CHIEF COMPLAINT: Fevers

PRESENT ILLNESS: Mr. [**Known lastname 4886**] is a 57 yo man recently discharged from [**Hospital1 18**]
following a prolonged hospital stay during which he developed
perforated bowel [**1-22**] metastatic lung cancer. He initially
presented to an OSH with worsening back pain and was eventually
diagnosed with ? cauda equina syndrome from metastatic lung CA.
While on the table for spinal fusion surgery, he became
hypotensive, and his abdomen was noted to be rigid. An upright
CXR demonstrated free air under the diaphragm and he underwent
emergent laparotomy and right hemicolectomy and ileostomy.
Attempts at weaning him from the ventilator were unsuccessful,
and he underwent trach and G-tube placement. Of note, he was
diagnosed with a lung abscess during his stay. Thoracic surgery
was consulted and felt his prognosis was too poor for any
surgical intervention to have a meaningful effect on his
survival. His abdominal fluid grew out Pseudomonas and E. coli.
Multiple sputum cultures grew out MSSA, and one grew out yeast
and another grew out E. coli. He was discharged to rehab on
vancomycin, pip-tazo, metronidazole, ciprofloxacin and
fluconazole.
He was transferred back to the [**Hospital1 18**] from rehab for fever. He
was afebrile on transfer to the rehab facility but by the night
of [**2152-5-19**] he spiked to 103.3. He was seen by the infectious
disease consultant on [**2152-5-20**] at which time ceftriaxone/flagl
and the prior antibiotics were stopped. Per the ID note, it was
unclear based on the available records to him if the pulmonary
cavitary lesion was an abscess. His vent settings for the 3 days
prior to transfer were CPAP/PS 10/5 50%. He has an 8-0 portex
tracheostomy.
In the ED, his initial vital signs were 99.9 [**Numeric Identifier 78882**]/66 10 100%.
A CXR was done as well as CT torso (with contrast). He received
vancomycin/zosyn as well as dilaudid and toradol for pain. He
received 4L normal saline.
On arrival to the MICU, he denied shortness of breath, worsening
secretions, chest pain, dysuria, or change in ostomy output. He
has a small amount of pain in his abdomen in the right lower
quadrant.

MEDICAL HISTORY: Probable metastatic lung ca (9mm lesion RUL)
h/o low back pain
hepatitis C
h/o ETOH

MEDICATION ON ADMISSION: Heparin 5,000 SC tid
Acetaminophen 650mg q4hrs prn
Oxycodone 5-10 mg q4hrs prn
Metoprolol Tartrate 50 tid
ceftriaxone 1g q24 (start [**2152-5-20**])
flagyl 500 mg q8 (start [**2152-5-13**])
Lorazepam 1 mg q4hrs
Insulin (regular insulin)
lansoprazole 30 mg daily
chlorhexidine 15mL [**Hospital1 **]
promote with fiber goal 50cc/hr

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.4 105 103/70 16 100%
vent: CPAP/PS 10/5 50%
GEN: thin, cachetic male in NAD
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection,
anicteric, OP clear, MMM, Neck supple, trach in place, no LAD,
no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: soft, NT, ND, + BS, no HSM. large vertical ex-lap scar
healing by secondary intent
EXT: muscle wasting. warm, dry, +2 distal pulses BL, no femoral
bruits. midline on left A/C
NEURO: alert & orientedx3 no R/L neglect, CN II-XII grossly
intact, 5/5 strength throughout upper extremity. [**2-23**]
plantar/dorsiflex bilat. No sensory deficits to light touch
appreciated. No asterixis
PSYCH: appropriate affect

FAMILY HISTORY: Mother with lung ca

SOCIAL HISTORY: Smokes [**12-22**] pack cigarettes per day. drinks ETOH heavily, [**1-23**]
beers per day and sometimes [**12-22**] pint of vodka per day
Abscess of lung,Peritoneal abscess,Acute respiratory failure,Malignant neoplasm of bronchus and lung, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Tobacco use disorder,Ileostomy status,Unspecified viral hepatitis C without hepatic coma
Abscess of lung,Peritoneal abscess,Acute respiratry failure,Mal neo bronch/lung NOS,Depressive disorder NEC,Long-term use of insulin,Tobacco use disorder,Ileostomy status,Hpt C w/o hepat coma NOS
Admission Date:  [**2152-5-22**]              Discharge Date:   [**2152-5-29**]

Date of Birth:  [**2094-11-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Fevers

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname 4886**] is a 57 yo man recently discharged from [**Hospital1 18**]
following a prolonged hospital stay during which he developed
perforated bowel [**1-22**] metastatic lung cancer. He initially
presented to an OSH with worsening back pain and was eventually
diagnosed with ? cauda equina syndrome from metastatic lung CA.
While on the table for spinal fusion surgery, he became
hypotensive, and his abdomen was noted to be rigid. An upright
CXR demonstrated free air under the diaphragm and he underwent
emergent laparotomy and right hemicolectomy and ileostomy.
Attempts at weaning him from the ventilator were unsuccessful,
and he underwent trach and G-tube placement. Of note, he was
diagnosed with a lung abscess during his stay. Thoracic surgery
was consulted and felt his prognosis was too poor for any
surgical intervention to have a meaningful effect on his
survival. His abdominal fluid grew out Pseudomonas and E. coli.
Multiple sputum cultures grew out MSSA, and one grew out yeast
and another grew out E. coli. He was discharged to rehab on
vancomycin, pip-tazo, metronidazole, ciprofloxacin and
fluconazole.
He was transferred back to the [**Hospital1 18**] from rehab for fever. He
was afebrile on transfer to the rehab facility but by the night
of [**2152-5-19**] he spiked to 103.3. He was seen by the infectious
disease consultant on [**2152-5-20**] at which time ceftriaxone/flagl
and the prior antibiotics were stopped. Per the ID note, it was
unclear based on the available records to him if the pulmonary
cavitary lesion was an abscess. His vent settings for the 3 days
prior to transfer were CPAP/PS 10/5 50%. He has an 8-0 portex
tracheostomy.
In the ED, his initial vital signs were 99.9 [**Numeric Identifier 78882**]/66 10 100%.
A CXR was done as well as CT torso (with contrast). He received
vancomycin/zosyn as well as dilaudid and toradol for pain. He
received 4L normal saline.
On arrival to the MICU, he denied shortness of breath, worsening
secretions, chest pain, dysuria, or change in ostomy output. He
has a small amount of pain in his abdomen in the right lower
quadrant.

Past Medical History:
Probable metastatic lung ca (9mm lesion RUL)
h/o low back pain
hepatitis C
h/o ETOH


Social History:
Smokes [**12-22**] pack cigarettes per day. drinks ETOH heavily, [**1-23**]
beers per day and sometimes [**12-22**] pint of vodka per day


Family History:
Mother with lung ca

Physical Exam:
VS: 99.4 105 103/70 16 100%
vent: CPAP/PS 10/5 50%
GEN: thin, cachetic male in NAD
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection,
anicteric, OP clear, MMM, Neck supple, trach in place, no LAD,
no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: soft, NT, ND, + BS, no HSM. large vertical ex-lap scar
healing by secondary intent
EXT: muscle wasting. warm, dry, +2 distal pulses BL, no femoral
bruits. midline on left A/C
NEURO: alert & orientedx3 no R/L neglect, CN II-XII grossly
intact, 5/5 strength throughout upper extremity. [**2-23**]
plantar/dorsiflex bilat. No sensory deficits to light touch
appreciated. No asterixis
PSYCH: appropriate affect


Pertinent Results:
[**2152-5-22**] 03:19PM   WBC-25.5*# RBC-3.79*# HGB-10.5*# HCT-33.0*#
MCV-87 MCH-27.8 MCHC-31.9 RDW-15.8*
[**2152-5-22**] 03:19PM   NEUTS-86.5* LYMPHS-7.8* MONOS-5.5 EOS-0.1
BASOS-0.1
[**2152-5-22**] 03:19PM   PLT COUNT-961*#
[**2152-5-22**] 03:19PM   GLUCOSE-126* UREA N-25* CREAT-1.2 SODIUM-133
POTASSIUM-4.7 CHLORIDE-103 TOTAL CO2-20* ANION GAP-15
[**2152-5-22**] 03:20PM   LACTATE-1.5
[**2152-5-22**] 04:30PM URINE  RBC-0 WBC-[**2-23**] BACTERIA-FEW YEAST-FEW
EPI-0
[**2152-5-22**] 04:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-TR
[**2152-5-22**] 04:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015
[**2152-5-22**] 03:19PM   ALT(SGPT)-8 AST(SGOT)-14 ALK PHOS-101 TOT
BILI-0.7
.
[**2152-5-23**] 5:13 am SPUTUM      Source: Endotracheal.

                            **FINAL REPORT [**2152-5-26**]**

   GRAM STAIN (Final [**2152-5-23**]):
      >25 PMNs and <10 epithelial cells/100X field.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.

   RESPIRATORY CULTURE (Final [**2152-5-26**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.
      STENOTROPHOMONAS (XANTHOMONAS) MALTOPHILIA.    SPARSE
GROWTH.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STENOTROPHOMONAS (XANTHOMONAS)
MALTOPHILIA
                             |
TRIMETHOPRIM/SULFA----   <=1 S
.
[**2152-5-24**] 3:56 pm URINE      Source: Catheter.

                            **FINAL REPORT [**2152-5-25**]**

   URINE CULTURE (Final [**2152-5-25**]):
      YEAST.    10,000-100,000 ORGANISMS/ML.
.
[**2152-5-22**] CT Torso: IMPRESSION:
1. Very limited evaluation for intra-abdominal abscess,
questionable focus of fluid collection in the right paracolic
gutter, smaller, when compared to [**5-4**] study.
2. Slight decrease in size of cavitated right upper lobe lesion.
3. Interval worsening of centrilobular ground-glass nodules
throughout both lung fields, consistent with multifocal
infection.
4. Lytic L5 vertebral lesions with pathologic compression
fracture.
5. Increase in conspicuity of hypodense hepatic parenchymal
lesions

Brief Hospital Course:
Mr. [**Known lastname 4886**] is a 57yo male with history of metastatic NSCLC c/b
cord compression c/b bowel perforation s/p hemicolectomy and
pulmonary abscess presenting with fevers and leukocytosis.

1)Fever: Likely related to pulmonary abcess vs. possible fluid
collection in the abdomen (right paracolic). He was initially
started on Vancomycin and Zosyn for broad spectrum coverage.
After several family meetings the decision was made not to
proceed with any further agressive work-up given his overall
prognosis. His antibiotic regimen was changed to Levaquin and
Flagyl. He was also started on Bactrim for his sputum cultures
(stenotrophomonas). He continued to spike fevers which was not
surprising in the setting of his underlying abcess.  He will be
discharged to complete 14 days of levofloxacin/flagyl/bactrim.


2)Respiratory failure: Patient was initially placed on CPAP + PS
but was then weaned to trach mask which he has been able to
tolerate well and is oxygenating appropriately.  He will be
transferred on trach collar FiO2 0.35.  He should use PMV at
least once daily as tolerated.

3)Lung cancer: No further treatment indicated given the advanced
stage.

4)Depression: On day of discharge, he was started on low dose
citalopram.  He should be monitored on this and dose can be
uptitrated upon discharge.

5)FEN: Continued on G tube feedings.  He was evaluated by speech
and swallow who felt that with 1:1 supervision, he can consume
pureed diet for pleasure.  He should be sitting upright and if
evidence of aspiration, PO food should be dicontinued.

6)Access: Midline.

7)Prophylaxis: Heparin SQ for DVT prophylaxis.

8)Code: DNR (confirmed with patient and family).

Medications on Admission:
Heparin 5,000 SC tid
Acetaminophen 650mg q4hrs prn
Oxycodone 5-10 mg q4hrs prn
Metoprolol Tartrate 50 tid
ceftriaxone 1g q24 (start [**2152-5-20**])
flagyl 500 mg q8 (start [**2152-5-13**])
Lorazepam 1 mg q4hrs
Insulin (regular insulin)
lansoprazole 30 mg daily
chlorhexidine 15mL [**Hospital1 **]
promote with fiber goal 50cc/hr


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
3. Oxycodone 5 mg/5 mL Solution Sig: 5-10 mg PO Q4H (every 4
hours) as needed.
4. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 14 days.
5. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 14 days.
6. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 14 days.
7. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Extended Care

Discharge Diagnosis:
Metastatic Lung CA
Perforated Bowel s/p partial colectomy [**4-/2152**]
Right paracolic fluid collection
Right lung loculated abscess
L5 metastatic lesion with cord compression


Discharge Condition:
Fair; comfort as goal.


Discharge Instructions:
Please continue to take your antibiotics as prescribed.
.
Please note that we have started you on a medication to help
your mood, citalopram.
.
Please inform staff at rehab if you are having fevers, chills,
increasing pain or any other symptoms that are uncomfortable
that concern you.
{'Abscess of lung,Peritoneal abscess,Acute respiratory failure,Malignant neoplasm of bronchus and lung, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Tobacco use disorder,Ileostomy status,Unspecified viral hepatitis C without hepatic coma'}


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 4886**] is a 57 yo man recently discharged from [**Hospital1 18**]
following a prolonged hospital stay during which he developed
perforated bowel [**1-22**] metastatic lung cancer. He initially
presented to an OSH with worsening back pain and was eventually
diagnosed with ? cauda equina syndrome from metastatic lung CA.
While on the table for spinal fusion surgery, he became
hypotensive, and his abdomen was noted to be rigid. An upright
CXR demonstrated free air under the diaphragm and he underwent
emergent laparotomy and right hemicolectomy and ileostomy.
Attempts at weaning him from the ventilator were unsuccessful,
and he underwent trach and G-tube placement. Of note, he was
diagnosed with a lung abscess during his stay. Thoracic surgery
was consulted and felt his prognosis was too poor for any
surgical intervention to have a meaningful effect on his
survival. His abdominal fluid grew out Pseudomonas and E. coli.
Multiple sputum cultures grew out MSSA, and one grew out yeast
and another grew out E. coli. He was discharged to rehab on
vancomycin, pip-tazo, metronidazole, ciprofloxacin and
fluconazole.
He was transferred back to the [**Hospital1 18**] from rehab for fever. He
was afebrile on transfer to the rehab facility but by the night
of [**2152-5-19**] he spiked to 103.3. He was seen by the infectious
disease consultant on [**2152-5-20**] at which time ceftriaxone/flagl
and the prior antibiotics were stopped. Per the ID note, it was
unclear based on the available records to him if the pulmonary
cavitary lesion was an abscess. His vent settings for the 3 days
prior to transfer were CPAP/PS 10/5 50%. He has an 8-0 portex
tracheostomy.
In the ED, his initial vital signs were 99.9 [**Numeric Identifier 78882**]/66 10 100%.
A CXR was done as well as CT torso (with contrast). He received
vancomycin/zosyn as well as dilaudid and toradol for pain. He
received 4L normal saline.
On arrival to the MICU, he denied shortness of breath, worsening
secretions, chest pain, dysuria, or change in ostomy output. He
has a small amount of pain in his abdomen in the right lower
quadrant.

MEDICAL HISTORY: Probable metastatic lung ca (9mm lesion RUL)
h/o low back pain
hepatitis C
h/o ETOH

MEDICATION ON ADMISSION: Heparin 5,000 SC tid
Acetaminophen 650mg q4hrs prn
Oxycodone 5-10 mg q4hrs prn
Metoprolol Tartrate 50 tid
ceftriaxone 1g q24 (start [**2152-5-20**])
flagyl 500 mg q8 (start [**2152-5-13**])
Lorazepam 1 mg q4hrs
Insulin (regular insulin)
lansoprazole 30 mg daily
chlorhexidine 15mL [**Hospital1 **]
promote with fiber goal 50cc/hr

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.4 105 103/70 16 100%
vent: CPAP/PS 10/5 50%
GEN: thin, cachetic male in NAD
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection,
anicteric, OP clear, MMM, Neck supple, trach in place, no LAD,
no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: soft, NT, ND, + BS, no HSM. large vertical ex-lap scar
healing by secondary intent
EXT: muscle wasting. warm, dry, +2 distal pulses BL, no femoral
bruits. midline on left A/C
NEURO: alert & orientedx3 no R/L neglect, CN II-XII grossly
intact, 5/5 strength throughout upper extremity. [**2-23**]
plantar/dorsiflex bilat. No sensory deficits to light touch
appreciated. No asterixis
PSYCH: appropriate affect

FAMILY HISTORY: Mother with lung ca

SOCIAL HISTORY: Smokes [**12-22**] pack cigarettes per day. drinks ETOH heavily, [**1-23**]
beers per day and sometimes [**12-22**] pint of vodka per day 

### Response:
{'Abscess of lung,Peritoneal abscess,Acute respiratory failure,Malignant neoplasm of bronchus and lung, unspecified,Depressive disorder, not elsewhere classified,Long-term (current) use of insulin,Tobacco use disorder,Ileostomy status,Unspecified viral hepatitis C without hepatic coma'}
