CHIEF COMPLAINT: tooth pain

PRESENT ILLNESS: 25 M with 4 day h/o dental abscess, worsening fever, chills,
submandibular TTP, erythema, difficulty swallowing, trismus.
Was given clindamycin 4 days ago, but swelling progressed.
Transferred from [**Location (un) **] for further management.  Received
Unasyn at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination on admission:
96.7 F   116    136/73    16    97% RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes dry.  Marked swelling
of soft tissue b/l submandibular, sublingual, submental spaces,
with induration and tenderness. Tongue elevated. No drainage.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: n/c

SOCIAL HISTORY: Lives with family.  Quit tobacco.  Occasional EtOH
Cellulitis and abscess of face,Cellulitis and abscess of oral soft tissues,Periapical abscess without sinus,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Dehydration,Other diseases of pharynx, not elsewhere classified
Cellulitis of face,Cellulitis/abscess mouth,Periapical abscess,Other streptococcus,Dehydration,Disease of pharynx NEC
Admission Date:  [**2129-12-24**]              Discharge Date:   [**2129-12-31**]

Date of Birth:  [**2104-4-26**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
tooth pain


Major Surgical or Invasive Procedure:
1. Extraoral, intraoral incision and drainage of bilateral
submandibular, bilateral sublingual mental space, right lateral
pharyngeal space infections.
2. Extraction of teeth #1 and #32.


History of Present Illness:
25 M with 4 day h/o dental abscess, worsening fever, chills,
submandibular TTP, erythema, difficulty swallowing, trismus.
Was given clindamycin 4 days ago, but swelling progressed.
Transferred from [**Location (un) **] for further management.  Received
Unasyn at OSH.


Past Medical History:
none

Social History:
Lives with family.  Quit tobacco.  Occasional EtOH


Family History:
n/c

Physical Exam:
Physical Examination on admission:
96.7 F   116    136/73    16    97% RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes dry.  Marked swelling
of soft tissue b/l submandibular, sublingual, submental spaces,
with induration and tenderness. Tongue elevated. No drainage.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused


Pertinent Results:
Admission labs:
[**2129-12-24**] 12:00AM BLOOD WBC-25.8* RBC-4.78 Hgb-15.3 Hct-41.5
MCV-87 MCH-32.0 MCHC-36.9* RDW-12.6 Plt Ct-175
[**2129-12-24**] 12:00AM BLOOD PT-16.5* PTT-30.0 INR(PT)-1.5*
[**2129-12-24**] 12:00AM BLOOD Glucose-99 UreaN-21* Creat-1.3* Na-135
K-3.2* Cl-99 HCO3-22 AnGap-17
[**2129-12-24**] 07:59PM BLOOD Calcium-7.3* Phos-2.6* Mg-2.0

Discharge labs:

[**2129-12-30**] 07:00AM BLOOD WBC-13.1*# RBC-4.38* Hgb-13.9* Hct-40.0
MCV-91 MCH-31.7 MCHC-34.6 RDW-13.4 Plt Ct-445*
[**2129-12-30**] 07:00AM BLOOD Plt Ct-445*

Brief Hospital Course:
Mr [**Known lastname 90443**] was admitted to the acute care service after an
incision and drainage of his submandibular abscess in fair
condition to the intensive care unit. He was intubated and
sedated and started on tube feeds. He was kept on IV unasyn and
IV flagyl as well as IV fluids.

[**12-24**]: to OR for incision and drainage, molar excision x2.
Admitted to SICU intubated, with nasal intubation on L and NGT
on R. Started on TFs. OR swab gram: 4+PMNs, 4+GNRs, 4+GPCs in
pairs, 2+GPRs.

[**12-25**]: sedation issues, started on ativan, finally settled but
resp drive decreased, changed from PSV/CPAP to CMV

[**12-26**]: Propofol decreased, started fentanyl gtt plus intermittent
ativan. Rec'd lasix 10 IV x2doses w/out response.

[**12-27**]: Dex started, weaning propofol. weaning vent AT

[**12-28**]: Extubated, tx to floor pending room. Foley d/c'd and
voided, clears diet. tube feeds discontinued.

[**12-29**]: Transferred to the floor on clears diet, IV dilaudid for
pain control,
on zosyn for antimicrobial coverage. He was advanced to full
liquids diet later in the day.

[**12-30**]: Continued zosyn. 1 drain d/ced by OMFS

[**12-31**]: Three drains d/ced by OMFS. Wound still draining though
incision site not actively erythematous but slightly swollen.

The patient was discharged home on oral augmentin for seven
days, with very close follow up at the [**Hospital6 **]
dental clinic. He was given both verbal and written instructions
for wound care.


Medications on Admission:
none

Discharge Medications:
1. Augmentin 500-125 mg Tablet Sig: One (1) Tablet PO three
times a day for 1 weeks.
Disp:*21 Tablet(s)* Refills:*0*
2. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain: take with colace.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Bilateral submandibular, sublingual, mental space and
    right lateral pharyngeal space infection.
2. Dental caries, teeth #1 and #32.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Lethargic but arousable.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You have a wound that is still draining. You should keep a dry
gauze dressing over it at all times and change the dressing at
least twice a day.

You have been given antibiotics. Please take as directed for
seven days.

You should contact the oral maxillary surgery clinic or present
to the emergency room if you have fevers, increased or changed
drainage from your wound, increased redness of the skin,
increased swelling or pain as these could be signs that you have
a serious infection.

- continue tongue blade exercises
- Keep the incision area dry
- Use suncreen over the incision area off L submand and
submental
when going outdoors to prevent scarring
- Apply gauze/dressing over the R submand area and change it as
needed at least twice daily
- If your condition worsen please go immediately to [**Hospital 40530**] clinic
or the
nearest ED

Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
.
General Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**4-4**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.

Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.


Followup Instructions:
Please follow up with the oral maxillary surgeons at the  Oral
Surgery Clinic at [**Hospital6 **], Yawkey building [**Location (un) 6332**], [**Last Name (NamePattern1) **], [**Location (un) 86**], MA, [**Telephone/Fax (1) 68463**] on Monday
([**1-2**]) at 2pm
{'Cellulitis and abscess of face,Cellulitis and abscess of oral soft tissues,Periapical abscess without sinus,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Dehydration,Other diseases of pharynx, not elsewhere classified'}


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: tooth pain

PRESENT ILLNESS: 25 M with 4 day h/o dental abscess, worsening fever, chills,
submandibular TTP, erythema, difficulty swallowing, trismus.
Was given clindamycin 4 days ago, but swelling progressed.
Transferred from [**Location (un) **] for further management.  Received
Unasyn at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination on admission:
96.7 F   116    136/73    16    97% RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes dry.  Marked swelling
of soft tissue b/l submandibular, sublingual, submental spaces,
with induration and tenderness. Tongue elevated. No drainage.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: n/c

SOCIAL HISTORY: Lives with family.  Quit tobacco.  Occasional EtOH 

### Response:
{'Cellulitis and abscess of face,Cellulitis and abscess of oral soft tissues,Periapical abscess without sinus,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Dehydration,Other diseases of pharynx, not elsewhere classified'}
