CHIEF COMPLAINT: Fever, MS changes

PRESENT ILLNESS: [**Age over 90 **] yo f with h/o CHF (EF unknown), AS, recent I/D of buttocks
abscess, who presented from [**Hospital1 5595**] on [**2-28**] with fever to 104.8,
sinus tach, and hypoxia. She was also reported to be delirious
more than her baseline. She also was found to have WBC=15.4 with
11% bands. She had been on keflex (s/p I/D) but was given
vanco/levo/flagyl in the ED (PCN allergy). She was transferred
to the [**Hospital Ward Name **] -- of note, when she arrived, she was
agitated, hypertensive, and found to be in sinus tach to 140s
(responded to BB and lasix). Since that time, she had been doing
well (WBC decreasing on abx). On the morning of [**3-3**], she was
found to be in afib with RVR (new) with rate to 170s (SBP
initially maintained). She was given PO lopressor (12.5), and IV
(5 mg, then 2.5 mg), 250 cc IVF. HR was minimally improved, and
SBP dropped to 80s (systolic) despite continued rates in the
140s.  She was transferred to ICU at this time. EKG while in RVR
showed worsening STE in AVR, V1, V2 with depressions in V4-6,
I/AVL.
.
In the [**Hospital Unit Name 153**], she was continued on IVF (1L), got 0.25 mg IV
digoxin, and then received 150 mg amiodarone. In this setting,
she converted to SR in 60s. Amio gtt was started. In the ICU,
she denied any symptoms of CP/SOB, no f/c (just c/o sinus
congestion).

MEDICAL HISTORY: - non-healing R ankle wound
- restless leg syndrome with falls from bed
- coccyx decub
- osteoporosis
- severe AS
- s/p R mastectomy
- pulm HTN

MEDICATION ON ADMISSION: Senna
morphine on [**2-28**]
keflex started [**2-28**]
oxycodone prn
oxycontin 10 qAM, 20 qPM started [**2-27**]
tylenol prn
dulcolex
fosamax 70 q monday
oscal
HCTZ 25 qday
MVI
KCl 20 meq daily
hot pack to buttock, shoulders, or back QID prn

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam on admission
VS: 97.4 104/44 67 19 100% 4L
Gen: NAD, pleasant female, A&Ox3
HEENT: PERRL, dry MM
Neck: no JVD appreciated
Lungs: slight crackles at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Buttocks: erythema around site of I/D; no frank pus
Extr: no c/c/e, 1+ DP bilat; L knee with fluctuant pocket of
[**Last Name (un) 3041**]
Neuro: moving all 4 extremities, MS as above.

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed. lives at [**Location 67290**]
Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified,Pressure ulcer, lower back,Cellulitis and abscess of buttock,Urinary tract infection, site not specified,Retention of urine, unspecified,Restless legs syndrome (RLS),Chronic pulmonary heart disease, unspecified,Osteoporosis, unspecified
Food/vomit pneumonitis,Atrial fibrillation,Aortic valve disorder,CHF NOS,Pressure ulcer, low back,Cellulitis of buttock,Urin tract infection NOS,Retention urine NOS,Restless legs syndrome,Chr pulmon heart dis NOS,Osteoporosis NOS
Admission Date:  [**2183-2-28**]              Discharge Date:   [**2183-3-6**]


Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
Fever, MS changes

Major Surgical or Invasive Procedure:
None


History of Present Illness:
[**Age over 90 **] yo f with h/o CHF (EF unknown), AS, recent I/D of buttocks
abscess, who presented from [**Hospital1 5595**] on [**2-28**] with fever to 104.8,
sinus tach, and hypoxia. She was also reported to be delirious
more than her baseline. She also was found to have WBC=15.4 with
11% bands. She had been on keflex (s/p I/D) but was given
vanco/levo/flagyl in the ED (PCN allergy). She was transferred
to the [**Hospital Ward Name **] -- of note, when she arrived, she was
agitated, hypertensive, and found to be in sinus tach to 140s
(responded to BB and lasix). Since that time, she had been doing
well (WBC decreasing on abx). On the morning of [**3-3**], she was
found to be in afib with RVR (new) with rate to 170s (SBP
initially maintained). She was given PO lopressor (12.5), and IV
(5 mg, then 2.5 mg), 250 cc IVF. HR was minimally improved, and
SBP dropped to 80s (systolic) despite continued rates in the
140s.  She was transferred to ICU at this time. EKG while in RVR
showed worsening STE in AVR, V1, V2 with depressions in V4-6,
I/AVL.
.
In the [**Hospital Unit Name 153**], she was continued on IVF (1L), got 0.25 mg IV
digoxin, and then received 150 mg amiodarone. In this setting,
she converted to SR in 60s. Amio gtt was started. In the ICU,
she denied any symptoms of CP/SOB, no f/c (just c/o sinus
congestion).

Past Medical History:
- non-healing R ankle wound
- restless leg syndrome with falls from bed
- coccyx decub
- osteoporosis
- severe AS
- s/p R mastectomy
- pulm HTN


Social History:
Widowed. lives at [**Location 67290**]

Family History:
NC

Physical Exam:
Physical Exam on admission
VS: 97.4 104/44 67 19 100% 4L
Gen: NAD, pleasant female, A&Ox3
HEENT: PERRL, dry MM
Neck: no JVD appreciated
Lungs: slight crackles at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Buttocks: erythema around site of I/D; no frank pus
Extr: no c/c/e, 1+ DP bilat; L knee with fluctuant pocket of
[**Last Name (un) 3041**]
Neuro: moving all 4 extremities, MS as above.


Pertinent Results:
[**2183-2-28**] 07:54PM BLOOD Lactate-2.0
[**2183-3-3**] 07:20AM BLOOD TSH-1.3
[**2183-3-1**] 12:37AM BLOOD CK-MB-8 cTropnT-0.16*
[**2183-3-4**] 12:59AM BLOOD CK-MB-17* MB Indx-8.1* cTropnT-0.87*
[**2183-3-6**] 07:58AM BLOOD CK-MB-5 cTropnT-0.52*
[**2183-3-1**] 12:37AM BLOOD CK(CPK)-191*
[**2183-3-4**] 12:59AM BLOOD CK(CPK)-210*
[**2183-3-6**] 07:58AM BLOOD CK(CPK)-87
[**2183-2-28**] 07:40PM BLOOD Glucose-166* UreaN-34* Creat-0.8 Na-137
K-2.9* Cl-95* HCO3-31 AnGap-14
[**2183-3-6**] 07:58AM BLOOD Glucose-115* UreaN-28* Creat-0.7 Na-143
K-4.4 Cl-105 HCO3-30 AnGap-12
[**2183-2-28**] 07:40PM BLOOD Neuts-91* Bands-3 Lymphs-4* Monos-2 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2183-3-5**] 07:45AM BLOOD Neuts-83.3* Lymphs-12.1* Monos-3.9
Eos-0.6 Baso-0.1
[**2183-2-28**] 07:40PM BLOOD WBC-16.5* RBC-4.03* Hgb-12.6 Hct-35.6*
MCV-88 MCH-31.2 MCHC-35.4* RDW-14.1 Plt Ct-200
[**2183-3-6**] 07:58AM BLOOD WBC-12.9* RBC-3.71* Hgb-11.4* Hct-33.8*
MCV-91 MCH-30.8 MCHC-33.8 RDW-14.6 Plt Ct-318
.
UCX: NG
.
Wound Cx:
WOUND CULTURE (Preliminary):
      GRAM POSITIVE BACTERIA.    RARE GROWTH.  (MSSA)
.
CXR (admission)
FINDINGS: Hazy opacity identified within the right upper lobe
consistent with infiltrate. There is linear atelectasis at the
left lung base. There are calcifications noted.
Cardiomediastinal silhouette is normal in appearance. Diffuse
osteopenia identified. There is bilateral hilar fullness, which
may or may not represent hilar lymph nodes.
.
IMPRESSION:
1. Infiltrate within the right upper lobe.
2. Linear atelectasis at the left lung base.
3. Bilateral hilar fullness, which may represent hilar
lymphadenopathy.
.
CXR #2:
The heart is mildly enlarged and there is new vascular
engorgement, perihilar haziness and septal thickening. Small
right pleural effusion is also noted.  IMPRESSION: CHF with
interstitial edema.
.
CXR #3:
SINGLE AP SEMI-UPRIGHT CHEST RADIOGRAPH: Compared to two days
prior, there has been marked improvement in pulmonary edema and
vascular engorgement. No evidence of airspace consolidations to
suggest pneumonia. Plate-like atelectasis or scarring is noted
at the left base. The heart is stablely mildly enlarged and the
aorta is tortuous with mural calcifications.
IMPRESSION: Improvement in CHF with no evidence of pneumonia.
.
Echo
The estimated right atrial pressure is 0-5mmHg. There is mild
symmetric left ventricular hypertrophy with normal cavity size
and systolic function (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. There are complex (>4mm)
atheroma in the abdominal aorta. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (area 0.6cm2). No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. The mitral valve
leaflets are mildly thickened. There is severe mitral annular
calcification. Mild (1+) mitral regurgitation is seen. [Due to
acoustic shadowing, the severity of mitral regurgitation may be
significantly UNDERestimated.] There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion.
IMPRESSION: Severe aortic valve stenosis. Pulmonary artery
systolic hypertension. Mild symmetric left ventricular
hypertrophy with preserved global and regional biventricular
systolic function. At least mild mitral regurgitation.


Brief Hospital Course:
#Cardiovascular Issues
-Ischemia: the patient developed impressive ECG changes in the
setting of rapid atrial fibrillation; these improved after
conversion to sinus rhythm.  She did have positive CE in this
setting, likely from subendocardial ischemia and not flank
plaque rupture causing an NSTEMI.  Therefore, she was not
started on IV Heparin.  ASA was started however.
-Pump:  Echo showed very severe AS (0.6cm2); pt is likely very
preload dependant and therefore should only be given lasix if
she is very symptomatic.
-Rhythm:  Per HPI, was started on both BB and Amio with
conversation to NSR.  Needs to be on Amio 200 [**Hospital1 **] x 1 week and
then Amio 200 daily (discussed with pharmacy).  Continued on
Lopressor as well.  Over the next week, she should have serial
ECGs to monitor her QTc.  Goal HR should be 60.  HCTZ d/c'd.
-Prevention:  started on Low-dose Lipitor 10 mg; goal LDL should
be less than 100.
.
#Sacral Decubitus Ulcer with surronding cellulitis: markedly
improved on IV Vancomycin.  Seen by plastics service who
recommended accuzyme dressing changes [**Hospital1 **].  Pt should be turned
frequently.  Discharged to complete an additional course of
Linezolid PO.  Wound cx grew MSSA.
.
Pneumonia:  treated with Levaquin; PNA cleared rapidly on
subsequent CXR.  Will complete a total of a 7 day course.


Medications on Admission:
Senna
morphine on [**2-28**]
keflex started [**2-28**]
oxycodone prn
oxycontin 10 qAM, 20 qPM started [**2-27**]
tylenol prn
dulcolex
fosamax 70 q monday
oscal
HCTZ 25 qday
MVI
KCl 20 meq daily
hot pack to buttock, shoulders, or back QID prn


Discharge Medications:
1. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4-6H (every 4 to 6
hours) as needed for pain.
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 1 weeks.
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
to begin after one week of amio 200 mg [**Hospital1 **].
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
8. Papain-Urea 830,000-10 unit/g-% Ointment Sig: One (1) Appl
Topical DAILY (Daily).
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day): hold for SBP <110, HR <60.
10. FOSAMAX 70 mg Tablet Sig: One (1) Tablet PO once a week.
11. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 3 days.
12. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **]

Discharge Diagnosis:
Primary Diagnoses:
Rapid Atrial Fibrillation with demand ischemia
Severe Aortic Stenosis ([**Location (un) 109**] 0.6 cm2)
Sacral Decubitus Ulcer with surronding cellulitis
Pneumonia
Diastolic CHF/Pulmonary Edema

Secondary Diagnoses:
- non-healing R ankle wound
- restless leg syndrome with falls from bed
- osteoporosis
- s/p R mastectomy
- pulm HTN


Discharge Condition:
stable


Discharge Instructions:
Please come back to the ED should you develop any fevers,
chills, sweats, chest pain, shortness of breath, palpitations,
or any other complaints.

Followup Instructions:
Please follow up with your PCP.
{'Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified,Pressure ulcer, lower back,Cellulitis and abscess of buttock,Urinary tract infection, site not specified,Retention of urine, unspecified,Restless legs syndrome (RLS),Chronic pulmonary heart disease, unspecified,Osteoporosis, 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: Fever, MS changes

PRESENT ILLNESS: [**Age over 90 **] yo f with h/o CHF (EF unknown), AS, recent I/D of buttocks
abscess, who presented from [**Hospital1 5595**] on [**2-28**] with fever to 104.8,
sinus tach, and hypoxia. She was also reported to be delirious
more than her baseline. She also was found to have WBC=15.4 with
11% bands. She had been on keflex (s/p I/D) but was given
vanco/levo/flagyl in the ED (PCN allergy). She was transferred
to the [**Hospital Ward Name **] -- of note, when she arrived, she was
agitated, hypertensive, and found to be in sinus tach to 140s
(responded to BB and lasix). Since that time, she had been doing
well (WBC decreasing on abx). On the morning of [**3-3**], she was
found to be in afib with RVR (new) with rate to 170s (SBP
initially maintained). She was given PO lopressor (12.5), and IV
(5 mg, then 2.5 mg), 250 cc IVF. HR was minimally improved, and
SBP dropped to 80s (systolic) despite continued rates in the
140s.  She was transferred to ICU at this time. EKG while in RVR
showed worsening STE in AVR, V1, V2 with depressions in V4-6,
I/AVL.
.
In the [**Hospital Unit Name 153**], she was continued on IVF (1L), got 0.25 mg IV
digoxin, and then received 150 mg amiodarone. In this setting,
she converted to SR in 60s. Amio gtt was started. In the ICU,
she denied any symptoms of CP/SOB, no f/c (just c/o sinus
congestion).

MEDICAL HISTORY: - non-healing R ankle wound
- restless leg syndrome with falls from bed
- coccyx decub
- osteoporosis
- severe AS
- s/p R mastectomy
- pulm HTN

MEDICATION ON ADMISSION: Senna
morphine on [**2-28**]
keflex started [**2-28**]
oxycodone prn
oxycontin 10 qAM, 20 qPM started [**2-27**]
tylenol prn
dulcolex
fosamax 70 q monday
oscal
HCTZ 25 qday
MVI
KCl 20 meq daily
hot pack to buttock, shoulders, or back QID prn

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam on admission
VS: 97.4 104/44 67 19 100% 4L
Gen: NAD, pleasant female, A&Ox3
HEENT: PERRL, dry MM
Neck: no JVD appreciated
Lungs: slight crackles at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Buttocks: erythema around site of I/D; no frank pus
Extr: no c/c/e, 1+ DP bilat; L knee with fluctuant pocket of
[**Last Name (un) 3041**]
Neuro: moving all 4 extremities, MS as above.

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed. lives at [**Location 67290**] 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified,Pressure ulcer, lower back,Cellulitis and abscess of buttock,Urinary tract infection, site not specified,Retention of urine, unspecified,Restless legs syndrome (RLS),Chronic pulmonary heart disease, unspecified,Osteoporosis, unspecified'}
