CHIEF COMPLAINT: Hemodynamic instability with right retroperitoneal bleed.

PRESENT ILLNESS: 93-y.o. male h/o CAD, COPD, and worsening renal insufficiency,
recently admitted to [**Hospital1 18**] [**Date range (1) 19174**] for worsening renal
insufficiency leading to volume overload.  He underwent a R
renal biopsy on [**2199-4-10**].  His renal failure was managed with
steroids, the volume overload with diuretics, and a UTI with
meropenem from [**Date range (1) 19175**].  His aspirin was held for 5days pre-
and post- renal biopsy.  He has been doing well at rehab until
last evening when began to experience R flank and abdominal
pain.  Brought to [**Location (un) 620**] ED where hemodynamically borderline,
Hct 26.5 (prior 28.5 on [**4-18**]), and CT non-contrast showed R
retroperitoneal hematoma.  Bolused 2L [**Hospital 19176**] transferred to [**Hospital1 18**]
ED, received 2u PRBC en route.  On arrival initial BP 70/40 and
emergent surgical consult requested.  Pt currently reports
notable R-flank pain, denies abd pain, and has mild dyspnea.
Denies chest pain.  Remaining interview truncated for placement
of CVL.

MEDICAL HISTORY: CAD s/p velocity stent x2 to RCA [**2190**]
Diastolic CHF (EF 55% [**2-/2199**])
Hypertension
Hypercholesterolemia
COPD on 2L home O2
Chronic renal insufficiency (recent exacerbation s/p R renal bx)
L parotid cancer
BPH
Obesity

MEDICATION ON ADMISSION: prednisone 60 mg daily
ASA 81 mg daily
metoprolol 50 mg [**Hospital1 **]
lisinopril 2.5 mg daily,
isosorbide dinitrate 40 mg TID
doxazosin 2 mg daily
lasix 120 mg daily
simvastatin 20 mg dailiy
nitro SL PRN
spiriva 18 mcg daily
atrovent PRN
albuterol PRN
omeprazole 20 mg dailyi
lidocaine 5% patch
colace 100 mg [**Hospital1 **]
vit D2 50,000 units Qweek
cyanocobalamin 1000 mcg daily
calcium carbonate 500 mg TID
acetaminophen PRN
senna PRN
trazadone 50 mg QHS PRN

ALLERGIES: Keflex / Bactrim

PHYSICAL EXAM: On admission:
Dopamine gtt 15
T 96.5  P 124  BP 122/68  RR 22  O2sat 100 on NRB
A&Ox3, uncomfortable and moaning
Lungs CTAB
Heart RRR / tachy
Abdomen soft, NT, ND, ecchymoses across lower abdomen
bilaterally (c/w subcutaneous injections)
R flank diffusely tender
No L CVA tenderness

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Sister and brother had strokes.  Father had CAD.  Mother had an
"enlarged heart."

SOCIAL HISTORY: Retired.  The patient is widowed, two children, 4 grandchildren,
7 great-grandchildren.
-Tobacco history:  40+ pack year history, quit in [**2148**], smoke a
pipe until [**2181**]
-ETOH: none currently, whiskey daily for many years, stopped two
months ago
-Illicit drugs: none
Hemorrhage complicating a procedure,Injury to renal artery,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic diastolic heart failure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other shock without mention of trauma,Encounter for palliative care,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Obesity, unspecified,Personal history of tobacco use
Hemorrhage complic proc,Injury renal artery,Ac kidny fail, tubr necr,Acute respiratry failure,Chr diastolic hrt fail,Abn react-procedure NEC,Shock w/o trauma NEC,Encountr palliative care,Crnry athrscl natve vssl,Status-post ptca,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Abdom aortic aneurysm,Hyperlipidemia NEC/NOS,Athscl extrm ntv art NOS,Chr airway obstruct NEC,Depend-supplement oxygen,Hx-oral/pharynx malg NEC,BPH w/o urinary obs/LUTS,Obesity NOS,History of tobacco use
Admission Date:  [**2199-4-23**]              Discharge Date:   [**2199-4-24**]


Service: SURGERY

Allergies:
Keflex / Bactrim

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Hemodynamic instability with right retroperitoneal bleed.

Major Surgical or Invasive Procedure:
Arteriogram of right kidney.
Coil embolization of right lower pole renal artery branch bleed.

History of Present Illness:
93-y.o. male h/o CAD, COPD, and worsening renal insufficiency,
recently admitted to [**Hospital1 18**] [**Date range (1) 19174**] for worsening renal
insufficiency leading to volume overload.  He underwent a R
renal biopsy on [**2199-4-10**].  His renal failure was managed with
steroids, the volume overload with diuretics, and a UTI with
meropenem from [**Date range (1) 19175**].  His aspirin was held for 5days pre-
and post- renal biopsy.  He has been doing well at rehab until
last evening when began to experience R flank and abdominal
pain.  Brought to [**Location (un) 620**] ED where hemodynamically borderline,
Hct 26.5 (prior 28.5 on [**4-18**]), and CT non-contrast showed R
retroperitoneal hematoma.  Bolused 2L [**Hospital 19176**] transferred to [**Hospital1 18**]
ED, received 2u PRBC en route.  On arrival initial BP 70/40 and
emergent surgical consult requested.  Pt currently reports
notable R-flank pain, denies abd pain, and has mild dyspnea.
Denies chest pain.  Remaining interview truncated for placement
of CVL.

Past Medical History:
CAD s/p velocity stent x2 to RCA [**2190**]
Diastolic CHF (EF 55% [**2-/2199**])
Hypertension
Hypercholesterolemia
COPD on 2L home O2
Chronic renal insufficiency (recent exacerbation s/p R renal bx)
L parotid cancer
BPH
Obesity

PAST SURGICAL HISTORY:
EVAR [**4-/2193**]
Debridement and closure of R3 toe [**2-/2199**]
Bilateral cataracts [**5-/2189**] and [**4-/2190**]

Social History:
Retired.  The patient is widowed, two children, 4 grandchildren,
7 great-grandchildren.
-Tobacco history:  40+ pack year history, quit in [**2148**], smoke a
pipe until [**2181**]
-ETOH: none currently, whiskey daily for many years, stopped two
months ago
-Illicit drugs: none

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Sister and brother had strokes.  Father had CAD.  Mother had an
"enlarged heart."

Physical Exam:
On admission:
Dopamine gtt 15
T 96.5  P 124  BP 122/68  RR 22  O2sat 100 on NRB
A&Ox3, uncomfortable and moaning
Lungs CTAB
Heart RRR / tachy
Abdomen soft, NT, ND, ecchymoses across lower abdomen
bilaterally (c/w subcutaneous injections)
R flank diffusely tender
No L CVA tenderness

Pertinent Results:
[**2199-4-23**] 05:23AM   WBC-20.0*# RBC-2.99* HGB-8.7* HCT-26.7*
MCV-90 MCH-29.1 MCHC-32.5 RDW-14.8
[**2199-4-23**] 05:23AM   NEUTS-88.0* LYMPHS-8.9* MONOS-3.0 EOS-0
BASOS-0
[**2199-4-23**] 05:23AM   PLT COUNT-78*#
[**2199-4-23**] 05:23AM   PT-13.7* PTT-31.2 INR(PT)-1.2*
[**2199-4-23**] 05:23AM   GLUCOSE-184* UREA N-132* CREAT-2.5*
SODIUM-140 POTASSIUM-4.6 CHLORIDE-102 TOTAL CO2-30 ANION GAP-13
[**2199-4-23**] 05:23AM   ALT(SGPT)-12 AST(SGOT)-14 ALK PHOS-38* TOT
BILI-0.4
[**2199-4-23**] 05:23AM   LIPASE-51
[**2199-4-23**] 05:23AM   ALBUMIN-2.1*
[**2199-4-23**] 05:23AM   cTropnT-0.08*
[**2199-4-23**] 06:55AM   HCT-33.7*#
[**2199-4-23**] 11:54AM   TYPE-ART PO2-78* PCO2-43 PH-7.38 TOTAL CO2-26
BASE XS-0
[**2199-4-23**] 11:54AM   LACTATE-5.1*
[**2199-4-23**] 12:10PM   WBC-31.1*# RBC-3.25* HGB-9.5* HCT-27.6*
MCV-85 MCH-29.1 MCHC-34.4 RDW-15.6*
[**2199-4-23**] 12:10PM   PLT COUNT-123*#
[**2199-4-23**] 01:44PM   TYPE-ART PO2-78* PCO2-45 PH-7.35 TOTAL CO2-26
BASE XS-0
[**2199-4-23**] 01:44PM   LACTATE-4.8*
[**2199-4-23**] 04:16PM   WBC-27.9* RBC-3.30* HGB-9.5* HCT-27.4* MCV-83
MCH-28.8 MCHC-34.7 RDW-15.7*
[**2199-4-23**] 04:16PM   PLT SMR-LOW PLT COUNT-83*
[**2199-4-23**] 04:52PM   TYPE-ART PO2-185* PCO2-47* PH-7.39 TOTAL
CO2-30 BASE XS-3
[**2199-4-23**] 04:52PM   LACTATE-4.7*
[**2199-4-23**] 08:40PM   WBC-30.9* RBC-3.63* HGB-10.5* HCT-29.3*
MCV-81* MCH-28.9 MCHC-35.9* RDW-15.9*
[**2199-4-23**] 08:40PM   PLT COUNT-85*
[**2199-4-23**] 08:54PM   TYPE-ART PO2-111* PCO2-50* PH-7.38 TOTAL
CO2-31* BASE XS-3
[**2199-4-23**] 08:54PM   LACTATE-4.3*

Brief Hospital Course:
On [**2199-4-23**] morning, the patient was admitted to the SICU for
retroperitoneal bleed and started on norepinephrine gtt for
hemodynamic instability.  Family was [**Name (NI) 653**], and the surgical
team discussed and confirmed DNR/DNI status and treatment wishes
with patient and family.  According to patient's wishes, he
underwent endovascular arteriographic coil embolization by
interventional radiology.  Throughout the day, the patient
received a total of 11 units PRBC, 6 units FFP, and 2 units
platelets to maintain hemodynamic stability.  He remained stable
on norepinephrine gtt after the procedure.  On [**2199-4-24**] early
morning, he suffered respiratory distress with increased oxygen
requirement, and CXR showed near complete opacification of the
right lung, likely secondary to mucous plug.  Bronchoscopy was
offered, which would have required intubation with low
likelihood of successful extubation, and patient and family
understood and declined in accordance to DNR/DNI wishes.  Over
the subsequent few hours, the patient suffered respiratory
failure and expired at 0715.  The family declined autopsy.

Medications on Admission:
prednisone 60 mg daily
ASA 81 mg daily
metoprolol 50 mg [**Hospital1 **]
lisinopril 2.5 mg daily,
isosorbide dinitrate 40 mg TID
doxazosin 2 mg daily
lasix 120 mg daily
simvastatin 20 mg dailiy
nitro SL PRN
spiriva 18 mcg daily
atrovent PRN
albuterol PRN
omeprazole 20 mg dailyi
lidocaine 5% patch
colace 100 mg [**Hospital1 **]
vit D2 50,000 units Qweek
cyanocobalamin 1000 mcg daily
calcium carbonate 500 mg TID
acetaminophen PRN
senna PRN
trazadone 50 mg QHS PRN

Discharge Medications:
None.

Discharge Disposition:
Expired

Discharge Diagnosis:
Retroperitoneal bleed.
Respiratory failure.

Discharge Condition:
Expired.

Discharge Instructions:
He who has gone, so we but cherish his memory.

Followup Instructions:
None needed.


Completed by:[**2199-4-24**]
{'Hemorrhage complicating a procedure,Injury to renal artery,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic diastolic heart failure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other shock without mention of trauma,Encounter for palliative care,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Obesity, unspecified,Personal history of tobacco use'}


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: Hemodynamic instability with right retroperitoneal bleed.

PRESENT ILLNESS: 93-y.o. male h/o CAD, COPD, and worsening renal insufficiency,
recently admitted to [**Hospital1 18**] [**Date range (1) 19174**] for worsening renal
insufficiency leading to volume overload.  He underwent a R
renal biopsy on [**2199-4-10**].  His renal failure was managed with
steroids, the volume overload with diuretics, and a UTI with
meropenem from [**Date range (1) 19175**].  His aspirin was held for 5days pre-
and post- renal biopsy.  He has been doing well at rehab until
last evening when began to experience R flank and abdominal
pain.  Brought to [**Location (un) 620**] ED where hemodynamically borderline,
Hct 26.5 (prior 28.5 on [**4-18**]), and CT non-contrast showed R
retroperitoneal hematoma.  Bolused 2L [**Hospital 19176**] transferred to [**Hospital1 18**]
ED, received 2u PRBC en route.  On arrival initial BP 70/40 and
emergent surgical consult requested.  Pt currently reports
notable R-flank pain, denies abd pain, and has mild dyspnea.
Denies chest pain.  Remaining interview truncated for placement
of CVL.

MEDICAL HISTORY: CAD s/p velocity stent x2 to RCA [**2190**]
Diastolic CHF (EF 55% [**2-/2199**])
Hypertension
Hypercholesterolemia
COPD on 2L home O2
Chronic renal insufficiency (recent exacerbation s/p R renal bx)
L parotid cancer
BPH
Obesity

MEDICATION ON ADMISSION: prednisone 60 mg daily
ASA 81 mg daily
metoprolol 50 mg [**Hospital1 **]
lisinopril 2.5 mg daily,
isosorbide dinitrate 40 mg TID
doxazosin 2 mg daily
lasix 120 mg daily
simvastatin 20 mg dailiy
nitro SL PRN
spiriva 18 mcg daily
atrovent PRN
albuterol PRN
omeprazole 20 mg dailyi
lidocaine 5% patch
colace 100 mg [**Hospital1 **]
vit D2 50,000 units Qweek
cyanocobalamin 1000 mcg daily
calcium carbonate 500 mg TID
acetaminophen PRN
senna PRN
trazadone 50 mg QHS PRN

ALLERGIES: Keflex / Bactrim

PHYSICAL EXAM: On admission:
Dopamine gtt 15
T 96.5  P 124  BP 122/68  RR 22  O2sat 100 on NRB
A&Ox3, uncomfortable and moaning
Lungs CTAB
Heart RRR / tachy
Abdomen soft, NT, ND, ecchymoses across lower abdomen
bilaterally (c/w subcutaneous injections)
R flank diffusely tender
No L CVA tenderness

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Sister and brother had strokes.  Father had CAD.  Mother had an
"enlarged heart."

SOCIAL HISTORY: Retired.  The patient is widowed, two children, 4 grandchildren,
7 great-grandchildren.
-Tobacco history:  40+ pack year history, quit in [**2148**], smoke a
pipe until [**2181**]
-ETOH: none currently, whiskey daily for many years, stopped two
months ago
-Illicit drugs: none 

### Response:
{'Hemorrhage complicating a procedure,Injury to renal artery,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Chronic diastolic heart failure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other shock without mention of trauma,Encounter for palliative care,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Obesity, unspecified,Personal history of tobacco use'}
