CHIEF COMPLAINT: 

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 51 year old
woman who, in [**2133-10-26**], around the 14th, sustained a
trauma when she became trapped between the counter-weight of
a backhoe and a concrete wall.  She had a crushing injury
between her left and right abdomen.  She was transferred to
[**Hospital 6930**] [**Hospital 12018**] Hospital at that time, and during her
work-up there was no evidence of any internal injury.  She
was stable, observed and sent home.  Approximately one week
after being sent home, she became increasingly dyspneic, and
was brought to [**Hospital 1514**] Hospital on [**2133-11-15**].  She was ill
and on work-up she was found to have free air in the abdomen.
She was taken to the Operating Room where she was found to
have a perforation of the distal ileum and intestinal
contents filling her abdomen.  A side-to-side functional
end-to-end anastomosis was made after resection of the
perforation three feet from the ileocecal valve.  G- and
J-tubes were placed intraoperatively, and she had tolerated
that procedure well.

MEDICAL HISTORY: 1.  As above.
2.  The patient reports having reactive airway disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Demerol and Phenylpiperone.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other specified septicemias,Iatrogenic pulmonary embolism and infarction,Iatrogenic pneumothorax,Cardiac arrest,Other convulsions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Peritoneal adhesions (postoperative) (postinfection),Calcium deposits in tendon and bursa
Septicemia NEC,Iatrogen pulm emb/infarc,Iatrogenic pneumothorax,Cardiac arrest,Convulsions NEC,React-oth vasc dev/graft,Intestinal fistula,Peritoneal adhesions,Calcium deposit tendon
Admission Date:  [**2133-12-29**]     Discharge Date:  [**2134-4-24**]

Date of Birth:   [**2082-4-9**]     Sex:  F

Service:  BLUE-[**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:  [**Known firstname **] [**Known lastname **] is a 51 year old
woman who, in [**2133-10-26**], around the 14th, sustained a
trauma when she became trapped between the counter-weight of
a backhoe and a concrete wall.  She had a crushing injury
between her left and right abdomen.  She was transferred to
[**Hospital 6930**] [**Hospital 12018**] Hospital at that time, and during her
work-up there was no evidence of any internal injury.  She
was stable, observed and sent home.  Approximately one week
after being sent home, she became increasingly dyspneic, and
was brought to [**Hospital 1514**] Hospital on [**2133-11-15**].  She was ill
and on work-up she was found to have free air in the abdomen.
She was taken to the Operating Room where she was found to
have a perforation of the distal ileum and intestinal
contents filling her abdomen.  A side-to-side functional
end-to-end anastomosis was made after resection of the
perforation three feet from the ileocecal valve.  G- and
J-tubes were placed intraoperatively, and she had tolerated
that procedure well.

One week after that procedure, it was noted that a bilious
nature was draining from her wound and she was taken back to
the Operating Room for re-exploration and found that the
sites of the G- and J-tubes were leaking intestinal contents
into the abdomen.  The tubes were changed and she tolerated
that procedure well.  Afterwards, she continued to leak and
she was brought back to the Operating Room for a third time
on [**12-12**]/200.  The G-tube site was closed with a TX-60 mm
stapler and oversewn with #3-0 Silk sutures.  The J-tube site
was oversewn with #3-0 Prolene sutures.

After the third procedure, she continued to appear to be
leaking from her wound and continued to have what was now
characterized as a small enterocutaneous fistula.  During her
time at this hospital, she was placed on TPN, continued NPO
and had a nasogastric tube.  They had placed a VAC dressings
in the wound containing the fistula, which was draining
approximately one liter a day.  She had undergone a
tracheostomy tube placement on [**12-12**].  On [**2133-11-26**],
she had undergone a catheter insertion for starting TPN.
During this procedure, it was noted that after the wire
insertion, the patient developed premature ventricular
contractions, subsequently turned to ventricular tachycardia
and then ventricular fibrillation arrest.  She was shocked
and underwent ACLS protocol.  She was recovered into sinus
rhythm after one shock.  The line was aborted at that time.
A line was then successfully placed afterwards.

She was then being transferred on [**2133-12-29**], to [**Hospital1 346**] under the care of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 957**]
of her enterocutaneous fistula.

PAST MEDICAL HISTORY:
1.  As above.
2.  The patient reports having reactive airway disease.

PAST SURGICAL HISTORY:
1.  As above.

MEDICATIONS ON ADMISSION FROM [**Hospital **] HOSPITAL:
1.  Unasyn 1.5 mg intravenous q. six hours.
2.  Fluconazole 200 mg q. 24.
3.  Heparin 5000 units subcutaneously q. 12 hours.
4.  Ativan 2 mg intravenous q. eight p.r.n.
5.  Nystatin oral swish and swallow, 1 cc twice a day.
6.  Fentanyl patch 50 micrograms q. 24.
7.  Versed 3 mg intravenous p.r.n.
8.  Morphine 10 mg intravenous p.r.n.
9.  Nystatin Powder twice a day.
10. Carafate one gram per NG tube.
11. Vancomycin one gram intravenous q. 12.
12. Total parenteral nutrition.

ALLERGIES:   Demerol and Phenylpiperone.

LABORATORY DATA:  On admission, white blood cell count of
9.1, hematocrit of 30.4, platelets of 512, PT of 13.0, PTT of
27.8, INR of 1.2.  Sodium of 140, potassium of 4.3, chloride
of 102, bicarbonate of 32, BUN of 14, creatinine of 0.4,
glucose of 111.  ALT of 34, AST of 26, alkaline phosphatase
is 113, total bilirubin is 0.5.

Urinalysis was negative.

Her gas on admission was pH of 7.45, pO2 of 104, pCO2 of 45,
bicarbonate of 34.

X-ray on admission showed a left lower lobe consolidation.

EKG on admission showed sinus tachycardia.

HOSPITAL COURSE:  The patient was admitted to the Blue
Surgery Service on [**2133-12-29**].  At that time, she had had a
VAC dressing applied to her fistula.  This was removed.
Multiple daily dressing changes were continued.  Wet-to-dry
were placed in the open areas and Duoderm were placed to
prevent skin breakdown.  She was continued on TPN.  A feeding
tube was placed into the fistula and tube feeds were started
at that time.  On [**1-7**], the patient spiked a temperature.
Blood cultures were sent which were positive for
Staphylococcus coagulase negative species.  At that time, it
was decided that a central line which was placed at [**Location (un) 1514**]
was to be changed and resited.  The catheter tip was sent for
culture and came back as Staphylococcus coagulase negative.

She underwent a line change on [**2134-1-8**].  During the line
placement, the patient became acutely short of breath.  Her
right chest was needle decompressed for a tension
pneumothorax.  She then subsequently went into cardiac
arrest.  CPR was initiated and she was shocked with 200
joules times one.  The ACLS protocol was continued for
approximately five minutes.  A right chest tube was placed
during this time as well.  She was transferred to the
Surgical Intensive Care Unit for further care, on full
pressor support, ventilation via the tracheostomy and for
close monitoring.

Upon transfer to the Intensive Care Unit, she also was
witnessed to have a post-arrest seizure.  Neurology was
consulted and she was started on Dilantin.  She was also
unresponsive after the Code and three days later she was
mentating at baseline.

On [**2134-1-12**], after stabilizing and after being weaned off
of pressors and her ventilatory support, with patient
mentating well, she was transferred back to the Floor.  On
[**2134-1-18**], the patient described sudden acute onset of
shortness of breath.  O2 saturations dropped down to 40%.
She was placed on 100% tracheostomy mask.  She underwent a
CTA which demonstrated massive bilateral pulmonary emboli and
showed bilateral pleural effusions.  She also underwent an
echocardiogram; this showed severe global right ventricular
free wall hypokinesis.  Ejection fraction of the left
ventricle remained greater than 75%.  She was transferred to
the Intensive Care Unit.  She was placed on a ventilator for
respiratory support.  After the findings of the CTA she was
started on TPA and had received her first dose and bright red
blood was suctioned from the tracheostomy.  TPA was stopped.
She was continued on heparin.

During this period, she was continued on TPN.  She was
receiving tube feeds via the tube feed placed into the
fistula.  She was started on Vancomycin, Ceftazidime and
Diflucan after the initial cultures were drawn.  She did have
an additional positive blood culture on [**2134-1-30**].  She
remained in the unit on heparin, started on Coumadin and was
weaned off the ventilator appropriately.  Her antibiotics
were stopped on [**2134-1-31**].  She continued to receive
aggressive pulmonary toilet.  On [**2134-2-3**], her O2
saturations were decreased.  She was evaluated and an IVC
Filter was placed by Interventional Radiology for presumed
continued pulmonary emboli.  She tolerated that procedure
well.  She remained in the Intensive Care Unit for several
weeks, receiving TPN, undergoing a ventilator wean and
receiving appropriate tracheostomy care.  During this time,
she also received Physical Therapy and was ambulating.

On [**2134-2-17**], she underwent a fistulogram which significant
for two enterocutaneous fistulas with approximately four to
five feet of small bowel between them, with contrast flowing
distally with no sign of an obstruction.  On [**2134-2-23**], her
tracheostomy was discontinued and was tolerated
appropriately.  On [**2134-2-25**], a PICC line was placed for
continued TPN.  A this time, she also spiked a temperature.
Blood cultures were positive for Enterococcus.  Sputum was
sent and was positive for Pseudomonas.  She was started on
antibiotics.  She was transferred to the Floor on [**2134-2-25**].


On the floor, her recovery continued.  She was on TPN, on
tube feeds, receiving Physical Therapy, receiving dressing
changes.  Her wound fistula output remained high.  A sump
catheter was placed on the edge of the wound to extract
fistula drainage.  The wound continued to granulate and had
progressed into the size of approximately 5 cm in diameter.
She had originally had two fistulas, a superior and an
inferior aspect.  The inferior fistula began to have
decreased output and began to have no output through the
month of [**Month (only) 956**].  The superior fistula continued to have a
high output.

On [**2134-3-10**], she again had a temperature spike.  Blood
cultures showed Staphylococcus coagulase negative and a
catheter tip after the line was changed showed Staphylococcus
coagulase negative.  She was started on Vancomycin and she
continued to have surveillance blood cultures which remained
negative until her discharge.  She remained on the Vancomycin
for 22 days which was then discontinued.

Her course on the Floor then remained unremarkable.  On
[**2134-4-8**], she underwent a second fistulogram which showed
no extra-luminal contrast or obstruction from the point of
injection.  It was decided for the patient to undergo
surgical correction of the fistula at that point; she was
scheduled for the Operating Room.  On [**2134-4-14**], she began
preoperative preparations which include Hibiclens abdominal
scrubs three times a day, Neomycin and Erythromycin base
antibiotics and Milk of Magnesia placed in the tube feeds for
bowel prep.  She was started on perioperative Levofloxacin,
Flagyl and Vancomycin.

On [**2134-4-15**], she went to the Operating Room where she
underwent an exploratory laparotomy, lysis of adhesions (3
hours), enterectomy, entero-ostomy, drainage of
intra-abdominal abscess, feeding jejunostomy, and complex
abdominal wall reconstruction.  She tolerated this procedure
well, received two units of packed cells with an estimated
blood loss of 500 cc and was then transferred to the Unit,
extubated and in stable condition.  She continued on her TPN
and was started on her tube feeds at 20 cc an hour.

After postoperative day number one, she remained
hemodynamically stable, awake and alert, and she was
transferred to the Floor for the remainder of her recovery.
Neurologically, she remained on a Dilaudid PCA which was
weaned to Tylenol #3.  Due to her heavy use of narcotics
during her hospital stay, she began to show symptoms of
withdrawal which included tachycardia, diaphoresis and
tremors.  She was placed on Ativan 0.5 mg q. six hours which
alleviated a lot of the symptoms.  She remained alert and
oriented times three.  Cardiovascular system remained stable.
She was placed on Lopressor intravenous postoperatively for
her tachycardia.  This was changed to p.o. Lopressor when she
was tolerating p.o.  She remained in a regular rate and
rhythm throughout the remainder of her recovery.

Respiratory-wise, she was weaned off of oxygen, had two
saturations in the high 90s.

Gastrointestinal:  She was continued on her tube feeds
postoperatively.  On postoperative day number eight, she was
changed and cycled for tube feeds at night with 2/3 strength
of Impact with fiber at 40 cc an hour.  She was advanced to a
Regular diet which she tolerated.  She was passing flatus and
having bowel movements which were loose for several days,
which then became formed.  There has been no evidence of any
leakage or drainage from the wound at this time.  Her TPN was
continued until postoperative day number seven and then it
was stopped.  Her renal function remained stable, her Foley
catheter was discontinued and she has been voiding without
any problem.

Hematologically, she was started on subcutaneous heparin
perioperatively and then restarted on her Coumadin.  Her most
recent INR was 2.1, therapeutic, on 7.5 mg p.o. q. day of
Coumadin.  The perioperative antibiotics were stopped on
postoperative day number four.  She remained afebrile and is
going to be discharged on no antibiotics.

The central line was taken out on postoperative day number
seven without any incidence.  Line tip culture was sent which
was negative on [**2134-4-22**].  She had two [**Location (un) 1661**]-[**Location (un) 1662**] placed
intraoperatively and they were draining serosanguinous
drainage, minimal amounts.  She received adequate teaching on
how to care for her [**Location (un) 1661**]-[**Location (un) 1662**] which will then be followed
in the office by Dr. [**Last Name (STitle) 957**].  She has worked with Physical
Therapy and has been ambulating.  She will require Physical
Therapy at home through visiting nurse.

Of note, during her long and complicated hospitalization,
[**First Name8 (NamePattern2) **] [**Known lastname **] had developed bilateral foot drop with weakness on
plantar extension.  She has been working with Physical
Therapy and has gained some of her strength and ability to
walk.  She is stable on postoperative day number 9, hospital
day number 115.

DISCHARGE INSTRUCTIONS:
1.  For discharge she will go home with [**Hospital6 1587**] services.
2.  She will follow-up with Dr. [**Last Name (STitle) 957**] in approximately a
week and a half and will call the office for an appointment.

DISCHARGE DIAGNOSES:
1.  Status post enterocutaneous fistulae.
2.  Exploratory laparotomy and repair of enterocutaneous
fistulae.
3.  Status post trauma with subsequent multiple surgeries.
4.  Status post cardiac arrest after line placement.
5.  Bilateral pulmonary emboli.

DISCHARGE MEDICATIONS:
1.  Ativan 0.5 mg p.o. four times a day.
2.  Reglan 5 mg p.o. q. six hours.
3.  Benadryl 25 mg p.o. q. six hours p.r.n.
4.  Cholestyramine 4 grams p.o. twice a day mixed with Ocean
Spray Cranberry Juice.
5.  Loperamide 2 mg p.o. q. 12 hours.
6.  Levofloxacin 500 mg p.o. q. day.
7.  Sucralfate 1 mg p.o. four times a day.
8.  Tylenol #3, 1 to 2 p.o. q. four hours p.r.n.
9.  Protonix 40 mg p.o. q. day.
10. Sertraline 100 mg p.o. q. h.s.
11. Misoprostol 100 micrograms p.o. four times a day.
12. Lopressor 50 mg p.o. three times a day.
13. Zaltidine 10 mg p.o. q. h.s. p.r.n.
14. Coumadin 7.5 mg p.o. q. day; levels will be phoned in to
Dr.[**Name (NI) 6275**] office.
15. Flovent 110 micrograms, one puff twice a day.
16. Combivent two to eight puffs q. six p.r.n.

SPECIAL INSTRUCTIONS FOR [**Hospital6 **]:
1.  Wound check:  Dressing will include Xeroform on the wound
with dry gauze and an abdominal binder at all times.
2.  Coagulation blood draws will be done twice a week and
results will be called to Dr. [**Last Name (STitle) 957**], [**Telephone/Fax (1) 17478**].
3.  Physical Therapy.
4.  She will continue with tube feeds 2/3 strength Impact
with fiber running from 9 p.m. to 7 a.m. at 40 cc an hour.
5.  She will follow-up with Dr. [**Last Name (STitle) 957**] in two weeks.  She
will call the office for an appointment.


                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4007**]

Dictated By:[**Last Name (NamePattern1) 3835**]

MEDQUIST36

D:  [**2134-4-25**]  15:46
T:  [**2134-4-26**]  15:55
JOB#:  [**Job Number 37602**]
{'Other specified septicemias,Iatrogenic pulmonary embolism and infarction,Iatrogenic pneumothorax,Cardiac arrest,Other convulsions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Peritoneal adhesions (postoperative) (postinfection),Calcium deposits in tendon and bursa'}


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: 

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 51 year old
woman who, in [**2133-10-26**], around the 14th, sustained a
trauma when she became trapped between the counter-weight of
a backhoe and a concrete wall.  She had a crushing injury
between her left and right abdomen.  She was transferred to
[**Hospital 6930**] [**Hospital 12018**] Hospital at that time, and during her
work-up there was no evidence of any internal injury.  She
was stable, observed and sent home.  Approximately one week
after being sent home, she became increasingly dyspneic, and
was brought to [**Hospital 1514**] Hospital on [**2133-11-15**].  She was ill
and on work-up she was found to have free air in the abdomen.
She was taken to the Operating Room where she was found to
have a perforation of the distal ileum and intestinal
contents filling her abdomen.  A side-to-side functional
end-to-end anastomosis was made after resection of the
perforation three feet from the ileocecal valve.  G- and
J-tubes were placed intraoperatively, and she had tolerated
that procedure well.

MEDICAL HISTORY: 1.  As above.
2.  The patient reports having reactive airway disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Demerol and Phenylpiperone.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other specified septicemias,Iatrogenic pulmonary embolism and infarction,Iatrogenic pneumothorax,Cardiac arrest,Other convulsions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Fistula of intestine, excluding rectum and anus,Peritoneal adhesions (postoperative) (postinfection),Calcium deposits in tendon and bursa'}
