CHIEF COMPLAINT: Gangrene of right 2nd and 3rd toes and cellulitis

PRESENT ILLNESS: 84 year old male with long standing history of bilateral leg
pain and worsening pain in right foot with associated gangrene
of 2nd and 3rd toes.  Patient reports history of intermittent
[**7-14**] sharp pain at rest and pain that increases with any
walking. Now patient with 10/10 pain in right foot often keeps
patient from sleep.  Pateint's chronic ulcers involving the
right 2nd and 3rd toes have been present for over one year.
Patient underwent a diagnostic lower extremity angiogram in [**Month (only) 205**]
and non-invasive studies which demonstrated Aphasic right
metatarsal PVR and low-amplitude left metatarsal PVR.  Patient
has been followed by Dr [**Last Name (STitle) 1391**] and is admitted for a right
transmetataral amputation.

MEDICAL HISTORY: -Htn.
-chronic renal insufficiency
-gout
-OA stage 3
-Atrial fibrillation s/p defibrillator
-MVR

MEDICATION ON ADMISSION: Omeprazole 20 mg PO Daily
Furosemide 80 mg PO Daily
Coumadin 4mg daily currently held
Digoxin 0.25 mg PO Daily
Colchicine 0.6mg [**12-7**] tab [**Hospital1 **]
Prednisone 15 mg PO Daily
Uloric *NF* 80 mg Oral daily
Cilostazol 100mg 2tab daily
Spironolactone 25mg Daily
Metoprolol 25 mg daily
Potassium 8mg tab TID

ALLERGIES: Codeine

PHYSICAL EXAM: T: 98.0 BP: 150/82 HR: 70 Res: 18 97%RZ FS 193
GEN: NAD
HEAD: NC, AT, no sinus tenderness
Neuro: PERRL, CN grossly intact
CV: RRR
PUL: CTA bilaterally
ABD: Soft, NT, ND
EXT: Bilateral swelling up to ankles, 1+ edema bilaterally.
Right
foot with dry gangrene black 2nd and 3rd toes.  Errythema up
dorsum of right foot to level of malleolus. Right foot tender to
touch.
Pulses:
        Fem     [**Doctor Last Name **]     DP          PT
RT     [**Name (NI) **]     Palp   no signal     Dop
LT     Palp    Palp     Dop           Dop

FAMILY HISTORY: N/C

SOCIAL HISTORY: Remote smoking history
Atherosclerosis of native arteries of the extremities with gangrene,Acute kidney failure, unspecified,Chronic systolic heart failure,Other primary cardiomyopathies,Cellulitis and abscess of toe, unspecified,Ventricular fibrillation,Other convulsions,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Gout, unspecified,Heart valve replaced by transplant,Automatic implantable cardiac defibrillator in situ,Chronic obstructive asthma, unspecified,Respiratory arrest
Ath ext ntv art gngrene,Acute kidney failure NOS,Chr systolic hrt failure,Prim cardiomyopathy NEC,Cellulitis, toe NOS,Ventricular fibrillation,Convulsions NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Gout NOS,Heart valve transplant,Status autm crd dfbrltr,Chronic obst asthma NOS,Respiratory arrest
Admission Date:  [**2132-9-30**]              Discharge Date:   [**2132-10-5**]

Date of Birth:  [**2048-6-28**]             Sex:   M

Service: SURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 4748**]
Chief Complaint:
Gangrene of right 2nd and 3rd toes and cellulitis


Major Surgical or Invasive Procedure:
Rt TMA [**2132-10-2**]

History of Present Illness:
84 year old male with long standing history of bilateral leg
pain and worsening pain in right foot with associated gangrene
of 2nd and 3rd toes.  Patient reports history of intermittent
[**7-14**] sharp pain at rest and pain that increases with any
walking. Now patient with 10/10 pain in right foot often keeps
patient from sleep.  Pateint's chronic ulcers involving the
right 2nd and 3rd toes have been present for over one year.
Patient underwent a diagnostic lower extremity angiogram in [**Month (only) 205**]
and non-invasive studies which demonstrated Aphasic right
metatarsal PVR and low-amplitude left metatarsal PVR.  Patient
has been followed by Dr [**Last Name (STitle) 1391**] and is admitted for a right
transmetataral amputation.

Past Medical History:
-Htn.
-chronic renal insufficiency
-gout
-OA stage 3
-Atrial fibrillation s/p defibrillator
-MVR

Past Surgical History:
Appendectomy, cholecystectomy, multiple back surgeries,
Mitral valvue replacement, pacer+defibrillator

Social History:
Remote smoking history


Family History:
N/C

Physical Exam:
T: 98.0 BP: 150/82 HR: 70 Res: 18 97%RZ FS 193
GEN: NAD
HEAD: NC, AT, no sinus tenderness
Neuro: PERRL, CN grossly intact
CV: RRR
PUL: CTA bilaterally
ABD: Soft, NT, ND
EXT: Bilateral swelling up to ankles, 1+ edema bilaterally.
Right
foot with dry gangrene black 2nd and 3rd toes.  Errythema up
dorsum of right foot to level of malleolus. Right foot tender to
touch.
Pulses:
        Fem     [**Doctor Last Name **]     DP          PT
RT     [**Name (NI) **]     Palp   no signal     Dop
LT     Palp    Palp     Dop           Dop


Pertinent Results:
[**2132-9-30**] 06:00PM BLOOD WBC-9.8 RBC-3.61* Hgb-11.1* Hct-31.7*
MCV-88 MCH-30.8 MCHC-35.1* RDW-16.5* Plt Ct-155
[**2132-9-30**] 06:00PM BLOOD PT-20.1* PTT-24.6 INR(PT)-1.9*
[**2132-9-30**] 06:00PM BLOOD Glucose-167* UreaN-62* Creat-1.9* Na-142
K-3.9 Cl-102 HCO3-30 AnGap-14
[**2132-9-30**] 06:00PM BLOOD Digoxin-3.1*

[**2132-10-2**] 04:12AM BLOOD Glucose-162* UreaN-46* Creat-2.0* Na-145
K-4.4 Cl-111* HCO3-24 AnGap-14
[**2132-10-3**] 01:48AM BLOOD Glucose-86 UreaN-51* Creat-2.8* Na-144
K-4.3 Cl-111* HCO3-19* AnGap-18
[**2132-10-4**] 02:13AM BLOOD Glucose-238* UreaN-59* Creat-3.3* Na-139
K-4.9 Cl-107 HCO3-20* AnGap-17
[**2132-10-2**] 04:12AM BLOOD CK-MB-35* MB Indx-18.3* cTropnT-0.61*
[**2132-10-2**] 11:13AM BLOOD CK-MB-92* MB Indx-17.7* cTropnT-2.54*
[**2132-10-2**] 07:19PM BLOOD CK-MB-118* MB Indx-20.5* cTropnT-3.52*
[**2132-10-3**] 01:48AM BLOOD CK-MB-115* MB Indx-21.1* cTropnT-3.46*
[**2132-10-3**] 05:40AM BLOOD CK-MB-108* MB Indx-21.5* cTropnT-3.76*

Brief Hospital Course:
The patient was admitted to the vascular surgery service on
[**2132-9-30**]. He was placed on IV antibiotics and gentle IV fluids.
His digoxin was held preoperatively due to a supratherapeutic
level on admission.  He underwent a right transmetatarsal
amputation on [**2132-10-1**] without complication.  Postoperatively he
recovered in the post-anesthesia care unit and then was
transferred to the vascular surgical floor.  On the evening of
POD 0 he was found unresponsive (last seen responsive 5 minutes
prior) and a code blue was initiated.  He was noted to have no
pulse and no spontaneous respirations.  CPR and bag mask
ventilation were begun as the code was initiated.  He was found
to be in ventricular fibrillation.  Intubation was performed
without difficulty.  The patient's internal defibrilator shocked
the patient intermittently.  External shocks were administered
as well.  He intermittently regained a pulse after shocks
however was unable to sustain this until approximately 10minutes
into the code.  CPR was continued throughout until a sustained
pulse was obtained.

[**2132-10-2**]
He was transfered to the SICU following the code.  He was noted
to have intermittent myoclonic jerking.  His pacemaker was
interogated to see if shocks were still being administered
despite a sustained paced rhythm however there was no
defibrilator activity and it was deemed that the jerking was
likely from seizure activity and neurology was immediately
called.  The Arctic Sun was initiated for hypothermic protocol.
He was put on continuous EEG monitoring and started on
antiepileptics. A TEE showed myocardial depression and
Dobutamine was started .  He was placed on a heparin gtt.

Over the course of the next two days he continued in acute renal
failure, cardiac troponin elevation, and seizure activity.
Discussions as to his poor prognosis were make with the family
and they elected to make the patient comfort measures only due
to his prior wishes to not be kept alive via external measures
for a prolonged period.  He was extubated on [**10-5**] and expired
with the family at the bedside.  Family and the medical examiner
declined autopsy.

Medications on Admission:
Omeprazole 20 mg PO Daily
Furosemide 80 mg PO Daily
Coumadin 4mg daily currently held
Digoxin 0.25 mg PO Daily
Colchicine 0.6mg [**12-7**] tab [**Hospital1 **]
Prednisone 15 mg PO Daily
Uloric *NF* 80 mg Oral daily
Cilostazol 100mg 2tab daily
Spironolactone 25mg Daily
Metoprolol 25 mg daily
Potassium 8mg tab TID


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
Peripheral vascular disease

Discharge Condition:
Expired

Discharge Instructions:
n/a

Followup Instructions:
n/a
{'Atherosclerosis of native arteries of the extremities with gangrene,Acute kidney failure, unspecified,Chronic systolic heart failure,Other primary cardiomyopathies,Cellulitis and abscess of toe, unspecified,Ventricular fibrillation,Other convulsions,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Gout, unspecified,Heart valve replaced by transplant,Automatic implantable cardiac defibrillator in situ,Chronic obstructive asthma, unspecified,Respiratory arrest'}


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: Gangrene of right 2nd and 3rd toes and cellulitis

PRESENT ILLNESS: 84 year old male with long standing history of bilateral leg
pain and worsening pain in right foot with associated gangrene
of 2nd and 3rd toes.  Patient reports history of intermittent
[**7-14**] sharp pain at rest and pain that increases with any
walking. Now patient with 10/10 pain in right foot often keeps
patient from sleep.  Pateint's chronic ulcers involving the
right 2nd and 3rd toes have been present for over one year.
Patient underwent a diagnostic lower extremity angiogram in [**Month (only) 205**]
and non-invasive studies which demonstrated Aphasic right
metatarsal PVR and low-amplitude left metatarsal PVR.  Patient
has been followed by Dr [**Last Name (STitle) 1391**] and is admitted for a right
transmetataral amputation.

MEDICAL HISTORY: -Htn.
-chronic renal insufficiency
-gout
-OA stage 3
-Atrial fibrillation s/p defibrillator
-MVR

MEDICATION ON ADMISSION: Omeprazole 20 mg PO Daily
Furosemide 80 mg PO Daily
Coumadin 4mg daily currently held
Digoxin 0.25 mg PO Daily
Colchicine 0.6mg [**12-7**] tab [**Hospital1 **]
Prednisone 15 mg PO Daily
Uloric *NF* 80 mg Oral daily
Cilostazol 100mg 2tab daily
Spironolactone 25mg Daily
Metoprolol 25 mg daily
Potassium 8mg tab TID

ALLERGIES: Codeine

PHYSICAL EXAM: T: 98.0 BP: 150/82 HR: 70 Res: 18 97%RZ FS 193
GEN: NAD
HEAD: NC, AT, no sinus tenderness
Neuro: PERRL, CN grossly intact
CV: RRR
PUL: CTA bilaterally
ABD: Soft, NT, ND
EXT: Bilateral swelling up to ankles, 1+ edema bilaterally.
Right
foot with dry gangrene black 2nd and 3rd toes.  Errythema up
dorsum of right foot to level of malleolus. Right foot tender to
touch.
Pulses:
        Fem     [**Doctor Last Name **]     DP          PT
RT     [**Name (NI) **]     Palp   no signal     Dop
LT     Palp    Palp     Dop           Dop

FAMILY HISTORY: N/C

SOCIAL HISTORY: Remote smoking history 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Acute kidney failure, unspecified,Chronic systolic heart failure,Other primary cardiomyopathies,Cellulitis and abscess of toe, unspecified,Ventricular fibrillation,Other convulsions,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Gout, unspecified,Heart valve replaced by transplant,Automatic implantable cardiac defibrillator in situ,Chronic obstructive asthma, unspecified,Respiratory arrest'}
