CHIEF COMPLAINT: Chronic nonhealing rt. foot wound

PRESENT ILLNESS: 52y/o male with known PVD s/p rt. fem-pr bpg with 3rd toe
amputation7/08 , discharged to rehab [**2146-6-17**] but rehospitalized
for Mi and underwent cardiac catherization witch was negative
for significant coronary artery diseas.He presents now [**2146-8-1**]
with low grade fever(99)[**8-1**] /08. Had [**Month/Year (2) 269**] servicces for wound
care.The [**Name8 (MD) 269**] RN note wound erythema two days prior to [**8-1**],
increasing foot drainage and pain brought patient to seek
medical care. Patient transfered here for further care.

MEDICAL HISTORY: history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-24**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of

MEDICATION ON ADMISSION: plavix 75mgm daily
digoxin 250mcg daily
tramadol 50mgm [**Hospital1 **]
ntg sl 0.3mgm prn
niacin 500mgm [**Hospital1 **]
fenofibrinate micronized 48mg [**Hospital1 **]
percocet tabs [**11-17**] q4h prn
senna tabs 8.6mgm [**Hospital1 **]
gabapentin 100mgm tid
glargine 25units [**Hospital1 **]
humalog ss
mirtazapine 15mgm HS
lasix 40mg [**Hospital1 **]
ntg patch 0.4mg.hr q24h,omeprazol 20mgm daily
lisinopril20mgm [**Hospital1 **]
rosuvastatin 20mgm daily
spirolactone/meprolol xl 150mgm daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 99.5-100-22 B/P 120/62 O2 sat 95% Room Air
Gen: AAOx3
Lungs: clear to A
Heart: RRR
abd: bengin
EXt: palpable rt. femoral and graft pulse, dopperable DP, PT.
Rt. foot plantar ulceration with fibrinous base, toe amp site
necrotic no purulance noted
     left pedal pulses dopperable.
Neuro: nonfocal

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives alone
former ETOH abuse, none x 7 yrs
Denies tobacco use
Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Chronic combined systolic and diastolic heart failure,Cellulitis and abscess of foot, except toes,Acute osteomyelitis, ankle and foot,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Aortocoronary bypass status,Other emphysema,Dysthymic disorder
Ath ext ntv art gngrene,Ulcer of heel & midfoot,Chr syst/diastl hrt fail,Cellulitis of foot,Ac osteomyelitis-ankle,Iatrogenc hypotnsion NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Long-term use of insulin,Aortocoronary bypass,Emphysema NEC,Dysthymic disorder
Admission Date:  [**2146-8-1**]              Discharge Date:   [**2146-8-22**]

Date of Birth:  [**2093-9-6**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4748**]
Chief Complaint:
Chronic nonhealing rt. foot wound

Major Surgical or Invasive Procedure:
Right BKA [**2146-8-18**]
rt. tma [**2146-8-8**]
rt. angioplasty of graft and PT [**2146-8-4**]


History of Present Illness:
52y/o male with known PVD s/p rt. fem-pr bpg with 3rd toe
amputation7/08 , discharged to rehab [**2146-6-17**] but rehospitalized
for Mi and underwent cardiac catherization witch was negative
for significant coronary artery diseas.He presents now [**2146-8-1**]
with low grade fever(99)[**8-1**] /08. Had [**Month/Year (2) 269**] servicces for wound
care.The [**Name8 (MD) 269**] RN note wound erythema two days prior to [**8-1**],
increasing foot drainage and pain brought patient to seek
medical care. Patient transfered here for further care.

Past Medical History:
history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-24**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of


Social History:
lives alone
former ETOH abuse, none x 7 yrs
Denies tobacco use

Family History:
noncontributory

Physical Exam:
Vital signs: 99.5-100-22 B/P 120/62 O2 sat 95% Room Air
Gen: AAOx3
Lungs: clear to A
Heart: RRR
abd: bengin
EXt: palpable rt. femoral and graft pulse, dopperable DP, PT.
Rt. foot plantar ulceration with fibrinous base, toe amp site
necrotic no purulance noted
     left pedal pulses dopperable.
Neuro: nonfocal

Pertinent Results:
Rt. foot film;
1. Regional progressive erosive change involving the second
through fourth
proximal phalanges is concerning for infection/osteomyelitis.
2. New planter ulcer, remote from the bony changes described
above.

arterial studies:
IMPRESSION: Low velocity, high resistance flow within the
femoral posterior
tibial bypass. There appears to be a flow-limiting stenosis in
the area of
the upper calf portion of the graft. This has the appearance of
a failing
bypass. Further imaging and angiography is recommended.


Brief Hospital Course:
[**2146-8-2**] Admitted Iv Vanco, cipro started, flagyl began wound c/s
obtained.
[**2146-8-3**] Podiatry consulted. fore foot PVR flat. Duplex of graft
with mid graft stenosis.
[**2146-8-4**] angiogram: right graft PT angioplasty.
[**2146-8-8**] Rt. TMA complicated by hypotension requiring neo.Gtt.
IV.Transfused 4units PRBC'sTransfered to ICU from PACU
[**2146-8-9**] POD#1,PPD#6. Neo gtt weaned. intermitted agitiation
which responds to lorazepam. Hemodynamically stable and
transfered to VICU.
[**2146-8-10**] POD#2/PPD#7 Evaluated by PT will [**Hospital **] rehab at d/c.PCA
converted to po pain meds.
9/25-26/08 POD#[**1-18**],PPD#[**6-25**] PCA reatarted, failed po medication
pain control.Being followed by psychiatry.
Patient ambulating against surigal services advice. TMA wound
with masseration and cyanosis.
9/26-28/08 POD#5/6/7,PPD#[**2150-8-27**] amp site not improving despite
IV antibiotics
and encouragment to main tain NWB. Ampuitation discussed with
patinet.
[**2146-8-15**] POD#8,PPD#13 accepting need of rt. BKA.Followed by psych
and social service.
Antibiotics continued.
[**2146-8-16**] POD#9,PPD#14 scheled for BKA defered secondary to
surgical emergency.and reschedualed.
[**2146-8-18**] POD#11,PPD#16 Right BKA without complication.
[**2146-8-19**] POD#[**11-27**],PPD#17 delined diet advanced. patient pain
controlled on diludid PCA.
Patient will be transfered to rehab when bed avaible and
converted to po painmedication with adequate pain control.

Medications on Admission:
plavix 75mgm daily
digoxin 250mcg daily
tramadol 50mgm [**Hospital1 **]
ntg sl 0.3mgm prn
niacin 500mgm [**Hospital1 **]
fenofibrinate micronized 48mg [**Hospital1 **]
percocet tabs [**11-17**] q4h prn
senna tabs 8.6mgm [**Hospital1 **]
gabapentin 100mgm tid
glargine 25units [**Hospital1 **]
humalog ss
mirtazapine 15mgm HS
lasix 40mg [**Hospital1 **]
ntg patch 0.4mg.hr q24h,omeprazol 20mgm daily
lisinopril20mgm [**Hospital1 **]
rosuvastatin 20mgm daily
spirolactone/meprolol xl 150mgm daily


Discharge Medications:
1. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Fenofibrate Micronized 48 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).

5. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
6. Niacin 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Nitroglycerin 0.4 mg/hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal Q24H (every 24 hours).
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Tramadol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
15. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q8H (every 8 hours).
16. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
17. Fenofibrate Micronized 48 mg Tablet Sig: Two (2) Tablet PO
QAM (once a day (in the morning)).
18. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
19. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed.


Discharge Disposition:
Extended Care

Facility:
LIBERTY COMMONS

Discharge Diagnosis:
chroinc rt. foot wounds
historoy of PVD, s/p rt. fem-pt bpg and rt. toe 3 amputation
[**5-24**]
history of DM2, uncontrolled
histroy of DM neuropathy
historoy of coronary artery disease,s/p MI [**2135**],s/p CABG'sx4 '[**38**]

history of HTN
history of COPD/emphysema on inhalers
history of Bell's Palsey side unknown
history of tonsillectomy
history of chronic systloic/diastoic CHF, compensated EF 20%
postoperative hypotension,resolved
postoperative acute blood loss anemia s/p transfusion, corrected


Discharge Condition:
stable


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
no stump shrinkers
leave skin clips of BK stump in place until seen in followup
with Dr. [**Last Name (STitle) 1391**]
call if wound develope swelling ,redness or drainage
call if developes fever >101.5

Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2146-9-8**] 11:00
[**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 81677**] 3-4 weeks,call for an appointment,[**Telephone/Fax (1) 1393**]



Completed by:[**2146-8-19**]

Name:  [**Known lastname **],[**Known firstname 126**] R.             Unit No:   [**Numeric Identifier 14706**]

Admission Date:  [**2146-8-1**]              Discharge Date:   [**2146-8-22**]

Date of Birth:  [**2093-9-6**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 231**]
Addendum:
Please note that Mr. [**Known lastname **] has been followed by Psychiatry
and Social Work for depressed mood and suicidal ideation while
an inpatient.

Discharge Medications:
1. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Fenofibrate Micronized 48 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).

5. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
6. Niacin 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Nitroglycerin 0.4 mg/hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal Q24H (every 24 hours).
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Tramadol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
15. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q8H (every 8 hours).
16. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
17. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed.


Discharge Disposition:
Extended Care

Facility:
LIBERTY COMMONS

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern1) 237**] MD [**MD Number(1) 238**]

Completed by:[**2146-8-22**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Chronic combined systolic and diastolic heart failure,Cellulitis and abscess of foot, except toes,Acute osteomyelitis, ankle and foot,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Aortocoronary bypass status,Other emphysema,Dysthymic disorder'}


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: Chronic nonhealing rt. foot wound

PRESENT ILLNESS: 52y/o male with known PVD s/p rt. fem-pr bpg with 3rd toe
amputation7/08 , discharged to rehab [**2146-6-17**] but rehospitalized
for Mi and underwent cardiac catherization witch was negative
for significant coronary artery diseas.He presents now [**2146-8-1**]
with low grade fever(99)[**8-1**] /08. Had [**Month/Year (2) 269**] servicces for wound
care.The [**Name8 (MD) 269**] RN note wound erythema two days prior to [**8-1**],
increasing foot drainage and pain brought patient to seek
medical care. Patient transfered here for further care.

MEDICAL HISTORY: history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-24**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of

MEDICATION ON ADMISSION: plavix 75mgm daily
digoxin 250mcg daily
tramadol 50mgm [**Hospital1 **]
ntg sl 0.3mgm prn
niacin 500mgm [**Hospital1 **]
fenofibrinate micronized 48mg [**Hospital1 **]
percocet tabs [**11-17**] q4h prn
senna tabs 8.6mgm [**Hospital1 **]
gabapentin 100mgm tid
glargine 25units [**Hospital1 **]
humalog ss
mirtazapine 15mgm HS
lasix 40mg [**Hospital1 **]
ntg patch 0.4mg.hr q24h,omeprazol 20mgm daily
lisinopril20mgm [**Hospital1 **]
rosuvastatin 20mgm daily
spirolactone/meprolol xl 150mgm daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 99.5-100-22 B/P 120/62 O2 sat 95% Room Air
Gen: AAOx3
Lungs: clear to A
Heart: RRR
abd: bengin
EXt: palpable rt. femoral and graft pulse, dopperable DP, PT.
Rt. foot plantar ulceration with fibrinous base, toe amp site
necrotic no purulance noted
     left pedal pulses dopperable.
Neuro: nonfocal

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives alone
former ETOH abuse, none x 7 yrs
Denies tobacco use 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Chronic combined systolic and diastolic heart failure,Cellulitis and abscess of foot, except toes,Acute osteomyelitis, ankle and foot,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Aortocoronary bypass status,Other emphysema,Dysthymic disorder'}
