CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known firstname **] [**Known lastname **] is a
68-year-old woman with multiple medical problems who
underwent a coronary artery bypass graft x3 on [**2187-3-26**]
by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  Her postoperative course was delayed
due to pulmonary problems requiring reintubation for
increased amount of secretions and also atrial fibrillation.
She was transferred out of the Intensive Care Unit on
postoperative day 9 and finally discharged to rehabilitation
on postoperative day 11 in a stable condition on po Kefzol.
She was seen by Dr. [**Last Name (STitle) **] on [**2187-4-25**] for
postoperative checkup where she was noted to have a small
amount of purulent drainage from her sternal wound.  As
stated above, she had been on Keflex which was changed to
clindamycin at that time.

MEDICAL HISTORY: 1.  Coronary artery bypass graft x3 on [**2187-3-26**].
2.  Asthma with occasional steroid use.
3.  Chronic obstructive pulmonary disease
4.  Gastroesophageal reflux disease
5.  Transient ischemic attacks.  The patient had a carotid
ultrasound on [**2190-3-22**] that showed 40% to 59% bilateral
ICA stenosis with right subclavian steel.
6.  Status post lacunar stroke in [**2178**]
7.  Insulin dependent diabetes
8.  Hypertension
9.  Episode of anaphylaxis due to ACE inhibitors and aspirin
in the past.
10. Status post THR in [**2182**]

MEDICATION ON ADMISSION: 

ALLERGIES: THE PATIENT HAS ANAPHYLACTIC REACTION TO ACE
INHIBITORS AND ASPIRIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other postoperative infection,Unspecified septicemia,Hyperpotassemia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status
Other postop infection,Septicemia NOS,Hyperpotassemia,Crnry athrscl natve vssl,Atrial fibrillation,Chronic obst asthma NOS,Convulsions NEC,DMII wo cmp nt st uncntr,Aortocoronary bypass
Admission Date:  [**2187-5-15**]       Discharge Date:  [**2187-5-18**]

Date of Birth:   [**2118-10-20**]       Sex:  F

Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known firstname **] [**Known lastname **] is a
68-year-old woman with multiple medical problems who
underwent a coronary artery bypass graft x3 on [**2187-3-26**]
by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  Her postoperative course was delayed
due to pulmonary problems requiring reintubation for
increased amount of secretions and also atrial fibrillation.
She was transferred out of the Intensive Care Unit on
postoperative day 9 and finally discharged to rehabilitation
on postoperative day 11 in a stable condition on po Kefzol.
She was seen by Dr. [**Last Name (STitle) **] on [**2187-4-25**] for
postoperative checkup where she was noted to have a small
amount of purulent drainage from her sternal wound.  As
stated above, she had been on Keflex which was changed to
clindamycin at that time.

Mrs. [**Known lastname **] returned for a wound check on [**2187-5-9**] from
rehabilitation where she had an open area approximately 1 cm
long and 1.5 cm deep at the distal aspect of her incision
with eschar and minimal erythema surrounding the open area.
She had been otherwise progressing well and remained
afebrile.  The wound was debrided locally and she was placed
on levofloxacin 500 mg and at that time was instructed to
keep for 14 days.  A follow up appointment was scheduled for
[**2187-5-18**].  On [**2187-5-13**], she was admitted to [**Hospital3 38921**] Hospital in [**Location (un) 8973**] with an episode of
hypertension, increased white blood cell count to 25,000.
She was found to be in atrial fibrillation, hyperkalemia up
to 9 as per outside report and found to be in renal
insufficiency.  She was intubated at that time for question
of respiratory failure, placed on intravenous Diltiazem to
control her heart rate and a dopamine drip for her
hypertension.  She was admitted to the Intensive Care Unit
for further management.

A chest CT at that time revealed a small substernal
collection.  Since she developed these findings and she was
better known to the [**Hospital6 256**], she
was transferred to this institution for further and
definitive treatment, as well as assessment of that sternal
wound.

PAST MEDICAL HISTORY:
1.  Coronary artery bypass graft x3 on [**2187-3-26**].
2.  Asthma with occasional steroid use.
3.  Chronic obstructive pulmonary disease
4.  Gastroesophageal reflux disease
5.  Transient ischemic attacks.  The patient had a carotid
ultrasound on [**2190-3-22**] that showed 40% to 59% bilateral
ICA stenosis with right subclavian steel.
6.  Status post lacunar stroke in [**2178**]
7.  Insulin dependent diabetes
8.  Hypertension
9.  Episode of anaphylaxis due to ACE inhibitors and aspirin
in the past.
10. Status post THR in [**2182**]

ALLERGIES:  THE PATIENT HAS ANAPHYLACTIC REACTION TO ACE
INHIBITORS AND ASPIRIN.

ADMISSION MEDICATIONS:
1.  Dilantin 100 mg po tid
2.  Trazodone 100 mg po q hs
3.  Bumex 6 mg q a.m. and 2 mg q p.m.
4.  Procardia XL 120 mg po q day
5.  Hydrocortisone and acetaminophen prn
6.  Prevacid 30 mg po bid
7.  Ativan 1 mg po tid
8.  Hydralazine 25 mg po tid
9.  Reglan 10 mg po q hs
10. Xanax 2.5 mg prn
11. Insulin 75/25 50 units q a.m. and 60 units q p.m.
12. Nitro-Dur patch at 7 a.m. and 10 p.m.
13. Catapres 0.3 mg transdermal patch once a week

ADMISSION PHYSICAL EXAMINATION:
GENERAL:  The patient was in atrial fibrillation with a rate
of 60s, intubated on assist control ventilation, but patient
was awake and alert, moving all extremities well.  Nodded her
head appropriately to questions.
LUNGS:  Clear to auscultation bilaterally anteriorly.
HEART:  Irregularly irregular and no murmurs, thrills or
rubs.
ABDOMEN:  Obese, nontender.
STERNUM:  Stable, small opening in the area at the distal
aspect of the incision with no erythema and very small amount
of scant yellow drainage.
EXTREMITIES:  Warm and well perfuse, no peripheral edema.

LABS:  A white blood cell count aspirate at the outside
hospital was 24,000 with a hematocrit of 43.5.  She had a
neutrophil count of 85, sodium of 140, potassium of 3.0,
chloride of 103, CO2 of 26, BUN of 21 with a creatinine of
1.3.  The glucose level was 215, bilirubin 1.9, AST of 48,
ALT of 49, alkaline phosphatase of 113, protein of 6.8.

HOSPITAL COURSE:  As stated above, the patient was admitted
to the Intensive Care Unit and her Diltiazem drip was weaned
to off.  She required multiple fluid boluses to improve her
blood pressure, but in spite of that the patient was kept on
the dopamine drip overnight.  Her antibiotics upon transfer
was levofloxacin and vancomycin that were kept on her
admission in the Intensive Care Unit.  By hospital day #2,
[**2187-5-16**], she was awake, alert and oriented.  She had no
complaints, except for some mild tenderness on her left
flank.  Her white count was 25,000 with a hematocrit of 35
and a platelet count of 144.  Her Chem-7 was sodium 139,
potassium 3.8, chloride 103, CO2 26, BUN 21 and her
creatinine came down to 0.9 with a glucose level of 117.
Once again, several exams documented that there was not a lot
of purulent drainage coming out of her sternal wound.  She
had an abdominal CT done that morning that was negative for
intraabdominal collections, diverticulitis or any other
abnormality.  She was found to have a heterogeneously
enhancing solid left renal mass that measured approximately
2.5 cm.  The patient required dopamine to be given through
the entire day to keep adequate blood pressures.

On [**2187-5-17**], SICU day 3, Mrs.[**Doctor Last Name 38922**] [**Name (STitle) **] count was
down to 14.6.  She remained afebrile and her dopamine was
weaned to off, keeping good blood pressures.  Sternal wound
had dressing changes wet to dry [**Hospital1 **] and there was no
increasing erythema observed.  On the afternoon of that day,
she was evaluated by the urology service for that incidental
left renal mass.  The consultation stated that it was unclear
whether the lesion was a renal CA primary versus an upper
tract urothelial renal pelvis malignancy.  They were
suggesting that this might be a renal cell carcinoma and
suggested that the patient would require an MRI with
gadolinium that could be obtained as an outpatient.  The
patient should make follow up arrangements with Dr.[**Name (NI) 13919**]
office in the urology clinic to further work up this renal
mass.

By hospital day #4, Mrs. [**Known lastname **] was off pressors, remained
afebrile, was started on a diabetic diet tolerating well
po's.  Her white count was 13.7 and her creatinine was 0.6.
She was asymptomatic.  The sternum remained stable.  No
drainage was evident.  She was offered a bed at
rehabilitation where she is being discharged under stable
conditions.

DISCHARGE MEDICATIONS:
1.  Dilantin 100 mg po tid
2.  Prednisone 5 mg po qd
3.  Accolate 20 mg po q day
4.  Digoxin 0.25 mg po q day
5.  Aldactone 75 mg po q 12 hours
6.  KCL 20 milliequivalents po q 12 hours
7.  Heparin subcutaneous 5000 units tid
8.  Colace 100 mg po bid
9.  Plavix 75 mg po q day
10. Albuterol/Atrovent metered dose inhaler 2 to 5 puffs q4h
and prn
11. Nystatin powder to groin area tid
12. Protonix 40 mg po q day
13. Amiodarone 20 mg po q day
14. Imdur 90 mg po q day
15. Regular insulin sliding scale
16. Percocet 5/325 mg 1 to 2 tablets po q 4 to 6 hours prn
17. Roxicet elixir 5 to 10 cc po q 4 to 6 hours prn

DIET:  American Diabetic Association diet

DISCHARGE INSTRUCTIONS:  The patient is to have sternal wound
dressing changes wet to dry [**Hospital1 **].  She will have to call Dr.[**Name (NI) 22446**] office and make a follow up appointment.  She is
also instructed to call Dr.[**Name (NI) 13919**] office, telephone
([**Telephone/Fax (1) 38923**], to make a follow up appointment with the
urology service.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern4) 26544**]
MEDQUIST36

D:  [**2187-5-18**]  11:42
T:  [**2187-5-18**]  12:18
JOB#:  [**Job Number 38924**]
{'Other postoperative infection,Unspecified septicemia,Hyperpotassemia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status'}


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: Mrs. [**Known firstname **] [**Known lastname **] is a
68-year-old woman with multiple medical problems who
underwent a coronary artery bypass graft x3 on [**2187-3-26**]
by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  Her postoperative course was delayed
due to pulmonary problems requiring reintubation for
increased amount of secretions and also atrial fibrillation.
She was transferred out of the Intensive Care Unit on
postoperative day 9 and finally discharged to rehabilitation
on postoperative day 11 in a stable condition on po Kefzol.
She was seen by Dr. [**Last Name (STitle) **] on [**2187-4-25**] for
postoperative checkup where she was noted to have a small
amount of purulent drainage from her sternal wound.  As
stated above, she had been on Keflex which was changed to
clindamycin at that time.

MEDICAL HISTORY: 1.  Coronary artery bypass graft x3 on [**2187-3-26**].
2.  Asthma with occasional steroid use.
3.  Chronic obstructive pulmonary disease
4.  Gastroesophageal reflux disease
5.  Transient ischemic attacks.  The patient had a carotid
ultrasound on [**2190-3-22**] that showed 40% to 59% bilateral
ICA stenosis with right subclavian steel.
6.  Status post lacunar stroke in [**2178**]
7.  Insulin dependent diabetes
8.  Hypertension
9.  Episode of anaphylaxis due to ACE inhibitors and aspirin
in the past.
10. Status post THR in [**2182**]

MEDICATION ON ADMISSION: 

ALLERGIES: THE PATIENT HAS ANAPHYLACTIC REACTION TO ACE
INHIBITORS AND ASPIRIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other postoperative infection,Unspecified septicemia,Hyperpotassemia,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Other convulsions,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status'}
