CHIEF COMPLAINT: Hip dissociation

PRESENT ILLNESS: 69 yo F with hx of left total hip replacement 8 years ago at
[**Hospital3 **] Hospital presents as transfer with left THR
dissociation on [**2185-5-7**]  now s/p revision of left total hip
[**2185-5-10**]. She described walking
out of dinner yesterday evening when she felt a sudden
"numbness"
in her left hip, a feeling like her leg was no longer there.
Denies any presyncopal symptoms. She fell to ground, landing on
her knees but without injury or headstrike. Had immediate left
hip pain with movement and was unable to bear weight. Was taken
to [**Hospital3 **] Hospital where imaging was obtained and she was
transferred for further orthopaedic care. She had a hip
aspiration on [**5-8**] showing [**Numeric Identifier 88552**] RBC, 1000 WBC, 76 polys.
.
During the operation, EBL 1000 cc. She received 500 cc blood,
3500 crystalloid. She had 1500 UOP.  She has 2 PIVs and an
arterial line. Neosynephrine at 0.5 at time of transfer. Pt was
on neosenphrine during entire case. When tried to wean off, pt
had low BP in mid 70s systolic but when on it SBPs in 100s. Pt
moving around w/out sedation but concern for possible fluid
overload and hypotension as she appeared a little more swollen
at the end of case than before. Also got opiods, dilaudid for
pain control.  [**Hospital Ward Name **] surgical moonlighter will be contact.

MEDICAL HISTORY: HTN
high cholesterol
hypothyroidism
appendectomy
tonsillectomy
ORIF right ankle
left total hip replacement at [**Hospital3 **] Hospital by Dr.
[**Last Name (STitle) 71113**] 8 years ago (currently followed by Dr. [**Last Name (STitle) 696**]

MEDICATION ON ADMISSION: enalapril daily, lipitor daily, Vit D, levothyroxine daily

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: On admission:
Vitals: T:98.4 BP: 110/51 P: 78 R: 15 O2: 100%
General: intubated, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, endotrach tube
in place
Neck: supple, JVP not elevated, no LAD
Lungs: coarse breath sounds bilaterally, vent sounds
CV: Limited exam b/c of breath and vent sounds. Regular rate and
rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. L
hip incision CDI with staples. +SILT, NVI distally.
+AT/PT/FHL/[**Last Name (un) 938**].

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Community ambulator, active. lives with husband. works
as teacher. former smoker, drinks [**1-2**] glasses of wine/night.
Broken prosthetic joint implant,Pneumonia, organism unspecified,Acute respiratory failure,Hip joint replacement,Other iatrogenic hypotension,Other fluid overload,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pure hypercholesterolemia,Unspecified acquired hypothyroidism
Broke prosthtc jt implnt,Pneumonia, organism NOS,Acute respiratry failure,Joint replaced hip,Iatrogenc hypotnsion NEC,Fluid overload NEC,Hypertension NOS,Abn react-artif implant,Accident in place NOS,Pure hypercholesterolem,Hypothyroidism NOS
Admission Date:  [**2185-5-7**]              Discharge Date:   [**2185-5-15**]

Date of Birth:  [**2115-11-30**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 7303**]
Chief Complaint:
Hip dissociation

Major Surgical or Invasive Procedure:
Left hip revision
Endotracheal intubation

History of Present Illness:
69 yo F with hx of left total hip replacement 8 years ago at
[**Hospital3 **] Hospital presents as transfer with left THR
dissociation on [**2185-5-7**]  now s/p revision of left total hip
[**2185-5-10**]. She described walking
out of dinner yesterday evening when she felt a sudden
"numbness"
in her left hip, a feeling like her leg was no longer there.
Denies any presyncopal symptoms. She fell to ground, landing on
her knees but without injury or headstrike. Had immediate left
hip pain with movement and was unable to bear weight. Was taken
to [**Hospital3 **] Hospital where imaging was obtained and she was
transferred for further orthopaedic care. She had a hip
aspiration on [**5-8**] showing [**Numeric Identifier 88552**] RBC, 1000 WBC, 76 polys.
.
During the operation, EBL 1000 cc. She received 500 cc blood,
3500 crystalloid. She had 1500 UOP.  She has 2 PIVs and an
arterial line. Neosynephrine at 0.5 at time of transfer. Pt was
on neosenphrine during entire case. When tried to wean off, pt
had low BP in mid 70s systolic but when on it SBPs in 100s. Pt
moving around w/out sedation but concern for possible fluid
overload and hypotension as she appeared a little more swollen
at the end of case than before. Also got opiods, dilaudid for
pain control.  [**Hospital Ward Name **] surgical moonlighter will be contact.

.
On the floor, final reported blood loss was 1500cc, got 6L total
fluids, made good urine of 1600 and got back 500cc of own blood
from cell [**Doctor Last Name 10105**]. HCT had been checked and was stable but conern
that this may be not completely accurate. Currently on propofol
for sedation given still intubated but had been moving around
when sedation weaned.
.
Review of sytems:
pt intubated, not able to obtain


Past Medical History:
HTN
high cholesterol
hypothyroidism
appendectomy
tonsillectomy
ORIF right ankle
left total hip replacement at [**Hospital3 **] Hospital by Dr.
[**Last Name (STitle) 71113**] 8 years ago (currently followed by Dr. [**Last Name (STitle) 696**]


Social History:
Community ambulator, active. lives with husband. works
as teacher. former smoker, drinks [**1-2**] glasses of wine/night.


Family History:
Non-contributory

Physical Exam:
On admission:
Vitals: T:98.4 BP: 110/51 P: 78 R: 15 O2: 100%
General: intubated, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, endotrach tube
in place
Neck: supple, JVP not elevated, no LAD
Lungs: coarse breath sounds bilaterally, vent sounds
CV: Limited exam b/c of breath and vent sounds. Regular rate and
rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. L
hip incision CDI with staples. +SILT, NVI distally.
+AT/PT/FHL/[**Last Name (un) 938**].

Pertinent Results:
[**2185-5-15**] 06:44AM BLOOD WBC-8.9 RBC-3.14* Hgb-9.5* Hct-28.3*
MCV-90 MCH-30.4 MCHC-33.7 RDW-13.7 Plt Ct-316
[**2185-5-14**] 06:58AM BLOOD WBC-9.6 RBC-2.79* Hgb-8.2* Hct-25.0*
MCV-90 MCH-29.4 MCHC-32.8 RDW-13.3 Plt Ct-259
[**2185-5-13**] 07:15AM BLOOD WBC-9.9 RBC-2.92* Hgb-8.6* Hct-26.4*
MCV-90 MCH-29.6 MCHC-32.7 RDW-13.3 Plt Ct-224
[**2185-5-12**] 04:47AM BLOOD WBC-10.6 RBC-2.97* Hgb-8.7* Hct-26.8*
MCV-90 MCH-29.2 MCHC-32.4 RDW-13.4 Plt Ct-212
[**2185-5-11**] 02:08PM BLOOD WBC-11.0 RBC-3.14* Hgb-9.4* Hct-28.6*
MCV-91 MCH-29.8 MCHC-32.7 RDW-13.2 Plt Ct-221
[**2185-5-11**] 01:50AM BLOOD WBC-16.9*# RBC-3.62* Hgb-10.8* Hct-32.9*
MCV-91 MCH-29.9 MCHC-32.9 RDW-13.1 Plt Ct-281
[**2185-5-15**] 06:44AM BLOOD Glucose-94 UreaN-10 Creat-0.6 Na-139
K-3.9 Cl-102 HCO3-27 AnGap-14
[**2185-5-14**] 06:58AM BLOOD Glucose-97 UreaN-9 Creat-0.5 Na-139 K-3.6
Cl-104 HCO3-27 AnGap-12
[**2185-5-13**] 07:15AM BLOOD Glucose-102* UreaN-7 Creat-0.5 Na-137
K-3.8 Cl-103 HCO3-27 AnGap-11

Brief Hospital Course:
69 yo F with hx of left total hip replacement 8 years ago at
[**Hospital3 **] Hospital presents as transfer with left THR
dissociation on [**2185-5-7**]  now s/p revision of left total hip
[**2185-5-10**]. During the operation, EBL 1000 cc; received 500 cc
blood, 3500 crystalloid and had 1500 UOP. Pt had hypotension and
required  Neosynephrine at 0.5 at time of transfer. Pt has 2
PIVs and an arterial line. Sent to ICU for management of
hypotension s/p surgery.
.
# Hypotension s/p hip replacement: patient had hypotension after
total hip replacement.  Estimated blood loss in OR was 1500cc,
got 500cc blood back from cell [**Doctor Last Name 10105**] plus total of 6L IVF and
made 1600cc urine. Pt also sedated and got pain medications
which may have contributed to labile blood pressures.  IV fluid
and blood transfusions, as well as phenylephrine, were given to
achieve goal MAP>65.  Hematocrits were trended regualarly to
evaluate for blood loss.
- wean propofol --> switch to fentynal and midazolam
- titrate pain meds down as much as possible given could be
contributing to hypotension.
.
# Respiratory status/right lower lobe infiltrate on chest x-ray:
Because of labile pressures when tried to wean neosenphrine and
concern that pt may be fluid overload b/c noted to be swollen
compared to start of case, decision was made to keep intubated
and slowly wean off neosenprhine in ICU. Pt successfully
extubated and weaned off pressors on [**2185-5-11**]. On CXR, patient
had right lower lobe infiltrate with differential diagnosis of
atelectasis vs. pneumonia.  Sputum and blood cultures were
obtained and ....  Monitor exam, CXR.
.
# s/p right hip revision: patient had sudden dissocation of
prothesis in setting of no trauma.   She is s/p left THR
dissociation on [**2185-5-7**] and now s/p revision of left total hip
[**2185-5-10**].
- monitor wound site for signs of bleeding or infection
- appropriate immobilzation for acute phase s/p hip replacement
- monitor coags, lytes, cbc
- sugery recs
- ancef
- enoxaparin per surgery
.
# Hypertension: home enalapril dose was held given hypotension
.
# Hypercholesteroloema: pt on lipitor at home
- hold for now in setting of acute hypotension and potential for
end organ damage; will restart once stablizes
- moniotor LFTs
.
# Hypothyroidism: patient is on levothyroxine at home, which was
continued during her hospitalization.

Postoperative course was remarkable for the following:

1. Transfer to ICU for hypotension (See above)

Otherwise, pain was initially controlled with a PCA followed by
a transition to oral pain medications on POD#1.  The patient
received lovenox for DVT prophylaxis starting on the morning of
POD#1.  The foley was removed on POD#2 and the patient was
voiding independently thereafter. The surgical dressing was
changed on POD#2 and the surgical incision was found to be clean
and intact without erythema or abnormal drainage. The patient
was seen daily by physical therapy. Labs were checked throughout
the hospital course and repleted accordingly. At the time of
discharge the patient was tolerating a regular diet and feeling
well.  The patient was afebrile with stable vital signs.  The
patient's hematocrit was acceptable and pain was adequately
controlled on an oral regimen. The operative extremity was
neurovascularly intact and the wound was benign.

2. Transfusion 1 u PRBC on [**2185-5-14**]. HCT 28.3 on discharge,
symptoms resolved.

The patient's weight-bearing status is PARTIAL weight bearing on
the operative extremity with posterior precautions. Two crutches
or walker at all times x 6 weeks. Hip abduction brace at all
times when out of bed.

Ms. [**Known lastname 7749**] is discharged to rehab in stable condition.

Medications on Admission:
enalapril daily, lipitor daily, Vit D, levothyroxine daily


Discharge Medications:
1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
5. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
dose PO DAILY (Daily).
6. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe
Subcutaneous DAILY (Daily) for 3 weeks.
Disp:*21 syringe* Refills:*0*
7. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO twice
a day for 3 weeks: AFTER completing Lovenox, take as directed
with food.
Disp:*42 Tablet(s)* Refills:*0*
8. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Cape & Islands

Discharge Diagnosis:
Left hip implant failure with breakage of trunnion of femoral
stem


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
1. Please return to the emergency department or notify your
physician if you experience any of the following: severe pain
not relieved by medication, increased swelling, decreased
sensation, difficulty with movement, fevers greater than 101.5,
shaking chills, increasing redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.

2. Please follow up with your primary physician regarding this
admission and any new medications and refills.

3. Resume your home medications unless otherwise instructed.

4. You have been given medications for pain control. Please do
not drive, operate heavy machinery, or drink alcohol while
taking these medications. As your pain decreases, take fewer
tablets and increase the time between doses. This medication can
cause constipation, so you should drink plenty of water daily
and take a stool softener (such as colace) as needed to prevent
this side effect.  Call your surgeons office 3 days before you
are out of medication so that it can be refilled.  These
medications cannot be called into your pharmacy and must be
picked up in the clinic or mailed to your house.  Please allow
an extra 2 days if you would like your medication mailed to your
home.

5. You may not drive a car until cleared to do so by your
surgeon or your primary physician.

6. Please keep your wounds clean. You may shower starting five
(5) days after surgery, but no tub baths or swimming for at
least four (4) weeks. No dressing is needed if wound continues
to be non-draining. Any stitches or staples that need to be
removed will be taken out by the visiting nurse (VNA) or rehab
facility two
weeks after your surgery.

7. Please call your surgeon's office to schedule or confirm your
follow-up appointment in four (4) weeks.

8. Please DO NOT take any non-steroidal anti-inflammatory
medications (NSAIDs such as celebrex, ibuprofen, advil, aleve,
motrin, etc).

9. ANTICOAGULATION: Please continue your lovenox for three (3)
weeks to help prevent deep vein thrombosis (blood clots).  After
completing the lovenox, please take Aspirin 325mg  TWICE  daily
for an additional three weeks.  [**Male First Name (un) **] STOCKINGS x 6 WEEKS.

10. WOUND CARE: Please keep your incision clean and dry. It is
okay to shower five days after surgery but no tub baths,
swimming, or submerging your incision until after your four (4)
week checkup. Please place a dry sterile dressing on the wound
each day if there is drainage, otherwise leave it open to air.
Check wound regularly for signs of infection such as redness or
thick yellow drainage. Staples will be removed by the visiting
nurse or rehab facility in two (2) weeks.

11. VNA (once at home): Home PT/OT, dressing changes as
instructed, wound checks, and staple removal at two weeks after
surgery.

12. ACTIVITY: Partial weight bearing on the operative extremity
until follow-up appointment. Posterior precautions. Hip
abduction brace on at all times when out of bed. No strenuous
exercise or heavy lifting until follow up appointment.
Physical Therapy:
PWB x 4 weeks
Hip abduction brace AAT when OOB
 - 0-90 flexion
 - 30 abduction
 - No internal rotation
Mobilize
2 Crutches/Walker x 6 weeks
Treatments Frequency:
Dry sterile dressing daily as needed for drainage
Wound checks
Ice as tolerated
Staple removal POD 14 - replace with steristrips
TEDS x 6 weeks

Followup Instructions:
Please call [**Telephone/Fax (1) 1228**] to schedule/confirm your follow-up
appointment with Dr. [**Last Name (STitle) 5322**] in 4 weeks.


                             [**First Name4 (NamePattern1) 6100**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 7305**]

Completed by:[**2185-5-15**]

Name:  [**Known lastname 2534**],[**Known firstname 14053**]                 Unit No:   [**Numeric Identifier 14054**]

Admission Date:  [**2185-5-7**]              Discharge Date:   [**2185-5-15**]

Date of Birth:  [**2115-11-30**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 942**]
Addendum:
Please note the proper admission diagnosis for this patient was
THR implant failure/broken femoral stem.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Cape & Islands

                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 945**]

Completed by:[**2185-5-20**]
{'Broken prosthetic joint implant,Pneumonia, organism unspecified,Acute respiratory failure,Hip joint replacement,Other iatrogenic hypotension,Other fluid overload,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pure hypercholesterolemia,Unspecified acquired hypothyroidism'}


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: Hip dissociation

PRESENT ILLNESS: 69 yo F with hx of left total hip replacement 8 years ago at
[**Hospital3 **] Hospital presents as transfer with left THR
dissociation on [**2185-5-7**]  now s/p revision of left total hip
[**2185-5-10**]. She described walking
out of dinner yesterday evening when she felt a sudden
"numbness"
in her left hip, a feeling like her leg was no longer there.
Denies any presyncopal symptoms. She fell to ground, landing on
her knees but without injury or headstrike. Had immediate left
hip pain with movement and was unable to bear weight. Was taken
to [**Hospital3 **] Hospital where imaging was obtained and she was
transferred for further orthopaedic care. She had a hip
aspiration on [**5-8**] showing [**Numeric Identifier 88552**] RBC, 1000 WBC, 76 polys.
.
During the operation, EBL 1000 cc. She received 500 cc blood,
3500 crystalloid. She had 1500 UOP.  She has 2 PIVs and an
arterial line. Neosynephrine at 0.5 at time of transfer. Pt was
on neosenphrine during entire case. When tried to wean off, pt
had low BP in mid 70s systolic but when on it SBPs in 100s. Pt
moving around w/out sedation but concern for possible fluid
overload and hypotension as she appeared a little more swollen
at the end of case than before. Also got opiods, dilaudid for
pain control.  [**Hospital Ward Name **] surgical moonlighter will be contact.

MEDICAL HISTORY: HTN
high cholesterol
hypothyroidism
appendectomy
tonsillectomy
ORIF right ankle
left total hip replacement at [**Hospital3 **] Hospital by Dr.
[**Last Name (STitle) 71113**] 8 years ago (currently followed by Dr. [**Last Name (STitle) 696**]

MEDICATION ON ADMISSION: enalapril daily, lipitor daily, Vit D, levothyroxine daily

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: On admission:
Vitals: T:98.4 BP: 110/51 P: 78 R: 15 O2: 100%
General: intubated, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, endotrach tube
in place
Neck: supple, JVP not elevated, no LAD
Lungs: coarse breath sounds bilaterally, vent sounds
CV: Limited exam b/c of breath and vent sounds. Regular rate and
rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. L
hip incision CDI with staples. +SILT, NVI distally.
+AT/PT/FHL/[**Last Name (un) 938**].

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Community ambulator, active. lives with husband. works
as teacher. former smoker, drinks [**1-2**] glasses of wine/night. 

### Response:
{'Broken prosthetic joint implant,Pneumonia, organism unspecified,Acute respiratory failure,Hip joint replacement,Other iatrogenic hypotension,Other fluid overload,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in unspecified place,Pure hypercholesterolemia,Unspecified acquired hypothyroidism'}
