CHIEF COMPLAINT: Sternal hematoma.

PRESENT ILLNESS: The patient is a 45-year-old
woman status post aortic root replacement for aortic ectasia
in [**2123-1-23**].  The patient has had multiple hospitalizations
since that time for wound debridement and superficial sternal
infections.

MEDICAL HISTORY: Aortic ectasia status post aortic root
replacement in [**2123-1-23**].  Sternal wound debridement in
[**2123-6-25**]; further sternal wound debridement in [**2123-9-25**].  Zenker's diverticulum.  Gastroesophageal reflux
disease.  Hypertension.  Nephrolithiasis.  Depression.
Anxiety.  Cholecystectomy.  Appendectomy.  Total abdominal
hysterectomy.  Exploratory laparotomy.  Lysis of adhesions.

MEDICATION ON ADMISSION: OxyContin 30 mg b.i.d., Vioxx 25
mg q.d., Colace 100 mg b.i.d., Prevacid 30 mg q.d., Senokot 2
mg q.d., Dulcolax 1 q.d., Vancomycin 1 g b.i.d., Dilaudid 2-6
mg q.4-6 hours p.r.n., Milk of Magnesia 30 q.d. p.r.n.,
Ativan 0.5 mg q.d.

ALLERGIES: CODEINE, ERYTHROMYCIN, SULFA, PREDNISONE,
TETRACYCLINE, BACTRIM, AMPICILLIN, AMOXICILLIN, ALBUTEROL,
ATROVENT.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Peripheral vascular complications, not elsewhere classified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other postoperative infection,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified
Surg comp-peri vasc syst,React-oth vasc dev/graft,Fx lumbar vertebra-close,Other postop infection,Abn react-artif implant,Esophageal reflux,Hypertension NOS,Depressive disorder NEC,Anxiety state NOS
Admission Date:  [**2123-12-19**]       Discharge Date:  [**2124-1-4**]

Date of Birth:   [**2078-6-20**]       Sex:  F

Service:  CARDIOTHORACIC

CHIEF COMPLAINT:  Sternal hematoma.

HISTORY OF PRESENT ILLNESS:  The patient is a 45-year-old
woman status post aortic root replacement for aortic ectasia
in [**2123-1-23**].  The patient has had multiple hospitalizations
since that time for wound debridement and superficial sternal
infections.

The patient was recently involved in a motor vehicle
accident, [**2123-12-4**], as an unrestrained driver with
airbag deployment, head-on into a truck at approximately
50-60 mph.  The patient sustained facial and nasal fractures,
bruises to chest and knees.  She was evaluated at [**Hospital6 10443**] and was also found to have a T12-L1 compression
spine fracture.

He was transferred to [**Hospital3 12564**] Facility on
[**12-17**], when the patient noticed a lump on her chest at
the top of her sternum.  The patient stated that it started
approximately one inch and reported that it increased in size
steadily since that time.  The patient stated that it was
very tender to touch.

She had no complaints of fever, chills, drainage,
palpitations, or radiation of pain.

MEDICATIONS ON ADMISSION:  OxyContin 30 mg b.i.d., Vioxx 25
mg q.d., Colace 100 mg b.i.d., Prevacid 30 mg q.d., Senokot 2
mg q.d., Dulcolax 1 q.d., Vancomycin 1 g b.i.d., Dilaudid 2-6
mg q.4-6 hours p.r.n., Milk of Magnesia 30 q.d. p.r.n.,
Ativan 0.5 mg q.d.

PAST MEDICAL HISTORY:  Aortic ectasia status post aortic root
replacement in [**2123-1-23**].  Sternal wound debridement in
[**2123-6-25**]; further sternal wound debridement in [**2123-9-25**].  Zenker's diverticulum.  Gastroesophageal reflux
disease.  Hypertension.  Nephrolithiasis.  Depression.
Anxiety.  Cholecystectomy.  Appendectomy.  Total abdominal
hysterectomy.  Exploratory laparotomy.  Lysis of adhesions.

ALLERGIES:  CODEINE, ERYTHROMYCIN, SULFA, PREDNISONE,
TETRACYCLINE, BACTRIM, AMPICILLIN, AMOXICILLIN, ALBUTEROL,
ATROVENT.

PHYSICAL EXAMINATION:  Vital signs:  On admission the patient
was afebrile, heart rate 96, blood pressure 170/70,
respirations 20.  General:  The patient was alert and
oriented times three.  She was in no acute distress.  She was
slightly anxious.  HEENT:  Pupils equal, round and reactive
to light.  Moist mucous membranes.  No jugular venous
distention.  Cardiovascular:  Regular, rate and rhythm.  No
murmurs, rubs, or gallops.  Positive swelling in the
suprasternal region, 5 x 5 cm area, with erythema.  Chest:
Breath sounds even and unlabored.  Clear to auscultation
bilaterally.  Abdomen:  Soft, nontender, nondistended.
Extremities:  No erythema or edema.

HOSPITAL COURSE:  The patient was admitted to Cardiothoracic
Surgery and scheduled for CAT scan of her chest.  This showed
a collection of the anterior to the manubrium, with an
enlarged pseudoaneurysm measuring 3.3 x 5.6.

On [**12-22**], the patient was brought to the Operating Room
at which time she underwent an aortic root replacement and
coronary artery bypass grafting times one.  Please see the
operative report for full details.

In summary the patient had an aortic root replacement and
coronary artery bypass grafting times one with saphenous vein
graft to the right coronary artery and an intra-aortic
balloon placement at that time.

She was transferred from the Operating Room to the
Cardiothoracic Intensive Care Unit.

At the time of transfer, the patient had an intra-aortic
balloon pump at 1:1, Milrinone 0.5 mcg/kg/min, Dobutamine 5
mcg/kg/min, and Levophed, Propofol, and .................

Upon arrival in the Cardiothoracic Intensive Care Unit, the
Levophed was weaned to off, and the patient was started on
Nitroglycerin which was gradually increased to 2.5
mcg/kg/min.

Additionally, the patient arrived in the Cardiothoracic
Intensive Care Unit with an open chest, and paralytics were
initiated at that time.

Following her arrival in the Intensive Care Unit setting, the
Plastic Surgery Service, as well as Infectious Disease
Service were consulted.

On postoperative day #1, the patient remained with an open
chest, continued on paralytics.  Her Dobutamine was weaned to
off.  Her Milrinone was weaned to 0.1 mcg/kg/min.  She
tolerated these procedures and remained hemodynamically
stable.

On postoperative day #2, the patient remained hemodynamically
stable.  Her cardioactive drips were weaned as tolerated.

On postoperative day #3, the patient returned to the
Operating Room at which time she underwent a clean-out of her
chest and primary closure of her chest.  She tolerated that
procedure well and was again transferred to the
Cardiothoracic Intensive Care Unit.

At the time of transfer, the patient had the intra-aortic
balloon pump at 1:1 and Milrinone at 0.25 mcg/kg/min.

Following her return to the Cardiothoracic Intensive Care
Unit, the patient's paralytics were discontinued.  Her
sedation was discontinued.  She was allowed to awaken and was
weaned on the ventilator to pressure support ventilation.

On the following morning, the patient's intra-aortic balloon
pump was weaned and successfully removed.  The patient's
Milrinone was weaned to off, and her PA line was removed.

Following removal of the intra-aortic balloon pump, the
patient was further weaned from her ventilator and
successfully extubated.

Over the next several days, the patient had an uneventful
Intensive Care Unit stay.  She remained in the Cardiothoracic
Intensive Care Unit to evaluation her hemodynamically and
from a respiratory standpoint, and furthermore, until her MRI
of the spine could be completed to additionally evaluate her
reported compression fractures and assess her neurological
status.

On postoperative day #8, the patient was transferred from the
Cardiothoracic Intensive Care Unit to .................. for
continuing postoperative care and cardiac rehabilitation.
She continued to be followed by not only the Cardiothoracic
Service but also by the Infectious Disease Service, as well
as the Neurosurgery Service.

It was their recommendation following MRI to continue the
patient in a brace for up to three months and to have
follow-up with her outside hospital neurosurgeon, as the MRI
showed no obvious cord compression, and only a slight bulge
at L1 with no compromise.

The patient's stay on ............ was relatively uneventful.
Her activity level was advanced with the assistance of the
nursing staff and Physical Therapy Service.

On postoperative day #14, it was decided that the patient was
stable and ready to be transferred to rehabilitation.

DISCHARGE PHYSICAL EXAMINATION:  Vital signs:  Temperature
98.5??????, heart rate 96 in sinus rhythm, blood pressure 110/70,
respirations 20, oxygen saturation 94% on room air.  Weight
preoperatively was 80 kg, discharge 90 kg.  General:  The
patient was alert and oriented times three.  She moves all
extremities and follows commands.  Chest:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular, rate and
rhythm.  S1 and S2.  Incision with Steri-Strips, open to air,
clean and dry.  Abdomen:  Soft, nontender, nondistended.
Positive bowel sounds.  Extremities:  Warm and well perfused
with no edema.  Left saphenous vein graft site with
Steri-Strips and open to air, clean and dry.

DISCHARGE LABORATORY DATA:  Sodium 135, potassium 4.0,
chloride 97, CO2 26, BUN 13, creatinine 0.5, glucose 121;
white count 11, hematocrit 37.6, platelet count 649.

DISCHARGE MEDICATIONS:  Vancomycin 1 g b.i.d., stop date of
[**1-30**], Rifampin 300 mg q.8 hours, to be continued
indefinitely, Gentamicin 100 mg q.8 hours, stop date of
[**1-8**].  Following completion of Gentamicin course, the
patient is to start on Levofloxacin 500 mg q.d., and this is
to continue indefinitely.  Aspirin 325 mg q.d., Lansoprazole
30 mg q.d., Lorazepam 1 mg q.h.s., Heparin 5000 U t.i.d.,
Colace 100 mg b.i.d., Metoprolol 75 mg b.i.d., Hydromorphone
2-4 mg q.4-6 hours p.r.n., Ibuprofen 400 mg q.6 hours p.r.n.,
Simethicone 40-80 mg q.i.d. p.r.n., Cyclobenzaprine 10 mg
t.i.d. p.r.n.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSIS:
1.  Status post aortic root replacement.
2.  Coronary artery bypass grafting times one with saphenous
vein graft to right coronary artery.
3.  Zenker's diverticulum.
4.  Gastroesophageal reflux disease.
5.  Hypertension.
6.  Nephrolithiasis.
7.  Depression.
8.  Anxiety.
9.  Status post cholecystectomy.
10. Status post appendectomy.
11. Status post total abdominal hysterectomy.
12. Status post exploratory laparotomy and lysis of
adhesions.

DISCHARGE STATUS:  The patient is to be discharged to
rehabilitation.

FOLLOW-UP:  She is to have follow-up with Dr. [**Last Name (STitle) 1140**] from
[**Hospital3 **] Neurosurgery Department in one month.
Follow-up with Infectious Disease Clinic, Dr. [**First Name (STitle) **], [**First Name3 (LF) **] 5,
10 a.m.  Follow-up with Dr. [**Last Name (STitle) 1537**] in one month.

Additionally, the patient is to have a CBC, BUN, creatinine,
LFTs, and Vancomycin trough checked on a weekly basis with
the results faxed to Dr.[**Name (NI) 103853**] office in the Infectious
Disease Clinic, [**Telephone/Fax (1) 1419**].




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2124-1-4**]  13:18
T:  [**2124-1-4**]  13:26
JOB#:  [**Job Number 103854**]
{'Peripheral vascular complications, not elsewhere classified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other postoperative infection,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, 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: Sternal hematoma.

PRESENT ILLNESS: The patient is a 45-year-old
woman status post aortic root replacement for aortic ectasia
in [**2123-1-23**].  The patient has had multiple hospitalizations
since that time for wound debridement and superficial sternal
infections.

MEDICAL HISTORY: Aortic ectasia status post aortic root
replacement in [**2123-1-23**].  Sternal wound debridement in
[**2123-6-25**]; further sternal wound debridement in [**2123-9-25**].  Zenker's diverticulum.  Gastroesophageal reflux
disease.  Hypertension.  Nephrolithiasis.  Depression.
Anxiety.  Cholecystectomy.  Appendectomy.  Total abdominal
hysterectomy.  Exploratory laparotomy.  Lysis of adhesions.

MEDICATION ON ADMISSION: OxyContin 30 mg b.i.d., Vioxx 25
mg q.d., Colace 100 mg b.i.d., Prevacid 30 mg q.d., Senokot 2
mg q.d., Dulcolax 1 q.d., Vancomycin 1 g b.i.d., Dilaudid 2-6
mg q.4-6 hours p.r.n., Milk of Magnesia 30 q.d. p.r.n.,
Ativan 0.5 mg q.d.

ALLERGIES: CODEINE, ERYTHROMYCIN, SULFA, PREDNISONE,
TETRACYCLINE, BACTRIM, AMPICILLIN, AMOXICILLIN, ALBUTEROL,
ATROVENT.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Peripheral vascular complications, not elsewhere classified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other postoperative infection,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified'}
