CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 9021**] is a 60 year old
female status post a right [**Hospital1 **]-malleolar ankle fracture with
internal fixation and repair performed by Orthopedic Surgery
on [**6-29**] of [**2149**], who presented on the [**6-4**] with
increasing shortness of breath, chest pain, hemoptysis and
the general feeling that something was wrong.  She reports
having blood tinged sputum while feeling some chest pressure
the night before admission.  She noted that she was
increasingly short of breath and at that point decided that
she needed to be evaluated in the Emergency Department.

MEDICAL HISTORY: 1.  Status post cholecystectomy in [**2120**].
2.  Right lumbar radiculopathy with spinal stenosis.
3.  Gastroesophageal reflux disease.
4.  Mitral valve prolapse.
5.  Right bimalleolar ankle fracture status post internal
fixation and repair on [**2150-6-29**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causing a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of diabetes mellitus or heart
disease.

SOCIAL HISTORY: The patient lives with her husband.  She
smoked for approximately nine years but quit 30 years ago.
She drinks an occasional glass of wine with dinner.
Iatrogenic pulmonary embolism and infarction,Pulmonary collapse,Esophageal reflux,Personal history of tobacco use
Iatrogen pulm emb/infarc,Pulmonary collapse,Esophageal reflux,History of tobacco use
Admission Date:  [**2150-7-4**]     Discharge Date:  [**2150-7-8**]

Date of Birth:   [**2089-12-1**]     Sex:  F

Service:  [**Doctor Last Name **] MED

CHIEF COMPLAINT:   Shortness of breath.

HISTORY OF PRESENT ILLNESS:   [**First Name8 (NamePattern2) **] [**Known lastname 9021**] is a 60 year old
female status post a right [**Hospital1 **]-malleolar ankle fracture with
internal fixation and repair performed by Orthopedic Surgery
on [**6-29**] of [**2149**], who presented on the [**6-4**] with
increasing shortness of breath, chest pain, hemoptysis and
the general feeling that something was wrong.  She reports
having blood tinged sputum while feeling some chest pressure
the night before admission.  She noted that she was
increasingly short of breath and at that point decided that
she needed to be evaluated in the Emergency Department.

In the Emergency Department, her EKG revealed a sinus
tachycardia with a Q wave in lead III, T wave inversions in
leads III, V1, 2 and 3, and small ST depressions in leads V4
through V6.

A chest CT scan performed at that time showed a large left
pulmonary embolus, multiple right pulmonary emboli, and
opacities in the right lower segments.  The patient was
admitted to the Intensive Care Unit and started on heparin
and warfarin.

PAST MEDICAL HISTORY:
1.  Status post cholecystectomy in [**2120**].
2.  Right lumbar radiculopathy with spinal stenosis.
3.  Gastroesophageal reflux disease.
4.  Mitral valve prolapse.
5.  Right bimalleolar ankle fracture status post internal
fixation and repair on [**2150-6-29**].

ALLERGIES:   Penicillin causing a rash.

MEDICATIONS AT HOME:
1.  Ranitidine 75 mg twice a day.

FAMILY HISTORY:  No history of diabetes mellitus or heart
disease.

SOCIAL HISTORY:   The patient lives with her husband.  She
smoked for approximately nine years but quit 30 years ago.
She drinks an occasional glass of wine with dinner.

PHYSICAL EXAMINATION:   Afebrile; heart rate 90 to 110;
oxygen saturation 92 to 96% on four liters; respiratory rate
18 to 24.  In general, alert, oriented, mildly tachypneic.
HEENT:  Supple neck.  Pupils are equal, round and reactive to
light.  Clear pharynx.  No lymphadenopathy, no jugular venous
distention.  Cardiovascular examination is regular rate and
rhythm, borderline tachycardia; no murmurs, rubs or gallops.
An occasional S3 and an occasional right ventricular heave
was palpated.  Lungs with decreased breath sounds at the
right base, otherwise, clear to auscultation bilaterally.
Abdomen soft, nontender, nondistended.  Extremities with
right lower extremity splint in place over the ankle;
sensation intact bilaterally in both feet; no edema.
Neurologic examination with cranial nerves II through XII
intact bilaterally.  Strength five out of five and symmetric
throughout upper and lower extremities.

LABORATORY:  Examination was white blood cell count 10.2,
hematocrit 37.5, platelets 261.  PTT 96 on heparin and INR
1.4 on Coumadin.  Potassium 3.9, BUN 9, creatinine 0.6.

Initial chest x-ray showed decreased right lung volumes,
elevated right hemidiaphragm.

HOSPITAL COURSE:
1.  PULMONARY EMBOLI:  The patient was admitted to the
Intensive Care Unit and was started on heparin and Coumadin.
She continued to require three to four liters of oxygen by
nasal cannula, however, after two days was stable enough to
be transferred out of the Intensive Care Unit.  At that time,
she was still requiring three to four liters of oxygen by
nasal cannula but had an oxygen saturation of 92 to 95%.  She
was continued on heparin while her Coumadin dose was titrated
to obtain a therapeutic level of an INR of 2.0 to 3.0.  She
was encouraged to use incentive spirometry as a repeat x-ray
showed some atelectasis at the bases and in the right middle
lobe.

She was very cooperative and concerned about her prognosis,
so she used incentive spirometry as directed and by the day
of discharge, had increased air flow to her right lung base
on auscultation.  In addition, she was able to tolerate
decreased oxygen requirement of three liters while
maintaining oxygen saturation of 95 to 96%.  She worked with
Physical Therapy to attempt some ambulatory oxygen
saturations, however, it was noted that she desaturated and
became diaphoretic and felt flushed while ambulating.  It was
determined that she would require home O2 and this was
arranged for her prior to discharge.

In addition, on the day of discharge, her INR had been stable
at over 2.0, and her heparin was discontinued and she was
discharged on Coumadin alone.  Visiting Nurses Association
will follow her to check her INR and adjust her Coumadin dose
as needed.

2.  RIGHT ANKLE FRACTURE:  The patient's ankle remained
wrapped in a splint during her admission.  She already has an
appointment scheduled with her Orthopedic surgeon to remove
the soft cast and place a hard cast in approximately a week
and a half after discharge.

3.  PAIN:  The patient complained of occasional pleuritic
pain related to her cough.  She had required only a one to
two percocet per day during the two to three days prior to
admission and she was discharged with a prescription for
percocet and directed to take one tablet every six hours as
needed for pain with a total of 28 tablets.

4. CONSTIPATION:  Due to the patient's occasional use of
narcotic pain medications, during her admission, she was
started on colace and will be discharged on outpatient bowel
regimen consisting of Colace and adequate fluid intake.

5.  GASTROESOPHAGEAL REFLUX DISEASE:  The patient was
maintained on Ranitidine throughout her hospital stay and was
told to continue to take Ranitidine at home as she had been
prior to admission.

CONDITION ON DISCHARGE:   Good.

DISCHARGE INSTRUCTIONS:
1.  Please follow-up at the Orthopedic Surgeon for splint
removal and hard cast placement as previously instructed.
2.  Please use your home oxygen as directed.
3.  Please follow-up with your primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 9022**], in one to two weeks.
4.  Please have the Visiting Nurses Association check your
INR on [**7-10**] and adjust your Coumadin dose accordingly so
that your INR remains in the therapeutic range of 2.0 to 3.0.

DISCHARGE DIAGNOSES:
1.  Multiple pulmonary emboli.
2.  Right bimalleolar ankle fracture status post internal
fixation.
3.  Gastroesophageal reflux disease.


                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D.  [**MD Number(1) 1212**]

Dictated By:  [**First Name8 (NamePattern2) 20**] [**Last Name (NamePattern1) 9023**], M.D.
MEDQUIST36
D:  [**2150-7-8**]  14:58
T:  [**2150-7-11**]  20:16
JOB#:  [**Job Number 9024**]
{'Iatrogenic pulmonary embolism and infarction,Pulmonary collapse,Esophageal reflux,Personal history of tobacco use'}


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: Shortness of breath.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 9021**] is a 60 year old
female status post a right [**Hospital1 **]-malleolar ankle fracture with
internal fixation and repair performed by Orthopedic Surgery
on [**6-29**] of [**2149**], who presented on the [**6-4**] with
increasing shortness of breath, chest pain, hemoptysis and
the general feeling that something was wrong.  She reports
having blood tinged sputum while feeling some chest pressure
the night before admission.  She noted that she was
increasingly short of breath and at that point decided that
she needed to be evaluated in the Emergency Department.

MEDICAL HISTORY: 1.  Status post cholecystectomy in [**2120**].
2.  Right lumbar radiculopathy with spinal stenosis.
3.  Gastroesophageal reflux disease.
4.  Mitral valve prolapse.
5.  Right bimalleolar ankle fracture status post internal
fixation and repair on [**2150-6-29**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causing a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of diabetes mellitus or heart
disease.

SOCIAL HISTORY: The patient lives with her husband.  She
smoked for approximately nine years but quit 30 years ago.
She drinks an occasional glass of wine with dinner. 

### Response:
{'Iatrogenic pulmonary embolism and infarction,Pulmonary collapse,Esophageal reflux,Personal history of tobacco use'}
