CHIEF COMPLAINT: synptomatic carotid stenosis

PRESENT ILLNESS: 87y/o male with history of reucrrent transinet ischemic attacks.
The first occured [**2186**] after motor vehicle accident with
resulting left sided weakness for one hour. Second episode
occured [**2188**] and presented as left uppper and lower extremity
weakness for thirty minuets. The third occured [**2195**] occured
while getting out of bed and presented with montery left hand
weakness. The fourth occured [**2199-8-9**] with left hand weakness
which lasted for thirty minuets. When he saw his neurologist, on
exam left handed weakness was noted. Ultra sound of carotids
show 60-79% stenosis on the right internal artery .MRA confirms
small stroke and reveals significant disease at the arch of
right carotid artery. Patient now admitted for  and elective
carotid endartectomy.

MEDICAL HISTORY: hyperthyroisism
squamous cell cancer
detached tetnia, s/p repair
begnin prostatic hypertrophy

MEDICATION ON ADMISSION: detrol 2mgm
flomax 0.4mgmqd
celebrex 200mgm
couomadin 2mgm qd
asa 81mgm qd

ALLERGIES: Penicillins

PHYSICAL EXAM: Remarkable for right carotid bruit.
Remaing exam unremarkable.

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired
lives with spouse
Denies alcohol or smoking
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other convulsions,Iatrogenic cerebrovascular infarction or hemorrhage,Cerebral embolism with cerebral infarction,Hematoma complicating a procedure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of patient's decision
Ocl crtd art wo infrct,Convulsions NEC,Iatrogen CV infarc/hmrhg,Crbl emblsm w infrct,Hematoma complic proc,Meth sus pneum d/t Staph,Atrial fibrillation,BPH w/o urinary obs/LUTS,Abn react-procedure NEC,No proc/patient decision
Admission Date:  [**2199-9-9**]              Discharge Date:   [**2199-10-7**]


Service: VSURG

Allergies:
Penicillins

Attending:[**First Name3 (LF) 4748**]
Chief Complaint:
synptomatic carotid stenosis

Major Surgical or Invasive Procedure:
right carotid endarectomy with introperative angiogram [**2199-9-9**]


History of Present Illness:
87y/o male with history of reucrrent transinet ischemic attacks.
The first occured [**2186**] after motor vehicle accident with
resulting left sided weakness for one hour. Second episode
occured [**2188**] and presented as left uppper and lower extremity
weakness for thirty minuets. The third occured [**2195**] occured
while getting out of bed and presented with montery left hand
weakness. The fourth occured [**2199-8-9**] with left hand weakness
which lasted for thirty minuets. When he saw his neurologist, on
exam left handed weakness was noted. Ultra sound of carotids
show 60-79% stenosis on the right internal artery .MRA confirms
small stroke and reveals significant disease at the arch of
right carotid artery. Patient now admitted for  and elective
carotid endartectomy.

Past Medical History:
hyperthyroisism
squamous cell cancer
detached tetnia, s/p repair
begnin prostatic hypertrophy

Social History:
retired
lives with spouse
Denies alcohol or smoking

Family History:
unknown

Physical Exam:
Remarkable for right carotid bruit.
Remaing exam unremarkable.

Pertinent Results:
[**2199-9-9**] 10:30PM   WBC-15.0*# RBC-3.33* HGB-10.0* HCT-30.0*
MCV-90 MCH-29.9 MCHC-33.3 RDW-13.3
[**2199-9-9**] 10:30PM   PLT COUNT-228
[**2199-9-9**] 10:30PM   PT-14.8* PTT-69.3* INR(PT)-1.4
[**2199-9-9**] 09:29PM   TYPE-ART O2-50 PO2-230* PCO2-45 PH-7.37 TOTAL
CO2-27 BASE XS-0 INTUBATED-INTUBATED
[**2199-9-9**] 09:29PM   freeCa-1.19
[**2199-9-9**] 09:21PM   GLUCOSE-131* UREA N-22* CREAT-0.9 SODIUM-144
POTASSIUM-3.8 CHLORIDE-109* TOTAL CO2-24 ANION GAP-15
[**2199-9-9**] 09:21PM   PHOSPHATE-5.1* MAGNESIUM-1.5*
[**2199-9-9**] 05:44PM   TYPE-ART RATES-/10 PEEP-5 O2-100 PO2-318*
PCO2-40 PH-7.36 TOTAL CO2-24 BASE XS--2 AADO2-372 REQ O2-65
INTUBATED-INTUBATED VENT-IMV

Brief Hospital Course:
[**2199-9-9**] s/p right carotid endartectomy.Transfered to PSACU
stable and neurologically intact. About 2300 resident was call
for activity suggestive of a seizure. Ct head obtained without
acute changes.blood gsases shwed patient ventilating and
oxygenating adequately. Neuro was consulted.FElt symptoms [**Last Name (un) 8966**]
secondary to embolic etology or ( but less likely) re expression
of old deficits. in the setting of bradycardia and hypotension.
Maintain systolic blood pressure greater than 130. continue
antiplatlet thearphy moniter neruro status. optmize glycemic
control.CT head obtained no bleed or or developing ischemia.
Dilantin load and dosing began. Patient transferd to ICU.
[**2199-9-10**] POD#1 nonresponsive to verable stimuli.clinical
findings not consistant with stroke. labateolol drip for blood
pressure control. Dopoff feeding tube placed .Remains in ICU
[**2199-9-11**] POD#2right neck hematoma stable. Remains somulent.tube
feed insututed.
[**Date range (1) 8967**] POD# [**2-8**] no changes neurologically. failed weaning
trial. EEG negative for seizure activity.Levofloxcin started for
temperaature of 102. sputum cultures pending.  Weaning
began.Remain in ICU .MSSA pneumonia by cultures. tolerating tube
feeds.
[**Date range (1) 8968**] POD# [**3-14**] weaning continued. hypernatremia corrected
with free water. Neck heamtoma stable.mores responsive today.
[**2199-9-18**] POD#9 Repeat MRI consistant with posterior occupital
infract and reperfusion of post parietal of fetal circulation of
PCA.Patient made DNR.Free water repalcement for hypernatremia.
(157).REsponds to verbal stimuli. No motor activity. Remains
intubated. Antibiotics continued for MSSA pneumonia. Tube feed
held for stooling.Remains in SICU.REpeat EEG remains negative
for seizure activity.Neuro felt mental status changes secondary
to metabilic encelopathy.
[**2199-9-19**] POD# 10 placed on pressure support ventilations.
hypernatremia corrected.(140) antibiotic coverage brodend. Fever
workup. Continued on pressure support. Family does not want peg
or trachectomy. Episode of hypotension requiring fluid boluses
with good response.continues to be intubated. Remainas in SICU.
[**Date range (1) 8969**] POD#[**10-22**] New onset Af converted with lopressor.
Cdiff cultures negative x3. Vanco started for GPC in blood
cultures.
transfused one unit PRBC"S for hct of 25.Tube feed a goal rate.
Attemped vent weaning restarted.Extubated [**2199-9-24**] on face mask.
postransfusionHCT. 34.7.
[**2199-9-25**] POD#12 requested bedside swallowing sutdy. study
defered secondary as patient not awake enought to participate in
study.VAncomycin d/c'd A line d/c'd.
[**2199-9-26**] POD# 13 Transfered to VICU.Bed side swallowing done
patient failed. to remain NPO.REcommendations to repat study in
[**4-12**] days.
[**2199-9-27**] POD#14 beganing to vocalize more.Physical thearphy
continues to work with patient.
10/23-28/04 POD#15-20 Patient self discontinued feeding tube.
Repeat speech and swallowing evaluation done [**2199-9-30**]
demonstrated overt signs of aspiration with thin and tick
liquids. and significant orapharyngeal dysphagia. Continue tube
feed and
maintain NPO.. Will require speech thearphy at rehab facility to
address dysphagia and dysarthria, and likely right hemisphere
cognitive-linguistic defecits.GI service conslulted.Endoscopic
PEG placed. [**2199-10-2**]. Seen by OT and recommend rehablitittion
would be benefical . has not met goals set by them on first
visit [**9-26**].
[**Date range (1) 8970**] POD# 21-24Peg feeds began.Epidose of somulance
over the weekend. repeat MRI of head done.no new changes.
Improved mental status to baseline. Tube feed slowly progressed
@ time of discharge promote with fiber [**2-7**] strnght @ 70 cc/hr.
Check residuals q4h if <100cc increase tube feed to 75cc and in
eight hours to 80cc if residule <100cc. Patient then will be at
goal rate.Patient tolerating feeds.
Transfered to rehabiltation in stable contintion.

Medications on Admission:
detrol 2mgm
flomax 0.4mgmqd
celebrex 200mgm
couomadin 2mgm qd
asa 81mgm qd

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO QD (once a day).
2. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed.
3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
5. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
6. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Fourteen
(14) units Subcutaneous twice a day: breakfast
dinner.
7. Insulin Regular Human 100 unit/mL Solution Sig: as directed
Injection every six (6) hours: regular insulin slidig scale:
glucoses<120/none
glucoses 121-140/4u
glucoses 141-160/7u
glucoses 161-180/10u
glucoses 181-200/13u
glucoses 201-220/16u
glucoses 221-240/19u
glucoses 241-260/22u
glucoses 261-280/25u
glucoses 281-300/28u
glucoses >300 [**Name8 (MD) 138**] Md.
8. Acetaminophen 160 mg/5 mL Elixir Sig: 650mgm mgm PO Q4-6H
(every 4 to 6 hours) as needed.
9. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
10. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 8971**] Rehabilitation Center (at [**Hospital6 8972**])
- [**Location (un) 8973**]

Discharge Diagnosis:
symptomatic carotid stenosis
hyperthyroidism
bph
squamous cell ca
postoperative right hemespheric stroke
[**Hospital 8974**] hospital acquired pneumonia
metabolic encelopathy
postoperative seizure, started on dilantin
blood loss anemia, transfused corrected.
hypernatremia, corrected


Discharge Condition:
stable

Discharge Instructions:
DNR

Followup Instructions:
4 weeks. Dr. [**Last Name (STitle) 1391**]. call for appointment. [**Telephone/Fax (1) 1393**]



Completed by:[**2199-10-7**]
{"Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other convulsions,Iatrogenic cerebrovascular infarction or hemorrhage,Cerebral embolism with cerebral infarction,Hematoma complicating a procedure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of patient's decision"}


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: synptomatic carotid stenosis

PRESENT ILLNESS: 87y/o male with history of reucrrent transinet ischemic attacks.
The first occured [**2186**] after motor vehicle accident with
resulting left sided weakness for one hour. Second episode
occured [**2188**] and presented as left uppper and lower extremity
weakness for thirty minuets. The third occured [**2195**] occured
while getting out of bed and presented with montery left hand
weakness. The fourth occured [**2199-8-9**] with left hand weakness
which lasted for thirty minuets. When he saw his neurologist, on
exam left handed weakness was noted. Ultra sound of carotids
show 60-79% stenosis on the right internal artery .MRA confirms
small stroke and reveals significant disease at the arch of
right carotid artery. Patient now admitted for  and elective
carotid endartectomy.

MEDICAL HISTORY: hyperthyroisism
squamous cell cancer
detached tetnia, s/p repair
begnin prostatic hypertrophy

MEDICATION ON ADMISSION: detrol 2mgm
flomax 0.4mgmqd
celebrex 200mgm
couomadin 2mgm qd
asa 81mgm qd

ALLERGIES: Penicillins

PHYSICAL EXAM: Remarkable for right carotid bruit.
Remaing exam unremarkable.

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired
lives with spouse
Denies alcohol or smoking 

### Response:
{"Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other convulsions,Iatrogenic cerebrovascular infarction or hemorrhage,Cerebral embolism with cerebral infarction,Hematoma complicating a procedure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of patient's decision"}
