CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 103266**] is a 69-year-old male
with a history of CAD, hypertension and diverticulosis as
well as diverticulitis who was brought to the Emergency Room
by ambulance for diarrhea, nausea and vomiting.  He was found
history of chest pain, shortness of breath or abdominal pain.
He does admit to mild headache.  Other past medical history
is abbreviated due to the fact that the patient presented
acutely ill.  On Emergency Room arrival his temperature was
99.3, blood pressure 82/42, heart rate 133, breathing 96% on
room air and overall he was sluggish.  He was given several
liters of normal saline and begun on peripheral Dopamine.  He
incident in the Emergency Room.  The patient was complaining
of headache and of neck pain.  He, however, denied chest
pain, abdominal pain, pelvic pain as well as any nausea.  In
the Emergency Room he had a total of 8 liters of normal
saline and Dopamine drip was started at 5 mg.  He was treated
with Levaquin and Gentamycin.  He spiked to 104.2 and initial
ABG was done and was 7.29/39/132 on a non rebreather.  About
90 minutes later on 4 liters, the patient's ABG was
7.32/28/66.

MEDICAL HISTORY: Significant for CAD, status post PTCA
in [**2169**] and again in [**2170**].  Last catheterization in [**2171**]
revealed two vessel disease.  Ejection fraction was normal
per patient's PCP with [**Name Initial (PRE) **] history of hypertension, spinal
fusion in the past, no history of diabetes, history of a
chronic muscle wasting disease, extensive work-up negative,
history of depression, history of diverticulosis and history
of diverticulitis, most recent recurrence [**2185-1-27**].
Surgery was recommended but the patient refused the
procedure.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives alone in [**Location (un) 86**].  He is a retired
taxi driver.  He is originally from [**State 2748**].  His mother
is currently living in [**State 2748**].  PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 32630**].
Unspecified septicemia,Other shock without mention of trauma,Acute myocardial infarction of unspecified site, initial episode of care,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Unspecified essential hypertension
Septicemia NOS,Shock w/o trauma NEC,AMI NOS, initial,React-oth vasc dev/graft,Food/vomit pneumonitis,Oth specf bacteria,Hypertension NOS
Name:  [**Known lastname 16719**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 16720**]

Admission Date:                 Discharge Date:

Date of Birth:                  Sex:  M

Service:

ADDENDUM:
HOSPITAL COURSE:  The patient had a PICC line placement on
[**2185-8-5**] for administration of IV vancomycin, to continue for
seven days.  Also during the last few days of his hospital
course, the patient's potassium was slightly low at 3.4 and
3.6 and this was repleted.  His hematocrit was slightly down
at 28.3 and this will be followed up at rehabilitation.  The
patient was discharged to rehabilitation to continue on a
seven day course of vancomycin.  No other new medications
were added.



                                   [**Name6 (MD) 27**] [**Name8 (MD) **] M.D.12.944

Dictated By:[**Name8 (MD) 3242**]

MEDQUIST36

D:  [**2185-8-5**]  15:30
T:  [**2185-8-8**]  23:47
JOB#:  [**Job Number 16721**]


Admission Date:  [**2185-7-21**]       Discharge Date:  [**2185-8-4**]

Date of Birth:   [**2116-6-26**]       Sex:  M


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 103266**] is a 69-year-old male
with a history of CAD, hypertension and diverticulosis as
well as diverticulitis who was brought to the Emergency Room
by ambulance for diarrhea, nausea and vomiting.  He was found
history of chest pain, shortness of breath or abdominal pain.
He does admit to mild headache.  Other past medical history
is abbreviated due to the fact that the patient presented
acutely ill.  On Emergency Room arrival his temperature was
99.3, blood pressure 82/42, heart rate 133, breathing 96% on
room air and overall he was sluggish.  He was given several
liters of normal saline and begun on peripheral Dopamine.  He
incident in the Emergency Room.  The patient was complaining
of headache and of neck pain.  He, however, denied chest
pain, abdominal pain, pelvic pain as well as any nausea.  In
the Emergency Room he had a total of 8 liters of normal
saline and Dopamine drip was started at 5 mg.  He was treated
with Levaquin and Gentamycin.  He spiked to 104.2 and initial
ABG was done and was 7.29/39/132 on a non rebreather.  About
90 minutes later on 4 liters, the patient's ABG was
7.32/28/66.

PAST MEDICAL HISTORY:  Significant for CAD, status post PTCA
in [**2169**] and again in [**2170**].  Last catheterization in [**2171**]
revealed two vessel disease.  Ejection fraction was normal
per patient's PCP with [**Name Initial (PRE) **] history of hypertension, spinal
fusion in the past, no history of diabetes, history of a
chronic muscle wasting disease, extensive work-up negative,
history of depression, history of diverticulosis and history
of diverticulitis, most recent recurrence [**2185-1-27**].
Surgery was recommended but the patient refused the
procedure.

MEDICATIONS:  Per the patient's PCP include Diltiazem 240 mg
q d, Atenolol 25 mg q d, Effexor 150 mg [**Hospital1 **], Trazodone 300 mg
q h.s., Risperdal 2 mg q d, Zocor and Aspirin.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  He lives alone in [**Location (un) 86**].  He is a retired
taxi driver.  He is originally from [**State 2748**].  His mother
is currently living in [**State 2748**].  PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 32630**].

PHYSICAL EXAMINATION:  He was moaning but alert, interactive
and oriented.  Temperature 103.4, heart rate 131, blood
pressure 79/49.  HEENT:  Extraocular movements intact.
Sclera anicteric.  Pupils equal, round and reactive to light.
Mucus membranes dry.  Neck supple.  Cardiovascular, regular
rhythm, tachycardic with distant heart sounds.  Pulmonary
exam, anterolaterally clear.  Abdomen obese, soft, nontender,
non distended, normoactive bowel sounds, no surgical scars.
Rectal exam, heme positive per Emergency Room staff.
Extremities without edema.  EKG tachycardic, likely sinus
tachycardia at 133, normal axis, right bundle branch block.
Old report also shows right bundle branch block.  Chest x-ray
with bibasilar infiltrate vs atelectasis.

LABORATORY DATA:  Initial laboratory data, white count 3.3,
hematocrit 44.7, platelet count 258,000, differential 41%
polys, 22% bands, 10% monos, 1% basophils, 2 metas.
Urinalysis was greater than 300 protein, trace ketones,
otherwise negative.  Chemistries, sodium 143, potassium 5.6,
hemolyzed repeat 3.5, chloride 105, CO2 18, BUN 31,
creatinine 2.6, glucose 150, anion gap 21. First CK 331,
troponin negative.  Serum tox and urine tox negative.

HOSPITAL COURSE:  The patient initially presented therefore a
69-year-old gentleman with past medical history of CAD and
diverticulitis with septic shock without a clear source on
the background of past medical history previously mentioned.
The patient was admitted to the medical ICU.  His respiratory
status worsened and he was intubated on [**2185-7-21**] and abdominal
CT was obtained that revealed an SBO, right middle lobe,
right lower lobe and left lower lobe consolidation.  In
Intensive Care Unit he required four pressors to maintain his
blood pressure including Neo, Levo, Dopa and Vasopressin. He
was also given stress dose steroids for a question of
Addison's.  He required approximately 16 liters of fluid
resuscitation.  He had an exploratory laparotomy on [**2185-7-22**]
after serial CT showed evidence of an SBO.  No bowel was
excised during the procedure, however, and the patient was
decompressed with an OG tube in the OR.  Perioperatively the
patient had a troponin leak with a CK bump thought to be
related to demand ischemia in the setting of overwhelming sepsis
and causing him to have an MI.
Postoperatively he was afebrile for a few days and then he
spiked a temperature again.  His mental status was slow to
return to baseline postoperatively.  His lines were changed
and coag negative staph grew from his right IJ line on
[**2185-7-26**].  He was then started on Vancomycin.  He had, at that
point, completed a 10 day course of Levo and Flagyl and had
completed a course of Vancomycin as well.  Within 24 hours of
starting the Vancomycin, his temperature stopped.  However,
they returned a couple of days later and A line was pulled on
[**2185-7-31**] and sent for culture as a potential source of his
persistent fevers.  The patient's mental status continued to
improve starting on [**2185-7-29**] and when his mental status had
started to clear he was complaining of back pain which is a
chronic problem for him.  An MRI of the spine was done and
was normal.  Repeat abdominal CT was negative.  He was
started to wean off the ventilator on [**2185-7-29**] and was
extubated on [**2185-7-31**].  On [**2185-8-1**] he was transferred to the
medicine floor and he was communicating with much improved
mental status and in retrospect, at the time of transfer to
the floor, it was felt that his initial septic shock was due
to severe likely aspiration pneumonia in the right middle,
right lower and left lower lobes and his subsequent fevers
postoperatively were likely due to line sepsis.

His medications on transfer to the medical floor included
Aspirin 325 mg q d, Protonix 40 mg q d, Lopressor 25 mg [**Hospital1 **],
Ramipril 2.5 mg q d as well as prn Tylenol, Nystatin cream,
Ambien 5 mg q h.s.

Hospital Course on the floor is as follows:
1.  Pulmonary:  He was extubated as mentioned on [**2185-7-29**] and
he was able to be weaned to room air by [**2185-8-3**] with oxygen
saturations in the high 90's.  An abdominal CT showed
moderate right and small left pleural effusions with collapse
of the left lower lobe.  The patient had completed a 10 day
course of Levo and Flagyl for presumed aspiration pneumonia
on admission.  His pleural effusions were found to be too
small to tap per ultrasound and interventional radiology.
His respiratory status was stable throughout the remainder of
his hospitalization.

2.  Infectious Disease:  The patient was continued on
Vancomycin intravenously for a 7 day course which started on
[**2185-8-1**].  This was treating an A line tip which grew out gram
positive bacteria.  There were mixed morphologies that were
not speciated, however, since the patient demonstrated
persistent fevers (despite antibiotics) with this line in place
which resolved promptly after its removal, there was reasonable
suspicion to suggest a true line infection. It was therefore felt
prudent to
continue the patient on a 7 day course of Vancomycin.
Echocardiogram done on [**2185-7-29**] was negative for any evidence
of endocarditis.  In summary then, the only cultures of his
that were positive included a catheter tip on [**7-26**] that was
coag negative staph treated with a course of Vancomycin.
Sputum gram stain [**7-31**] grew out gram positive cocci in pairs
and [**7-31**] A line tip grew out gram positive bacteria, not
speciated.  All other urine cultures and blood cultures are
negative at the time of this dictation.

3.  Neuro/Psychiatric:  The patient's mental status continued
to improve and he was awake, alert and conversational, able
to provide a history and an explanation for the reason he
came to the hospital initially.  The patient had been on
Haldol for agitation but that was discontinued when he was
transferred to the floor.  He was not agitated for the
remainder of his hospital stay on the medical floor.  He had
a head CT that was negative for any acute process.  An MR of
his spine was negative for any epidural abscess.  Based on
his own Effexor, Trazodone and Risperdal for depression, none
of those psychiatric medications were started while the
patient was in the hospital.

4.  Cardiovascular:  Patient with a history of CAD, status
post PTCA times three on Lopressor and Aspirin at baseline.
He was hemodynamically stable for his stay on the medical
floor.  As mentioned, his echocardiogram was negative except
for mild LVH.  Ejection fraction of 55%.  His troponin leak
represented likely demand ischemia leading to an MI in the
setting of severe sepsis and a known reversible ischemic lesion
from outpatient ETT performed prior to his admission. His CKs
were elevated but then were
trending down.  He will need to have an ETT done in
approximately 4-6 weeks following his discharge from the
hospital.  This will be arranged via his primary care
physician and will be done to follow-up this MI that he had
based on elevated troponin in the perioperative setting.

5.  Fluids, Electrolytes & Nutrition:  The patient was
tolerating po well and his electrolytes remained within
normal limits.

6.  GI:  Patient with a history of diverticulosis and
diverticulitis, has been on Protonix while in the hospital.
Exploratory laparotomy was negative.  He developed diarrhea
approximately on [**7-31**].  Stool cultures were sent for C. diff,
those results are not back at the time of this dictation.  At
this time there is a question of whether the diarrhea is due
to Vancomycin or C. diff.  Those culture results are as
mentioned, still pending.  The patient had a swallowing study
evaluation due to concern over future aspiration risk. That
study was interpreted as normal and the patient was
determined to be able to tolerate a regular diet including
clears.

7.  Prophylaxis:  The patient was maintained on subcutaneous
Heparin 5,000 units [**Hospital1 **].

8.  Pain:  The patient continued to complain of back pain and
neck pain which is a chronic problem for him.  He was treated
with Tylenol and Percocet for the pain.  In terms of
disposition, PT and OT consults were done and the patient was
screened for rehabilitation.  At the time of this dictation
it is not known what rehabilitation facility he will go to.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  Discharged to a rehabilitation facility.

DISCHARGE DIAGNOSIS:
1.  Septic shock.
2.  Aspiration pneumonia.
3.  Bacteremia.
4.  Coronary artery disease, status post PTCA times three.
5.  Hypertension.
6.  Diverticulosis.
7.  Status post spinal fusion L5,S1.
8.  Chronic muscle wasting disease of unknown etiology.
9.  Depression.
10. Status post compound fracture of his left wrist and skull
fracture as a child due to an accident.

DISCHARGE MEDICATIONS:  Aspirin 325 mg po q day, Protonix 40
mg po q day, Lopressor 25 mg po bid, Ramipril 2.5 mg po q d,
Tylenol 650 mg q 4-6 hours prn, Nystatin cream, Miconazole
powder, Ambien 5 mg po q h.s. and Vancomycin 1 gm q 12 hours
times 7 day course.  The course started on [**2185-8-1**].




                            [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Last Name (NamePattern1) 29450**]
MEDQUIST36

D:  [**2185-8-3**]  17:47
T:  [**2185-8-3**]  20:17
JOB#:  [**Job Number **]
{'Unspecified septicemia,Other shock without mention of trauma,Acute myocardial infarction of unspecified site, initial episode of care,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Unspecified essential hypertension'}


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: Mr. [**Known lastname 103266**] is a 69-year-old male
with a history of CAD, hypertension and diverticulosis as
well as diverticulitis who was brought to the Emergency Room
by ambulance for diarrhea, nausea and vomiting.  He was found
history of chest pain, shortness of breath or abdominal pain.
He does admit to mild headache.  Other past medical history
is abbreviated due to the fact that the patient presented
acutely ill.  On Emergency Room arrival his temperature was
99.3, blood pressure 82/42, heart rate 133, breathing 96% on
room air and overall he was sluggish.  He was given several
liters of normal saline and begun on peripheral Dopamine.  He
incident in the Emergency Room.  The patient was complaining
of headache and of neck pain.  He, however, denied chest
pain, abdominal pain, pelvic pain as well as any nausea.  In
the Emergency Room he had a total of 8 liters of normal
saline and Dopamine drip was started at 5 mg.  He was treated
with Levaquin and Gentamycin.  He spiked to 104.2 and initial
ABG was done and was 7.29/39/132 on a non rebreather.  About
90 minutes later on 4 liters, the patient's ABG was
7.32/28/66.

MEDICAL HISTORY: Significant for CAD, status post PTCA
in [**2169**] and again in [**2170**].  Last catheterization in [**2171**]
revealed two vessel disease.  Ejection fraction was normal
per patient's PCP with [**Name Initial (PRE) **] history of hypertension, spinal
fusion in the past, no history of diabetes, history of a
chronic muscle wasting disease, extensive work-up negative,
history of depression, history of diverticulosis and history
of diverticulitis, most recent recurrence [**2185-1-27**].
Surgery was recommended but the patient refused the
procedure.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives alone in [**Location (un) 86**].  He is a retired
taxi driver.  He is originally from [**State 2748**].  His mother
is currently living in [**State 2748**].  PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 32630**]. 

### Response:
{'Unspecified septicemia,Other shock without mention of trauma,Acute myocardial infarction of unspecified site, initial episode of care,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Unspecified essential hypertension'}
