CHIEF COMPLAINT: Melena of 1 day's duration, hematemesis x 1, lightheadedness of
half day's duration.

PRESENT ILLNESS: The patient is a 55 year-old female well-known to the Chairman's
surgery service, who presented to the [**Hospital1 18**] ED with 1 day of
melena, 1 episode of hematemesis, and lightheadedness. She
denied chest pain, SOB, and diaphoresis on presentation.

MEDICAL HISTORY: s/p ventral hernia repair [**9-30**]
s/p roux-en-Y gastric bypass [**9-30**]
s/p open chole [**9-30**] with T tube placement
cholangitis from T tube requiring pigtail drainage [**2137-11-12**]
s/p multiple abdominal operations
s/p Enterocutaneous fistula repair
morbid obesity
back pain
asthma

MEDICATION ON ADMISSION: 1. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation
Q4H (every 4 hours) as needed.
2. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
3. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
30-60 MLs PO QID (4 times a day) as needed.
4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Amylase-Lipase-Protease 33,200-10,000- 37,500 unit Capsule,
Delayed Release(E.C.) Sig: One (1) Cap PO BIDWM (2 times a day
(with meals)).
7. Prochlorperazine 25 mg Suppository Sig: One (1) Suppository
Rectal Q12H (every 12 hours).
Disp:*60 Suppository(s)* Refills:*2*
8. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*Disp:*28 g* Refills:*0*
9. linezolid 600mg i po BID x 14 days.
10. PICC line care
PICC line care per protocol
12. Paxil 30 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*

ALLERGIES: Demerol / Ativan / Petroleum

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Pt lives in [**Location (un) 37609**] for her significant other of many years. No
children. [**Name (NI) 1094**] brother died in [**Name (NI) **], found dead after 5 days.
Pt's remaining family in in [**State 531**]
Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Abnormal coagulation profile,Personal history of venous thrombosis and embolism
Gastrointest hemorr NOS,Chronic obst asthma NOS,Abnrml coagultion prfile,Hx-ven thrombosis/embols
Admission Date:  [**2138-3-12**]              Discharge Date:   [**2138-3-15**]

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

Service: SURGERY

Allergies:
Demerol / Ativan / Petroleum

Attending:[**First Name3 (LF) 4111**]
Chief Complaint:
Melena of 1 day's duration, hematemesis x 1, lightheadedness of
half day's duration.

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
The patient is a 55 year-old female well-known to the Chairman's
surgery service, who presented to the [**Hospital1 18**] ED with 1 day of
melena, 1 episode of hematemesis, and lightheadedness. She
denied chest pain, SOB, and diaphoresis on presentation.

Past Medical History:
s/p ventral hernia repair [**9-30**]
s/p roux-en-Y gastric bypass [**9-30**]
s/p open chole [**9-30**] with T tube placement
cholangitis from T tube requiring pigtail drainage [**2137-11-12**]
s/p multiple abdominal operations
s/p Enterocutaneous fistula repair
morbid obesity
back pain
asthma

Social History:
Pt lives in [**Location (un) 37609**] for her significant other of many years. No
children. [**Name (NI) 1094**] brother died in [**Name (NI) **], found dead after 5 days.
Pt's remaining family in in [**State 531**]

Brief Hospital Course:
Preliminary work-up of the patient's illness revealed a
supratherapeutic PT [**Name (NI) 263**] of 6.8), and an initial Hct of 29.6.
She was admitted to the SICU for presumed GI bleed and was
administered 4 units of FFP, pantoprazole therapy and aggressive
intravenous fluid resuscutation.  Hct level 14 hours after the
original was 19.4, a precipitous drop of 10 points. Within 10
hours of this laboratory value, the patient received 6 units of
FFP and 4 units of PBRCs, with resulting INR and Hct of 1.9 and
29.8, respectively.

After reversal of supratherapeutic PT, the patient's GI bleed
stopped. The patient was kept in the SICU until Hcts were stable
for 48 hours. Discussion was undertaken with gastroenterologist,
Dr. [**Last Name (STitle) **]. It was decided that no intervention was needed as
the patient's bleed had resolved.

The patient's vital signs remained stable throughout her
hospital course. Though she apparently had a brisk GI bleed, her
vital signs never reflected hypovolemic shock.

The patient was transferred from the SICU to the surgical floor
on HD#5. At this time, she was on a stage 5 bariatric diet,
ambulating, having regular bowel movements and was free of
nausea. The surgical team felt she was stable enough to be sent
home with visiting nurses services, a very conservative return
to warfarin use, and biweekly PT monitoring. As preparations
were underway for discharge, the patient began to complain of
shortness of breath, chest congestion and URI symptoms. Her V/S
revealed a temperature of 101.7F and oxygen saturation of 95% on
room air. The patient had diffuse expiratory wheezes on physical
exam. The patient's discharge planning was put on hold. A fever
work-up was initiated, and nebulizer treatments were ordered.
However, despite being counseled on the need for adequate
evaluation and treatment of her condition, the patient left the
hospital without being officially discharged.

At the time of discharge, the patient was in possession of
prescriptions and discharge instructions, as these had been
given to the patient prior to her febrile episode.

Of note, the patient's chest x-ray was negative for pneumonia;
sputum sample was inadequate for analysis.  Blood cultures were
negative at the time of this writing. The patient did not submit
a sample of urine for analysis and culture.


Medications on Admission:
1. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation
Q4H (every 4 hours) as needed.
2. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
3. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
30-60 MLs PO QID (4 times a day) as needed.
4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Amylase-Lipase-Protease 33,200-10,000- 37,500 unit Capsule,
Delayed Release(E.C.) Sig: One (1) Cap PO BIDWM (2 times a day
(with meals)).
7. Prochlorperazine 25 mg Suppository Sig: One (1) Suppository
Rectal Q12H (every 12 hours).
Disp:*60 Suppository(s)* Refills:*2*
8. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*Disp:*28 g* Refills:*0*
9. linezolid 600mg i po BID x 14 days.
10. PICC line care
PICC line care per protocol
12. Paxil 30 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Medications:
The above medications and:

1. Warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2* (CHANGED FROM ORIGINAL DOSE)
2. Lansoprazole 15 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
3. Paroxetine HCl 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
4. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**First Name5 (NamePattern1) 6930**] [**Last Name (NamePattern1) 269**]

Discharge Diagnosis:
GI bleed
URI/LRI


Discharge Condition:
Stable.


Discharge Instructions:
You may resume your pre-hospital medications. Take the linezolid
for 7 more days.
Your new dose of coumadin will be 1mg daily.
You must have your INR and PT checked at least twice per week.
Call Dr. [**Last Name (STitle) 957**] or come to the emergency room if you have:
??????	fever above 101.4F
??????	nausea or vomiting that doesn??????t stop
*       more bleeding from your GI tract
You may resume your normal diet. Just take it easy in the
beginning.

Followup Instructions:
See Dr. [**Last Name (STitle) 957**] in clinic in [**1-27**] weeks. Call for an appointment.

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 3628**] SURGICAL ASSOC [**Name11 (NameIs) 3628**]-3A (NHB)
Date/Time:[**2138-5-14**] 11:45



Completed by:[**2138-3-16**]
{'Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Abnormal coagulation profile,Personal history of venous thrombosis and embolism'}


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: Melena of 1 day's duration, hematemesis x 1, lightheadedness of
half day's duration.

PRESENT ILLNESS: The patient is a 55 year-old female well-known to the Chairman's
surgery service, who presented to the [**Hospital1 18**] ED with 1 day of
melena, 1 episode of hematemesis, and lightheadedness. She
denied chest pain, SOB, and diaphoresis on presentation.

MEDICAL HISTORY: s/p ventral hernia repair [**9-30**]
s/p roux-en-Y gastric bypass [**9-30**]
s/p open chole [**9-30**] with T tube placement
cholangitis from T tube requiring pigtail drainage [**2137-11-12**]
s/p multiple abdominal operations
s/p Enterocutaneous fistula repair
morbid obesity
back pain
asthma

MEDICATION ON ADMISSION: 1. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation
Q4H (every 4 hours) as needed.
2. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
3. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
30-60 MLs PO QID (4 times a day) as needed.
4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Amylase-Lipase-Protease 33,200-10,000- 37,500 unit Capsule,
Delayed Release(E.C.) Sig: One (1) Cap PO BIDWM (2 times a day
(with meals)).
7. Prochlorperazine 25 mg Suppository Sig: One (1) Suppository
Rectal Q12H (every 12 hours).
Disp:*60 Suppository(s)* Refills:*2*
8. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*Disp:*28 g* Refills:*0*
9. linezolid 600mg i po BID x 14 days.
10. PICC line care
PICC line care per protocol
12. Paxil 30 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*

ALLERGIES: Demerol / Ativan / Petroleum

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Pt lives in [**Location (un) 37609**] for her significant other of many years. No
children. [**Name (NI) 1094**] brother died in [**Name (NI) **], found dead after 5 days.
Pt's remaining family in in [**State 531**] 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Abnormal coagulation profile,Personal history of venous thrombosis and embolism'}
