CHIEF COMPLAINT: 74 year old male who returned from rehab after a prolonged
hospital stay with hypotension, abd. and chest pain, and
hypoxia.

PRESENT ILLNESS: 

MEDICAL HISTORY: chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions

MEDICATION ON ADMISSION: Protonix 40 mg PO daily
Levoquin 250 mg PO daily
Digoxin 0.125 mg PO daily
Oxybutinin 10 q am, 5 q pm
Lasix 40 mg PO BID
Colace 100 mg PO BID
Allopurinol 100 mg PO daily
Lisinopril 2.5 mg PO daily
Toprol XL 25 mg PO daily

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: Gen: Pale [**Male First Name (un) 4746**] in NAD
VS: BP: 107/79 HR: 100 AF
HEENT: NC/AT. PERLA, EOMI, oropharynx adentulous
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+= bilat. without bruits.
Lungs: R clear to A+P, L has decreased BS
CV: IRRR without R/G
Abd: sl. distended, decreased BS, generalized tenderness, LIH
Ext: without clubbing, cyanosis, or edema, chronic bilat. stasis
ulcers
Neuro: sl. lethargic, but non focal.

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol.
Hypotension, unspecified,Anemia of other chronic disease,Acute respiratory failure,Blood vessel replaced by other means,Attention to tracheostomy,Atrial fibrillation,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Calculus of ureter,Long-term (current) use of anticoagulants,Acquired absence of teeth, unspecified,Dwarfism, not elsewhere classified
Hypotension NOS,Anemia-other chronic dis,Acute respiratry failure,Blood vessel replac NEC,Atten to tracheostomy,Atrial fibrillation,Unilat ing hernia w obst,Calculus of ureter,Long-term use anticoagul,Acq absence of teeth NOS,Dwarfism NEC
Admission Date:  [**2195-7-4**]              Discharge Date:   [**2195-7-7**]

Date of Birth:  [**2121-2-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Aspirin / Bactrim

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
74 year old male who returned from rehab after a prolonged
hospital stay with hypotension, abd. and chest pain, and
hypoxia.

Major Surgical or Invasive Procedure:
None


Past Medical History:
chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions


Social History:
Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol.


Family History:
Unremarkable

Physical Exam:
Gen: Pale [**Male First Name (un) 4746**] in NAD
VS: BP: 107/79 HR: 100 AF
HEENT: NC/AT. PERLA, EOMI, oropharynx adentulous
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+= bilat. without bruits.
Lungs: R clear to A+P, L has decreased BS
CV: IRRR without R/G
Abd: sl. distended, decreased BS, generalized tenderness, LIH
Ext: without clubbing, cyanosis, or edema, chronic bilat. stasis
ulcers
Neuro: sl. lethargic, but non focal.

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2195-7-7**] 04:37AM    9.0 3.13* 9.6* 28.9* 92 30.8 33.3 16.6*
103*
Source: Line-r picc
DIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas
[**2195-7-4**] 06:56PM    87.6*   7.4* 4.5 0.5 0.1
RED CELL MORPHOLOGY Hypochr Anisocy Macrocy
[**2195-7-4**] 06:56PM    3+ 1+ 2+
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2195-7-7**] 04:37AM        103*
[**2195-7-7**] 04:37AM    14.4*1 35.6*   1.4

Chemistry
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2195-7-7**] 04:37AM    101 40* 1.9* 131* 5.3* 99 251 12
ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase
TotBili DirBili
[**2195-7-4**] 06:56PM    24 35   37* 299* 55 2.2*
OTHER ENZYMES & BILIRUBINS Lipase
[**2195-7-4**] 06:56PM    40
ANTIBIOTICS Vanco
[**2195-7-5**] 02:29AM    33.0



Brief Hospital Course:
The patient had a long hospital stay following an AVR homograft
on [**6-9**] and was transferred to rehab on [**2195-7-3**]. At rehab he
became hypotensive, hypoxic, and had abdominal pain.  He was
given volume in the ED and his Hct was 21.  He was transfused a
total of 3 units PRBC in 24 hours and was intermittently on a
low dose of Neo.  He had a CTA on chest and abdomen which
revealed that there was some hematoma around the graft, but no
active bleeding.  His CXR was much clearer than when he was
discharged.  He was admitted to the CSRU and received
respiratory therapy and intermittent Neo.  He had a negative
cortisol stim. test and was stable.  He has been on trach mask
and off Neo for 24 hours and doing well.  He will be transferred
to rehab today.

Medications on Admission:
Protonix 40 mg PO daily
Levoquin 250 mg PO daily
Digoxin 0.125 mg PO daily
Oxybutinin 10 q am, 5 q pm
Lasix 40 mg PO BID
Colace 100 mg PO BID
Allopurinol 100 mg PO daily
Lisinopril 2.5 mg PO daily
Toprol XL 25 mg PO daily

Discharge Medications:
1. Pantoprazole Sodium 40 mg Recon Soln Sig: One (1) Recon Soln
Intravenous  Q24H (every 24 hours).
2. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
4. Warfarin Sodium 2 mg Tablet Sig: 1.5 Tablets PO once a day:
INR goal 2-2.5.
5. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO once a day.
6. Ecotrin Low Strength 81 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day.
7. Combivent 103-18 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation four times a day.
8. Flovent 110 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation twice a day.
9. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO once a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 86**]

Discharge Diagnosis:
Hypotension
s/p AV homograft [**6-9**]
Respiratory failure w/ trach


Discharge Condition:
Good.

Discharge Instructions:
Trach mask with CPAP and PS PRN.
Tracheostomy care per protocol.
Follow medications on discharge instructions.
Do not use lotions, creams, or powders on wounds.
Do not lift more than 10 lbs. for 3 months.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 1290**] following discharge from
rehab.
Make an appointment with Dr. [**Last Name (STitle) 5456**] following discharge from
rehab.
Make an appointment with Dr. [**Last Name (STitle) **] following discharge from rehab.
Make an appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 2 weeks re:
hernia. [**Telephone/Fax (1) **]



Completed by:[**2195-7-7**]
{'Hypotension, unspecified,Anemia of other chronic disease,Acute respiratory failure,Blood vessel replaced by other means,Attention to tracheostomy,Atrial fibrillation,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Calculus of ureter,Long-term (current) use of anticoagulants,Acquired absence of teeth, unspecified,Dwarfism, not elsewhere classified'}


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: 74 year old male who returned from rehab after a prolonged
hospital stay with hypotension, abd. and chest pain, and
hypoxia.

PRESENT ILLNESS: 

MEDICAL HISTORY: chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions

MEDICATION ON ADMISSION: Protonix 40 mg PO daily
Levoquin 250 mg PO daily
Digoxin 0.125 mg PO daily
Oxybutinin 10 q am, 5 q pm
Lasix 40 mg PO BID
Colace 100 mg PO BID
Allopurinol 100 mg PO daily
Lisinopril 2.5 mg PO daily
Toprol XL 25 mg PO daily

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: Gen: Pale [**Male First Name (un) 4746**] in NAD
VS: BP: 107/79 HR: 100 AF
HEENT: NC/AT. PERLA, EOMI, oropharynx adentulous
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+= bilat. without bruits.
Lungs: R clear to A+P, L has decreased BS
CV: IRRR without R/G
Abd: sl. distended, decreased BS, generalized tenderness, LIH
Ext: without clubbing, cyanosis, or edema, chronic bilat. stasis
ulcers
Neuro: sl. lethargic, but non focal.

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol. 

### Response:
{'Hypotension, unspecified,Anemia of other chronic disease,Acute respiratory failure,Blood vessel replaced by other means,Attention to tracheostomy,Atrial fibrillation,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Calculus of ureter,Long-term (current) use of anticoagulants,Acquired absence of teeth, unspecified,Dwarfism, not elsewhere classified'}
