CHIEF COMPLAINT: Fevers

PRESENT ILLNESS: Mr. [**Known lastname **] is a 77 year old man who presented to [**Hospital1 18**] 25
days after undergoing a femoral-bipopliteal bypass graft of an
abdominal aortic aneurysm. with fevers to 102F and chills.

MEDICAL HISTORY: PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

MEDICATION ON ADMISSION: Lasix 20mg daily
Potassium Chloride 20 meq daily
Lopressor 50 mg TID
Coumadin 6.5 mg daily
MVI

ALLERGIES: Lorazepam

PHYSICAL EXAM: On Admission:
Vitals: 104.0 F, HR 102, BP 125/76, RR 27, O2 sat 100% 2L
Mucous membranes moist
Tachycardic, regular
Decreased breath sounds at the bases
Abdomen is obese, soft, with RUQ tenderness to palpation.,
minimal lower abdominal discomfort.  VAC in place in the lower
portion of the abdominal wound.  Good granulation tissue noted
on removal of VAC sponge.
Bilateral groins incision sites clean, no discharge
Bilateral lower extremity edema
Right calf rash - psoriatic per patient
Rectal: normal tone, guiac negative

FAMILY HISTORY: N/C
Wife and children RN

SOCIAL HISTORY: Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery.
Infection and inflammatory reaction due to other vascular device, implant, and graft,Disruption of internal operation (surgical) wound,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypotension, unspecified,Atrial fibrillation,Esophageal reflux,Alcohol abuse, continuous
React-oth vasc dev/graft,Disrup internal op wound,CHF NOS,Abn react-anastom/graft,Hypotension NOS,Atrial fibrillation,Esophageal reflux,Alcohol abuse-continuous
Admission Date:  [**2172-3-14**]              Discharge Date:   [**2172-3-24**]

Date of Birth:  [**2094-6-12**]             Sex:   M

Service: SURGERY

Allergies:
Lorazepam

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
Fevers

Major Surgical or Invasive Procedure:
Drainage of peripancreatic fluid collections
Swan-Ganz catheter placement


History of Present Illness:
Mr. [**Known lastname **] is a 77 year old man who presented to [**Hospital1 18**] 25
days after undergoing a femoral-bipopliteal bypass graft of an
abdominal aortic aneurysm. with fevers to 102F and chills.

Past Medical History:
PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

Social History:
Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery.


Family History:
N/C
Wife and children RN

Physical Exam:
On Admission:
Vitals: 104.0 F, HR 102, BP 125/76, RR 27, O2 sat 100% 2L
Mucous membranes moist
Tachycardic, regular
Decreased breath sounds at the bases
Abdomen is obese, soft, with RUQ tenderness to palpation.,
minimal lower abdominal discomfort.  VAC in place in the lower
portion of the abdominal wound.  Good granulation tissue noted
on removal of VAC sponge.
Bilateral groins incision sites clean, no discharge
Bilateral lower extremity edema
Right calf rash - psoriatic per patient
Rectal: normal tone, guiac negative

Pertinent Results:
[**2172-3-14**] 09:40PM   WBC-20.6*# RBC-3.71* HGB-12.0* HCT-35.3*
MCV-95 MCH-32.3* MCHC-34.0 RDW-13.7
[**2172-3-14**] 09:40PM   NEUTS-83* BANDS-3 LYMPHS-4* MONOS-2 EOS-1
BASOS-0 ATYPS-7* METAS-0 MYELOS-0 NUC RBCS-1*
[**2172-3-14**] 09:40PM   PT-18.3* PTT-29.2 INR(PT)-1.7*
[**2172-3-14**] 09:40PM   GLUCOSE-111* UREA N-11 CREAT-0.7 SODIUM-133
POTASSIUM-4.1 CHLORIDE-100 TOTAL CO2-23 ANION GAP-14
[**2172-3-14**] 09:40PM   ALT(SGPT)-45* AST(SGOT)-29 CK(CPK)-29* ALK
PHOS-168* AMYLASE-30 TOT BILI-0.6
[**2172-3-14**] 09:40PM   LIPASE-37

RADIOLOGY:
[**3-14**]: CT Abdomen/Pelvis
1. Ahaustral colon filled with fluid; findings are nonspecific
but can be seen in C. difficile colitis. Please correlate
clinically.
2. Multiple peripancreatic fluid collections more coalescent
since the last examination.
3. Evidence of aortofemoral bypass, without leak.
4. Similar appearance of renal lesions.
5. Similar appearance of bilateral lower lobe atelectasis.

[**3-14**]: U/S liver/gallbladder
Small amount of fatty sparing around the gallbladder.

[**3-14**]: CXR
Linear atelectasis/scarring in the left lung base. PA and
lateral is recommended for better characterization.

[**3-16**]: Echocardiogram
LEFT ATRIUM: Elongated LA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV.
LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and
systolic  function (LVEF>55%). Suboptimal technical quality, a
focal LV wall motion  abnormality cannot be fully excluded. No
resting LVOT gradient.
RIGHT VENTRICLE: Borderline normal RV systolic function.
AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta.
AORTIC VALVE: Mildly thickened aortic valve leaflets (3).
Minimally increased gradient c/w minimal AS. Trace AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Mild (1+) MR.
TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild
to moderate [[**2-4**]+] TR. Mild PA systolic hypertension.
PULMONIC VALVE/PULMONARY ARTERY: No PS.
PERICARDIUM: No pericardial effusion.
GENERAL COMMENTS: Suboptimal image quality - poor echo windows.

Conclusions:
The left atrium is elongated. There is mild symmetric left
ventricular hypertrophy with normal cavity size and systolic
function (LVEF>55%). Due to suboptimal technical quality, a
focal wall motion abnormality cannot be fully excluded. Right
ventricular systolic function is borderline normal. The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
are mildly thickened. There is a minimally increased gradient
consistent with minimal aortic valve stenosis. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is mild pulmonary artery systolic hypertension.
There is no pericardial effusion.

[**3-16**]: CXR
Swan-Ganz catheter remains in place, but distal tip is difficult
to visualize due to technical factors of the examination.
Cardiac silhouette is enlarged but stable. Aorta remains
tortuous. There has been decrease in degree of pulmonary
vascular engorgement and perihilar haziness, consistent with
resolving interstitial edema. Patchy and linear opacity in the
left lower lung region has similar appearance to earlier
radiograph dating back to [**2172-2-3**] and favors an area of
atelectasis over an infectious consolidation

[**3-17**]: CXR
Lateral aspect of the left lower chest is excluded from the
examination as the patient is turned to the right. Interstitial
edema has worsened. Severe left mid lung atelectasis is more
pronounced. Moderate enlargement of the heart and distension of
mediastinal vessels is exaggerated by patient positioning.
Tip of the right jugular sheath is at the junction of the
brachiocephalic veins transmitting a catheter that can be traced
as far as the right atrium, but is obscured more distally. No
pneumothorax.

[**3-20**]: CXR
Right PICC line tip is seen in the cavoatrial junction. Discoid
atelectasis in the left lower lobe are unchanged. There is no
pleural effusion. There is no pneumothorax. Cardiac size top
normal.

CULTURES:
[**3-14**]: Urine CX: Skin contamination
[**3-14**]: Blood Cx: Negative
[**3-15**]: Abdominal swab: MRSA
[**3-15**]: Urine Cx: Negative
[**3-15**]: C. diff: Negative
[**3-15**]: Abdominal fluid: Negative
[**3-16**]: Blood Cx (x2): Negative
[**3-16**]: C. diff: Negative
[**3-17**]: C. diff: Negative

Brief Hospital Course:
Mr. [**Known lastname **] was admitted to [**Hospital1 18**] after experiencing fevers at
home, 25 days after undergoing an aorto-bifemoral graft repair
of an abdominal aortic aneurysm.  A course of Vancomycin, Zosyn,
and Flagyl was instituted.  He was initally admitted to the
vascular surgery floor, but was transferred to the Surgical
Intensive Care Unit after a CT scan demonstrated a
peripancreatic fluid collection that was thought to be the
etiology of these fevers and he demostrated blood pressure
instability.  While in the ICU initially, he required pressor
support to maintain a systolic blood pressure over 100 mmHg.  On
HD3, to more accurately assess his volume and cardiac status, a
Swan-Ganz catheter was placed.  His Dopamine drip was weaned
off.
  His abdominal wound was packed with damp gauze.  On HD4, he
also had the peri-pancreatic fluid collection drained.  On HD5,
he was transferred out of the SICU, and back to the [**Hospital1 **].  On
HD6, input from Infectious disease was requested, and Mr.
[**Known lastname **] antibiotic course was determined to be 4 weeks or
Vancomycin and Zosyn.  A PICC line was placed and his central
line was removed.  Diuresis was continued, and he remained
stable.  Due to elevated blood glucose and the peri-pancreatic
fluid collection, [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] consult was requested to evaluate
whenther Mr. [**Known lastname **] might need home insulin.  Discharge
planned for home with VNA for VAC care, PICC care, IV
antibiotics and physical therapy. He will continue on Vanco and
Zosyn for an additional 18 days for a total of 4 weeks. Labs
weekly will be obtained and faxed to [**Hospital **] clinic. He will follow
up with both ID and Dr. [**Last Name (STitle) **].

Medications on Admission:
Lasix 20mg daily
Potassium Chloride 20 meq daily
Lopressor 50 mg TID
Coumadin 6.5 mg daily
MVI

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Vancomycin 500 mg Recon Soln Sig: 1250 (1250) mg
mg Intravenous Q 12H (Every 12 Hours) for 18 days: Check through
weekly and fax to [**Hospital **] clinic [**Telephone/Fax (1) 432**].
Disp:*36 1* Refills:*0*
3. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: 4.5 g
Intravenous Q8H (every 8 hours) for 18 days.
Disp:*QS * Refills:*0*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed.
Disp:*QS * Refills:*0*
6. Warfarin 5 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime): As
directed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. [**Telephone/Fax (1) 3183**].
Disp:*50 Tablet(s)* Refills:*0*
7. Potassium Chloride 20 mEq Packet Sig: Three (3)  PO once a
day.
Disp:*90 packets* Refills:*2*
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO three
times a day.
Disp:*90 Tablet(s)* Refills:*2*
9. Outpatient Lab Work
Please check Vancomycin trough prior to the AM dose on [**2172-3-25**].
Call or fax results to [**Hospital **] clinic (phone [**Telephone/Fax (1) 14774**], fax
[**Telephone/Fax (1) 432**])
Please check CBC, BUN, Creatinine, Potassium, LFTs and Vanco
through weely. Fax results to [**Telephone/Fax (1) 432**]: [**Hospital **] Clinic)
Please check PT/INR weekly and send results to Primary Care MR-
Dr. [**Last Name (STitle) **] (manages anticoagulation) [**Telephone/Fax (1) 3183**]
10. PICC line
PICC line care per CCS protocol


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Fever, CT abdomen [**3-15**] - fluid collection around the pancreas
PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse
PSH: s/p Aortobifem [**2-18**] for 6.3cm infrarenal AAA


Discharge Condition:
Good
INR 1.6


Discharge Instructions:
Please call the Vascular Surgery office or return to the
Emergency Room if you experience:
--Fever greater than 101.5 F
--Fever with shaking chills
--Increasing pain, redness, or discharge from your incision
sites
--Foul smelling drainage from your incision sites
--Blue toes
--Any other concerns

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in [**2-4**] weeks.  You may call his
office at [**Telephone/Fax (1) 3121**].

Follow up [**Hospital **] Clinic- [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**2172-4-6**] at 1145am. [**Hospital Unit Name 3269**]-Basement.
RN Phone: [**Telephone/Fax (1) 14774**]
Clinic phone [**Telephone/Fax (1) 457**]
Fax: [**Telephone/Fax (1) 457**]



Completed by:[**2172-3-24**]
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Disruption of internal operation (surgical) wound,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypotension, unspecified,Atrial fibrillation,Esophageal reflux,Alcohol abuse, continuous'}


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: Fevers

PRESENT ILLNESS: Mr. [**Known lastname **] is a 77 year old man who presented to [**Hospital1 18**] 25
days after undergoing a femoral-bipopliteal bypass graft of an
abdominal aortic aneurysm. with fevers to 102F and chills.

MEDICAL HISTORY: PMH: afib, GERD; echo [**10-8**] EF 55%, biatrial enlargement; stress
[**10-8**] inf wall reversible defect, EtOH abuse

MEDICATION ON ADMISSION: Lasix 20mg daily
Potassium Chloride 20 meq daily
Lopressor 50 mg TID
Coumadin 6.5 mg daily
MVI

ALLERGIES: Lorazepam

PHYSICAL EXAM: On Admission:
Vitals: 104.0 F, HR 102, BP 125/76, RR 27, O2 sat 100% 2L
Mucous membranes moist
Tachycardic, regular
Decreased breath sounds at the bases
Abdomen is obese, soft, with RUQ tenderness to palpation.,
minimal lower abdominal discomfort.  VAC in place in the lower
portion of the abdominal wound.  Good granulation tissue noted
on removal of VAC sponge.
Bilateral groins incision sites clean, no discharge
Bilateral lower extremity edema
Right calf rash - psoriatic per patient
Rectal: normal tone, guiac negative

FAMILY HISTORY: N/C
Wife and children RN

SOCIAL HISTORY: Remote smoker, quit 10 years ago
ETOH daily.
Quit ETOH 2 weeks prior to surgery. 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Disruption of internal operation (surgical) wound,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypotension, unspecified,Atrial fibrillation,Esophageal reflux,Alcohol abuse, continuous'}
