noted to have Clostridium difficile.
The patient was transferred to the floor on [**2152-3-1**].  Chart was reviewed and the patient was seen and
examined.

In summary, the patient is an 83 year old female with
hypertension, hypothyroidism, depression, atrial tachycardia,
transferred from the outside hospital status post surgical
repair for a duodenal ulcer and was sent to [**Hospital6 1760**] for EP ablation for atrial
tachycardia.  The patient was admitted to Coronary Care Unit
secondary to decreased blood pressure in the setting of
intravenous calcium channel blocker for rate control, lymph
assist and tachycardia.  Intensive Care Unit course thought a
right pneumothorax secondary to attempted internal jugular
line placement.  The patient underwent successful ablation of
atrial tachycardia, atrial flutter on [**2-28**].
Infectious disease issues included Clostridium difficile in
stool, Methicillin-resistant Staphylococcus aureus pyuria in
urine in the setting of Foley catheterization.  On the floor
the patient remained stable and had numerous complaints of
pain.  The patient had no cardiac events.  The patient was
placed on Flagyl for a 14 day course, 500 mg b.i.d.  The
patient was on Vancomycin intravenously 750 q. 18 for a
course of seven days.  The patient got tube feeds via the
gastrostomy tube.  The patient is to be screened for
rehabilitation to assist with placement.  The patient's
laboratory data indicated the patient was generally
hypophosphatemic and would supplement as such.  The patient's
TSH was also elevated to 25 and we would be increasing her
Synthroid dose.

DISCHARGE DIAGNOSIS:
1.  Status post EP ablation for atrial tachycardia
2.  Clostridium difficile in stool
3.  Methicillin-resistant Staphylococcus aureus, urinary
tract infection
4.  Status post surgery for perforated duodenal ulcer
5.  Status post pneumothorax.

DISCHARGE MEDICATIONS:
1.  Risperdal .5 mg p.o. q.h.s.
2.  Tylenol 650 mg p.o. q. 4 to 6 hours prn
3.  Prevacid 30 mg p.o. q.d.
4.  Synthroid 200 mg p.o. q.d.
5.  Nystatin powder to affected groin q.d.
6.  Neutra-Phos 2 packets q.d.
7.  Heparin 5000 units subcutaneously b.i.d. as the patient
is not ambulating
8.  Tube feeds - ProMod with fiber at 65 cc/hr, check
residuals q. 4, hold if greater than 100 cc, free of water
bolus 100 cc per gastrostomy tube t.i.d.
9.  Vancomycin intravenously 750 mg q. 18 hours, stop on
[**2152-3-5**]
10. Flagyl 500 mg p.o. t.i.d., stop on [**2152-3-11**]

DISCHARGE CONDITION:  Stable.

DISCHARGE PLAN:  The patient is to see Dr. [**Last Name (STitle) **] at the
[**Hospital1 37853**] Medical Building on [**2152-3-10**] at 10 AM,
phone [**Telephone/Fax (1) 37854**].  Treatment at rehabilitation, gastrostomy
tube should remain clamped, change dressings of gastrostomy
and jejunostomy tube q.d.  Tube feeds - Cardiac diet, advance
diet as tolerated.  Check TSH in three weeks and adjust
Synthroid.  Check fingersticks b.i.d. and cover with sliding
scale insulin.



                            DR.[**First Name (STitle) **],[**First Name3 (LF) 734**] 12-944

Dictated By:[**Last Name (NamePattern4) 8102**]
MEDQUIST36

D:  [**2152-3-3**]  15:32
T:  [**2152-3-3**]  16:14
JOB#:  [**Job Number 37855**]
{'Paroxysmal supraventricular tachycardia,Iatrogenic pneumothorax,Infection of colostomy or enterostomy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Unspecified acquired hypothyroidism'}


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: The patient is an 83 year old female status
post atrial ablation, status post gastric ulcer perforation
repair, status post pneumothorax after internal jugular
placement, Methicillin-resistant Staphylococcus aureus,
sepsis, Clostridium difficile.

PRESENT ILLNESS: This is a complicated patient
who essentially was admitted to [**Hospital6 2018**] for EP ablation.  The patient had been admitted to
[**Hospital1 **]-Gluver on [**2-10**] through [**2-24**].  The
patient complained of left heart palpitations with weakness,
dry cough, no nausea, fever, chills or vomiting.  The patient
did have a little bit of yellow mucous when social history
awoke on [**2-10**] with palpitations, notified her primary
care physician who noted [**Name Initial (PRE) **] heartrate of 180 and sent her to
the Emergency Room.  The patient did have a history of atrial
tachycardia but it had been quiescent.  The patient had a
long ventriculoperitoneal tachycardiac narrow complex at 139,
a Dopamine drip was terminated but recurred.  Sotalol and
Metoprolol was added.  Cardizem eventually was made p.o.
Blood pressure had been limiting.  On [**2-12**] ? the
patient had had surgery for repair of gastric ulcer
perforation.  Records are not available at this time
regarding that procedure.  The patient had near total gastric
outlet obstruction, silk suture closed and placement of
jejunostomy tube and gastrostomy tube.  Right internal
jugular line was placed at the same time.  It was hard to
control the patient's arrhythmias and was originally
transferred to Dr.[**Name (NI) 1565**] service for EP ablation.
However, the procedure was cancelled secondary to the patient
developing a fever.  On transfer to the Medicine Intensive
Care Unit the patient denies shortness of breath, chest pain,
dizziness and was evaluated in the Medicine Intensive Care
Unit.

MEDICAL HISTORY: Significant for hypothyroidism,
hypertension, paroxysmal atrial fibrillation treated with
Verapamil and Digoxin with no recent episodes, status post
appendectomy, depression status post total abdominal
hysterectomy, status post motor vehicle accident.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with sister, no children.  She has
five siblings. 

### Response:
{'Paroxysmal supraventricular tachycardia,Iatrogenic pneumothorax,Infection of colostomy or enterostomy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Unspecified acquired hypothyroidism'}
