CHIEF COMPLAINT: Sternal drainage

PRESENT ILLNESS: 82M who underwent AVR (tissue); CABG X3 on [**2163-5-5**] who was
discharged to rehab on [**2163-5-17**]. He was then transferred to
[**Hospital 5279**] hospital on [**2163-5-18**] with sternal drainage and a
leukocytosis of 23,000. He was started on broad spectum
antibiotics and then transferred back to [**Hospital1 18**] after 4 days at
[**Hospital 5279**] Hospital.

MEDICAL HISTORY: s/p AVR(#25 tissue)CABG x3(LIMA-LAD, SVG-PM, SVG-dRCA/PDA)[**5-5**]
insulin-dependent diabetes mellitus
severe dilated cardiomyopathy
macular degeneration (partially blind)
emphysema
neuropathy left leg

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Benadryl / Ace Inhibitors

PHYSICAL EXAM: Admission:

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives alone
20 pack-years -quit many years ago
no recent ETOH use
Non-healing surgical wound,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other emphysema,Macular degeneration (senile), unspecified,Long-term (current) use of insulin,Heart valve replaced by transplant,Aortocoronary bypass status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Non-healing surgcl wound,Acute kidney failure NOS,Ac on chr syst hrt fail,Prim cardiomyopathy NEC,Delirium d/t other cond,Surg compl-urinary tract,Retention urine NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Emphysema NEC,Macular degeneration NOS,Long-term use of insulin,Heart valve transplant,Aortocoronary bypass,Abn react-anastom/graft
Admission Date:  [**2163-5-22**]              Discharge Date:   [**2163-6-1**]

Date of Birth:  [**2081-3-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Benadryl / Ace Inhibitors

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Sternal drainage

Major Surgical or Invasive Procedure:
s/p Sternal debridement/advancement of Pec flap/Talon plating
[**5-24**]


History of Present Illness:
 82M who underwent AVR (tissue); CABG X3 on [**2163-5-5**] who was
discharged to rehab on [**2163-5-17**]. He was then transferred to
[**Hospital 5279**] hospital on [**2163-5-18**] with sternal drainage and a
leukocytosis of 23,000. He was started on broad spectum
antibiotics and then transferred back to [**Hospital1 18**] after 4 days at
[**Hospital 5279**] Hospital.

Past Medical History:
s/p AVR(#25 tissue)CABG x3(LIMA-LAD, SVG-PM, SVG-dRCA/PDA)[**5-5**]
insulin-dependent diabetes mellitus
severe dilated cardiomyopathy
macular degeneration (partially blind)
emphysema
neuropathy left leg


Social History:
retired
lives alone
20 pack-years -quit many years ago
no recent ETOH use


Family History:
NC

Physical Exam:
Admission:

Pulse: Resp:  O2 sat:
B/P  Right:    Left:
Height: 5'9"    Weight: 91K
VS: T 98.7  HR 68SR  BP 100/50   RR 18  O2sat 93%-RA
General: NAD
Skin: Dry [x] intact []- sternal wound open at mid point 3cm in
lenth and tunnels 3cm cephalad and 1cm deep. Scant amount of
yellow drainage expressed. Sternum stable.
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs course throughout -clear somewhat with coughing.
Heart: RRR [x]
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: 2+ pitting LE
edema
Neuro: seems angry and depressed regarding care recieved upon
D/C
from [**Hospital1 18**]. Alert and oriented x3 but conversation is
tangential.


Pertinent Results:
[**2163-5-22**] 07:10PM   SED RATE-100*
[**2163-5-22**] 07:10PM   PT-29.0* INR(PT)-2.9*
[**2163-5-22**] 07:10PM   PLT COUNT-571*
[**2163-5-22**] 07:10PM   NEUTS-84.4* LYMPHS-8.2* MONOS-4.3 EOS-2.6
BASOS-0.5
[**2163-5-22**] 07:10PM   WBC-14.8* RBC-3.70* HGB-10.9* HCT-33.2*
MCV-90 MCH-29.4 MCHC-32.8 RDW-15.4
[**2163-5-22**] 07:10PM   CRP-26.1*
[**2163-5-22**] 07:10PM   ALBUMIN-3.3* CALCIUM-8.5 PHOSPHATE-4.1
MAGNESIUM-2.2
[**2163-5-22**] 07:10PM   LIPASE-57
[**2163-5-22**] 07:10PM   ALT(SGPT)-13 AST(SGOT)-16 LD(LDH)-287* ALK
PHOS-93 AMYLASE-106* TOT BILI-0.6
[**2163-5-22**] 07:10PM   GLUCOSE-103 UREA N-39* CREAT-2.1* SODIUM-140
POTASSIUM-4.0 CHLORIDE-97 TOTAL CO2-31 ANION GAP-16
[**2163-5-22**] 09:13PM URINE  RBC->50 WBC-[**3-3**] BACTERIA-MANY YEAST-NONE
EPI-<1
[**2163-5-22**] 09:13PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-TR
[**2163-5-30**] 06:42AM BLOOD WBC-9.5 RBC-3.06* Hgb-9.0* Hct-27.2*
MCV-89 MCH-29.3 MCHC-33.1 RDW-16.0* Plt Ct-406
[**2163-5-30**] 06:42AM BLOOD Plt Ct-406
[**2163-5-27**] 04:46AM BLOOD PT-13.6* PTT-30.8 INR(PT)-1.2*
[**2163-5-30**] 06:42AM BLOOD Glucose-98 UreaN-33* Creat-1.6* Na-142
K-4.0 Cl-101 HCO3-30 AnGap-15
    [**Known lastname 82102**],[**Known firstname **] F [**Age over 90 82104**] M  82  [**2081-3-30**]
Radiology Report CHEST (PA & LAT) Study Date of [**2163-5-29**] 3:19 PM

[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2163-5-29**] 3:19 PM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 82105**]
[**Hospital 93**] MEDICAL CONDITION:
   82 year old man with s/p sternal plating
REASON FOR THIS EXAMINATION:
   evaluation for ptx and effusion
Final Report CHEST
HISTORY: Sternal plating, evaluate for pneumothorax.
AP and lateral views. Comparison with [**2163-5-25**]. There is
continued evidence
of small bilateral pleural effusions, greater on the left. There
is increased density in the retrocardiac area consistent with
atelectasis or consolidation as before. The left heart border is
obscured. The heart appears large.
Mediastinal structures are unchanged in appearance. Multiple
surgical clips are scattered about the mediastinum. Four
metallic clips are present in the sternum as demonstrated
previously. A left PICC line can be followed to the level of the
right atrium.
Allowing for differences in technique, there is no significant
change.
IMPRESSION: No significant interval change.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**]
Approved: MON [**2163-5-30**] 8:09 AM





Brief Hospital Course:
Mr [**Known lastname **] was admitted to [**Hospital1 18**] for sternal drainage following
AVR/CABG. He had been on Coumadin so his INR was corrected and
he was brought to the operating room on [**5-24**] for sternal
debridement and Talon plating with pectoral muscle advancement.
Please see operative report for details. He tolerated the
procedure well and was transferred to the cardiac surgery ICU
after completion. He did well in the immediate post-operative
period and was extubated shortly after arrival. He remained in
the ICU on POD1 to monitor his renal function(CRI-baseline Cr
1.9)creatine rose to 2.8 on day of surgery. By POD2 it was
improving and he was transferred to the stepdown floor. Once on
the floor his post-op course was uneventful. Culture data was
positive for rare growth of PROPIONIBACTERIUM ACNES, infectious
disease service was consulted and he will be treated with
Vancomycin for 6-8 weeks. During hospital stay the patient had a
corneal abrasion , opthamology was consulted and treatment
instituted. Additionally he had periods of intermittant atrial
fibrillation that were rate controlled with Amiodarone and beta
blockers. He was also anticoagulated with Coumadin.
The patient was not started on [**First Name8 (NamePattern2) **] [**Last Name (un) **] or ACE inhibitor for his
heart failure as his BP was not adequate and his elevated
creatinine was still resolvoving. Consider instituting this
therapy as his condition continues to improve.
He worked with physical therapy and on POD8 he was transferred
to rehabilitation at [**Location (un) **] [**Doctor Last Name **].

Medications on Admission:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).


3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every [**4-4**]
hours as needed for temp.
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
8. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
11. Ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q12H
(every 12 hours) for 5 days.
12. Furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection
[**Hospital1 **] (2 times a day).
13. Potassium Chloride 20 mEq Packet Sig: Twenty (20) mEq PO
Q12H (every 12 hours).
14. Insulin Glargine 100 unit/mL Solution Sig: Twelve (12) units

Subcutaneous once a day.
15. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q2H (every 2 hours) as
needed for wheezes.
16. Warfarin 1 mg Tablet Sig: as directed Tablet PO once a day
as needed for a fib: adjust dose daily to target INR 2-2.5***2mg

to be administered on [**5-17**].
Last 3 days recieved 5/5/5.* Tablet(s)* Refills:*0*
17. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours).
18. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation

Q6H (every 6 hours).


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
3. Haloperidol 1 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for confusion .
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
8. Insulin Glargine 100 unit/mL Solution Sig: Twelve (12) units
Subcutaneous daily-lunch.
9. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale
 Injection Q AC&HS.
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day.
11. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Carvedilol 3.125 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
13. Lasix 80 mg Tablet Sig: One (1) Tablet PO twice a day.
14. Outpatient [**Month/Year (2) **] Work
While on antibiotics weekly CBC, Chem 7, LFT, ESR, CRP,
vancomycin trough with results to [**Hospital **] clinic fax ([**Telephone/Fax (1) 6313**] -
phone RN if questions [**Telephone/Fax (1) 14774**] -current vancomycin dose 1000
mg IV q24h given at 8pm [**5-31**] - needs trough prior to 4th dose
which will be [**6-3**] pm for further dosing - goal level 15-20 -
results to [**Hospital **] clinic for management of antibiotics
15. Outpatient [**Hospital **] Work
Please check Biweekly potassium, magnesium, creatinine, bun
while on lasix

16. Outpatient [**Name (NI) **] Work
PT/INR for coumadin dosing - atrial fibrillation with goal INR
2.0-2.5 please check at least twice a week until on steady dose
first draw [**2163-6-3**]
17. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
18. Erythromycin 5 mg/g Ointment Sig: One (1) strip Ophthalmic
four times a day for 7 days: to right eye .
19. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-31**]
Drops Ophthalmic PRN (as needed) as needed for dryness.
20. Warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day: goal
INR 2.0-2.5 - started [**6-1**] 1mg .
21. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
gram  Intravenous Q 24H (Every 24 Hours): given at 8pm - trough
[**6-3**] before dose .


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] [**Doctor Last Name **]

Discharge Diagnosis:
s/p Sternal debridement/advancement of Pectoral flap/Talon
plating [**5-24**]
s/p Aortic Valve Replacement(#25 tissue)Coronary Artery Bypass
Graft x3(Left Internal Mamary Artery-Left Anterior Descending,
Saphenous Vein Graft-Obtuse Marginal, Saphenous Vein
Graft-distal Right Coronary Aartery-Posterior Descending
Artery)[**5-5**]
Acute on chronic systolic heart failure
Acute renal failure resolving from previous admission
Diabetes Mellitus
Macular degeneration
Emphysema
Neuropathy


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving until cleared by Dr [**Last Name (STitle) 914**]
[**Name (STitle) **] lifting more than 10 pounds until cleared by Dr [**Last Name (STitle) 914**]
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
PT/INR for coumadin dosing - atrial fibrillation with goal INR
2.0-2.5 please check at least twice a week until on steady dose
first draw [**2163-6-3**]
Please check Biweekly potassium, magnesium, creatinine, bun
while on lasix
While on antibiotics weekly CBC, Chem 7, LFT, ESR, CRP,
vancomycin trough with results to [**Hospital **] clinic fax ([**Telephone/Fax (1) 6313**] -
phone RN ifquestions [**Telephone/Fax (1) 14774**] - current vancomycin dose 1000
mg IV q24h given at 8pm [**5-31**] - needs trough prior to 4th dose
which will be [**6-3**] pm for further dosing - goal level 15-20 -
results to [**Hospital **] clinic for management of antibiotics

Followup Instructions:
Please call to schedule appointments
Dr [**Last Name (STitle) 914**] (cardiac surgeon) in 2 weeks.  ([**Telephone/Fax (1) 170**]).
Dr [**Last Name (STitle) 39975**] (cardiologist) after discharge from rehab
Dr [**Last Name (STitle) 76130**] (PCP) after discharge from rehab
Dr [**First Name (STitle) **](Plastic Surgery Clinic) in 2 weeks. [**Telephone/Fax (1) 82106**]
Dr [**Last Name (STitle) **] ([**Hospital **] clinic) call to schedule
PT/INR for coumadin dosing - atrial fibrillation with goal INR
2.0-2.5 please check at least twice a week until on steady dose
first draw [**2163-6-3**]
Please check Biweekly potassium, magnesium, creatinine, bun
while on lasix
While on antibiotics weekly CBC, Chem 7, LFT, ESR, CRP,
vancomycin trough with results to [**Hospital **] clinic fax ([**Telephone/Fax (1) 6313**] -
phone RN if questions [**Telephone/Fax (1) 14774**] -current vancomycin dose 1000
mg IV q24h given at 8pm [**5-31**] - needs trough prior to 4th dose
which will be [**6-3**] pm for further dosing - goal level 15-20 -
results to [**Hospital **] clinic for management of antibiotics



Completed by:[**2163-6-1**]

Name:  [**Known lastname 13151**],[**Known firstname 126**] F               Unit No:   [**Numeric Identifier 13152**]

Admission Date:  [**2163-5-22**]              Discharge Date:   [**2163-6-1**]

Date of Birth:  [**2081-3-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Benadryl / Ace Inhibitors

Attending:[**First Name3 (LF) 1543**]
Addendum:
Per Dr [**Last Name (STitle) 12465**] request - to increase amiodarone back to 400 mg
daily due to intermittent atrial fibrillation.  Continue 400 mg
daily until follow up with Dr [**Last Name (STitle) 12465**].

Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] [**Doctor Last Name **]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2163-6-1**]
{'Non-healing surgical wound,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other emphysema,Macular degeneration (senile), unspecified,Long-term (current) use of insulin,Heart valve replaced by transplant,Aortocoronary bypass status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Sternal drainage

PRESENT ILLNESS: 82M who underwent AVR (tissue); CABG X3 on [**2163-5-5**] who was
discharged to rehab on [**2163-5-17**]. He was then transferred to
[**Hospital 5279**] hospital on [**2163-5-18**] with sternal drainage and a
leukocytosis of 23,000. He was started on broad spectum
antibiotics and then transferred back to [**Hospital1 18**] after 4 days at
[**Hospital 5279**] Hospital.

MEDICAL HISTORY: s/p AVR(#25 tissue)CABG x3(LIMA-LAD, SVG-PM, SVG-dRCA/PDA)[**5-5**]
insulin-dependent diabetes mellitus
severe dilated cardiomyopathy
macular degeneration (partially blind)
emphysema
neuropathy left leg

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Benadryl / Ace Inhibitors

PHYSICAL EXAM: Admission:

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives alone
20 pack-years -quit many years ago
no recent ETOH use 

### Response:
{'Non-healing surgical wound,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other emphysema,Macular degeneration (senile), unspecified,Long-term (current) use of insulin,Heart valve replaced by transplant,Aortocoronary bypass status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
