CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 66 year old female
admitted on [**2127-7-11**], mid afternoon, four days after
discharge from the Thrombus Service where she had had a right
pneumothorax and right-sided rib fractures due to a motor
vehicle accident.  At that time she had been discharged to a
rehabilitation facility, primarily due to her social
situation where she was considered to a fall risk and she
lives at home alone without any social support.  One day
prior to admission, staff at the skilled nursing facility
noticed increased drainage from the chest tube wound sight
and today the patient was noted to have a temperature of
101.6.  The patient has also noticed worsening shortness of
breath.  She was transported back to [**Hospital6 649**] and admitted back to the Trauma Service.

MEDICAL HISTORY: Status post motor vehicle crash ten
days prior with multiple right rib fractures, status post
right-sided chest tube, glaucoma, chronic neuritic pain,
depression and otherwise nonspecified psychiatric history,
most likely a paranoid personality disorder.

MEDICATION ON ADMISSION: Timolol, eye drops for glaucoma,
Nortriptyline 75 mg q.d., Neurontin 600 mg t.i.d., Colace,
Celexa 10 mg q.d., Percocet prn and Ibuprofen.

ALLERGIES: The patient has stated allergies to Effexor,
Penicillin and Topamax, none of which were related to rash or
shortness of breath by her history.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father has diabetes and had an
myocardial infarction.  Mother had an myocardial infarction.
Brother had an myocardial infarction.  Negative for cancer.

SOCIAL HISTORY: The patient lives alone, occasionally drinks
alcohol and has a significant smoking history, however, she
quit six years ago.
Pneumonia, organism unspecified,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Hypotension, unspecified,Chest pain, unspecified
Pneumonia, organism NOS,Other pulmonary insuff,CHF NOS,Urin tract infection NOS,Chr airway obstruct NEC,Pleural effusion NOS,Hypotension NOS,Chest pain NOS
Admission Date:  [**2127-7-12**]       Discharge Date:  [**2127-7-14**]

Date of Birth:   [**2060-9-26**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This is a 66 year old female
admitted on [**2127-7-11**], mid afternoon, four days after
discharge from the Thrombus Service where she had had a right
pneumothorax and right-sided rib fractures due to a motor
vehicle accident.  At that time she had been discharged to a
rehabilitation facility, primarily due to her social
situation where she was considered to a fall risk and she
lives at home alone without any social support.  One day
prior to admission, staff at the skilled nursing facility
noticed increased drainage from the chest tube wound sight
and today the patient was noted to have a temperature of
101.6.  The patient has also noticed worsening shortness of
breath.  She was transported back to [**Hospital6 649**] and admitted back to the Trauma Service.

PAST MEDICAL HISTORY:  Status post motor vehicle crash ten
days prior with multiple right rib fractures, status post
right-sided chest tube, glaucoma, chronic neuritic pain,
depression and otherwise nonspecified psychiatric history,
most likely a paranoid personality disorder.

PAST SURGICAL HISTORY:  Status post left open reduction and
internal fixation of the tibial plateau and status post
bilateral hip replacement.

MEDICATIONS ON ADMISSION:  Timolol, eye drops for glaucoma,
Nortriptyline 75 mg q.d., Neurontin 600 mg t.i.d., Colace,
Celexa 10 mg q.d., Percocet prn and Ibuprofen.

ALLERGIES:  The patient has stated allergies to Effexor,
Penicillin and Topamax, none of which were related to rash or
shortness of breath by her history.

PHYSICAL EXAMINATION:  Physical examination on arrival showed
temperature 97.6, heartrate 98, blood pressure 145/37 and
respiratory rate 18.  Oxygen saturations were 82% on room air
and 99% on nonrebreather.  The patient was awake and alert in
no acute distress, not tachypneic.  There was a right-sided
chest crepitus palpated and auscultated.  Left side of the
lung, decreased breathsounds as well at the base.  There was
no jugulovenous distension.  Heart had a regular rate.  The
abdomen was soft, nontender, and had good bowel sounds.  The
left knee had an area of ecchymosis but was not tender to
palpation nor warm to the touch.  Left eye also had some
ecchymosis from a prior hematoma on the left anterior portion
of her scalp.

LABORATORY DATA:  Initial laboratory data were significant
for a white count of 19.8, hematocrit 28, the patient having
a baseline hematocrit at discharge between 28 and 30.
Urinalysis with numerous white blood cells.  Initial
radiology, chest x-ray was obtained showing left lower lobe
and right lower lobe consolidation, as well as a right lower
lobe effusion.  Electrocardiogram was performed which showed
no acute change from her prior electrocardiogram.

HOSPITAL COURSE:  The patient was admitted to the floor for
possible empyema versus pneumonia versus urinary tract
infection and started on Vancomycin and Ceftriaxone.  It was
difficult to maintain the patient's oxygenation due to her
pain.  A chest tube was attempted to be placed but was placed
in the chest wall and not in the intrapleural space.  Said
chest tube was discontinued and upon thoracic surgery
consultation was not felt to be needed.  The chest
computerized tomographic angiography was required to rule out
pulmonary embolism which showed the patient to be without
emboli.  Chest computerized tomography scan did reveal a
small right apical pneumothorax as well as a small right
hydropneumothorax near the pulmonary artery and atelectasis
versus pneumonia at the right middle lobe.  Aggressive chest
physical therapy and antibiotics gradually improved the
patient's oxygenation until she was sating well on simple
nasal cannula.  Antibiotics were switched over to Levaquin
and as her condition has improved, she is stable for transfer
back to the rehabilitation facility where it is crucial that
she use incentive spirometry, has gotten out of bed as often
as possible and that her pain is managed well to prevent
relapse of possible pneumonia.  She should follow up at the
Trauma Clinic in one to two weeks and should have an
outpatient colonoscopy scheduled as she has a persistent
anemia with heme positive stools.  After she is done
completing her course of Fluoroquinolones it is recommended
that she be started on iron therapy but not prior to
finishing her Levaquin as Fluoroquinolone levels are reduced
in the face of concurrent iron therapy.  At this time the
patient is discharged with the following diagnoses.

DISCHARGE DIAGNOSIS:
1.  Right rib fractures from prior motor vehicle accident
status post second chest tube insertion
2.  Urinary tract infection
3.  Pneumonia
4.  Loculated hydropneumothoraces on the right times two
5.  Anemia

DISCHARGE MEDICATIONS:
1.  Nortriptyline 75 mg h.s.
2.  Neurontin 600 mg t.i.d.
3.  Docusate 100 mg b.i.d.
4.  Celexa 10 mg q.d.
5.  Dilaudid 2 to 4 mg p.o. q. 6 hours prn for ten days
6.  Levaquin 500 mg q.d. for nine days

DISCHARGE INSTRUCTIONS:  Chest physiotherapy one to two times
per day as well as physical therapy for general strengthening
and gait safety.  It is expected that as her condition
improves she will be safe to be discharged back home.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern1) 4791**]
MEDQUIST36

D:  [**2127-7-14**]  19:19
T:  [**2127-7-14**]  19:34
JOB#:  [**Job Number 98696**]


Admission Date:  [**2127-7-14**]       Discharge Date:  [**2127-7-22**]

Date of Birth:   [**2060-9-26**]       Sex:  F

Service:  [**Hospital1 212**]

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 97368**] is a 66 year-old
female status post motor vehicle accident on [**2127-7-3**]
sustaining right rib fractures and pneumothorax.  She was
hospitalized from [**7-3**] to [**7-8**] and treated with a chest tube,
which was removed after five days.  The patient was
discharged to a rehab on [**2127-7-8**].  She represented with fever,
cough, shortness of breath and right rib pain on [**2127-7-11**] with
hypoxia.  She had an elevated white blood cell count and
blood cultures were drawn showing no growth.  She was
admitted to the trauma service and please refer to separate
discharge summary number [**Serial Number 98697**] for her hospital course while
on the surgery service.

PAST MEDICAL HISTORY:
1.  Status post motor vehicle accident on [**2127-7-3**] with
multiple right rib fractures.
2.  Status post right sided chest tube.
3.  Glaucoma.
4.  Chronic neuritic pain.
5.  Depression.
6.  Psychiatric history NOS.

PAST SURGICAL HISTORY:
1.  Status post left open reduction and internal fixation
tibial fracture.
2.  Status post bilateral hip replacement.

MEDICATIONS ON ADMISSION:
1.  Timolol eye drops for glaucoma.
2.  Nortriptyline 75 mg q.d.
3.  Neurontin 600 mg t.i.d.
4.  Colace 100 mg b.i.d.
5.  Celexa 10 mg q.d.
6.  Percocet prn.
7.  Ibuprofen prn.

ALLERGIES:  The patient has allergies to Effexor, Penicillin
and Topamax.

SOCIAL HISTORY:  The patient lives alone, occasionally drinks
alcohol and has a significant smoking history, however, she
quit six years ago.

FAMILY HISTORY:  Her father has diabetes and had an
myocardial infarction.  Mother had an myocardial infarction.
Brother had an myocardial infarction.  Negative for cancer.

PHYSICAL EXAMINATION UPON TRANSFER TO [**Hospital1 212**] MEDICINE
SERVICE:  Temperature 97.7.  Heart rate 85.  Blood pressure
92/palpable.  Respiratory rate 18.  O2 sat 100% on 4 liters.
General the patient appears comfortable and in no acute
distress.  Neck 8 cm JVD.  Positive hepatojugular reflex.
Chest clear at apices.  Decreased breath sounds at right
base.  Coarse crackles half way up bilaterally.  Heart
irregular, clicking noises when resolved when holding breath.
Regular rate and rhythm.  Normal S1 and S2.  No murmurs, rubs
or gallops.  Abdomen positive bowel sounds, all quadrants,
soft, nontender, nondistended.  No hepatosplenomegaly.
Extremities 2+ pedal pulses bilaterally, trace edema, cool
extremities, no cyanosis, Pneumoboots in place.

PERTINENT LABORATORIES/X-RAYS/EKGS AND OTHER TESTS:  On
[**2127-7-15**] hematocrit was 23.0.  On [**2127-7-15**] the patient was
ruled out for an myocardial infarction.  Her CKs were 86,
112, 89, troponin was 0.18, 0.2, 0.14.  Swab taken [**2127-7-12**]
from right chest tube site revealed 1+ polys on gram stain,
carinii bacteria and coag negative staph with two colonial
morphologies.  Chest x-ray on [**2127-7-21**] showed no evidence of
cardiac failure, multiple right sided rib fractures, soft
tissue thickening consistent with stable versus resolved
hematoma, loculated right pleural effusion with atelectasis
at right base, no pneumothorax, left lung is well aerated.

HOSPITAL COURSE:  On the early morning of [**2127-7-15**] the patient
was transferred from the surgery service to the trauma CICU
for increased respiratory stress and agitation.  Her O2 sats
dropped to 70% when not on O2, but improved to 100% on 4
liters by face mask.  She was also found to be hypercarbic on
blood gas.  She was confused, tachycardic and tachypneic.  A
chest x-ray showed no changes with no congestive heart
failure and no pneumothorax.  A Foley was placed and an A
line was placed for access for repeated arterial blood gas.
She was transfused 2 units of packed red blood cells for a
hematocrit of 23.0 on [**7-15**].  She also was ruled out for an
myocardial infarction.  Her CKs and troponins increased
slightly, however, this was not felt to be consistent with a
myocardial infarction.  On [**7-16**] she was started on a beta
blocker, Captopril and aspirin.  Her neurological examination
fluctuated from being calm to restless and agitated.  A CTE
was performed revealing prior anterior septal and apical
akinesis with global hypokinesis and an EF of 25 to 30%.  On
[**7-17**] she was transferred to the MICU.  She demonstrated
evidence of decompensated heart failure and had hypotension
to systolic blood pressures of 70 with codeine.  She showed
she was very sensitive to Captopril and beta blockers and
subsequently dropped her systolic blood pressures and
required several boluses of intravenous fluids.

On [**7-18**] she was transferred to the regular medical floor and
her beta blockers and ace inhibitors were held given her
history of hypotension.  She was diuresed with Lasix, which
improved her O2 requirements and her tachypnea.  On [**7-19**] she
demonstrated an elevated white blood cell count from 12 to 19
and underwent a repeat chest x-ray, repeat blood culture and
urinalysis and urine culture.  Her chest x-ray showed no
change from previously seen right loculated effusion and
showed no evidence of congestive heart failure.  Her urine
culture showed 10 to 100,000 yeast.  Her blood cultures are
negative to date.  On [**7-21**] the patient remained afebrile and
continued to clinically improve.  Her O2 requirements
decreased to 2 and then 1 liter of oxygen by nasal cannula.
She was seen by physical therapy who felt she needed further
rehab.  They recommended she needed ability training,
therapeutic exercises and monitoring of her pulmonary status.
On [**7-22**] she continued to clinically improve.  Her breathing
was subjectively improving.  She received a bed at the [**Hospital 533**]
Rehab.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE STATUS:  To rehab facility.

DISCHARGE DIAGNOSES:
1.  Right rib fractures status post chest tube insertions
times two.
2.  Urinary tract infection.
3.  Right lower lobe pneumonia.
4.  Loculated pleural effusion.
5.  Anemia.

DISCHARGE MEDICATIONS:
1.  Nortriptyline 75 mg q.h.s.
2.  Gabapentin 600 mg t.i.d.
3.  Colace 100 mg b.i.d.
4.  Citalopram 10 mg q.d.
5.  Levofloxacin 500 mg q.d. times five days.
6.  Aspirin 325 mg.
7.  Timolol 0.25% eye drops b.i.d.
8.  Guaifenesin 100 mg per 5 ml syrup 5 to 10 ml q 6 hours as
needed.
9.  Codeine 15 to 30 mg q 4 to 6 hours prn.
10.  Bisacodyl 10 mg po q.d. prn.
11.  Nitroglycerin sublingual 0.3 mg prn chest pain.
12.  Metoprolol 12.5 mg b.i.d.

FOLLOW UP PLANS:  The patient was instructed to follow up
with the trauma clinic in one to two weeks after discharge.
She is also instructed to follow up with her primary care
physician in two weeks following discharge.  Also she was
instructed to make an appointment with a cardiologist
regarding her newly diagnosed decreased systolic ejection
fraction.






                            [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**Last Name (NamePattern1) 98698**]
MEDQUIST36

D:  [**2127-7-22**]  11:41
T:  [**2127-7-22**]  12:01
JOB#:  [**Job Number 98699**]
{'Pneumonia, organism unspecified,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Hypotension, unspecified,Chest pain, unspecified'}


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: This is a 66 year old female
admitted on [**2127-7-11**], mid afternoon, four days after
discharge from the Thrombus Service where she had had a right
pneumothorax and right-sided rib fractures due to a motor
vehicle accident.  At that time she had been discharged to a
rehabilitation facility, primarily due to her social
situation where she was considered to a fall risk and she
lives at home alone without any social support.  One day
prior to admission, staff at the skilled nursing facility
noticed increased drainage from the chest tube wound sight
and today the patient was noted to have a temperature of
101.6.  The patient has also noticed worsening shortness of
breath.  She was transported back to [**Hospital6 649**] and admitted back to the Trauma Service.

MEDICAL HISTORY: Status post motor vehicle crash ten
days prior with multiple right rib fractures, status post
right-sided chest tube, glaucoma, chronic neuritic pain,
depression and otherwise nonspecified psychiatric history,
most likely a paranoid personality disorder.

MEDICATION ON ADMISSION: Timolol, eye drops for glaucoma,
Nortriptyline 75 mg q.d., Neurontin 600 mg t.i.d., Colace,
Celexa 10 mg q.d., Percocet prn and Ibuprofen.

ALLERGIES: The patient has stated allergies to Effexor,
Penicillin and Topamax, none of which were related to rash or
shortness of breath by her history.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father has diabetes and had an
myocardial infarction.  Mother had an myocardial infarction.
Brother had an myocardial infarction.  Negative for cancer.

SOCIAL HISTORY: The patient lives alone, occasionally drinks
alcohol and has a significant smoking history, however, she
quit six years ago. 

### Response:
{'Pneumonia, organism unspecified,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Hypotension, unspecified,Chest pain, unspecified'}
