CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This is a 25 year old gentleman with a history of IV drug abuse
who presented to [**Hospital1 **] [**Location (un) 620**] on [**2150-2-17**] with 2 weeks of pleuritic
chest pain and was found to have a large right-sided pleural
effusion and a left lower lobe infiltrate. The patient reports
pain with deep inspiration and coughin. He describes chills. He
has no prior history of pneumonia or pulmonary problems. At
[**Name2 (NI) **] he was febrile to a temp of 102 and cultures were drawn;
he was started empirically on ceftriaxone and zithromax. He
became progressively hypoxic to 88 on room air (up to 95% on 4
liters). A thoracentesis was performed but failed and his
effusion worsened.

MEDICAL HISTORY: Depression
Polysubstance Abuse
Suicidal Ideation
Motor Vehicle Accident

MEDICATION ON ADMISSION: Motrin

ALLERGIES: Hurricaine

PHYSICAL EXAM: ON admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: The patient has a history of IV heroin and cocaine use. He
smokes 4 packs of tobacco/week. He completed some community
college. He lives with his mother in [**Name (NI) 932**], MA. He is working
in construction.
Empyema without mention of fistula,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other, mixed, or unspecified drug abuse, unspecified,Frontal lobe syndrome,Late effect of intracranial injury without mention of skull fracture,Anemia, unspecified,Acute pharyngitis,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Dysthymic disorder,Other and unspecified diseases of the oral soft tissues,Methemoglobinemia
Empyema w/o fistula,Pneumonia, organism NOS,Hemorrhage complic proc,Other pulmonary insuff,Ac kidny fail, tubr necr,Drug abuse NEC-unspec,Frontal lobe syndrome,Lt eff intracranial inj,Anemia NOS,Acute pharyngitis,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins,Dysthymic disorder,Oral soft tissue dis NEC,Methemoglobinemia
Admission Date:  [**2150-2-18**]              Discharge Date:   [**2150-3-10**]

Date of Birth:  [**2124-5-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Hurricaine

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Thoracentesis [**2150-2-19**]
Bronchoscopy, Right VATS with lung decortication and chest tube
placement [**2150-2-20**]
Bronchoscopy, Right VATS, evacuation of hematoma [**2150-2-25**]
Transesophageal Echocardiogram [**2150-3-6**]

History of Present Illness:
This is a 25 year old gentleman with a history of IV drug abuse
who presented to [**Hospital1 **] [**Location (un) 620**] on [**2150-2-17**] with 2 weeks of pleuritic
chest pain and was found to have a large right-sided pleural
effusion and a left lower lobe infiltrate. The patient reports
pain with deep inspiration and coughin. He describes chills. He
has no prior history of pneumonia or pulmonary problems. At
[**Name2 (NI) **] he was febrile to a temp of 102 and cultures were drawn;
he was started empirically on ceftriaxone and zithromax. He
became progressively hypoxic to 88 on room air (up to 95% on 4
liters). A thoracentesis was performed but failed and his
effusion worsened.

Past Medical History:
Depression
Polysubstance Abuse
Suicidal Ideation
Motor Vehicle Accident


Social History:
The patient has a history of IV heroin and cocaine use. He
smokes 4 packs of tobacco/week. He completed some community
college. He lives with his mother in [**Name (NI) 932**], MA. He is working
in construction.


Family History:
Noncontributory

Physical Exam:
ON admission:

v/s 101.8, 148/66, pulse 120 sinus, 27, 93% on 4 L
Gen: answering questions appropriately, falling asleep
(sedatives on-board)
HEENT: PERRL, EOMI, MMM
Neck: no LAD
CV: sinus tachycardia, no murmur
Chest: poor inspiratory effort, bronchial breath sounds at right
base, crackles at left base
Abd: soft, + BS, nontender
Extr: warm, 2+ DP, no edema
Neur: CN 2-12 grossly intact, strength 5/5 throughout

Pertinent Results:
SEROLOGIES

[**2150-2-18**] 09:41PM BLOOD WBC-24.4* RBC-4.19* Hgb-12.3* Hct-34.5*
MCV-82 MCH-29.5 MCHC-35.8* RDW-13.0 Plt Ct-354
[**2150-2-19**] 06:45PM BLOOD WBC-18.3* RBC-3.21* Hgb-9.8* Hct-27.0*
MCV-84 MCH-30.4 MCHC-36.1* RDW-13.2 Plt Ct-276
[**2150-2-19**] 11:53PM BLOOD WBC-20.5* RBC-3.74* Hgb-11.0* Hct-31.3*
MCV-84 MCH-29.4 MCHC-35.1* RDW-13.1 Plt Ct-349
[**2150-2-23**] 10:40AM BLOOD WBC-12.9* RBC-2.97* Hgb-9.2* Hct-24.9*
MCV-84 MCH-30.9 MCHC-36.9* RDW-13.1 Plt Ct-500*
[**2150-2-26**] 03:29PM BLOOD WBC-16.6* RBC-2.90* Hgb-8.7* Hct-24.4*
MCV-84 MCH-30.1 MCHC-35.9* RDW-13.5 Plt Ct-571*
[**2150-3-6**] 06:00AM BLOOD WBC-12.7* RBC-3.50* Hgb-9.9* Hct-29.0*
MCV-83 MCH-28.3 MCHC-34.1 RDW-13.4 Plt Ct-592*
[**2150-3-7**] 10:00AM BLOOD WBC-10.5 RBC-3.36* Hgb-9.6* Hct-27.8*
MCV-83 MCH-28.6 MCHC-34.5 RDW-13.4 Plt Ct-541*
[**2150-3-8**] 04:35AM BLOOD WBC-9.6 RBC-3.56* Hgb-10.5* Hct-29.3*
MCV-82 MCH-29.4 MCHC-35.8* RDW-13.3 Plt Ct-474*
[**2150-2-18**] 09:41PM BLOOD PT-14.3* PTT-35.3* INR(PT)-1.4
[**2150-2-20**] 01:58AM BLOOD PT-13.6* PTT-33.2 INR(PT)-1.2
[**2150-3-5**] 11:46AM BLOOD Fibrino-738*
[**2150-3-6**] 06:00AM BLOOD Fibrino-767*
[**2150-3-6**] 09:00AM BLOOD Eos Ct-490*
[**2150-2-21**] 01:16PM BLOOD Ret Aut-1.0*
[**2150-2-18**] 09:41PM BLOOD Glucose-123* UreaN-8 Creat-0.7 Na-132*
K-4.0 Cl-96 HCO3-26 AnGap-14
[**2150-2-19**] 06:45PM BLOOD Glucose-97 UreaN-7 Creat-0.6 Na-134 K-4.0
Cl-97 HCO3-28 AnGap-13
[**2150-2-20**] 01:58AM BLOOD Glucose-119* UreaN-9 Creat-0.6 Na-135
K-3.8 Cl-97 HCO3-29 AnGap-13
[**2150-3-6**] 06:00AM BLOOD Glucose-89 UreaN-21* Creat-1.8* Na-142
K-4.8 Cl-103 HCO3-26 AnGap-18
[**2150-3-7**] 10:00AM BLOOD Glucose-91 UreaN-23* Creat-1.8* Na-140
K-4.5 Cl-104 HCO3-26 AnGap-15
[**2150-3-8**] 04:35AM BLOOD Glucose-104 UreaN-24* Creat-1.7* Na-141
K-4.2 Cl-104 HCO3-26 AnGap-15
[**2150-2-18**] 09:41PM BLOOD ALT-13 AST-17 LD(LDH)-197 AlkPhos-75
TotBili-0.6
[**2150-2-18**] 09:41PM BLOOD Albumin-3.5 Calcium-9.1 Phos-3.9 Mg-1.7
[**2150-2-19**] 06:45PM BLOOD Albumin-3.3* Calcium-8.9 Phos-4.3 Mg-1.8
[**2150-2-21**] 01:16PM BLOOD Calcium-8.1* Phos-3.8 Mg-1.9 Iron-10*
[**2150-2-20**] 01:58AM BLOOD VitB12-714 Folate-7.2
[**2150-2-21**] 01:16PM BLOOD calTIBC-183* Ferritn-465* TRF-141*
[**2150-2-20**] 01:58AM BLOOD TSH-2.7
[**2150-3-6**] 09:00AM BLOOD C3-210* C4-50*
[**2150-2-26**] 05:13PM BLOOD HIV Ab-NEGATIVE
[**2150-2-22**] 06:00AM BLOOD Vanco-7.2*
[**2150-2-22**] 09:02PM BLOOD Vanco-4.4*
[**2150-2-28**] 08:34PM BLOOD Vanco-18.5*
[**2150-3-2**] 04:34PM BLOOD Vanco-24.2*
[**2150-3-4**] 09:45AM BLOOD Vanco-17.4*

RADIOLOGY:

[**2150-2-18**] CXR: There is a large right pleural effusion. Cannot
exclude loculation and decubitus chest radiograph could be
performed if indicated. The large pleural effusion obscures the
detail of the lung parenchyma. The left lung demonstrates only
mild atelectasis of the left base. No focal consolidations of
the left lung is seen. The pleural effusion is causing mass
effect and mild shift of the mediastinal structures to left
side. There is no evidence of pneumothorax.

[**2150-2-19**] CT Chest:
1) Massive right-sided pleural effusion, with associated
atelectasis of the entire right lung. No hematocrit level. No
particular loculations are seen, and the density attenuation
values are at the upper limits of normal for simple fluid.
Empyema should be considered in patient with history of IVDA.
Differential diagnosis includes TB, malignancy, and trauma (no
evidence of active or recent bleeding).

2) Left-sided peripheral ground glass opacities are likely
infectious. Septic emboli should be considered given history of
IVDA.

[**2150-2-23**] CT Chest: 1. Interval placement of two right-sided chest
tubes, as detailed above, with decrease in size of massive
right-sided effusion.
 2. Residual loculated fluid collections within the right
hemithorax as
detailed above with higher attenuation collections near the
right lung apex, which could represent areas of hemothorax.
3. Small focal area of consolidation in the left lung base
medially, which  could represent an area of rounded atelectasis
or small developing infiltrate.

[**2150-2-27**] Renal US: . No evidence of hydronephrosis.
 2. Large kidneys bilaterally with relatively echogenic
cortices.

[**2150-3-4**] Ultrasound: No evidence of DVT in either lower
extremity.

[**2150-3-6**] TEE: A catheter is seen in the right atrium that extends
to the tricuspid annulus. There is no associated
thrombus/vegetation. No spontaneous echo contrast or thrombus is
seen in the body of the left atrium/left atrial appendage or the
body of the right atrium/right atrial appendage. No atrial
septal defect is seen by 2D or color Doppler. Left ventricular
wall thicknesses and cavity size are normal. Overall left
ventricular systolic function is low normal (LVEF 50-55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. No masses or vegetations are seen on the
aortic valve. No aortic regurgitation is seen. The mitral valve
leaflets are structurally normal. No mass or vegetation is seen
on the mitral valve. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion. A TEE procedure related
complication occurred (see comments for details).

IMPRESSION: Low normal LV systolic function with mild mitral
regurgitation. Mild mitral regurgitation with normal valve
morphology. No definite evidence of endocarditis.

PATHOLOGY:
Pleural rind":

-  Scant fibroadipose tissue and granulation tissue with
abundant fibrinopurulent exudates.
-  No malignancy identified.

MICROBIOLOGY:

[**2150-2-19**] Pleural fluid culture: negative

[**2149-2-20**] Bronchial Fluid culture: negative


Brief Hospital Course:
This is a 25 year old gentleman with polysubstance abuse who
presented from [**Hospital1 18**] [**Location (un) 620**] with fevers and a large right
pleural effusion that was not drainable via thoracentesis. He
was admitted to the medical intensive care unit. He was started
on broad-spectrum antibiotics. Ultrasound-guided thoracentesis
was performed on admission but was unsuccessful in draining
adequate fluid. Thoracic surgery was consulted and the pateint
underwent a VATS with mechanical pleurodesis and placement of a
chest tube and [**Doctor Last Name 406**] drain on [**2150-2-19**] (please see the operative
note of Dr. [**Last Name (STitle) **] for full details). Infectious disease
consultation was obtained and the patient was started on Zosyn
and Vancomycin; AFB and sputum cultures were sent but were
negative. Given the patient's aggitation on admission and
substance abuse history, psychiatric consultation services were
obtained and recommended refraining from benzodiazepenes and
Haldol/Seroquel prn. On post-operative day 4 a CT scan revealed
worsening effusion and the patient again was taken for VATS with
evacuation of hemothorax. He did well post-operatively with no
pain-related or respiratory complications. A Trans-esophageal
echocardiogram was performed on [**2150-3-3**] but discontinued
secondary to hypoxia from meth-hemoglobinemia; a repeat TEE
performed on [**2150-3-7**] revealed no evidence of endocarditis. The
patient developed a rise in his creatinine around this time and
Renal consultation was obtained; it was thought that he
developed acute interstitial nephritis from his antibiotics and
the Vancomycin was discontinued. He remained afebrile with the
Zosyn and his leukocytosis resolved. His [**Doctor Last Name 406**] drain was changed
to a Heimlich valve on [**2150-3-5**]. His chest-tube was removed on
[**2150-3-6**] and his [**Doctor Last Name 406**] drain on [**2150-3-8**]. A PICC was placed for
outpatient continuation of his 4 weeks of antibiotics. Because
of the patient's substance abuse history, he was not deemed a
candidate for home antibiotic therapy and a rehabilitation
hospital was found for him. He was discharged with continuation
of his inpatient medications and planned follow-up with thoracic
surgery, infectious diseases, and psychiatry. All questions were
answered to his satisfaction upon discharge.

Medications on Admission:
Motrin

Discharge Medications:
1. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
2. Senna  Oral
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q2-3 PRN () as
needed for pain.
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection [**Hospital1 **] (2 times a day).

8. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day) as needed for prn agitation.
9. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
10. Haloperidol 5 mg IV Q4H:PRN agitation
11. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: 4.5 g Recon
Solns Intravenous  Q8H (every 8 hours): Continue for total of 4
weeks, through [**2150-3-24**].
12. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN
10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.
13. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
Primary: Right-sided hemothorax
Secondary: polysubstance abuse, depression, acute renal failure
from interstitial nephritis


Discharge Condition:
Tolerating POs. Good pain control. Afebrile.


Discharge Instructions:
Take all medications as prescribed. You should call the office
with any worsening shortness of breath or chest pain, or fevers
to 102. Only take narcotics as necessary for pain control, and
note that they can cause confusion and nausea. You may shower
and resume your regular diet and physical activity, but refrain
from strenuous activity for 3 weeks. Please call with any
questions.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4340**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2150-3-24**] 11:30 [Infectious [**Hospital 2228**] Clinic]

You should follow-up in the office with Dr. [**First Name (STitle) **] [**Name (STitle) **]
(thoracic surgery) within 2 weeks-- call for an appointment at a
time of your convenience at [**Telephone/Fax (1) 170**]

Follow-up with your outpatient psychiatrist (Dr. [**Last Name (STitle) 64786**]
[**Telephone/Fax (1) 64787**]) within 2 weeks.



Completed by:[**2150-3-9**]
{'Empyema without mention of fistula,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other, mixed, or unspecified drug abuse, unspecified,Frontal lobe syndrome,Late effect of intracranial injury without mention of skull fracture,Anemia, unspecified,Acute pharyngitis,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Dysthymic disorder,Other and unspecified diseases of the oral soft tissues,Methemoglobinemia'}


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: chest pain

PRESENT ILLNESS: This is a 25 year old gentleman with a history of IV drug abuse
who presented to [**Hospital1 **] [**Location (un) 620**] on [**2150-2-17**] with 2 weeks of pleuritic
chest pain and was found to have a large right-sided pleural
effusion and a left lower lobe infiltrate. The patient reports
pain with deep inspiration and coughin. He describes chills. He
has no prior history of pneumonia or pulmonary problems. At
[**Name2 (NI) **] he was febrile to a temp of 102 and cultures were drawn;
he was started empirically on ceftriaxone and zithromax. He
became progressively hypoxic to 88 on room air (up to 95% on 4
liters). A thoracentesis was performed but failed and his
effusion worsened.

MEDICAL HISTORY: Depression
Polysubstance Abuse
Suicidal Ideation
Motor Vehicle Accident

MEDICATION ON ADMISSION: Motrin

ALLERGIES: Hurricaine

PHYSICAL EXAM: ON admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: The patient has a history of IV heroin and cocaine use. He
smokes 4 packs of tobacco/week. He completed some community
college. He lives with his mother in [**Name (NI) 932**], MA. He is working
in construction. 

### Response:
{'Empyema without mention of fistula,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other, mixed, or unspecified drug abuse, unspecified,Frontal lobe syndrome,Late effect of intracranial injury without mention of skull fracture,Anemia, unspecified,Acute pharyngitis,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Dysthymic disorder,Other and unspecified diseases of the oral soft tissues,Methemoglobinemia'}
