CHIEF COMPLAINT: Fevers and increased WBC

PRESENT ILLNESS: 64 year old female with two-day vascular surgery ~ 5/808. Has
bovine aortic arch and innominate artery aneurysm. Had bypasses
to all of his great vessels and then covered stent to aorta (
anatomy unclear). Was dc'd to rehab and then represented [**6-14**] to
[**Hospital1 **] with resp distress and infection (multiple possible sources).

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.

MEDICATION ON ADMISSION: vicodin 500, lipitor 20, lopressor 25", aricept 10', celexa 10',
plavix 75'

ALLERGIES: Penicillins / Linezolid

PHYSICAL EXAM: Obese AA woman laying in bed, appears to be acutely ill and
older
than staged age.
cta
rrr
abd benign
palp fems, dopp L DP only, dopp R DP/PT

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day.
Infection and inflammatory reaction due to other vascular device, implant, and graft,Subendocardial infarction, initial episode of care,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Urinary tract infection, site not specified,Atrial fibrillation,Pressure ulcer, other site,Infection with microorganisms resistant to penicillins,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Asthma, unspecified type, unspecified
React-oth vasc dev/graft,Subendo infarct, initial,Meth susc Staph aur sept,Severe sepsis,Acute respiratry failure,Urin tract infection NOS,Atrial fibrillation,Pressure ulcer, site NEC,Inf mcrg rstn pncllins,Proteus infection NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Asthma NOS
Admission Date:  [**2125-6-14**]              Discharge Date:   [**2125-6-29**]

Date of Birth:  [**2060-7-29**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins / Linezolid

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
Fevers and increased WBC

Major Surgical or Invasive Procedure:
Interventional Radiology placed PICC line


History of Present Illness:
64 year old female with two-day vascular surgery ~ 5/808. Has
bovine aortic arch and innominate artery aneurysm. Had bypasses
to all of his great vessels and then covered stent to aorta (
anatomy unclear). Was dc'd to rehab and then represented [**6-14**] to
[**Hospital1 **] with resp distress and infection (multiple possible sources).


Past Medical History:
-- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.


Social History:
The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day.

Family History:
Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.


Physical Exam:
Obese AA woman laying in bed, appears to be acutely ill and
older
than staged age.
cta
rrr
abd benign
palp fems, dopp L DP only, dopp R DP/PT

Nuero
Comprehension seems intact.
Able to do months/days forwards but not backwards.
Registration intact but recall 0/3 in 3 min and [**2-17**] with prompt.

Speech is extremely slowed but coherent. Minimal output.
Mood is "OK".
Affect is flat

Pertinent Results:
ON ADMISSION:
[**2125-6-14**] 05:22PM BLOOD WBC-11.8* RBC-2.68* Hgb-7.5* Hct-23.4*
MCV-88 MCH-28.1 MCHC-32.2 RDW-17.3* Plt Ct-287
[**2125-6-14**] 05:22PM BLOOD PT-21.8* PTT-38.9* INR(PT)-2.1*
[**2125-6-14**] 05:22PM BLOOD Glucose-132* UreaN-25* Creat-1.6* Na-142
K-4.2 Cl-109* HCO3-22 AnGap-15
[**2125-6-14**] 05:22PM BLOOD CK(CPK)-348*
[**2125-6-14**] 05:22PM BLOOD CK-MB-2
[**2125-6-14**] 11:00PM BLOOD Mg-2.1
[**2125-6-14**] 08:57PM BLOOD Type-ART pO2-211* pCO2-25* pH-7.45
calTCO2-18* Base XS--4
[**2125-6-14**] 05:28PM BLOOD Lactate-1.7
[**2125-6-14**] 08:57PM BLOOD Glucose-103 Lactate-1.0
[**2125-6-14**] 08:57PM BLOOD O2 Sat-98
[**2125-6-14**] 10:22PM BLOOD freeCa-1.00*
.
ON DISCHARGE:

[**2125-6-28**] 05:26AM BLOOD WBC-10.1 RBC-3.23* Hgb-9.2* Hct-26.9*
MCV-83 MCH-28.5 MCHC-34.2 RDW-18.1* Plt Ct-256
[**2125-6-29**] 08:56AM BLOOD PT-15.9* PTT-33.4 INR(PT)-1.4*
[**2125-6-28**] 05:26AM BLOOD Glucose-79 UreaN-11 Creat-1.1 Na-141
K-4.0 Cl-107 HCO3-24 AnGap-14
[**2125-6-28**] 05:26AM BLOOD CK(CPK)-91
[**2125-6-28**] 05:26AM BLOOD Calcium-8.5 Phos-4.1 Mg-2.2

[**2125-6-14**] 5:22 pm BLOOD CULTURE

STAPH AUREUS COAG +.    FINAL SENSITIVITIES.

STAPHYLOCOCCUS, COAGULASE NEGATIVE.    ISOLATED FROM ONE SET
ONLY.

                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------   =>8 R
DAPTOMYCIN------------       S
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------   =>8 R
OXACILLIN-------------   =>4 R
PENICILLIN------------ =>0.5 R
RIFAMPIN-------------- <=0.5 S
TETRACYCLINE----------   <=1 S
TRIMETHOPRIM/SULFA----       S
VANCOMYCIN------------   <=1 S

[**2125-6-20**] 6:44 pm BLOOD CULTURE      Source: Line-picc.

ENTEROCOCCUS FAECIUM.    FINAL SENSITIVITIES.

                             ENTEROCOCCUS FAECIUM
                             |
AMPICILLIN------------  =>32 R
LINEZOLID-------------     2 S
PENICILLIN------------  =>64 R
TETRACYCLINE----------   <=1 S
VANCOMYCIN------------  =>32 R

[**2125-6-14**] 7:10 pm URINE     Site: CATHETER

PROTEUS MIRABILIS.    10,000-100,000 ORGANISMS/ML..

                             PROTEUS MIRABILIS
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--    16 I
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------   0.5 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN----------    16 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S


Brief Hospital Course:
Started on broad spectrum AB on admission

Pan CX'd

On first hospital night had resp distress followed PEA arrest
after meds given for intubation.  transferd to the SICU. Got 1
min cpr, epi which led to af with rvr, and then dccv for AF.
Echo (reviewed with [**Doctor Last Name **]) showed large anterior mi with
aneurysmal apex. EKG also suggests anterior event in past month
(prwp). Suspect that she decompensated from cariopulmonary
perspective because of this infection and presented for care.

Cardiology consult / ID consult obtained

Pt delined / Cx's taken / Pt delined / blood, urine, surgical
site, cxr

Bronchoscopy performed [**6-15**]

Swnaz ganz placed [**6-16**]

orignal PICC pos for staph coag pos.

proteus UTI

[**6-19**] epi weaned / extubate / transfer to VICU

ID adjusts AB

PT consult / OT consult

heparin started per cardiology for ACAS / DVT upper extremity,
possible catherizationn discusse. Coumadin on hold.

Psych consult / depression.

[**6-21**] cipro dc for UTI

[**6-22**] vanco stopped / daptomycin started

pt with 2 days negative blood cx's / PICC replaced

[**6-26**] foley DC'd

Cardiolgy decides against catherization / to be arranged at
alter date

Id makes final recommendations

Pt stable for DC


Medications on Admission:
vicodin 500, lipitor 20, lopressor 25", aricept 10', celexa 10',
plavix 75'

Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Albuterol 90 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation Q6H (every 6 hours).
4. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
INH Inhalation Q6H (every 6 hours).
5. Beclomethasone Dipropionate 80 mcg/Actuation Aerosol Sig: One
(1) INH Inhalation [**Hospital1 **] (2 times a day).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day): Hold for SBP < 100 or HR < 60.
10. Daptomycin 500 mg Recon Soln Sig: One (1) Recon Soln
Intravenous Q24H (every 24 hours) for 4 weeks: from [**6-15**] /
may DC [**7-29**] Follow labs as on Pg 1.
11. Insulin
Sliding Scale

Fingerstick Q6H

Insulin SC Sliding Scale

Regular

Glucose Insulin Dose

0-60      mg/dL 1 amp D50
61-120    mg/dL 0   Units
121-140   mg/dL 2   Units
141-160   mg/dL 4   Units
161-180   mg/dL 6   Units
181-200   mg/dL 8   Units
201-220   mg/dL 10   Units
221-240   mg/dL 12   Units
241-260   mg/dL 14   Units
261-280   mg/dL 16   Units
281-300   mg/dL 18   Units
> 300   mg/dL Notify M.D.

12. Enoxaparin 120 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours) for 7 days: DC when INR is greater then 2/
Keep INR [**2-17**].
13. Coumadin 5 mg Tablet Sig: One (1) Tablet PO at bedtime: INR
goal is [**2-17**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Primary:

Wound infection
PEA arrest after
MI
VRE, MRSA

Secondary:

HTN, PVD, depression, urinary incontinence, DM2, anemia(iron
def), CRI (1.1-1.4), vascular dementia,


Discharge Condition:
Stable


Discharge Instructions:
WOUND CARE:

PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS:

Redness in or drainage from your wound(s).

New pain, numbness or discoloration of your lower or upper
extremities (notably on the side of the incision).

Watch for signs and symptoms of infection. These are: a fever
greater than 101 degrees, chills, increased redness, or pus
draining from the incision site. If you experience any of these
or bleeding at the incision site, CALL THE DOCTOR.


Followup Instructions:
Scheduled Appointments :
Provider CAT SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2125-7-12**] 8:45

Please follow with Dr [**Last Name (STitle) 3394**] her office number is [**Telephone/Fax (1) 79526**].
You have an appointment [**7-10**] at 1030 hrs.

Appointments to be made:

Please followup with Dr [**Last Name (STitle) **] at [**Telephone/Fax (1) 2625**]. This
appointment should be in 4 weeks.

Call Dr [**Last Name (STitle) 30977**] office, you should see him in 4 weeks. he can be
reached at,  Phone: [**Telephone/Fax (1) 5003**].



Completed by:[**2125-6-29**]
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Subendocardial infarction, initial episode of care,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Urinary tract infection, site not specified,Atrial fibrillation,Pressure ulcer, other site,Infection with microorganisms resistant to penicillins,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Asthma, unspecified type, 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: Fevers and increased WBC

PRESENT ILLNESS: 64 year old female with two-day vascular surgery ~ 5/808. Has
bovine aortic arch and innominate artery aneurysm. Had bypasses
to all of his great vessels and then covered stent to aorta (
anatomy unclear). Was dc'd to rehab and then represented [**6-14**] to
[**Hospital1 **] with resp distress and infection (multiple possible sources).

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- OA
-- obesity
-- asthma
-- leg pain/neuropathy
-- depression
-- anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis treated at
[**Hospital3 **]
.
Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
Old CVAs.
Neuropathy, peripheral.
Anxiety and panic disorder.
Status post total abdominal hysterectomy.
Hypercholesterolemia.

MEDICATION ON ADMISSION: vicodin 500, lipitor 20, lopressor 25", aricept 10', celexa 10',
plavix 75'

ALLERGIES: Penicillins / Linezolid

PHYSICAL EXAM: Obese AA woman laying in bed, appears to be acutely ill and
older
than staged age.
cta
rrr
abd benign
palp fems, dopp L DP only, dopp R DP/PT

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: The patient lives with her daughter [**Name (NI) 2048**] and her three kids
since being d/c'ed from a nursing home last [**Month (only) 205**]. Has seven
children, many grandchildren. Smokes [**1-16**] to 1 pack per day. 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Subendocardial infarction, initial episode of care,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Urinary tract infection, site not specified,Atrial fibrillation,Pressure ulcer, other site,Infection with microorganisms resistant to penicillins,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Asthma, unspecified type, unspecified'}
